Perforación timpánica y colesteatoma, una patología de niños y adultos / Tympanic perforation and cholesteatoma, a pathology of children and adults

INTRODUCCIÓN. La patología de oído es una enfermedad frecuente en nuestro medio, asociada a infecciones a repetición del oído, con la presencia de perforación timpánica y colesteatoma, que determinará la presencia de lesiones mucho más acentuadas en cuanto a la evolución auditiva o complicaciones locales o sistémicas. OBJETIVO. Determinar la asociación existente entre la presencia de colesteatoma y perforación timpánica en pacientes con otitis media crónica. MATERIALES Y MÉTODOS. Estudio epidemiológico analítico retrospectivo. Población de 4 733 y muestra de 75 pacientes para casos y 75 para controles basados en historias clínicas tomadas del sistema informático AS 400, que acudieron a la consulta externa de torrinolaringología del Hospital de Especialidades Carlos Andrade Marín en el periodo de enero de 2018 a diciembre de 2019; Criterios de inclusión para grupo de casos: Hombres y mujeres de 20 a 65 años de edad, diagnóstico de otitis media crónica, diagnóstico de colesteatoma ótico. Criterios de inclusión para grupo controles: Hombres y mujeres de 20 a 65 años de edad, no presentar diagnóstico de colesteatoma. RESULTADOS. Se observó una relación fuerte entre el poseer perforación timpánica y el desarrollo de colesteatoma con un valor de OR 33,14 con un IC al 95% de 31,94 ­ 34,34, con lo que se comprobó la hipótesis del estudio. Se determinó que la perforación timpánica es un factor de riesgo asociado con el desarrollo de colesteatoma en pacientes con otitis media crónica, la prevalencia de colesteatoma en relación a la edad estuvo en un 72% en pacientes de 41 a 65 años, con mayor predominancia en mujeres en un 57,3%. DISCUSIÓN. La presencia de perforación timpánica de acuerdo a lo observado es un factor de riesgo para el desarrollo de colesteatoma, ligado en su mayoría a cuadros de Otitis Media Crónica. CONCLUSIONES. Se confirmó que la perforación timpánica, es un factor de riesgo en el desarrollo del colesteatoma en los pacientes que tienen otitis media crónica, lo que demuestra la necesidad de manejo actualizado y continuo en pacientes con esta patología de oído. Se requieren estudios con muestras más amplias para determinar otros factores de riesgo como sexo, nivel de educación y edad que podrían influir en el desarrollo de colesteatoma.

INTRODUCTION. Ear pathology is a frequent disease in our environment, associated with repeated ear infections, with the presence of tympanic perforation and cholesteatoma, which will determine the presence of much more accentuated lesions in terms of auditory evolution or local or systemic complications. OBJECTIVE. To determine the association between the presence of cholesteatoma and tympanic perforation in patients with chronic otitis media. MATERIALS AND METHODS. Retrospective analytical epidemiological study. Population of 4 733 and sample of 75 patients for cases and 75 for controls based on clinical histories taken from the AS 400 computer system, who attended the Otorhinolaryngology outpatient clinic of the Carlos Andrade Marín Specialties Hospital in the period from January 2018 to December 2019; Inclusion criteria for case group: Men and women aged 20 to 65 years, diagnosis of chronic otitis media, diagnosis of otic cholesteatoma. Inclusion criteria for controls group: men and women aged 20 to 65 years, no diagnosis of cholesteatoma. RESULTS. A strong relationship was observed between having tympanic perforation and the development of cholesteatoma with an OR value of 33,14 with a 95% CI of 31,94 - 34,34, thus proving the study hypothesis. It was determined that tympanic perforation is a risk factor associated with the development of cholesteatoma in patients with chronic otitis media, the prevalence of cholesteatoma in relation to age was 72% in patients aged 41 to 65 years, with greater predominance in women in 57,3%. DISCUSSION. The presence of tympanic perforation according to what was observed is a risk factor for the development of cholesteatoma, mostly linked to Chronic Otitis Media. CONCLUSIONS. It was confirmed that tympanic perforation is a risk factor in the development of cholesteatoma in patients with chronic otitis media, which demonstrates the need for updated and continuous management in patients with this ear pathology. Studies with larger samples are required to determine other risk factors such as sex, education level and age that could influence the development of cholesteatoma.

