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2.
World Neurosurg ; 138: 253-256, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32194265

RESUMO

BACKGROUND: Intracranial pneumocephalus, the accumulation of air, occurs most frequently from trauma, tumor, cranial surgeries, or infection. Intraparenchymal otogenic pneumocephalus is a rare but well-documented development. We describe a patient who developed pneumocephalus in the context of eardrum perforation secondary to toothpick use for ear wax. CASE DESCRIPTION: An 86-year-old female presented to the emergency room with a 1-day history of dysarthria and a few days of cough and sneezing. History revealed she had recently been advised to avoid Q-Tips to clean her ears and instead was using toothpicks. She denied otalgia or otorrhea and had no signs of infection near the ear. On otoscopic examination, the right tympanic membrane was perforated. On head computed tomography, she was found to have a large right temporal pneumocephalus extending from the petrous bone. Magnetic resonance imaging of the brain revealed a defect in the right tegmen. She was started on empiric antibiotics and subsequently taken to the operating room for craniotomy and repair of bony and dural defects. CONCLUSIONS: Otogenic pneumocephalus is a rare occurrence. This is the first reported case of pneumocephalus related to self-induced middle ear trauma with a toothpick that ultimately required craniotomy for repair.


Assuntos
Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Membrana Timpânica/lesões , Idoso de 80 Anos ou mais , Dispositivos para o Cuidado Bucal Domiciliar , Feminino , Humanos , Pneumocefalia/diagnóstico por imagem
3.
Sci Rep ; 10(1): 1479, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001770

RESUMO

There is increasing interest in applications which use the 30 to 90 GHz frequency range, including automotive radar, 5 G cellular networks and wireless local area links. This study investigated pulsed 30-90 GHz radiation penetration into the human ear canal and tympanic membrane using computational phantoms. Modelling involved 100 ps and 20 ps pulsed excitation at three angles: direct (orthogonal), 30° anterior, and 45° superior to the ear canal. The incident power flux density (PD) estimation was normalised to the International Commission on Non-Ionizing Radiation Protection (1998) standard for general population exposure of 10 Wm-2 and occupational exposure of 50 Wm-2. The PD, specific absorption rate (SAR) and temperature rise within the tympanic membrane was highly dependent on the incident angle of the radiation and frequency. Using a 30 GHz pulse directed orthogonally into the ear canal, the PD in the tympanic membrane was 0.2% of the original maximal signal intensity. The corresponding PD at 90 GHz was 13.8%. A temperature rise of 0.032° C (+20%, -50%) was noted within the tympanic membrane using the equivalent of an occupational standard exposure at 90 GHz. The central area of the tympanic membrane is exposed in a preferential way and local effects on small regions cannot be excluded. The authors strongly advocate further research into the effects of radiation above 60 GHz on the structures of the ear to assist the process of setting standards.


Assuntos
Meato Acústico Externo/lesões , Meato Acústico Externo/efeitos da radiação , Lesões por Radiação/etiologia , Ondas de Rádio/efeitos adversos , Membrana Timpânica/lesões , Membrana Timpânica/efeitos da radiação , Uso do Telefone Celular/efeitos adversos , Simulação por Computador , Humanos , Modelos Biológicos , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/normas , Imagens de Fantasmas , Radar , Temperatura , Tecnologia sem Fio
4.
Mil Med ; 185(Suppl 1): 248-255, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074377

RESUMO

INTRODUCTION: The peripheral auditory system and various structures within the central auditory system are vulnerable to blast injuries, and even blast overpressure is at relatively mild traumatic brain injury (TBI) level. However, the extent of hearing loss in relation to blast number and time course of post-blast is not well understood. This study reports the progressive hearing damage measured in chinchillas after multiple blast exposures at mild TBI levels (103-138 kPa or 15-20 psi). MATERIALS AND METHODS: Sixteen animals (two controls) were exposed to two blasts and three blasts, respectively, in two groups with both ears plugged with foam earplugs to prevent the eardrum from rupturing. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) were measured in pre- and post-blasts. Immunohistochemical study of chinchilla brains were performed at the end of experiment. RESULTS: Results show that the ABR threshold and DPOAE level shifts in 2-blast animals were recovered after 7 days. In 3-blast animals, the ABR and DPOAE shifts remained at 26 and 23 dB, respectively after 14 days. Variation of auditory cortex damage between 2-blast and 3-blast was also observed in immunofluorescence images. CONCLUSIONS: This study demonstrates that the number of blasts causing mild TBI critically affects hearing damage.


