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1.
Artigo em Chinês | MEDLINE | ID: mdl-38973037

RESUMO

Objective:To analyze the surgical efficacy and safety of tympanoplasty with and without mastoidectomy for the treatment of active simple chronic suppurative otitis media(CSOM), and to investigate whether mastoidectomy can be avoided in tympanoplasty for active CSOM. Methods:The clinical data of 55 patients(55 ears) with active CSOM were retrospectively analyzed. Based on the development of the mastoid process and the upper tympanic chamber, patients who met the criteria for wall-up mastoidectomy were classified as group A (30 patients), and underwent tympanoplasty combined with wall-up mastoidectomy. Patients who did not meet the criteria for wall-up mastoidectomy were classified as group B(25 cases), and underwent tympanoplasty with the opening of the middle and upper tympanic chambers and sinus drainage after partial removal of the shield plate bone. The survival rate of tympanic membrane grafts, hearing before and after surgery, and complications such as reperforation were compared between the two groups at 3 months postoperatively. Results:The overall postoperative tympanic membrane survival rate of patients with active CSOM was 96.4%(53/55), including 96.7% in group A; 96.0% in group B. There was no significant difference in the tympanic membrane survival rate between the two groups(P>0.05). The postoperative mean air-bone gap(ABG) was significantly reduced in both groups compared with the preoperative period, but there was no significant difference in ABG gain between the two groups(P>0.05). No patients experienced serious adverse conditions such as peripheral facial paralysis, cerebrospinal fluid leakage, or sensorineural deafness after surgery. Conclusion:Microscopic tympanoplasty with patency of the middle and upper tympanic chambers and tympanic sinus drainage can be used to treat active simple chronic otitis media with satisfactory tympanic membrane viability and hearing improvement efficacy. This approach reduces patient trauma, prevents complications such as skin depressions in the mastoid area due to abrasion of the mastoid bone, and shortens the waiting time before surgery.


Assuntos
Mastoidectomia , Otite Média Supurativa , Timpanoplastia , Humanos , Otite Média Supurativa/cirurgia , Timpanoplastia/métodos , Estudos Retrospectivos , Mastoidectomia/métodos , Masculino , Feminino , Resultado do Tratamento , Doença Crônica , Pessoa de Meia-Idade , Adulto , Membrana Timpânica/cirurgia , Processo Mastoide/cirurgia
2.
J R Soc Interface ; 21(215): 20230779, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38903010

RESUMO

Many animals employ a second frequency filter beyond the initial filtering of the eardrum (or tympanal membrane). In the field cricket ear, both the filtering mechanism and the transmission path from the posterior tympanal membrane (PTM) have remained unclear. A mismatch between PTM vibrations and sensilla tuning has prompted speculations of a second filter. PTM coupling to the tracheal branches is suggested to support a transmission pathway. Here, we present three independent lines of evidence converging on the same conclusion: the existence of a series of linked membranes with distinct resonant frequencies serving both filtering and transmission functions. Micro-computed tomography (µ-CT) highlighted the 'dividing membrane (DivM)', separating the tracheal branches and connected to the PTM via the dorsal membrane of the posterior tracheal branch (DM-PTB). Thickness analysis showed the DivM to share significant thinness similarity with the PTM. Laser Doppler vibrometry indicated the first of two PTM vibrational peaks, at 6 and 14 kHz, originates not from the PTM but from the coupled DM-PTB. This result was corroborated by µ-CT-based finite element analysis. These findings clarify further the biophysical source of neuroethological pathways in what is an important model of behavioural neuroscience. Tuned microscale coupled membranes may also hold biomimetic relevance.


Assuntos
Análise de Elementos Finitos , Gryllidae , Microtomografia por Raio-X , Animais , Gryllidae/fisiologia , Membrana Timpânica/fisiologia , Membrana Timpânica/diagnóstico por imagem , Vibração
3.
ACS Biomater Sci Eng ; 10(7): 4400-4410, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38917429

RESUMO

Tympanic membrane perforation (TMP) is prevalent in clinical settings. Patients with TMPs often suffer from infections caused by Staphylococcus aureus and Pseudomonas aeruginosa, leading to middle ear and external ear canal infections, which hinder eardrum healing. The objective of this study is to fabricate an enzyme-responsive antibacterial electrospun scaffold using poly(lactic-co-glycolic acid) and hyaluronic acid for the treatment of infected TMPs. The properties of the scaffold were characterized, including morphology, wettability, mechanical properties, degradation properties, antimicrobial properties, and biocompatibility. The results indicated that the fabricated scaffold had a core-shell structure and exhibited excellent mechanical properties, hydrophobicity, degradability, and cytocompatibility. Furthermore, in vitro bacterial tests and ex vivo investigations on eardrum infections suggested that this scaffold possesses hyaluronidase-responsive antibacterial properties. It may rapidly release antibiotics when exposed to the enzyme released by S. aureus and P. aeruginosa. These findings suggest that the scaffold has great potential for repairing TMPs with infections.


