Middle Ear

Use of the chorda tympani nerve in reconstruction of the ossicular chain

April 27, 2015     Yi Qiao, MD; Wen-Wen Chen, MD; Ya-Xin Deng, MD; Jun Tong, MD
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Abstract

We conducted a study to assess the use of the chorda tympani nerve in reconstruction of the ossicular chain. We retrospectively examined the medical records of 141 patients (154 ears) who had undergone middle ear surgery with 12 months of follow-up. The study population was made up of 58 males and 83 females, aged 9 to 83 years (mean: 45). These patients were divided into three groups based on the specific type of surgery they had undergone: in 35 patients, the chorda tympani nerve was used to spring and press the auricular bone prosthesis (CTN group); in 67 patients, the tympanic membrane was used to spring and press the auricular bone prosthesis (TM group); and in 39 patients, a gelatin sponge was used to support the auricular bone prosthesis (GS group). We compared pre- and postoperative air-bone gaps (ABGs) in each group, as well as the differences between these gaps among the three groups. We found significant differences between the pre- and postoperative ABGs in all three groups (all p < 0.01). These differences were also compared between the CTN and TM groups (t = 0.41; p > 0.05), between the CTN and GS groups (t = 2.07; p < 0.05), and between the TM and GS groups (t = 2.51; p < 0.05). In the CTN group, 1 patient experienced temporary postoperative hypogeusia, and another developed a mild case of delayed facial paralysis; both patients recovered within 2 weeks. We conclude that the chorda tympani nerve can be used to repair the ossicular chain to improve hearing without causing taste and facial nerve dysfunction and without the need for a second operation.

Cochlear implantation leading to successful stapedectomy in the contralateral only-hearing ear

March 2, 2015     Samantha J. Mikals, MD; Gerald I. Schuchman, PhD; Joshua G.W. Bernstein, PhD; Arnaldo L. Rivera, MD
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Abstract

Cochlear implants have recently begun to be offered to patients with single-sided deafness (SSD). Implantation in these patients has led to good results in suppressing ipsilateral tinnitus and in providing audiologic benefits in terms of speech perception in noise and localization. One previously unreported benefit of cochlear implantation in patients with SSD is the restoration of functional hearing in the previously deaf ear, which may allow for surgical opportunities in the contralateral hearing ear. We report a case in which cochlear implantation in the deaf left ear of a 50-year-old man allowed for surgical intervention in the previously only-hearing right ear, which in turn led to the restoration of normal middle ear function. Further studies may be warranted to consider the surgical candidacy of the contralateral only-hearing ear as another potential indication for cochlear implantation in patients with SSD.

Metastatic breast carcinoma presenting as unilateral pulsatile tinnitus: A case report

February 2, 2015     Andrew Moore, MRCS, DOHNS; Max Cunnane, BMBS, BMedSci; Jason C. Fleming, MRCS, DOHNS, MEd
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Abstract

Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.

Salivary gland choristoma of the middle ear

February 2, 2015     Shubin Chen, MD; Yongxin Li, MD
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Abstract

Salivary gland choristoma of the middle ear is a rare entity. It is believed to be a developmental abnormality that may be associated with anomalies of adjacent structures. We describe the case of a 6-year-old girl who had a salivary gland choristoma in the middle ear that was associated with an ossicular chain anomaly and a facial nerve anomaly. We discuss the clinical features and management of this condition, and we review the literature.

Vestibular dehiscence syndrome caused by a labyrinthine congenital cholesteatoma

February 2, 2015     Francesco Fiorino, MD; Francesca B. Pizzini, MD, PhD; Barbara Mattellini, MD; Franco Barbieri, MD
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Abstract

A 40-year-old man presented with conductive hearing loss and pressure- and sound-related vestibular symptoms. Computed tomography and diffusion-weighted magnetic resonance imaging revealed the presence of a cholesteatoma involving the vestibular labyrinth. The patient underwent a canal-wall-up tympanoplasty, which revealed evidence of a disruption of the vestibular labyrinth and a wide dehiscence of the vestibule, which was immediately resurfaced. At the 2-month follow-up, the patient's pressure- and sound-related vestibular symptoms had disappeared. Pure-tone audiometry showed a reduction in the air-bone gap with a slight deterioration of bone conduction and an improvement in the air-conduction threshold. Fistulization of the otic capsule produces a “third window,” which can lead to a dehiscence syndrome. One possible cause is a cholesteatoma of the middle ear or petrous bone. When the vestibule is invaded by a cholesteatoma, hearing is almost invariably lost, either pre- or postoperatively. However, in our case, wide opening of the vestibule resulted in hearing preservation.

