ABSTRACT
The resection of middle ear paragangliomas can be challenging given their vascular nature and the small volume of the tympanic cavity, particularly when the tumor in the hypotympanum is close or attached to the internal carotid artery (ICA). We performed combined underwater endoscopic and microscopic surgery for a Class B1 middle ear paraganglioma according to the modified Fisch classification. The suspicious bone in the hypotympanum and around the petrous ICA was drilled with underwater endoscopy. The feeding arteries, the caroticotympanic and inferior tympanic arteries, were suctioned and cauterized under microscopy. To the best of our knowledge, no case of middle ear paraganglioma treated with underwater endoscopy has been reported. Underwater endoscopy, providing a clear operative field with blood and bone dust irrigation, is a good indication for middle ear paragangliomas. In contrast, microscopic preparation for unexpected bleeding is important, particularly when the tumor closely extends to vital structures, such as the ICA or the jugular bulb.
Subject(s)
Ear Neoplasms , Ear, Middle , Endoscopy , Paraganglioma , Humans , Endoscopy/methods , Ear, Middle/surgery , Ear, Middle/pathology , Paraganglioma/surgery , Paraganglioma/pathology , Paraganglioma/diagnostic imaging , Ear Neoplasms/surgery , Ear Neoplasms/pathology , Microsurgery/methods , Female , Middle Aged , MaleSubject(s)
Biological Evolution , Ear, Middle , Jaw , Tooth , Animals , Ear, Middle/anatomy & histology , Tooth/anatomy & histology , Jaw/anatomy & histology , MammalsABSTRACT
The current work investigated the effects of mass-loading the eardrum on wideband absorbance in humans. A non-invasive approach to mass-loading the eardrum was utilized in which water was placed on the eardrum via ear canal access. The mass-loaded absorbance was compared to absorbance measured for two alternative middle ear states: normal and stiffened. To stiffen the ear, subjects pressurized the middle ear through either exsufflation or insufflation concurrent with Eustachian tube opening. Mass-loading the eardrum was hypothesized to reduce high-frequency absorbance, whereas pressurizing the middle ear was hypothesized to reduce low- to mid-frequency absorbance. Discriminant linear analysis classification was performed to evaluate the utility of absorbance in differentiating between conditions. Water on the eardrum reduced absorbance over the 0.7- to 6-kHz frequency range and increased absorbance at frequencies below approximately 0.5 kHz; these changes approximated the pattern of changes reported in both hearing thresholds and stapes motion upon mass-loading the eardrum. Pressurizing the middle ear reduced the absorbance over the 0.125- to 4-kHz frequency range. Several classification models based on the absorbance in two- or three-frequency bands had accuracy exceeding 88%.
Subject(s)
Ear, Middle , Pressure , Tympanic Membrane , Humans , Male , Female , Tympanic Membrane/physiology , Tympanic Membrane/anatomy & histology , Ear, Middle/physiology , Ear, Middle/anatomy & histology , Adult , Young Adult , Elasticity , Acoustic Stimulation , Eustachian Tube/physiology , Eustachian Tube/anatomy & histology , Stapes/physiology , Water , Discriminant AnalysisABSTRACT
The round window (RW) membrane plays an important role in normal inner ear mechanics. Occlusion or reinforcement of the RW has been described in the context of congenital anomalies or after cochlear implantation and is applied as a surgical treatment for hyperacusis. Multiple lumped and finite element models predict a low-frequency hearing loss with air conduction of up to 20 dB after RW reinforcement and limited to no effect on hearing with bone conduction stimulation. Experimental verification of these results, however, remains limited. Here, we present an experimental study measuring the impact of RW reinforcement on the middle and inner ear mechanics with air and bone conduction stimulation. In a within-specimen repeated measures design with human cadaveric specimens (n = 6), we compared the intracochlear pressures in scala vestibuli (PSV) and scala tympani (PST) before and after RW reinforcement with soft tissue, cartilage, and bone cement. The differential pressure (PDIFF) across the basilar membrane - known to be closely related to the hearing sensation - was calculated as the complex difference between PSV and PST. With air conduction stimulation, both PSV and PSTincreased on average up to 22 dB at frequencies below 1500 Hz with larger effect sizes for PST compared to PSV. The PDIFF, in contrast, decreased up to 11 dB at frequencies between 700 and 800 Hz after reinforcement with bone cement. With bone conduction, the average within-specimen effects were less than 5 dB for either PSV, PST, or PDIFF. The inter-specimen variability with bone conduction, however, was considerably larger than with air conduction. This experimental study shows that RW reinforcement impacts air conduction stimulation at low frequencies. Bone conduction stimulation seems to be largely unaffected. From a clinical point of view, these results support the hypothesis that delayed loss of air conduction hearing after cochlear implantation could be partially explained by the impact of RW reinforcement.