Assuntos
Antibacterianos , Ácido Hialurônico , Hialuronoglucosaminidase , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Pseudomonas aeruginosa , Staphylococcus aureus , Alicerces Teciduais , Membrana Timpânica , Antibacterianos/farmacologia , Antibacterianos/química , Hialuronoglucosaminidase/metabolismo , Hialuronoglucosaminidase/química , Staphylococcus aureus/efeitos dos fármacos , Alicerces Teciduais/química , Pseudomonas aeruginosa/efeitos dos fármacos , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/farmacologia , Ácido Hialurônico/química , Ácido Hialurônico/farmacologia , Animais , Humanos , Ácido Poliglicólico/química , Ácido Poliglicólico/farmacologia , Ácido Láctico/química , Ácido Láctico/farmacologia , Perfuração da Membrana Timpânica/tratamento farmacológico , Perfuração da Membrana Timpânica/terapia , Testes de Sensibilidade Microbiana
4.
J Acoust Soc Am ; 155(6): 3615-3626, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38833283

RESUMO

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%.


Assuntos
Orelha Média , Pressão , Membrana Timpânica , Humanos , Masculino , Feminino , Membrana Timpânica/fisiologia , Membrana Timpânica/anatomia & histologia , Orelha Média/fisiologia , Orelha Média/anatomia & histologia , Adulto , Adulto Jovem , Elasticidade , Estimulação Acústica , Tuba Auditiva/fisiologia , Tuba Auditiva/anatomia & histologia , Estribo/fisiologia , Água , Análise Discriminante
5.
Am J Otolaryngol ; 45(4): 104334, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38723380

RESUMO

PURPOSE: Tympanostomy tube (TT) placement is the most frequently performed ambulatory surgery in children under 15. After the procedure it is recommended that patients follow up regularly for "tube checks" until TT extrusion. Such visits incur direct and indirect costs to families in the form of days off from work, copays, and travel expenses. This pilot study aims to compare the efficacy of tympanic membrane (TM) evaluation by an artificial intelligence algorithm with that of clinical staff for determining presence or absence of a tympanostomy tube within the TM. METHODS: Using a digital otoscope, we performed a prospective study in children (ages 10 months-10 years) with a history of TTs who were being seen for follow up in a pediatric otolaryngology clinic. A smartphone otoscope was used by study personnel who were not physicians to take ear exam images, then through conventional otoscopic exam, ears were assessed by a clinician for tubes being in place or tubes having extruded from the TM. We trained and tested a deep learning (artificial intelligence) algorithm to assess the images and compared that with the clinician's assessment. RESULTS: A total of 123 images were obtained from 28 subjects. The algorithm classified images as TM with or without tube in place. Overall classification accuracy was 97.7 %. Recall and precision were 100 % and 96 %, respectively, for TM without a tube present, and 95 % and 100 %, respectively, for TM with a tube in place. DISCUSSION: This is a promising deep learning algorithm for classifying ear tube presence in the TM utilizing images obtained in awake children using an over-the-counter otoscope available to the lay population. We are continuing enrollment, with the goal of building an algorithm to assess tube patency and extrusion.


Assuntos
Aprendizado Profundo , Ventilação da Orelha Média , Humanos , Ventilação da Orelha Média/métodos , Criança , Pré-Escolar , Estudos Prospectivos , Lactente , Projetos Piloto , Masculino , Feminino , Membrana Timpânica/cirurgia , Otoscopia/métodos , Algoritmos , Otoscópios
6.
Int J Numer Method Biomed Eng ; 40(6): e3817, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38602150

RESUMO

Finite Element modeling has been an extended methodology to build numerical model to simulate the behavior of the hearing system. Due to the complexity of the system and the difficulties to reduce the uncertainties of the geometric data, they result in computationally expensive models, sometimes generic, representative of average geometries. It makes it difficult to validate the model with direct experimental data from the same specimen or to establish a patient-oriented modeling strategy. In the present paper, a first attempt to automatize the process of model building is made. The source information is geometrical information obtained from CT of the different elements that compose the system. Importing that data, we have designed the complete procedure to build a model including tympanic membrane, ossicular chain and cavities. The methodology includes the proper coupling of all the elements and the generation of the corresponding finite element model. The whole automatic procedure is not complete, as we need to make some human-assisted decisions; however, the model development time is reduced from 4 weeks to approximately 3 days. The goal of the modeling algorithm is to build a Finite Element Model with a limited computational cost. Several tasks as contour identification or model decimation are designed and integrated in order to follow a semi-automated process that allows generating a patient-oriented model.