Osteoma of the middle ear

October 17, 2014     Tsung-Shun Chang, MD; Wen-Sen Lai, MD; Chao-Yin Kuo, MD; Chih-Hung Wang, MD, PhD
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Management of middle ear osteoma can be complicated when the round window is obliterated. Therefore, the patient should be informed about what to expect prior to surgery.

Salivary gland choristoma of the middle ear

October 17, 2014     Paolo Fois, MD; Anna Lisa Giannuzzi, MD; Carlo Terenzio Paties, MD; Maurizio Falcioni, MD
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Abstract

Choristoma of the middle ear is a rare condition characterized by the presence of normal salivary gland tissue in the middle ear space. Salivary gland choristomas are benign lesions that are frequently associated with ossicular chain and facial nerve anomalies. Total surgical excision is indicated when there is no risk of damaging the facial nerve. We describe a new case of salivary gland choristoma of the middle ear, and we discuss the etiology, histologic features, and management of such lesions. Our patient was a 22-year-old woman in whom we surgically removed a whitish retrotympanic mass. Intraoperatively, we also detected an ossicular chain malformation. Histologic examination of the choristoma revealed the presence of salivary gland tissue. Furthermore, the lesion contained an extensive and previously undescribed component: a well-defined pseudostratified respiratory-type epithelium, similar to that of a normal eustachian tube. Ten months after removal of the choristoma, we surgically repaired the ossicular chain anomalies. No recurrence was noted on follow-up.

Bilateral nontuberculous mycobacterial middle ear infection: A rare case

September 17, 2014     Ing Ping Tang, MS; Shashinder Singh, MS; Raman Rajagopalan, MS
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Abstract

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

Ear mold impression material as an aural foreign body

September 17, 2014     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD
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Physicians should not rush indiscriminately into action without a careful otoscopic examination and a detailed history, to discern whether a patient has abnormal anatomy and is at risk for complications.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Ototoxicity in Nigeria: Why it persists

July 13, 2014     Daniel D. Kokong, MBBS, FWACS; Aminu Bakari, MBBS, FWACS, FICS; Babagana M. Ahmad, MBBS, FWACS, FICS
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Abstract

No therapy is currently available to reverse the serious damage that can be caused by ototoxic drugs, such as permanent hearing loss and balance disorders. Otolaryngologists in various regions of the world have developed strategies aimed at curtailing drug-induced ototoxicity, but similar efforts in most developing nations have yet to be well established. We conducted a study to document our experience in Nigeria. Our study population was made up of 156 patients-66 males and 90 females, aged 5 to 85 years (mean: 32.1 ± 30.7)-who were diagnosed with drug-induced ototoxicity over a 3-year period. Tinnitus was the first and the predominant symptom in 140 patients (89.7%). The most common cause of drug-induced ototoxicity among the 156 patients was injection of an unknown agent (n = 55 [35.3%]); among the known agents, the most common were chloramphenicol (n = 25 [16.0%]), chloroquine (n = 22 [14.1%]), and gentamicin (n = 20 [12.8%]). One pregnant woman experienced a miscarriage at 4 months after receiving intramuscular chloroquine, and another woman fell into a coma after receiving intramuscular streptomycin. Two agents that have not been linked to ototoxicity-oxytocin and thiopentone sodium-were found to be ototoxic in our study (1 case each). Of the 312 ears, 31 (9.9%) showed normal audiometric patterns; on the other end of the spectrum, 155 ears (49.7%) had profound sensorineural hearing loss (SNHL). Mixed hearing loss was seen in 90 ears (28.8%). Hearing loss was bilaterally symmetrical in 127 patients (81.4%), bilaterally asymmetrical in 15 patients (9.6%), and unilateral in 14 patients (9.0%). Treatment was primarily medical; hearing aids were fitted for 7 patients (4.5%). Only 41 patients (26.3%) kept as many as 3 scheduled follow-up appointments. Ototoxicity remains prevalent in the developing countries of Africa. Numerous drugs and other agents are responsible, and management outcomes are difficult to ascertain. Thus, our emphasis must be placed on prevention if we are to minimize the potentially devastating effects of ototoxicity.

Ceruminous adenocarcinoma of the ear

May 7, 2014     Jagdeep Singh Virk, MA (Cantab), MRCS, DOHNS; Gaurav Kumar, FRCS(ORL-HNS); Sherif Khalil, MS, FRCS(ORL-HNS), MD
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Ceruminous carcinomas are extremely rare and tend to present as a mass or with otalgia. They are difficult to diagnose histopathologically (in part due to varied and nonstandardized nomenclature).

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