Middle Ear

Middle ear encephalocele: Not just another chronic ear

February 18, 2012     John C. Goddard, MD and Jose N. Fayad, MD
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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
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Facial nerve paralysis following transtympanic penetrating middle ear trauma

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

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
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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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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
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Abstract

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.

Congenital middle ear cholesteatoma

October 31, 2010     Min-Tsan Shu, MD, Hung-Ching Lin, MD, Cheng-Chien Yang, MD, and Yu-Chun Chen, MD
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A prospective, randomized, placebo-controlled, double-blind study of montelukast's effect on persistent middle ear effusion

August 31, 2010     Scott R. Schoem, MD, Alice Willard, RN, and Jerome T. Combs, MD
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Abstract

We conducted a prospective, randomized, placebo-controlled, double-blind study to determine if the leukotriene inhibitor montelukast is effective in eliminating persistent middle ear drainage in patients with otitis media with effusion (OME). Our study population was made up of patients aged 2 to 6 years who had had confirmed OME in one or both ears for at least 2 months. Patients were randomized to receive either placebo or 4 mg of montelukast daily for 1 month. The main outcome measure was clearance of middle ear effusion as demonstrated by otoscopy and tympanometry 1 month after the initiation of treatment. Our goal was to recruit 120 patients; however, an interim analysis was conducted after 38 patients had completed their regimen (19 patients in each group) when it became apparent that montelukast was not having any effect in clearing the effusions. Indeed, the OME had cleared in only 3 montelukast patients (15.8%) and 4 controls (21.1%); the difference was not statistically significant (p > 0.90). Based on this early trend, the study was terminated at this point. We conclude that montelukast appears to be no more effective than placebo in eliminating persistent middle ear effusion.

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.

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