[The technique and application of individualized tympanic membrane flap in the repair of tympanic membrane under endoscopy ear surgery].

Objective:To investigate the technique of personalized flap making under otoscopy and its clinical application. Methods:The clinical data of patients who underwent 301 Military Hospital myringoplasty in the Department of otoendoscopic surgery, Department of Otorhinolaryngology, head and neck surgery, Department of Otorhinolaryngology, from October 2022 to 2023 August were analyzed retrospectively, all enrolled patients were performed independently by the same skilled otoendoscopic surgeon. The patients' general condition, medical history, tympanic membrane perforation scope, perforation size, need for tympanic cavity exploration, thickness of skin flap, tympanic cavity lesion scope, skin flap making method and postoperative rehabilitation were collected. Results:Many factors such as the location of tympanic membrane perforation, the thickness of the skin flap, the degree of curvature or stricture of the ear canal and the extent of the lesion in the tympanic cavity should be considered in the manufacture of the individualized tympanic membrane skin flap, the way of skin flap making does not affect the long-term postoperative rehabilitation, but it can effectively avoid unnecessary ear canal skin flap injury and improve the operation efficiency. Conclusion:Scientific flap fabrication is important for improving surgical efficiency and enhancing surgical confidence.

[The application of endoscope and microscope in the stapes surgeries].

Objective:To compare the application of endoscope and microscope in all kinds of stapes surgeries. Methods:Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School. Hearing level, hospital stay post-operation, times of hospital visit post-operation, etc. have been compared between the endoscopic group and microscopic group. Patients who were failed to place the stapes prosthesis because of the poor exposure of the oval window have been analyzed. Results:Otosclerosis was the most common diagnosis in both groups. There was 1（1/23） middle ear malformation in the endoscopic group and 5（5/36） middle ear malformations in the microscopic group. There were 2 Van Der Hover syndromes and 4 Treacher Collins syndromes in the microscopic group. In the endoscopic group ABG of 10 ears（43.5%） ≤ 10 dB, and ABG of 21 ears（91.3%） ≤20 dB.In the microscopic group ABG of 13 ears（41.9%） ≤ 10 dB, and ABG of 28 ears（90.3%） ≤ 20 dB. There was no statistic difference between 2 groups. Times of hospital visit post-operation in the endoscopic group was less than in the microscopic group（P<0.01）. There was no facial palsy, tympanic perforation or profound sensorineural hearing loss in both groups. Conclusion:Endoscope is more suitable for patients who are evaluated with no severe stapes malformation, or less manipulation of drilling the bone. It could also reduce the hospital visit post-operation. Patients with narrow ear canal or severe middle ear malformation are recommended to perform the surgery with microscope, because it provides the chance of manipulation with 2-hands of surgeons.

An Innovative Tympanoplasty-Sleeve&Tongue Technique.

An innovative tympanoplasty method, blending the merits of traditional overlay and underlay techniques while avoiding the pitfalls. It enhances visualization, facilitates placement of the graft and preserves excellent blood supply, helps secure the fascia in place, as well as preserves the central-dented conical shape of the tympanic membrane. Laryngoscope, 133:3139-3143, 2023.

Accuracy of individualized 3D modeling of ossicles using high-resolution computed tomography imaging data.

BACKGROUND: The present study aimed to investigate the visibility of small ossicle parts/landmarks on high-resolution computed tomography (HRCT)/3D reconstruction (3D) to investigate what improvements in scanning resolution are needed before accurate 3D printing of patient-specific ossicles is possible. METHODS: A total of 24 patients with sudden deafness sought consultation at the Department of Otorhinolaryngology Head and Neck Surgery at the Sixth Medical Center of People's Liberation Army General Hospital between October 2013 and June 2014 were enrolled in the study. All participants underwent a 256-slice spiral HRCT temporal bone axial scan, yielding a Digital Imaging and Communications in Medicine documents series. These documents were then inputted into Mimics 16.0 interactive medical image processing software for data conversion and the creation of 3D segmentation and visualizations of the ossicles. Finally, the 3D images were compared using multiplanar reformation (MPR) and 3D volume-rendering (VR) reconstructed images of ossicles to verify their consistency. These were then compared with the normal ossicle structure to evaluate the accuracy of the restoration. RESULTS: The findings indicated that the morphology of the ossicles from the converted Mimics 16.0 data achieved a display rate of ≥90% when used to display 7 landmarks (the caput mallei, collum mallei, processus lateralis mallei, manubrium mallei, corpus incudis, crus longum incudis, and crus breve incudis). This demonstrates excellent matching with the images of ossicles obtained from MPR and 3D VR reconstruction. Kappa consistency testing found that the κ-value was higher than 0.75. When displaying the lenticular process, caput stapedis, crus anterius stapedis, and crus posterius stapedis landmarks. The display rate was around 60%, which shows good matching with the ossicles' images obtained from MPR and 3D VR reconstruction, with a κ-value >0.4. However, the display rate of the stapes footplate was only 25%, showing greater differences with the images obtained from MPR (76.4%) and 3D VR reconstruction (52.8%), with a κ-value <0.4. CONCLUSIONS: The accuracy of the visualization of the malleus and incus after restoration via Mimics 16.0 software, based on temporal bone HRCT data, was high, and the degree of restoration was good. However, the accuracy and degree of restoration of the stapes footplate require further improvement.