Assuntos
Algoritmos , Análise de Elementos Finitos , Audição , Humanos , Audição/fisiologia , Microtomografia por Raio-X , Modelos Biológicos , Membrana Timpânica/fisiologia , Membrana Timpânica/diagnóstico por imagem
7.
J Assoc Res Otolaryngol ; 25(3): 285-302, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38561524

RESUMO

PURPOSE: Several treatment methods for hearing disorders rely on attaching medical devices to the tympanic membrane. This study aims to systematically analyze the effects of the material and geometrical properties and location of the medical devices attached to the tympanic membrane on middle-ear vibrations. METHODS: A finite-element model of the human middle ear was employed to simulate the effects of attachment of medical devices. Various types of material and geometrical properties, locations, and modeling scenarios were investigated for the medical device. RESULTS: The attachment of the device magnifies the effects of anti-resonances of the middle ear. Additionally, the variations of the material properties of the device significantly alter the middle-ear resonance frequency while changes in the umbo and stapes footplate motions are negligible at frequencies above 5 kHz. Furthermore, modeling the device as a point mass cannot accurately represent the implanted middle-ear behavior. The variations of the diameter and height of the medical device have negligible effects on the middle-ear vibrations at frequencies below 200 Hz but can have considerable impacts at higher frequencies. The effects of changing the device height were negligible at frequencies above 2 kHz. We also discuss the effects of medical device attachment on the vibration patterns of the tympanic membrane as well as the impacts of the variations of the location of the device on the stapes footplate responses. CONCLUSION: The findings of our study aid the development and optimization of new therapeutic devices, attached to the tympanic membrane, to have the least adverse effects on middle-ear vibrations.


Assuntos
Análise de Elementos Finitos , Membrana Timpânica , Vibração , Humanos , Membrana Timpânica/fisiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-38575378

RESUMO

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.


Assuntos
Miringoplastia , Perfuração da Membrana Timpânica , Humanos , Miringoplastia/métodos , Perfuração da Membrana Timpânica/cirurgia , Perfuração da Membrana Timpânica/patologia , Resultado do Tratamento , Membrana Timpânica/cirurgia , Membrana Timpânica/patologia , Estudos Retrospectivos
9.
J Acoust Soc Am ; 155(4): 2769-2785, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38662609

RESUMO

Assuming plane waves, ear-canal acoustic quantities, collectively known as wideband acoustic immittance (WAI), are frequently used in research and in the clinic to assess the conductive status of the middle ear. Secondary applications include compensating for the ear-canal acoustics when delivering stimuli to the ear and measuring otoacoustic emissions. However, the ear canal is inherently non-uniform and terminated at an oblique angle by the conical-shaped tympanic membrane (TM), thus potentially confounding the ability of WAI quantities in characterizing the middle-ear status. This paper studies the isolated possible confounding effects of TM orientation and shape on characterizing the middle ear using WAI in human ears. That is, the non-uniform geometry of the ear canal is not considered except for that resulting from the TM orientation and shape. This is achieved using finite-element models of uniform ear canals terminated by both lumped-element and finite-element middle-ear models. In addition, the effects on stimulation and reverse-transmission quantities are investigated, including the physical significance of quantities seeking to approximate the sound pressure at the TM. The results show a relatively small effect of the TM orientation on WAI quantities, except for a distinct delay above 10 kHz, further affecting some stimulation and reverse-transmission quantities.


Assuntos
Meato Acústico Externo , Análise de Elementos Finitos , Pressão , Membrana Timpânica , Humanos , Membrana Timpânica/fisiologia , Meato Acústico Externo/fisiologia , Som , Acústica , Estimulação Acústica , Simulação por Computador , Modelos Anatômicos , Emissões Otoacústicas Espontâneas/fisiologia , Orelha Média/fisiologia , Testes de Impedância Acústica/métodos
10.
Otol Neurotol ; 45(4): e333-e336, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38478411

RESUMO

OBJECTIVE: Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management. PATIENTS: Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history. INTERVENTIONS: Surgical excision of tophaceous middle ear lesions. MAIN OUTCOME MEASURE: Improvements in facial weakness and conductive hearing loss. RESULTS: The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively. CONCLUSION: Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.


