Abstract Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose...Abstract Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose a three-dimensional finite element model of human ear that incorporates the canal, tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, middle ear cavity and inner ear fluid. Numerical analysis is conducted and employed to predict the effects of middle ear cavity, malleus handle defect, hypoplasia of the long process of incus, and stapedial crus defect on sound transmission. The present finite element model is shown to be reasonable in predicting the ossicular mechanics of human ear.展开更多
Aim: To assess the quality of high-resolution CT section planes(HRCT), multi-planar reformation(MPR) and 3-dimensional volume rendered computer tomography(3D-CTVR) were here used in the fine differential diagnosis of ...Aim: To assess the quality of high-resolution CT section planes(HRCT), multi-planar reformation(MPR) and 3-dimensional volume rendered computer tomography(3D-CTVR) were here used in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane.Methods: Here, 17 cases of otosclerosis and 22 cases of ossicular chain deformity were selected. All patients had normal external ear canals,intact tympanic membranes, conductive hearing loss, type A tympanograms, and negative Gelle's tests. The respective radiological reports of the status of the ossicles via 3 protocols were compared to surgical findings. The quantitative assessments of the representation of different segments of the ossicular chain were based on a 3-point scoring system.Results: MPR and CTVR imaging both showed the integrity of whole ossicular chain well. MPR and CTVR imaging were found to be superior to section planes with respect to showing the superstructure of the stapes and malformations(P > 0.05).Conclusion: CTVR and MPR imaging were found to be better able to show the whole ossicular chain in the conductive hearing loss with normal tympanic membranes. Furthermore, the use of these techniques can have profound contributive value in the differential diagnosis of otosclerosis and ossicular chain absence or malformation.展开更多
Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively.Drilling through a sclerotic and small mastoid cavity,keep...Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively.Drilling through a sclerotic and small mastoid cavity,keeping the canal wall intactis often difficult and increases the risk of serious injury.Consequently,a canal-wall-down mastoidectomy is often performed.The endoscopic transcanal modified canal-wall-down mastoidectomy approach al lows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.展开更多
Background The recombinant human bone morphogenetic protein 2 （rhBMP-2） has been used to induce osteogenesis in animals＇ middle ear and this technique is possible to be used to reconstruct the defects of ossicles. ...Background The recombinant human bone morphogenetic protein 2 （rhBMP-2） has been used to induce osteogenesis in animals＇ middle ear and this technique is possible to be used to reconstruct the defects of ossicles. The side effects of the rhBMP-2 in middle ear should be observed before using in clinic. Thus we prepared the controlled release rhBMP-2 and implanted it into the acoustic bulla of guinea pigs. The effect on the cochlea was observed. Methods We prepared the acellular cancellous bone, accompanied with rhBMP-2. The material accompanied with rhBMP-2 was implanted into one acoustic bulla of the animal and the opposite side of the acoustic bulla was implanted with acellular cancellous bone without rhBMP-2. Totally 20 guinea pigs were undergone this procedure. After the operation, the auditory brainstem response （ABR） of the animals was tested according to the time sequence. Three months after the operation, the animals were sacrificed. The osteogenesis induced by rhBMP-2, the acoustic bulla and cochlea affected by rhBMP-2 were observed. The structures of hair cells were observed after silver nitrate staining. Results The animals were recovered soon after surgery. The hearing thresholds of the animals were declined slightly just after the surgery and come back completely after 3 months. Also, the bulla and cochlea were normal in shape. The osteogenesis occurred in the pore of the acellular cancellous bone with rhBMP-2. There was not any abnormal hyperplasia of bone in the bulla and cochlea. The articulation between the stapes and oval window was not merged. The shapes of the hair cells were normal and there was no obvious deletion of the hair cells compared with control group. Conclusions The controlled release rhBMP-2 transplanted into the middle ear could induce osteogenesis in the bulla of the animals. It did not affect the shape of the bulla and the hearing threshold of the animal, and did not induce the abnormal hyperplasia of bone in the bulla and might be used to reconstruct the defects of os展开更多
Chronic inflammatory demyelinating polyneuropathy(CIDP) is a progressive autoimmune disorder that targets peripheral nerves. It commonly presents with motor-predominant dysfunction and enlargement of cranial nerves. W...Chronic inflammatory demyelinating polyneuropathy(CIDP) is a progressive autoimmune disorder that targets peripheral nerves. It commonly presents with motor-predominant dysfunction and enlargement of cranial nerves. With regards to hearing loss, a few cases of sensorineural loss have been described. We present a novel case of conductive hearing loss caused by a mass on the tympanic segment of the facial nerve in the setting of CIDP.展开更多
The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review w...The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review was performed from September 2009 to December 2011. Of the 17 cases, 9 had moderate MERI while 8 had severe MERI. 9 patients underwent Tympanomastoidectomy with Total Ossicular Reconstruction Prostheses (TORP) and 8 with Partial Ossicular Reconstruction Prostheses (PORP). Hearing gain of 25.31 dB was achieved in cases with moderate MERI compared to 29.37 dB in severe MERI. Less than 20 dB average air-bone gap was achieved in 75% of PORP and 77.77% of TORP reconstructions. In developing countries with limited resources, decision regarding ossicular reconstruction should be made taking into account MERI, intra operative findings and type of surgery. Best results are achieved in cases of CWD with TORP and ICW with PORP.展开更多
