Middle Ear

Topical mitomycin C application before myringotomy and ventilation tube insertion: Does it affect the final outcome?

August 10, 2012     Ahmed Hesham, MD; Ayman Hussien, MD; Ahmed Hussein, MD


Previous animal studies have shown that the topical application of mitomycin C is safe and effective in prolonging the patency of myringotomy openings in ears that have not received a ventilation tube. We conducted a randomized, controlled study in humans to determine if this treatment would make a difference in outcomes when a ventilation tube is inserted. To that end, we prospectively studied a group of patients with resistant otitis media with effusion who underwent bilateral myringotomy and ventilation tube insertion. Our original study population was made up of 55 children aged 2 to 12 years; 15 of these patients were lost to follow-up, leaving us with 40 patients and 80 ears. Each patient served as his or her own control, as mitomycin C was applied to the tympanic membrane on one side just prior to myringotomy creation and normal saline was applied to the other side. Our main outcomes measures were the duration of tube placement (i.e., the length of time before extrusion of the tube) and the incidence of other early and late postoperative complications. We found no statistically significant difference between the mitomycin C-treated ears and the control ears in any of these parameters. We conclude that the use of mitomycin C prior to myringotomy and ventilation tube insertion is not worthwhile.

Recurrent pre-B-cell acute lymphoblastic leukemia in the middle ear: A form of granulocytic sarcoma

July 5, 2012     David Manning, MD; Enrique Palacios, MD, FACR; Harold Neitzschman, MD, FACR

Leukemia of the middle ear easily can be misidentified as acute otitis media or Bell palsy. It occurs most often in children 2 to 5 years of age and in the elderly population.

Huge middle ear adenoma with delayed facial nerve paralysis

June 4, 2012     Seung Ho Lee, MD; Hoseok Choi, MD, PhD; Young Chae Chu, MD; Young Hyo Kim, MD; Kyu-Sung Kim, MD, PhD


Middle ear adenoma is a rare disease that arises from the mucosa of the middle ear. Only a few cases of associated facial nerve paralysis have been reported. Facial nerve involvement is most likely related to nerve compression rather than tumor invasion of the nerve. We describe a case of a huge middle ear adenoma in a 63-year-old man. He presented with a 1-month history of right-sided otalgia, otorrhea, and facial palsy; he also had a 10-year history of right-sided hearing loss. A tympanomastoidectomy was performed. Intraoperatively, the tumor was found to fill the middle ear cavity as well as the entire diameter of the external auditory canal. The tumor had eroded the wall of the facial canal at the second genu, and it was tightly adherent to the epineurium. Focal inflammation around the tumor was observed at the exposed facial nerve. The tumor was removed and the facial nerve was decompressed. Immediately after surgery, the patient’s aural symptoms resolved. The final pathology evaluation established the diagnosis of a middle ear adenoma. At the 3-year follow-up, the ear cavity was completely healed and facial nerve function was improved.

Otoscopic findings in otosclerosis

March 31, 2012     John C. Goddard, MD and Jose N. Fayad, MD

Only 10% of patients with otosclerosis exhibit the reddish hue of the Schwartze sign. It is believed to appear because of increased vascularity over the promontory in the middle ear.

Is there an ototoxicity risk from Cortisporin and comparable otic suspensions? Distortion-product otoacoustic emission findings

March 1, 2012     Leonard P. Berenholz, MD, Dyana L. Rossi, MA, William H. Lippy, MD, and John M. Burkey, MA


The purpose of this investigation was to use distortion-product otoacoustic emission (DPOAE) testing to address the issue of possible ototoxicity from the use of neomycin/polymyxin B/hydrocortisone otic suspension following tympanostomy tube placement. We retrospectively reviewed our clinical records and identified 36 children (52 ears) who had met our three study criteria: (1) unilateral or bilateral placement of transtympanic ventilation tubes, (2) treatment for 3 to 5 days with neomycin/polymyxin B/hydrocortisone drops, and (3) postoperative evaluation by DPOAE testing. We identified another set of 36 children (52 ears) who had not received these drops and who had not undergone tube placement but who had been evaluated by DPOAE testing to serve as a control group. We found no significant differences in DPOAE amplitudes between the treatment and control groups. These findings are consistent with decades of clinical experience indicating that neomycin/polymyxin B/hydrocortisone otic suspension is safe when used responsibly.

