Anatomy Of Ear Research Articles

Validation of the novel Deep Reality Viewer (DRV) 3D digital stereo viewer in otology surgery.

PurposeMagnification with accurate optic reproduction of the surgical field is essential in otology surgery, but current technologies are subject to specific disadvantages. This study aims to evaluate a novel 3D digital stereo viewer, the Deep Reality Viewer (DRV), in otology surgery, in comparison to both a 2D monitor and the gold standard of microscopy.MethodsIn this prospective clinical research study, ENT consultants and trainees evaluated visual and practical applications of the DRV. In visual assessment, participants (n = 11) viewed pre-recorded in vivo mastoid exploration displayed on a 2D monitor and the DRV screen. In practical assessment, participants (n = 9) performed otology surgical tasks on a cadaveric human head using both the microscope and DRV. Face, task-specific (TSV) and global content (GCV) outcomes were assessed using 5-point Likert scale questionnaires. Construct validity was assessed separately.ResultsThe DRV achieved the pre-determined validation threshold of 4 for all validation parameters in both visual and practical assessment. The DRV significantly outperformed the 2D monitor in fourteen of 16 parameters. In comparison to microscopy, there was no significant difference in 13 of 16 parameters, with the DRV significantly outperforming in the remaining 3: defining anatomy (GCV), assessing middle ear anatomy (TSV) and overall TSV. Construct validity was not demonstrated for either technology.ConclusionThe DRV achieved the validation threshold for all parameters, and outperformed the 2D monitor and microscopy in several parameters. This validates the DRV for performing otological procedures, and suggests that it would be a useful alternative to the gold standard of microscopy in otology surgery.Level of evidenceN/A.

Etiologies of hearing loss in Fanconi Anemia

ObjectivesWe aim to describe types of hearing loss associated with Fanconi anemia patients who underwent a bone marrow transplant (BMT) to identify possible etiologies of hearing loss. Additionally, we hope to investigate hearing loss early in life as a potential predictor of needing a BMT surgery. Fanconi anemia is a rare autosomal recessive disease that is the most common inherited bone marrow failure syndrome, characterized by bone marrow failure and multiple congenital anomalies, including hearing loss. This is the largest study to date reviewing types of hearing loss in patients with Fanconi anemia, specifically in those who have undergone BMTs. MethodsA retrospective chart review of patients diagnosed with Fanconi anemia at a single institution, tertiary, referral-based children's hospital with a bone marrow transplant team specializing in Fanconi anemia was conducted from 4/19/1976 to 10/19/2015. History, physical examination, audiometry, and imaging findings were reviewed in patients with and without history of bone marrow transplant. Patient hearing levels, as measured by pure tone audiometry at 500 Hz, 1, 2, and 4 kHz, were evaluated. Patients were grouped by transplant status and results and were assessed to determine type and degree of hearing loss. Statistical analysis was performed to compare the likelihood of bone marrow transplant procedures in Fanconi anemia patients with normal and abnormal hearing. ResultsThere were 252 patients with Fanconi anemia identified via diagnosis search in institutional electronic medical records using CPT codes and cross referencing with the Fanconi Anemia database, 58 of whom had available audiometric data. Of the 58 Fanconi anemia patients with available audiograms, 21 (36%) had abnormal audiograms; 37 patients had normal audiograms. Twenty out of 21 (95%) patients who had abnormal audiograms had undergone bone marrow transplants. Thirty-one of 37 (84%) patients with normal audiograms had received bone marrow transplants. Statistical analysis showed that patients with hearing loss were more likely to require a BMT in the future (OR = 3.87, p = 0.05). Of the patients with abnormal audiograms and a bone marrow transplant (n = 20), 14 (70%) had conductive hearing loss, 5 (25%) had mixed hearing loss, and 1 patient (5%) had sensorineural hearing loss. 13 of 20 patients (65%) had bilateral hearing loss and eight of 20 (40%) had unilateral hearing loss. Of those patients with conductive hearing loss (n = 15), the most common etiologies were Eustachian tube dysfunction (47%), external auditory canal stenosis (33%), and abnormal middle ear anatomy (13%). ConclusionsHearing loss is a common finding in Fanconi anemia patients who have undergone BMTs with conductive hearing loss being the most common audiologic manifestation in our cohort of patients. This demonstrates the necessity of frequent hearing screenings in this population and close collaboration with audiology throughout patient care. Our study indicates that hearing status early in life may be a predictor of needing a bone marrow transplant in the future. Further studies should explore the long-term impact of BMT surgery on hearing status.