The purpose of this paper is to review some of the promising technological developments related to hearing restoration part of ENT practice. If success-fully implemented in product or procedure form, these technologie...The purpose of this paper is to review some of the promising technological developments related to hearing restoration part of ENT practice. If success-fully implemented in product or procedure form, these technologies are likely to simplify surgical pro-cedures related to hearing restoration and improve the condition of patients. The developments are com-piled from scientific sources as well as from recent patent documents and they are not yet commercially available.展开更多
Purpose:Partial ossicular replacement(PORP)and total ossicular replacement prostheses(TORP)are used to restore ossicular chain function.Despite favorable auditory outcomes,these interventions have associated risks and...Purpose:Partial ossicular replacement(PORP)and total ossicular replacement prostheses(TORP)are used to restore ossicular chain function.Despite favorable auditory outcomes,these interventions have associated risks and complications.This study examines the FDA MAUDE database for ossicular chain prosthesis adverse events to highlight complications,interventions,and root cause analysis(RCA)findings.Materials and methods:The MAUDE database was searched for Medical Device Reports(MDRs)relating to PORPs and TORPs from 2010 to 2020.MDR event descriptions were reviewed,and adverse events were identified as a device issue,patient issue,and/or packaging issue that occurred intraoperatively or postoperatively.Results:Our search identified 70 MDRs which included 110 reported adverse events.Events consisted of 63 device issues,often due to device breaks and displacements,39 patient issues,including common complaints of hearing loss and erosion,and 8 packaging issues.When comparing PORPs and TORPs,TORPs had more reported device issues whereas PORPs had more packaging issues.Intraoperative device issues were commonly resolved by completing the procedure with a backup device and most postoperative device issues required additional surgery.For devices returned to the manufacturer,RCA determined that most breaks were caused by modification and/or mishandling or that the product met specifications with an undetermined cause for the break.Conclusion:Device issues were the most common adverse events and frequently required subsequent intervention.Displacement occurred more often with TORPs and was associated with changes in hearing or erosion.The findings of this study are purely descriptive and may not have direct clinical relevance.展开更多
<strong>Aim:</strong> Chronic otitis media (COM) is chronic muco purulent discharge through a perforated tympanic membrane. Theossicular chain damage is found in both mucosal and squamosal types of COM. We...<strong>Aim:</strong> Chronic otitis media (COM) is chronic muco purulent discharge through a perforated tympanic membrane. Theossicular chain damage is found in both mucosal and squamosal types of COM. We aim to evaluate relationship between preoperative otologic features, pure tone audiometric findings and intraoperative ossicular chain status in patients with chronic otitis media. <strong>Material and Methods:</strong> 100 patients of either sex aged between 12 to 60 years operated for active or inactive, squamosal or mucosal chronic otitis media attending Ram Lal Eye and ENT Hospital, Government Medical College Amritsar were taken. The preoperative ossicular chain status based on set parameters was compared with the intraoperative ossicular chain status. <strong>Results:</strong> The ossicular chain integrity is more commonly compromised in squamosal COM and the most common ossicle eroded is Incus. Pure tone audiogram has got a very important role in determining the ossicular chain integrity preoperatively and must be done in all cases with accuracy. <strong>Conclusion:</strong> It is concluded that on the basis of otoscopic examination and pure tone audiometry values, we can accurately classify the COM as mucosal or squamosal type and get an idea of the ossicular chain integrity preoperatively hence planning the extent of surgery.展开更多
Acoustic reflex is a sensitive indicator of middle ear lesions when the tympanic membrane is in-tact and tympanometry is normal. Acoustic reflex is not usually observed in conductive hearing loss caused by disruption ...Acoustic reflex is a sensitive indicator of middle ear lesions when the tympanic membrane is in-tact and tympanometry is normal. Acoustic reflex is not usually observed in conductive hearing loss caused by disruption of the ossicular chain including ossicular discontinuity and fixation. Ossicular disruption can show at least partially intact acoustic reflex under a certain condition. Moreover, ossicular discontinuity with a nearly intact acoustic reflex is quite rare and there have been few reports published to date. We here present a rare case of conductive hearing loss with a nearly intact acoustic reflex, and the patient was surgically confirmed to have ossicular discontinuity.展开更多
Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral compute...Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dis展开更多
基金supported by the National Natural Science Foundation of China (10472025, 10672036, and 10872043)
文摘Abstract Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose a three-dimensional finite element model of human ear that incorporates the canal, tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, middle ear cavity and inner ear fluid. Numerical analysis is conducted and employed to predict the effects of middle ear cavity, malleus handle defect, hypoplasia of the long process of incus, and stapedial crus defect on sound transmission. The present finite element model is shown to be reasonable in predicting the ossicular mechanics of human ear.
