ABSTRACT
Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.
Subject(s)
Humans , Tympanoplasty , Ear, Middle , Ear Ossicles/surgery , Tympanic Membrane/surgery , TympanosclerosisABSTRACT
Objective:For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. Methods:From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People's Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group(OCM), 56 cases in the ossicular chain bypass reconstruction group(OCB), and 40 cases in the malleus-incus complex resection reconstruction group(MICR). Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed. Results:There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group(0) was significantly lower than that in OCM group(11.76%) and MICR group(7.5%)(P<0.05). At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group(P<0.05). At 36 months after operation, ΔABG of OCB group was better than that in the OCM group(P<0.05), and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis(ETS) at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis(PTS) and total tympanosclerosis(TTS)(P<0.05). Conclusion:Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.
Subject(s)
Humans , Tympanosclerosis , Ear Ossicles/surgery , Ear, Middle , Malleus/surgery , Cholesteatoma , Retrospective Studies , Ossicular Prosthesis , Treatment OutcomeABSTRACT
Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.
Subject(s)
Adult , Humans , Ear Ossicles/surgery , Ear, Middle/surgery , Hearing Loss, Conductive/surgery , Osteoma/surgery , Tympanic MembraneABSTRACT
Abstract Introduction The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. Objective Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. Methods Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz. Results Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB. Conclusion We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.
Resumo Introdução A ossiculoplastia tem como objetivo a melhoria da audição e o sucesso desse procedimento depende de diversos fatores. Objetivo Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico. Método Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, total de 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhoria dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz. Resultados A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB. Conclusão Melhora significativa da audição foi observada em pacientes submetidos à ossiculoplastia, os resultados foram comparáveis aos de outros centros. O "status" dos ossículos influenciou os resultados pós-operatórios, principalmente a presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Otitis Media/surgery , Ossicular Prosthesis/standards , Ear Ossicles/surgery , Hearing/physiology , Postoperative Period , Prognosis , Audiometry , Tympanoplasty , Severity of Illness Index , Chronic Disease , Treatment Outcome , Risk Assessment , Recovery of FunctionABSTRACT
Abstract Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.
Subject(s)
Humans , Infant, Newborn , Temporal Bone/anatomy & histology , Temporal Bone/surgery , Cochlea/surgery , Cochlear Implantation/methods , Tympanic Membrane/surgery , Cadaver , Pregnancy , Tomography, X-Ray Computed , Clinical Trial , Minimally Invasive Surgical Procedures , Ear, Middle/anatomy & histology , Ear Ossicles/surgery , Stillbirth , Facial Nerve/surgery , Ear, Inner/surgeryABSTRACT
Abstract Introduction: Disjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium. Objective: Because of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation. Methods: Two anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method. Results: A total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed. Conclusion: Resin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.
Resumo Introdução: É frequente a disjunção da cadeia ossicular nas doenças crônicas da orelha média. Além de interposições ossiculares, vários materiais já foram usados com a finalidade de reconstruí-la, como próteses de cerâmica, polietileno e titânio. Objetivo: Devido ao alto custo das opções existentes, propomos reconstruir a cadeia com cimento resinoso, material usado normalmente na reconstrução e fixação dentária. Método: Serão usadas duas peças anatômicas de ossos temporais, nas quais será criada uma disjunção da cadeia entre a bigorna e o estribo que, a seguir, será reconstruída com o cimento resinoso. Essas reconstruções serão repetidas quatro vezes por três cirurgiões diferentes, para certificação da viabilidade do método. Resultados: Foram feitas 12 reconstruções, quatro por cada cirurgião. Após aplicação do cimento, conseguimos, ao toque, perceber que o espaço foi preenchido adequadamente pelo material empregado. Notamos ainda adequada articulação com transferência de movimento para toda a cadeia ossicular. Conclusão: O cimento resinoso é um material viável na reconstrução de lesões da cadeia ossicular e proporciona um método tecnicamente simples e de baixo custo.
Subject(s)
Humans , Ossicular Prosthesis , Resin Cements , Ear Ossicles/surgery , Plastic Surgery ProceduresABSTRACT
A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10 por cento e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P≤0,05. RESULTADOS: Havia algum envolvimento da cadeia ossicular em 65 casos. O ossículo mais freqüentemente afetado era a bigorna, seguida pelo estribo e pelo martelo. Ao aplicarmos o coeficiente de Spearman entre o grau de comprometimento da cadeia ossicular com a idade do paciente à cirurgia, a espessura da perimatriz e o grau histológico de inflamação não foram detectadas correlações. CONCLUSÃO: Os nossos achados indicam que é praticamente universal o acometimento da cadeia ossicular na presença de colesteatoma. Não foi encontrada correção entre a erosão ossicular e os achados histológicos.
Chronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change. AIM: to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix. STUDY DESGN: Cross-sectional study. METHODS: Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10 percent formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P≤0.05. RESULTS: the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of surgery, perimatrix thickness and histological degree of inflammation, correlations were not established. CONCLUSION: Our findings indicate that ossicular chain changes are practically universal when a cholesteatoma is present. We didn't find correlations related with bone erosion and cholesteatoma's histological findings.
Subject(s)
Humans , Adolescent , Adult , Child , Cholesteatoma, Middle Ear/pathology , Ear Ossicles/parasitology , Otitis Media/pathology , Age Factors , Chronic Disease , Cross-Sectional Studies , Cholesteatoma, Middle Ear/surgery , Cholesteatoma, Middle Ear/complications , Ear Ossicles/surgery , Otitis Media/surgery , Otitis Media/etiology , Severity of Illness IndexABSTRACT
Introducción: Las intervenciones quirúrgicas del oído medio por colesteatoma tienen por objetivo prioritario la erradicación de la enfermedad, logrando en ocasiones conservar o mejorar la audición de estos pacientes. La aticotomía con antroexclusión es una cirugía conservadora que permite la eliminación de un colesteatoma atical manteniendo una anatomía cercana a la normal. Objetivo: Este trabajo busca determinar los cambios auditivos en pacientes sometidos a este procedimiento quirúrgico. Material y método: Se realiza un estudio transversal con audiometrías a pacientes sometidos a aticoantrostomía con antroexclusión entre los años 2000 y 2005. Se registran datos individuales, hallazgos intraoperatorios y valores audiométricos pre y posoperatorios. Resultados: Se incluyen 18 pacientes, edad promedio de 48 años, 61 por ciento de sexo femenino. La diferencia ósea-aérea preoperatoria promedio es de 38 dB (10-51 dB), mientras la posoperatoria es de 33 dB (18-50 dB). El 50 por ciento de los pacientes obtiene un cierre posoperatorio inferior a 30 dB. No existen cambios significativos con respecto a umbrales de vías óseas o aéreas. Conclusiones: La aticoantrostomía es un procedimiento quirúrgico que permite erradicarla enfermedad y preservar la audición de los pacientes. En nuestra serie existe una conservación de la audición, lo que constituye una ventaja con respecto a otras alternativas quirúrgicas.
Introduction. The primary aim of middle ear surgical intervention due to cholesteatoma is the elimination of the disease, while conserving or in some cases improving the patient's hearing ability. Atticostomy with antrum exclution is a conservative surgery that allows attic cholesteatoma removal, maintaining a relatively normal anatomy. Aims. The main goal of this study is to characterize the audiological changes in patients that underwent this surgical procedure. Material and methods. Audiometries were performed to patients that had atticostomy with antrum exclution, between years 2000 and 2005. Individual data, intra-surgery findings, and audiometric data prior and post surgery were recorded. Results. Results from 18 patients, average age 48 years old, 61% females, are presented. Pre surgical average difference between air and bone conduction was 38dB (10-51 dB), whereas post surgical difference was 33 dB (18-50). Fifty percent of patients reached a post surgical level lower than 30 dB. There were no significant changes related to air or bone conduction thresholds. Conclusions. Atticoantrostomy is a surgical procedure that allows both disease elimination and hearing preservation. In our series, hearing was preserved, which represents an advantage over other surgical alternatives.
Subject(s)
Male , Female , Adult , Middle Aged , Humans , Hearing , Cholesteatoma, Middle Ear/surgery , Cholesteatoma, Middle Ear/diagnosis , Otologic Surgical Procedures/methods , Audiometry , Cholesteatoma, Middle Ear/epidemiology , Ear Diseases/surgery , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional Studies , Ear Ossicles/surgery , Ear, Middle/surgery , Postoperative Period , Plastic Surgery Procedures/methodsABSTRACT
A orelha média funciona como um amplificador sonoro. Utiliza para isso três mecanismos: o hidráulico, a alavanca dos ossículos e o jogo das janelas, sendo o mais importante o fato da energia mecânica captada pela membrana timpânica ser concentrada na área da janela oval, que é muitas vezes menor (mecanismo hidráulico). Podemos dividir o não funcionamento da cadeia ossicular em duas categorias: com diminuição da vibração da cadeia e com interrupção da cadeia. Neste artigo, o autor discorre sobre os problemas da cirurgia de reconstrução.
