[Features of otosurgery in children after blast injuries]. / Osobennosti rekonstruktivnoi otokhirurgii u detei posle minno-vzryvnykh ranenii.

An explosion is a process that rapidly releases a huge amount of energy in the form of heat, kinetic energy, and high-pressure shock waves. Since the organ of hearing is most susceptible to pressure changes, damage to the sound-conducting or sound-receiving systems is inevitable in case of an explosive injury. This article examines the mechanism of formation of explosive injuries of the middle and inner ear in children and adolescents, the features of diagnosis and tactics of surgical reconstructive treatment of explosive ear injuries based on the data available in the scientific literature and their own experience.

Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage?

BACKGROUND: Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. OBJECTIVES: The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. MATERIALS UND METHODS: The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). RESULTS: 83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. CONCLUSION: Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.

Comparative analysis of titanium clip prostheses for partial ossiculoplasty.

OBJECTIVES: The aim of our study was to perform a comparative analysis in our cases with titanium partial clip ossiculoplasty in terms of audiometric outcome and extrusion rates as well as to review the literature for relevant information on this surgical issue. MATERIALS AND METHODS: The records of all patients who had undergone primary partial ossiculoplasty with the implantation of a CliP® Partial Prosthesis Dresden Type (CPPDT, group A) or a CliP Partial FlexiBAL® (CPF, Group B, both Heinz Kurz GmbH, Dusslingen, Germany) between 2012 and 2020 were studied retrospectively. RESULTS: 274 patients made up our study sample (148 men, 126 women, male to female ratio: 1.17). Their mean age at the time of first surgery was 39.6 years (range: 4-79 years). The mean preoperative air-bone gap (ABG) was 22.7dΒ ± 10.5 dB. Mean follow-up was approximately 4 months (1-12 months). The mean postoperative ABG was 15.7 ± 8.1 dB. In total, the postoperative ABG was significantly improved compared to preoperative values (P < 0.001). Surgical success, defined as an ABG ≤ 20 dB, was achieved in the majority of our study patients (210/274, 76.6%). Extrusion of the prosthesis was detected in 3/216 CPF and 5/58 CPPDT cases (p = 0.012). Comparison of both prosthesis groups revealed a significantly better audiological outcome for the patients with ossicular reconstruction using CPF. A significantly better audiological outcome was detected in the cases with a normal aeration of the middle ear. DISCUSSION: Titanium clip partial ossiculoplasty is a reliable component of modern tympanoplasty, allowing a satisfying audiologic outcome. The higher adaptability of the CPF to the changing postoperative circumstances and the frequently defective aeration of the middle ear is reflected in the better audiologic outcome for this prosthesis.

Unlearning the ABCs of Tympanometry.

Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric peak pressure (TPP). This convention had value for prior generations of otolaryngologists in diagnosing severe, chronic middle ear disease requiring surgical intervention but may not be well suited for the present-day evaluation of less severe disease. The existing definition of a type C curve (less than -100 daPa) is likely insensitive to detect subtle abnormalities, including some presentations of obstructive eustachian tube dysfunction. The accuracy of clinical diagnosis may be improved by reporting the absolute values of TPP and moving beyond classification according to arbitrary thresholds.

Bone-conduction threshold and air-bone gap may predict frequency-specific air-conduction threshold after tympanoplasty.

Postoperative hearing improvement is one of the main expectations for patients receiving tympanoplasty. The capacity to predict postoperative hearing may help to counsel a patient properly and avoid untoward expectations. It is difficult to predict postoperative hearing without knowing the disease process in the middle ear, which can only be assessed intraoperatively. However, the duration and extent of the underlying pathologies may represent in bone-conduction threshold and air-bone gap. Here in patients undergoing tympanoplasty without ossiculoplasty, we sorted and separated the surgery dates into the first group to build the predicting models and the second group to test the predictions. There were 87 and 30 ears, respectively. No specific enrollment or exclusion criteria were based on underlying pathologies such as the perforation size of the tympanic membrane or the middle ear conditions. The results show that bone-conduction threshold and air-bone gap together predicted air-conduction threshold after the surgery, including each frequency of 0.5k, 1k, 2k, and 4k Hz. The discrepancies between the predictions and recordings did not differ among these four frequencies. Of the variance in mean postoperative air-conduction threshold, 56.7% was linearly accounted for by these two preoperative predictors in this sample. The results suggest a trend that, the higher the frequency, the larger the part was accounted for by these two preoperative predictors. These together may help a surgeon to estimate frequency-specific hearing outcome after the surgery, answer patients' questions with quantitative statistics, and counsel patients with proper expectations.

Can the negative pressures found in obstructive sleep apnea and Eustachian tube dysfunction be related?

