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At least 73 records · Page 4Linked to original sources
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↗
PubMed2005

Comparison of real-ear to coupler difference values in the right and left ear of adults using three earmold configurations.

OBJECTIVE: The purpose of the study was to compare real-ear to coupler difference (RECD) values in the right and left ear of adults using three earmold configurations. DESIGN: The RECD was obtained from both ears of 18 normal hearing adults by subtracting the HA2 2-cc coupler response from the real-ear response using an ER-3A insert earphone and a swept pure tone on the Audioscan RM500 probe-tube microphone system. The measurements were made with a personal earmold, foam eartip, and oto-admittance tip. RESULTS: The mean difference between the right and left RECD was close to 0 dB for all earmold configurations and was not statistically significant on a repeated-measures analysis of variance (p > 0.05). In 90% of participants, the difference between ears was generally less than 3 dB at 0.5 to 4 kHz. CONCLUSIONS: Cooperative participants with non-occluding wax and normal middle ear function (on tympanometry) show small differences in RECD between the right and left ear, irrespective of the earmold configuration. The study has yet to be extended to the clinical setting where subject cooperation and earmold fit may differ from the present study. In the meantime, the findings from the present study indicate that where an RECD can be obtained from only one ear of a participant, it is probably best to use this to derive real-ear SPL of both ears instead of relying on average age appropriate corrections.

Adult↗
PubMedDate not supplied

Clearance of middle ear effusions and middle ear pressures.

Twenty-six children presenting bilateral secretory otitis media (SOM) had ventilating tubes inserted into both middle ears. Mucus was, however, aspirated only from one ear, the right side. The vast majority of ears right and left were seen to have cleared their effusion equally well regardless of whether they were aspirated on not. This experiment points toward the essential intactness of the mucociliary system and the patency of the lumen of the Eustachian tube in SOM. Promotion of middle ear clearance through ventilation, which reminds one of the second opening in a beer can, does obviously suggest the relief of some negative pressure. Direct manometric measurements of SOM middle pressure were performed in 41 ears showing negative pressure averaging --1.7 mm H2O, this range being two orders of magnitude less than tympanometric measurements. Normal ears did not have even such a small negative pressure. The validity of these direct manometric measurements was checked against a model of the middle ear. Tympanometry, which is a valid diagnostic tool, does indicate in all probability the presence of middle ear effusion due to its rheologic effects on the drum and ossicles rather than the measure of actual middle ear pressures. This is determined by the fact that direct needling of the middle ear, or even the insertion of a ventilating tube, did not change tympanometric values but aspiration of part of the effusion did: indeed the latter tended to bring manometry to normal values.

Child, Preschool↗
PubMed1993

Middle ear air injection after chronic ear surgery.

In the early period after chronic ear surgery, the reasons for conductive hearing loss may be difficult to determine. Patients who cannot autoinflate the middle ear after 3 weeks, or who have a negative Rinne test result with the 512 Hz tuning fork, are treated with a transtympanic injection of 0.5 cc of air with a 27-gauge needle and tuberculin syringe. This represents 20% of patients who had chronic ear surgery. Results show that hearing may be immediately improved, the sensation of pressure in the ear may be reduced, and fluid may be cleared from the middle ear. Other benefits may include the release of adhesions. The surgeon is better able to assess the thickness of the graft, and the status of the ossicular chain reconstruction can be determined. There have been no complications of middle ear infection or failure of the micropuncture site to heal. In our practice, middle ear air injection is a routine procedure in patients with inadequate eustachian tube function after chronic ear surgery. This report describes the results of 100 patients over 14 years who received middle ear air injections after chronic ear surgery compared with a control group of 100 patients who did not meet the criteria for requiring air injection. Hearing was immediately improved in 74% of patients as determined by Rinne testing. Audiograms were performed in 25 of these patients, documenting a mean improvement in pure-tone average of 16 dB. The long-term hearing results in patients undergoing air injection, who by definition had evidence of poor eustachian tube function, are similar to the results in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed2000

[An observation on long-term influence of middle ear bacterial infection on inner ear function and systemic immune reaction].