Independent origins of a novel atympanic middle ear system within Chamaeleonidae.

The evolution of the vertebrate ear is a complicated story of convergence, co-option, loss of function, and occasional regaining of said function. An incredible variety of structures has been adopted as sound receptors, but only chameleons are known to have a bony airborne sound receiver. In some chameleons, the pterygoid bone captures sound vibrations and relays them to the inner ear via a connection to the extracolumella. The distribution of this unique hearing system has not been examined across Chamaeleonidae. Here, I report on dissections on 12 species across four genera and describe their middle ear anatomy for the first time. Half of these species were found to have a link between their extracolumella and pterygoid, and ancestral state reconstruction supports four independent acquisitions of this novel sound-conduction pathway. Species with this pathway tend to have a gular pouch, which seems to produce biotremors and possibly airborne sound, suggesting that this hearing system plays some role in intraspecific communication. Three species were also μ-CT scanned using enhanced contrast to investigate differences in the musculature surrounding the middle ear cavity. In species with a middle ear connected to the pterygoid, the muscles directly lateral to the pterygoid insert farther anterior onto the mandible, which may serve to minimize dampening of vibrations on the pterygoid. Together, these data suggest that the ear plays a more significant role in the lives of some chameleons than has been recognized, and that parallelism is common in the evolution of the ear.

Examination of inner ear structures: a micro-CT study

Background We investigated the inner ear anatomy accurately in detail by microcomputed tomography (micro-CT) to contribute to the data related to the inner ear anatomy and the potential clinical contribution of these data in the treatment of the inner ear’s pathologies. Aims/objectives This study aimed to define a range for normal measurements of the VA, vestibule, lateral semicircular canal, and cochlea. We scanned temporal dry bone samples at high resolution using micro-CT. Material and Methods Forty dry temporal bones used in anatomy student education were included in this study with a micro-CT device. All measurements were made on sections in the axial plane with micro-CT programs. Results The operculum and the vestibular aqueduct middle diameters median values were 0.487 mm and 0.294 mm, respectively. The median value of middle diameters for the nonampullated section of lateral semicircular canal was 1.103 mm. The mean height of the cochlea was 3.417 mm and the width of the cochlea was 5.615 mm. The mean length of the vestibule was 6.085 mm and the width of the vestibule was 3.002 mm. Conclusions and significance We present a database that clinicians can consider in their studies by creating normal anatomical values measured with high precision for the bone labyrinth.

Relevant Anatomical Details in Rats Regarding Otologic Research

The objective of the study was to provide a detailed anatomical description of the rat’s ear anatomy that will prove insightful to different experimental otologic surgical procedures regardless of scope. Three male Wistar rats were enrolled in the study. Candidates were screened for systemic and otologic pathology. External ear canal endoscopy was carried out with a 30˚ rigid endoscope through an image capture system. Middle ear anatomical elements were analyzed under stereomicroscopy. 3D computer tomography image reconstruction was realized with a micro-CT to describe the anatomy. Image data from all three rats were analyzed. Anatomical annotations and surgical exposure recommendations were added for key elements. The most relevant images from all three rats were selected for representation. Detailed visualization of the structural elements of the tympanic cavity were clearly visible: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane were all constant findings. We describe a step wise ventral surgical approach of the middle and inner ear for which we found that the clavotrapezius muscle was a reliable landmark. For the transtympanic approach the endoscopic transcanal access was an easy and reliable method for which a detailed anatomical representation was depicted. Further, anatomical similarities to humans were observed by stereomicroscopy and Micro-CT imaging reiterating that the rat model is suitable for otologic research. The endoscopic approach to the tympanic membrane is comfortable and less expensive than a microscope. The tendon of the clavotrapezius muscle can be a reliable landmark for discovering the tympanic bulla when considering a ventral approach. 3D Micro-CT reconstruction allows intact evaluation of the samples, simultaneously being a diagnostic and also a learning tool.

