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PubMed1998

[Middle ear carcinoma].

Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.

Carcinoma, Squamous Cell↗
PubMed2002

Effects of age and size in the ears of gekkonomorph lizards: middle-ear sensitivity.

Previous studies of electrophysiological audiograms in gekkonomorph lizards revealed greater sensitivity in adults than in juveniles. We investigated whether this difference, as far as it is affected by the middle ear, is due to animal age or size. The velocity transfer function of the tympanic membrane (TM) was examined using laser interferometry in nine samples: adults of three large gekkonomorph species, adults of three small species (each related to one of the former), and juveniles of the large species, their sizes matching those of the small-species adults. Each transfer function exhibited an inverted 'V' or 'U' shape, with the velocity of TM motion peaking in the mid-frequency range and becoming poorer at lower and higher frequencies. Among samples, maximum TM velocity correlated with animal length, perhaps because of a damping change in the larger TM. The frequency at maximum velocity negatively correlated with measurements of TM area. Presumably, with a larger TM area, the best frequency shifted downward because of increased middle-ear mass or decreased stiffness. The bandwidth of the transfer function negatively correlated with animal length, being broader in smaller animals and sharper in larger animals. This effect can be attributed to increased mass, decreased damping, or both. Among the middle-ear morphological measurements, the one most closely correlated with body length was the length of the extracolumellar anchorage at the TM. Among the physiological variables investigated, maximum velocity was negatively correlated with the frequency at which it occurred. The dependence of these transfer function variables on animal and ear size was similar, regardless of whether the comparison was among adults of species of different sizes, or among age classes within a species, so that age differences appear to be largely the result of size differences.

Acoustic Stimulation↗
PubMed2006

Key features of the human middle ear.

The human middle ear was investigated using a generalised circuit model which can simulate the spatial vibrations of the ossicular chain. The behaviour was observed for acoustic excitation via the normal air conduction path and for mechanic excitation due to shaking the complete temporal bone. More insight into the functionality of the middle ear was obtained by also considering abnormal conditions such as stiffenings. It turned out that the mammalian middle ear is superior to a columella ear due to its particular design. The placement of comparably heavy bones (malleus head and incus body) outside the main transmission path between the manubrium and the stapes footplate in combination with a very flexible ossicular chain creates several favourable properties.

Acoustic Stimulation↗
PubMed2004

Neonatal middle ear effusion predicts chronic otitis media with effusion.

HYPOTHESIS AND AIMS: The specific aims of the research are to determine whether newborn ears with persistent middle ear effusion at age 30 to 48 hours are more likely to develop chronic otitis media with effusion over the first year of life when compared with ears without persistent middle ear effusion. The hypothesis is that neonates with middle ear effusion persisting to 30 to 48 hours are more likely to develop chronic otitis media with effusion. STUDY DESIGN: Prospective, case-control design. Loupe-magnified pneumatic otoscopy performed at the time of newborn hearing screening determined presence or absence of effusion. Infants enrolled in the study returned for outpatient examinations. SETTING: University medical center well-baby nursery and out-patient audiology clinic. SUBJECTS: From 454 neonates, 14 experimental subjects with neonatal middle ear effusions and 15 control subjects free of neonatal effusion were recruited for the study and followed-up for 1 year. INTERVENTIONS: Outpatient study tests included transient-evoked otoacoustic emissions, tympanometry, pneumatic otoscopy, and visual reinforcement audiometry (starting at age 6 months), at 3, 6, 9, and 12 months of age. Experimental (neonatal effusion) infants were followed-up starting at age 1 month. Infants found at any follow-up examination to have effusion on otoscopy were followed-up and tested 1 month later. MAIN OUTCOME MEASURES: Chronic otitis media with effusion defined as hypomobile or immobile tympanic membrane on pneumatic otoscopy in one or both ears for three consecutive monthly examinations. Hearing loss defined as greater than 25-dB hearing loss visual reinforcement audiometry thresholds. RESULTS: Eight experimental infants (58%) and three control infants (20%) developed chronic otitis media with effusion (p < 0.04). The average number of effusions was 1.27 for control and 4.14 for experimental infants (average number of effusions for each group at 3-, 6-, 9-, and 12-month visits). Warbled tone and speech visual reinforcement audiometry thresholds averaged 3 dB worse in the experimental group, but these differences were not statistically significant. For the control group, mean visual reinforcement audiometry thresholds never exceeded 25 dB hearing loss. For the experimental group, mean visual reinforcement audiometry thresholds exceeded 25 dB hearing loss at 1,000, 2,000, and 4,000 Hz at 9 months. CONCLUSIONS: A majority of infants with persistent neonatal middle ear effusion found by pneumatic otoscopy at 30 to 48 hours will develop chronic otitis media with effusion during the first year of life. However, chronic otitis media with effusion is common in all infants (20% of controls), a time during which infants are examined and tested frequently.

