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Navigation-assisted construction of an external ear canal using an autogenous foreskin graft.

Classic microtia is combined with external ear canal atresia and middle ear malformation. In order to evaluate whether an operation to improve hearing ability and the use of computer-assisted surgery are indicated, preoperative high-resolution navigation CT is mandatory. We combined atresia surgery and tympanoplasty with auricular reconstruction in the case of an 8-year-old boy with bilateral microtia, aural atresia and malformation of the middle ear. After creating an auricle framework with rib cartilage and transplanting it under the skin of the mastoid plane, we shifted it forward in the second step, and the new auditory canal was drilled under computer-assisted navigation and facial nerve monitoring. In the same operation, tympanoplasty was accomplished, and a silastic cylinder, wrapped into pieces of rib cartilage, was inserted into the constructed canal and removed 2 months later. For lining the new auditory canal, we used the patient's prepuce, harvested by elective circumcision.

Child↗

[Histologic scoring system for various cancers of the external ear].

A histological scoring system was created to determine the aggressiveness of basal cell carcinomas of the head and neck and to determine which squamous cell carcinomas of the external ear will develop metastases. Basal cell carcinomas of the external ear were the most aggressive. The parameters depth of growth and mode of invasion were the most valuable in predicting metastases.

Basal Cell Carcinoma↗

[The significance of the external ear for spatial hearing in man from the point of view of the engineer-scientist].

In this paper the function of the external ear is investigated from the point of view of an acoustic engineer. After some basic considerations the "external ear transfer functions" which determine the spatial hearing are discussed. These functions may be split into two parts, one depending on the direction of sound, the other independent of it. A physical interpretation is possible. Finally the two most important applications are represented: the head-related stereophony ("dummy head") and the "binaural mixing console".

Acoustics↗

[Trans-external ear canal blow oxygen method].

OBJECTIVE: To study a new method for the treatment of the glue ear and the other out and middle ear diseases. METHOD: 28 ears of the glue ear were treatment with blow oxygen method trans-external ear canal after myringotomy with grommet insertion. The results were compared with that of only tube insertion group of 20 ears in same period. This method were also used to treatment the patients with otitis media after mastoidectomy to compared the effect on dry ear time. RESULT: The therapy time of the blow oxygen group for glue ear were 1.20 +/- 0.42 days, and the control group were 3.50 +/- 0.87 days. The blow oxygen group need only 3.92 +/- 0.77 weeks for dry ear after mastoidectomy. And the control group need 5.82 +/- 2.03 weeks. The results are statistic significant between this two groups. CONCLUSION: The blow oxygen method is a good way for the treatment of glue ear, and can short the time for dry ear after mastoidectomy.

Adolescent↗

[Advanced squamous carcinoma of external ear canal].

Squamous carcinoma of the external ear canal (CEEC) is an uncommon neoplasm which prognostic changes following the tumour spread. Because of its location in ECC as well as the anatomical fissures between osseous and cartilaginous parties it's possible the spread to areas of surgical accessibility complicated restricting the complete tumoral removal. We report one of those cases, when first visited had already meningeal infiltration and was accordingly treated with radiotherapy. Analysis of the case and review of the literature.

Aged↗

Stenosis of the external ear canal: prevention using hydroxylated polyvinyl acetal wicks.

Hydroxylated polyvinyl acetal wicks may be very helpful in preventing postsurgical stenosis of the external ear canal. The wick is inserted into the canal, wetted with Polysporin Otic, and changed periodically until scar tissue becomes stabilized. This method is simple, quick, and well tolerated by the patient. Polyvinyl wicks provide a useful adjunct in preventing stenosis of the external ear canal.

Acetals↗

Congenital ossicular anomalies without malformations of the external ear.

Eighteen ears of congenital ossicular malformation without deformities of the external ear were presented. They were classified into three groups; eight incudostapedial joint separations, three malleus and/or incus fixations, and seven stapes fixations. The surgical correction for the first group was to connect the malleus handle to the stapes using a silicon tube specially designed or a gelfoam wire in the uncustomary way. This group showed the best surgical results with 35.4 dB of the average hearing gain in speech frequencies. In the second group, removal of the fixed part of the ossicles yielded satisfactory results, but mobilization failed to improve the hearing. For the group of stapes fixation, stapedectomy and the gelfoam wire prosthesis were performed. The result was not satisfactory in some cases with the undeveloped oval window. The embryological consideration leads us to the following conjecture; the incudostapedial joint separation results from the failure in build-up of "the secondary continuity", the malleus and/or incus fixation is the result of disturbances in separation process by the undifferentiated mesenchyme, and the stapes fixation is due to maldevelopment of the stapedial lamina. This classification for the congenital ossicular malformation is practically valid as it would suggest the maldeveloped point in ossicular genesis and results of surgical correction.

Adolescent↗

Staphylococcus schleiferi subsp. coagulans subsp. nov., isolated from the external auditory meatus of dogs with external ear otitis.