Radiological spectrum of temporal bone, inner ear and brain parenchymal abnormalities in the preoperative cross-sectional imaging of sensorineural hearing loss in cochlear implant candidates: A prospective study

Cochlear implantation is a prudent method of rehabilitation in severe sensorineural hearing loss where other means like hearing aids fail. Not everybody with severe sensorineural hearing loss benefits from implantation, in fact is contraindicated in some. A thorough pre-surgical imaging evaluation of inner ear, temporal bone and cerebral parenchyma is important in decision making, more so as the implants and costs involved are quite expensive. Limited studies exist in the Indian setting. Aim was to evaluate the role of combined computed tomography (CT) and Magnetic Resonance imaging (MRI) in pre operative imaging assessment for cochlear implantation, a prospective study was concluded at the Department of Radiodiagnosis over 30 months (2017 to 2019). Patients with severe hearing loss underwent HRCT temporal bone on 128 slice MDCT and MRI with BFFE, T2/Flair etc. Sequences targeting inner ear, cochlear nerve and brain on 3 Tesla scanner. Data was entered in MS EXCEL and analyzed in SPSS software using cross tabulations or correlation coefficient to compare the two imaging modalities. Chi square and P values were obtained for the cross tabulation data of comparison of CT and MRI in assessment of inner ear structures. The study focused on cochleovestibular malformations, patency of the cochlea-vestibule, cochlear nerve status on MRI and to see if there was any correlation with the bony cochlear nerve canal diameter on CT, isolated or associated brain parenchymal abnormalities and important surgical access criteria like normal variants and altered middle ear anatomy. Abnormal imaging findings were seen in 15 of 32 patients, on the basis of which 5 were rejected for implantation; suboptimal results were predicted in 5 other abnormal cases. Side selection and predicting ease of electrode insertion could also be ascertained in unilateral pathologies. Seventeen cases had normal imaging, twelve of which were operated. Eleven of these had uneventful surgery. All three cases with abnormal imaging, taken for surgery under varied risk of suboptimal results had mild and manageable intraoperative complications. Tailored protocol of MRI with BFFE, T2/FLAIR axials and HRCT temporal bone is an indispensable tool and radiologist plays key role in candidate selection and exclusion, surgical planning and warning surgeon about potential intraoperative complications in cochlear implant surgery.

Partial auricular reconstruction surgery for facial skin cancer

Auricular defects resulting from excision of cutaneous malignancies pose a challenge to the reconstructive surgeon due to the complex anatomy, convexities, and concavities of the ear. A surgeon must be familiar with analyzing defects of the ear and understand the variety of reconstructive options available with the goals of restoring function, re-establishing anatomic units, and achieving aesthetic balance. This review summarizes current methods for reconstruction of partial auricular defects resulting from neoplasm. A brief overview of ear anatomy and aesthetic relationships is also provided. Techniques for the reconstruction are classified by anatomic region: upper-third, middle-third, and lower-third defects.

Evolution of Middle Ear Modelling Techniques: A Review.

This review article attempts to analyze the various research studies conducted in developing the models to evaluate the anatomy of the middle ear, its biomechanics, and the applications of these models in normal and diseased states.Various studies conducted over the past 50-60 years have been critically analyzed. We also discuss the various advantages and disadvantages of different methods of measurement of middle ear parameters. Beginning from anatomical modelling to histopathological sections and the latest three-dimensional (3D) reconstruction with finite element modelling, various methods of middle ear measurements have been critically analyzed.At the end of this review, we have concluded that the best and most effective method of middle ear modelling is the 3D reconstruction using high-resolution computed tomography and finite element modelling.

Visualization of the saccule and utricle with non-contrast-enhanced FLAIR sequences.

3D-fluid attenuation inversion recovery (FLAIR) collected 4h after intravenous gadolinium injection can delineate the perilymphatic space (PLS) from the endolymphatic space (ELS) to capture endolymphatic hydrops, the pathological counterpart of Ménière's disease. We aimed to optimize visualization of such inner ear internal anatomy using 3D-FLAIR without injection. 3D-FLAIR signal from different fluid compartments such as PLS and ELS was first simulated. Then, twenty-two healthy subjects were scanned at 3.0-T MRI with non-injected 3D-FLAIR using variable T2 preparations (T2Preps) (OFF, 200, 400, and 600ms) and variable inversion times (TIs) (from 224 to 5000ms) and different resolutions (1.0 × 1.0 × 1.5, 0.6 × 0.6 × 0.8, and 0.6 × 0.6 × 0.6 mm3). The relative contrast between PLS and ELS and the visibility of the saccule and utricle were assessed. Additionally, non-injected 3D-FLAIR with the optimal setting was tested in a Ménière patient and compared with gadolinium-injected 3D-FLAIR. The PLS and ELS were differentiated when T2Prep was used but not without. The relative contrast was larger with T2Prep at 400ms than at 200 or 600ms (0.72 ± 0.22 vs. 0.44 ± 0.11, p = 0.019; and 0.72 ± 0.22 vs. 0.46 ± 0.28, p = 0.034, respectively). The saccule and utricle were best delineated in 87. % cases with T2Prep = 400 and TI = 2100ms at the highest resolution. Visualization of the saccule and utricle in the optimized non-injected 3D-FLAIR was similar to conventional injected 3D-FLAIR in a patient. Combining a specific T2Prep and TI in non-injected 3D-FLAIR could separate PLS and ELS and even the saccule and utricle, paving the way toward future application to diagnose Ménière's disease. • MRI can capture the internal anatomy of inner ear without injection of contrast media. • Specific parameters consisting of a T2 preparation of 400ms and an inversion time of 2100ms must be used to visualize the saccule and utricle on non-injected 3D-FLAIR.

