Temporomandibular treatments are significantly efficient in improving otologic symptoms.

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.

Reverse activated hyrax pressure appliance for treatment of a keloid located at auricula helix.

Keloids are considered aberrations of the wound healing process, and various treatment regimens are described depending on the morphology and size of the lesion. Compression therapy using custom-made pressure clips or splints is widely used for the treatment of keloids. The most common complication of this therapy is ulceration due to excessive soft tissue pressure, resulting in delays and prolonged treatment time. This article describes the fabrication of a custom-made pressure appliance for the treatment of a keloid located at the auricle helix. The pressure appliance can be modified to fit the auricle helix and covers the area needing pressure.

Is there an association between otologic symptoms and temporomandibular disorders?: An evidence-based review.

BACKGROUND: The aim of this article is to discuss the scientific evidence available on the pathophysiology and management of otologic complaints in patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED: The authors conducted an electronic search in MEDLINE, Web of Science and ScienceDirect and retrieved all the relevant peer-reviewed journal articles available in English on the topic. No time restriction was applied. RESULTS: No consensus exists on the management of otologic symptoms in patients with concomitant TMD. The scientific evidence suggests that conservative or reversible TMD therapy might provide relief. However, this evidence is scarce and low, thus further studies with larger sample sizes and better designed methodological frameworks are needed. Until such evidence is available, dentists and orofacial pain specialists should treat TMD patients using current guidelines and refer those with otologic symptoms to an otolaryngologist. PRACTICAL IMPLICATIONS: Given the wide range of potential pathophysiologies and treatments for each otologic symptom described in the TMD patient, close collaboration with otolaryngologists is essential to achieve the best patient care.

Therapeutic hotline: An alternative adjuvant treatment after ear keloid excision using a custom-made methyl methacrylate stent.

The efficacy of most pressure devices developed for treatment of ear keloids is limited by the insufficient control of the applied pressure, sometimes causing pain and repeated bleeding with a subsequently increased risk of infections and cosmetic problems. The present study aims to describe the efficacy of the custom-made methyl methacrylate stent in patients that were surgically treated for ear keloids and afterward underwent pressure therapy. The recurrence rate of the ear keloids was evaluated after at least 12 months. Adjuvant treatment with the methyl methacrylate stent resulted in an 83% success rate in our experience with 23 patients that completed the intended therapeutic duration of 18 months. No cases of severe complications were seen during or after the treatment. Furthermore, all the items of the Patient and Observer Scar Assessment Scale resulted in a statistically significant improvement of the scar (p < 0.05). Postoperative pressure therapy with the custom-made methyl methacrylate stent seems efficacious, safe, and is usable for keloids of both the helix and the earlobe.

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series.

OBJECTIVES/HYPOTHESIS: To report the efficacy and safety of transtympanic plugging of the eustachian tube (ET) using a silicone plug (Kobayashi plug) for chronic patulous ET (PET). STUDY DESIGN: Prospective and multicenter trial conducted in which 30 PET patients were resistant to at least 6 months of conservative treatment. METHODS: The efficacy and safety of 28 and 27 patients, respectively, were analyzed. All patients fulfilled inclusion and exclusion criteria. The primary end point used the patulous eustachian tube handicap inventory-10 (PHI-10), and the secondary end point used ET function tests such as sonotubometry, tubo-tympano-aerodynamic-graphy, and respiratory movement of the tympanic membrane and auscultation of voice sounds transmitted from the nose through the ET to the external auditory canal at 3months after surgery. RESULTS: PHI-10 scores were 34.4 ± 4.2, 6.4 ± 9, and 5.7 ± 8.6 at screening, and 3 and 6 months after surgery. Twenty-three cases (82.1%, 95% confidence interval: 63.1%-93.9%) were judged as successes. There were five cases (17.2%) of middle ear effusion, four cases (13.8%) of tympanic membrane perforation, and one case of tinnitus due to surgery to remove the plug. No severe or life-threatening complications were found. CONCLUSIONS: This study revealed the efficacy and safety of silicone plug insertion for severe PET patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1304-1309, 2020.