Subject(s)
Acoustic Stimulation , Bone Conduction , Cadaver , Round Window, Ear , Humans , Round Window, Ear/physiology , Round Window, Ear/surgery , Pressure , Aged , Ear, Middle/physiology , Ear, Middle/surgery , Scala Tympani/surgery , Scala Tympani/physiology , Male , Female , Scala Vestibuli/surgery , Scala Vestibuli/physiology , Scala Vestibuli/physiopathology , Bone Cements , Middle Aged , Biomechanical Phenomena , Hearing , Aged, 80 and over , Ear, Inner/physiology , Ear, Inner/physiopathologyABSTRACT
OBJECTIVES: This study aims to investigate whether the middle ear resonance frequency (RF) is affected in acromegaly, which causes growth in the skull bone. METHODS: Thirty acromegaly patients and 38 volunteers were included in the study. Pure tone average scores and middle ear RF values of the groups that underwent pure tone audiometry, tympanometry, and multifrequency tympanometry tests were compared. RESULTS: The pure tone mean was 14.95 ± 12.13 in acromegaly patients and 5.70 ± 8.52 in the control group (p:0.18). Sensorineural hearing loss(SNHL) was observed in 16.6% of the patients. The average middle ear RF was calculated as 815 ± 179.05 Hz in patients with acromegaly and 773 ± 127.15 in the control group. (p = 0.0001). CONCLUSION: This study is the first to evaluate middle-ear RF in acromegaly patients. Acromegaly-induced changes in soft tissues and bone structures impact middle ear functions. In this patient group, we found an increase in middle ear RF without conductive-type hearing loss and a 16.6% rate of SNHL.
Subject(s)
Acromegaly , Ear, Middle , Skull , Humans , Acromegaly/physiopathology , Acromegaly/pathology , Female , Ear, Middle/pathology , Male , Adult , Skull/diagnostic imaging , Middle Aged , Case-Control Studies , Hearing Loss, Sensorineural , Acoustic Impedance Tests , Audiometry, Pure-Tone , PrognosisABSTRACT
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.
Subject(s)
Blast Injuries , Otologic Surgical Procedures , Humans , Blast Injuries/surgery , Blast Injuries/physiopathology , Child , Otologic Surgical Procedures/methods , Otologic Surgical Procedures/adverse effects , Adolescent , Plastic Surgery Procedures/methods , Ear, Middle/surgery , Ear, Middle/injuries , Ear, Middle/physiopathology , Ear, Inner/injuries , Ear, Inner/surgery , Ear, Inner/physiopathologyABSTRACT
OBJECTIVES: To evaluate the bacterial biofilm's role in mucosal chronic suppurative otitis media (CSOM) utilizing scanning electron microscopy (SEM). METHODS: This study involved 123 participating patients with active and inactive mucosal CSOM who underwent tympanomastoid surgery. SEM was used to examine middle ear mucosa biopsies for the development of biofilms. Middle ear discharge or mucosal swabs from patients were cultured to detect any bacterial growth. The biofilm formation was correlated to the culture results. RESULTS: The biofilm was present in 69.9 % of patients (59% of them were with active mucosal CSOM) and absent in 30.1% of the patients (70% of them were with inactive mucosal CSOM), being more statistically significant in active mucosal CSOM (p-valueâ¯=â¯0.003). A correlation that was statistically significant was found between active mucosal CSOM and higher grades (3 and 4) of biofilms (p-value <0.05). The mucosal CSOM type and the results of the culture had a relationship that was statistically significant (p-value <0.001). 60% of patients had positive culture (70% of them were with active mucosal CSOM). There was a statistically significant relation between Pseudomonas aeruginosa bacterial growth and active mucosal CSOM (p-valueâ¯=â¯0.004) as well as higher grades of biofilms in mucosal CSOM. CONCLUSION: Mucosal CSOM, especially the active type, is a biofilm-related disease. There is a significant relation between the state of mucosal CSOM (active or inactive) and culture results with predominance of Pseudomonas aeruginosa bacterial growth in active mucosal CSOM and in higher grades of biofilms in mucosal CSOM.