Vías de ventilación y retracción epitimpánica en otitis media crónica no colesteatomatosa

Objetivo: Describir los hallazgos endoscópicos de las vías de ventilación encontrados durante la timpanoplastías tipo I en pacientes con OMC (Otitis media crónica) no colesteatomatosa. Materiales y métodos: Investigación transversal descriptiva, evaluamos 32 pacientes con OMC no colesteatomatosa con y sin retracción epitimpánica (RE) (Grado I-III, según clasificación de Mirko Tos), con antecedente de timpanoplastía tipo I (junio, 2018 - enero, 2020) en el servicio de otorrinolaringología del Hospital Nacional Arzobispo Loayza. Se excluyeron pacientes con cirugías previas de oído medio, con OMC colesteatomatosa, con RE grado IV y actos quirúrgicos no almacenados digitalmente. Resultados: El 71,8% de pacientes presentaron RE (Grado I 3,0%, grado II 30,0% y grado III 56,5%), todos presentaron istmo timpánico (IT) bloqueado. El 68,8% de participantes con RE, presentaron tensor fold (TF) completo. Se observó una relación significativa entre TF completo e IT bloqueado con RE (p=0,026 y 0,003 respectivamente). Conclusiones: Los hallazgos más frecuentes fueron el TF completo e IT bloqueado, estos tuvieron asociación significativa con la presencia de RE en pacientes con OMC no colesteatomatosa.

Objective: To describe the endoscopic findings of the ventilation pathways found during type I tympanoplasty in patients with non-cholesteatomatous COM (chronic otitis media). Materials and methods : Cross-sectional descriptive study, we evaluated 32 patients with non-cholesteatomatous COM with and without epitympanic retraction (ER) (Grade I-III, according to Mirko Tos classification), with a history of type I tympanoplasty (June, 2018 - January, 2020) in the otorhinolaryngology service of the Arzobispo Loayza National Hospital. Patients with previous middle ear surgeries, with cholesteatomatous COM, with ER grade IV and surgical acts not digitally stored were excluded. Results: 71.8% of patients presented ER (Grade I 3.0%, grade II 30.0% and grade III 56.5%), all presented blocked tympanic isthmus (TI). 68.8% of participants with ER presented complete tensor fold (TF). A significant relationship was observed between complete TF and blocked IT with ER (p=0.026 and 0.003, respectively). Conclusions: The most frequent findings were complete TF and blocked IT, these had a significant association with the presence of ER in patients with non-cholesteatomatous COM.

Middle ear adenomatous neuroendocrine tumors: suggestion for surgical strategy / Tumores neuroendócrinos adenomatosos da orelha média: sugestão de estratégia cirúrgica

Abstract Introduction Middle ear adenomatous neuroendocrine tumors are extremely rare neoplasms with epithelial and neuroendocrine differentiation, accounting for fewer than 2% of all middle and inner ear tumors. Universal standard surgical procedures for different stages of these tumors remain elusive due to the limitation of the small number of case reports or investigations. Objective(s) This study intends to investigate proper surgical strategies for patients with middle ear adenomatous neuroendocrine tumors. Methods Six patients with middle ear adenomatous neuroendocrine tumors who were treated at the Second Affiliated Hospital of Nanchang University (Nanchang, China) and the Eye, Ear, Nose, and Throat Hospital of Fudan University (Shanghai, China) respectively. Clinical characteristics and management strategies of patients were reviewed. The mean follow-up time was 63.7 months (range, 13-153 months). All the information was collected from medical records and prognosis postoperatively. Results Three patients underwent canal wall-up tympanomastoidectomy, including one patient with recurrence who underwent a previous tympanotomy; the other three patients underwent lateral temporal bone resection All of these patients were followed up with no evidence of recurrence or metastasis. Patients underwent canal wall-up surgery treatment accompanied with hearing function preservation measurements during follow-up periods. Conclusions Complete surgical resection provided good results for patients with middle ear adenomatous neuroendocrine tumors. The ossicular chain should be removed. Because of the propensity for local recurrence and invasiveness, as well as regional or distant metastasis of these tumors, it is necessary to schedule long-term follow-up and an observation plan postoperatively.

Resumo Introdução Os tumores neuroendócrinos adenomatosos da orelha média são neoplasias extremamente raras, com diferenciação epitelial e neuroendócrina, responsáveis por menos de 2% de todos os tumores de orelha média e interna. Os procedimentos cirúrgicos padrão universais para diferentes estágios desses tumores permanecem indefinidos, devido à limitação do pequeno número de relatos de casos ou investigações. Objetivo Este estudo foi feito com o objetivo de investigar estratégias cirúrgicas adequadas para pacientes com tumores neuroendócrinos adenomatosos da orelha média. Método Seis pacientes com tumores neuroendócrinos adenomatosos da orelha média foram tratados no Second Affiliated Hospital da Nanchang University (Nanchang, China) e no Eye, Ear, Nose, and Throat Hospital da Fudan University (Xanghai, China), respectivamente. As características clínicas e estratégias de tratamento dos pacientes foram revisadas. O tempo médio de seguimento foi de 63,7 meses (variação de 13 a 153 meses). Todas as informações foram coletadas dos prontuários e prognóstico no pós-operatório. Resultados Três pacientes foram submetidos à timpanomastoidectomia do tipo canal wall-up, inclusive um paciente com recorrência submetido a uma timpanotomia anterior; os outros três pacientes foram submetidos à ressecção lateral do osso temporal. Todos os pacientes foram acompanhados, sem evidência de recorrência ou metástase. Os pacientes foram submetidos ao tratamento cirúrgico com a técnica de canal wall-up acompanhado de medidas de preservação da função auditiva durante os períodos de seguimento. Conclusões A ressecção cirúrgica completa proporcionou bons resultados para pacientes com tumores neuroendócrinos adenomatosos da orelha média. A cadeia ossicular deve ser removida. Devido a propensão à recorrência e invasão local, bem como metástases regionais ou distantes desses tumores, é necessário um seguimento de longo prazo e um plano de seguimento no pós-operatório.

