Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation / Anatomia aplicada da janela redonda e estruturas adjacentes relacionadas ao implante coclear

Abstract Introduction: Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. Objective: The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. Methods: Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. Results: When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27 mm (mean of 0.69 ± 0.25 mm). Maximum width of round window ranged from 0.51 to 2.04 mm (mean of 1.16 ± 0.47 mm). Average minimum distance between round window and carotid canal was 3.71 ± 0.88 mm (range of 2.79-5.34 mm) and that between round window and jugular fossa was 2.47 ± 0.9 mm (range of 1.24-4.3 mm). Conclusion: The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.

Resumo Introdução: Vários aspectos da anatomia da janela redonda e da anatomia da caixa timpânica posterior são relevantes, devido a suas implicações no desenho dos eletrodos para o implante coclear e na visibilidade da janela redonda através do recesso facial. Informações prévias sobre possíveis variações anatômicas da janela redonda e suas relações com as estruturas neurovasculares adjacentes podem ajudar a reduzir as complicações dessa cirurgia. Objetivo: O presente estudo foi realizado para avaliar as diversas variações da anatomia da janela redonda e sua relação com as estruturas adjacentes, o que pode ser relevante para a cirurgia de implante coclear. Método: Trinta e cinco ossos temporais normais de cadáveres humanos frescos foram dissecados para avaliação da anatomia da janela redonda e sua relação com o nervo facial, canal carotídeo, fossa jugular e outras estruturas da caixa timpânica posterior. Os ossos dissecados foram fotografados com uma câmera digital de 18 megapixels e as imagens importadas para um computador para determinar diversos parâmetros, utilizando-se o software ScopyDoc versão 8.0.0.22, após a calibração adequada e com ampliação de 1×. Resultados: Quando o nicho da janela redonda se encontra posicionado posteriormente e inferiormente, a distância entre a janela redonda e o nervo facial vertical diminui, enquanto aquela com o nervo facial horizontal aumenta. Em tais casos, a distância entre a janela oval e a janela redonda também aumenta. A altura máxima da janela redonda em nosso estudo variou de 0,51 a 1,27 mm (média de 0,69 ± 0,25 mm). A largura máxima da janela redonda variou de 0,51 a 2,04 mm (média de 1,16 a 0,47 mm). A distância mínima média entre a janela redonda e o canal carotídeo foi de 3,71 ± 0,88 mm (variação de 2,79 a 5,34 mm) e entre a janela redonda e a fossa jugular, em nosso estudo, foi de 2,47 ± 0,9 mm (variação de 1,24 ± 4,3 mm). Conclusão: A distância da janela redonda a partir da janela oval e do nervo facial são parâmetros importantes para a identificação do difícil nicho da janela redonda. A modificação do desenho do eletrodo pode ser uma opção melhor do que o broqueamento das margens da janela redonda para a inserção dos eletrodos no implante coclear.

The Clinical Application of Eucalyptol, Limonene and Pinene Enteric Soft Capsules in the Treatment of the Prophylaxis of Tympanum Fluid in Secretory Otitis Media in Children / 听力学及言语疾病杂志

Objective To investigate the effects of the eucalyptol,limonene and pinene enteric soft capsules (mucoregulatory agents) in preventing from tympanum fluid in children.Methods A total of 341 children (497 ears) with acute otitis media were randomly divided into two groups:the experimental group and the control group.The experimental group was given symptomatic treatment and oral in-take of the eucalyptol,limonene and pinene enteric soft capsules,while the control group with acute otitis media received conventional symptomatic treatment.All the patients were followed-up 7 and 14 days after treatment.Clinical data were collected,including symptoms,and tympanogram changes.Results Seven days after the initial treatment,tympanum fluid occurred in 110 cases of 170 ears(65.09％,110/170) in the control group,and in 51 cases of 70 ears (29.65％,51/172) in the experimental group.The difference was statistically significant (P＜0.01).After 14 days,41 cases (66 ears)of tympanum fluid occurred in the control group (24.26％,41/169),32 cases(36 ears) of otitis media (18.60％,32/172) occurred in the experimental group.The difference was statistically significant (P＜0.01).In the control group,the tympanum fluid disappeared in 54 cases(60 ears) after regular treatment 72.0％,54/75),and reliefed in 15 cases(22 ears) with irregular treatment (42.86％,15/35).The difference was statistically significant (P＜0.01).Conclusion Eucalyptol,limonene and pinene enteric soft capsules can effectively reduce the incidence of tympanum fluid in children with acute otitis media.Mucoregulatory agents may promote the eduction of effusion.

