Predictors of hearing outcomes in patients undergoing ossicular chain reconstruction in a developing country / Factores predictores de desenlaces auditivos en pacientes llevados a reconstrucción de la cadena osicular en un país en vía de desarrollo

Objective: To explore the social and clinical factors that predict audiometric outcomes in patients undergoing ossicular chain reconstruction. Methods: A retrospective analytical cohort study was conducted, including patients 18 years of age or older with a history of chronic otitis media (COM) and/or any of its complications, who underwent ossicular chain reconstruction with Partial Ossicular Replacement Prosthesis (PORP) or Total Ossicular Replacement Prosthesis (TORP), at Hospital San José and Hospital infantile Universitario de San José between 2012 and 2020. We excluded patients with ossicular chain malformations and those with incomplete information. Information about sociodemographic and clinical factors was collected. Additionally, the surgery findings information was analyzed using the Ossiculoplasty outcome parameter staging ( OOPS) index. Results: A total of 35 adult patients who underwent ossicular chain reconstruction were retrospectively studied. An improvement was evidenced in the Preoperative Pure-Tone Average (PTA) and postoperative PTA (p-value=0.036), as well as in the pre and postoperative air-bone gap (ABG) (p-value < 0.01). A moderate correlation coefficient was found between the OOPS index and the postoperative PTA (p= 0.429), and between the OOPS index and the postoperative (ABG) (p= 0.653). Conclusion: We found that a higher OOPS score is correlated with worse hearing outcomes postoperatively, and there was no association between the demographic or pathologic factors with a worse postoperative hearing outcome. Therefore, OOPS index can predict audiometric outcomes in patients undergoing ossicular chain reconstruction in a developing country, regardless of the demographic or pathologic factors.

Objetivo: Evaluar los factores sociales y clínicos que predicen los desenlaces audiométricos en pacientes llevados a reconstrucción de cadena osicular en un país envía de desarrollo. Métodos: Se realizo un estudio de cohorte analítico retrospectivo donde se incluyeron pacientes mayores de 18 años, con antecedente de otitis media crónica y/o alguna complicación/secuela de esta, que fueron llevados a reconstrucción de la cadena osicular con prótesis PORP - TORP de la Fundación Universitaria de Ciencias de la Salud entre el año 2012 y 2020, se excluyeron pacientes con malformaciones de la cadena osicular y aquellos con informacion incompleta de su historia clinica y quirurgica. Resultados: La población estudiada fue 35 pacientes, en los cuales se compararon variables demográficas, antecedentes de rinitis o tabaquismo activo, parámetros audiológicos pre y postoperatorios, y hallazgos intraquirurgicos. Se evidenció una diferencia estadísticamente significativa entre el promedio tonal auditivo (PTA) preoperatorio y el PTA postoperatorio (p-valor=0.036), así como en el gap aéreo- oseo pre y post operatorio ( p-valor < 0.01). Se reportó un coeficiente de correlación moderado entre el índice OOPS y el PTA post operatorio (p = 0.429), y entre el índice OOPS y el gap aéreo óseo post operatorio (p = 0.653), lo que indica que a mayor puntaje en el índice OOPS peores desenlaces auditivos. Conclusión: En este estudio un mayor puntaje en el índice OOPS se correlacionó con peores desenlaces auditivos. No se evidenció correlación entre los factores demográficos u otras comorbilidades descritas y un peor desenlace auditivo post operatorio. Aunque se obtuvo un GAO postoperatorio ≤20dB en el 48.5% de los pacientes, se observó una disminución en el GAO estadísticamente significativo.

Evaluation of Recurrence and Hearing Outcome for Inactive Squamosal Disease after Cartilage Strengthening Tympanoplasty

Abstract Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.