Relación entre el tipo de fisura labiopalatina y la disfunción de la trompa de Eustaquio en niños, Perú 2020 / Relationship between type of cleft palate and Eustachian tube function in children, Peru 2020

RESUMEN Introducción y objetivos : Determinar si el tipo de fisura labio palatina está asociada a mayor riesgo de alteración de la trompa de Eustaquio. Materiales y métodos : Se realizó un estudio descriptivo serie de casos con análisis inferencial de niños operados de fisura labiopalatina en el Hospital San Bartolomé durante el 2018 y 2019. Resultados : Se evaluó a un total de 48 pacientes a quienes se les realizó timpanometría, encontrándose 62,5 % varones (n=30) y 37,5 % mujeres (n=18) y la media de edad fue de 1,3 años, para determinar el tipo de fisura labiopalatina se usó la clasificación de Veau, el tipo más frecuente hallado fue Veau tipo III, con 62,5 % (n=30), siendo la menos frecuente Veau tipo I con 4,2 % (n=2). La evaluación de la función de la trompa de Eustaquio se realizó mediante timpanometría definiéndose como patológica la curva tipo B, en el grupo de estudio se encontró una prevalencia global de curvas tipo B de 66,7 % (n= 32), mientras que las curvas A y C, tuvieron 33,3 % (n=16). La probabilidad que el diagnóstico Veau IV tenga curvas tipo B de forma más frecuentes que los otros tipos, mediante la prueba Binomial fue significativo. (p=0,000038<0,05). Conclusiones : El tipo de fisura palatina mayormente asociado con alteración de la función del oído medio, expresado mediante curvas de timpanometría tipo B, es la fisura tipo IV según clasificación de Veau, esta relación es estadísticamente significativa.

ABSTRACT Introduction and objectives : The objective of this study is to determine if the type of cleft lip and palate is associated with a higher risk of alteration of the Eustachian tube. Materials and methods : A descriptive case series study was carried out with an inferential analysis of children operated on for cleft lip and palate at the San Bartolomé hospital during the years 2018 and 2019. Results : 48 patients with tympanometry were evaluated, 62.5% male (n = 30) and 37.5% female (n = 18), the mean age was 1.3 years. The type of cleft lip and palate was determined using the Veau classification, the most frequent type found was Veau type III: 62.5% (n = 30), the least frequent type was Veau I with 4.2% (n = 2). The evaluation of the function of the Eustachian tube was performed with tympanometry, defining the type B curve as pathological. In the study group, there was an overall prevalence of type B curves of 66.7% (n = 32), while type A and C curves were 33.3% (n = 16). The probability that the Veau IV crack type has an association with type B curves more frequently than the other types, using the Binomial test, was significant. (p = 0.000038 <0.05). Conclusions : The type of cleft palate that is most associated with impaired middle ear function, expressed by type B tympanometry curves, is type IV cleft according to Veau's classification, this relationship is statistically significant.

Serum sclerostin levels in chronic otitis media with and without cholesteatoma

SUMMARY OBJECTIVE Sclerostin is a glycoprotein that plays a catabolic role in bone and is involved in the regulation of bone metabolism by increasing the osteoclastic bone resorption. In this study, serum sclerostin levels were measured in chronic otitis media (COM) with and without cholesteatoma, assuming that it might have a role in the aetiopathogenesis of bone resorption. METHODS A total of 44 patients with cholesteatomatous COM (cCOM) (n = 22) and non-cholesteatomatous COM (ncCOM) (n = 22) were included in this study, and 26 healthy volunteers without any chronic ear disease problem(s) constituted the control group (n = 26). RESULTS No significant difference was not found in terms of serum iPTH, ALP, and vitamin D levels between ncCOM, cCOM, and the control groups. A significant difference was found in terms of serum sclerostin, Ca, and P levels between ncCOM, cCOM, and the control groups (p<0.05). Serum sclerostin levels in the study groups were significantly higher but their serum Ca and P levels were significantly lower compared to the control group. CONCLUSION We think that serum sclerostin concentrations, which were significantly higher in patients with cCOM and ncCOM compared to healthy controls are associated with bone erosion. There is a need for further studies with larger samples in order to determine the relationship between sclerostin and bone erosion in cholesteatoma to help in establishing preventive measures against cholesteatoma and set new targets for the development of non-surgical treatments.

