Analysis of medium and long term efficacy of ossicle chain bypass technique in treatment of tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

Objective:For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. Methods:From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People's Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group（OCM）, 56 cases in the ossicular chain bypass reconstruction group（OCB）, and 40 cases in the malleus-incus complex resection reconstruction group（MICR）. Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed. Results:There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group（0） was significantly lower than that in OCM group（11.76%） and MICR group（7.5%）（P<0.05）. At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group（P<0.05）. At 36 months after operation, ΔABG of OCB group was better than that in the OCM group（P<0.05）, and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis（ETS） at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis（PTS） and total tympanosclerosis（TTS）（P<0.05）. Conclusion:Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.

Reparación de fractura aislada del mango del martillo con cemento ionomérico vidrioso autocurado / Repair of a malleus handle fracture using glass ionomer luting cement

Resumen La fractura aislada del mango del martillo es una entidad clínica poco habitual, pero frecuentemente subdiagnosticada. Lo fundamental es la sospecha clínica. El diagnóstico se confirma con la otoscopia neumática o la otomicroscopia con maniobra de Valsalva, en la cual se observa una movilidad anormal del mango del martillo. El rasgo de fractura se puede demostrar con tomografía computada de alta resolución o cone beam. Existen diferentes opciones de tratamiento como interposición de cartílago o uso de prótesis de reemplazo osicular así como cemento óseo. El cemento ionomérico vidrioso autocurado, muy utilizado en odontología, se ha usado en distintas cirugías otológicas con buenos resultados y biocompatibilidad. A nuestro saber no se ha usado en esta patología por lo que presentamos esta serie de tres casos en los cuales se ha usado esta novedosa técnica con buenos resultados clínicos.

Abstract Isolated fracture of the manubrium of the malleus is a rare clinical entity. Clinical suspicion is paramount. The usual clinical presentation is acute otalgia followed by tinnitus and fluctuating hearing loss after a brisk introduction and withdrawal of a finger into the external auditory canal. On physical examination, the eardrum looks normal on otoscopy. Only in pneumatic otoscopy or otomicroscopy with Valsalva an abnormal motility of the manubrium could bee seen. High-resolution computed tomography (CT) or cone beam CT is able to show the fracture line. Several treatment options have been proposed, such as interposition of bone or cartilage between the manubrium and the incus, total or partial ossicular replacement prosthesis; and the use of bone cement. Glass ionomer luting cement, with wide use in dentistry, has been used in several otological procedures with good biocompatibility and results, however, to our best knowledge, it has not been used to repair this type of fractures, so we present this novel material in three cases.

Anatomical and morphometric study of goat middle ear ossicles (Capra aegagrus hircus) / [Estudo anatômico e morfométrico dos ossículos da orelha média de caprinos (Capra aegagrus hircus)]

The social and economic roles of goat farming in Northeastern Brazil, allied to the fact that the use of goat middle ear ossicles for research and human ear surgery training has not yet been proposed, justify the study of their applicability as an experimental model. The middle ears of 19 goats (Capra aegagrus hircus) from the bone collection of the Laboratory and Didactic Anatomy Museum of Domestic and Wild Animals of the Federal University of Vale do São Francisco (UNIVASF) were dissected. The malleus, incus, and stapes were evaluated regarding their macroscopic morphology and biometry (length, width, and height). Ossicle morphology was similar to sheep, human, and bovine morphology. The malleus was 1.3 times heavier and 2.2 times longer than the incus, and 9.0 times heavier and 3.7 times longer than the stapes. The size relationship was positive between the stapes and the malleus and negative between the stapes and the incus. It is concluded that the middle ear size and the anatomical similarities with human ossicles make goats a useful model for experimental scientific studies, reconstructive surgery practice of the ossicular chain, and human ear surgery training.(AU)