Intra-Tympanic Steroid Treatment Alone as an Initial Treatment for the Patients with Severe or Profound Sudden Sensorineural Hearing Loss and Medical Problems in Steroid Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the feasibility of intra-tympanic steroid injection (ITS) treatment alone for patients with severe or profound sudden sensorineural hearing loss (SSNHL), who have medical problems in systemic steroid use. SUBJECTS AND METHOD: Medical records of 43 patients from March 2012 to March 2014 were investigated. Patients who did not have any medical problems in steroid use were treated by systemic steroid but patients with medical problems were treated by ITS alone. RESULTS: Systemic steroid was used in 32 patients, and 11 patients were treated by ITS alone. The mean follow up periods were 6.5±1.4 weeks for ITS only, and 6.5±2.6 weeks for the systemic steroid group. In the final audiometry results, the mean hearing level and the mean gain of affected ear in the two groups were not different, and the mean differences with unaffected ear in the two groups showed no differences. However, five patients of systemic steroid group recovered completely by Siegel's criteria. CONCLUSION: ITS only therapy for SSNHL is considered a great alternative for patients whose condition does not allow systemic steroid therapy.

Hearing Outcome According to the Timing of Intratympanic Dexamethasone Injection in Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oral systemic steroids are the most commonly accepted treatment for idiopathic sudden sensorineural hearing loss (SSNHL) despite pathophysiological uncertainty. Recently, intratympanic dexamethasone (ITD) has been proposed as an effective, alternative method for patients in whom oral steroids either fail to respond or are contraindicated. The authors compared the efficacy of ITD according to the duration of hearing loss prior to first dose of ITD. SUBJECTS AND METHOD: We retrospectively reviewed the medical records and audiologic data of 86 SSNHL patients who received ITD from May 2009 to April 2012. Injections were repeated 5 times for 2 weeks and the favorable recovery was defined as complete or partial recovery using Siegel's criteria. We compared the hearing outcomes between pre-ITD and post-ITD with respect to the duration of hearing loss. RESULTS: The mean pure-tone audiograms before and after ITD were 57.91+/-25.52 dB and 50.81+/-24.28 dB (p<0.01), respectively. According to Siegel's criteria, the overall rate of hearing improvement after ITD was 22.1% (19/86). Favorable hearing recovery was observed in 8 of 18 (44.4%) patients within 10 days, 7 out of 41 (17.1%) between 10 days and 20 days, 2 of 18 (11.1%) between 20 days and 30 days, 2 of 7 (28.6%) over 30 days. CONCLUSION: ITD is a useful method as primary or salvage treatment of SSNHL. The results of this study suggest that early ITD after hearing loss increase the probability of hearing recovery.

Human oscicular chain articulations: asymmetric sound transmission / Articulaciones de la cadena oscicular humana: transmisión asimétrica del sonido

The mechanism for conducting acoustic energy via middle ear oscicles is still a controversial topic and will remain so until consensus is reached regarding whether it amplifies or reduces sound transmission. 22 paired human temporal bone blocks and 1 left block were studied. Digital measurements were taken of the tympanic membrane, oscicular articulations and the oval window; the results were then correlated. A relationship of non-lineal areas was found amongst the structures being studied, suggesting a sound transmission relationship combining both sound reduction and amplification. A complex relationship of levers could be observed originating in an oscicular and articular asymmetric relationship suggesting an amplifying function in initial sound transmission and also a final reducer destination for such conduction.

El mecanismo para conducir la energía acústica a través de oscículos del oído medio es todavía un tema controvertido y lo seguirá siendo hasta alcanzar un consenso con respecto a si se amplía o reduce la transmisión del sonido. Fueron estudiados 22 pares de bloques de hueso temporal izquierdo y uno derecho hmanos. Mediciones digitales fueron tomadas de la membrana timpánica, articulaciones osciculares y de la ventana oval, siendo estos resultados correlacionados. Una relación de las áreas no-lineal se encontró entre las estructuras, lo que sugiere una relación de transmisión de sonido que incluye tanto la reducción de sonido y amplificación. Una compleja relación de las palancas se pudo observar originando una relación oscicular y articular asimétrica, lo que sugiere una función de amplificación de la transmisión del sonido inicial y también un destino reductor final para su conducción.

Preliminary study on diplopore puncture of tympanum and intratympanic administration for management of acute secretory otitis media / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the therapeutical effects of diplopore puncture of tympanum and intratympanic administration(DPTIA) on patients with acute secretory otitis media(ASOM).Method:One hundred and forty -one cases with ASOM were divided into two groups randomly,with 69 cases(80 ears) in group A(experimental group) and 72 cases(84 ears) in group B(control group).Group A was treated with DPTIA combined with medication, group B was treated with haplopore puncture of tympanum combined with medication. All patients accepted 1 to 3 courses of treament,and were observed during the period of treatment and 3 months after treatment.Result:The factors (including gender, age, side of ailing ear, course of disease, air-bone gap in the pure tone average,and acoustic immitance type in ailing ear) which may impact the prognosis were matched in two groups prior treatment(P＞0.05). While there was a significant difference in the cure rate and the total effective rate respectively between two groups after treatment(P＜0.05).No adverse reaction or complication was seen.Conclusion:DPTIA is a safe, reliable and effective way to manage patients with ASOM.