文摘Aim: To assess the quality of high-resolution CT section planes(HRCT), multi-planar reformation(MPR) and 3-dimensional volume rendered computer tomography(3D-CTVR) were here used in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane.Methods: Here, 17 cases of otosclerosis and 22 cases of ossicular chain deformity were selected. All patients had normal external ear canals,intact tympanic membranes, conductive hearing loss, type A tympanograms, and negative Gelle's tests. The respective radiological reports of the status of the ossicles via 3 protocols were compared to surgical findings. The quantitative assessments of the representation of different segments of the ossicular chain were based on a 3-point scoring system.Results: MPR and CTVR imaging both showed the integrity of whole ossicular chain well. MPR and CTVR imaging were found to be superior to section planes with respect to showing the superstructure of the stapes and malformations(P > 0.05).Conclusion: CTVR and MPR imaging were found to be better able to show the whole ossicular chain in the conductive hearing loss with normal tympanic membranes. Furthermore, the use of these techniques can have profound contributive value in the differential diagnosis of otosclerosis and ossicular chain absence or malformation.
文摘Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively.Drilling through a sclerotic and small mastoid cavity,keeping the canal wall intactis often difficult and increases the risk of serious injury.Consequently,a canal-wall-down mastoidectomy is often performed.The endoscopic transcanal modified canal-wall-down mastoidectomy approach al lows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.
基金This work was supported by grants from Beijing Medical Development Foundation （No. 2002-3075） and China Postdoctoral Science Foundation （No. 20080440224）.
文摘Background The recombinant human bone morphogenetic protein 2 （rhBMP-2） has been used to induce osteogenesis in animals＇ middle ear and this technique is possible to be used to reconstruct the defects of ossicles. The side effects of the rhBMP-2 in middle ear should be observed before using in clinic. Thus we prepared the controlled release rhBMP-2 and implanted it into the acoustic bulla of guinea pigs. The effect on the cochlea was observed. Methods We prepared the acellular cancellous bone, accompanied with rhBMP-2. The material accompanied with rhBMP-2 was implanted into one acoustic bulla of the animal and the opposite side of the acoustic bulla was implanted with acellular cancellous bone without rhBMP-2. Totally 20 guinea pigs were undergone this procedure. After the operation, the auditory brainstem response （ABR） of the animals was tested according to the time sequence. Three months after the operation, the animals were sacrificed. The osteogenesis induced by rhBMP-2, the acoustic bulla and cochlea affected by rhBMP-2 were observed. The structures of hair cells were observed after silver nitrate staining. Results The animals were recovered soon after surgery. The hearing thresholds of the animals were declined slightly just after the surgery and come back completely after 3 months. Also, the bulla and cochlea were normal in shape. The osteogenesis occurred in the pore of the acellular cancellous bone with rhBMP-2. There was not any abnormal hyperplasia of bone in the bulla and cochlea. The articulation between the stapes and oval window was not merged. The shapes of the hair cells were normal and there was no obvious deletion of the hair cells compared with control group. Conclusions The controlled release rhBMP-2 transplanted into the middle ear could induce osteogenesis in the bulla of the animals. It did not affect the shape of the bulla and the hearing threshold of the animal, and did not induce the abnormal hyperplasia of bone in the bulla and might be used to reconstruct the defects of os
文摘Chronic inflammatory demyelinating polyneuropathy(CIDP) is a progressive autoimmune disorder that targets peripheral nerves. It commonly presents with motor-predominant dysfunction and enlargement of cranial nerves. With regards to hearing loss, a few cases of sensorineural loss have been described. We present a novel case of conductive hearing loss caused by a mass on the tympanic segment of the facial nerve in the setting of CIDP.