OBJECTIVE: The association between obstructive sleep apnea (OSA) and Eustachian tube dysfunction (ETD) is well known. When both exist in a single pediatric patient, one of the expected culprits is adenoid enlargement. We hypothesize, in contrast, that the negative pharyngeal pressure found in OSA may be transmitted to the middle ear as negative middle ear pressure (MEP), which subsequently results in pathology. The objective of this study was to determine whether the degree of OSA and MEP are associated while using MEP as a quantifiable measurement of ETD. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic center (Jan 2000-Jan 2018). SUBJECTS AND METHODS: The relationship between apnea-hypopnea index (AHI) and MEP was examined. A non-anatomic model was utilized to support causality. RESULTS: Thirty-four pediatric patients and twenty-three adult patients were included in the analysis. REM AHI showed a moderate negative correlation with MEP in children (r = -0.265), and a weak positive correlation with MEP in adults (r = 0.171). Children with an AHI in the severe OSA category had a more negative mean MEP than those in the mild category (p = 0.36). Adults with an AHI in the severe OSA category had a more positive mean MEP than those in the mild category (p = 0.11). CONCLUSION: In children, increasing severity of OSA is associated with a negative MEP, suggesting that negative pressure associated with OSA may be transmitted to the middle ear. In adults, increasing severity of OSA is associated with a more positive MEP.

Wideband acoustic immitance - Absorbance measurements in ears after stapes surgery.

OBJECTIVES: The study aimed to thoroughly assess absorbance in ears after stapes surgery (stapedotomy/stapedectomy) and how stapes surgery affects wideband acoustic immittance (WAI) metrics. METHODS: Eighty-three otosclerotic ears were analyzed pre- and postoperatively. The analysis comprised: air-bone gap (ABG) and WAI which included absorbance measurements, resonance frequency assessment, low frequency tympanometry and metrics derived from these measures. RESULTS: Absorbance after stapes surgery changed considerably compared to otosclerotic ears before surgery and also differed from normal ears. Absorbance after stapes surgery revealed two significantly different plot types: single-low-frequency-peak absorbance and two-peaks absorbance. Stapes surgery reduced resonance frequency in majority of operated ears and increased static compliance in low frequency tympanometry. Static compliance difference was directly proportional to ABG improvement at low frequencies. Postoperative ABG at 250 Hz and 500 Hz was most commonly correlated with postoperative WAI parameters. ABG improvement at 3000 Hz and 4000 Hz was directly proportional to absorbance difference at ~3000 Hz and 4000 Hz. It influenced the width of the postoperative absorbance by shifting both sides of the plot (negative values shift the points of the plot toward lower frequencies) with the correlation being more pronounced in postoperative two-peaks absorbance type ears. CONCLUSIONS: Absorbance by itself is not sufficient for assessment of changes to middle function following stapes surgery, and should be complemented with other measures. WAI measurements including absorbance, resonance frequency assessment, low frequency tympanometry, and metrics derived from these measures combined with air-bone gap provide insight into mechano-acoustic changes in the middle-ear system as a result of stapes surgery.

Transcanal endoscopic excision of glomus tympanicum: A case report.

Glomus tympanicum is a highly vascular tumour traditionally treated surgically via a post-auricular approach. We present here the first published case in Malaysia where total excision was achieved transcanal endoscopically. The procedure was safe, quick and effective due to the better visualisation of the surgical field with the endoscope. Haemostasis was achieved with a modified suction catheter that performed as a functioning suction diathermy.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction / Comparação entre adenoidectomia por curetagem e adenoidectomia por microdebridador assistida por endoscopia, em relação à disfunção tubária

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.

A new device for real-time peroperative monitoring of ossicular chain reconstruction during middle ear surgery.

To limit functional surgical failure and reduce the rate of revision surgery in case of surgical ossicular chain reconstruction, a piezoelectric device was developed for assessment of ossicular chain vibrations during the middle ear surgery. The device resembled a pen and consisted of a reusable main body and a disposable sensitive head including piezoelectric polymer sensor. Almost all of components of the device were made of polymer for light weight and for acoustic impedance matching to the middle ear system. Several frequencies can be analyzed simultaneously and several measures can be taken by time. The results showed that the device can record normal and reconstructed ossicular chain vibration in response to an acoustic stimulation, with similar results to those achieved by laser Doppler vibrometer. This light, handheld and low-cost device allows fast, easy and safe assessments of normal ossicular chain mobility and ossicular chain reconstruction efficiency. Primary pre-clinical trial showed very promising performance of the device that could be used to qualitatively control ossiculoplasty during real-time surgical procedure. Clinical assessments will be done to further evaluate the real-life performance of the device.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction.