Assuntos
Traumatismos por Explosões/complicações , Perda Auditiva Provocada por Ruído/etiologia , Perda Auditiva/etiologia , Animais , Traumatismos por Explosões/fisiopatologia , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Chinchila/lesões , Chinchila/fisiologia , Modelos Animais de Doenças , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva/fisiopatologia , Perda Auditiva Provocada por Ruído/fisiopatologia , Emissões Otoacústicas Espontâneas/fisiologia , Pressão/efeitos adversos , Membrana Timpânica/lesões , Membrana Timpânica/fisiopatologia
5.
Mil Med ; 185(Suppl 1): 234-242, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074353

RESUMO

INTRODUCTION: There is no dose-response model available for the assessment of the risk of tympanic membrane rupture (TMR), commonly known as eardrum rupture, from exposures to blast from nonlethal flashbangs, which can occur concurrently with temporary threshold shift. Therefore, the objective of this work was to develop a fast-running, lumped parameter model of the tympanic membrane (TM) with probabilistic dose-dependent prediction of injury risk. MATERIALS AND METHODS: The lumped parameter model was first benchmarked with a finite element model of the middle ear. To develop the dose-response curves, TMR data from a historic cadaver study were utilized. From these data, the binary probability response was constructed and logistic regression was applied to generate the respective dose-response curves at moderate and severe eardrum rupture severity. RESULTS: Hosmer-Lemeshow statistical and receiver operation characteristic analyses showed that maximum stored TM energy was the overall best dose metric or injury correlate when compared with total work and peak TM pressure. CONCLUSIONS: Dose-response curves are needed for probabilistic risk assessments of unintended effects like TMR. For increased functionality, the lumped parameter model was packaged as a software library that predicts eardrum rupture for a given blast loading condition.


Assuntos
Traumatismos por Explosões/complicações , Explosões/classificação , Pressão/efeitos adversos , Perfuração da Membrana Timpânica/etiologia , Membrana Timpânica/fisiopatologia , Traumatismos por Explosões/fisiopatologia , Cadáver , Explosões/estatística & dados numéricos , Análise de Elementos Finitos , Humanos , Curva ROC , Medição de Risco/métodos , Membrana Timpânica/lesões , Perfuração da Membrana Timpânica/fisiopatologia
6.
J Laryngol Otol ; 133(12): 1092-1096, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791431

RESUMO

OBJECTIVES: To evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations. METHODS: A total of 120 patients with slap- or fist-induced tympanic membrane perforations, with inverted or everted edges, affecting 50-75 per cent of the entire tympanic membrane, were randomly divided into 2 groups: an edge approximation group and a spontaneous healing group. The edge approximation group was divided into subgroups A and B based on the reversed edge area (reversed edge was more or less than 50 per cent of the total perforation, respectively). Healing outcomes and hearing improvements at six months were compared. RESULTS: The data of 118 patients were analysed. The closure rate of perforations in subgroup A, subgroup B, and the spontaneous healing group was 90.9 per cent, 92.1 per cent and 84.5 per cent, respectively; the difference between the three groups was not significant (p = 0.393). CONCLUSION: The area of reversed edges for slap- or fist-induced tympanic membrane perforations did not seem to affect healing and hearing outcomes, regardless of edge approximation and everted or inverted edges.


Assuntos
Perfuração da Membrana Timpânica/diagnóstico , Perfuração da Membrana Timpânica/patologia , Membrana Timpânica/lesões , Cicatrização , Ferimentos não Penetrantes/patologia , Adulto , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Membrana Timpânica/patologia , Perfuração da Membrana Timpânica/etiologia , Ferimentos não Penetrantes/complicações , Adulto Jovem
7.
PLoS One ; 14(9): e0222728, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536572

RESUMO

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer.