Middle ear encephalocele: Not just another chronic ear

February 18, 2012     John C. Goddard, MD and Jose N. Fayad, MD

Squamous cell carcinoma of the middle ear

January 25, 2012     Min-Tsan Shu, MD, Jehn-Chuan Lee, MD, Cheng-Chien Yang, MD, and Kang-Chao Wu, MD

Facial nerve paralysis following transtympanic penetrating middle ear trauma

November 22, 2011     Alfred Marc Iloreta, MD and Benjamin D. Malkin, MD

The effect of early division of the chorda tympani on gustatory function

November 22, 2011     Bruno Kenway, BMedSci, MRCS, DOHNS, Anand Kasbekar, BMedSci, MRCS, DOHNS, Neil Donnelly, MSc, FRCS (ORLHNS), and Patrick Axon, MD, FRCS (ORLHNS)


This study was undertaken to assess dysgeusia in patients who have undergone middle ear surgery for chronic suppurative otitis media (CSOM) when the surgeon's practice was to cleanly divide the chorda tympani without prior manipulation, if it in any way hindered operative access or the aims of surgery. We wanted to determine whether lower rates of taste disturbance might be obtained by early, clean division of the nerve. We followed 110 patients prospectively and asked them to complete a postoperative dysgeusia questionnaire 1 year after surgery. The “cut nerve” group included 81 patients, and the “uncut nerve” group included 29 patients. In the uncut group, the nerve was untouched or underwent minimal handling. In the cut nerve group, 68% of patients had no taste disturbance after surgery; 4% of patients in this group had ongoing symptoms at 1 year postoperatively. In the uncut nerve group, 67% were asymptomatic, while 11% had ongoing taste disturbance at 1 year. Statistical analysis of symptoms beyond 1 year showed a mean difference of 7%, but this is not statistically significant (p = 0.38). These results suggest that early division of the chorda tympani without prior manipulation in patients with chronic suppurative otitis media does not result in higher rates of taste disturbance than in patients with uncut nerves. Indeed rates of taste disturbance in our cut group were lower than in the uncut group, and lower than or comparable to those seen in other studies.

Aneurysm of the internal carotid artery in the middle ear

August 15, 2011     Andreas Anagiotos, MD, Markus Stenner, MD, and Dirk Beutner, MD

Is virtual endoscopy of the middle ear useful?

June 13, 2011     Ambrose Chung-Wai Ho, FRCSEd, Raymond Lee, FRCR, Michael Tiong-Hong Co, MRCSEd, Chun-Kuen Chow, FRCSEd, and Kai-Ming Au Yeung, FRCR


Virtual endoscopy is a relatively new imaging technology in otology, and therefore data on its efficacy in clinical situations are limited. We conducted a prospective study to evaluate the clinical relevance of radiologic diagnoses based on virtual endoscopy of the middle ear. Our patient population was made up of 30 adults who were scheduled to undergo surgery to correct conductive hearing loss of unknown etiology. Virtual endoscopy was performed on three-dimensional images that were constructed from images obtained with conventional two-dimensional computed tomography (CT). Findings on virtual endoscopy were then compared with the subsequent surgical findings. Virtual endoscopy suggested a middle ear pathology in 19 patients and a normal middle ear in 11 patients. Postoperatively, we found that the virtual diagnoses correlated moderately well with the surgical findings in the group of patients with predicted pathology; 13 of these 19 patients were found to have middle ear problems such as ossicular chain anomalies, otosclerosis, and cholesteatoma (positive predictive value: 68%). However, among the 11 patients whose middle ear structures were radiologically predicted to be normal, only 2 had negative middle ear findings on surgical exploration; of the remaining 9 patients, 8 had otosclerosis and 1 had malleus fixation (negative predictive value: 18%). Thus, the sensitivity and specificity of virtual endoscopy were 59 and 25%, respectively. Virtual endoscopy provides images from a surgeon's perspective, and so it has the potential to be useful in the preoperative evaluation of the middle ear cavity. With ongoing advancements in computer systems and imaging techniques, the cost, reliability, and efficacy of virtual endoscopy may improve. However, further clinical validation and cost-benefit analysis are required before we can determine if it has any additional advantages over conventional two-dimensional CT.

Otomyiasis of the mastoid cavity: An unusual complication of cotton-swab use

June 13, 2011     Chaudhary F. Riaz, BSc, BM, MRCS, DOHNS, Owen Judd, MRCP, MRCS, DCH, and Peter J. Conboy, FRCS
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