Acoustic Impedance Tests↗
PubMed1998

Comparison of subhypnotic doses of thiopentone vs propofol on the incidence of postoperative nausea and vomiting following middle ear surgery.

BACKGROUND: Middle ear surgery is associated with a high incidence of emetic sequelae and propofol has been reported to have antiemetic activity in subhypnotic doses. METHODS: In a double-blind, randomized study, the patients received either thiopentone 1.0 mg.kg-1 (n = 26) or 0.5 mg.kg-1 propofol (n = 26) at the end of middle ear surgery under isoflurane-N2O-fentanyl-vecuronium anaesthesia. Trained nurses, unaware of the group assignment, assessed postoperative nausea, retching and vomiting up to 24 h after the end of anaesthesia. Droperidol 10 micrograms.kg-1 was used as a "rescue" antiemetic. RESULTS: The main result was that the patient in the propofol group did not suffer from retching and vomiting (R&V) during the first 6 h, whereas these symptoms occurred in 46% (P < 0.001) of the patients in the thiopentone group. The patients in the propofol group needed significantly less droperidol during the first 24 h (mean number of doses 0.39 +/- 0.57 (SD)) than the patients in the thiopentone group (1.35 +/- 1.47, P < 0.005). Treatment with propofol was a predictor for lowered incidence of R&V, as well as male gender and negative history of motion sickness. CONCLUSION: Propofol at a subhypnotic dose of 0.5 mg.kg-1 provides prophylaxis against retching and vomiting for the first 6 h postoperatively after middle ear surgery. The incidence of nausea was not reduced by propofol.

Adult↗
PubMed1981

Inflammatory cell subpopulations in the middle ear mucosa of ears with effusion.

Middle ear mucosal biopsies were taken from 11 patients with middle ear effusion. In 8 cases the specimens were sufficiently large to allow detailed studies of the submucosal cellular components. It appears that in noncomplicated serous middle ear effusion, due to mechanical obstruction of the Eustachian tube, the submucosa is not infiltrated by inflammatory cells. In all types of mucoid effusion of variable duration, various lymphocyte classes, i.e. T- and B-lymphocytes and plasma cells, were present, suggesting a normal cellular immune response. The lack of granulocytes seems to indicate that there is no submucosal infection.

B-Lymphocytes↗
PubMed2006

Why do some children have good hearing results following type III and IV tympanoplasty? Current theories of middle ear mechanics.

INTRODUCTION: Middle ear reconstruction in children following tympanomastoidectomy for cholesteatoma is commonly limited to a Wullstein type III or IV reconstruction owing to ossicular erosion. The hearing outcomes of this procedure have been unpredictable. Nevertheless, there are children who have remarkably good hearing results despite having extensive and aggressive cholesteatoma surgery and limited reconstruction. METHODS: The current theories of middle ear mechanics following tympanoplasty and ossicular reconstruction are reviewed. In addition, a selective retrospective chart review of pediatric type III and IV tympanoplasty at The Hospital for Sick Children between 1998 and 2003 is presented. RESULTS: Nine patients were reconstructed with a type III (n = 3) or IV (n = 6) tympanoplasty. The mean pre- and postoperative air-bone gaps were 43.6 and 24.9 dB. Speech reception threshold improved from 37.5 to 22.8 dB. The changes were statistically significant (p < .05). CONCLUSIONS: This series of patients demonstrated a statistically significant hearing improvement at long-term follow-up. The improvements are consistent with optimal hearing outcomes predicted by current theories of middle ear mechanics.