OBJECTIVE: To understand whether long-term inner ear heat shock response related to heat shock protein(HSP70) caused by middle ear bacterial infection and the potential influence on inner ear function. METHODS: Sixty BALB/c mice were randomly classified into 6 groups including Klebsiella pneumoniae (KP), Staphylococcus aureus, Bacillus pyocyaneus, Bacillus coli, Bacillus proteus and physiological saline control groups. On 135 days after injection, distortion product otoacoustic emissions(DPOAE) was tested and all the samples were collected, which were examined with light and electronic microscopes. HSP70 related molecule expression in inner ear, nuclear factor (NF) kappa Bp65 characterization in mononuclear cell, anti-KP antibody and anti-membranous labyrinth proteins (MLP) were examined. RESULTS: No nuclear transfer of NF kappa Bp65 was observed in any animal. Anti-KP antibody was detected in 30% (3/10) of Staphylococcus aureus group, 29% (2/7) of KP group, 33% (3/9) of Bacillus pyocyaneus group and 10% (1/10) of control group. Anti-MLP antibody was created in 20% (2/10) of Staphylococcus aureus group, 20% (2/10) of KP group, one each in Bacillus pyocyaneus group and control group respectively. Double positive antibody against KP and MLP were found in Staphylococcus aureus group and KP group. When analyzed with Western blot, all the positive bands were small molecules including strongest 26,000-30,000, medium degree 38,000-41,000 and weak 46,000-50,000 except for 68,000 in one case. There was only one significant DPOAE amplification decrease at 1,625 Hz (2f1-f2) in left ear of Bacillus pyocyaneus group and right ear of Bacillus proteus group. No abnormal phenomenon was found in inner ear both under light microscope and electronic microscope. No significant expression of HSP70 was observed in inner ears. CONCLUSION: No long-term heat shock response related to HSP70 existed in the inner ear and the immune inner ear damage may be caused by multiplefactors.

Animals↗
PubMedDate not supplied

External and middle ear trauma resulting from ear impressions.

When taking an impression of the external ear canal and ear, the audiologist is engaged in an invasive procedure whereby a foreign body is first placed into the ear canal and then removed. There is always an element of risk for significant medical problems when a clinician is performing an invasive procedure. Although some minor patient discomfort and, at times, some slight trauma to the ear canal occur when taking ear impressions, the incidence of significant trauma to the external or middle ear appears to be low. The purpose of this report is to provide some illustrative cases of significant external and middle ear trauma as a result of taking impressions of the external ear. Audiologists are advised to develop and implement an appropriate risk management program for taking ear impressions to reduce the potential risks associated with this procedure to their patients and to their practices.

Aged↗
PubMed2005

Accuracy of tympanometric middle ear pressure determination in secretory otitis media: dose-dependent overestimation related to the viscosity and amount of middle ear fluid.

HYPOTHESIS: Tympanometric measurements of middle ear pressure in children with secretory otitis media are overestimated in a dose-response manner because of increased hysteresis explained by the viscosity and amount of middle ear fluid. BACKGROUND: Tympanometric middle ear pressure is important in evaluating children with secretory otitis media. These measurements are influenced by hysteresis appearing as a peak pressure difference in bidirectional tympanometry. This represents an inaccuracy of 0.5 x peak pressure difference, which is only 5 to 25 daPa in normal ears. However, previous experiments found increased hysteresis, suggesting an inaccuracy of 225 daPa in secretory otitis media ears. MATERIALS AND METHODS: In 56 patients with secretory otitis media, bidirectional tympanometry was performed; Type B curves were excluded. The middle ear fluid was semiquantified subsequently at surgery according to viscosity (serous, seromucoid, or mucoid) and amount (small, medium, or large). A control group included 28 normal children. Peak pressure difference was calculated by the difference between middle ear pressure determined by a positive and negative pressure sweep. RESULTS: Mean peak pressure difference was 10 and 69 daPa in the normal and secretory otitis media groups, respectively (p <0.001). However, peak pressure difference ranged to 205 daPa in the secretory otitis media group and showed a significant positive correlation to viscosity and amount of the fluid (both p <0.0001). CONCLUSION: Peak pressure difference is significantly increased in secretory otitis media because of additional damping explained by the viscosity and amount of the fluid. The mean error was 5 daPa in normal ears and 35 daPa in secretory otitis media ears, but ranged to greater than 100 daPa. These results were only a low estimate of the inaccuracy, because patients with Type B tympanograms could not be included, and errors of more than 100 daPa can be anticipated.