Assuntos
Cartilagem/transplante , Osso Temporal/cirurgia , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/cirurgia , Timpanoplastia/métodos , Estimulação Acústica , Humanos , Som , Cirurgia do Estribo/métodos , Osso Temporal/lesões , Osso Temporal/fisiopatologia , Membrana Timpânica/lesões , Membrana Timpânica/fisiopatologia , Perfuração da Membrana Timpânica/fisiopatologia , Vibração
8.
Acta Otolaryngol ; 139(6): 487-491, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30957610

RESUMO

BACKGROUND: Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature. OBJECTIVES: The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation. MATERIALS AND METHODS: The medical records of 40 patients with TTMP who visited the authors' hospital were retrospectively reviewed. RESULTS: Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure. CONCLUSIONS AND SIGNIFICANCE: In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.


Assuntos
Perfuração da Membrana Timpânica/etiologia , Perfuração da Membrana Timpânica/fisiopatologia , Membrana Timpânica/lesões , Cicatrização/fisiologia , Adulto , Fatores Etários , Criança , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Remissão Espontânea , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
9.
Am J Vet Res ; 80(4): 325-334, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30919672

RESUMO

OBJECTIVE: To determine whether an enrofloxacin-silver sulfadiazine emulsion (ESS) labeled for treatment of otitis externa in dogs has ototoxic effects in rabbits following myringotomy. ANIMALS: 6 healthy adult New Zealand White rabbits. PROCEDURES: Rabbits were anesthetized for brainstem auditory-evoked response (BAER) tests on day 0. Myringotomy was performed, and BAER testing was repeated. Saline (0.9% NaCl) solution and ESS were then instilled in the left and right middle ears, respectively, and BAER testing was repeated prior to recovery of rabbits from anesthesia. Application of assigned treatments was continued every 12 hours for 7 days, and rabbits were anesthetized for BAER testing on day 8. Rabbits were euthanized, and samples were collected for histologic (6 ears/treatment) and scanning electron microscopic (1 ear/treatment) examination. RESULTS: Most hearing thresholds (11/12 ears) were subjectively increased after myringotomy, with BAER measurements ranging from 30 to 85 dB in both ears. All day 8 hearing thresholds exceeded baseline (premyringotomy) values; results ranged from 30 to 85 dB and 80 to > 95 dB (the upper test limit) in saline solution-treated and ESS-treated ears, respectively. All ESS-treated ears had heterophilic otitis externa, epithelial hyperplasia of the external ear canal, various degrees of mucoperiosteal edema, and periosteal new bone formation on histologic examination. Scanning electron microscopy revealed that most outer hair cells in the ESS-treated ear lacked stereocilia or were absent. CONCLUSIONS AND CLINICAL RELEVANCE: Results supported that ESS has ototoxic effects in the middle ear of rabbits. Further research is needed to confirm these findings. Myringotomized laboratory rabbits may be useful to study ototoxicity of drugs used in human medicine.


Assuntos
Enrofloxacina/toxicidade , Sulfadiazina de Prata/toxicidade , Perfuração da Membrana Timpânica/tratamento farmacológico , Membrana Timpânica/efeitos dos fármacos , Membrana Timpânica/lesões , Animais , Orelha Média/patologia , Feminino , Audição , Humanos , Masculino , Ventilação da Orelha Média , Coelhos , Membrana Timpânica/patologia
10.
Mil Med ; 184(Suppl 1): 251-260, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901470

