Comparison of two Methods for the Modeling of Tympanosclerosis in Rat / 听力学及言语疾病杂志

Objective To establish a rat model of tympanosclerosis(TS) by myringotomy and inoculation of streptococcus pneummoniae, and to observe the morphological change in the tympanic membrane (TM) and middle ear mucous.Methods Forty Sprague-Dawley rats were randomly divided into two groups (n=20/group) and then ten in each group were chosen to serve as the control and the other ten were set up for the TS model.Group A (myringotomy): myringotomy was performed on the bilateral TMs of all rats except the control group.Group B (bacterial inoculation): streptococcus pneumoniae was inoculated into the bilateral middle ear cavity of all rats except the control group.The condition of the TMs and the middle ears in the two groups were respectively examined at 2 weeks after myringotomy and at the five time points (1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks) after bacterial inoculation.Then the rats were decapitated and the morphological changes were observed by hematoxylin and eosin staining.Results One rat in group B died two weeks after the inoculation.In the two experimental groups, the calcifications were observed in 70%of the TMs (14/20) in group A and in 33.33%of the TMs (6/18) at 8 weeks in group B.At the same time, the inflammatory infiltration and hyaline degeneration markedly appeared in the tympanic membrane and middle ear mucous membrane.In the two control groups, neither morphological changes nor calcifications occurred.Conclusion The current study indicated that the animal model of TS was successfully accomplished by myringotomy and inoculation of streptococcus pneummoniae, and their morphological changes were basically consistent.However, the method of myringotomy is easier to use and can obtain a higher modeling rate in a relatively short time.

Spontaneous middle fossa encephalocele

@#A 48-year old man presented with a unilateral right hearing loss of four months’ duration. A right middle ear effusion was noted on physical examination. Endoscopic examination of the nasopharynx was unremarkable. Due to the duration of the symptoms, myringotomy with ventilation tube insertion was offered as a treatment option. Upon myringotomy, clear pulsatile liquid flowed out of the incision. More than 5 cc of liquid was collected which continued to flow out despite active suctioning. Due to the realization that the liquid most likely represented cerebrospinal fluid, insertion of a ventilation tube was not performed. The ear canal was packed with sterile cotton, and the patient was given a short course of acetazolamide to decrease CSF production. Upon further questioning, the patient did not have any prior head trauma. The patient then underwent both computerized tomographic (CT) imaging and magnetic resonance imaging (MRI) of the temporal bone to look specifically for evidence of a dehiscence in the middle fossa plate (tegmen) or posterior fossa plate, as well as the presence of a meningoencephalocele.

How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child?

The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should keep in mind that pediatric anesthesia has a potential risk. Despite infrequent serious complications, their seriousness necessitates that sedation or general anesthesia should be done by an anesthesiologist and thus children requiring tympanostomy tube insertion should be referred to secondary or tertiary hospitals, even if they have been followed by a primary care physician for a long time. Previous evidence showed that local anesthesia is appropriate for tympanostomy tube insertion in selected children, especially in children older than 5 years are older. Proper choice of anesthesia method is helpful for both patient and medical service provider. Local anesthesia can give psychological relief to children and their parent. It is easier for the medical service providers to schedule the operation and allocate the medical resources in their hospital. Local anesthesia can reduce individual, social, and national burdens for the health care services.

Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population

BACKGROUND AND OBJECTIVES: To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children. SUBJECTS AND METHODS: We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups. RESULTS: Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years. CONCLUSIONS: In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion.

The Clinical Effectiveness of the Minimally Invasive Transcanal Myringotomy for the Removal of Early Stage Congenital Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because of the wide application of the endoscopic diagnostic system and increased amount of attention for early stage congenital cholesteatoma (CC) recently, the detection of CC in stages I and II has increased. In this study, we investigated the effectiveness of minimally invasive transcanal myringotomy (MITM), and compared its results with those of postauricular approach (PAA) in early stage CC consisting of stage I and II of Potsic's classification. SUBJECTS AND METHOD: We retrospectively studied 70 patients who were diagnosed with CC after surgery performed by an otologist from June 2006 to June 2013. Thirty-two patients were in early stage CC consisting stage I and II. Of the 32 patients, MITM was performed on 20 and PAA was performed on 12. We analyzed the characteristics of disease, operation time, hospitalization period, recurrence and complications according to the stage and each operation. RESULTS: There were no significant differences between the stages and types of the disease between the MITM and the PAA group (p>0.05). The operation time and hospitalization period for the MITM group were significantly shorter than for the PAA group (p<0.001). There was no recurrence in the two groups during the average follow-up period of 33 months follow-up. Tympanic membrane perforation occurred in one patient in the MITM group. One patient presenting an external aural epidermal cyst in the PAA group was treated with surgical removal. CONCLUSION: The MITM is an efficacious and feasible method to remove early stage CC.

Myringotomy with Grommet Insertion for Treatment of Tympanic Membrane / 听力学及言语疾病杂志

Objective To evaluate the efficacy of myringotomy with grommet insertion in the treatment of tympanic membrane atelectasis .Methods From July 2011 to July 2013 ,62 patient with tympanic membrane atelecta-sis were treated with myringotomy with grommet insertion in our hospital ,we evaluated 54 patients(56 ears)whose follow -up period was 1 year or more .Of the 54 patients included in this study ,28 (30 ears))were female and 26(26 ears)were male .The age of the patients ranged from 8 to 54 ,with a mean age of 25 .8 ± 6 .6 years old ,and 18 pa-tients (32% ) were under the age of 16 .The air -bone gap(ABG)was compared at pre -operation and 1 year after post-operation .Results The average ABG of pre-operation and post -operation ,including all patients ,were 27 . 07 ± 5 .03 dB and 15 .52 ± 5 .73 dB ,respectively (P<0 .05) ,and the difference was statistically significant .All the 3 groups ,the ABG of pre- and post-operation ,the difference of each group was statistically significant .Conclusion Myringotomy with grommet insertion was effective in treating tympanic membrane atelectasis .