Acoustic Impedance Tests↗
PubMed1987

An ultrastructural and functional study of the inner ear after administration of hyaluronan into the middle ear of the guinea pig.

A single dose of hyaluronan, 19 mg/ml was administered into the right middle ear cavity of guinea pigs. The auditory function of the right ear was tested by recording the gross neural action potential (N1) before, directly after, and 28 days after the administration of hyaluronan. In a control group the right ear was sham-operated and the gross neural action potential (N1) was recorded twice; on the day of the sham operation and 28 days later. All animals were killed 28 days after the operation. All treated as well as sham-operated ears and every second intact ear were studied by scanning electron microscopy (SEM.) No ear had signs of hearing deterioration. Macroscopically, most of the hyaluronan was eliminated from the middle ear after 28 days. In the histological examination, pathological stereocilia were found in the apical turn of the cochlea in the ears to which hyaluronan was administered, the sham operated and the intact ears.

Animals↗
PubMed2001

[Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma].

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.

Adolescent↗
PubMed1999

[Analysis of surgical reconstructions of canal and middle ear via "direct entrance" approach in 53 ears with congenital aural atresia].

OBJECTIVE: To recognize the indication of surgical reconstruction via the "direct entrance" surgical approach (superoanterior surgical approach) for congenital atresia of the external acoustic canal and malformations of the middle ear. METHODS: A series of 53 ears operated on via the superoanterior surgical approach during 10 years from January 1988 to December 1997 was analyzed. RESULTS: The tympanic cavity was encountered without difficulty in 52 ears. Facial paralysis occurred postoperatively in one ear, which recovered after two months. The hearing improvement was observed in 45 ears (84.9%), of which 24 ears had hearing improvement greater than 30 dB and the air-bone conduction gap was within 15 dB (45.3%). A long-term (1-9 years) follow-up of 25 ears demonstrated that the hearing levels in 18 ears were kept unchanged. Postoperative stenosis of the canal occurred in one ear of a 2 years-old child. CONCLUSION: Based on the scanning images of the temporal bone by high-resolution computed tomography before the operation, the authors classified the bony structures of the paths of external acoustic canals into four types. Our results indicated that the selerotic and the diploetic paths of external acoustic cmeati could be indications for the "direct entrance" surgical approach, whereas the mixed type, either containing a little small cells or diploetic bone in sclerotic bone, might be suitable for this surgical approach also.

Adolescent↗
PubMedDate not supplied

Distribution of HRP in the inner ear after injection into the middle ear cavity.

The distribution patterns of horseradish peroxidase (HRP) reaction products in the inner ears of guinea pigs were studied after injections into the middle ear cavities and perilymphatic and subarachnoid spaces. The normal round window membrane resisted HRP penetration from the middle ear side, but when it became pathological after repeated applications, its permeability increased. HRP deposits were found in the cochlear and vestibular sensory cells and in the lumen of the endolymphatic sac. HRP reaction products were minimal at the cochlear apex even after long survival times, suggesting that perilymph flow, if it exists, is rather weak toward this direction. Whereas the stria vascularis is impermeable to HRP, the vestibular dark cells were accessible; thus, the metabolic activity of the dark cells can be more readily controlled by drug applications through the middle ear cavity. The finding of HRP deposits on the scala vestibuli surface of Reissner's membrane and the absence of HRP in the upper portion of the spiral ligament at the basal turn suggests that the oval window is a secondary route of passage for these particles from the middle ear cavity to the inner ear. In order to determine the route of HRP into the endolymphatic sac from the middle ear cavity or scala tympani, the cochlear and/or vestibular aqueducts were obliterated singly or together. The route of HRP was determined to be the vestibular aqueduct. HRP is believed to enter the sac lumen through Reissner's and saccular membranes and the sac epithelium. Drugs and other large molecular substances instilled in or gaining access to the middle ear cavity may reach the endolymphatic sac causing its functional alteration.

Animals↗
PubMedDate not supplied

Subtotal ear reconstruction for correction of type 3 constricted ears.