Alteração auditiva em osteogênese imperfeita: revisão sistemática de literatura / Auditory alteration in osteogenesis imperfecta: systematic literature review

RESUMO Objetivos Analisar as publicações científicas sobre audição em indivíduos com osteogênese imperfeita. Estratégias de pesquisa Trata-se de revisão sistemática de literatura. Foram selecionados os descritores Hearing OR Hearing Loss AND Osteogenesis Imperfecta. Duas revisoras consultaram as bases de dados Cochrane Library, PubMed, LILACS, Scopus e Embase. Critérios de seleção utilizaram-se os Descritores em Ciências da Saúde, não sendo delimitado período de publicação dos estudos. Foram critérios de inclusão estudos de coorte, seguimento, transversais, casos controle e em idioma inglês. Foram critérios de exclusão artigos editoriais, relatos/séries de casos, resumos de eventos e estudos conduzidos em animais. Os estudos selecionados foram analisados pela Iniciativa STROBE e pelo Sistema GRADE. Resultados Dos 652 estudos obtidos, foram selecionados 16. A perda auditiva do tipo condutiva foi o tipo mais comum na população com osteogênese imperfeita (OI) e seu início ocorre por volta da segunda década de vida. A definição e a classificação para aferição de perda auditiva, nas publicações com a população com osteogênese imperfeita, apresentaram discordância entre os estudos. Conclusão Esta revisão respondeu às perguntas a que se propôs, constatando que as alterações audiológicas encontradas em pacientes com OI são do tipo condutivo, neurossensorial e misto. Alterações condutivas são mais comuns em pacientes mais jovens e alterações neurossensoriais, em pacientes mais velhos. A Iniciativa STROBE apontou itens descritos de forma parcial e o Sistema GRADE concluiu que os estudos apresentaram alguma falha metodológica.

ABSTRACT Purpose To analyze scientific publications on the hearing issue of patients with osteogenesis imperfecta. Reserch strategy This study is a systematic literature review. The following descriptors were selected "Hearing" OR "Hearing Loss" AND "Osteogenesis Imperfecta". Two reviewers searched the Cochrane Library, Pubmed, Latin American and Caribbean Health Sciences Literature, Scopus and Embase databases. Selection criteria Descriptors in Health Sciences were used and the publication period of studies was not limited. Inclusion criteria were cohort, follow-up, cross-sectional, and control studies in English language. Exclusion criteria were editorial articles, case reports, case summaries, and animal studies. Selected studies were analyzed by the STROBE Initiative and the GRADE System. Results Of the 652 studies, 16 were selected. Conductive hearing loss is the most common type in the osteogenesis imperfecta (OI) population and its onset is around the second decade of life. Definition and classification for hearing loss measurement in publications with the osteogenesis imperfecta population present disparities among studies. Conclusion This review met the objectives proposed, concluding that audiological alterations found in OI patients are of conductive, sensorineural and mixed types; conductive alterations are more common in younger patients and sensorineural alterations in older ones. The STROBE initiative partially pointed out described items and the GRADE system concluded that studies present some methodological failure.

A multi-center retrospective study of ossiculoplasty surgery under oto-endoscope in 45 cases of conductive hearing loss with intact tympanic membrane / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the efficacy of ossiculoplasty surgery under oto-endoscope in patients of conductive hearing loss with intact tympanic membrane.@*Methods@#A retrospective study was conducted. The clinical data of 45 patients with conductive hearing loss who had undergone simple ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China (West China Hospital of Sichuan University, General Hospital of the People′s Liberation Army, Shanghai Ninth People′s Hospital, Shanghai JiaoTong University School of Medicine, Xijing Hospital, Fourth Military Medical University and Shenzhen Sixth People′s Hospital) were collected. There were 28 males and 17 females, with the age ranging from 12 to 69 years old. The tympanic membranes of those patients were intact before surgery. The lesion only occurred in the ossicular chain from CT and intraoperative exploration. The cases of otosclerosis, tympanosclerosis, cholesteatoma of middle ear, chronic suppurative otitis media, and tumor of middle ear were excluded. The postoperative complications, hearing improvements and operation time were observed. SPSS 23.0 software was used for statistic analysis.@*Results@#There was neither sensorineural hearing loss nor facial paralysis after surgery in this group. Seven patients had transient mild tinnitus after surgery and gradually relieved during the follow-up period. Nine patients developed dysgeusia after surgery. Two patients developed dizziness after surgery, and the symptoms were mild and relieved during 1 week without special intervention. The air-bone gap (ABG) range of pre-operation was 22.5-45.7 dB, and the average ABG was (25.3±8.6) dB. The ABG range in the third month after surgery was 5.7-26.8 dB, and the average ABG was (9.3±8.6) dB. The mean value of ABG was significantly lower in the third month after surgery compared with that of pre-operation (t=2.31, P<0.05). The operation time of the surgeons in each research center was similar. The overall average of operation time was (43.56±18.25) min. There was no significant difference in the duration of operation between the centers (F=3.26, P>0.05).@*Conclusion@#The ossiculoplasty surgery under oto-endoscope has good efficacy.

Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

Abstract Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of themalleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8-72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

The use of CO2 laser in treatment of the malformation of ossicular chain / 中国耳鼻咽喉头颈外科

OBJECTIVE To share surgical experience of ossicular chain malformations with CO2 laser.METHODS A retrospective analysis was performed.9 patients with clinical diagnosis of ossicular malformations underwent ossicular reconstruction with CO2 laser-assisted from May 2010 to Mar 2016,the results were evaluated by comparing preoperative and postoperative audiometric outcomes and the rate of postoperative complications.RESULTS 8 cases with complex lesion combining incus and stapes were found intraoperatively,the deformity located on stapes was showed in one case.The mean postoperative air conduction (AC) value was (26.53 ± 12.28) dB,the mean postoperative air-bone gap (ABG) was (9.44 ± 9.62) dB,the postoperative AC and ABG value improved considerably comparing with the preoperative value in all the patients,the difference was statistically significant.CONCLUTION CO2 laser is a suitable and effective adjunct in surgery for ossicular malformations such as otosclerosis.The use of the laser improves hearing results and operation efficiency and is not likely to increase side-effects to patients.

Revisión bibliográfica de la detección temprana de luxación incudomaleolar mediante imágenes tomográficas / Revisão da literatura de detecção precoce do deslocamento incudomallear por imagens tomográficas / Literature review of early detection of incudomalleolar dislocation by using tomographic imaging

Introducción: Esta revisión hace énfasis en la luxación incudomaleolar. Aunque poco frecuente, es una patología con gran relevancia clínica debido a la afectación de la audición a corto y mediano plazo en los pacientes, afectando así su calidad de vida, por lo que es necesario un diagnóstico oportuno para un tratamiento temprano y eficaz. Objetivo: describir los hallazgos imagenológicos e identificar los diferentes mecanismos etiológicos de la luxación incudomaleolar. Metodología: Se realizó una revisión bibliográfica en PubMed de los artículos publicados hasta febrero de 2015 con las palabras claves: “Ear ossicles”; “Temporal bone”; “Bone”; “Fractures”; “Dislocation”; “Conductive hearing loss”. Se encontraron 352 artículos de los cuales se seleccionaron aquellos donde se menciona la luxación incudomaleolar. Resultados: Se revisaron los abstracts de los 352 artículos, encontrando 20 donde mencionaban la definición, la epidemiología, la clínica y el diagnóstico imagenológico de la luxación incudomaleolar, los cuales fueron utilizados para la elaboración de esta revisión. Conclusiones: La principal causa de daño en la cadena de huesecillos es la fractura del hueso temporal y dentro de las patologías que puede generar está la luxación incudomaleolar, por lo que es de interés el diagnóstico temprano a todos los pacientes con sospecha clínica para llegar a prevenir complicaciones. La revisión de la literatura permite concluir que la técnica más eficaz para la identificación de la luxación Incudomaleolar es la tomografía computarizada, la cual requiere una adecuada identificación en los diferentes cortes multiplanares, o en las reconstrucciones 3D para poder diagnosticarla.