Tanto o papel social quanto o econômico da caprinocultura na região Nordeste do Brasil, somados ao fato de que o uso de ossículos da orelha média de caprinos para estudos e treinamento cirúrgico otológico humano ainda não foi proposto, justificam o estudo de sua aplicabilidade como modelo experimental. Foram dissecadas as orelhas médias de 19 caprinos (Capra aegagrus hircus), provenientes do ossuário do Laboratório e Museu Didático de Anatomia dos Animais Domésticos e Silvestres - Universidade Federal do Vale do São Francisco. Martelos, bigornas e estribos tiveram a morfologia macroscópica e a biometria (comprimento, largura e altura) avaliadas. A morfologia dos ossículos assemelhou-se a de ovinos, humanos e bovinos. O martelo foi 1,3 vez mais pesado e 2,2 vezes mais comprido que a bigorna e 9,0 vezes mais pesado e 3,7 vezes mais comprido que o estribo. A relação de tamanho entre o estribo e o martelo foi positiva, e entre o estribo e a bigorna negativa. Conclui-se que o tamanho da orelha média e as semelhanças anatômicas com os ossículos humanos tornam os caprinos um modelo útil para estudos científicos experimentais, prática cirúrgica reconstrutiva da cadeia ossicular e treinamento cirúrgico otológico humano.(AU)

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,

Absence de méat acoustique externe et fixation antérieure du malleus : à propos d'un cas

L'absence de méat acoustique externe constitue 5.7% de l'ensemble des malformations de l'oreille. Il peut être isolé ou associé à d'autres malformations de l'oreille dont la fixation du malléus à la paroi latérale de la caisse du tympan. Nous rapportons un cas d'absence de méat acoustique externe gauche associée à une fixation pariétale antérieure bilatérale du malléus à la caisse tympanique

In Vivo Vibration Measurement of Middle Ear Structure Using Doppler Optical Coherence Tomography: Preliminary Study

OBJECTIVES: Doppler optical coherence tomography (DOCT) is useful for both, the spatially resolved measurement of the tympanic membrane (TM) oscillation and high-resolution imaging. We demonstrated a new technique capable of providing real-time two-dimensional Doppler OCT image of rapidly oscillatory latex mini-drum and in vivo rat TM and ossicles. METHODS: Using DOCT system, the oscillation of sample was measured at frequency range of 1–4 kHz at an output of 15 W. After the sensitivity of the DOCT system was verified using a latex mini-drum consisting of a 100 μm-thick latex membrane, changes in displacement of the umbo and contacted area between TM and malleus in normal and pathologic conditions. RESULTS: The oscillation cycles of the mini-drum for stimulus frequencies were 1.006 kHz for 1 kHz, 2.012 kHz for 2kHz, and 3.912 kHz for 4 kHz, which means that the oscillation cycle of the mini-drum become short in proportional to the frequency of stimuli. The oscillation cycles of umbo area and the junction area in normal TM for frequencies of the stimuli showed similar integer ratio with the data of latex mini-drum for stimuli less than 4 kHz. In the case of middle ear effusion condition, the Doppler signal showed a tendency of attenuation in all frequencies, which was prominent at 1 kHz and 2 kHz. CONCLUSION: The TM vibration under sound stimulation with frequencies from 1 kHz to 4 kHz in normal and pathologic conditions was demonstrated using signal demodulation method in in vivo condition. The OCT technology could be helpful for functional and structural assessment as an optional modality.

Presencia y relaciones anatomofuncionales del ligamento discomaleolar: una revisión de la literatura / Presence and anatomofunctional relations of the discomaleolar ligament: a literature review