Constricted ears are characterized by four features: (a) lop deformity, (b) protrusion, (c) low ear position, and (d) decreased ear size. These deformities, resulting from inadequate length of the helix, have been described by Tanzer (1975) as a purse-string closure of the ear. Constricted ears are classified into types 1, 2, and 3 according to the severity of the deformity. Type 3 constricted ear, the most severe, with decreased size and loss of the upper half of the normal ear contour, is classified currently as a mild form of microtia. Therefore, autogenous rib cartilage was used to reconstruct the affected ear much as in correction of microtia. The expanded skin flap in the mastoid area was used to reconstruct auricles for 14 patients with type 3 constricted ear in the authors' center from 2001 to 2004. All the patients were satisfied with the final results. Therefore, the authors conclude that their operative technique is practical and reliable.

Adolescent↗
PubMed2002

Fgf8 and Fgf3 are required for zebrafish ear placode induction, maintenance and inner ear patterning.

The vertebrate inner ear develops from initially 'simple' ectodermal placode and vesicle stages into the complex three-dimensional structure which is necessary for the senses of hearing and equilibrium. Although the main morphological events in vertebrate inner ear development are known, the genetic mechanisms controlling them are scarcely understood. Previous studies have suggested that the otic placode is induced by signals from the chordamesoderm and the hindbrain, notably by fibroblast growth factors (Fgfs) and Wnt proteins. Here we study the role of Fgf8 as a bona-fide hindbrain-derived signal that acts in conjunction with Fgf3 during placode induction, maintenance and otic vesicle patterning. Acerebellar (ace) is a mutant in the fgf8 gene that results in a non-functional Fgf8 product. Homozygous mutants for acerebellar (ace) have smaller ears that typically have only one otolith, abnormal semi-circular canals, and behavioral defects. Using gene expression markers for the otic placode, we find that ace/fgf8 and Fgf-signaling are required for normal otic placode formation and maintenance. Conversely, misexpression of fgf8 or Fgf8-coated beads implanted into the vicinity of the otic placode can increase ear size and marker gene expression, although competence to respond to the induction appears restricted. Cell transplantation experiments and expression analysis suggest that Fgf8 is required in the hindbrain in the rhombomere 4-6 area to restore normal placode development in ace mutants, in close neighbourhood to the forming placode, but not in mesodermal tissues. Fgf3 and Fgf8 are expressed in hindbrain rhombomere 4 during the stages that are critical for placode induction. Joint inactivation of Fgf3 and Fgf8 by mutation or antisense-morpholino injection causes failure of placode formation and results in ear-less embryos, mimicking the phenotype we observe after pharmacological inhibition of Fgf-signaling. Fgf8 and Fgf3 together therefore act during induction and differentiation of the ear placode. In addition to the early requirement for Fgf signaling, the abnormal differentiation of inner ear structures and mechanosensory hair cells in ace mutants, pharmacological inhibition of Fgf signaling, and the expression of fgf8 and fgf3 in the otic vesicle demonstrate independent Fgf function(s) during later development of the otic vesicle and lateral line organ. We furthermore addressed a potential role of endomesomerm by studying mzoep mutant embryos that are depleted of head endomesodermal tissue, including chordamesoderm, due to a lack of Nodal-pathway signaling. In these embryos, early placode induction proceeds largely normally, but the ear placode extends abnormally to midline levels at later stages, suggesting a role for the midline in restricting placode development to dorsolateral levels. We suggest a model of zebrafish inner ear development with several discrete steps that utilize sequential Fgf signals during otic placode induction and vesicle patterning.

Acridine Orange↗
PubMed2003

Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up.

OBJECTIVES/HYPOTHESIS: The objectives were to report the authors' experience with the long-term follow-up of patients with diving-related inner ear decompression sickness and inner ear barotrauma and to discuss residual cochlear and vestibular damage in relation to the question of fitness to dive. STUDY DESIGN: Retrospective consecutive case series. METHODS: Eleven recreational divers with inner ear decompression sickness and nine with inner ear barotrauma (IEB) were followed. A complete otoneurological physical examination and laboratory evaluation were carried out. The latter included audiometry, electronystagmography, a rotatory chair test using the sinusoidal harmonic acceleration protocol, and computerized dynamic posturography. RESULTS: Residual cochleovestibular deficits were found in 10 (91%) of the patients with inner ear decompression sickness and 3 (33%) of those with IEB (P <.02, Fisher's Exact test; odds ratio, 20). A significantly shorter follow-up period was required for the inner ear barotrauma group (P <.05, simple t test) because three patients (33%) recovered completely within 1 month of the diving accident. Eight patients had residual vestibular deficits on follow-up, but only one (12.5%) was symptomatic. However, five (56%) of the nine patients who had a cochlear insult, as documented by follow-up audiometry, complained of significant hearing loss and tinnitus. CONCLUSION: Inner ear decompression sickness carries a high risk for residual inner ear damage despite hyperbaric oxygen recompression therapy. A favorable prognosis might be anticipated for inner ear barotrauma. The finding that most patients with residual vestibular deficits were asymptomatic at the time of follow-up emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before a return to diving activity may be considered.

