Diagnosis Of Middle Ear Pathology Research Articles

Middle Ear Meningioma With Recurrence Secretory Otitis Media.

Middle ear meningiomas (MEMs) are rare tumors that can present with nonspecific symptoms, posing challenges in diagnosis and management. This case report focuses on a middle-aged female patient who was misdiagnosed with secretory otitis media for 5 years. However, further evaluation through computed tomography imaging and subsequent pathologic biopsy revealed the presence of a MEM. The patient underwent surgical and gamma knife resection of the tumor and follow-up examination after 1 year showed no signs of recurrence. This case report highlights the importance of considering meningiomas in the differential diagnosis of middle ear pathologies and the need for careful preoperative planning for optimal outcomes. Overall, this case demonstrates that correct diagnosis and appropriate treatment can lead to successful management of MEMs.

Pseudo air–bone gap in sensorineural hearing loss: Effect of signal frequency and degree of hearing loss – implications for clinical diagnosis

Introduction: Pseudo air–bone gaps (ABGs) in the audiogram can lead to a false diagnosis of middle ear pathology where none exists. While it is known that the magnitude of such false ABGs are frequency dependent, the effect on the severity of hearing loss on this relationship needs more clarity. Objective: The purpose of the study was to identify frequencies that are susceptible to pseudo-ABGs and investigate the effect of the degree of hearing loss on the magnitude of such air–bone gaps. Materials and Methods: A retrospective analysis of the ABG in three degrees of sensorineural hearing loss: mild (26–40 dB HL), moderate (41–55 dB HL), and moderately severe (56-70 dB HL) was carried out. One hundred and fifty samples were considered in each category (18–60 years). Differences across frequencies and degree of hearing loss were assessed. Results: Large ABGs were observed at 250 Hz and 4000 Hz, and the ABGs significantly increased with the degree of hearing loss at 250 Hz and 500 Hz. Conclusions: Caution needs to be exercised while interpreting the ABG at the low frequencies and 4000 Hz, especially when the degree of hearing loss is moderate and higher, to avoid the misdiagnosis of a conductive component in a sensorineural pathology.

Otologic Manifestations of IgG4-Related Disease: Literature Review and Report of Two Cases

Background: IgG4-related disease (IgG4-RD) is an inflammatory process. The literature on IgG4-RD is rather limited, with mastoid involvement being uncommon. In such cases, presentation may mimic other middle ear and mastoid cavity pathologies. Objective: To summarize findings of patients with IgG4-RD involving the mastoid. Methods: Description of two new cases and summary of findings with previous reports. Results: Nineteen cases of IgG4-RD with mastoid bone involvement were reported in the literature, the earliest appearing at the beginning of the previous decade. Most frequent symptoms included hearing deterioration, tinnitus and otalgia. In 58% of the cases, the process was restricted to otologic manifestations. In 7 out of 19 cases, tissue IgG4 levels were elevated. In all histopathologic samples taken from the operative sites, a dense lymphoplasmacytic cell infiltration was observed. Following definitive pathological diagnosis, the most common treatment was corticosteroids. Generally, the time from onset to final diagnosis was usually more than six months. The treatment is corticosteroids, followed by immunosuppressive agents such as rituximab, cyclophosphamide, and methotrexate. Conclusions: IgG4-RD involving the mastoid is a challenging condition, both in diagnosis and treatment. Hence, IgG4-RD should be included in the differential diagnosis of middle ear pathologies and include a multi-disciplinary team for treatment.

Towards low cost automated smartphone- and cloud-based otitis media diagnosis

Abstract Otitis media is one of the most common childhood illnesses. Access to ear specialists and specialist equipment is rudimentary in many third world countries, and general practitioners do not always have enough experience in diagnosing the different otitis medias. In this paper a system recently proposed by three of the authors for automated diagnosis of middle ear pathology, or otitis media, is extended to enable the use of the system on a smartphone with an Internet connection. In addition, a neural network is also proposed in the current system as a classifier, and compared to a decision tree similar to what was proposed before. The system is able to diagnose with high accuracy (1) a normal tympanic membrane, (2) obstructing wax or foreign bodies in the external ear canal (W/O), (3) acute otitis media (AOM), (4) otitis media with effusion (OME) and (5) chronic suppurative otitis media (CSOM). The average classification accuracy of the proposed system is 81.58% (decision tree) and 86.84% (neural network) for images captured with commercial video-otoscopes, using 80% of the 389 images for training, and 20% for testing and validation.

