Tympanic membrane perforations cannot be reliably detected using computed tomography based on 15 cadaver dogs.

The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model.

Radiological and Audiological Prediction for Ossicular Fixation in Chronic Otitis Media and Tympanic Membrane Perforation.

OBJECTIVES: Recurrent middle-ear infection can lead to ossicular fixation, adversely affecting post-tympanoplasty hearing outcomes. Preoperative prediction of ossicular fixation remains challenging. We aimed to investigate potential predictors of ossicular fixation in patients with chronic otitis media. STUDY DESIGN: Retrospective. SETTING: Tertiary academic medical center. PATIENTS: Patients with noncholesteatomatous chronic otitis media and tympanic membrane perforation, without ossicular discontinuities. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: The fixation of each ossicle was assessed during tympanoplasty. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of ossicular fixation was evaluated using uni- and multivariable logistic regression analyses. RESULTS: One hundred thirty-five patients were included. Soft-tissue density between the malleus head and the anterior wall (odds ratio, 3.789 [95% confidence interval, 1.177-12.196]; p = 0.0255) and poor development of mastoid cells (16.826 [2.015-134.520]; p = 0.0078) were independent predictors of malleus fixation. In addition, ≥50% tympanic membrane perforation (5.412 [1.908-15.353]; p = 0.0015), poor development of mastoid cells (3.386 [1.039-11.034]; p = 0.0431), and a ≥40-dB preoperative air-bone gap (ABG) at 500 Hz (4.970 [1.732-14.261]; p = 0.0029) were independent predictors of incus fixation. Soft-tissue density surrounding the stapes (18.833 [1.856-191.104]; p = 0.0119) and a ≥40-dB preoperative ABG at 500 Hz (13.452 [1.640-∞]; p = 0.0138) were correlated with stapes fixation. CONCLUSIONS: The accurate prediction of ossicular fixation in patients with chronic otitis media based on CT features and the ABG may facilitate decision-making regarding the need for ossiculoplasty, possibly avoiding unnecessary manipulation or overlooking of fixation.

Correlation between tympanometry volume and three-dimensional computed tomography mastoid volumetry in tympanoplasty candidates.

OBJECTIVE: Ventilation of the middle ear and mastoid air cells is believed to play an important role in the pathogenesis of chronic ear disease. Traditionally, ventilation is assessed by computed tomography. However, this exposes patients to cumulative radiation injury. In cases with a perforation in the tympanic membrane, tympanometry potentially presents a non-invasive alternative to measure the ventilated middle-ear and mastoid air cell volume. This study hypothesised that total tympanometry volume correlates with ventilated middle-ear and mastoid air cell volume. METHOD: Total tympanometry volume was compared with ventilated middle-ear and mastoid air cell volume on computed tomography scans in 20 tympanic membrane perforations. RESULTS: There was a high correlation between tympanometry and computed tomography volumes (r = 0.78; p < 0.001). A tympanometry volume more than 2 ml predicted good ventilation on computed tomography. CONCLUSION: These results may help reduce the need for pre-operative computed tomography in uncomplicated cases with tympanic membrane perforations.

Use of endoscope in teaching of otolaryngology residents about site and size of tympanic membrane perforation and its impact on degree of hearing loss in adult patients: A cross sectional study.

OBJECTIVE: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing. METHODS: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane using Image J software. Data analysis was done using Stata 12. RESULTS: Of the 55 patients, 29(53%) were males and 26(47%) were females. The overall mean age was 33+/-15 years. With every 5% increase in the size of perforation, the hearing loss increased by 1 decibel. A difference of 5.5 decibels was noted between anterior and posterior perforations of similar size. CONCLUSION: Hearing loss increased with increase in the size of perforation.

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts.

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations / Identificação e conduta nas perfurações traumáticas da membrana timpânica com bordas invertidas ou evertidas

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations.

INTRODUCTION: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. OBJECTIVE: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. METHODS: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes. RESULTS: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. CONCLUSION: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Large-scale otoscopic and audiometric population assessment: A pilot study.

OBJECTIVE: Large-scale otoscopic and audiometric assessment of populations is difficult due to logistic impracticalities, particularly in low- and middle-income countries (LMIC). We report a novel assessment methodology based on training local field workers, advances in audiometric testing equipment and cloud-based technology. METHODS: Prospective observational study in Bohol, Philippines. A U.S. otolaryngologist/audiologist team trained 5 local nurses on all procedures in a didactic and hands-on process. An operating otoscope (Welch-AllynR) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMedR). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path SentieroR), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreenR). Sound-booth audiometry was reserved for failed subjects. Data were uploaded to a REDCap database. Teenage children previously enrolled in a 2000-2004 Phase 3 pneumococcal conjugate vaccine trial, were the subjects of the trainees. RESULTS: During 4 days of training, 47 Filipino children (M/F = 28/19; mean/median age = 14.6/14.6 years) were the subjects of the trainee nurses. After the training, all nurses could perform all procedures independently. Otoscopic findings by ears included: normal (N = 77), otitis media with effusion (N = 2), myringosclerosis (N = 5), healed perforation (N = 6), perforation (N = 2) and retraction pocket/cholesteatoma (N = 2). Abnormal audiometric findings included: tympanogram (N = 4), DPOAE (N = 4) and screening audiometry (N = 0). CONCLUSION: Training of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations / Observação endoscópica de diferentes padrões de reparo em perfurações humanas traumáticas da membrana timpânica

Abstract Introduction: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. Objective: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. Methods: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. Results: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01). Conclusion: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.

