Escuchar con los ojos: evaluación por tomografía axial computarizada de la pérdida auditiva / Listening with your eyes: computed tomography assessment of hearing loss

Múltiples patologías pueden afectar el funcionamiento del aparato auditivo. El conocimiento anatómico de los compartimentos del hueso temporal en la tomografía axial computarizada (TAC) conduce a una mejor comprensión de estas entidades y mejora el enfoque clínico hacia la pérdida auditiva conductiva o neurosensorial. Un diagnóstico preciso significa un inicio rápido del tratamiento, lo cual puede modificar el pronóstico del paciente

Multiple pathologies can affect the function of the auditory apparatus. Anatomical knowledge of the temporal bone compartments on computed tomography leads to a better understanding of these entities and improves the clinical approach toward conductive or sensorineural hearing loss. An accurate diagnosis means a rapid initiation of treatment, which can change the patient's prognosis.

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)

Post-traumatic malleo-incudal complex dislocation

@#A 27-year-old man undergoes otolaryngologic evaluation for blunt head trauma suffered in a vehicular accident. With regards to the right ear, pertinent otologic findings include an ear canal laceration and a delayed-onset facial nerve paresis. Tuning fork testing reveals an abnormal Rinne test on the right (AC<BC). The radiologist’s interpretation of the computerized tomographic imaging study of the temporal bone indicated the presence of a longitudinal fracture of the right temporal bone with no disruption of the ossicular chain. (Figure 1) However, careful examination of the anatomy of the malleo-incudal complex in relation to the other structures in the epitympanum actually reveals findings indicative of a malleo-incudal complex dislocation. How can this discrepancy in the radiologic interpretation be accounted for? By what objective parameters can the presence of a malleoincudal complex dislocation be identified?

Effect of malleostapedotomy procedure on 17 cases of congenital middle ear malformation / 中华耳鼻咽喉头颈外科杂志

Objective: To conclude the clinical features and the postoperative efficacy of congenital middle ear malformation treated with Malleostapedotomy (MS), and to explore the security and effectiveness of MS surgery. Methods: The clinical data of 17 patients (18 ears) with congenital middle ear malformation undergoing MS procedure were analyzed. There were 10 males (11 ears) and 7 females (7 ears), aged from 7 to 48 years. The imaging examination, pure-tone audiometry, intraoperative findings and postoperative hearing improvement of these patients were analyzed and summarized, and software SPSS23.0 was used for statistical analysis. Rusults All the 17 patients (18 ears) presented with hearing loss since childhood on the affected sides. Preoperative high resolution CT (HRCT) of the temporal bone revealed definite malformations in 9 ears (6 ears with incus long process dysplasia and 3 ears with anterior and posterior crus dysplasia). Before surgery, the mean bone conductive hearing threshold at 500, 1 000, 2 000 and 4 000 Hz was (15.6±10.2) dB HL, the mean air conductive hearing threshold was (60.6±9.7) dB HL, and the mean air-bone gap was (45.0±8.9) dB. During the surgery, all 18 ears were found to be accompanied by absence or hypoplasia of incus long process. 12 ears had stapes fixation, 6 ears had oval window atresia. All patients were treated with MS procedure by using Piston. The patients were followed up for 3 months to 1 year. The mean bone conductive hearing threshold was (14.7±8.8) dB HL. The mean air conductive hearing threshold was (37.7±11.6) dB HL, and the mean air-bone gap was (23.0±8.0) dB. There were statistically significant differences in the mean air conductive hearing threshold and mean air-bone gap before and after surgery (P<0.05). While there were no statistically significant differences in the mean bone conductive hearing threshold before and after surgery (P=0.550). Conclusions: MS procedure is safe and reliable in patients with congenital middle ear malformation of incus long process dysplasia, stapes fixation or oval window atresia. HRCT is useful in evaluating the major deformity of ossicular chain and facial nerve deformity. However, it is not enough to evaluate the joint of incus-stapes and oval window atresia. MS surgery in middle ear malformation requires advanced surgical experience and skills. The hearing improvement can be significant, even though some air-bone gap after surgery exist.

Analysis of clinical characteristics of middle ear osteoma at different locations / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.

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,

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors / Reconstrução da cadeia ossicular na otite média crônica: resultados auditivos e análise de fatores prognósticos

Abstract Introduction The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. Objective Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. Methods Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz. Results Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB. Conclusion We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.