Correlação entre timpanograma e fluído de miringotomia em crianças portadoras de otite média com efusão / Correlation between tympanogram and myringotomy fluid in pediatric patients with otitis media with effusion

A Otite Média com Efusão é uma das causas da impotência auditiva que pode ser tratada simplesmente com a miringotomia ou sem a inserção do tubo de ventilação. Objetivo: Este estudo tem o objetivo de avaliar os diferentes tipos de fluidos após a miringotomia em Otite Média com Efusão; avaliar o exame de timpanograma de pacientes que são submetidos à miringotomia; correlacionar o fluído de miringotomia e o timpanograma pré-operatório em crianças portadoras de Otite Média com Efusão. Método: Um estudo retrospectivo em crianças menores de 12 anos portadoras de Otite Média com Efusão foi realizado na seção de otorrinolaringologia na escola da T.U. em Katmandu entre outubro de 2005 e setembro de 2007. Todos os pacientes que foram submetidos à miringotomia foram avaliados pelo exame timpanométrico e este foi comparado com os tipos de fluidos durante a cirurgia. O resultado foi estatisticamente analisado através do teste Qui-Quadrado. Resultados: A faixa etária dos pacientes era entre cinco e oito anos. Cerca de 56,8% das crianças apresentavam fluido de miringotomia espesso com aspiração seca em 27,5%. O timpanograma evidenciou curva tipo B em 90,2% das crianças. Curva tipo B e fluido espesso foram encontrados em 63%, e 21% das crianças apresentavam aspiração seca. Entretanto, todos os pacientes com fluido expesso apresentaram curva tipo B no timpanograma. A sensibilidade da curva B para prever a presença de fluido foi de 97,3%, enquanto a especificidade para foi de 28,6%. Conclusão: A Curva tipo B é a curva comum no timpanograma em pacientes portadores de Otitie Média com Efusão, porém, nem sempre ela indica a presença de fluido na orelha média. O timpanograma é bastante útil para prever a origem do fluído de miringotomia

Otitis Media with Effusion is a common cause of hearing disability that can be treated simply with myringotomy with or without ventilation tube insertion. Aim: The aims of this study are 1) to assess different types of fluid after myringotomy in Otitis Media with Effusion, 2) to assess the Pre Operative Tympanogram in Patients undergoing myringotomy 3)to correlate between myringotomy fluid and pre operative tympanogram in pediatric patients with Otitis Media with Effusion Method: A retrospective study in children (< 12 years) with Otitis media with effusion was carried out in ENT Department, T.U. Teaching Hospital, Kathmandu between October 2005 to September 2007. All patients undergoing myringotomy were assessed by tympanometry and compared with the types of fluid during surgery. Result was analyzed statistically using Chi -Square Test. Results: Most of the patients were in age group 5-8 years. Around 56.8 % of children had thick myringotomy fluid with dry tap in 27.5 %. Tympanogram showed B type curve in 90.2 % children. In patients with B type curve, thick fluid was found in 63.0%, while 21.0 % children had dry tap. But all patients with thick fluid had B type curve in Tympanogram. Sensitivity of B curve to predict fluid was 97.3% while Specificity was 28.6%. Conclusion: Common type of tympanogram curve in patients with Otitis Media with Effusion is B type, but it doesn?t always indicate to have fluid in middle ear. Tympanogram is useful in predicting the nature of the myringotomy fluid.

Clinical Study of Laser Myringotomy with Ventilation Tube Insertion on Pediatric Chronic Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Complications of a knife myringotomy with ventilation tube insertion is rather frequently encountered. To reduce such complications, we have performed myringotomy using a contact Nd: YAG laser. The purpose of this study was to evaluate the efficacy and safety of laser assisted myringotomy (LAM). MATERIALS AND METHODS: Sixty three patients (106 ears) of ages 1 to 7 were investigated retrospectively. Under the intravenous general anesthesia, LAM was performed to create a 2.0 mm sized perforation. After LAM, a ventilation tube was inserted. RESULTS: All ears underwent successful placement of ventilation tubes. Compared with knife myringotomies, LAM was safe to use in the atrophic tympanic membrane. There were also less intraoperative bleeding and tube plugging, with much lower postoperative otorrhea and myringosclerosis compared to knife myringotomies. Granuloma around the tube did not occurred. Postoperative improvement of air-bone gap reflects that LAM does not damage the inner ear. CONCLUSION: LAM with ventilation tube insertion is more effective than the previous knife myringotomy.

Cleft Palate Patients With Secretory Otitis Media / 听力学及言语疾病杂志

Objective To study the relationship between cleft palate and secretory otitis media(SOM)and the change of hearing of cleft palate patients with SOM before and after tube insertion.Methods 203 cleft palate patients(406 ears)were investigated by pure tone audiometry,acoustic immitance audiometry and auditory brainstem response(ABR).21 cleft palate patients with SOM underwent palatoplasty and myringotomy with tube insertion at the same time.Results The incidence of middle ear disfunction was 68.5% in 203 cases with cleft palate,which in the cases under 6 years the incidence was 80%.After operation,21 cases were followed up one to three years,their average hearing improvement was 17dB by tube insertion( P