Recent Developments in FullField Thickness Measurements of the Human Eardrum

Recently, we published several full-field human tympanic membrane data sets that were obtained using a modified high-resolution optical coherence tomography setup. In this short communication letter, we provide an overview of the active research fields in which these data have been used or in which human tympanic membrane thickness measurements play an instrumental role. These applications include finite element modeling of the middle ear system, medical diagnosis of middle ear pathology and the design of tympanic membrane grafts.

Acute Otitis Media Curriculum.

Studies have shown that clinicians do a poor job of diagnosing middle ear infections, and an inaccurate diagnosis may result in inappropriate treatment, such as overuse of antibiotics. Antibiotic overuse is known to lead to increased bacterial resistance and puts patients at risk of deleterious side effects, including allergic reactions, vomiting, diarrhea, and rash. In this curriculum, we teach three important topics for achieving a successful middle ear exam and diagnosis of pathology. The topics covered during the session are middle ear examination techniques, diagnosis of middle ear pathology and criteria for diagnosing acute otitis media, and treatment of acute otitis media. Each topic has a 30-minute lesson plan with broad goals, specific and measurable learning objectives, interactive learning activities, and assessment measures. Teaching activities include a mix of knowledge, skill, and attitude activities. Assessment measures aim at the highest level of Miller's pyramid of assessment when possible. Also included is a scholarship map that relates how this learning activity can fit into the assessment of learners at the program level by linking learning objectives with pediatric developmental milestones. The interactive nature of these lessons has been very well received by learners, and pediatric residents have had a self-perceived increase in skills. This curriculum provides a standardized approach to teaching the middle ear exam structured by educational rubrics and allows for accurate assessment of learners.

Chronic inflammatory middle ear disease: Postoperative CT and MRI findings

AimTo prospectively evaluate the value of CT and MRI in diagnosis of middle ear pathologies following operation for chronic otitis media (COM). Patients and methodsFifty patients, who had been operated on for chronic middle ear disease, were referred for either CT alone or followed by MRI depending on the different case scenarios. Imaging findings were correlated with surgical findings. ResultsCT alone was done in 10 patients; 6/10 showed a free mastoidectomy cavity and 4/10 showed a clear cavity with abnormal position of the prosthesis. The rest of the 40 patients did a CT followed by MRI which showed granulation tissue in 17 patients, cholesteatoma in 13/14 patients of which one showed intracranial extension, combined granulation tissue with cholesteatoma in 5/6 patients, cholesterol granuloma in 2 patients and meningocele in another 2 patients. Overall CT sensitivity and specificity was 46.25% and 90.77% and MRI sensitivity and specificity was 95.23% and 99.16% respectively. ConclusionCT and MRI are both safe non-invasive diagnostic methods. Both procedures can provide radiologists a confident diagnosis of postoperative middle ear complications, assisting otologists with a provisional diagnosis for a better management.

Pole-zero characterization of middle ear acoustic reflectance data

Middle ear acoustic reflectance (AR) measurements have valuable clinical applications. AR is measured using a foam-tipped probe sealed in the ear canal, containing a microphone and receiver (i.e. MEPA3 system, Mimosa Acoustics). From the complex pressure response to a broadband stimulus, the acoustic impedance and reflectance of the middle ear can be calculated as functions of frequency. A sizeable pool of normal and pathological AR data, collected by various researchers, indicates that many pathological ears have an AR that systematically differs from normative data. Assessment of such data typically relies on consideration of the magnitude AR, or separate consideration of AR magnitude and phase. By fitting poles and zeros to AR data, we have achieved a compact and accurate representation of the complex data (<5% RMS relative error). It was found that removing an approximated ear canal phase delay from AR data before fitting allowed for better comparison across ears, and better comparison with existing network models of the middle ear. Pole-zero fits indicated isolated regions of individual variation for normal ears, and showed differences between normal and pathological ears. Pole-zero fitting shows promise for more quantitative, robust diagnosis of middle ear pathology than AR magnitude alone.

