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PubMed1992

The evaluation of ear canal, middle ear, temporal bone, and cerebellopontine angle masses in infants, children, and adolescents.

Ear canal, middle ear, temporal bone, and CPA angle masses (except for cholesteatomas) are rare in the pediatric population. The physician needs to have a high degree of suspicion for such lesions if a child presents with ear pain unrelated to infection or otorrhea that fails to improve after treatment. A precise diagnosis needs to be made in these children and also in those with hearing loss, vertigo, and facial paralysis. The most useful imaging procedures for ear, temporal bone, and CPA masses are CT and MR imaging. With a suspected vascular lesion, a definitive diagnosis usually can be made by an imaging procedure or angiography. In all cases of mass lesions, except for some aneurysms and infections, a tissue diagnosis must be secured.

Adolescent↗
PubMed1986

Preoperative swabs for the treatment of draining ears after middle ear surgery.

The value of a preoperative swab for the treatment of postoperative infection after middle ear surgery was investigated. In a selected group of 80 patients with postoperative infection a preoperative swab was available, and the variability was analysed for each species. The well-known pathogens Pseudomonas aeruginosa, Staphylococcus aureus, Proteus and Escherichia coli showed good correlation between pre- and postoperative swabs. In contrast to this all other species found in preoperative swabs were of little value postoperatively. This observation is important for the treatment of infection after middle ear surgery, and should be considered if prophylactic antibiotics are planned.

Bacteria↗
PubMed1995

Middle ear gas composition and middle ear aeration.

Partial pressures of the gases in the middle ears of 14 guinea pigs were measured continuously on-line with a specially designed mass spectrometer. The average values were carbon dioxide 67.55 mm Hg, oxygen 48.91 mm Hg, and nitrogen 596.54 mm Hg. These values confirm earlier measurements and show that the gas composition of the middle ear differs basically from that of air and resembles that of venous blood. These findings are indicative of bilateral diffusion between the middle ear cavity and the blood. We propose that under physiologic as well as under pathologic (ie, atelectatic) conditions, the gas content of the middle ear is also controlled by diffusion. This mechanism fits well with the fluctuating character of atelectatic ears. Thus, a negative middle ear pressure could be secondary to excessive loss of gases through increased and excessive diffusion, although additional mechanisms are probably also involved. A likely contributing factor is poor pneumatization of the mastoid, with consequent absence of a physiologic pressure regulation mechanism by its pneumatic system.

Animals↗
PubMed2000

Long-term middle-ear effects of middle-ear/eustachian tube packing after translabyrinthine surgery.

The purpose of this study was to evaluate the long-term effect on middle ear and eustachian tube function following the packing of the middle-ear space to prevent cerebrospinal fluid rhinorrhoea at the termination of translabyrinthine vestibular schwannoma removal. This was an observational study of a sample of 14 patients examined between two and five years post-operatively. Photo-otoscopy and tympanometry were performed bilaterally to evaluate appearance and function. All operated middle ears were air-containing although eight out of 14 showed scarring as evidence of operative intervention. There were no drum retractions. Ten out of 14 middle-ear compliance peaks were lower in the operated ear with four flat traces. Two out of 14 were the same and two out of 14 showed high compliance. The middle-ear pressure was always within the normal range when determinable. This technique appears to have no detrimental effects on the middle ear and does not permanently obliterate the eustachian tube. The reduced compliance in the majority of cases is probably a result of scarring and fibrosis. When drum hypermobility is seen this is accounted for by incus removal.

Acoustic Impedance Tests↗
PubMed1982

Spontaneous improvement in ears with middle ear disease.

The 'healthy-baby-clinics' in Göteborg, as in all Sweden, test all 4-year-olds with pure tone screening (failure criterion greater than 20 dB). Those who fail are referred to an oto-audiological health center. In an effort to prevent over-referrals of false positives as well as under-referrals of false negatives all referred children in this study have been tested with pure tone audiometry supplemented by tympanometry. At the oto-audiological health center a test program including 3 tests with intervals of 6 weeks was initiated. Failure criteria were middle ear pressure less than - 150 mm H2O and hearing loss (HL) in the frequency range 0.125-8 kHz greater than 20 dB. In Göteborg (430,000 inhabitants) 5928 4-year-olds were tested at the 'healthy-baby-clinics' during 1980. Of these 498 (8.4%) failed in pure tone screening, 248 of which are included in the present study. At the first check in our test program, which was performed 3-8 weeks after referral, only 45% of the children were abnormal. Of these 60% normalized during the test program. Thus of the ears referred following the pure tone screening at the 'healthy-baby-clinics' only 18% remained after 15-20 weeks for referral to an ENT-doctor.

Acoustic Impedance Tests↗
PubMed1998

Microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media.