Retaining time of tympanic ventilation tube and aural complications / 临床耳鼻咽喉头颈外科杂志

Objective:To study the relationship of retaining time of tympanic ventilation tube and aural complications. Method:Three-hundred-five patients(659 ears)with otitis media with effusion(OME)received tympanostomy tube insertion. The tube were removed 6-36 months after tube insertion. Then aural complications were recorded in different tube retaining time, followed with a statistic analysis. Result: Fifty-five tubes of 29 patients were removed at 1-6 months after tube insertion, with spontaneous extrusion 3.4%, blocked tube 10. 3%, intrusion into the middle ear O, granulation 'tissue O, cholesteatoma O, otorrhea 6.9%, perforation O. One hundred and ninty tubes of 96 patients were removed at 6-12 months after tube insertion,with spontaneous extrusion 7. 3%,blocked tube 15.6%, intrusion into the middle ear 1%, granulation tissue O, cholesteatoma O, otorrhea 5.2%,perforation O. Three huandred and eight tubes of 156 patients were removed at 12-24 months after tube insertion, with spontaneous extrusion 9%,blocked tube 12.8% ,intrusion into the middle ear 1.3%,granulation tissue 1.9% ,cholesteatoma 0.6%,otorrhea 2.5%,perforation was O. One hundred and sixty one tubes of 83 patients were removed at 24-36 months after tube insertion, with spontaneous extrusion 36.1%, blocked tube 53%, intrusion into the middle ear 6%, granulation tissue 3. 6%, cholesteatoma 2.4%, otorrhea 2.4%, perforation 2.4%. Conclusion:The occurrence of complication didn't increase with time going by when the ventilation tube retained less than two years. However, when the ventilation tube retained more than two years, the occurrence of spontaneous extrusion and blocked tube increased obviously.

Manifestação otológica localizada em paciente com granulomatose de Wegener / Localized otologic manifestation in a patient with Wegener's granulomatosis

A granulomatose de Wegener (GW) é uma vasculite granulomatosa multissistêmica rara, idiopática, que acomete vasos de pequeno e médio calibres, e que classicamente envolvem os tratos respiratórios superior, inferior e rins. Na forma limitada da doença, diversos sítios anatômicos podem ser afetados isoladamente. Foi descrito o caso de uma paciente jovem, que iniciou o acometimento da GW por dispnéia, estridor laríngeo e hipacusia. A investigação evidenciou o acometimento localizado na glote, e envolvimento da membrana timpânica comprovado por biópsia. A paciente obteve resposta com o tratamento instituído, mas permaneceu com seqüelas otológicas. Revisa-se neste artigo algumas das manifestações focais da GW, salientando especialmente as manifestações otológicas.

Wegener's granulomatosis (WG) is a rare, idiopathic granulomatous vasculitis, affecting small and medium-sized vessels, classically involving upper and lower respiratory tracts and kidneys. In the limited form of the disease, several other sites can be affected. We describe the case of a young woman who presented her disease with dyspnea, laryngeal stridor and hearing loss. Investigation revealed localized glottis involvement and a tympanum biopsy confirmed granulomatous vasculitis. The patient had a partial response with the treatment, with residual deafness. We performed a review concerning the focal manifestations of WG, focusing in the ear involvement.

The Clinical Meaning of "C" Tympanum Figure in Secretory Otitis Media / 浙江中医药大学学报

-140dapa for 25 ears with positive figure 48.0%,when tympanum pressure ≤-140dapa for 43 ears with positive puncture 93.0%,there's marked difference between the 2 groups.[Conclusion] The negative pressure in the "C" tympanum figure was closely related with auris media fluid,esp.the tympanum pressure≤-140dapa.

The Effects of Intratympanic Steroid Injection for the Patients with Refractory Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High-dose steroid therapy has been known as the treatment of choice for sudden sensorineural hearing loss (SSNHL). However, about one third of patients do not generally respond to any treatments, and there seem to be no definitive treatment for the patients with refractory SSNHL. We prospectively studied the effect of intratympanic steroid injection (ITSI) for patients with refractory SSNHL. SUBJECTS AND METHOD: Sixty six patients with SSNHL, who were refractory to a course of oral steroid therapy, were included in this study. Thirty three patients (34 ears) were treated with ITSI and the other 33 patients had no further treatments as control. ITSI was performed with dexamethasone in the supine position on 4 separate occasions over the course of 2 weeks. Hearing was assessed immediately before every injection, and at 1 and 4 weeks after therapy. Hearing improvement was defined as more than 10 dB in pure tone average (PTA). RESULTS: Hearing improvement was observed in 13 (39.4%) of 33 patients who underwent ITSI and in 2 (6.1%) of 33 patients in control group. Five of 13 showed hearing improvement over 20 dB in PTA, and 11 of 20 patients showed no improvement in PTA by ITSI, but showed improvement over 10dB in some frequencies. There were no definite prognostic factors between the patients who responded to ITSI and those who didn't. CONCLUSION: ITSI is a simple and effective therapy for patients with refractory SSNHL.

Intratympanic Gentamycin for Intractable Meniere Disease / 听力学及言语疾病杂志

Objective To explore the effect of intratympanic gentamycin on intractable Meniere's disease.Methods 10 patients diagnosed of intractable Meniere disease were analyzed respectively.Results 9 patients got A and 2 patients got B in controlling vertigo.1 patient gots B and 9 patients got C in hearing result.Conclusion Intratympanic gentamycin for intractable Meniere disease is an effective method.It should be studied further.