Introduction: This research emphasizes in the incudomallear dislocation. Although it is rare, it is a disease with great clinical relevance due to the short and long term involvement of patients’ hearing so that it affects their quality of life, so it is very important a timely diagnosis for an early and effective treatment. Objective: To describe the imaging findings and identify the different etiologic mechanisms of incudomallear dislocation. Methodology: A literature review was carried out in PubMed about articles published until February 2015 with the keywords: "Ear ossicles"; "Temporal bone"; "Bone," "Fractures"; "Dislocation"; "Conductive hearing loss" finding 352 articles and selecting those that mentioned the incudomallear dislocation. Results: The abstracts of 352 articles were examined and 20 of them mentioned the definition, epidemiology, clinical and imaging diagnosis of incudomallear dislocation, and they were used to prepare this research. Conclusions: The main cause of damage to the ossicles is the temporal bone fracture, and among the diseases that this can produce, there is the incudomallear dislocation, therefore it is of great interest a timely diagnosis to all patients with clinical suspicion to prevent complications. The literature review allows us to conclude that the most effective technique to identify the incudomallear dislocation is computed tomography, which requires proper identification in different multiplanar cuts, or 3D reconstructions to diagnose it.

Introdução: Esta revisão enfatiza o deslocamento incudomallear. Embora seja raro, é uma doença de grande relevância clínica por causa do envolvimento da audição em pacientes a curto e a longo prazo, afetando sua qualidade de vida, por isso é muito importante o diagnóstico e assim poder realizar o tratamento precoce e eficaz. Objetivos: Descrever o diagnostico da imagem e identificar os diferentes mecanismos etiológicos da luxação incudomallear. Metodologia: A revisão da literatura foi realizada no PubMed para artigos publicados até fevereiro de 2015, com as palavras-chave: "ossículos do ouvido"; "Osso temporal"; "Osso", "fraturas"; "Deslocamento"; "A perda auditiva condutiva" foram encontrados 352 artigos e selecionados aqueles que mencionam o deslocamento incudomallear. Resultados: Foram revisados os resumos de 352 artigos e se encontrou que 20 artigos mencionavam a definição, epidemiologia, diagnóstico clínico e de imagem de incudomallear deslocamento, que foram utilizados para a preparação desta revisão. Conclusões: A principal causa de danos aos ossículos é a fratura do osso temporal e o deslocamento incudomallear é uma das patologias que poderia ocorrer, por esta causa é muito importante obter o diagnostico oportunamente e fazer o respectivo tratamento evitando então, graves complicações. A revisão da literatura permite-nos concluir que da técnica mais eficaz para a identificação de deslocamento incudomallear é a tomografia computadorizada, o que exige uma identificação adequada nos diferentes cortes multiplanares, ou reconstruções 3D para diagnosticar.

Audiologic Patterns of Otic Capsule Preserving Temporal Bone Fracture: Effects of the Affected Subsites

OBJECTIVES: This study was aimed to assess the relationship between the type of temporal bone area involved and conductive hearing loss. METHODS: We enrolled 97 patients who visited the otolaryngology clinics of Seoul National University Hospital or Boramae Medical Center, Seoul Metropolitan Government-Seoul National University with temporal bone fracture between January 2004 and January 2014. Audiometric parameters, including initial and improved air-bone (AB) conduction gap values, were reviewed in accordance with the temporal bone computed tomography (external auditory canal [EAC], middle ear [ME], mastoid [M], and ossicle [O]). RESULTS: Patients with ossicular chain involvement exhibited a larger AB gap compared to those with no ossicular chain involvement at 250, 1,000, 2,000, and 4,000 Hz. Among the groups without ossicular chain involvement, the initial AB gap was largest in patients with EAC+ME+M involvement, followed by the ME+M and M-only involvement groups. The greatest improvement in the AB gap was observed in the EAC+ME+M group followed by the ME+M and M-only groups, irrespective of ossicular chain involvement. Improvements in AB gap values were smallest at 2,000 Hz. CONCLUSION: Conductive hearing loss pattern differed according to the temporal bone area involved. Therefore, areas such as the hematoma and hemotympanum, as well as the fracture line of the temporal bone area, must be evaluated to predict audiologic patterns with otic capsule preserving temporal bone fracture.

