Tympanum

Intratympanic steroid use for hearing salvage in Vogt-Koyanagi-Harada syndrome

December 15, 2011     Stanley Pelosi, MD and Sujana S. Chandrasekhar, MD, FACS
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Abstract

We discuss the rare case of a 68-year-old woman with Vogt-Koyanagi-Harada (VKH) syndrome and sensorineural hearing loss (SNHL) who was successfully treated with intratympanic corticosteroid injections. The patient had presented with bilaterally asymmetric (i.e., moderate and moderate to severe) SNHL, tinnitus, vertigo, and vitiligo. She received two intratympanic injections in her worse-hearing ear over the course of 1 month. Subsequent audiometry showed an immediate 5- to 10-dB improvement in her hearing across multiple frequencies, as well as a long-term improvement to near-normal thresholds. The hearing thresholds in her untreated ear remained stable. To the best of our knowledge, this is the first report of a patient with VKH syndrome who was successfully treated with intratympanic steroid application.

Congenital cholesteatoma of the tympanic membrane

December 15, 2011     Byung Don Lee, MD and Moo Kyun Park, MD
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"Epithelial pearl" after tympanoplasty with the underlay technique

April 30, 2011     Min-Tsan Shu, MD and Yu-Chun Chen, MD
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A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis

April 30, 2011     Hatice Gul Hatipoglu, MD, Mehmet Ali Cetin, MD, Enis Yuksel, MD, and Huseyin Dere, MD
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Abstract

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a “reverse 7” shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.

Incidence of tympanic membrane perforation after intratympanic steroid treatment through myringotomy tubes

March 31, 2011     Amy L. Rutt, DO, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA, FACS
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Abstract

Intratympanic (IT) steroids are often used to treat inner ear disorders such as sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, and Ménière disease. Administration of corticosteroids via IT injection, via application with a pledget to the round window, or via catheter has been used for this purpose. The frequency of adverse events related to the IT injection of steroids is low, with pain, short-lasting vertigo, otitis media, and tympanic perforations being the most common complications. However, the safety of IT steroid therapy has not yet been established in a randomized clinical trial. In this article, we discuss a group of 11 patients with sensorineural hearing loss who underwent myringotomy and tube placement for home-based dexamethasone instillation and subsequently developed the complication of tympanic membrane perforation. It appears that there is a significantly increased incidence of tympanic membrane perforations in this population.

Glomus jugulare

January 1, 2011     Jeffrey D. Suh, MD, Ashley E. Balaker, MD, Brian D. Suh, MD, and Keith E. Blackwell, MD
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Concurrent nasal surgery and tympanoplasty in adults

September 30, 2010     Theodore A. Schuman, MD and Robert F. Labadie, MD, PhD
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Abstract

We conducted a retrospective chart review to determine if performing simultaneous nasal surgery and tympanoplasty jeopardizes tympanic membrane graft survival and the surgical outcome. Our study population consisted of 14 consecutively presenting adults with nasal septal deviation and otologic pathology who had undergone simultaneous nasal and otologic procedures at an academic tertiary care medical center. Surgical procedures included septoplasty and bilateral inferior turbinate submucous reduction with concurrent primary or revision tympanoplasty with or without mastoidectomy and ossicular chain reconstruction. Follow-up ranged from 1.8 to 29.8 months (mean: 12.8 ± 10.8). The primary outcomes measures were tympanic membrane graft survival and surgical success; the latter was defined as an absence of middle ear effusion and a lack of need for pressure-equalization tube placement in patients with intact grafts. We found that 13 of the 14 tympanic membrane grafts (92.9%) survived at the most recent follow-up and that 11 patients (78.6%) achieved an aerated middle ear without the need for a pressure-equalization tube. These rates compare favorably with those quoted in the literature for tympanoplasty performed without concomitant nasal surgery. We conclude that septoplasty can be safely and effectively performed at the same time as tympanoplasty with or without mastoidectomy with no increase in the risk of surgical failure.

Measurements of the facial recess anatomy: Implications for sparing the facial nerve and chorda tympani during posterior tympanotomy

September 30, 2010     Caglar Calli, MD, Ercan Pinar, MD, Semih Oncel, MD, Bekir Tatar, MD, and Mehmet Ali Tuncbilek, MD
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Abstract

Posterior tympanotomy is commonly performed through the facial recess to facilitate cochlear implantation. A rare but serious complication of this procedure is paralysis of the facial nerve and/or the chorda tympani. These complications generally occur because of a limited understanding of the anatomy of the facial recess. To help further define this area, we used computer-aided design software to measure (1) the angle between the facial nerve and the chorda tympani nerve and (2) the distance between the takeoff point of the chorda tympani and the posteriormost prominent point of the short process of the incus in 30 cadaveric adult temporal bones. The mean angle was 23.58° (±6.84), and the mean distance was 7.78 mm (±2.68). Our most important finding was that there was a correlation between the two measurements in that the distance tended to be greater when the angle was less than the mean and vice versa. This trend approached but did not quite reach statistical significance (r = -0.248, p = 0.059).

Congenital cholesteatoma in the tympanic membrane

July 31, 2010     Min-Tsan Shu, MD, Hung-Ching Lin, MD, Cheng-Chien Yang, MD, and Yu-Chun Chen, MD
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An insect on the tympanic membrane

March 1, 2010     Arun K. Gadre, MD, FACS, DORL
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Tympanum-canal angles anteriorly, anteroinferiorly, and inferiorly: A postmortem study of 41 adult crania

August 31, 2009     N. Wendell Todd, MD, MPH
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Abstract

The angles formed by the tympanic membrane and the external ear canal anteriorly, anteroinferiorly, and inferiorly can pose surgical challenges, and the spaces they form can harbor iatrogenic cholesteatoma. The range of values previously reported for these angles-27° to 60°-seems not to have been determined in a clinically applicable manner. To clinically describe the tympanum-canal angles, assess bilateral symmetry, assess the angles relative to mastoid pneumatization, and assess the relationship of the angles to manubrium orientation in the skull, the author conducted a postmortem anatomic study of 41 bequeathed adult crania without clinical otitis media. As viewed through the external ear canal, the tympanum-canal angles were measured in 10° increments anteriorly, anteroinferiorly, and inferiorly relative to the line of the manubrium. Mastoid sizes were determined radiographically. In the right ear, the tympanum-canal angles ranged from 40° to 60° anteriorly (median: 55°), from 50° to 70° anteroinferiorly (median: 60°), and from 70° to 80° inferiorly (median: 75°). Bilateral symmetry was found (each rs ≥ 0.69, p < 0.001). Although the angles did not correlate with either mastoid pneumatization or manubrium orientation relative to the Frankfort plane, nonvisualization of the annulus anteriorly was significantly more common in specimens with well-pneumatized mastoids (p < 0.05). The author concludes that the tympanum-canal angles anteriorly, anteroinferiorly, and inferiorly have comparatively narrow ranges, exhibit bilateral symmetry, and are unrelated to both mastoid size and manubrium orientation in the skull.

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.

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