Middle Ear

Diffusion-weighted imaging for cholesteatoma evaluation

March 31, 2010     Kara M. Schwartz, MD, John I. Lane, MD, Brian A. Neff, MD, Bradley D. Bolster Jr., PhD, Colin L. Driscoll, MD, and Charles W. Beatty, MD
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Abstract

Computed tomography (CT) has long been considered the optimal imaging technique for the detection of cholesteatomas. However, this modality often lacks specificity, particularly in patients with an absence of definite bony erosion or a history of surgical excision. Several investigators have proposed magnetic resonance imaging with diffusion-weighted imaging (DWI) as a means of diagnosing the presence and extent of cholesteatomas, particularly when CT results are equivocal. The rationale for the use of DWI is that cholesteatomas demonstrate restricted diffusion and granulation tissue does not. In this retrospective study, we review our experience with 12 patients who had undergone DWI for evaluation of a mass in the middle ear, mastoid, or petrous apex. Ten of these patients had previously undergone middle ear surgery, 8 for cholesteatoma resection. On DWI, 9 patients demonstrated restricted diffusion. Of these, 8 patients underwent surgical resection, and all were found to have had a cholesteatoma. Of the 3 patients who had not demonstrated restricted diffusion on DWI, 2 did not undergo surgery and the other was found to have only chronic inflammation at surgery. Based on our limited experience, we believe that DWI can be useful in confirming the diagnosis of cholesteatoma. Moreover, it may alter patient management, particularly in patients whose previous tympanoplasty/mastoidectomy does not allow for an adequate clinical inspection of the middle ear cavity.

Characterization of ossicular chain vibration at the umbo: Implications for a middle ear microelectromechanical system design

January 1, 2010     Darrin J. Young, PhD, Mark A. Zurcher, MS, Tung Trang, MD, Cliff A. Megerian, MD, and Wen H. Ko, PhD
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Abstract

We propose the use of a microelectromechanical system (MEMS) accelerometer as a middle ear microphone for future totally implantable cochlear prostheses. The MEMS accelerometer would be attached to the umbo to detect and convert the natural bone vibration that occurs in response to external sounds into an electrical signal that represents the acoustic information. The signal could be further processed to stimulate cochlear implant electrodes. To determine the feasibility of our proposal, we conducted a study to investigate whether the characteristics of umbo vibration along two orthogonal axes-one axis being perpendicular to the tympanic membrane and the other axis being parallel to the tympanic membrane plane but orthogonal to the long process of the malleus-differ significantly enough to compromise the sensing performance of the proposed accelerometer should a position misalignment occur during the implant procedure. We used laser Doppler vibrometry to measure the displacement of the umbo along the two orthogonal axes in 4 cadaveric temporal bones at multiple frequencies within the audible spectrum. We found that the peak-to-peak displacement frequency response along both axes was nearly flat from 250 Hz to 1 kHz, and it gradually rolled off with a slope of approximately -20 dB and -40 dB per decade above 1 kHz and 4 kHz, respectively. At each frequency, the displacement exhibited a linear function of the input sound level with a slope of 20 dB per decade. A comparison of measurements along the two axes indicated a similar frequency response, with an average amplitude difference of 20%. The characterization data suggest that the performance of a miniature ossicular vibration-sensing device attached on the umbo would not be degraded in the event of a position misalignment. The data also indicate that a MEMS accelerometer needs to achieve a resolution of

to detect normal conversation.

Synovial chondromatosis of the middle ear: A case report

June 30, 2009     Domenico Saggese, MD, Ignacio Javier Fernandez, MD, Nunzio C.M. Salfi, MD, and Alberto Rinaldi Ceroni, MD
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Abstract

Synovial chondromatosis is a rare pathology of unknown etiology characterized by multinodular cartilaginous proliferation in the synovium. When it does occur, it usually develops in the large synovial joints (e.g., the knee, hip, elbow, and shoulder). Only rarely does it occur in the head and neck (most often in the temporomandibular joint). We report a case of synovial chondromatosis of the middle ear (i.e., the incudomalleolar joint) in a 64-year-old woman, and we describe the clinical, radiologic, and intraoperative findings in this case. To the best of our knowledge, this is the first reported case of synovial chondromatosis in the middle ear.

Ear trauma caused by a yucca plant leaf spine

May 31, 2009     Yoav P. Talmi, MD, FACS, Michael Wolf, MD, Lela Migirov, MD, and Jona Kronenberg, MD
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Abstract

Three uncommon cases of ear trauma caused by a yucca plant leaf spine are presented. One patient presented with tympanic perforation and the second with mixed hearing loss after spontaneous closure. The third patient probably had a perilymphatic fistula with subsequent labyrinthitis and hearing loss. Although the yucca is a ubiquitous plant, to the best of our knowledge, such incidents have not been previously reported.

Eustachian tube foreign body undetected for 30 years: Case report

March 31, 2009     David M. Filsoof, MD and Steven Y. Park, MD
article

Abstract

This case report describes the unexpected finding of a eustachian tube prosthesis placed 30 years earlier, after the patient had experienced years of chronic rhinorrhea.

Neuroendocrine adenoma of the middle ear (NAME)

March 31, 2009     Karen Leong, MD, Marian M. Haber, MD, Venu Divi, MD, and Robert T. Sataloff, MD, DMA, FACS
article

Abstract

Neuroendocrine adenoma of the middle ear (NAME) is a rare tumor. We report a case of NAME, the clinical and pathologic findings of which illustrate the biologic behavior of adenomatous tumors of the middle ear and their relationship with rare carcinoid tumors of the middle ear. A 29-year-old man presented with a history of recurrent otitis media, right conductive hearing loss, and aural fullness. The tumor was removed in its entirety. Otolaryngologists should be familiar with this unusual but important entity.

Facial nerve hemangioma of the middle ear

March 1, 2009     Issam Saliba, MD and Jose N. Fayad, MD
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From the Department of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (Dr. Saliba), and the House Ear Clinic, Los Angeles (Dr. Fayad)

Middle ear barotrauma with hyperbaric oxygen therapy: Incidence and the predictive value of the nine-step inflation/deflation test and otoscopy

December 1, 2008     Serdar Karahatay, MD, Yavuz Fuat Yilmaz, MD, Hakan Birkent, MD, Hakan Ay, MD, and Bulent Satar, MD
article

Abstract

We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearing loss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.

White mass in the middle ear

October 31, 2008     Maroun T. Semaan, MD and Jose N. Fayad, MD
article

Migration of T-tubes to the middle ear

July 31, 2008    
article

Hemotympanum

June 30, 2008     Marc K. Bassim, MD and Jose N. Fayad, MD
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