Subject(s)
Biofilms , Ear, Middle , Mucous Membrane , Otitis Media, Suppurative , Pseudomonas aeruginosa , Humans , Biofilms/growth & development , Otitis Media, Suppurative/microbiology , Ear, Middle/microbiology , Female , Chronic Disease , Male , Mucous Membrane/microbiology , Adult , Middle Aged , Microscopy, Electron, Scanning , Adolescent , Child , Young Adult , AgedSubject(s)
Adenoma , Ear Neoplasms , Ear, Middle , Humans , Ear Neoplasms/surgery , Ear Neoplasms/pathology , Ear Neoplasms/diagnostic imaging , Ear, Middle/diagnostic imaging , Ear, Middle/surgery , Ear, Middle/pathology , Adenoma/surgery , Adenoma/diagnostic imaging , Adenoma/pathology , Endoscopy , Neuroendocrine Tumors/surgery , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/pathology , Female , Tomography, X-Ray Computed , Male , Middle AgedABSTRACT
BACKGROUND: Inflammation and infection of the middle ear, known as otitis media (OM), is a leading cause of hearing loss and the most frequently diagnosed disease in children worldwide. Traditionally, mouse models for OM rely on inducing acute infection through inoculation of the middle ear, e.g. with the human otopathogen non-typeable Haemophilus influenzae (NTHi), and with very few genetic models with spontaneous or chronic OM. A2ML1 variants, including loss-of-function variants, were associated with susceptibility to OM in humans, but no animal model has been reported for A2ml1-related OM. Here, we report our middle ear findings in a mouse line with a CRISPR-induced knockout (KO) of A2ml1. METHODS: Mice were X-rayed prior to harvest to determine if there are craniofacial or skeletal abnormalities. Tissue from mouse middle ears, as well as other upper respiratory mucosal tissues, were harvested. The harvested middle ear bullae were examined under microscope and submitted for histologic preparation to study phenotypic indications of OM. RNA samples isolated from middle ear tissue were assayed for expression of genes correlated with A2ML1 expression in humans. RESULTS: Data from a total of 119 mice (35 wildtype, 40 heterozygous, 44 homozygous) are presented here, with each analyses being performed on subsets of these mice. There were no significant craniofacial differences by genotype (n = 22). Findings in mice with the A2ml1-KO indicated an increased incidence of OM (n=29; odds ratio = 11; CI: 1.1, 573.6; Fisher exact two-sided p = 0.02) with tympanic membrane perforations or thickening, as well as cases of middle ear effusion, inflammatory cells, or fluid from histologic sections. Dsp was upregulated in the middle ear tissues of homozygous mice (Wilcoxon test p = 0.001). CONCLUSION: Thus far, our results in this A2ml1-KO mouse line indicate spontaneous occurrence of OM and dysregulation of Dsp in the middle ear as a potential disease mechanism for A2ml1-related OM.
Subject(s)
Disease Models, Animal , Mice, Knockout , Otitis Media , Animals , Mice , Ear, Middle/pathology , Otitis Media/geneticsABSTRACT
OBJECTIVE: Convolutional neural networks (CNNs) have revolutionized medical image segmentation in recent years. This scoping review aimed to carry out a comprehensive review of the literature describing automated image segmentation of the middle ear using CNNs from computed tomography (CT) scans. DATA SOURCES: A comprehensive literature search, generated jointly with a medical librarian, was performed on Medline, Embase, Scopus, Web of Science, and Cochrane, using Medical Subject Heading terms and keywords. Databases were searched from inception to July 2023. Reference lists of included papers were also screened. REVIEW METHODS: Ten studies were included for analysis, which contained a total of 866 scans which were used in model training/testing. Thirteen different architectures were described to perform automated segmentation. The best Dice similarity coefficient (DSC) for the entire ossicular chain was 0.87 using ResNet. The highest DSC for any structure was the incus using 3D-V-Net at 0.93. The most difficult structure to segment was the stapes, with the highest DSC of 0.84 using 3D-V-Net. CONCLUSIONS: Numerous architectures have demonstrated good performance in segmenting the middle ear using CNNs. To overcome some of the difficulties in segmenting the stapes, we recommend the development of an architecture trained on cone beam CTs to provide improved spatial resolution to assist with delineating the smallest ossicle. IMPLICATIONS FOR PRACTICE: This has clinical applications for preoperative planning, diagnosis, and simulation.