Bilateral Ossiculoplasty in 1 Case of Achondroplasia

Achondroplasia is the most common skeletal dysplasia and it combines various complications with normal longevity. Hearing disturbance due to otitis media or an ossicular anomaly is one of the most common complications. Conductive hearing loss is suggested as the most common form of hearing loss. Temporal bone and middle ear structures are distorted in achondroplasia because of rotational change of the skull base. Authors experienced a case of an achondroplastic patient with bilateral hearing disturbance. We faced making a potential mistake during the previous operation but a favorable postoperative result occurred. Our experience could be helpful to other clinicians who face achondroplastic patients.

Distribution of elastic fibers in the head and neck: a histological study using late-stage human fetuses / 대한해부학회지

There is little or no information about the distribution of elastic fibers in the human fetal head. We examined this issue in 15 late-stage fetuses (crown-rump length, 220-320 mm) using aldehyde-fuchsin and elastica-Masson staining, and we used the arterial wall elastic laminae and external ear cartilages as positive staining controls. The posterior pharyngeal wall, as well as the ligaments connecting the laryngeal cartilages, contained abundant elastic fibers. In contrast with the sphenomandibular ligament and the temporomandibular joint disk, in which elastic fibers were partly present, the discomalleolar ligament and the fascial structures around the pterygoid muscles did not have any elastic fibers. In addition, the posterior marginal fascia of the prestyloid space did contain such fibers. Notably, in the middle ear, elastic fibers accumulated along the tendons of the tensor tympani and stapedius muscles and in the joint capsules of the ear ossicle articulations. Elastic fibers were not seen in any other muscle tendons or vertebral facet capsules in the head and neck. Despite being composed of smooth muscle, the orbitalis muscle did not contain any elastic fibers. The elastic fibers in the sphenomandibular ligament seemed to correspond to an intermediate step of development between Meckel's cartilage and the final ligament. Overall, there seemed to be a mini-version of elastic fiber distribution compared to that in adults and a different specific developmental pattern of connective tissues. The latter morphology might be a result of an adaptation to hypoxic conditions during development.

Estapedotomia totalmente endoscópica: técnica e resultados preliminares / Fully endoscopic stapes surgery (stapedotomy): technique and preliminary results

Estapedotomias são realizadas atualmente com o auxílio de microscópios cirúrgicos. Entretanto, o uso do microscópio possui algumas limitações, podendo causar algumas complicações, como lesão no nervo corda do tímpano. Há poucos casos e nenhuma série publicada sobre a utilização de endoscópios nasossinusais na realização de estapedotomias. OBJETIVOS: a) Investigar o uso do endoscópio nasossinusal em estapedotomias, com foco na visualização de estruturas importantes. b) Mostrar os resultados iniciais, discutindo as possíveis vantagens e desvantagens deste instrumento. METODOLOGIA: 15 pacientes com otosclerose foram selecionados para realizar estapedotomias em 2010. Os dados e vídeo cirúrgico foram analisados retrospectivamente (estudo de série de casos). As condições anatômicas do nicho da janela oval e passos cirúrgicos foram descritos para avaliar possíveis benefícios do procedimento endoscópico. RESULTADOS: As cirurgias foram realizadas exclusivamente com endoscópios e todas as estruturas com relevância anatômica, visualizadas sem maiores dificuldades. Nenhuma complicação foi observada e 14 dos 15 pacientes referiram melhora auditiva, confirmada com exames audiológicos pós-operatórios. CONCLUSÃO: Estapedotomias totalmente endoscópicas são tecnicamente viáveis, seguras e promissoras. Nesta pequena série as principais vantagens foram: praticamente nenhum trauma no nervo corda do tímpano e excelente campo de visão. As desvantagens foram falta de visão estereoscópica, trabalho unimanual e curva de aprendizado.