文摘The study was done to review postoperative hearing gain of patients with different Middle Ear Risk Index (MERI) undergoing Tympanomastoidectomies with titanium prostheses reconstruction. A Retrospective chart review was performed from September 2009 to December 2011. Of the 17 cases, 9 had moderate MERI while 8 had severe MERI. 9 patients underwent Tympanomastoidectomy with Total Ossicular Reconstruction Prostheses (TORP) and 8 with Partial Ossicular Reconstruction Prostheses (PORP). Hearing gain of 25.31 dB was achieved in cases with moderate MERI compared to 29.37 dB in severe MERI. Less than 20 dB average air-bone gap was achieved in 75% of PORP and 77.77% of TORP reconstructions. In developing countries with limited resources, decision regarding ossicular reconstruction should be made taking into account MERI, intra operative findings and type of surgery. Best results are achieved in cases of CWD with TORP and ICW with PORP.
文摘The purpose of this paper is to review some of the promising technological developments related to hearing restoration part of ENT practice. If success-fully implemented in product or procedure form, these technologies are likely to simplify surgical pro-cedures related to hearing restoration and improve the condition of patients. The developments are com-piled from scientific sources as well as from recent patent documents and they are not yet commercially available.
文摘Purpose:Partial ossicular replacement(PORP)and total ossicular replacement prostheses(TORP)are used to restore ossicular chain function.Despite favorable auditory outcomes,these interventions have associated risks and complications.This study examines the FDA MAUDE database for ossicular chain prosthesis adverse events to highlight complications,interventions,and root cause analysis(RCA)findings.Materials and methods:The MAUDE database was searched for Medical Device Reports(MDRs)relating to PORPs and TORPs from 2010 to 2020.MDR event descriptions were reviewed,and adverse events were identified as a device issue,patient issue,and/or packaging issue that occurred intraoperatively or postoperatively.Results:Our search identified 70 MDRs which included 110 reported adverse events.Events consisted of 63 device issues,often due to device breaks and displacements,39 patient issues,including common complaints of hearing loss and erosion,and 8 packaging issues.When comparing PORPs and TORPs,TORPs had more reported device issues whereas PORPs had more packaging issues.Intraoperative device issues were commonly resolved by completing the procedure with a backup device and most postoperative device issues required additional surgery.For devices returned to the manufacturer,RCA determined that most breaks were caused by modification and/or mishandling or that the product met specifications with an undetermined cause for the break.Conclusion:Device issues were the most common adverse events and frequently required subsequent intervention.Displacement occurred more often with TORPs and was associated with changes in hearing or erosion.The findings of this study are purely descriptive and may not have direct clinical relevance.
文摘<strong>Aim:</strong> Chronic otitis media (COM) is chronic muco purulent discharge through a perforated tympanic membrane. Theossicular chain damage is found in both mucosal and squamosal types of COM. We aim to evaluate relationship between preoperative otologic features, pure tone audiometric findings and intraoperative ossicular chain status in patients with chronic otitis media. <strong>Material and Methods:</strong> 100 patients of either sex aged between 12 to 60 years operated for active or inactive, squamosal or mucosal chronic otitis media attending Ram Lal Eye and ENT Hospital, Government Medical College Amritsar were taken. The preoperative ossicular chain status based on set parameters was compared with the intraoperative ossicular chain status. <strong>Results:</strong> The ossicular chain integrity is more commonly compromised in squamosal COM and the most common ossicle eroded is Incus. Pure tone audiogram has got a very important role in determining the ossicular chain integrity preoperatively and must be done in all cases with accuracy. <strong>Conclusion:</strong> It is concluded that on the basis of otoscopic examination and pure tone audiometry values, we can accurately classify the COM as mucosal or squamosal type and get an idea of the ossicular chain integrity preoperatively hence planning the extent of surgery.
文摘Acoustic reflex is a sensitive indicator of middle ear lesions when the tympanic membrane is in-tact and tympanometry is normal. Acoustic reflex is not usually observed in conductive hearing loss caused by disruption of the ossicular chain including ossicular discontinuity and fixation. Ossicular disruption can show at least partially intact acoustic reflex under a certain condition. Moreover, ossicular discontinuity with a nearly intact acoustic reflex is quite rare and there have been few reports published to date. We here present a rare case of conductive hearing loss with a nearly intact acoustic reflex, and the patient was surgically confirmed to have ossicular discontinuity.
基金This study was supported by Medical Research Fund Projects of Guangdong Province，Jinan University Scientific Research Opening Stock Project
文摘Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dis