RESUMO

Hearing damage induced by blast exposure is a common injury in military personnel involved in most operation activities. Personal hearing protection devices such as earplugs come as a standard issue for Service members; however, it is not clear how to accurately evaluate the protection mechanisms of different hearing protection devices for blast overpressures (BOP). This paper reports a recent study on characterization of earplugs' protective function to BOP using human cadaver ears and 3D finite element (FE) model of the human ear. The cadaver ear mounted with pressure sensors near the eardrum (P1) and inside the middle ear (P2) and with an earplug inserted was exposed to BOP in the blast test chamber. P1, P2, and BOP at the ear canal entrance (P0) were simultaneously recorded. The measured P0 waveform was then applied at the ear canal entrance in the FE model and the P1 and P2 pressures were derived from the model. Both experiments and FE modeling resulted in the P1 reduction which represents the effective protection function of the earplug. Different earplugs showed variations in pressure waveforms transmitted to the eardrum, which determine the protection level of earplugs.


Assuntos
Fenômenos Biomecânicos , Simulação por Computador , Dispositivos de Proteção das Orelhas/normas , Explosões , Cadáver , Desenho de Equipamento/normas , Perda Auditiva Provocada por Ruído/prevenção & controle , Humanos , Pressão/efeitos adversos , Membrana Timpânica/lesões , Membrana Timpânica/fisiologia
11.
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 77-82, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002183

RESUMO

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Fibrina Rica em Plaquetas , Miringoplastia , Otite Média Supurativa/cirurgia , Transplante Autólogo , Membrana Timpânica/lesões , Cicatrização , Resultado do Tratamento
12.
Braz. j. otorhinolaryngol. (Impr.) ; 85(1): 17-23, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984055

RESUMO

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.


Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Membrana Timpânica/patologia , Perfuração da Membrana Timpânica/patologia , Remissão Espontânea , Fatores de Tempo , Membrana Timpânica/lesões , Membrana Timpânica/diagnóstico por imagem , Cicatrização/fisiologia , Perfuração da Membrana Timpânica/diagnóstico por imagem , Distribuição por Sexo , Otoscopia/métodos
13.
Croat Med J ; 60(6): 503-507, 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31894915

RESUMO

AIM: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching. METHODS: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury. RESULTS: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P=0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P=0.042). CONCLUSION: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma.


Assuntos
Traumatismos por Explosões/cirurgia , Silício/uso terapêutico , Perfuração da Membrana Timpânica/cirurgia , Cicatrização , Adulto , Croácia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Membrana Timpânica/lesões , Membrana Timpânica/cirurgia , Perfuração da Membrana Timpânica/etiologia , Adulto Jovem
14.
Braz J Otorhinolaryngol ; 85(1): 17-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29137879

RESUMO

INTRODUCTION: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. OBJECTIVE: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. METHODS: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes. RESULTS: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. CONCLUSION: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.


Assuntos
Perfuração da Membrana Timpânica/patologia , Membrana Timpânica/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otoscopia/métodos , Remissão Espontânea , Distribuição por Sexo , Fatores de Tempo , Membrana Timpânica/diagnóstico por imagem , Membrana Timpânica/lesões , Perfuração da Membrana Timpânica/diagnóstico por imagem , Cicatrização/fisiologia , Adulto Jovem
15.
Laryngoscope ; 129(1): 203-208, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30229918

RESUMO

OBJECTIVES/HYPOTHESIS: To report on the safety and efficacy of cartilage-buttressed T-tube tympanoplasty for long-term middle ear ventilation, specifically by examining duration of tube survival, as well as adverse events associated with prolonged middle ear intubation, including persistent tympanic membrane perforation. STUDY DESIGN: Retrospective case series of patients undergoing cartilage-buttressed T-tube tympanoplasty between January 2005 and December 2016 in a tertiary-care neurotology private practice. METHODS: Patients who underwent cartilage T-tube tympanoplasty with complete pre- and postoperative audiometric data and a minimum follow-up duration of 12 months were analyzed. T-tube survival and adverse events including persistent tympanic membrane perforation were recorded and compared to published data for other long-term middle ear ventilation techniques. RESULTS: The study cohort included 72 cartilage-buttressed T-tube tympanoplasties in 68 patients. Median tube survival was 34 months (range, 2-131 months). Incidence of persistent tympanic membrane perforation (n = 1) was 1.4% CONCLUSIONS: Cartilage-buttressed T-tube tympanoplasty is a safe and effective means of accomplishing long-term middle ear ventilation with a considerably lower rate of persistent tympanic membrane perforation as compared to alternative methods of prolonged middle ear ventilation. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:203-208, 2019.


