Multicenter Study of Congenital Middle Ear Anomalies. Report on 246 Ears.

OBJECTIVES/HYPOTHESIS: Congenital middle ear anomalies represent a relatively rare condition. This study aimed to describe the characteristics and the surgical outcomes for patients with middle ear anomalies. METHODS: A multicenter study was conducted of consecutive patients with congenital middle ear anomalies who underwent primary surgical treatment between January 2008 and December 2017. Demographics, surgical procedures, and audiometric data were registered into the institutional database. Hearing changes and postoperative air-bone gap (ABG) were evaluated 1 year after surgery. RESULTS: A total of 246 patients (246 ears) (median age: 14 years, range: 4-75 years old) were included in this study. Anomalies were subdivided using the Teunissen and Cremers classification: 53 ears (22%) were categorized as class I, comprising only stapes ankylosis; 35 ears (14%) as class II, having ossicular chain anomalies with stapes ankylosis; 139 ears (57%) as class III, having ossicular chain anomalies with a mobile stapes-footplate; and 19 ears (8%) as class IV, with aplasia of the oval window. Evaluation of hearing outcomes for 198 ears with more than 1 year of follow-up revealed that good postoperative ABG (≤20 dB) was achieved in 82% of class I, 68% of class II, 74% of class III, and 23% of class IV anomalies. The postoperative ABG in class IV was significantly worse than in class I (P < .001) or class III (P < .01). CONCLUSIONS: This study demonstrated that class III anomalies comprised the majority of middle ear anomalies and surgical outcomes for class IV anomalies are unfavorable. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2323-E2328, 2021.

Transient Hearing Loss and Objective Tinnitus Induced by Mouth Opening: A Rare Connection Between the Temporomandibular Joint and Middle Ear Space.

OBJECTIVES: To describe objective tinnitus complicated with transient low-tone hearing loss coinciding with mouth opening, which was related to the connection between the mandibular fossa and middle ear space. PATIENTS: A 41-year-old man presented with tinnitus, ear fullness, and hearing loss in the left ear on mouth opening. MAIN OUTCOME MEASURES: Clinical case records, audiological data, and radiological analyses including computed tomography (CT) and magnetic resonance imaging. RESULTS: Hearing thresholds on the affected side, which were evaluated with mouth opening, showed elevations of approximately 20 dB in the frequencies below 1000 Hz. Again, peak pressure on the tympanogram deviated negatively to -220 mmH2O under mouth opening without changing peak amplitude. CT showed a connection between the mandibular fossa and middle ear space, as revealed by a gas collection around the joint capsule evaluated in two phases (with and without mouth closing). Ear symptoms resolved after myringotomy. CONCLUSIONS: Although an influence of temporomandibular disorder (TMD) on tinnitus perception has been debated, whether this association is causal or fortuitous has remained contentious. The present case showed a unique feature of tinnitus attributed to a connection between the mandibular fossa and middle ear space.

Postoperative results of simple underlay myringoplasty in better hearing ears.

CONCLUSIONS: Simple underlay myringoplasty with fibrin glue (SUM) is indicated for repair of tympanic membrane (TM) perforation in the better hearing ear because postoperative hearing deterioration is extremely rare. OBJECTIVE: To evaluate the postoperative results, including the hearing and the re-perforation rate, in the better hearing ear. MATERIALS AND METHODS: The procedure of SUM is removal of the perforation edge and bonding of the graft to the remnant TM with a few drops of fibrin glue by underlay technique. This method was applied to 75 patients with a perforated TM in the better hearing ear. The postoperative hearing and the re-perforation rate were investigated. RESULTS: The mean of the postoperative hearing gain was 10.3 dB and no cases of postoperative hearing loss were observed. Although postoperative re-perforation was found in 18 cases (24.0%), the re-perforation was closed in 16 of these cases in the outpatient department by the same procedure using frozen autologous tissue that had been harvested previously in surgery. Including these cases, the total success rate was 97.3%.

Habitual sniffing and postoperative configuration of the posterior meatal wall reconstructed with soft tissue.

CONCLUSIONS: Habitual sniffing is a significant contributing factor to the development of postoperative retraction of the reconstructed posterior meatal wall and tympanic membrane, although it still seems a multifactorial event. OBJECTIVE: To examine the possible contribution of habitual sniffing to retraction-type middle ear pathology in a more direct way than previous reports. PATIENTS AND METHODS: The correlation between habitual sniffing and the postoperative configuration of the posterior meatal wall was examined in 58 patients with cholesteatoma who underwent tympanoplasty with reconstruction of the soft meatal wall. RESULTS: The postoperative configuration of the posterior meatal wall showed severe retraction in 7 of 8 patients with habitual sniffing, but only 22 of 47 without habitual sniffing. Habitual sniffing was significantly associated with postoperative severe retraction (Fisher's exact test, p<0.05).

Effects of hearing level on habitual sniffing in patients with cholesteatoma.

CONCLUSIONS: Quality of hearing is one of the key conditions promoting habitual sniffing associated with closing failure of the Eustachian tube and sniffing may stop with deterioration of hearing due to progression of the disease. OBJECTIVE: To examine habitual sniffing associated with closing failure of the Eustachian tube and hearing level in patients with cholesteatoma. PATIENTS AND METHODS: A total of 171 patients with middle ear cholesteatoma treated in Tohoku University Hospital (106 sides in 101 patients, 63 males and 38 females, mean age 43.3 years), and Sendai Ear Surgi Center (70 sides in 70 patients, 37 males and 33 females, mean age 42.7 years) were included. The patients were divided into two groups based on the presence or absence of habitual sniffing, and pre- and postoperative hearing was compared between the two groups. RESULTS: Habitual sniffing was not found in patients with air conduction hearing level worse than 60 dB or air-bone gap larger than 40 dB. Habitual sniffing disappeared in all patients with expanded air-bone gaps in lower frequency regions after surgery.

An apparatus for diagnosis of ossicular chain mobility in humans.

Confirmation of the conditions of the ossicles is essential for tympanoplasty. However, at present, ossicular mobility is experimentally estimated with palpation by a surgeon, and the results depend on the surgeon's skill. In this study, a new apparatus for quantitatively measuring ossicular mobility was developed. With this apparatus, the ossicles were displaced and the reaction force from the ossicles, (i.e. the load applied to the ossicles) was simultaneously detected. Ossicular mobility of three patients with otosclerosis or chronic otitis media was measured to evaluate the usability of the apparatus. The apparatus can distinguish the differences in ossicular mobility between normal and fixed ossicles, and it makes estimating the change of mobility between pre- and posttreatments for ossicular fixation possible. Positive correlation was seen between ossicular mobility and hearing level.