RESUMO OBJETIVO A esclerostina é uma glicoproteína que desempenha um papel catabólico no osso e também envolve a regulação do metabolismo ósseo, aumentando a reabsorção óssea osteoclástica. Neste estudo, os níveis séricos de esclerostina foram medidos em otite média crônica (OMC) com e sem colesteatoma, e presumiu-se se que ela poderia ter um papel na etiopatogênese da reabsorção óssea. MÉTODOS Um total de 44 pacientes com otite média crônica colesteatomatosa (OMCc) (n=22), não colesteatomatosa (OMCnc)(n=22) foram incluídos neste estudo, e 26 voluntários saudáveis e sem doenças crônicas do ouvido constituíram o grupo de controle (n=26). RESULTADOS Não foi encontrada diferença significativa em termos de níveis séricos de iPTH, ALP e vitamina D entre OMCnc, OMCc e o grupo de controle. Foi encontrada uma diferença significativa em termos de níveis séricos de esclerostina, Ca e P entre OMCnc, OMCc e o grupo de controle (p<0,05). Os níveis séricos de esclerostina nos grupos de estudo foram significativamente mais altos, mas os níveis séricos de Ca e P foram significativamente mais baixos em comparação com o grupo de controle. CONCLUSÃO Acreditamos que as concentrações séricas de esclerostina, significativamente maiores em pacientes com OMCc e OMCnc em relação aos controles saudáveis, estão associadas à erosão óssea. Há necessidade de mais estudos com amostras maiores para determinar a relação entre esclerostina e erosão óssea no colesteatoma, já que essas pesquisas podem ajudar a estabelecer medidas preventivas contra o colesteatoma e novas metas para o desenvolvimento de tratamentos não cirúrgicos.

Congenital middle ear malformation: clinical analysis and discussion of classification / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical characteristics and appropriate surgical procedures, and discuss the classification of congenital middle ear malformation.@*Methods@#All cases were from the Center of Otorhinolaryngology, the Sixth Medical Center of Department of PLA General Hospital. All of these cases, including 26 male patients (ears) , 10 female patients (11 ears) , aged from 7 to 57 years old, had normal external auditory canal, tympanic membrane, conductive hearing loss, type A tympanogram and negative Gelle′s test. Tympanoplasty was performed in all cases. The deformity was classified to three types,i.e., Type I (stapes foot plate mobility): Ⅰa, ossicular chain deformity with normal stapes suprastructure; Ⅰb, ossicular chain deformity with abnormal stapes suprastructure; Type Ⅱ (stapes foot plate fixation): Ⅱ a,normal ossicular chain, Ⅱ b, ossicular chain malformation; and Type Ⅲ: vestibular window osseous atresia or undeveloped, or with round window atresia. The malformation of type Ⅱ and Ⅲ may be accompanied with abnormal facial nerve. In addition, the papers on middle ear malformation published from 1982 to 2017 were analyzed retrospectively. The clinical data of 451 ears malformation were summarized.@*Results@#According to the revisional classification criteria in 37 ear samples from our hospital, 20 ears were type I. 6 type Ⅰa cases were used PORP (partial ossicular replacement prosthesis) to reconstruct the ossicular chain; 14 type Ⅰb cases were used TORP (total ossicular replacement prosthesis) to reconstruct the ossicular chain. For the 5 ears of type Ⅱ, 2 of which were type Ⅱ a and 3 were type Ⅱ b. 4 ear samples of type Ⅱ were implanted with Piston ossicular prosthesis, 1 was implanted with TORP in which the ossificated foot plate was removed with periosteum preserved. 12 ear samples were type Ⅲ, with vestibular window osseous atresia, facial nerve malformation, and stapes suprastructure malformation. The pistons ossicular prosthesis were implanted in vestibular window in 3 ears with facial nerve covering vestibular window partially. The surgery had to be given up in 5 ears, and TORP was implanted in 4 ears at the opening with preserved periosteum at the beginning of the tympanic scala because of facial nerve covering vestibular window totally. 30 ears with complete follow-up data had no sensorineural hearing loss and the average air-bone conduction decreased 23.3±10.7 dB (P<0.05).There were 234 ears of type Ⅰ in 451 ears of congenital middle ear malformation reported in the literature. 113 of which were type Ⅰa, the basic surgery was ossicular chain shaking and artificial or autogenous PORP implantation. Type Ⅰb was 121 ears, with autogenous or artificial TORP and PORP. Type Ⅱ was125 ears, including type Ⅱa 22 ears, Ⅱb 60 ears, and no subclassification for 43 ears. The surgery of type Ⅱ was the same as otosclerosis. The vestibular window atresia of type Ⅲ was 92 ears, the surgery of 17 ears had to be abandoned, the other ears underwent vestibular window, promontory or semicircular canal opening to reconstruct hearing with Piston, autogenous or artificial TORP.@*Conclusion@#Referring to the classification of congenital middle ear malformation combining with appropriate surgical materials and methods, otologists can better understand and choose appropriate surgical method to the middle ear malformation.