A new subspecies, Staphylococcus schleiferi subsp. coagulans, was isolated from the external auditory meatus of dogs suffering from external ear otitis and is described on the basis of studies of 21 strains. Phenotypic studies showed that these strains are more closely related to Staphylococcus intermedius than to other staphylococci, but DNA hybridization studies indicated that they are closely related to Staphylococcus schleiferi N850274T. On the basis of biochemical distinctiveness (positive test tube coagulase test and different carbohydrate reactions) and the etiological importance (frequent isolation from otitis specimens from dogs) of these strains, we propose to classify them as a subspecies of S. schleiferi. The strains of this new subspecies are coagulase tube test, beta-hemolysin, and heat-stable nuclease positive but clumping factor negative. A simple scheme for the differentiation of S. schleiferi subsp. coagulans from the other coagulase-positive staphylococci is presented. The type strain is GA211 (= JCM 7470).

Animals↗

Atypical presentation of Kaposi's sarcoma in the external ear.

We presented a case of Kaposi's sarcoma that occurred in the external ear of a 36-year-old Caucasian man. He was otherwise healthy without a history of any predisposing factors. He had a nodular lesion in the left ear, of three-month duration. The lesion was excised completely. Histologic and immunohistologic findings were consistent with a diagnosis of Kaposi's sarcoma. Serologic analyses were negative for anti-HIV antibody and anti-cytomegalovirus IgM and IgG and blood count was normal. Differential count of leucocytes and immunoglobulin electrophoresis were normal. During a two-year follow-up, no recurrences, development of new lesions, or HIV seroconversion were detected. To our knowledge, this case is the first to report a solitary lesion of Kaposi's sarcoma occurring in the helix of the ear in a healthy young patient.

Adult↗

[Congenital auditory ossicle malformation without external ear abnormality].

In 29 ears of 24 patients with auditory ossicle malformation, but without external ear abnormalities, who were operated on at our clinic in the 10 years between June 1993 and June 2002, we studied the condition of ossicles, preoperative examination, surgical procedures, and postoperative hearing improvement. Our study did not include patients with cholesteatoma or those with only fixed stapes but without ossicular deformity. Samples were 12 ears of 11 men and 17 ears of 13 women. We clinically distinguished 3 major categories: (i) discontinuity between the incus and stapes with mobile stapes, (ii) congenital fixation of the stapes with ossicular deformity, and (iii) congenital fixation of the malleus and deformity of the incus with mobile stapes. We classified each category into minor abnormalities based on the condition of the long process of the incus, the superstructure of the stapes, and the stapes footplate. We conducted auditory ossicle reconstruction by mobilization of the malleus and incus in 2 ears, by type III tympanoplasty in 5 ears, by type IV tympanoplasty in 13 ears, and by stapes surgery in 8 ears. Improvement in hearing after the operation was observed in 25 of the 29 ears treated. In the classification of the auditory ossicle malformation without external ear abnormalities, we should evaluate discontinuity or fixation of the ossicles and their deformity. This requires that varied ossicular reconstruction be prepared for surgery, but the possibility of hearing improvement is high, so intensive treatment is needed in many cases of auditory ossicle malformation.

Adolescent↗

Bacterial colonization of the nose and external ear canal in newborn infants.

The bacterial flora of the nose and external ear canal of 132 newborn infants, aged 3 days and 4 to 7 days, was examined. Cultures taken from the nose showed the following pattern of bacterial colonization: normal flora (39%); potentially pathologic gram-positive microorganisms (23%); gram-negative enteric rods (16%); and sterile cultures (22%). The most frequent bacterial cultures from nostrils were Staphylococcus epidermidis (39%); Staph. aureus (11%) and Escherichia coli (8%). The cultures from the external ear canal showed normal flora (37%); potentially pathologic gram-positive microorganisms (5%); gram-negative enteric rods (24%); and sterile cultures (34%). The most frequent bacteria cultured from the ear canal were: Staph. epidermidis (37%); E. coli (8%); and Klebsiella pneumoniae (7.5%). Of several factors studied, the type of delivery, Apgar score and the duration of hospitalization were found to have a significant influence on the pattern of bacterial colonization.

Apgar Score↗

[Combined reconstruction of tympanic membrane and posterior wall of external ear canal with cartilage].

OBJECTIVE: To study the reconstruction technique of tympanic membrane and posterior wall of external ear canal with auricular cartilage at same time. METHOD: The tympanic membrane and posterior wall of external ear canal of 43 cases of chronic suppurative otitis media were reconstructed with auricular cartilage after mastoidectomy between 1995-2000. The results were compared with that of without reconstruction of the posterior wall of external canal group of 60 ears in same period. RESULT: The average follow-up period was 32 months, 3 cases were faced in all of 43 cases, the others were healed in one stage. Postoperative period to be a dry ear was significantly shorter in the reconstruction group than in the canal-wall-down and open group (t-test, t = 3.98, < 0.01). The rezidive results is statistic not significant between this two groups. The patients of both groups have had good hearing results. CONCLUSION: The auricular cartilage is a good material for the reconstruction of tympanic membrane and posterior wall of the external auditory canal. It can not only reduce the time of drying ear, improve the hearing results, but also avoid the second operation. The quality of the patients life can be improved.

