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.

Ossicular chain status in ear pathology cases

Introduction: The tympanic cavity contains three ossicles in humans, the malleus, incus and stapes. These ossicles form a chain across the tympanic cavity from the tympanic membrane to fenestra vestibuli respectively. They develop from mesenchymal condensation of tubotympanic recess at the 6th week of intrauterine life. Later due to programmed cell death a part of tissue remains as ossicles. It attains adult size in the fetal life itself. However, studies have shown gain in size and weight even 2 years after birth. The ossicles help in sound conducting mechanism in hearing. These ossicles are vulnerable to damage in the various diseases of the middle ear cleft resulting into either partial or total loss. Incus is the most, followed by stapes and least by malleus. 20% mucosal diseases show ossicular damage, while squamous epithelial disease involve in 80% [1,2]. The integrity of the ossicular chain is most important for the transmission mechanism of external sounds to the inner ear fluids. Objectives: 1. To study the percentage of ossicular damage in the diseases of the middle ear cleft among the patients being operated for chronic suppurative otitis media in our tertiary care hospital. 2.To assess the extent and frequency of individual ossicular chain involvement in simple mucosal disease and squamous epithelial diseases. Methods: A prospective clinical study was conducted in our tertiary care hospital over a period of five and a half years in our tertiary care hospital among 100 cases of chronic suppurative otitis media after ethical committee clearance. Detailed clinical and radiological examinations of the patients were done and ossicular chain status was noted on table. Patients were also called up for regular follow up. Results: Ossicular chain erosion was mostly seen in squamosal disease, with incus and incudo-stapedial joint being the most common sites for ossicular erosion. Conclusion: it was concluded that long process of incus was the most commonly eroded structure, with the incus being the most commonly involved ossicle Few factors that were found to be associated with ossicular erosion were atticoantral disease, pediatric age group and bigger tympanic membrane perforations.

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.

Are Hounsfield Unit Measurements of Bony Absorption Changes in Cholesteatoma Helpful?

Abstract Introduction High-resolution computed tomography (HRCT) scans of the temporal bone are used to assess the bony erosion of the middle-ear structures whenever cholesteatoma is suspected. Objective To study the differences in HRCT Hounsfield unit (HU) index measurements of middle-ear bony structures between an ears with and without cholesteatoma. Methods A retrospective study of 59 patients who underwent surgery due to unilateral cholesteatoma. The HRCT HU index of the scutum, of three middle-ear ossicles, of the lateral semicircular canal (LSCC), and of the fallopian canal was measured in both ears. A comparison was made between the cholesteatoma and the non-cholesteatomatous ear (control). All measurements were conducted by an otolaryngologist. To assess the interobserver bias, 10% of the samples were randomly and independently assessed by another otolaryngologist and a neuroradiologist who were blinded. Results The average HU index was lower in the ear with cholesteatoma when compared with the non-cholesteatomatous ear. While the differences were statistically significant regarding the measurements of the scutum (516.02 ± 311.693 versus 855.64 ± 389.999; p = 0.001), the malleus (1049.44 ± 481.765 versus 1413.47 ± 313.376; p = 0.01), and the incus (498.03 ± 264.184 versus 714.25 ± 405.631; p = 0.001), the differences in the measurements of the LSCC (1042.34 ± 301.066 versus 1154.53 ± 359.609; p = 0.69) and of the fallopian canal (467.19 ± 221.556 versus 543.51 ± 263.573; p = 0.108) were not significantly different between both groups. The stapes was immeasurable in both groups due to its small size. Conclusion Hounsfield unit index measurements are a useful tool that may aid in the diagnosis of early-stage cholesteatoma.