Clinical analysis of mastoid abnormal MRI singals In the infant / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyse the result of mastoid abnormal MRI singals in infants without clinical symptoms and to evaluate the diagnostic value. METHODS The MRI data of abnormal signals in the middle ear and mastoid of 42 infants(62 ears) were analyzed with 1000 Hz probe tone tympanometry and oto-endoscope. RESULTS Of the infants with abnormal MRI signals of the middle ear and mastoid, 50 ears were secretory otitis media(80.7％), 10 ears had dysfunction of middle ear (16.1％), and 2 ears were not identified. CONCLUSION In the infant who had a abnormal long T2 singals MRI but without clinical symptoms, 80.7％ were caused by SOM or AOM. It is valuable for clinical efficacy evaluation and treatment planning in advance.

Middle ear teratoma in infant: report of three cases and review of the literatures / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize the clinical characteristics and therapeutic experiences of the middle ear teratoma in infants.@*Methods@#Three cases of middle ear teratoma, from 2012-2015 in Beijing Friendship Hospital were analyzed.@*Results@#The three cases all developed slowly and presented unilateral otorrhea and hearing loss. Otoscopy showed the granulation tissue in the external ear canal. Audiological changes varied according to the degree of severity. Imaging features showed the pocket-like occupancy lesions in the Eustachian tube area. The temporal bone CT showed mass with soft tissue density usually involved in the mastoid and tympanic cavity. MRI showed mixed signal intense on both T1 and T2 weighted imaging. All the three cases received neoplasm resection of the middle ear. Only one case received tympanoplasty surgery at the same time. And all the pathology results displayed mature teratoma. The follow-up time was 17 to 54 months. MRI showed complete removal of the tumor.@*Conclusions@#Teratoma are rare in the head and neck neoplasm. When the infants suffer from the unilateral otorrhea, hearing loss, and granulation tissue formed in the external ear canal, it should be vigilant for teratoma. The differential diagnosis is middle ear cholesteatoma, congenital first branchial cyst or fistula, and middle ear carcinoma. Temporal bone CT combined with MRI could improve the accuracy of diagnosis. It should be totally resection as soon as possible if there is no contraindication. Postoperative follow-up and imaging examination are necessary to eliminate tumor recurrence.

Efficacy of ultrasound-guided great auricular nerve block combined with general anesthesia for middle ear microsurgery in adult patients / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve (GAN)block combined with general anesthesia for middle ear microsurgery in adult patients.Methods Sixty-four adult patients of both sexes,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective middle ear microsurgery,were assigned into 2 groups (n =32 each) using a random number tabte:GAN block combined with general anesthesia group (group GANB+G) and general anesthesia group (group G).Patients received GAN block with 0.25％ ropivacaine 2 ml using ultrasoundguided in-plane technique before anesthesia induction in group GANB+G.Anesthesia induction and maintenance protocols (IV infusion of propofol and target-controlled infusion of remifentanil) were similar in two groups.Analgesia was performed with sufentanil,flurbiprofen axetil or parecoxib sodium after operation to maintain visual analog scale score ＜4 within 48 h after operation.The infusion duration and consumption of propofol and remifentanil,requirement for postoperative analgesia and occurrence of postoperative nausea and vomiting were recorded.Results Compared with group G,the consumption of remifentanil was significantly reduced,and the requirement for postoperative analgesia and incidence of postoperative nausea and vomiting were decreased in group GANB + G (P ＜ 0.05 or 0.01).Conclusion Ultrasound-guided GAN block combined with general anesthesia provides better analgesic efficacy in the the perioperative period in adult patients undergoing middle ear microsurgery.

Whole ear involvement in non-elder patients with relapsing polychondritis / 中华风湿病学杂志

Objective To investigate the clinical and audiological characteristics of non-elder patients with relapsing polychondritis (RP).Methods Clinical and audiological data of patients with RP under 60 years old were collected consecutively and analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups in quantitative data in normal distribution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results One hundred and seventy four patients with complete data who fulfilled the Michet criteria were enrolled with a M∶F=1∶1.1.The mean age of disease onset was (39±13) (8-60) years;the median time of disease duration was 12 (1-480) months;the median relapsing polychondritis disease activity index (RPDAI) was 38(10-77) and the median RPODI was 2.4(0.1-56).Auricular chondritis (32.8％,57/174),ocular involvement (24.7％,43/174) and airway chonchritis (21.3％,37/174) were the top three onset-pattern.All parts of external,middle and inner ear were involved in RP.Inner-ear damage was the most common (95.4％,166/174) with insidious cochlea and vestibule equally distributed.Auricular chondritis was predominant in external ear involvement (55.2％,96/174);ET dysfunction was included in eardrum abnormalities of neglected middle-ear involvement (29.9％,52/174).Positive HL by active detection was 71.8％(125/174) with 14.3(25/174) HL fulfilled world health organization (WHO)-2006 criteria,including 52.0％(13/25) disabling HL.Sensorineural hearing loss (SNHL) was predominant in RP after 21 years old while 60.0％(6/10) was seen in childhood RP with non-SNHL.At least two parts of ear involvement were seen in almost all patients with heavy overlap.Conclusion All parts of ear are involved in non-elder RP with age related clinical characteristics.Active detection is a key to find insidious middle-and inner-ear involvement for early RP recognition.RPODI is a potential marker for RP evaluation.