Subject(s)
Deep Learning , Ear, Middle , Tomography, X-Ray Computed , Humans , Ear, Middle/diagnostic imaging , Tomography, X-Ray Computed/methods , Image Processing, Computer-Assisted/methodsABSTRACT
BACKGROUND: There are different ways to analyze energy absorbance (EA) in the human auditory system. In previous research, we developed a complete finite element model (FEM) of the human auditory system. OBJECTIVE: In this current work, the external auditory canal (EAC), middle ear, and inner ear (spiral cochlea, vestibule, and semi-circular canals) were modelled based on human temporal bone histological sections. METHODS: Multiple acoustic, structure, and fluid-coupled analyses were conducted using the FEM to perform harmonic analyses in the 0.1-10 kHz range. Once the FEM had been validated with published experimental data, its numerical results were used to calculate the EA or energy reflected (ER) by the tympanic membrane. This EA was also measured in clinical audiology tests which were used as a diagnostic parameter. RESULTS: A mathematical approach was developed to calculate the EA and ER, with numerical and experimental results showing adequate correlation up to 1 kHz. Another published FEM had adapted its boundary conditions to replicate experimental results. Here, we recalculated those numerical results by applying the natural boundary conditions of human hearing and found that the results almost totally agreed with our FEM. CONCLUSION: This boundary problem is frequent and problematic in experimental hearing test protocols: the more invasive they are, the more the results are affected. One of the main objectives of using FEMs is to explore how the experimental test conditions influence the results. Further work will still be required to uncover the relationship between middle ear structures and EA to clarify how to best use FEMs. Moreover, the FEM boundary conditions must be more representative in future work to ensure their adequate interpretation.
Subject(s)
Finite Element Analysis , Humans , Temporal Bone , Hearing/physiology , Ear, Inner/physiology , Ear, Middle/physiologyABSTRACT
Although domestic dogs vary considerably in both body size and skull morphology, behavioural audiograms have previously been found to be similar in breeds as distinct as a Chihuahua and a St Bernard. In this study, we created micro-CT reconstructions of the middle ears and bony labyrinths from the skulls of 17 dog breeds, including both Chihuahua and St Bernard, plus a mongrel and a wolf. From these reconstructions, we measured middle ear cavity and ossicular volumes, eardrum and stapes footplate areas and bony labyrinth volumes. All of these ear structures scaled with skull size with negative allometry and generally correlated better with condylobasal length than with maximum or interaural skull widths. Larger dogs have larger ear structures in absolute terms: the volume of the St Bernard's middle ear cavity was 14 times that of the Chihuahua. The middle and inner ears are otherwise very similar in morphology, the ossicular structure being particularly well-conserved across breeds. The expectation that larger ear structures in larger dogs would translate into hearing ranges shifted towards lower frequencies is not consistent with the existing audiogram data. Assuming that the audiograms accurately reflect the hearing of the breeds in question, oversimplifications in existing models of middle ear function or limitations imposed by other parts of the auditory system may be responsible for this paradox.