Stapedotomies are perfomed with the aid of surgical microscopes. However, the microscope has some limitations and may cause complications such as damage to the chorda tympani nerve. There are just a few cases and no series published on the use of sino-nasal endoscopes in stapedotomies. OBJECTIVES: a) To investigate the feasibility of using sino-nasal endoscopes in stapedotomies, focusing on the visualization of important structures. b) To show initial results, discuss possible advantages and disadvantages of this instrument. METHODS: 15 patients with otosclerosis were selected to undergo stapedotomies in 2010. The data and surgery videos were analyzed retrospectively (study case series). The anatomical conditions of the oval window niche and surgical steps were described and used to assess possible benefits of such procedures. RESULTS: The surgeries were performed with endoscopes only and all relevant anatomical structures were visualized without difficulty. No complications were observed and 14 of the 15 patients reported improvement of their hearing, confirmed by postoperative audiological tests. CONCLUSION: Totally endoscopic stapes surgeries are technically feasible, safe and promising. In this small series, the main advantages were: virtually no trauma to the chorda tympani nerve and excellent vision. The disadvantages were the lack of stereoscopic vision, having to work with one hand only and the learning curve.

Study on the Development of the Mouse Ossicles Using Micro-CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Detailed information on how ossicles change in the developing temporal bone would be helpful in understanding biomechanical knowledge of ossicles. In this study, three dimensional structural images of mouse were investigated through Micro-CT to understand developmental anatomy of its ossicles. MATERIALS AND METHOD: Thirty five temporal bones of BALB/c mice, aged from gestational day 11 to postnatal day 21, and adults were investigated. Three-dimensional highresolution reconstructions of the ossicles of the left sided temporal bones were obtained using a Micro-CT system. The right sided temporal bones were used for the histological study. RESULTS: Internal biomechanical characters (volume fraction, structure model index, degree of anisotropy, etc) of murine ossicles and temporal bones were attained to the adult level at postnatal day 21. CONCLUSION: This study will be useful in understanding the more accurate microstructure of murine temporal bone, and will provide the anatomical basis for the future animal studies.

Clinical Manifestation and Treatment of Malleus Fixation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Malleus fixation is one of the important causes of persistent conductive hearing loss. This study was designed to evaluate the clinical manifestation and the treatment outcome of malleus fixation. SUBJECTS AND METHOD: This study was a retrospective review of medical records between 1989 and 2008. Patients diagnosed as malleus fixation by intraoperative findings at the Department of Otorhinolaryngology, Seoul National University Hospital were included. Those cases with chronic otitis media and congenital ossicular anomaly involving the incus or stapes were excluded. A total of 13 patients were included (M:F=4:9, Mean age: 24.4 years old). RESULTS: All patients (100%) complained of hearing loss. Preoperative mean air-bone conduction gap was 34.4 dB and 5 (83.3%) out of 6 patients had A-type in impedence audiometry and 3 (75%) out of 4 patients had negative results in Gelle test. In the temporal bone computed tomography (TBCT) findings, we could identify bony spicules (2 cases), sclerosis of ligament (3 cases) and epitympanic contraction (2 cases). According to the different causes of conductive hearing loss, corrective surgery was performed: the release of bony ankylosis (2 cases), lysis of ligament (6 cases) and ossiculoplasty (5 cases) were performed. There was a statistically significant improvement in air-bone conduction gap (34.4 dB vs. 20.3 dB, p=0.009) after surgery. CONCLUSION: Considering the improvement of air-bone conduction gap after the corrective surgery, clinical suspicion of malleus fixation is important in cases of unknown conductive hearing loss.