Assuntos
Condrocalcinose , Paralisia Facial , Gota , Masculino , Humanos , Idoso , Orelha Média/diagnóstico por imagem , Orelha Média/cirurgia , Orelha Média/patologia , Membrana Timpânica/patologia , Gota/diagnóstico , Gota/patologia , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/cirurgia , Perda Auditiva Condutiva/diagnóstico , Paralisia Facial/patologia
11.
Biomater Adv ; 159: 213827, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38490018

RESUMO

Chronic suppurative otitis media (CSOM) is often associated with permanent tympanic membrane (TM) perforation and conductive hearing loss. The current clinical gold standard, using autografts and allografts, suffers from several drawbacks. Artificial replacement materials can help to overcome these drawbacks. Therefore, scaffolds fabricated through digital light processing (DLP) were herein created to support TM regeneration. Various UV-curable printing inks, including gelatin methacryloyl (GelMA), gelatin-norbornene-norbornene (GelNBNB) (crosslinked with thiolated gelatin (GelSH)) and alkene-functionalized poly-ε-caprolactone (E-PCL) (crosslinked with pentaerythritol tetrakis(3-mercaptopropionate) (PETA4SH)) were optimized regarding photo-initiator (PI) and photo-absorber (PA) concentrations through viscosity characterization, photo-rheology and the establishment of working curves for DLP. Our material platform enabled the development of constructs with a range of mechanical properties (plateau storage modulus varying between 15 and 119 kPa). Excellent network connectivity for the GelNBNB and E-PCL constructs was demonstrated (gel fractions >95 %) whereas a post-crosslinking step was required for the GelMA constructs. All samples showed excellent biocompatibility (viability >93 % and metabolic activity >88 %). Finally, in vivo and ex vivo assessments, including histology, vibration and deformation responses measured through laser doppler vibrometry and digital image correlation respectively, were performed to investigate the effects of the scaffolds on the anatomical and physiological regeneration of acute TM perforations in rabbits. The data showed that the most efficient healing with the best functional quality was obtained when both mechanical (obtained with the PCL-based resin) and biological (obtained with the gelatin-based resins) material properties were taken into account.


Assuntos
Perfuração da Membrana Timpânica , Membrana Timpânica , Animais , Coelhos , Gelatina , Sinais (Psicologia) , Perfuração da Membrana Timpânica/cirurgia , Regeneração , Norbornanos
12.
JAMA Pediatr ; 178(4): 401-407, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38436941

RESUMO

Importance: Acute otitis media (AOM) is a frequently diagnosed illness in children, yet the accuracy of diagnosis has been consistently low. Multiple neural networks have been developed to recognize the presence of AOM with limited clinical application. Objective: To develop and internally validate an artificial intelligence decision-support tool to interpret videos of the tympanic membrane and enhance accuracy in the diagnosis of AOM. Design, Setting, and Participants: This diagnostic study analyzed otoscopic videos of the tympanic membrane captured using a smartphone during outpatient clinic visits at 2 sites in Pennsylvania between 2018 and 2023. Eligible participants included children who presented for sick visits or wellness visits. Exposure: Otoscopic examination. Main Outcomes and Measures: Using the otoscopic videos that were annotated by validated otoscopists, a deep residual-recurrent neural network was trained to predict both features of the tympanic membrane and the diagnosis of AOM vs no AOM. The accuracy of this network was compared with a second network trained using a decision tree approach. A noise quality filter was also trained to prompt users that the video segment acquired may not be adequate for diagnostic purposes. Results: Using 1151 videos from 635 children (majority younger than 3 years of age), the deep residual-recurrent neural network had almost identical diagnostic accuracy as the decision tree network. The finalized deep residual-recurrent neural network algorithm classified tympanic membrane videos into AOM vs no AOM categories with a sensitivity of 93.8% (95% CI, 92.6%-95.0%) and specificity of 93.5% (95% CI, 92.8%-94.3%) and the decision tree model had a sensitivity of 93.7% (95% CI, 92.4%-94.9%) and specificity of 93.3% (92.5%-94.1%). Of the tympanic membrane features outputted, bulging of the TM most closely aligned with the predicted diagnosis; bulging was present in 230 of 230 cases (100%) in which the diagnosis was predicted to be AOM in the test set. Conclusions and Relevance: These findings suggest that given its high accuracy, the algorithm and medical-grade application that facilitates image acquisition and quality filtering could reasonably be used in primary care or acute care settings to aid with automated diagnosis of AOM and decisions regarding treatment.