El Ligamento Discomaleolar es una estructura que no se describe en los textos clásicos de anatomía a pesar de ser descrito por primera vez por Rees, Pinto y luego por diversos autores como una estructura ligamentosa de tejido fibroelástico que conecta el cuello y el proceso anterior del martillo a través de la fisura petrotimpánica hasta la parte medioposterosuperior de la cápsula de la articulación temporomandibular (ATM), el disco articular y el ligamento esfenomandibular. Diversos estudios han reportado las implicaciones clínicas del ligamento discomaleolar y la relación entre los trastornos temporomandibulares con los síntomas asociados al oído medio. El objetivo de este estudio fue realizar una revisión sobre estudios que describen el ligamento discomaleolar y determinar si se considera una estructura independiente anatómica y funcionalmente y su relación con el oído medio. Se realizó una búsqueda de literatura científica identificó artículos donde se identifican las estructuras anatómicas asociadas a la articulación témporomandibular y el oído medio, fueron seleccionados 24 artículos según los criterios de selección. Los resultados obtenidos en los estudios seleccionados en esta revisión sugieren la existencia de una lámina o fascículo fibroso que conecta el disco de la ATM con el maléolo del oído medio, lo que validaría la presencia y relación entre el ligamento discomaleolar y los trastornos del oído medio.

The Discomaleolar Ligament is a structure that is not described in the classic texts of anatomy despite being described for the first time by Rees, Pinto and later by various authors as a ligamentous structure of fibroelastic tissue that connects the neck and the anterior process of the malleus through the petrotympanic cleft to the mid-superior part of the capsule of the temporomandibular joint (TMJ), the articular disc and the sphenomandibular ligament. Several studies have reported the clinical implications of the discomaleolar ligament and the relationship between temporomandibular disorders and symptoms associated with the middle ear. The aim of this study was to conduct a review of studies that describe the discomaleolar ligament and determine if an anatomically and functionally independent structure and its relation to the middle ear is considered. A search was performed of scientific literature identified articles where the anatomical structures associated with the temporomandibular joint and the middle ear were identified, 24 articles were selected according to the selection criteria. The results obtained in the studies selected in this review suggest the existence of a lamina or fibrous fascicle that connects the TMJ disc with the malleolus of the middle ear, which would validate the presence and relationship between the discomaleolar ligament and middle ear disorders.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

OBJECTIVES: The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes. METHODS: Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed. RESULTS: A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P < 0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%. CONCLUSION: The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

A Case of Incus Extrusion into the External Auditory Canal after Head Trauma

Various types of ossicular chain interruption may occur in temporal bone fractures. The most common type is incudostapedial joint disruption. Incus is the most vulnerable to traumatic injury as compared with malleus or stapes, because it is suspended only by ligamentous structures and connected to the incudomalleolar and incudostapedial joints. Incus may rarely be pushed through tympanic membrane or pass through a fracture of posterosuperior external auditory canal. However, a case of complete extrusion of incus into the external auditory canal has not been reported. The author presents a rare case of incus extrusion into the external auditory canal with temporal bone fracture after head trauma.

Minimally Invasive Transcanal Removal of Attic Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In treating attic cholesteatoma, traditional microscopic approach provides limited exposure to the attic space. Recently, the use of endoscope has emerged as a new treatment option for attic cholesteatoma. The aim of this study is to report the preliminary results of transcanal endoscopic removal of attic cholesteatoma and to evaluate the feasibility of endoscopic approach to attic cholesteatoma. SUBJECTS AND METHOD: Six patients with attic cholesteatoma were enrolled in this study from Sep 2014 to Oct 2015. Cholesteatoma was removed via transcanal endoscopic approach. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: All patients had attic cholesteatoma in the epitympanic space with scutum erosion. However, the disease was restricted to the epitympanic space in three patients, whereas a limited extension of cholesteatoma to the aditus ad antrum was observed in two patients, and mesotympanum was involved in the remaining one patient. All of the patients suffered from conductive or mixed hearing loss with mean air-bone gap of 17.4 dB, and underwent endoscopic transcanal removal of cholesteatoma and scutoplasty. In three patients, the incus and malleus head were removed due to ossicular erosion, and a second-stage ossicular reconstruction was planned. No residual or recurrent diseases were noted during the follow-up period (mean: 13 months). No surgical complications were observed postoperatively, and favorable hearing outcome was obtained in all patients. CONCLUSION: Transcanal endoscopic approach was successfully performed in patients with limited attic cholesteatoma. Further studies involving a large number of patients with long-term follow-ups are necessary to prove the clinical efficacy of transcanal endoscopic approach in managing limited attic cholesteatoma.