Utilisation of a smartphone-enabled video otoscope to train novices in otological examination and procedural skills.

The ai/m of this study was to compare the self-reported confidence of novices in using a smartphone-enabled video otoscope, a microscope and loupes for ear examination and external ear canal procedures. Medical students (n = 29) undertook a pre-study questionnaire to ascertain their knowledge of techniques for otoscopy and aural microsuction. Participants underwent teaching on ear anatomy, examination and procedural techniques using a microscope, loupes and smartphone-enabled video otoscopes. Confidence and preference using each modality was rated using a Likert-like questionnaire. After teaching, all modalities demonstrated a significant increase in confidence in ear examination (p < 0.0001). Confidence in using the smartphone-enabled otoscope post-teaching was highest (p = 0.015). Overall, the smartphone-enabled video otoscope was the preferred method in all other parameters assessed including learning anatomy or pathology (51.72 per cent) and learning microsuction (65.51 per cent). Smartphone-enabled video otoscopes provide an alternative approach to ear examination and aural microsuction that can be undertaken outside of a traditional clinical setting and can be used by novices.

Systematic review and meta-analysis of cochlear implantation in deaf patients with large vestibular aqueduct deformity.

Abnormal inner ear anatomy increases the risk of cochlear implantation because only a certain number of neurons can input signals to the auditory cortex. Therefore, the effectiveness and safety of cochlear implantation for patients with large vestibular aqueduct deformity (LVAD) are controversial and we explored whether cochlear implantation can improve the hearing of patients with this defect. Randomized controlled trials of cochlear implantation for the treatment of LVAD were retrieved from the CNKI, Baidu Academic, VIP Medical, Wanfang Data, PubMed, EBSCO, Medline, and Cochrane databases from the date of establishment of the database to July 20, 2021. Chinese and English search keywords included Large vestibular canal malformation, Deafness, large vestibular aqueduct, and Cochlear implants. We used RevMan 5.3 to evaluate the quality of the literature. A total of 5 documents that met the inclusion criteria were tested for overall heterogeneity. For the heterogeneity test of categories of auditory performance, Chi-squared (Chi2) =4.00, degrees of freedom (df) =1, I2=75%>50%, and P=0.05. Overall analysis using a random-effects model showed no statistically considerable difference between the deformity group and the control group [Z=0.78, mean difference (MD) =-0.65, 95% confidence interval (CI): -2.29 to 0.98, P=0.43]. There was no substantial difference in postoperative hearing ability between LVAD patients and those with normal inner ear structure. Continuous variables were used to describe the speech intelligibility rate (SIR) in a total of 48 cases, including 24 cases in the deformity group and 24 cases in the control group. For the heterogeneity test of the whole population, Chi2 =1.75, df =1, I2=43%<50%, and P=0.19. Overall analysis using a fixed-effects model showed that the difference between the deformity group and the control group was statistically considerable (Z=3.09, MD =-1.03, 95% CI: -1.69 to -0.38, P=0.002). The meta-analysis results confirmed that with postoperative rehabilitation for LVAD patients with cochlear implants the clinical efficacy is similar to that of deaf patients with normal inner ear structure, providing an important basis for hearing restoration.

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study.