Resumo Introdução A ossiculoplastia tem como objetivo a melhoria da audição e o sucesso desse procedimento depende de diversos fatores. Objetivo Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico. Método Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, total de 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhoria dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz. Resultados A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB. Conclusão Melhora significativa da audição foi observada em pacientes submetidos à ossiculoplastia, os resultados foram comparáveis aos de outros centros. O "status" dos ossículos influenciou os resultados pós-operatórios, principalmente a presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.

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.

Numerical analysis of the influence of otitis media on the hearing compensation performance of round-window stimulation / 生物医学工程学杂志

In order to study the influence of tympanic membrane lesion and ossicular erosion caused by otitis media on the hearing compensation performance of round-window stimulation, a human ear finite element model including cochlear asymmetric structure was established by computed tomography (CT) technique and reverse engineering technique. The reliability of the model was verified by comparing with the published experimental data. Based on this model, the tympanic membrane lesion and ossicular erosion caused by otitis media were simulated by changing the corresponding tissue structure. Besides, these simulated diseases' effects on the round-window stimulation were studied by comparing the corresponding basilar-membrane's displacement at the frequency-dependent characteristic position. The results show that the thickening and the hardening of the tympanic membrane mainly deteriorated the hearing compensation performance of round-window stimulation in the low frequency; tympanic membrane perforation and the minor erosion of ossicle with ossicular chain connected slightly effected the hearing compensation performance of round-window stimulation. Whereas, different from the influence of the aforementioned lesions, the ossicular erosion involving the ossicular chain detachment increased its influence on performance of round-window stimulation at the low frequency. Therefore, the effect of otitis media on the hearing compensation performance of round-window stimulation should be considered comprehensively when designing its actuator, especially the low-frequency deterioration caused by the thickening and the hardening of the tympanic membrane; the actuator's low-frequency output should be enhanced accordingly to ensure its postoperative hearing compensation performance.

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.

Evaluation of the Facial Recess and Cochlea on the Temporal Bone of Stillbirths regarding the Percutaneous Cochlear Implant

Abstract Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.

Feasibility of ossicular chain reconstruction with resin cement / Viabilidade da reconstrução da cadeia ossicular com cimento resinoso

Abstract Introduction: Disjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium. Objective: Because of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation. Methods: Two anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method. Results: A total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed. Conclusion: Resin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.

Resumo Introdução: É frequente a disjunção da cadeia ossicular nas doenças crônicas da orelha média. Além de interposições ossiculares, vários materiais já foram usados com a finalidade de reconstruí-la, como próteses de cerâmica, polietileno e titânio. Objetivo: Devido ao alto custo das opções existentes, propomos reconstruir a cadeia com cimento resinoso, material usado normalmente na reconstrução e fixação dentária. Método: Serão usadas duas peças anatômicas de ossos temporais, nas quais será criada uma disjunção da cadeia entre a bigorna e o estribo que, a seguir, será reconstruída com o cimento resinoso. Essas reconstruções serão repetidas quatro vezes por três cirurgiões diferentes, para certificação da viabilidade do método. Resultados: Foram feitas 12 reconstruções, quatro por cada cirurgião. Após aplicação do cimento, conseguimos, ao toque, perceber que o espaço foi preenchido adequadamente pelo material empregado. Notamos ainda adequada articulação com transferência de movimento para toda a cadeia ossicular. Conclusão: O cimento resinoso é um material viável na reconstrução de lesões da cadeia ossicular e proporciona um método tecnicamente simples e de baixo custo.

Medidas de imitância acústica de banda larga em indivíduos com otosclerose / Wideband acoustic immittance measurements in subjects with otosclerosis