Morfología y morfometría comparada entre los huesecillos auditivos del cerdo común (Sus scrofa domestica) y el Humano (Homo sapiens sapiens) / Comparative study of the morphology between the ossicles of the common pig (Sus scrofa domestica) and human (Homo sapiens sapiens)

El cerdo doméstico (Sus scrofa domestica) ha sido utilizado como modelo para estudiar métodos de implante en el oído medio previo a estudios clínicos humanos. Diferentes investigaciones han destacado la utilidad en este ámbito, como también su alta comparabilidad morfológica en relación con los humanos. Sin embargo, las descripciones anatómicas sobre sus huesecillos auditivos son insuficientes, al igual que las comparaciones en relación con el humano. Por ello, con el objetivo de realizar una descripción detallada de la anatomía de dichos huesecillos comparados con los del humano, se procedió a disecar seis cabezas de cerdo, de las cuales se extrajeron sus huesecillos para observar su morfología. Los resultados preliminares demostraron que la cadena de huesecillos del Cerdo comparte la presencia de las mismas formaciones anatómicas que se pueden identificar en los huesecillos del hombre, pero aún así existen diferencias descriptivas y morfométricas en la morfología de ellas. Los resultados permitieron concluir que existe alta comparabilidad morfológica entre ambas cadenas de huesecillos debido a sus diferencias y similitudes, lo cual lo hace ser un buen modelo didáctico para el estudio y la enseñanza de la morfología auditiva en distintos niveles educacionales.

The domestic Pig (Sus scrofa domestica)has been used as a model to study implants methods in clinical cases of the human middle ear. Different studies have highlighted the usefulness in this area, as well as its high morphological comparability with regard to humans. However, the anatomical descriptions about its ear bones are scarce, as comparisons in relation to the human. Therefore, in order to make a detailed description of the anatomy of these bones compared to human, it was necessary to dissect six pig heads of which its ossicles were removed to observe its morphology. Preliminary results showed that the pig'sossicles share the same anatomical formations that can be identified in the human ones, but there are some descriptive and morphometric differences in its morphology. The results concluded that there is high comparability between both morphological ossicular chains due to their differences and similarities, which makes it a great teaching model for the study and teaching of auditory morphology at different educational levels.

Phylogenic Oto-stomatognathic Connection of the Mammalian Jaw: A Novel Hypothesis for Tensor Tympani Muscle and TMD-related Otologic Symptoms / 체질인류학회지

Otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss, are known to be related to temporomandibular disorders (TMDs). There have been several hypotheses regarding the clinical correlation between otologic complaints and TMDs, based on clinical phenomena with corresponding symptoms, the close neurological relationship between otic and masticatory structures, and anatomical features of the tympanic cavity and jaw joint. Function of the tensor tympani muscle seems to be crucial to understanding TMD-related otologic symptoms. The tensor tympani inserts into the handle of the malleus and it modulates sound transduction in situations of excessive noise. This muscle is innervated by the trigeminal nerve, like the masticatory muscles. Voluntary eardrum movement by pathological tensor tympani contraction results in various otologic symptoms. Thus, co-contraction of the tensor tympani with the masticatory muscle could be a possible cause of TMD-related otologic symptoms. The tensor tympani is rather unrelated to the acoustic reflex, in which the stapedius is strongly involved. The tensor tympani seem to be controlled by proprioceptive information from the trigeminal sensory nucleus. The peripheral innervation pattern of the tensor tympani and masticatory muscles is also supposed to be interconnected. The middle ear structure, including the malleus, incus, and tensor tympani, of mammals had been adapted for acoustic function and lacks the masticatory role seen in non-mammalian jawed vertebrates. The tensor tympani in non-mammals is one of the masticatory muscles and plays a role in the modulation of sound transduction and mastication. After the functional differentiation of the mammalian middle ear, the nervous connection of the tensor tympani with other masticatory apparatus still remains. Through this oto-stomatognathic vestige, the tensor tympani seems to contract unnecessarily in some pathological conditions of the TMD in which the masticatory muscles contract excessively. We hypothesized that the phylogenic relationship between the tensor tympani and masticatory apparatus is a significant and logical reason for TMD-related otologic complaints.