Diagnosis of middle ear disease using tympanograms and digital imaging

The study investigates the ability of physicians with different levels of training to accurately identify middle ear (ME) pathology using tympanograms and tympanic membrane (TM) digital photographs. Groups of medical students, internal medicine residents, and attending and resident otolaryngologists were presented with a set of 50 matched tympanograms and photographs of TMs. The physicians were asked to differentiate between a normal and an abnormal-appearing TM. The sensitivity and specificity of diagnosis of ME pathology by physicians were compared with the gold standard, examining the ME cavity for pathology during myringotomy. The sensitivity did not vary among physicians with different levels of training; however, specificity improved with an increase in physician experience. This study establishes a baseline for accuracy of diagnosis of ME pathology using tympanograms and photographs of TMs as compared with binocular otomicroscopy and the gold standard, myringotomy. B-2.

Tympanic membrane/middle ear pathologic correlates in chronic otitis media.

To correlate pathologic findings of the tympanic membrane with pathologic changes in the middle ear cleft in chronic otitis media. Retrospective. One hundred-fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear pathologic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correlate the presence of these middle ear pathologies with histopathologic changes of the tympanic membrane. The tympanic membrane pathologies included perforation, myringosclerosis, retraction, hemorrhage, fluid-filled cystic spaces, or dilated vessels. Temporal bones were also assessed for atelectasis. Fifty-six normal temporal bones were taken as controls for measurements. Significant correlations between tympanic membrane and middle ear pathology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossicular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying multiple pathologic changes in the middle ear. When tympanic membrane pathology is detected otoscopically, its presence, alone or in combination, can be a strong indicator of underlying middle ear pathology. However, a normal-appearing tympanic membrane does not exclude the possibility of middle ear pathology. These findings suggest the need for other diagnostic tools such as multifrequency tympanometry and otoacoustic emissions to complement otoscopy for diagnosis of middle ear pathology, especially in a tympanic membrane that appears "normal."

Middle ear pathology in day-care centre children.

Middle ear pathology, either otitis media with effusion or tubal dysfunction, is frequently seen in day-care centre children. Recognition and early treatment of this condition is crucial to the prevention of chronic otitis media, which is a major cause of hearing loss in later life. We aimed to reveal the incidence of silent otitis media in day-care centre children and to determine the predisposing factors, risk factors and the awareness of the parents of the middle ear disease of their children. Two hundred and thirteen children, aged 3-6 years, were screened in four daycare centres. A questionnaire was prepared that would reveal the predisposing factors. Information was gathered from both the parents and teachers. Children were examined by otoscopy, pneumotoscopy, tympanometry and X-rays for sinus pathology. Forty-three of 213 children had middle ear pathology; 39 of them were confirmed by tympanometry; 56.1 % of children had some degree of sinus pathology. We revealed that, although most of the children do not have the risk factors, they develop middle ear pathology. Among the parents, 81.4% of them were unaware of the condition. Early diagnosis of middle ear pathologies is necessary for prevention of future complications. In early stages the condition is silent. We emphasize the importance of the primary care physician's role in diagnosing the early stages of middle ear pathologies and recommend that teaching of otoscopic and pneumotoscopic skills should be part of the training for family physicians.

Computerized Interpretation of the Tympanogram for Diagnosis of Middle Ear Pathology

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Validity of tympanometry in cases of confirmed otosclerosis.

The otoadmittence or impedance measurements are common procedures in the diagnosis of middle ear pathologies. The present study was undertaken for the purpose of studying the clinical validity of static admittance values in 42 confirmed otosclerotic ears. For both 220 Hz and 660 Hz probe tones only one third of the otosclrotic ears had low admittance values, as expected. The remainder showed admittance values in the normal or high ranges. No significant correlation was found between air bone gap (ABG) and the admittance values.