Assuntos
Ventilação da Orelha Média , Otite Média/cirurgia , Timpanoplastia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria , Criança , Pré-Escolar , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Ventilação da Orelha Média/efeitos adversos , Ventilação da Orelha Média/métodos , Estudos Retrospectivos , Resultado do Tratamento , Membrana Timpânica/lesões , Membrana Timpânica/cirurgia , Timpanoplastia/efeitos adversos , Timpanoplastia/instrumentação , Adulto Jovem
16.
Int J Pediatr Otorhinolaryngol ; 118: 79-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30590281

RESUMO

OBJECTIVES: Our preliminary study performed on perforated rat's tympanic membrane (TM) using Rat Wound Healing RT2 Profiler PCR Array showed significantly increased levels of mRNA for collagens type I and V. Enhanced expression of those genes does not assure that their protein products are indeed present, and in what quantity. Therefore, this study was undertaken to analyze the collagen type I and V content in the healing TM. METHODS: Sixty rats were used, of which 10 served as controls and the others had their TM perforated. The experimental animals were divided into five subgroups on the basis of time points (03, 06, 09, 14, 20 day after injury). Videootoscopy and histology were employed to assess the morphology of the healing process. The expression of collagen type I and V was evaluated using Western blot analysis. Tissue localization of collagens was determined by the immunofluorescence method. RESULTS: The collagen type I expression was three times higher on the third day after injury and remained on that level for whole period of observation, up to day 20. The increase of the collagen type V expression was gradual, reaching the highest level on day 14 following injury. In comparison to the control TM statistically significant increase in the level of expression was observed starting from day 09 to the end of observation period. In healing TM immunofluorescent labeling of collagen type I and V was seen on the surface of remnants of previous lamina propria and in the loose proliferating fibrous tissue. On day 20 immunofluorescence was present mainly on the surface of thin connective tissue layers forming the scar in the place of previous perforation. CONCLUSION: Although the collagens type I and V are present only in subepithelial layer in the normal rat's TM they play significant role in TM healing process.


Assuntos
Colágeno Tipo I/metabolismo , Colágeno Tipo V/metabolismo , Perfuração da Membrana Timpânica/metabolismo , Membrana Timpânica/fisiologia , Cicatrização , Animais , Cicatriz/metabolismo , Tecido Conjuntivo/metabolismo , Masculino , Membrana Mucosa/metabolismo , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Membrana Timpânica/lesões , Perfuração da Membrana Timpânica/patologia
17.
Fa Yi Xue Za Zhi ; 34(4): 392-395, 2018 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-30465405

RESUMO

OBJECTIVES: To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations. METHODS: Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated. RESULTS: For the traumatic tympanic membrane perforations, the study showed that the small size of perforation (<1/2 quadrant) with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%. CONCLUSIONS: In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification.


Assuntos
Perfuração da Membrana Timpânica/diagnóstico , Perfuração da Membrana Timpânica/fisiopatologia , Membrana Timpânica/lesões , Cicatrização/fisiologia , Humanos , Estudos Retrospectivos , Perfuração da Membrana Timpânica/complicações
18.
J Craniofac Surg ; 29(7): 1922-1924, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30290584