A Case of Congenital Cholesteatoma : Combined with Ossicular Anomaly / 대한이비인후과학회지

Congenital middle ear cholesteatoma is presented as a pearl-like-material behind an intact tympanic membrane. Congenital cholesteatoma can be associated with other congenital anomalies, especially ossicular anomalies. The patient was a 10-year-old male with incidentally known hearing disturbance with intact tympanic membrane. The pure tone average through air conduction of his left ear was 55dB. During exploratory tympanotomy, congenital cholesteatoma was found in the middle ear cavity in a scattered pattern and fibrous stapes was located below the oval window with an intact stapedial footplate. We removed cholesteatoma matrix and performed ossiculoplasty with total ossicular replacement prosthesis (TORP). After 1 month, the postoperative pure tone average through air conduction of the left ear was 33dB. We report one case of congenital middle ear cholesteatoma with congenital ossicular anomaly with a review of the related literature.

Proposal for Classification of Isolated Congenital Ossicular Anomalies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many different types of congenital ossicular anomalies, which may be broadly divided into major ear anomalies and minor ear anomalies. Minor congenital anomalies are restricted to the middle ear, while major congenital anomalies are malformations of the middle ear and external meatus and sometimes the auricle. The great diversity of anomalies of the middle ear described in the literature makes it difficult to compare and analyze it. The objective of this study is to review and analyze the isolated congenital ossicular anomalies published in the Korean literatures with special reference to the pattern of anomalies and surgical treatment results, and to propose a new systematic classification of isolated congenital ossicular anomalies. SUBJECTS AND METHOD: We reviewed retrospectively 10 Korean literatures concerning isolated congenital ossicular anomalies, which included 117 cases. We also reviewed 9 cases of isolated congenital ossicular anomalies from Ajou University Hospital from Jan 2002 to June 2003, which were not reported in the literature. Among the total 126 cases of isolated congenital ossicular anomalies, follow-up on the hearing results was possible in 112 ears. RESULTS: We proposed a new classification of isolated congenital ossicular anomalies using 5 types based on the stapes status. Twenty-six anomalous patterns were detected out of 126 cases of isolated congenital ossicular anomalies. Using the new classification, the more severe anomaly stapes could be displayed, and the worse postoperative hearing gain could be also predicted. CONCLUSION: Ossicular anomalies were detected without a certain rule of pattern, and big variety of those patterns could be detected in the future. Our proposed new classification will be helpful to analyze the pattern and surgical result of congenital ossicular anomalies.

Volume Fraction of the Human Pathologic Ossicles Destructed by Cholesteatoma Using Micro-CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conventional studies for the middle ear ossicles destructed by cholesteatoma give relatively limited information on shape, mechanical strength and 3-dimensional relationship. Recently, Micro-CT scanning technology has been applied to analysis of skeletal structure. This study aims to reconstruct the 3-dimensional structure of normal ossicles and destructed ossicles by different cholesteatomas and to compare volume fraction of destructed ossicles with that of normal ossicles. MATERIALS AND METHOD: 13 pathological ossicles obtained during cholesteatoma surgery were used in this study (2 malleuses and 2 incuses from attic cholesteatoma;1 malleus and 2 incuses from sinus cholesteatoma;2 malleuses and 2 incuses from tensa retraction cholesteatoma; 2 incuses from congenital cholesteatoma). As a control, normal ossicles harvested from cadaveric temporal bone specimens were used. The structure of obtained ossicles was analyzed through Micro-CT (SkySan-1072, Belgium) by filming the 2-dimensional cross section image running perpendicular to the long axis of the ossicles. The 3-dimensional images were thereby reconstructed for each, and were analyzed using CT-Analyzer(TM) and ANTTM. Based on the results, the strength of each ossicle were measured. RESULTS: The volume fraction, indicating relative strengths of ossicles, was lower in the portion of destructed surface. The pattern of destructed ossicles by cholesteatoma was different according to pathological status of cholesteatoma. CONCLUSION: Our preliminary data of ossicular structure analyzed by Micro-CT scan will be helpful for elucidation of pathological ossicles in middle ear cholesteatoma and will make a great contribution to research of middle ear cholesteatoma.