OBJECTIVE: To compare microbial flora and antimicrobial susceptibility patterns of isolated pathogens from the horizontal ear canal and middle ear in dogs with otitis media. DESIGN: Prospective study. ANIMALS: 23 dogs with chronic bilateral otitis externa. PROCEDURES: Swab specimens of the horizontal ear canal and middle ear were obtained for cytologic analysis, bacterial culture, and antimicrobial susceptibility testing. Integrity of the tympanic membrane was observed. If the tympanic membrane was intact, myringotomy was performed to collect specimens. RESULTS: Otitis media was diagnosed in 38 of 46 (82.6%) ears evaluated. The tympanic membrane was intact in 71.1% of the ears with otitis media. The 3 most common organisms isolated from the horizontal ear canal and middle ear were Staphylococcus intermedius, yeast, and Pseudomonas spp. A difference in total isolates or susceptibility patterns between the horizontal ear canal and middle ear was found in 34 (89.5%) ears. Compared with results of bacterial culture, cytologic examination of swab specimens was not as effective for detection of rods and cocci from the middle ear. CLINICAL IMPLICATIONS: In dogs with chronic otitis externa, otitis media often exists even when there is an intact tympanic membrane. In our study, the same isolates were rarely found in the horizontal ear canal and middle ear. Therefore, to choose appropriate antimicrobial agents, in addition to cytologic examination, bacterial culture and susceptibility testing of swab specimens from the horizontal ear canal and middle ear should be performed.

Animals↗
PubMed2006

[Multi-channel cochlear implantation in patients with congenital inner ear malformation accompanied middle ear malformation].

OBJECTIVE: To report the multi-channel cochlear implantation in three patients with congenital inner ear malformation accompanied middle ear malformation, including CI surgery and postoperative outcomes of hearing and speech recovery. METHOD: Multi-channel cochlear implantation surgeries have been performed in three cases with congenital inner ear malformation accompanied middle ear malformation in our hospital from May 1995 to May 2002. The transmastoid approach was performed to the cases with congenital inner ear malformation accompanied middle ear malformation. The postoperative sound field hearing tests were taken to the cases three months after the cochlear implantation. RESULT: Multi-channel cochlear implantation was successfully performed in three cases with congenital inner ear malformation accompanied middle ear malformation. The 27, 28, 32 electrodes were inserted respectively in three cases. The intraoperative "Ozze" occurred in three patients. No severe intraoperative and postoperative complications occurred in three cases. All postoperative hearing thresholds were at 35-40 dBHL. CONCLUSION Multi-channel cochlear implantation could be performed in the cases with congenital inner ear malformation accompanied middle ear malformation through the transmastoid approach. The postoperative outcomes were satisfied.

Child↗
PubMed1999

Relationship between severity of middle ear mucosal lesion and middle ear pneumatic space volume in patients with otitis media with effusion.

If we assume that the state of suppression of pneumatic cells is the result of suppression of pneumatic cell growth by inflammatory stimulation in the middle ear pneumatic space, it is possible to improve the state of suppression by performing sufficient treatment during the growth period of the pneumatic cells. We indwelt a tympanic membrane ventilation tube (hereinafter referred to as tube) for treatment of otitis media with effusion (OME) in child patients aged 3-13 years and investigated the following points: i) relationship between the severity of inflammation of the lamina propria of middle ear mucosal specimens (hereinafter referred to as lamina propria) collected at the time of tube indwelling and the degree of growth of the pneumatic space; and ii) changes in the pneumatic space associated with treatment by tube indwelling, which was studied by comparing the above-described mucosal severity with the pneumatic space area of 2 years after tube indwelling, and with increase in the pneumatic space volume measured periodically after tube indwelling. The results indicated that mastoid cell growth suppression is higher in patients with a higher degree of inflammatory changes in the lamina propria. In association with treatment by tube indwelling, effusion accumulated in the pneumatic space and mucosal swelling disappeared early after the treatment, or 2 months of tube indwelling. After that, in patients with severe mucosal lesion, a long time, 1.5-2 years, was found to be required for repneumatization accompanying regrowth of the temporal bone. We confirmed that the severity of inflammation of the lamina propria is deeply involved in the growth and repneumatization of the pneumatic cells.

Adolescent↗
PubMed1998

[Expressions of fibronectin and laminin in the middle ear mucosa with experimental middle ear effusions: immunohistochemical study].

OBJECTIVE: To understand the role of two components of extracellular matrix: fibronectin (FN) and laminin (LN) in the proliferated mucosa of otitis media with effusions. METHODS: A model of otitis media with effusions was established by coagulating the orifices of the eustachian tube under an endoscope in 30 guinea pigs. The expressions of FN and LN in the proliferated mucosa from these ears were detected using Streptavidin peroxidase (SP) method. RESULTS: In 60 ears with the orifices of the eustachinan tube coagulated, 28 ears showed otitis media with effusions. The increased expressions of FN on the fibroblasts and LN on the basement membranes and neovasculations were noted in the ears with otitis media with effusions. CONCLUSION: FN and LN may involve in the proliferated response of middle ear mucosa with otitis media with effusions. It may play a certain role in the occurrence of middle ear mucosa proliferations and adhesions.

Animals↗
PubMedDate not supplied

Long-term observation of ears with reduced middle ear pressure.