INTRODUCTION: Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. OBJECTIVE: The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. METHODS: This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. RESULTS: There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p<0.001, p<0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p=0.376, p=0.128). CONCLUSION: Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

A Study of Wideband Energy Reflectance in Patients with Otosclerosis: Data from a Chinese Population.

OBJECTIVES: The purpose of this study was to explore the effectiveness of wideband acoustic immittance (WAI) in the diagnosis of otosclerosis by comparing the differences in the energy reflectance (ER) of WAI between patients with otosclerosis and age- and gender-matched normal hearing controls in the Chinese population. METHODS: Twenty surgically confirmed otosclerotic ears were included in the otosclerotic group. The ER of WAI at ambient and peak pressures, resonance frequency, and 226-Hz tympanogram were collected prior to surgery using a Titan hearing test platform (Interacoustics A/S, Middelfart, Denmark). All diagnoses of otosclerosis in the tested ear were confirmed by surgery after the measurements. Thirteen normal adults (26 ears) who were age- and gender-matched with the otosclerotic patients were included as the control group. RESULTS: At peak pressure, the ERs of otosclerotic patients were higher than those of the control group for frequencies less than 4,000Hz and were lower for frequencies greater than 4,000Hz. In addition, within the analyzed frequencies, the differences observed at 2,520Hz was statistically significant (p<0.05/16=0.003, Bonferroni corrected). At ambient pressure, the differences observed at 1,260 and 6,350Hz were statistically significant (p<0.05/16=0.003, Bonferroni corrected). Although the differences between the otosclerotic and control groups exhibited similar trends to those in studies implemented in Caucasian populations, the norms in the present study in the control group were different from those in the Caucasian populations, suggesting racial differences in WAI test results. Regarding the middle ear resonance frequency, no significant difference was observed between the two groups (P>0.05). CONCLUSION: WAI can provide valuable information for the diagnosis of otosclerosis in the Chinese population. Norms and diagnostic criteria corresponding to the patient's racial group are necessary to improve the efficiency of WAI in the diagnosis of otosclerosis.

The optimal and safe intensity for facial nerve stimulation during intraoperative neuromonitoring in middle ear surgery.

OBJECTIVE: This study aimed to investigate the optimal and safe intensity for facial nerve stimulation during middle ear surgery. METHODS: Thirty-seven patients who had their facial nerve exposed prior to surgery were prospectively enrolled in this study, and electromyography (EMG) recordings were obtained from the orbicularis oculi and orbicularis oris muscles. Four pigs were also enrolled in an animal study, and continuous stimulation was performed on the facial nerves of the pigs for 10 minutes. The EMG responses were measured and the pathologic outcomes of the facial nerve after stimulation were determined. RESULTS: In the human study, the mean intensity of the minimal electrical stimulation threshold was 0.21 mA (range: 0.1-0.3 mA). A linear correlation was observed between stimulus intensity and response amplitude for intensities below 0.4 mA. Response amplitudes reached a plateau between 0.4 mA and 1.0 mA. The minimal stimulus intensity that could generate a maximal response was 0.4 mA in the orbicularis oculi (244 µV) and orbicularis oris (545 µV). In the animal study, there were no observed changes in EMG or nerve damage incidence after the continuous stimulation of 3.0 mA. CONCLUSIONS: 0.4 mA is considered to be the optimal intensity of facial nerve stimulation during middle ear surgery, and it was estimated through the animal study that a stimulation of 3.0 mA is safe from facial nerve damage.

Principles of Pediatric Endoscopic Ear Surgery.

The article describes the unique benefits and challenges of transcanal (and transmastoid) endoscopic ear surgery (EES) for management of middle ear disease in children. It provides a rationale for EES in children and describes differences in anatomy between the pediatric and adult ear. The basic principles of EES, from operating room layout, choice of surgical instruments, and tips and pearls to avoid complications specific to the endoscope, are reviewed. Finally, techniques and outcomes in pediatric EES for tympanic membrane perforation, congenital cholesteatoma, and acquired cholesteatoma are summarized.

A systematic review and meta-analysis of extratympanic electrocochleography in Ménière's disease diagnosis.