Subject(s)
Humans , Ossicular Replacement , Ear, Middle/surgery , Ear Ossicles/surgery , Transplants , TympanoplastyABSTRACT
La timpanoplastía tipo III es una técnica quirúrgica reconstructiva de los mecanismos de conducción del oído medio cuando existe una discontinuidad incudo-estapedial. Según la patología osicular existente, las timpanoplastías tipo III se subdividen en clásica, III A y III B. Se realiza un estudio retrospectivo de 29 cirugías (27 pacientes) correspondientes al período 1993-2003. El abordaje quirúrgico más frecuente fue el retroauricular, y la fascia temporal fue el tejido más utilizado para reparar la membrana timpánica. El defecto osicular encontrado más a menudo fue la erosión de la apófisis larga del yunque, en el 57,7 por ciento de los casos. La osiculoplastía más frecuente fue la maleoloestapediopexia con interposición de yunque (51,9 por ciento). Se obtuvo un éxito anatómico de 88,9 por ciento, y un éxito auditivo de 69,2 por ciento. Las timpanoplastías III A se asociaron, en forma no significativa, a un mayor éxito auditivo que las III B. La conservación de la pared posterior del conducto auditivo externo se asoció significativamente a un mejor resultado auditivo. No se demostró diferencias entre las diferentes alternativas de osiculoplastía en timpanoplastías III A, mientras que en las 3 B, el uso de prótesis sintética (TORP) exhibió un mejor resultado que la utilización de autoinjertos.
Subject(s)
Humans , Ear Ossicles/surgery , Hearing Loss, Conductive/surgery , Tympanoplasty/methods , Audiometry , Ear Diseases/surgery , Retrospective Studies , Ear Ossicles/transplantation , Plastic Surgery Procedures/methods , Ossicular ProsthesisABSTRACT
Os autores revêem a literatura sobre reconstrução de cadeia ossicular e fazem uma análise comparando os diferentes materiais e técnicas com a utilização de bigorna moldada interposta entre a membrana timpânica e estribo íntegro.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Ear Ossicles/surgery , Tympanoplasty , Audiometry , Incus/injuries , Incus/surgery , Ossicular Replacement/methodsABSTRACT
En este trabajo la atención sobre un capítulo muy especial de la otología. En algunas obras está mencionada esta patología muy someramente, algunas veces mal incluida en el capítulo de las atresias del conducto auditivo externo, y en varios libros clásicos, ni siquiera se menciona. El tema se refiere a las anomalias congénitas enteramente limitadas a la cadena osicular y sus sistema propio muscular, diferenciándolas de las anomalías de mayor grado que abarca la aurícula y el conducto auditivo externo. El autor introduce una nueva nomenclatura, para identificar este tipo de disgenesias, limitadas a los huesecillos del oído medio. Presenta una serie de 17 casos detectados personalmente, y hace una descripción concreta de los hallazgos quirúrgicos encontrados y expone los resultados de la reconstrucción de la función auditiva que ha realizado en 15 casos de esta serie. Adivierte la importancia de tener presente este peculiar tipo de patología en los casos de hipoacusias conductivas, para considerarla al establecer el diagnóstico diferencial, especialmente en niños y adultos jóvenes. Asismismo invita al otocirujano moderno a familiarizarse con estos casos, y desarrollar una gran imaginación reconstructiva, para lograr la habilitación de la audición en estos pacientes. Finalmente propone una clasificación general de las diversas modalidades que se pueden observar en estas disgenesias, en base a una revisión bibliográfica sobre la materia y su experiencia personal
Subject(s)
Congenital Abnormalities/embryology , Ear Ossicles/abnormalities , Ear Ossicles/surgery , Ear Ossicles/embryologyABSTRACT
Os autores däo uma visäo geral dos princípios básicos da reconstruçåo do conjunto tímpano-ossícular. Propöem um plano de atuaçåo cirúrgica com base nas próprias caracterísiticas acústicas do sistema. Comentam e discutem sobre os vários tipos de enxertos e próteses usados nos diferentes procedimentos, analisando suas vantagens e desvantagens relatadas na literatura e produto de suas experiências em seus locais de trabalho
Subject(s)
Humans , Male , Female , Ossicular Prosthesis , Ear Ossicles/surgery , Ear, Middle , TympanoplastyABSTRACT
Foram estudados 27 casos de reconstruçäo ossicular em pacientes portadores de timpanosclerose. Os autores classificaram tais casos de acordo com o tipo de envolvimento da cadeia ossicular e resultados funcionais pós-operatórios, comparando estes dados com os da literatura levantada
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Otitis Media/surgery , Ear, Middle/surgery , Audiometry , Ear Ossicles/surgery , Otitis Media/pathology , Ear, Middle/pathology , Retrospective Studies , TympanoplastyABSTRACT
As técnicas cirúrgicas de recuperaçäo da audiçäo na otite crônica continuam em discussäo. A interposiçäo adequada de ossículos mostrou ser o método mais eficaz e de menor controvérsia. O implante de cartilagem resulta em geral numa melhora auditiva temporária, por ocorrência de absorçäo. O uso de implantes metálicos e outros materiais sintéticos foi condenado e abandonado devido, principalmente, à extrusäo. Os resultados iniciais com o TORP e PORP de plastipore foram animadores. Posteriormente, com maior tempo de permanência no ouvido médio, foi constatado que também esse material podia sofrer extrusäo. Uma prótese de reconstituiçäo ossicular total ou parcial (TORP e PORP) de constituiçäo mista, com haste sintética e disco ósseo, é um método de recuperaçäo da audiçäo com resultados superiores ao das próteses sintéticas puras