Value of section plane, MPR, and 3D-CTVR techniques in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane.

AIM: To assess the quality of high-resolution CT section planes (HRCT), multi-planar reformation (MPR) and 3-dimensional volume rendered computer tomography (3D-CTVR) were here used in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane. METHODS: Here, 17 cases of otosclerosis and 22 cases of ossicular chain deformity were selected. All patients had normal external ear canals, intact tympanic membranes, conductive hearing loss, type A tympanograms, and negative Gelle's tests. The respective radiological reports of the status of the ossicles via 3 protocols were compared to surgical findings. The quantitative assessments of the representation of different segments of the ossicular chain were based on a 3-point scoring system. RESULTS: MPR and CTVR imaging both showed the integrity of whole ossicular chain well. MPR and CTVR imaging were found to be superior to section planes with respect to showing the superstructure of the stapes and malformations (P > 0.05). CONCLUSION: CTVR and MPR imaging were found to be better able to show the whole ossicular chain in the conductive hearing loss with normal tympanic membranes. Furthermore, the use of these techniques can have profound contributive value in the differential diagnosis of otosclerosis and ossicular chain absence or malformation.

Quality assessment of 3D-CTVR, MPR and section plane techniques in ossicular chain reconstruction in middle ear cholesteatoma.

AIM: To assess the quality of three-dimensional volume rendered computer tomography (3D-CTVR), multi-planar reformation (MPR) and CT section plane in the fine diagnosis of ossicular chain in middle ear cholesteatoma. METHODS: Sixty patients with middle ear cholesteatoma were selected in this retrospective study. All cases underwent pre-operative CT scan. The respective radiologic reports of the ossicles status via three protocols were then compared to surgical findings. RESULTS: Quality assessment of these three protocols in the fine diagnosis of fine ossicles buried inside the soft tissue showed that both CTVR and MPR are more superior to conventional section plane, especially CTVR. CONCLUSION: The uses of CTVR and MPR, in conjunction with conventional section plane, are better able to show where the true and fine ossicular chain in the cholesteatoma mass is. In the final analysis, we believe that the use of CTVR and MPR techniques can have profound contributive value in future clinical work.

Epitympanoplasty with cartilage obliteration in the preservation of posterior canal wall: a technique for surgical treatment of attic cholesteatoma.

To report and evaluate the surgical outcomes of the treatment of attic cholesteatoma using epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall. Our study group consists of 138 subjects with attic cholesteatoma who underwent surgery of the mastoidectomy of the intact posterior canal wall and epitympanoplasty with cartilage obliteration, from November 2008 to November 2010. The major techniques employed included the following: (1) mastoidectomy with the preservation of the posterior canal; (2) removal of the scutum; (3) epitympanum obliteration with cartilage, and (4) mastoid obliteration with bone dust. The post-operative observation period was between 2 and 4 years. All patients were examined via microscopy and oto-endoscopy. Of these 138 subjects, 91 subjects have a follow up period of more than 3 years. There was no retraction pocket formation in the epitympanum in all cases. However, in two subjects, there was a recurrence of cholesteatoma within the mesotympanum. Other observable post-surgery complications were also recorded. For hearing results, 64 of the 138 subjects underwent post-operative audiometric testing for 2 to 3 years and 3 to 4 years consecutively. The average pre- and post-operative air-bone gap closure was found to be 11.97 ± 11.02 dB for the 2 to 3 year period, and 10.08 ± 10.34 dB for the 3 to 4 year period. Based on the results of our study group, epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall is a better alternative treatment technique for attic cholesteatoma.