Adult↗
PubMedDate not supplied

Antibodies against inner-ear proteins in the sera of patients with inner-ear diseases.

Sera from patients with various inner-ear diseases, especially Ménière's disease, were investigated by Western blot against guinea pig inner-ear proteins. Of 45 patients, 24 (53%) with various inner-ear diseases had antibodies against inner-ear proteins, compared with 0 of 10 (0%) in control subjects without inner-ear diseases. Of the 10 proteins that showed a positive reaction with patient sera, the 28-kD band was unique in that it appeared only in the membranous fraction of the inner ear and was highly positive (28%) in reaction with Ménière's disease patient sera. The results in the present study with proteins extracted from guinea pig inner ear were consistent with our previous study using proteins from human inner ear, suggesting that the 28-kD protein may be a candidate for detecting autoimmune inner-ear disease.

Animals↗
PubMed2001

[Relationship between three inner ear antigens and autoimmune inner ear disease].

OBJECTIVE: To investigate the relationship between three purified inner ear antigens and autoimmune inner ear disease (AIED), and to determine their expressions in normal guinea pig cochleas. METHODS: Guinea pigs were divided into group B, group C and group D and immunized respectively with three subcomponents of crude inner ear antigens (31,000, 42,000-45,000 and 60,000 proteins). Hearing thresholds, serum IgG levels and morphological changes of inner ear were observed. The protein expressions of these antigens were examined by immunohistochemistry. In the control group, antigens were replaced by gel homogenate of polyacrylamide. RESULTS: There were no significant differences of hearing threshold among groups before immunization with inner ear antigens (F = 0.07, P > 0.05). There were no significant changes of hearing thresholds and inner ear morphology in group C and control group. Hearing thresholds dropped in part of animals immunized with 31,000 or 60,000 protein. Hearing threshold of group B and D changed significantly after immunization, as compared with the control group(F = 9.12, P < 0.01). Serum IgG levels increased significantly in all experimental groups compared with the control group(F = 7.46, P < 0.01). The 31,000 protein distributed strictly in cochlear nerve, and 42,000-45,000 or 60,000 protein distributed widely, including the spiral ganglion, Corti's organ, stria vascularis and spiral ligament. CONCLUSIONS: Two subcomponents of 31,000 and 60,000 in crude inner ear antigen could induce autoimmune inner ear disease. The distribution of 31,000 protein was more tissue specific and might be used as a marker protein for clinical diagnosis of autoimmune inner ear disease.

Animals↗
PubMed1991

[Experimental middle ear cholesteatoma originated from free skin graft of the external ear].

The pathogenesis of middle ear cholesteatoma has been thought to be invasion of squamous epithelium originated from the external ear skin including the tympanic membrane. There is no evidence, however, that the external ear skin has more potential to form cholesteatoma than that of other sites. In this report experimental middle ear cholesteatoma of guinea pigs originated from the external ear skin was histologically compared with that originated from the auricular skin. Cholesteatoma as dermal cyst was seen in the middle ear of almost all animals (25/28 = 89.3%), using a free skin graft (3 x 3 mm), regardless of the skin taken from superior (group A) or inferior (group B) part of the external ear, or the auricle (group C) eight weeks after skin implantation. The activity of epithelium such as keratinization was evident in group C. There is, however, no obvious difference in surrounding granulation tissues among group A, B, and C. In a half of this series, cyst wall was broken and its contents (debris) mainly consisted of keratin were put on surrounding granulation tissues three weeks after skin implantation. Striking keratinized epithelium and subepithelial inflammations in relation to the amount of debris were observed at the eighth week. These findings suggest that the external ear skin does not have specific potential to form cholesteatoma and keratin plays some roles in growth of cholesteatoma.

Animals↗