Morphology of endoskeleton and spination in the sea star Midgardia xandaros (Brisingida: Brisingidae) from the Gulf of Mexico / Morfología del endoesqueleto y ornamentación de la estrella de mar Midgardia xandaros (Brisingida: Brisingidae) en el Golfo de México

Introduction: The deep-sea asteroid species of Brisingida have a nearly global distribution but have remained poorly understood due to their deep bathymetric distributions and fragile skeletons. Objective: To describe the external and internal morphology of Midgardia xandaros including the skeletal arrangement, through multifocal and SEM techniques. Methods: We examined a total of 21 specimens, including 27 arm fragments, from the Gulf of Mexico and Honduras. Two specimens were dissected. Results: Detailed descriptions of pedicellariae, abactinal, intercostal, inferomarginal, adambulacral, ambulacral, odontophore, and oral ossicles, and their spines are provided, emphasizing the articulations and muscle attachments. C-shaped valves pedicellariae and small pedicellariae valves with shorter denticulation areas were recognized. Conclusions: The morphological description of M. xandaros is expanded, providing the most extensive description of abactinal, first adambulacral, first and subsequent inferomarginal ossicles, abactinal spines, and C-shaped, crossed pedicellariae, as well as the distal arm plates, for a brisingid species using SEM to date.

Introducción: Las estrellas de mar de profundidad del orden Brisingida tienen una distribución casi global, sin embargo, han sido poco estudiadas debido a su profunda distribución batimétrica y esqueleto frágil. Objetivo: Describir la morfología externa e interna de Midgardia xandaros incluyendo el arreglo de las placas del esqueleto mediante técnicas de microscopía multifocal y electrónica de barrido (MEB). Métodos: Se examinó un total de 21 ejemplares, incluyendo 27 fragmentos de brazos, provenientes del Golfo de México y Honduras. Dos de estos ejemplares fueron disectados. Resultados: Se presenta la descripción de pedicelarios; placas abactinales, intercostales, inferomarginales, adambulacrales, ambulacrales, orales y odontóforo, y sus espinas, enfatizando los sitios de articulaciones e inserción de músculos. Se reconocieron pedicelarios con valvas con forma de C, y pequeños pedicelarios cuyas valvas poseen áreas de denticulación cortas. Conclusiones: La descripción morfológica de M. xandaros es ampliada, presentado por primera vez la morfología de las placas abactinales, primera adambulacrales, primera y subsecuentes inferomarginales, espinas abactinales y pedicelarios con valvas con forma de "C", así como las placas distales de los brazos para una especie del orden Brisingida.

Ontogenetic variation of the odontophore of Luidia superba (Asteroidea: Paxillosida) and its taxonomic implications

Introduction: The sea star odontophore is the structure positioned between the paired oral ossicles, with which they articulate through proximal and distal processes. The internal anatomy structures may be used as taxonomic characters for a precise differentiation between species, so it is necessary to describe the structures variation throughout growth. Objective: To describe the odontophore shape and variation of Luidia superba A. H. Clark, 1917 from specimens of the Gulf of California deposited in the Echinoderm National Collection, ICML UNAM. Methods: A total of 735 specimens were examined to describe the external characters, from which 55 selected specimens, within a range of R = 14 mm and R = 210 mm, were dissected to extract the odontophores and analyzed with geometric morphometrics. Results: Scanning electronic microscopy (SEM) images of the odontophores showing the variations in shape throughout growth are presented. Differences in shape between size groups were confirmed with a Canonical Variables Analysis (P < 0.05). Conclusions: There are three main groups in this size ranges where specialization of the stereom can be observed through the ontogenetic series; the variation in shape of the odontophore shown here is a precedent for the use of internal anatomy as new taxonomic characters of identification.