Understanding and Assessing Communicative Disorders in Children

The pediatrician is frequently confronted with the problem of diagnosis and treatment of preschool-aged children suspected of having middle ear disease and speech / language impairments. Guidelines for referral of these children (otolaryngologist, audiologist, speech therapist) have not been clearly defined. The use of tympanometry and acoustic reflex testing was described to assist in the diagnosis of middle ear pathology, to provide an objective way to monitor spontaneous or antibiotic-induced remissions and to determine more accurately when a referral for surgical intervention is needed. A 35-item screening test is described, permitting speech and language assessments in the office and quantifying and comparing with age peers: vocabulary, articulation, receptive language and expressive language abilities. These office interventions enhance the physician's ability to judiciously recommend consultations.

Tympanometry for Eustachian tube evaluation.

Since Metz first suggested in 1946 that impedance measures may detect the status of the eustachian tube as a middle ear ventilator, only a few reports have appeared in the literature on this subject until just recently. This, in spite of the fact that the principle of tympanometry has been gaining a significant role in the differential diagnosis of middle ear pathology in the Scandinavian countries for the past dozen years. The availability of a commercial electro-acoustic impedance bridge was the impetus for a recent surge of interest in the concept of impedance audiometry in the United States. Tympanometry is the segment of impedance audiometry that consists of a graphic measurement of the ear drum's compliance during changes in static pressure in the external ear canal. It is a simple, quick procedure administered by nonmedical personnel on patients of all ages. It has the potential to serve as an adjunct to the diagnosis of eustachian tube insufficiency, to monitor treatment restoring adequate function, and, possibly, as a screening device to detect preclinical pathological conditions of the middle ear.

Use of Impedance Indicator in Diagnosis of Middle Ear Pathology

The object of the investigation was to determine to what extent observation of changes in the acoustic impedance of the ear could be used in the diagnosis of middle ear lesions.The investigation comprised 77 patients with various middle ear lesions but without pathological findings on otoscopy.Changes in the acoustic impedance were recorded by means of an electro-acoustic impedance indicator.Recording of impedance changes following tactile stimulation of the homolateral ear was found to be a reliable method in differentiating between ears with normal and pathological middle ear function. Absence of impedance changes was indicative of a disturbance of the middle ear function. The middle ear lesion could be diagnosed more precisely by measuring the middle ear pressure and by recording the impedance changes resulting from the acoustically-elicited stapedial reflex and from a defensive reaction which produces contractions of both the tympanic muscles.The investigations show that the following procedures should be carried out in the diagnosis of middle ear lesions.1. Measurement of middle ear pressure as described by Terkildsen and Thomsen (1959).2. Observation of impedance changes elicited by touching the skin around the opening of the homolateral external meatus with cotton.3. Observation of impedance changes elicited by acoustic stimulation of the contralateral ear with Barany's noise box.4. Observation of impedance changes elicited by lifting the upper eyelids to produce a defensive reaction including contraction of the tympanic muscles, the periorbital musculature and numerous other muscles of the head and neck.RésuméL'utilisation d'un indicateur d'impédance dans le diagnostic des affections de l'oreille moyenne.Le but du travail que nous présentons était de déterminer à quel point les variations de l'impédance acoustique pouvaient ětre utilisées dans le diagnostic des lésions de l'oreille moyenne. Le travail repose sur 77 patients porteurs de différentes lésions de l'oreille moyenne, mais sans image pathologique à l'otoscopie.Les modifications de l'impédance acoustique ont été enregistrées au moyen d'un appareil électro-acoustique. Les variations de l'impédance acoustique après stimulation tactile de l'oreille homolatérale (en touchant la peau de la partie antérieure du pavilion avec une boulette de coton) se sont révélées comme une méthode súre pour différencier des oreilles ayant un fonctionnement de l'oreille moyenne normal ou pathologique. L'absence de modifications de l'impédance prouve l'existence d'un trouble de la fonction de l'oreille moyenne.La lésion de l'oreille moyenne peut-ětre diagnostiquée avec plus de précision en mesurant la pression de l'oreille moyenne et en enregistrant les modifications de l'impédance résultant du réflexe stapédien provoqué acoustiquement et par la réaction de peur et de défense qui provoque des contractions des deux muscles tympaniques.Les résultats trouvés dans les différentes lésions de l'oreille moyenne sont rapportés.