Clinical analysis of tympanosclerosis: characteristics and treatment / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical characteristics, diagnosis and surgical management of tympanosclerosis.@*METHOD@#The data of 73 patients who underwent surgery for tympanosclerosis were retrospectively analyzed with respects to the clinical characteristics, diagnosis and management.@*RESULT@#Seventy-three patients with tympanosclerosis (involving 73 ears) , including 17 patients with sclerosis of tympanic membrane (type I), 23 patients with fixed Malleus-incus complex (type II), 8 (type III) with fixed stapes, and 25 (type IV) with extensive typannosclerosis. Sclerosis was seen most frequently in the malleus, incus and attic, followed by the tympanic membrane, incudomalleolar joint and other regions. Audiometry was performed for all the patients 1 weeks before and 1 year( the least) after operation, which were (51.70 ± 14.93)dB HL and (36.24 ± 11.58) dB HL respectively, with success rate 83% (61/73).@*CONCLUSION@#Most of the patients suffer from conductive hearing loss. Teatment of the sclerosis around stapes is a key point. Acording to the sites of lesion and hearing level, hearing structures should be reconstructed by the rules of tympanoplasty and stapes surgery.

Análisis de los términos utilizados en la literatura científica para referirse a los ligamentos extracapsulares de la articulación témporomandibular: Parte I: Ligamentum sphenomandibulare / A study of terms used in scientific literature to refer to the extracapsular ligaments of the temporomandibular joint: Part I: Ligamentum sphenomandibulare

La Terminología Anatómica es la base de correcta comunicación anatómica y establece la unificación internacionalmente aceptada para diversas estructuras anatómicas. Sin embargo, su uso en la literatura pedagógica y científica no se ha aplicado por completo. El objetivo de esta investigación fue analizar la literatura en relación al uso correcto de los términos referentes al Ligamento esfenomandibular de la Articulación témporomandibular (ATM). Se realizó una revisión en libros de anatomía y artículos científicos relacionados y se comparó el uso de términos referentes al ligamento esfenomandibular con la Terminología Anatómica Internacional (TAI). Se encontraron diferencias en cuanto a los términos usados (sinonimia) para referirse tanto al ligamento esfenomandibular, así como a las estructuras que sirven de origen e inserción a este con los términos establecidos por la TAI en latín, inglés y algunos términos traducidos al español. La sinonimia y uso de epónimos encontrados dificultan la comunicación entre los científicos del área, así como el aprendizaje de los alumnos de pregrado y postgrado, cuya principal fuente de estudio continúan siendo los libros de anatomía.

Terminología Anatómica is currently the international standard for anatomical terminology, and establishes an internationally accepted and unified nomenclature for several anatomical structures. However, International Anatomical Terminology (IAT) is not always used correctly in scientific literature. The purpose of this review is to examine scientific literature in order to determine whether the terms that refer to the sphenomandibular ligament of the temporomandibular joint (TMJ) are being used correctly. Scientific books and articles were reviewed, and the terms used were compared with those established by the IAT. Our study found differences between the terms actually used (Synonyms) to refer to the sphenomandibular ligament and to the anatomical structures where the ligament originates and where it is inserted and those established by the IAT in Latin, English and some terms translated into Spanish. The use of eponyms and synonyms found, creates difficulties in communication between scientists and in the learning process of undergraduate students, who frequently use textbooks.