Facial nerve hemangioma in the middle ear / Hemangioma de nervo facial em orelha média

ABSTRACT Facial nerve hemangioma is a rare and benign vascular tumor, and accounts for 0.7% of intratemporal tumors. We report the second case described in the literature of a facial nerve hemangioma in its tympanic segment. A 14-year-old male patient presented with a history of progressive right ear hearing loss with preserved facial mimicry. Pure tone audiometry showed a right ear moderate conductive hearing loss. Magnetic resonance imaging demonstrated an expansive lesion involving the tympanic segment of the right facial nerve, suggestive of hemangioma. Watchful waiting was chosen as management. In the first case of middle ear facial hemangioma described in the literature, facial palsy was the symptom that led the patient to seek medical care. In the present case, it can be inferred that the first symptom was conductive hearing loss ipsilateral to the lesion. Facial palsy may not be present and the clinical presentation may resemble otosclerosis, ossicular chain disruption, and third window abnormalities, among other differential diagnoses of conductive hearing loss. The second case of tympanic portion facial nerve hemangioma is reported, describing the specificity of conductive hearing loss as its only clinical manifestation.

RESUMO O hemangioma do nervo facial é um tumor vascular raro e benigno, que corresponde a 0,7% dos tumores intratemporais. Apresentamos o segundo caso descrito na literatura de hemangioma do nervo facial em sua porção timpânica. Paciente de 14 anos, sexo masculino, apresentando hipoacusia progressiva em orelha direita com mímica facial preservada. A audiometria evidenciou perda condutiva moderada à direita. A ressonância magnética demonstrou lesão expansiva, comprometendo o segmento timpânico do nervo facial direito, sugestiva de hemangioma do nervo facial. A conduta foi expectante. No primeiro caso descrito na literatura de hemangioma do facial em orelha média, o sintoma que levou o paciente ao atendimento médico foi paralisia facial. No presente caso, pode-se inferir que o primeiro sintoma foi a perda auditiva condutiva ipsilateral à lesão. A paralisia facial pode não estar presente, e o quadro clínico pode se assemelhar à otosclerose, disjunção de cadeia e síndrome da terceira janela, dentre outros diagnósticos diferenciais de perdas auditivas condutivas. O artigo relata o segundo caso de hemangioma do nervo facial em sua porção timpânica, mostrando a peculiaridade de perda auditiva condutiva como única manifestação clínica.

Effect of the position of PORP on the middle ear transferfunction——a finite element model / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the effect of partial ossicular replacement prothesis (PORP) on the middle ear transfer function.METHODS On a incus removed finite element model,a titanium columnar structure which link the malleus and the stapes was used to simulate the function of PORP to transmit acoustic pressure.The effect of placement of PORP on different positions of the manubrium,as well as the insertion of the cartilage between the artificial bone and the fascia on the middle ear transfer function were calculated.RESULTS When the PORP is placed on the neck of manubrium,mid-manubrium and headof malleus removed,the vibration amplitude of the umbo ofthe tympanic membrane is reduced in 200-8000 Hz,and thereduction range in 200-3200 Hz is more than that of 3200-8000 Hz.While the vibration amplitude of the stapes in the200-8000 Hz amplitude increased.The vibration amplitude is basically the same when placed on the neck of manubrium and mid-manubrium,while it slightly increased about 2-3 dB than the former two when the head of malleus removed.In 1000-8000 Hz.When putting the cartilage between the PORP and transplanted fascia,the vibration amplitude of the stapes footplate was slightly increased,but there was a slight difference with different cartilages.CONCLUSION The placement and material property of PORP play an important role in the middle ear transfer function.

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.