Introducción: El odontóforo es la estructura posicionada entre las placas orales pareadas con las que se articula a través de procesos proximales y distales. Las estructuras de la anatomía interna se pueden usar como caracteres taxonómicos para la diferenciación más precisa entre especies, por lo que es necesario describir la variación de las estructuras a lo largo del crecimiento. Objetivo: Describir la forma y la variación del odontóforo de Luidia superba A. H. Clark, 1917 de ejemplares del Golfo de California depositados en la Colección Nacional de Equinodermos, ICML UNAM. Métodos: Se revisaron un total de 735 ejemplares para describir los caracteres externos y de las cuales se seleccionaron 55 ejemplares, dentro de un intervalo de R = 14 mm a R = 210 mm, de los cuales se extrajeron los odontóforos y fueron analizados utilizando morfometría geométrica. Resultados: Se presentan imágenes de microscopía electrónica de barrido (MEB) de los odontóforos que muestran las variaciones de la forma durante el crecimiento. Se confirmaron diferencias significativas de la forma entre los grupos de tallas mediante un CVA (p< 0.05). Conclusiones: Se observa especialización del estereoma a lo largo de la serie ontogenética; la variación en la forma del odontóforo aquí mostrada es precedente para el uso de estructuras de la anatomía interna como nuevos caracteres de identificación.

Numerical study on the effect of middle ear malformations on energy absorbance / 生物医学工程学杂志

In order to study the effect of middle ear malformations on energy absorbance, we constructed a mechanical model that can simulate the energy absorbance of the human ear based on our previous human ear finite element model. The validation of this model was confirmed by two sets of experimental data. Based on this model, three common types of middle ear malformations,

Micro-architecture study of the normal infant auditory ossicles with micro-computed tomography / Estudio de microarquitectura de los osículos auditivos infantiles normales con tomografía microcomputarizada

This study aimed to investigate the micro-anatomical morphology of ossicular chain in term fetus using micro-CT, in order to analyze the parameters of internal ossicular structure that may affect sound conduction.Four ossicular chains from two term fetuses were scanned by micro-CT. The related structural parameters of the trabeculae within the incus and malleus were calculated and compared. The fine anatomical structure of the auditory ossicles was analyzed.The microstructure of each auditory ossicles in term fetuses was clearly revealed by micro-CT. A marrow cavity was observed in the incus and malleus. In statistical analysis of the structural parameters of trabeculae in the incus and malleus, significant differences were found in BS/BV and Tb.Th (P < 0.05). Micro-CT enables the visualization of internal ossicular structure. The auditory ossicles in term fetus has good bone quality. The obtained bone structure data will help to clarify the physiological functions of normal fetal auditory ossicles.

Este estudio tuvo como objetivo investigar la morfología microanatómica de la cadena osicular en el feto a término con micro-CT, con el fin de analizar los parámetros de la estructura osicular interna que pueden afectar la conducción del sonido. Cuatro cadenas osiculares de dos fetos a término fueron examinadas por micro-CT. Se calcularon y compararon los parámetros estructurales relacionados de las trabéculas dentro de los incus y malleus. Se analizó la estructura anatómica fina de los osículos. Se observó claramente la microestructura de cada osículo en los fetos y la cavidad medular en el incus y el malleus. En el análisis estadístico de los parámetros estructurales de las trabéculas en el incus y el malleus, se encontraron diferencias significativas en BS / BV y Tb.Th (P <0,05). Micro-CT permite la visualización de la estructura osicular interna. Los osículos en el feto a término tienen buena calidad ósea. Los datos obtenidos de la estructura ósea ayudarán para aclarar las funciones fisiológicas de los osículos auditivos fetales normales.

Morphological variations and accessory ossicles in the peroneal and tibialis muscles / 대한해부학회지

This study describes five bilateral anatomical variations in the feet of a 97-year-old male cadaver. Following routine dissection, all variants were measured and documented. Three accessory tendons and two accessory ossicles were identified. Bilateral accessory tendons were present from the tibialis anterior (type II), peroneus tertius (type III), and peroneus brevis muscles. Accessory tendon length was 36–104 mm and width was 1–3 mm each inserting more distally then the main tendon. Accessory ossicles were identified as an accessory navicular and os peroneum, respectively. Individually, each variation has varying prevalence rates in the literature, but to date, no known studies have been published describing the combined presence of all five bilateral variations. The acknowledgement of multi-variant cases such as this one may be helpful in the clinical setting, particularly for patients with pathology or for those undergoing foot and ankle surgery.