Assuntos
Inteligência Artificial , Otite Média , Criança , Humanos , Otoscopia/métodos , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Membrana Timpânica , Algoritmos
13.
J Mech Behav Biomed Mater ; 153: 106478, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38493562

RESUMO

This study aims to introduce a novel non-invasive method for rapid material characterization of middle-ear structures, taking into consideration the invaluable insights provided by the mechanical properties of ear tissues. Valuable insights into various ear pathologies can be gleaned from the mechanical properties of ear tissues, yet conventional techniques for assessing these properties often entail invasive procedures that preclude their use on living patients. In this study, in the first step, we developed machine-learning models of the middle ear to predict its responses with a significantly lower computational cost in comparison to finite-element models. Leveraging findings from prior research, we focused on the most influential model parameters: the Young's modulus and thickness of the tympanic membrane and the Young's modulus of the stapedial annular ligament. The eXtreme Gradient Boosting (XGBoost) method was implemented for creating the machine-learning models. Subsequently, we combined the created machine-learning models with Bayesian optimization (BoTorch) for fast and efficient estimation of the Young's moduli of the tympanic membrane and the stapedial annular ligament. We demonstrate that the resultant surrogate models can fairly represent the vibrational responses of the umbo, stapes footplate, and vibration patterns of the tympanic membrane at most frequencies. Also, our proposed material characterization approach successfully estimated the Young's moduli of the tympanic membrane and stapedial annular ligament (separately and simultaneously) with values of mean absolute percentage error of less than 7%. The remarkable accuracy achieved through the proposed material characterization method underscores its potential for eventual clinical applications of estimating mechanical properties of the middle-ear structures for diagnostic purposes.


Assuntos
Orelha Média , Membrana Timpânica , Humanos , Teorema de Bayes , Orelha Média/fisiologia , Vibração , Módulo de Elasticidade , Análise de Elementos Finitos
14.
Int Tinnitus J ; 27(2): 135-140, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38507626

RESUMO

BACKGROUND: Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment. AIM OF THE STUDY: To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media. PATIENTS AND METHODS: A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation. RESULTS: The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168). CONCLUSION: In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.


Assuntos
Surdez , Perda Auditiva , Otite Média Supurativa , Perfuração da Membrana Timpânica , Adulto , Masculino , Feminino , Humanos , Otite Média Supurativa/complicações , Perfuração da Membrana Timpânica/diagnóstico , Perfuração da Membrana Timpânica/etiologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Estudos Prospectivos , Estudos Transversais , Membrana Timpânica
15.
Am J Otolaryngol ; 45(3): 104258, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38513512

RESUMO

OBJECTIVES: This study aimed to compare the side effects of different steroids used in the intratympanic injections (IT). METHODS: One hundred and sixty patients diagnosed with sudden sensorineural hearing loss and undergoing IT were assigned to four groups based on the type or concentration of steroids administered (Group DM5: 5 mg/ml Dexamethasone sodium phosphate; Group DM10: 10 mg/ml Dexamethasone sodium phosphate; Group MP: 40 mg/ml Methylprednisolone sodium succinate; Group BM: 4 mg/ml Betamethasone sodium phosphate). Each group comprised 40 patients, and all participants received IT six times. The study assessed and compared the degrees and duration of pain, dizziness, and tympanic membrane damage following IT. Patients were asked to report the pain they felt using the numeric rating scale (NRS). RESULTS: NRS scores for pain after IT showed significant differences among the four groups (p < 0.001). The average NRS scores for pain in each group were as follows: Group DM5: 1.53 ± 1.04; Group DM10: 1.45 ± 1.30; Group MP: 4.33 ± 2.22; Group BM: 6.03 ± 1.46. The durations of pain after IT also exhibited significant differences among the four groups (p < 0.001), with the longest duration observed in Group MP at 31.93 ± 15.20 min. CONCLUSION: Different types of steroids could lead to varying degrees of pain when used in IT. Betamethasone could cause the most severe pain, and methylprednisolone could result in the longest duration of pain.