Study on the Three Dimensional Structure of the Human Ossicle Using Micro CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conventional studies of the middle ear ossicles give relatively limited information on shape, mechanical strength and 3-dimensional relationship. Recently, Micro CT scanning technology has been applied to analysis of skeletal structures. This study aims to reconstruct the 3-dimensional structure of the ossicles, including length, thickness, strength, and the angle. MATERIALS AND METHOD: The structures of ossicles obtained from 3 cadavers were analyzed through micro CT by filming the 2-dimensional cross section image running perpendicular to the long axis of the ossicles. The 3-dimensional images were thereby reconstructed for each, and were analyzed using CT-Analyzer(TM) and Ant(TM). Based on the results, the strength, length, and angle of each ossicle were measured. RESULTS: The ratio between the handle of malleus (4.413 mm) and the long process of incus (3.559 mm), which acts as a lever of the middle ear impedance transformer, was 1.24. The volume fraction, indicating relative strengths of ossicles, was higher in the portion close to the articular surface. CONCLUSION: Our preliminary data of the ossicular structure analysed by micro CT scan will be helpful for the elucidation of ossicle's structure and the further development of artificial prosthesis.

Conductive Hearing Loss with Intact Tympanic Membrane: Two Cases of Fibrous Change of the Ossicles / 대한이비인후과학회지

In general, causes of conductive hearing loss with the intact tympanic membrane and external auditory canal are known as congenital anomaly of the ossicular chain, otosclerosis, and head trauma-induced ossicular discontinuity. But it may also occur due to fibrotic change by potential inflammation of the ossicular chain as a result of otitis media in the infancy or childhood. We report two cases of fibrous change of the ossicles by probable middle ear inflammation with a review of the related literature.

Congenital Ossicular Anomaly with Intact Tympanic Membrane / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A nonprogressive and conductive hearing loss in the range of 40 to 60 dB with normal tympanic membrane which has no history of trauma or infection is highly suggestive of a congenital ossicular malformation. Stapes anomaly is the most common among such ossicular anomalies and it is clinically important because hearing loss can be corrected by appropriate procedures. In this study, we attempted to describe the patterns of ossicular anomalies encountered in patients who have a normal eardrum. We also analyzed the surgical result with special reference to the pattern of ossicular anomaly. MATERIALS AND METHOD: We experienced 28 ears (23 patients) of congenital ossicular anomalies which were confirmed through the exploratory tympanotomy at Ajou University Hospital between September 1994 and December 2001. The preoperative and postoperative audiologic findings, operative findings and CT findings were analyzed. RESULT: There were 7 patterns of ossicular anomalies among which stapes footplate fixation was the most common anomaly. We could get 64.3% of hearing improvement after ossiculoplasty with several kinds of prosthesis. CONCLUSION: There was a great diversity of patterns of ossicular anomalies without certain rule. Stapes anomaly was the most commonly detected. Stapes footplate fixation was the most common type which was usually bilateral. Anomalies associated with incus and malleus were usually unilateral. The surgical result of congenital ossicular anomaly was generally good.

Clinical Study of Three-dimensional CT Virtual Endoscopy (CTVE) of the Auditory Ossicular Chain in the Middle Ear / 实用放射学杂志

Objective (1)To observe the imaging features of the normal anatomic structures of middle ear using CT virtual endoscopy.(2)To study morphologic changes of ear ossicles and auditory ossicular chain of patients with conductive deafness.Methods CTVE of the auditory ossicular chain was performed on GE Hispeed CT/I with 1.0 mm slice thickness at pitch 1, bone algorithm, voltage 140 kV, electric current 170～220 mA, 9.6 cm field of view.Results CTVE could clearly demonstrate the normal auditory ossicular chain and its anatomic details. The demonstration rate of CTVE images in detecting the malleus-incus joint was 100%(162/162), in detecting "L"type incus-stapes joint was 80%(130/162), in detecting the anterior and posterior stapes footplate was 73%(121/162); CTVE could well display the destruction of auditory ossicular chain in otitis media and cholesteatoma and could acurately show the malformation of the auditory ossicular chain.Conclusion CTVE can quickly, non-invasively, three-dimensionally display the middle ear auditory ossicular chain, can provide direct and reliable imaging information for discovering the cause of a disease of conductive deafness.