Adolescent↗

A semiquantitative cytological evaluation of normal and pathological samples from the external ear canal of dogs and cats.

Numbers of desquamated epithelial cells, yeast cells and bacterial organisms were counted in samples collected from the external ear canal of 37 normal dogs and 16 normal cats, and from 24 dogs and 22 cats with otitis externa. The aims of the study were to establish quantitative reference ranges and to correlate these data with the clinical status of the dogs and cats. Numbers of yeast cells and bacterial organisms were significantly increased in dogs (P = 0.05; P = 0.0001) and cats (P = 0.0001; P = 0.0001) with otitis externa, and in most cases high counts were correlated with clinical signs. Mean Malassezia counts per high-power dry field of > or = 5 in the dog and > or = 12 in the cat were considered abnormal. Mean bacterial counts per high-power dry field of > or = 25 in the dog and > or = 15 in the cat were considered abnormal. When used to differentiate normal from inflamed external ear canals, these figures provided a low sensitivity but a specificity of > or = 95%.

Animals↗

The external ear: more attention to detail may aid syndrome diagnosis and contribute answers to embryological questions.

The human pinna has a complex shape and yet the basic components of normal structure are remarkably constant between individuals. It is precocious in its appearance during embryogenesis and it has been subject to many developmental and surgical studies, yet questions remain as to its primary embryogenesis and the causes of its malformations. Unfortunately, the vast majority of clinical reports of syndromes and of individuals with dysmorphic signs provide limited and inadequate description of the external ear. Given the intricate pattern of the pinna, and hence its potential for morphological variation, we think that more attention to the specific description of ear anomalies may lead to a better appreciation of the etiology and embryology of the malformations. Furthermore, in some cases correlation with specific syndromes may provide an aid to diagnosis. Towards those ends this paper reviews some of the controversy concerning the embryology of the pinna, and discusses a number of the better-defined anomalies of the external ear. Although it has been suggested that anomalies of the insertion and orientation of intrinsic muscles of the pinna may be responsible for variations in external ear morphology, we think it likely that in many cases the anomalous insertions may be secondary.

Ear Diseases↗

[Ear prostheses in burns of the external ear. Technical notes].

Ear reconstruction is best performed with autologous tissue. However, there are selected cases in which a prosthesis may be preferred. Some patients are unwilling to undertake multiple surgical procedures, others do not accept the chest wall scar. More importantly, in severe post burn cases, the scars in the periauricular region can truly compromise the outcome of an autologous reconstruction. In such cases, the authors perform a prosthetic reconstruction which is anchored to the cranial bone by means of osteointegrated titanium screws. The method described here has been modified compared to the original Bränemark system. A new microscrew design allows the implants to be inserted in a single surgical procedure. A magnetic anchoring system avoids cumbersome external rods, and the overall size of the masses emerging from the skin is significantly reduced. These improvements increase patient comfort and compliance.

Bioprosthesis↗

Congenital deformities of the middle and external ear.

Congenital deformities of the external and middle ears were shown by tomography in 246 patients. Surgical exploration has been undertaken at some time in many of these ears. The appearance of the tomograms and their significance were reviewed in the light of the operative findings and the authors' experience of congenital ear lesions. In nearly every case a middle ear cavity could be demonstrated although this varied from a normally aerated middle ear and mastoid in association with an isolated unilateral atresia of the external auditory meatus to a small slit-like hypotympanum in patients with craniofacial abnormalities. The ossicles were nearly always present but deformed. The typical appearances of the ossicles and the frequently aberrant pathways of the facial nerve are described.

Ear↗

Factors associated with the prevalence of Malassezia species in the external ears of cattle from the state of Minas Gerais, Brazil.

Swabs collected from the external ears of 942 cattle, including both European and zebu breeds, were used to evaluate the epidemiology of Malassezia species. High numbers of Malassezia isolates were significantly associated with maturity of the animals and with diagnosed otitis. In healthy animals, a particularly low prevalence of the genus was found in Holstein cows, especially in the summer months, a finding perhaps correlating with the open, air-exposed ears of this breed. Pendutlous-eared zebu breeds and hybrids had higher levels of colonization, although this effect was more pronounced in humid regions, and was least in the dry north and west of the state. The most common species seen was M. sympodialis, which accounted for 47.1% of isolates from healthy cattle and 39.1% from cattle with otitis. In cattle with otitis sampled in summer, we found that the relatively thermotolerant M. sympodialis made up 80.8% of isolates. By contrast, during the winter the less thermotolerant M. globosa was the most common species from otitis, making up 56% of the isolates. Humidity and temperature may be the main factors explaining the epidemiology of Malassezia diseases and colonizations in both animals and humans.

Animals↗