Na prática clínica, nota-se uma dificuldade em identificar a rigidez do sistema tímpano-ossicular decorrente da Otosclerose por meio dos métodos de avaliação rotineiramente empregados. Assim, as medidas de imitância acústica de banda larga podem fornecer mais informações sobre a condição do sistema tímpano-ossicular por avaliarem uma ampla faixa de frequência. O objetivo do estudo foi caracterizar as medidas de imitância acústica de banda larga com os estímulos tom puro e chirp em indivíduos com diagnóstico de Otosclerose submetidos à estapedectomia ou estapedotomia. Foram avaliados 40 indivíduos na faixa etária de 33 a 80 anos, totalizando 54 orelhas operadas e 22 orelhas não operadas. A avaliação audiológica foi realizada por meio da otoscopia, audiometria tonal liminar, logoaudiometria e imitanciometria. As medidas de imitância acústica de banda larga foram obtidas por meio do sistema de medidas Middle-Ear Power Analyzer MEPA3, versão 5.0 (Mimosa Acoustics), utilizando os estímulos tom puro e chirp. Os dados obtidos foram submetidos à análise estatística descritiva e inferencial, com nível de significância de 0,05. As orelhas com Otosclerose apresentaram maior absorvância em 750 Hz, uma tênue diminuição até 3000 Hz, acentuando-se a partir desta frequência. A magnitude da admitância foi maior na faixa de frequência de 1992 a 4008 Hz, assim como a magnitude da impedância foi maior nas frequências baixas com diminuição até 4008 Hz e aumento em 6000 Hz. Estas orelhas foram dominadas pela rigidez nos sons graves e médios, por resistência entre 3000 e 4008 Hz e a partir desta frequência pela massa. A fase da impedância foi maior em 258 Hz e o delay da reflectância (slope) apresentou uma variação de comportamento entre as frequências, não sendo possível caracterizar um padrão de resposta. Conclui-se que há diferenças nas medidas obtidas nas orelhas com Otosclerose submetidas à cirurgia, quando analisadas as frequências baixas e médias, o que demonstra o impacto positivo da intervenção cirúrgica na funcionalidade do sistema tímpano-ossicular.(AU)

In clinical practice, there is a difficulty in identifying the rigidity of the tympano-ossicular system resulting from Otosclerosis through the routinely employed evaluation methods. Thus, wideband acoustic immitance measurements can provide more information on the condition of the tympanic-ossicle system by evaluating a wide frequency range. This study aimed at characterizing the wideband acoustic immitance measurements with the pure tone and chirp stimuli in individuals diagnosed with Otosclerosis submitted to stapedectomy or stapedotomy. Forty individuals aged 33 to 80 years were evaluated, totaling 54 operated and 22 non-operated ears. Audiology assessment was performed through otoscopy, pure-tone audiometry, logoaudiometry and imitanciometry. Wideband acoustic immitance measurements were obtained using the Middle-Ear Power Analyzer (MEPA3), version 5.0 (Mimosa Acoustics), by means of pure tone and chirp stimuli. Data were submitted to descriptive and inferential statistical analysis, with a significance level of 0.05. The ears with Otosclerosis presented a greater absorbance in 750 Hz, a slight diminution until 3000 Hz, being accentuated from this frequency. The admittance magnitude was higher in the frequency range from 1992 to 4008 Hz, as well as the impedance magnitude was higher in the low frequencies with a decrease up to 4008 Hz and an increase in 6000 Hz. These ears were dominated by rigidity in the low and medium sounds, by resistance between 3000 and 4008 Hz, and from this frequency, by the mass. The impedance phase was higher at 258 Hz and the reflectance delay (slope) showed a behavioral variation between the frequencies, a response not being characterized. It can be concluded that there are differences in the measurements obtained in Otosclerosis ears submitted to surgery, when the low and medium frequencies were analyzed, which demonstrates the positive impact of the surgical intervention on the tympano-ossicle system.(AU)

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.

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.