Subject(s)
Ear, Middle , Animals , Dogs/anatomy & histology , Ear, Middle/anatomy & histology , Skull/anatomy & histology , X-Ray Microtomography , Ear, Inner/anatomy & histology , Body SizeSubject(s)
Ear Neoplasms , Ear, Middle , Neuroendocrine Tumors , Humans , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgery , Ear Neoplasms/diagnostic imaging , Ear Neoplasms/pathology , Ear Neoplasms/diagnosis , Ear, Middle/pathology , Ear, Middle/diagnostic imaging , Female , Male , Middle AgedSubject(s)
Ear, External , Ear, Middle , Humans , Consensus , Ear, Middle/surgery , Ear, External/abnormalities , HearingABSTRACT
Objective:To study the characteristics of Mismatch negativityï¼MMNï¼ in normal hearing patients of different ages, and to compare the MMN of normal hearing subjects at different ages to explore the differences in MMN between different ages. Methods:MMN test was performed on both ears using the classic Oddball mode. A frequency of 1 000 Hzï¼standard stimuliï¼ and 2 000 Hzï¼deviant stimuliï¼ was used to evoked the MMN. According to different age groups: the juvenile groupï¼7-17 years oldï¼, the youth groupï¼18-44 years oldï¼, the middle-aged groupï¼45-59 years oldï¼, and the elderly groupï¼60-75 years oldï¼, with 25 cases in each group. The MMN characteristics of normal hearing subjects in different age groups were analyzed statistically and the differences between groups were compared. All subjects underwent pure tone threshold test, tympanic reactance test and ABR test before MMN test. Results:MMN waveform could be elicited from both ears of 100 subjects. Among them, the average latency of the juvenile group wasï¼159.70±20.34ï¼ ms while the average amplitude wasï¼4.34±2.26ï¼ µV, For the youth group, the average latency wasï¼166.01±28.67ï¼ ms and the average amplitude wasï¼3.70±2.28ï¼ µV. Then in the middle-aged group, the average latency wasï¼175.16±37.24ï¼ ms, meanwhile, the average amplitude wasï¼2.69±0.84ï¼ µV. Finally, the elderly group has an average latency ofï¼178.03±14.37ï¼ ms and an average amplitude ofï¼2.11±0.70ï¼ µV. Therefore, there was no statistical difference in latency and amplitude between all groupsï¼P>0.05ï¼, and there was no statistical difference in latency and amplitude between left and right ears among all subjects as a wholeï¼P>0.05ï¼. However, when the left and right ears of all groups were compared, it was found that the latency between the left and right ears of the Juvenile group had statistical significanceï¼P<0.05ï¼, and the amplitude difference was not statistically significantï¼P>0.05ï¼, while the latency and amplitude differences between the left and right ears of other groups had no statistical significanceï¼P>0.05ï¼. There were also no significant differences in latency and amplitude between men and womenï¼P>0.05ï¼. Conclusion:There was no statistically significant difference in the latency and amplitude of mismatched negative among normal hearing subjects of different ages, and no statistically significant difference in the MMN latency and amplitude between the left and right ears of subjects and between men and women. Therefore, the study inferred that the auditory cerebral cortex of subjects aged 7-75 years old maintained a stable state for a long time after maturity, and the latency and amplitude of mismatched negative waves were relatively stable. It is not affected by age, gender and ear side, and can stably reflect the auditory cortex function of the subjects. It has broad application prospects in clinical practice, and provides a reliable detection means for future research on the changes of the auditory cerebral cortex of patients, which is worthy of our further research and clinical promotion.
Subject(s)
Auditory Cortex , Hearing , Male , Middle Aged , Aged , Adolescent , Humans , Female , Child , Young Adult , Adult , Hearing/physiology , Ear, Middle , Evoked Potentials, Auditory/physiology , Acoustic StimulationABSTRACT
Objective:To investigate the clinical features of patients with congenitally enlarged bony portions of the Eustachian tubeï¼ETï¼. Methods:The medical history, physical examination, hearing test, temporal bone high resolution computed tomographyï¼HRCTï¼ of six patientsï¼nine earsï¼ with congenitally enlarged bony portion of the ET were retrospectively analyzed. Results:Four patients were men and two were women. The minimum, maximum, and average ages were 5, 21, andï¼14.7±6.4ï¼ years, respectively. Three malformations were bilateral and three were left-sided. Three ears had conductive hearing lossï¼average bone and air conduction thresholds were 13.7 dB and 71.3 dBï¼, three had mixed hearing lossï¼average bone and air conduction thresholds were 27.7 dB and 83.7 dBï¼, and one had extremely severe sensorineural hearing loss. The average maximum length and width of the enlarged bony ET on temporal bone HRCT wereï¼22.61±2.94ï¼ mm andï¼6.50±2.33ï¼ mm, respectively. The enlargement was combined with an external auditory canal malformation in six ears, narrow tympanic cavity in six, tympanic antrum malformation in five, ossicular chain malformation in seven, cochlear malformation in six, helicotrema malformation in three, vestibule widening in two, semicircular canal malformation in three, vestibular window malformation in six, facial nerve abnormality in five, internal auditory meatus malformation in two, low middle cranial fossa in eight, and severe internal carotid artery malformation in one. Conclusion:Bony ET enlargement is a rare congenital middle ear malformation which could combined with other ear malformations. Patients can have no ET dysfunction but different patterns of hearing loss. The defect is usually found unintentionally during imaging, and the HRCT of temporal bone is significant.