Resumo Introdução: Na última década, houve um uso crescente de placas biomateriais na regeneração de perfurações traumáticas da membrana timpânica. As principais vantagens das placas de biomateriais são restaurar provisoriamente a função fisiológica da orelha média, assim melhoram imediatamente os sintomas da orelha e atuam como um suporte para a migração do epitélio. No entanto, não se sabe se há efeitos clínicos adicionais na regeneração do tímpano em relação ao fragmento de material biológico. Objetivo: Avaliar a resposta de cicatrização para diferentes padrões de reparo em perfurações de membrana timpânica traumáticas humanas por meio de observação endoscópica. Método: Foram alocados 114 pacientes com perfurações de membrana timpânica traumáticas sequencialmente para dois grupos: o de cicatrização espontânea (n = 57) e o tratado com esponja de Gelfoam (n = 57). A velocidade de fechamento, o tempo de fechamento e a taxa de otorreia foram comparados entre os grupos aos três meses. Resultados: Foram analisados 107 pacientes nos dois grupos (52 no de cicatrização espontânea e 55 no tratado com esponja de Gelfoam). A velocidade global de fechamento no fim do período de seguimento de três meses foi de 90,4% no grupo de cicatrização espontânea e de 94,5% no grupo tratado com esponja de Gelfoam; a diferença não foi estatisticamente significativa (p > 0,05). No entanto, o tempo total médio de fechamento foi significativamente diferente entre os dois grupos (26,8 ± 9,1 dias no de cicatrização espontânea versus 14,7 ± 9,1 dias no tratado com esponja de Gelfoam, p < 0,01). Além disso, a velocidade de fechamento não foi significativamente diferente entre o grupo de cicatrização espontânea e o grupo tratado com esponja de Gelfoam, independentemente do tamanho da perfuração. O tempo de fechamento no grupo tratado com esponjas de Gelfoam foi significativamente menor do que no grupo de cicatrização espontânea, independentemente do tamanho da perfuração (pequenas perfurações: 7,1 ± 1,6 dias vs. 12,6 ± 3,9, perfurações de tamanho médio: 13,3 ± 2,2 dias vs. 21,8 ± 4,2 dias e grandes perfurações: 21,2 ± 4,7 dias vs. 38,4 ± 5,7 dias; p < 0,01). Conclusão: Na regeneração de PMT traumáticas, a esponja de Gelfoam não só desempenha um papel de estrutura para a migração epitelial, mas também promove edema e hiperplasia de tecido de granulação nas bordas da perfuração e acelera a cicatrização do tímpano.

Narrow band imaging endoscopy improves visualization of vessels of the perforated tympanic membrane.

PURPOSE: Because successful healing of a tympanic membrane perforation (TMP) depends upon the maintenance of blood supply to the injured area, we assessed the usefulness of narrow band imaging (NBI) video endoscopy to evaluate its vascularization. To our knowledge, the use of NBI to assess tympanic membrane (TM) vascular patterns has never been attempted. METHODS: Prospective observational study. NBI and cold white light (CWL) flexible videoendoscopy was used to explore perforated TMs of 100 patients. Main outcome measures were visualization of vessels among abnormal TM findings: monomeric areas (MA) (n = 6), myringosclerosis plaques (MP) (n = 65) and perforation edges (n = 100). They were graded by a vascular otoendoscopic score (VOS) comparing both types of lights (Wilcoxon test). Location and vascularization patterns were analyzed (Fisher's test). RESULTS: NBI was better to observe vascularization of 32% of perforation edges and 75.4% of MP (p < 0.001). NBI displayed higher (better) VOS when evaluating TMP edges (1.05 vs. 0.73) and MP (1.56 vs. 0.81, p < 0.001). The majority of TMP edges showed a ring pattern (66%), followed by irregular (19%), avascular (12%) and radial patterns (3%). The avascular pattern was more frequent in posterior perforations (p = 0.003). The radial pattern was most frequently found in MP, especially at posterior quadrants (p = 0.048). MA presented an irregular pattern in 83.3% of TMs. CONCLUSIONS: NBI videoendoscopy is a promising non-invasive technique, superior to CWL for visualizing vessels among TMP edges and MP, based on further study, could become a supplementary diagnostic tool in the workup of TMP and the decision-making surgical field.

Prognostic roles of preoperative CT findings and air-bone gaps in type 1 tympanoplasty.