Analyses of the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane, and summarize the key diagnostic points, differential diagnosis and observe the effects of surgical treatment.</p><p><b>METHODS</b>We reviewed data from 82 patients with unilateral conductive hearing loss with intact tympanic membranes who accepted the exploratory tympanotomy from April 2011 to September 2013. There were 41 males and 41 females, aged from 7 to 66( averaged 26.5±13.7)years, with a history of one month to 50 years. The history, clinical symptoms, audiological evaluation, high resolution temporal bone CT, the results of surgical exploration and hearing reconstruction were analyzed.</p><p><b>RESULTS</b>The exploratory tympanotomy revealed 43 cases of congenital middle ear malformations (52.4%), 22 cases of otosclerosis (26.8%), eight cases of congenital cholesteatoma (9.8%), six cases of trauma induced conductive hearing loss (7.3%), three cases of congenital ossicular malformations with congenital cholesteatoma (3.7%). Progressive hearing loss was common in patients with otosclerosis and congenital cholesteatoma, and patients with congenital middle ear malformations described their hearing loss since childhood. High resolution temporal bone CT of congenital middle ear malformation, trauma induced conductive hearing loss, congenital cholesteatoma diagnosis rate was 40.0%, 50.0%, and 83.3% respectively. The preoperative air-conductive threshold of patients with absence of the oval window were increased to (66.9±1.1)dBHL, the preoperative bone-conductive threshold achieved (28.3±10.4)dBHL at 2 000 Hz. While patients with stapes fixation and that with ossicular chain discontinuity were (27.2±9.7)dBHL and (17.8±8.8)dBHL(P=0.000)respectively. Through the tympanic exploration with endaural incision under the microscope, different hearing reconstruction were applied according to different lesions. After the operation, the hearing level of 52 patients with return visit were improved, the mean air-conductive threshold were decreased from (60.0±11.4)dBHL to (32.2±12.1)dBHL(P=0.000); and the mean ABG were decreased from (43.2±12.0)dB to (16.3±9.4)dB(P=0.000).</p><p><b>CONCLUSIONS</b>Congenital middle ear malformations, otosclerosis, congenital cholesteatoma are the most common causes in unilateral conductive hearing loss with an intact tympanic membrane. The diagnosis rate can be improved by analyzing the clinical features. Through exploratory tympanotomy and hearing reconstruction, we can clarify the diagnosis and achieve a satisfying hearing recover.</p>

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.

Macroscopic description of the external and middle ear of paca (Cuniculus paca Linnaeus, 1766) / Descrição macroscópica da orelha externa e media da paca (Cuniculus paca Linnaeus, 1766)

Paca (Cuniculus paca), one of the largest rodents of the Brazilian fauna, has inherent characteristics of its species which can conribute as a new option for animal experimantation. As there is a growing demand for suitable experimental models in audiologic and otologic surgical research, the gross anatomy and ultrastructural ear of this rodent have been analyzed and described in detail. Fifteen adult pacas from the Wild Animals Sector herd of Faculdade de Ciências Agrárias e Veterinárias, Unesp-Jaboticabal, were used in this study. After anesthesia and euthanasia, we evaluated the entire composition of the external ear, registering and ddescribing the details; the temporal region was often dissected for a better view and detailing of the tympanic bulla which was removed and opened to expose the ear structures analyzed mascroscopically and ultrastructurally. The ear pinna has a triangular and concave shape with irregular ridges and sharp apex. The external auditory canal is winding in its path to the tympanic mebrane. The tympanic bulla is is on the back-bottom of the skull. The middle ear is formed by a cavity region filled with bone and membranous structures bounded by the tympanic membrane and the oval and round windows. The tympanic membrane is flat and seals the ear canal. The anatomy of the paca ear is similar to the guinea pig and from the viewpoint of experimental model has major advantages compared with the mouse ear.

A paca (Cuniculus paca), um dos maiores roedores da fauna brasileira, possui características inerentes à sua espécie que podem contribuir como uma nova opção de animal experimental; assim, considerando-se que há crescente busca por modelos experimentais apropriados para pesquisas audiológicas e otológica cirúrgicas foram analisados e descritos em detalhes a anatomia macroscópica e ultraestrutural da orelha desse roedor. Para o estudo, utilizaram-se 15 animais adultos provenientes do plantel do Setor de Animais Silvestres da Faculdade de Ciências Agrárias e Veterinárias, Unesp-Jaboticabal, Jaboticabal/SP. Após anestesia e eutanásia, avaliou-se toda a composição da orelha externa, registrando-se e descrevendo-se os detalhes, também se dissecou a região temporal para melhor visibilização e detalhamento da bula timpânica e estas foram removidas e abertas a fim de expor as estruturas da orelha, as quais foram analisadas, macroscopicamente e ultraestruturalmente. O pavilhão auricular apresenta forma triangular e côncava com cristas irregulares e ápice pontiagudo; o conduto auditivo externo é sinuoso em seu trajeto até a membrana timpânica; a bula timpânica encontra-se na parte posterior-inferior do crânio; a orelha média é formada por uma região cavitária preenchida por estruturas ósseas e membranosas. É delimitada pela membrana timpânica e as janelas redonda e oval, sendo a membrana timpânica de forma plana e que veda todo o conduto auditivo. A anatomia da orelha da paca é semelhante à da cobaia e do ponto de vista de modelo experimental apresenta grandes vantagens em comparação com a orelha do rato.