Audiometry↗
PubMed2006

Multidetector row CT demonstration of inner and middle ear structures.

The aim of this study is to evaluate the anatomical details of the inner ear and middle ear, using multidetector row CT. Temporal bone CT scans were obtained using 16-detector row CT scanner (Lightspeed 16, General Electric Medical Systems, Milwaukee, WI) in 30 patients with dizziness, vertigo, or hearing loss. The three-dimensional (3D) images were reconstructed with volume rendering techniques. The 3D images were reviewed by two radiologists and scored by using a three-point quality rating for qualitative assessment of the 23 representative structures of the middle and inner ear. The malleus, incus, and facial nerve canal were identified in all patients. The incudomalleolar joint appeared fused in all patients. The stapes were seen clearly in 27 (90%) of 30 patients except in three patients. Among the three remaining patients, there was one who had effusions in the middle ear cavity. Another patient had left cholesteatoma. The third patient had normal middle ear cavity. The cochlea and the three semicircular canals (anterior, posterior, and lateral) were well demonstrated in 29 (97%) of 30 patients except for one old woman with osteoporosis. Sixteen-detector row CT imaging of temporal bone with advanced 3D reformation yields state-of-the-art anatomical details of the temporal region useful to address anatomical localization issues and ease conceptual structural learning.

Adult↗
PubMed1995

Oxygen diving-induced middle ear under-aeration.

Middle ear negative pressure and effusions have been described after oxygen diving. The prevalence, dynamics and pathophysiology of this phenomenon are not clear, and were hence investigated in the present study. Thirty-four oxygen divers with normal otoscopic and tympanometric evaluation participated in the study. The subjects' symptoms were documented, and pneumatic otoscopy and tympanometry were repeated immediately after the completion of a 3 h, 15 feet oxygen dive, and 7 h later on awakening from the night's sleep. Most divers had positive otoscopic findings the morning after the dive, all of which cleared within 4 h of rising. A significant decrease was observed in average middle ear compliance (p = 0.0463, one way ANOVA), and an increase was found in the number of ears with tympanic compliance less than 0.3 ml (p = 0.0001, Kruskal-Wallis non-parametric ANOVA). In addition, 14.7% of the ears had type C, and 27.9% type B tympanograms the morning after the dive (p = 0.0001 chi2). The generalized nature of oxygen-induced middle ear under-aeration, combined with the dynamics of the symptoms and signs observed, make middle ear barotrauma, tympanic cavity oxygen absorption, and middle ear epithelial oxygen toxicity all unlikely explanations. The observed phenomenon and its dynamics might stem from a reversible derangement in a middle ear chemoreceptor reflex arch, which has recently been suggested as regulating middle ear aeration.

Acoustic Impedance Tests↗
PubMed1984

Bilateral congenital middle ear cholesteatomas.

Congenital middle ear cholesteatomas remain of interest because of their relative rarity and unknown origin. A 4-month-old child presenting with bilateral congenital middle ear cholesteatomas forms the basis for this report. The nature of the epithelial debris found suggests an external origin. An extended transcanal tympanotomy approach for removal, based upon an operative experience of 11 similar ears, will be discussed.

Child, Preschool↗
PubMed1998

Role of pneumatic otoscopy in the evaluation of tympanic membrane and middle ear diseases.

Many middle ear diseases show visible changes on the tympanic membrane which can be identified with pneumatic otoscopy. With practice and patience the technique can be easily performed even on infants and very young children and can reveal what may guide therapeutic approach. Careful positioning of the patient and proper insertion of a fitting ear speculum are of paramount importance. Mobility of the tympanic membrane may be absent in certain conditions and decreased or increased in other conditions. White masses are sometimes observed in the tympanic membrane or in the middle ear. These may be normal bony structures, tympanosclerosis or cholesteatoma and pneumatic otoscopy may help differentiate these conditions.

Age Factors↗