Objective: Determine whether a combination of electrocochleography determined summating/action potential (SP/AP) ratio and other audiological measurements has greater sensitivity and specificity than that achieved with electrocochleography SP/AP ratio alone in diagnosing definite Ménière's Disease. Design: Systematic review and meta-analysis. Study sample: Pubmed, Cochrane Library, and Web of Science were searched using search terms "electrocochleography", "ECochG, ,"ECoG", "Ménière's Disease", and "Idiopathic Endolymphatic Hydrops". Inclusion criteria were extratympanic electrocochleography methodology, English language publication between January 2002 and December 2017, and the 1995 American Academy of Otolaryngology and Head and Neck Surgery Ménière's disease diagnostic criteria. Five articles satisfied inclusion criteria and were sufficiently detailed for aggregate quantitative analysis of SP/AP ratio (315 subjects) and combination audiological measures (113 subjects). Results: The diagnostic sensitivity and specificity of the SP/AP amplitude ratio was 47.6% and 83.8% and of combination diagnostic measures 63.5% and 89.3%, respectively. Point estimates of sensitivity (p = 0.248) and specificity (p = 0.969) and the summary Receiver Operator Characteristic Curve (p = 0.407) were not statistically significant. Conclusion: Statistically, combination diagnostic measures do not result in greater accuracy of definite Ménière's disease diagnosis compared to the SP/AP amplitude ratio alone. However, given the small sample size further studies are recommended to arrive at a definitive conclusion.

Wideband Tympanmetry Results of Bone Cement Ossiculoplasty.

OBJECTIVE: We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study. STUDY DESIGN: A prospective study. SETTING: Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed. RESULTS: A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups. CONCLUSION: Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.

Wideband acoustic absorbance in children with Down syndrome / Absorvância acústica de banda larga em crianças com síndrome de Down

Abstract Introduction: Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226 Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. Objective: The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. Methods: Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000 Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. Results: With the 226 Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520 Hz (p = 0.008) for those with normal tympanometry results, and 226-4000 Hz (p < 0.03) for those with a Type B tympanometry curve. Conclusion: The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities.

Resumo Introdução: A timpanometria é a ferramenta mais usada para avaliar o status da orelha média, comumente avaliada por meio de uma única frequência com o tom de 226 Hz. No entanto, o uso da medida de imitância acústica com estímulo de banda larga é uma avaliação de alta resolução promissora, especialmente em pacientes conhecidos por frequentemente apresentar alterações da orelha média, como na síndrome de Down. Objetivo: Analisar as medidas de absorvância acústica em crianças com síndrome de Down. Método: Estudo transversal, aprovado pelo comitê de ética da instituição. Foram coletados dados de 30 crianças, com idade média de 8,4 anos, sendo 15 com síndrome de Down (SD-grupo de estudo) e 15 crianças desenvolvimento típico e sem queixas auditivas (grupo controle). A absorvância de energia foi medida nas frequências de 226-8.000 Hz à pressão ambiente e no pico de pressão em função da frequência, usou-se o equipamento Titan. A análise estatística foi feita com o nível de significância estatística adotado de 5%. Resultados: Com o tom de sonda de 226 Hz foram observadas 30 orelhas do grupo controle e 22 do grupo estudo com timpanometria Tipo A e o Tipo B foi observado apenas em oito crianças do grupo estudo. A razão média de absorvância acústica do grupo estudo foi menor do que a do controle nas frequências centradas em 2.520 Hz (p = 0,008) para aqueles com resultados timpanométricos normais e de 226-4.000 Hz (p < 0,03) para aqueles com curva timpanométrica Tipo B. Conclusão: A baixa absorção de energia na presença de timpanogramas normais nas crianças com síndrome de Down pode sugerir anormalidades na orelha média.

Do Intubation Devices Affect Middle Ear Pressure Dynamics?

Our study aimed to investigate the effects of different intubation devices on middle ear pressure (MEP) dynamics by evaluating MEP during stages of anesthesia.Sixty-one consecutive patients were randomly assigned to 2 groups: the classical endotracheal intubation group and the Baska Mask (a new laryngeal mask [LMA]) group. All patients received the same anesthesia protocol. The right and left MEP values of the patients were measured and recorded preoperatively, during the induction of anesthesia, at the time of intubation and at 5th minute of anesthesia.In group 1, the pressure values measured in the right ear during anesthesia induction, at the time of intubation and at 5th minute of anesthesia were 10.97 ±â€Š27.06, 16.77 ±â€Š29.40, and 21.64 ±â€Š90.31, respectively, compared to left ear values of 8.61 ±â€Š26.39, 18.77 ±â€Š37.84, and 38.61 ±â€Š56.96 daPa, respectively. In group 2, MEP values measured in the right ear during anesthesia induction, at the time of intubation, and at 5th minute of anesthesia were 9.53 ±â€Š20.43, 22.30 ±â€Š41.50, and 20.60 ±â€Š46.85 daPa, respectively, compared to left ear values of -4.26 ±â€Š25.17, 6.20 ±â€Š26.56, and 30.30 ± 65.17 daPa, respectively. MEP was statistically significantly increased in the classical endotracheal intubation group compared to the LMA group.We found that the increase in pressure is lower in patients receiving LMA compared to classical endotracheal intubation. The Baska Mask LMA is recommended in selected patients to prevent complications of MEP elevation.