Intratympanic steroid injection treatment of sudden hearing loss with diabetes: a Meta-analysis / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the efficacyand safety of intratympanic injection of steroids in the treatment of sudden hearing loss with diabetes.METHODS PubMed, Medline, CNKI, CBM, VIP, and Wanfang databases were searched by electronic retrieval to collect documents meeting the inclusion criteria and extract data.Meta-analysis was performed using RevMan 5.3.RESULTS There were 9 articles included in the literature search,a total number of 587 ears, of which 294 ears accepted intratympanic injection of steroids as the experimental group. Another 293 ears was control group,of which 217 ears accepted systemic steroids and 76 ears accepted non-hormone therapy.Meta analysis results showed that the clinical effect of experimental group was more remarkable than that of the control group (Z=3.65, P<0.05;Z=3.70,P<0.05). The influence on blood sugar in experimental group was smaller than that of the control group (χ2=7.471,P<0.05). Other complications of intratympanic steroid injection were self-healing after tympanic membrane perforation, transient dizziness and so on.CONCLUSION There was a significant effect on patients with sudden hearing loss and diabetes through intratympanic steroid injection. It has little effect on blood glucose and slight complications, which is a priority in clinical practice.

The efficacy of early intratympanic steroid of high concentration combined with systemic steroid on idiopathic sudden sensorineural hearing loss / 重庆医学

Objective To evaluate the therapeutic effects of early intratympanic steroid of different concentrations and types combined with systemic steroid on severe idiopathic sudden sensorineurl hearing loss(ISSNHL).Methods We reviewed 95 patients with unilateral ISSNHL from January 2012 to June 2016 in the Department of Otolaryngology of the People's Hospital of Changshou and according to the steroid treatment methods,Patients were divided into systemic steroid therapy alone group(group A,30 cases),early intratympanic steroid of low concentration combined with systemic steroid group (group B,32 cases) and early intratympanic steroid of high concentration combined with systemic steroid group (group C,33 cases).Results Total effective rates of the group A,group B and group C were 46.67 ％,56.25 ％,78.79％.Group C was significantly higher than that of group A and group B(P＜0.05);the average pure tone threshold improvement was (46.67±9.32) in group C which was better than group A (20.53±8.83) and group B(25.19± 7.46),the differences were stastically significant (P＜0.01).Conclusion Severe ISSNHL should be treated by intratympanic steroid of high concentration combined with systemic steroid as early as possible in order to rescue the hearing,the efficacy of which is much better than other steroid treatments so far.

Fístula de oído medio: presentación de un caso / Fistula of the middle ear: a case report

Fundamento: las fístulas de líquido cefalorraquídeo en el oído son multicausales. Las translaberínticas están asociadas a causas congénitas en el 95 % de los pacientes. La otolicuorrea espontánea es consecuencia de un defecto dural que causa una anormal comunicación entre el espacio subaracnoideo y las cavidades neumatizadas del hueso temporal. Dicha comunicación constituye una vía de entrada de gérmenes patógenos y una posibilidad de desarrollar una infección del sistema nervioso central. Esta complicación grave puede comprometer la vida del enfermo. El riesgo de meningitis en pacientes con fístula de líquido cefalorraquídeo varía hasta un 50 %. Objetivo: describir el caso de una paciente con fistula congénita y cuadros reiterados de meningoencefalitis. Caso clínico: paciente femenina de nueve años de edad con fistula congénita que había presentado 25 cuadros de meningoencefalitis. En la operación se utilizó tejido autólogo en múltiples capas unidas con Tisuacryl®. Se realizó el cierre vestibular de la fístula lo que previno la recurrencia de meningoencefalitis. La paciente tuvo una evolución satisfactoria después de la cirugía. Conclusiones: el diagnóstico precoz mediante una correcta exploración física, la confirmación por el laboratorio de la naturaleza del líquido y una prueba de imagen que corroboró la sospecha clínica, así como el cierre combinado de la fístula con material autólogo constituyeron la secuencia diagnóstico-terapéutica idónea, que garantizó el éxito en la paciente.

Background: fistulas of cephalospinal liquid in the ear have many causes. Translabyrinthine fistulae are associated with congenital causes in the 95 % of the patients. Spontaneous otorrhea fistulae are consequence of a dural defect that causes an abnormal communication between the subarachnoid space and pneumatized cavities of the temporal bone. This abnormal communication is the access of pathogenic germs and can cause an infection in the central nervous system. This serious complication can compromise the life of the patient. The risk of meningitis in patients with fistulae of the cephalospinal liquid is about a 50 %. Objective: to describe the case of a female patient with a congenital fistula and repeated manifestations of meningoencephalitis. Clinical case: a nine-year-old female patient with a congenital fistula who had presented manifestations of meningoencephalitis 25 times. The surgery was conducted using autologous tissue placed in multiple layers linked with Tisuacryl®. A vestibular closure of the fistula was performed preventing the recurrence of meningoencephalitis. The patient had a favorable progress after the operation. Conclusion: the early diagnosis through a correct physical examination, the confirmation of the nature of the liquid by the laboratory, the imaging test that confirmed the clinical suspicion, and the combined closure of the fistula with autologous tissue constituted the right diagnostic-therapeutic sequence that guaranteed the success in this patient.