Antropometría del martillo en humanos: un estudio anatómico directo / Anthropometry of the malleus in humans: a direct anatomic study

El conocimiento morfométrico de las estructuras del oído medio, incluidos cada uno de los oscículos, es importante para la comprensión de su complejidad biomecánica. Las características estructurales y dimensionales del martillo son registradas en 23 martillos de población mestiza adulta Colombiana. Las medidas registradas involucran el área de la cabeza, el cuello, el manubrio, el proceso anterior y lateral y el área de la articulación incudo-maleolar. Tres de los diecinueve registros tomados en este estudio pudieron ser comparados concienzudamente con otros estudios que mostraron similitudes. El largo total del martillo fue de 8,18 mm DE 0,24, la longitud del manubrio fue de 4,91 mm DE 0,25 y la proporción del largo del manubrio y el largo total fue de 60,11 % DE 3,47. Conforme a la población estudiada no se logro encontrar variación individual o pareada en la anatomía del martillo lo que lo hace un hueso morfométricamente uniforme y estable.

Morphometric knowledge of middle ear structures, including each of the oscicles, is important for the understanding of its biomechanics complexity. The structural and dimensional characteristics of the malleus are registered in 23 samples of Colombian adult mestizo population. Registered measures involve the area of the head, neck, the manubrium, the anterior and lateral process and the area of the incudo-maleolar joint. Three of nineteen records taken in this study could be carefully compared to other studies, which showed similarities. The total length of the malleus was 8,18 mm SD 0.24, the length of the handle was 4.91 mm SD 0.25 and the ratio of the length of the manubrium and the malleus total length was 60,11% of 3.47. In accordance with the studied population, individual or paired variations were not found in the anatomy of the malleus that makes it a morphometrically uniform and stable bone.

The study between temporal bone HRCT and operations in congenital abnormality of external and middle ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We explore the deformity degrees of external ear, mastoid process, tympanic cavity and auditory ossicle by the HRCT features of bilateral and unilateral patients of congenital abnormality of external and middle ear for preoperative analysis and selection for surgical approaches.@*METHOD@#Twenty-nine patients were enrolled in our study, and HRCT were performed on all patients. There were 23 unilateral ears deformity (13 right and 10 left), 6 patients with bilateral ears deformity in the study group. Nineteen patients (19 ears) were treated with operations.@*RESULT@#The deformity degree of auricle was correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. We got data of shortest distance from tympanic cape to atresia board in HRCT, (0.59 +/- 0.13)cm in comparison group, (0.45 +/- 0.19)cm in unilateral deformity group, (0.32 +/- 0.12)cm in bilateral deformity group, and there were significant differences compared the two deformity groups with the comparison group. There were 1 ear with normal auditory ossicle (2.86%), 5 ears with fixation of stapes foot board (14.29%), 3 ears with no auditory ossicle (8.57%); 26 ears with malleus and incus abnormality (74.29%). Abnormality of malleus was always concomitant with that of incus. Degeneration of malleus, the joint amalgamation of malleus and incus were discovered mostly in this research.@*CONCLUSION@#The deformity degree of auricle is correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. The shortest distance from tympanic cape to atresia board in HRCT in unilateral ears deformity group are shorten 0.15 cm in that of comparison group. And that of bilateral ears deformity group are shorten 0.25 cm in that of comparison group. The main abnormality of auditory ossicle in our research present in both malleus and incus, and degeneration of malleus and the joint amalgamation of malleus and incus are main types.