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.

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.

Common accessory ossicles of the foot: imaging features, pitfalls and associated pathology

Accessory ossicles are normal variants that are frequently seen but often overlooked or misdiagnosed. Commonly seen at the foot and ankle, they may be mistaken for fracture fragments or loose bodies, or not be recognised as a cause of the patient's symptoms. This pictorial essay aimed to review commonly encountered accessory ossicles of the foot and ankle by highlighting anatomic landmarks and associated pathologic processes through the use of both basic and advanced imaging modalities, in an effort to increase awareness of these clinical entities.

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.

Características biométricas de los osículos del oído de individuos chilenos / Biometric characteristics of ear ossicles in Chilean subjects

El crecimiento y desarrollo de los osículos del oído medio no muestran grandes variaciones después del nacimiento. Nuevas tecnologías en cirugía de implantes, corrección y tratamiento de las enfermedades del oído medio necesitan un detallado conocimiento biométrico de estos osículos. Basados en lo anterior, se estudiaron 22 Malleus, 16 Incus y 3 Estapedios de individuos adultos de sexo masculino, de cadáveres secos, todos individuos de la Región Central de Chile. Los osículos fueron analizados y fotografiados con un Microscopio quirúrgico de diagnóstico OPMI Pico, Carl Zeiss, imagen estereoscópica. Los datos métricos se obtuvieron con un calyper digital Mitutoyo y sometidos a análisis digital con el AxioVision LE 4.8.2.0. Software de Carl Zeiss. El malleus tuvo una longitud promedio desde la cabeza al ápice del manubrio de 8,08 mm y su proceso anterior una longitud de 0,76 mm; el proceso largo del incus tuvo una longitud promedio de 3,37 mm y el proceso corto de 3,07 mm; la base del estapedio tuvo una longitud antero-posterior de 2,53 mm. Los resultados obtenidos son un aporte al conocimiento de los osículos del oído en nuestra población.

The growth and development of the ossicles of the middle ear do not show large variations after birth. New technologies in implant surgery, correction and treatment of diseases of the middle ear require an increasingly larger biometric knowledge of these ossicles. Therefore, we studied 22 Malleus, 16 Incus and 3 Stapes of male adult subjects, from dry corpses, and, one Malleus, one Incus and one Stapes of a seven-month-old male fetus, all Chilean subjects from the Central Region in Chile. These bones were analyzed and photographed with a model OPMI Microscope tilting binocular tube with stereoscopic 3D image. Metric data were obtained with the AxioVision L.E 4.8.2.0. Carl Zeiss software. The malleus had an average length from head to apex of 8.08 mm, the anterior process had a length of 0.76 mm, the long limb of the incus was an average length of 3.37 mm and the short limb 3.07 mm, the base of the stapes measured 2.53 mm. The results are a contribution to the knowledge of ear ossicles in our population.

Supernumerary Bones in the Walls of the Bony Orbit.

Occurrence of supernumerary bones in the walls of the orbit especially in the medial wall and the roof has been described in the literature. Studies of the prevalence of supernumerary bones in the bony wall of the orbit are scarce in the literature. Present study was undertaken to find the prevalence of supernumerary bones in the walls of the orbit in a collection of adult Indian skulls. In the present study three hundred and twenty six orbital walls from one hundred and sixty three skulls were examined for the presence of the sutural bones. Their location with reference to the sutures in the walls of the orbit and their size was noted. The supernumerary bones were found in 25 skulls (15.34 %) mainly in the lateral wall (11.04 %) and the roof of the orbit (4.29 %). Prevalence of such supernumerary bones in the walls of the bony orbit is of anthropological interest. Many of the bony ossicles were of sufficiently large size, enough to be visualized on lateral skull X-ray and could easily be mistaken for fracture of the bony wall of the orbit.

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.