Significance of diagnosis of tympanosclerosis by HRCT combined with pure tone audiometry / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the significance of diagnosis of tempanosclerosis by HRCT combined with pure tone audiometry. METHODS 176 patients(181 ears) with chronic suppurative otitis media in stationary phase were recruited in Guizhou Medical University Affiliated Hospital between January 2014 to December 2015. Temporal bone HRCT combined with pure tone audiometry were applied to all patients before operation to diagnose tempanosclerosis. Intraoperative exploration results was the gold standard to observe sensitivity, specificity, positive likelihood ratio and the difference of accuracy of two diagnostic methods. RESULTS 1. The sensitivity, specificity, positive likelihood, negative likelihood ratio and accuracy of tympanosclerosis diagnosed only by temporal bone HRCT were 58.55%, 93.10%, 8.49, 0.46 and 64.09% respectively. 2. The sensitivity, specificity, positive likelihood, negative likelihood ratio and accuracy of tympanosclerosis diagnosed by HRCT combined with pure tone audiometry were caculated as 94.08%, 89.66%, 9.09, 0.01 and 93.37% respectively. Type I diagnostic accordance rate was 89.66%, type II was 87.50%, type III was 84.62%and type IV was 82.14%. The total diagnosis coincidence rate was 86.18%. The diagnostic efficacy increased significantly by the combined method than by the temporal bone HRCT alone. CONCLUSION Temporal bone HRCT combined with pure tone audiometry is valuable in diagnosis of tympanosclerosis. It can provide theoretical basis for making optimal operation scheme in suspect tympanosclerosis patients.

Diagnosis and treatment of cholesterol granuloma of the middle ear / 中国耳鼻咽喉头颈外科

OBJECTIVE To discuss the diagnosis and treatment of cholesterol granuloma of the middle ear and the choice and effect of surgical methods. METHODS A retrospective analysis was conducted on 18 cases of cholesterol granuloma of the middle ear confirmed by surgery and pathology. Different choices of surgical methods were made according to the lesion extension of this disease. RESULTS All patients were followed up for at least 6 months. Two cases with eustachian tube obstruction had ventilation tube inserted for a long time. One case who had recurrence and metastasis of nasopharyngeal carcinoma in the middle ear was transferred to oncology department for further treatment. Post-operative dry ears were obtained in the other cases whose pure tone thresholds were improved to different degrees. CONCLUSION Etiology of cholesterol granuloma of middle ear remains controversial. It's supposed to result from the bleeding, occlusion of ventilation and disturbance of drainage of the air cavity because of the middle ear inflammation, and bone marrow exposure. The middle ear and mastoid surgery can completely remove the disease tissues, and establish ventilation system of mastoid-tympani-eustachian, which is the key point of the middle ear surgery.

Methodology for Intraoperative Laser Doppler Vibrometry Measurements of Ossicular Chain Reconstruction

OBJECTIVES: Despite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction. METHODS: Ten patients who underwent "second look" tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements. RESULTS: There were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam. CONCLUSION: LDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.

Medidas de imitância acústica de banda larga com estímulo chirp e tom puro em lactentes com normalidade de orelha média / Wideband acoustic immittance measures using chirp and pure tone stimuli in infants with middle ear integrity

RESUMO Objetivo: Caracterizar os valores de reflectância e absorvância de banda larga em lactentes com integridade de orelha média. Métodos: Foram analisados os valores de reflectância e absorvância de banda larga, para os estímulos chirp e tom puro, de 31 orelhas de 18 lactentes, na faixa etária de 10 dias a cinco meses de idade. Considerou-se como critérios de inclusão: ausência de fator de risco para deficiência auditiva, timpanometria com sonda de 1000 Hz, sugerindo normalidade de orelha média e presença de emissões otoacústicas evocadas por estímulo transiente, na triagem auditiva neonatal. Resultados: Os valores de reflectância mostraram-se maiores para as baixas frequências, reduzindo para as médias e aumentando, novamente, para as frequências altas, enquanto para os valores de absorvância, o comportamento foi o oposto. Não existiu diferença significativa entre os estímulos chirp e tom puro. Conclusão: Observou-se um comportamento típico das medidas estudadas, caracterizado por maior reflectância nas frequências graves e maior absorvância para as frequências médias.

ABSTRACT Purpose: To characterize the wideband reflectance and absorbance values in infants with middle ear integrity. Methods: The wideband reflectance and absorbance values for chirp and pure tone stimuli of 31 ears of infants aged 10 days to five months were analyzed. Inclusion criteria considered: 1000 Hz tympanometry. suggesting normal middle ear and the presence of transient evoked otoacoustic emission. Results: The reflectance values were shown to be greater for low frequencies, reducing to medium ones and increasing once again to high frequencies, while the absorbance values displayed an opposite behavior. No significant difference was verified between chirp and pure tone stimuli. Conclusion: A typical behavior of the measures, characterized by a higher reflectance at low frequencies and higher absorbance at medium frequencies was observed in the population studied.