The impact of malleus processing in ossicular chain reconstruction on the therapeutic effect in patients with tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of different malleus treatments on the postoperative efficacy in the tympanosclerosis patients receiving ossicular chain reconstruction.@*METHOD@#Fifty-nine patients (62 ears) with tympanosclerosis were treated by ossicular chain reconstruction. All the patients were divided into three groups, including malleus removal group (A, 24 ears), retaining only the malleus handle group (B, 18 ears) and the intact malleus group (C, 20 ears). All the patients were followed up 3 months pre-operation, 3 months and 1 year post-operation by audiometric measurement (the average hearing threshold at 0.5, 1.0, 2.0 kHz HI). Tympanic membrane was examined by ear endoscope.@*RESULT@#The pre-operation mean air bone gap (ABG) in these groups were 40.07 +/- 77.56 dB, 37.31 +/- 76.45 dB, and 36.75 +/- 76.72 dB, among which the difference had no statistical significance (P > 0.05). At 3 months after operation, the ABG in all cases was improved at 0.5, 1 and 2 kHz. The difference of ABG improvement among these three groups had no statistical significance (P > 0.05). One year after surgery, the ABG of the three groups were decreased by 17.92 +/- 9.28 dB, 16.76 +/- 5.19 dB and 10.58 +/- 7.38 dB respectively. The hearing improvement in group C is less than the other two groups (P = 0.03, P = 0.016). The difference of hearing improvement between group A and group B had no statistical significance(P > 0.05). Group A and group B each have one case of tympanic membrane perforation and artificial ossicle falling off.@*CONCLUSION@#The operating processes of malleus in ossicular chain reconstruction of patients with tympanosclerosis were introduced. In terms of short-term efficacy, the three groups showed no significant difference. However, the long-term efficacy of the patients in the group A and group B were better compared with the group C.

The relationship between ossicular status and conductive hearing loss in cholesteatoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate and analyze the characteristic of destructive ossicular chain and it's impact on air-bone gap (ABG) among patients with cholesteatoma.@*METHOD@#Data from 204 cases (213 ears) undergoing an initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative pure tone audiometry data and intraoperative assessment of individual ossicular destruction.@*RESULT@#Incus was the most significantly affected ossicle. Furthermore, the destruction of malleus and stapes was often accompanied by the destruction of incus. A partially eroded incus caused significantly increase in ABG from that of an intact incus with cholesteatoma abutting (P < 0.05). A partially eroded incus and a partially eroded stapes caused significantly increase in ABG compared to a partially eroded incus (P < 0.05). A completely eroded incus caused significantly increase in ABG compared to a partially eroded incus (P < 0.05). False fibre-connected would significantly influence on ABG in some ossicular chain erosion patterns (P < 0.05). Cholesteatoma abutting an intact ossicle significantly altered average ABG compared to a normal ossicle (P < 0 01).@*CONCLUSION@#Different ossicular chain erosion pattern caused different degrees of ABG.

Audiologic Results of Ossiculoplasty Using Malleus Footplate Assembly: The Comparison between Autologous Incus and Hydroxyapatite

BACKGROUND AND OBJECTIVES: Absence of incus is one of the most common ossicular anomalies and also frequently found in chronic otitis media or chornic otitis media with cholesteatoma. Ossiculoplasty with malleus footplate assembly (MFA) can be an excellent option in the above situations. We reviewed our procedures and evaluated the hearing results of ossiculoplasty using the MFA. SUBJECTS AND METHODS: This study retrospectively reviews a series of 32 patients who underwent MFA ossiculoplasty between September 2001 and March 2010 in an academic tertiary referral center. The autologous incus or hydroxyapatite (HA) was used as materials for reconstruction. RESULTS: Thirteen of 32 patients (40.6%) had ossicular chain anomaly, 9 patients (28.1%) had congenital cholesteatoma and 8 patients (25.0%) had chronic otitis media with cholesteatoma and 2 patients (6.3%) had chronic otitis media. The patients with ossicular chain ano-maly showed the greatest air-bone gap (ABG) closure. Overall, postoperative ABG was 17.7+/-11.7 dB at postoperative 6 months and 19.7+/-14.3 dB at postoperative 1 year, compared with preoperative ABG of 37.9+/-9.3 dB. There was no statistical difference of ABG at postoperative 12 months, 24 months between MFA using incus (n=17) and HA (n=15)(p=0.300, and p=0.563). There was no meaningful difference of postoperative ABG between the patients with combined mastoidectomy (n=10) and those without mastoidecmoy (n=22)(p=0.555). No extrusions occurred. CONCLUSIONS: MFA can be an effective option in the case of absent incus expecting good postoperative hearing results.