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy.

The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p < 0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms.

Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations.

Rhinologic and oral maxillofacial complications from scuba diving are common, representing approximately 35% of head and neck pathology related to diving. We performed a systematic and comprehensive literature review on the pathophysiology, diagnosis, and treatment of rhinologic and oral maxillofacial pathology related to diving. This included complications due to sinus barotrauma, barodontalgia, odontocrexis, temporomandibular joint dysfunction, partially dentulous patients, and considerations for patients following major head and neck surgery. Of 113 papers accessed, 32 were included in the final synthesis. We created a succinct summary on each topic that should inform clinical decision making by otolaryngologists, dive medicine specialists and primary care providers when faced with pathology of these anatomic sub-sites.

Krazy Glue® in the ear: A case report of child abuse.

Krazy Glue® or cyanoacrylate glue is an acrylic resin that polymerizes in less than a minute when in contact with moisture or water. We present a case of a one month old referred to our tertiary pediatric otolaryngology clinic from an outside emergency department with a history of application of cyanoacrylate glue in the external ear canals. This report presents the management of this case along with the medical and legal outcomes surrounding this case of child abuse.

False-positive positron-emission tomography-CT of a Teflon granuloma in the parapharyngeal space occurring after treatment for a patulous eustachian tube.

This report presents a 55-year-old woman who underwent 2 Teflon injections in 1971 for a patulous eustachian tube. The patient returned in 2006 with a bloody left otorrhea. A positron-emission tomography-CT scan demonstrated a 2-cm hypermetabolic parapharyngeal mass, initially interpreted as a skull base tumor. Repeat neck CT confirmed a 2-cm hyperattenuated left parapharyngeal granulomatous mass. This is the first reported case of a Teflon granuloma presenting as a false-positive parapharyngeal mass.

A Simplified Nonsurgical Method for the Correction of Neonatal Deformational Auricular Anomalies.

Despite reported success of early nonsurgical splinting of congenital ear deformities, the technique has not been widely utilized due to difficulty with application and positional maintenance of these devices. Delay in treatment can result in unnecessary surgery for the child later in life. In response to this need, we developed a simplified system consisting of Velcro, conformers, and polysiloxane gel that can be applied in 3 steps. Before and after photos after application of the device were graded by a plastic surgeon independent of the study. A total of 33 ear deformities were treated. In all, 92.3% of ears achieved significant improvement and normalization of their ears after therapy. This device allows for a more straightforward and individualized application than current products available. Our hope is that practitioners involved early in the infant's care will utilize this technology resulting in improved outcomes and avoiding unnecessary surgery.

Wrestling and sports medicine.

The coverage of wrestling events from the perspective of medical personnel is reviewed here. Considerations are made regarding the role of medical personnel, the supplies that are important for wrestling event coverage, and the injuries that are frequently encountered in wrestling. Attention is given to treatment of injuries and conditions that are largely specific to wrestling.

Treating "cauliflower ear" with silicone mold.

Acute hematoma of the ear (cauliflower ear) can be satisfactorily treated with aspiration and the use of the silicone mold to prevent reaccumulation of the blood or serum in the ear. Advantages of the silicone mold over other dressings appears to be ease of application, patient acceptance, and prevention of reoccurrence of reaccumulation of the hematoma.

Silicone ear splints in the management of acute haematoma auris.

A discussion of the rationale of management of acute haematoma auris and a description of a simple, reliable method of management using Otoform K Silicone impression material to form ear splints.

Treatment of acute auricular haematoma.

Auricular haematoma is a problem frequently complicated by recurrence due to failure to apply adequate pressure over the pinna following simple drainage. We describe a simple method of splinting the pinna using silicone putty which overcomes this problem.

Results of 310 cases of rapid maxillary expansion selected for medical reasons.