BACKGROUND: Although CT has been used widely, the role of preoperative CT findings including other factors in tympanoplasty has not been elucidated comprehensively. AIMS/OBJECTIVES: To evaluate relationship of CT findings with other factors and audiological results in type 1 tympanoplasty. MATERIAL AND METHODS: A cohort of consecutive 175 patients with type 1 tympanoplasty was enrolled. Addition of mastoidectomy was based on the presence of soft tissue in antrum on CT. Postoperative air-bone gap (ABG) and reperforation rate were analyzed. RESULTS: Positive soft tissue in antrum on CT was found in 52 (29.7%) patients and showed larger preoperative ABG than the negative group. Successful ABG closure (≤20 dB) was obtained in 97% when preoperative ABG ≤20 dB, but it decreased as the preoperative ABG increased (83% with preoperative ABG of 21-30 dB, and 0% with preoperative ABG >30 dB). Postoperative reperforation rate was positively related to the preoperative ABG, but not the presence of soft tissue in the antrum, the size, or locations of preoperative perforations. CONCLUSIONS AND SIGNIFICANCE: Our findings showed that temporal bone CT was helpful in determining addition of mastoidectomy and the presence of soft tissue in the antrum was associated with large ABG.

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations.

INTRODUCTION: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. OBJECTIVE: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. METHODS: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n=57) and Gelfoam patch-treated group (n=57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. RESULTS: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p>0.05). However, the total average closure time was significantly different between the two groups (26.8±9.1 days in the spontaneous healing group vs. 14.7±9.1 days in the Gelfoam patch-treated group, p<0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1±1.6 days vs. 12.6±3.9, medium-sized perforations: 13.3±2.2 days vs. 21.8±4.2 days, and large perforations: 21.2±4.7 days vs. 38.4±5.7 days; p<0.01). CONCLUSION: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.

Optical assessment of the in vivo tympanic membrane status using a handheld optical coherence tomography-based otoscope.

OBJECTIVE: Conventional otoscopes and oto-endoscopes, which are used to examine the tympanic membrane (TM), do not provide tomographic information. Optical coherence tomography (OCT) non-invasively reveals the depth-resolved internal microstructure of the TM with very high spatial resolution. We designed this study to examine the TMs with middle ear diseases using a handheld otoscope employing 860 nm spectral domain (SD)-OCT, combined with video camera and to demonstrate the clinical applicability of this system. DESIGN: A total of 120 patients with otologic symptoms were enrolled. TM images were obtained using the handheld OCT-based otoscope (860 nm central wave length, 15 µm axial resolution, 15 µm lateral resolution, and 7 mm scanning range using relay lens). Both OCT and oto-endoscope images were compared according to the clinical characteristics such as perforation, retraction, and postoperative healing process. RESULTS: The objective grade about the thickness of perforation margins and the accurate information about the extent of TM retraction that was not distinguishable by oto-endoscopic exam could be identified using this system. The postoperative healing process of TMs could be also followed using the OCT device. CONCLUSION: These analyses from the surgeon-oriented perspective suggest another useful application of the handheld OCT device.

Ruptured tympanic membrane from underwater impact with an Atlantic salmon, Salmo salar.

An unusual case of tympanic membrane rupture in a diver due to impact from an Atlantic salmon, Salmo salar is described. The diver was treated conservatively and the injury fully healed by eight weeks after which the diver successfully returned to diving. The author contends that the appearances of such traumatic perforations differ from barotrauma in divers secondary to ear clearing problems on descent.

Mesenchymal stem cell-laden hybrid scaffold for regenerating subacute tympanic membrane perforation.

Tympanic membrane (TM) perforation is one of the most common otology complications. To date, there has not been reported TM regeneration using bioprinted scaffold. The purpose of this study was to evaluate the efficacy and feasibility of bioprinted polycaprolactone/collagen/alginate-mesenchymal stem cell (PCAMSC) scaffolds for the regeneration of subacute TM perforation. Sprague-Dawley rats were used in an animal model of subacute TM perforation. In the experimental group (n=7), bioprinted 3D PCAMSC scaffold was placed on the perforation. The control group (n=7) were treated with polycaprolactone/collagen/alginate (PCA) scaffold. Healing time, acoustic-mechanical properties, and morphological analysis were performed by otoendoscopy, auditory brainstem response (ABR), single-point laser doppler vibrometer (LDV), optical coherence tomography (OCT), and light microscopic evaluation. The closure of the TM perforation was achieved in 100% of the experimental group vs. 72% of the control group, and this difference was statistically significant (p<0.05). The ABR threshold at all frequencies of the experimental group was recovered to the normal level compared to the control group. TM vibration velocity in the experimental group recovered similar to the normal control level. The difference are very small and they are not statistically significant below 1kHz (p=0.074). By OCT and light microscopic examination, regenerated TM of the experimental group showed thickened fibrous and mucosal layer. In contrast, the control group showed well regenerated but less thickened than experimental group. From these results, the cell-laden PCAMSC scaffold offers a significant advantage in the TM regeneration in a rat subacute TM perforation model. It may offer attractive opportunities in the conservative clinical treatment.

[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring]. / Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal.

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

OBJECTIVE: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. METHODS: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. RESULTS: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. CONCLUSION: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. ADVANCES IN KNOWLEDGE: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.