Assuntos
Betametasona , Betametasona/análogos & derivados , Dexametasona , Dexametasona/análogos & derivados , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Injeção Intratimpânica , Metilprednisolona , Humanos , Masculino , Feminino , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Betametasona/administração & dosagem , Betametasona/efeitos adversos , Pessoa de Meia-Idade , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Adulto , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/induzido quimicamente , Perda Auditiva Neurossensorial/induzido quimicamente , Membrana Timpânica , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Hemissuccinato de Metilprednisolona/administração & dosagem , Hemissuccinato de Metilprednisolona/efeitos adversos , Tontura/induzido quimicamente , Idoso , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor
16.
Int Tinnitus J ; 27(2): 242-246, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38512871

RESUMO

A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Postsurgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure.However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease.


Assuntos
Colesteatoma da Orelha Média , Otite Média , Adulto , Humanos , Masculino , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Otite Média/complicações , Otite Média/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Membrana Timpânica , Timpanoplastia/métodos
17.
Otol Neurotol ; 45(4): 419-425, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38437809

RESUMO

OBJECTIVE: This study aims to analyze the impact of age and other prognostic factors on the success of myringoplasty. STUDY DESIGN: A retrospective case series. SETTINGS: Pediatric ENT department of a tertiary academic center. PATIENTS: Two hundred forty-one children (318 ears) aged 3 to 17 years with tympanic perforation. INTERVENTION: Myringoplasty performed between 2009 and 2019. MAIN OUTCOMES MEASURES: The rate of tympanic closure, perforation recurrence, revision surgery, and audiometric gain were collected. The impact of age and anatomical and surgical factors was analyzed for each procedure. RESULTS: With a mean follow-up time of 1 year, the tympanic closure rate was 87.7%, the perforation recurrence rate was 18.6%, and 16.7% of ears required reoperation. The mean air-bone gap decreased from 21 dB preoperatively to 12 dB postoperatively ( p < 0.0001). We did not find different anatomical and audiometric results for our three groups of patients classified according to age. Audiometric results were associated with the location of the perforation, intraoperative inflammation of the middle ear mucosa, and the surgical technique performed. CONCLUSION: Myringoplasty in children is associated with excellent anatomical and functional results, even in the youngest patients. It can be proposed whatever the child's age if the patients are well selected before giving the indication.


Assuntos
Perfuração da Membrana Timpânica , Humanos , Criança , Estudos Retrospectivos , Resultado do Tratamento , Perfuração da Membrana Timpânica/cirurgia , Miringoplastia/métodos , Membrana Timpânica
18.
Vet Radiol Ultrasound ; 65(3): 250-254, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38414135

RESUMO

The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model.


Assuntos
Cadáver , Tomografia Computadorizada por Raios X , Perfuração da Membrana Timpânica , Animais , Cães/lesões , Perfuração da Membrana Timpânica/veterinária , Perfuração da Membrana Timpânica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Estudos Prospectivos , Membrana Timpânica/diagnóstico por imagem , Membrana Timpânica/lesões , Doenças do Cão/diagnóstico por imagem , Otoscopia/veterinária , Variações Dependentes do Observador , Feminino
19.
Dis Model Mech ; 17(3)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38390727

RESUMO

The tympanic membrane (i.e. eardrum) sits at the interface between the middle and external ear. The tympanic membrane is composed of three layers: an outer ectoderm-derived layer, a middle neural crest-derived fibroblast layer with contribution from the mesoderm-derived vasculature, and an inner endoderm-derived mucosal layer. These layers form a thin sandwich that is often perforated following trauma, pressure changes or middle ear inflammation. During healing, cells need to bridge the perforation in the absence of an initial scaffold. Here, we assessed the contribution, timing and interaction of the different layers during membrane repair by using markers and reporter mice. We showed that the ectodermal layer is retracted after perforation, before proliferating away from the wound edge, with keratin 5 basal cells migrating over the hole to bridge the gap. The mesenchymal and mucosal layers then used this scaffold to complete the repair, followed by advancement of the vasculature. Finally, differentiation of the epithelium led to formation of a scab. Our results reveal the dynamics and interconnections between the embryonic germ layers during repair and highlight how defects might occur.


Assuntos
Perfuração da Membrana Timpânica , Membrana Timpânica , Camundongos , Animais , Membrana Timpânica/lesões , Epitélio , Mucosa , Diferenciação Celular
20.
Artigo em Chinês | MEDLINE | ID: mdl-38297857

RESUMO

Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.


Assuntos
Timpanoplastia , Timpanoesclerose , Humanos , Orelha Média , Ossículos da Orelha/cirurgia , Membrana Timpânica/cirurgia
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