335 ears from 210 childred in which tympanometry initially indicated middle ear pressure less than or equal to -100 mm H2O or a flat tympanogram have been reinvestigated 3 years later. When the inital investigation was performed all children were 7 years old. The present study reveals that 25% of these ears still have middle ear pressure less than or equal to -100 mm H2O and 16% middle ear pressure less than or equal to -150 mm H2O. In normal material of the same age group 9% have middle ear pressure less than or equal to -100 mm H2O and 4% middle ear pressure less than or equal to -150 mm H2O. The study also reveals effusion in 10% of ears with normal screening audiograms. In ears with normal screening audiograms and middle ear pressure greater than or equal to -145 mm H2O effusion was found in 5% and in ears with abnormal screening audiograms and middle ear pressure less than or equal to -150 mm H2O effusion was found in 81%. As tympanometric criterion for otologist referral, middle ear pressure less than or equal to -150 mm H2O or a flat tympanogram is suggested. The inclusion of tympanometry in routine screening for middle ear pathology in children is recommended.

Acoustic Impedance Tests↗
PubMed1997

Effect of middle ear pressure change on middle ear mechanics.

The effect of graded variations in middle ear pressure on ossicular vibration was measured in 15 normal human temporal bone specimens. The displacement amplitude of the umbo and stapes head was measured at 16 frequencies between 0.2 kHz and 3.5 kHz at a constant sound pressure of 134 dB SPL at the tympanic membrane (TM) using a non-contacting video measuring system. Both negative and positive pressures decreased umbo and stapes vibration at low frequencies and slightly increased the vibration at higher frequencies. The effects were greater for negative pressure than for positive pressure. The change in stapes vibration was less than that of the umbo at low frequencies, but increased at higher frequencies. In some temporal bones, a small positive pressure produced improvement in stapes vibration at all frequencies. These effects were thought to be primarily due to an increased stiffness of the TM and a damping of ossicular vibration, due to stretching of the ossicular suspensory ligaments and the annular ligament of the footplate.

Aged↗
PubMed1998

The comparative anatomy of the pig middle ear cavity: a model for middle ear inflammation in the human?

This study was undertaken to develop a functional model of otitis media with effusion (OME) in the pig (Sus scrofa), with the purpose of investigating the origin of lymphocytes populating the middle ear during the course of an inflammatory process. The relevance of the model to the human condition of OME is to a large extent dependent on the anatomical and physiological similarities between the middle ear cavity and the pharyngeal lymphoid tissue of the pig and man. Anatomical specimens were collected from 7 young Large White pigs to determine the gross anatomy of the middle ear cavity and the histological characteristics of the middle ear mucosa. It was found that the anatomy of the 3 parts of the middle ear cavity in man and in the pig is broadly similar, although some minor differences were observed. The porcine eustachian tube was seen to be cartilaginous throughout its length in contrast to the part osseous, part cartilaginous structure found in man; the porcine ossicles were slightly different in shape to those of man and the air cell system was situated inferior to the tympanic cavity in the pig as opposed to posteriorly in man. This paper describes the structure and morphology of the pig middle ear cavity and compares and contrasts it with that of man. The minor differences observed are of anatomical importance but do not diminish the usefulness of the pig middle ear cleft as a potential model for human middle ear disorders.

Animals↗
PubMed2004

Application of modified transmastoid approach methods to congenital atresia of the external ear canal with middle ear infection.

OBJECTIVE: To present our surgical technique for congenital atresia of the external ear canal with middle ear infection. METHODS: A modified transmastoid approach to congenital atresia of the external ear canal with middle ear infection was applied. Our method is to visualize the landmarks of the mastoid cavity such as the antrum, sinodural angle and digastric ridge by the canal-open method to avoid facial nerve injury and then prepare a relatively large external ear canal with reconstruction of the posterior wall of the external ear canal. RESULTS AND CONCLUSION: This method is suitable not only for treating congenital atresia of the external ear canal with middle ear infection, but also for avoiding facial nerve injury and postoperative complications such as re-stenosis of the new ear canal and postoperative middle ear infection.

Adult↗
PubMed1999

Standardized measurements of the sound transmission of middle ear implants using a mechanical middle ear model.

Several ways to evaluate the sound transmission properties of middle ear implants are now established. Besides computer-based simulations using acoustic and electrical analog circuits or finite element analysis, measurements can be performed with temporal bone preparations. Experiments with these preparations consider various anatomical properties, but a large number of parameters influence the outcome of measurements. To facilitate standardized measurements, a mechanical middle ear model was developed that allows comparison of the transfer function of middle ear implants on defined conditions. The model approximates the impedances of the tympanic membrane and inner ear with the aid of thin, flexible membranes. The implants are fit between the membranes, and displacement at an artificial stapes foot-plate is measured with an optical probe. Fundamental influences on the sound transmission properties of nine different middle ear implants (total ossicular replacement prostheses) were examined. Although the material and shape were different, some of the prostheses revealed very similar transfer functions. The mass of the implant showed the largest influence on sound conduction. With a higher mass, the frequency area above approximately 1 kHz was found to be significantly deteriorated. The lightest implant used was 4 mg and showed the best overall results. These findings show that middle ear prostheses should be as light as possible for optimum high-frequency transmission.

Acoustics↗