1. Rapid Maxillary Expansion is a comparatively simple, conservative method of treating impaired nasal respiration. 2. It can be used from 4 years to 25 or 30 years of age, but the younger the patient the better the long term results. 3. The medical indications are a combination of poor nasal airway, septal deformity, recurrent ear or nasal infection, allergic rhinitis and asthma, and prior to septoplasty. 4. The dental indications are mainly unilateral or bilateral cross bite, class III (prognathoid) malocclusion, maxillary compression, and cleft palate. 5. The dental contra-indications are normal occlusion in the permanent dentition and to a lesser degree severe class II occlusion and micromandible. 6. In selected cases, it produces a change of over 80 percent from mouth to nose breathing. In this series of 310 consecutive cases 87 percent were greatly improved, 9 percent had a fair result and 4 percent a poor result. 7. It also gives considerable improvement in colds and respiratory infection, nasal allergy and many cases of asthma. The improvement in health and confidence and concentration in over 30 percent of cases is particularly pleasing. 8. The rationale of Rapid Maxillary Expansion can be explained by the maxillary moulding theory of production of septal and facial deformities.

[Hyperbaric oxygen therapy application in otorhinolaryngology and head and neck surgery: state of the art and review of literature]. / Applicazioni dell'ossigenoterapia iperbarica in otorinolaringoiatria e in chirurgia cervico-facciale: stato dell'arte e revisione della letteratura.

Hyperbaric Oxygen Therapy (HOT) encompasses an extensive research area in which new indications, some of which are now well-codified, have emerged both in the fields of medical and surgical pathology. Its utilization in carefully targeted clinical situations, in which its true efficacy can be demonstrated, is first of all connected with medicolegal responsibility, in suspected iatrogenic accidents; its application must furthermore be subordinated to a favourable cost/benefit ratio for the health service employing it. In otorhinolaryngology and head and neck surgery, HOT is a strategic therapeutic weapon in several applications. Its most widely recognized indications are radiation lesions, chronic osteomyelitis of the mandible, head and neck infections, malignant external otitis, sudden hypoacusia, chronic tinnitus, encephalitis, treatment of the gasseous embolus, skin grafts, vascularized flaps, cervicoencephalic traumas. HOT indications as a radiosensitizing and/or chemiosensitizing factor are still being studied. Both a review of the literature and our experience appear, beyond any doubt, to confirm that HOT promotes faster recovery and reduces hospital stays, thus qualifying as a new therapeutic aid that complements the usual well-established methods.

Endoscopic hydroxyapatite augmentation for patulous Eustachian tube.

OBJECTIVES/HYPOTHESIS: To evaluate the safety and efficacy of endoscopic calcium hydroxyapatite injection in patients with patulous Eustachian tube. STUDY DESIGN: Retrospective case series. METHODS: Fourteen patients diagnosed with patulous Eustachian tube (PET) underwent endoscopic hydroxyapatite injection under general anesthesia. All patients had at least two of three major PET symptoms including voice autophony, breathing autophony, or aural fullness/pressure. Patients were evaluated postoperatively with nasal endoscopy and a symptom questionnaire. RESULTS: Endoscopic Eustachian tube injection was performed in a total of 23 sides in 14 patients with an average volume of 2.1 cc injected per side. Mean follow-up was 17.5 months. The most common symptoms reported preoperatively were voice autophony (96%), breathing autophony (91%), and ear fullness (83%). A complete or significant response to treatment was noted in 13/22 sides with voice autophony (59%), 12/21 sides with breathing autophony (57%), and 12/19 sides with ear fullness (63%). All complete or significant symptom improvements remained durable through the entirety of the follow-up period. Four sides that had temporary or no improvement with treatment underwent repeat injection but did not achieve additional improvement. No intraoperative or postoperative complications were observed. CONCLUSION: Endoscopic hydroxyapatite injection of the Eustachian tube is a minimally invasive procedure that provided significant or complete relief of autophony and ear fullness in 57% to 63% of sides treated. The procedure is well tolerated and can be performed safely under endoscopic visualization. Hydroxyapatite injection may be a satisfactory alternative to more invasive treatments for PET.