[Morphology of cricopharyngeal muscle under suspension laryngeal endoscope].

OBJECTIVE: To observe the morphologic features of cricopharyngeal muscle (CPM) under suspension laryngeal endoscope. METHODS: This prospective study was conducted on a series of 100 consecutive patients who undergone endoscopic microlaryngeal surgery with intubation general anesthesia. The suspension laryngoscope was introduced down to postcricoid area approaching esophageal inlet. By lifting the larynx with the laryngoscope, the mucosa-covered cricopharyngeal muscle was easily identified as the mound of tissue just at the posterior pharyngeal wall. The image of cricopharyngeal muscle under the laryngoscope was saved. RESULTS: In 94 out of 100 patients, CPM could be visualized with laryngoscope. In the other 6 patients, both CPM and glottic could not be exposed because of cervical vertebra stiffness and obesity. According to the image of CPM under the laryngoscope, the shape of the CPM was divided into three types. It was named for flat type in which there was no mound of tissue visible at the posterior pharyngeal wall and esophageal cavity could be visible completely, semi-bar type in which there was a bar at the posterior pharyngeal wall and partial esophageal cavity could be visible and full-bar type in which the bar contact esophageal anterior wall and esophageal cavity could not be visible. There were 14(14.9%) patients as flat type, 59(62.8%) as semi-bar type and 21(22.3%) as full-bar type. No significant difference was found between adults group and the aged (≥ 65 years old) group (χ(2) = 1.224, P = 0.747) and reflux associated group and non-reflux associated group respectively (χ(2) = 5.252, P = 0.072). CONCLUSIONS: The CPM could be well exposed in most of the patients with suspension laryngeal endoscope. It provides anatomy basis for endoscopic cricopharyngeal myotomy.

Otoendoscopic treatment of hidden lesions in otomastoiditis.

BACKGROUND: Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery. METHODS: We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip. RESULTS: All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold's abscess, hyperplastic granulation tissue developed at the antrum. CONCLUSIONS: Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recurrence.

[Non-distinctive features on CT scan of fungal sinusitis].

OBJECTIVE: This article was a retrospective analysis on the preoperative CT scan of fungal sinusitis patients. The non-distinctive clinic feature was suggested to improve the accuracy of preoperative diagnosis. METHOD: A retrospective analysis was made for 176 patients with fungal sinusitis,which were confirmed by postoperative pathologic diagnosis from January 2000 to January 2008. Every patient was performed both CT examination and nasal endoscopy preoperatively. All patients underwent endoscopic sinus surgery and the lesions in sinus were cleared and confirmed fungal infection by pathology. Thirty-five cases fungal infection located in sphenoid sinus, 84 cases in maxillary sinus, 49 cases in both maxillary and ethmoid sinus, 3 cases in all sinus, 5 cases in both ethmoid and sphenoid sinus. There were 179 sinuses in 176 patients were infected. RESULT: This group totally had 175 cases (179 sides). One hundred and seventy-three cases had unilateral lesion,3 cases had bilateral lesion. The CT scan showed non-distinctive features including uniform dense, uneven dense in the sinus and bone resorption of the inner side bone wall. Five cases in sphenoid sinus lesion were found calcification in CT scan but 8 cases didn't show such features. Among these cases, 5 cases showed uniform dense and 3 cases showed uneven dense. In 84 cases maxillary sinus lesion, there were 12 cases without distinctive change, among these cases,8 cases showed uniform dense, 4 cases showed uneven dense and 5 cases had bone resorption. In 49 cases both ethmoid and maxillary sinus lesion, 13 cases didn't show distinctive change, among these cases, 9 cases showed uniform dense, 4 cases showed uneven dense and 6 cases had bone resorption. Five cases had calcification in the both sphenoid and ethmoid sinus. Totally 81.56% of these patients had calcification feature in the CT scan. CONCLUSION: The calcification in the lesion of sinus is usually featured as characteristic manifestation of fungal sinusitis. But in clinic, the calcification does not exit in some patients CT scan. When being absent of the featured sign in CT scan, the fungal sinusitis have to be diagnosed by other detecting means,even postoperative pathology.