RESUMO

The authors aim to analyze the effects of oral antibiotic treatment for traumatic tympanic membrane perforations and to compare the outcomes of patients with traumatic tympanic membrane perforation after paper-patching procedure and spontaneous healing.In this study, 80 patients with traumatic tympanic membrane perforation diagnosed in the otorhinolaryngology emergency department and outpatient clinic from March 2010 to January 2015 were retrospectively reviewed. If the patient is diagnosed at first week and the edge of perforation is moist with blood, our routine procedure is paper-patching (group 1). However, if the patients reject treatment or delay in admission, the authors follow up patients for spontaneous closure (group 2). Some of the patients got oral antibiotics for 7 days (amoxicillin/clavulanic acid, 1000 mg 2 times/d) while some others did not. Closure rates and effectivity of oral antibiotics were evaluated and compared between 2 groups.In total, 80 patients were analyzed. The closure rates of perforations were 95.2% for group 1 (n = 42) and 81.6% for group 2 (n = 38). Although the paper-patched patients (group 1) perforation closure rate (95.2%) is higher than the nontreated patients (group 2) closure rate (81.6%), it is not statistically significant (P > 0.05). Antibiotic administered 55 patients had a significantly higher closure rate (94.5%) than the 25 patients who are not treated with antibiotics (76%) (P = 0.023; P < 0.05).In patients with traumatic tympanic membrane perforations, spontaneous closure rate is quite high. This study showed us that antibiotherapy and paper-patch treatments increase the healing rates.


Assuntos
Miringoplastia/métodos , Perfuração da Membrana Timpânica/fisiopatologia , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/lesões , Cicatrização , Adolescente , Adulto , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miringoplastia/instrumentação , Papel , Estudos Retrospectivos , Membrana Timpânica/fisiopatologia , Membrana Timpânica/cirurgia , Perfuração da Membrana Timpânica/tratamento farmacológico , Perfuração da Membrana Timpânica/etiologia , Adulto Jovem , Inibidores de beta-Lactamases/uso terapêutico
19.
J Laryngol Otol ; 132(9): 790-795, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30232949

RESUMO

OBJECTIVE: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma. METHODS: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device. RESULTS: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch. CONCLUSION: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.


Assuntos
Barotrauma/epidemiologia , Orelha Média/lesões , Dor de Orelha/prevenção & controle , Membrana Timpânica/lesões , Testes de Impedância Acústica/métodos , Adulto , Medicina Aeroespacial/métodos , Viagem Aérea/estatística & dados numéricos , Barotrauma/tratamento farmacológico , Barotrauma/prevenção & controle , Método Duplo-Cego , Orelha Média/efeitos dos fármacos , Orelha Média/patologia , Dor de Orelha/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placebos/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Membrana Timpânica/efeitos dos fármacos , Membrana Timpânica/patologia
20.
Otolaryngol Head Neck Surg ; 159(6): 1028-1036, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30060707

RESUMO

OBJECTIVE: To compare the outcomes of epidermal growth factor (EGF) and gelatin sponge patch treatments for traumatic tympanic membrane perforations. STUDY DESIGN: Prospective, randomized, controlled. SETTING: University-affiliated teaching hospital. SUBJECTS AND METHODS: In total, 141 perforations encompassing >50% of the eardrum were randomly divided into 3 groups: EGF (n = 47), gelatin sponge patch (n = 47), and observation (n = 47). The edges of the perforations were not approximated. The closure rate, mean closure time, and infection rate were evaluated at 6 months and the related factors analyzed. RESULTS: A total of 135 perforations were analyzed. At 6 months, the closure rates were 97.8%, 86.7%, and 82.2% in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively (P = .054). The mean ± SD closure time was 11.12 ± 4.60, 13.67 ± 5.37, and 25.65 ± 13.32 days in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively (P < .001). In addition, the presence of infection was not significantly associated with rate of closure in any group. CONCLUSIONS: As compared with spontaneous healing, daily application of EGF and gelatin sponge patching reduced the closure time of traumatic tympanic membrane perforations. EGF treatment had a higher closure rate and shorter closure time but resulted in otorrhea. By contrast, gelatin sponge patches did not improve the closure rate or cause otorrhea but required repeated patch removal and reapplication. Thus, the appropriate treatment should be selected according to patient need.


Assuntos
Fator de Crescimento Epidérmico/uso terapêutico , Esponja de Gelatina Absorvível/uso terapêutico , Perfuração da Membrana Timpânica/terapia , Membrana Timpânica/lesões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Perfuração da Membrana Timpânica/etiologia
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