Despite the complete embodiment of the stapedius muscle (SM) into the pyramidal eminence, it is possible to safely gain access to the SM belly via a retrofacial approach. This presents a novel approach to directly measure the electrically evoked stapedius reflex threshold (eSRT). Objective fitting of maximum comfortable loudness levels for cochlear implant users can improve the benefit introduced by the device. Sensing SM activity via direct surgical access represents a potential tool for objective eSRT fitting. Eighteen human temporal bones (TBs) were used. Micro-computed tomography was performed for six TBs. Standard computed tomography for six TBs. Manual 3D-segmentation of the relevant middle and inner ear anatomy was performed on 12 TBs. Mastoidectomy and posterior tympanotomy allowed the access to middle ear of all 18 the TBs. Once identified the mastoidal segment of the facial nerve (FN), the retrofacial access to the SM was drilled. The total access rate was 72.2%. Only in the first three cases the posterior semi-circular canal was hit. The SM access was identified posterior to the FN at a 4 ± 0.78 mm distance from the stapes' head, almost halfway to the chorda tympani's branching point along the FN direction. The drilling depth to access the SM posterior to the external surface of FN on average was 2 ± 0.30 mm. The exposure took on average of 5 to 8 minutes. The retrofacial approach seems to offer a feasible and reproducible access to the SM belly opening an avenue to electromyographic sensing of eSRT.

Simulation of the objective occlusion effect induced by bone-conducted stimulation using a three-dimensional finite-element model of a human head.

The occlusion effect (OE) refers to the phenomenon that more bone-conducted physiological sounds are transmitted into the earcanal when it is blocked and may cause discomfort on users of hearing protection devices. Models have been proposed to study the OE as they can help understand the physical mechanisms and can be used to evaluate the individual contribution on the OE of the factors that may affect it (i.e., occlusion device, ear anatomy, and stimulation). The existing finite element models developed to study the OE are limited by their truncated ear geometries. In order to progress in the understanding of the OE, the goal of this paper is to develop a finite element model of an entire head to predict the sound pressure field in its earcanals, open or occluded by earplugs. The model is evaluated by comparing the computed input mechanical impedances and OEs in various configurations with literature data. It is able to reproduce common behavior of the OE reported in the literature. In addition, the model is used to assess the effects on the simulated OEs of several parameters, including the modeling of the external air, the boundary condition at the head base and the material properties.

English

BACKGROUND The complicated middle and inner ear anatomy challenge the diagnostic ease in radiological evaluation of the temporal bone. Their tiny dimension and close neighbouring of the structures limited the successful imaging facilities for long periods of time. Conventional radiological procedures have been inadequate for diagnostic imaging but recently multidirectional tomography and high-resolution computed tomography (HRCT) has gained importance. Inflammatory and infectious diseases of the temporal bone are a major indication to perform highresolution CT. Such studies allow one to evaluate the extent of the disease in the soft tissues and in the bony structures of the temporal bone. The purpose of this study was to evaluate temporal bone infectious pathologies using high resolution computed tomography (HRCT). METHODS The study is completely observational &amp; retrospective type of study. HRCT of temporal bone was carried out on 50 cases with SIEMENS SOMATOM emotion 16 slice CT scan machine, GMERS Medical College &amp; Hospital, Valsad, Gujarat depending upon the availability from February 2019 to January 2020 including all age groups, both sexes with suspicion of temporal bone infective pathologies based on sign and symptoms. RESULTS Out of 50 patients, 38 patients were diagnosed with chronic suppurative otitis media (CSOM) and 12 patients were diagnosed with acute suppurative otitis media (ASOM), of which 65 % of CSOM showed cholesteatoma formation. All the patients with ASOM showed air-fluid levels. Male to female ratio was nearly 1.77 : 1. Out of which, 52 % were paediatric patients. Common symptoms were ear, discharge, headache and deafness. Most commonly affected site was right side. There were 6 extra cranial and 2 intracranial complications seen. CONCLUSIONS Due to the ability to delineate the bony and soft tissue anatomy with high accuracy, high-resolution CT is the imaging modality of choice for topographic evaluation of temporal infective pathologies and their extracranial and intracranial complications. KEYWORDS ASOM, CSOM, Cholesteatoma, Air Fluid Level, Pneumatization, Ossicles, Middle Ear, Inner Ear, Complications

“Transcanal view” computed tomography reformat: Applications for transcanal endoscopic ear surgery

PurposeTranscanal endoscopic ear surgery (TEES) is an increasingly used surgical approach for otologic surgeries, but no en face preoperative imaging format currently exists. We aim to assess the utility of a transcanal high resolution computed tomography (HRCT) reformat suitable for TEES preoperative planning. Materials and methodsPreoperative HRCTs of patients with middle ear pathologies (cholesteatoma, otosclerosis, and glomus tympanicum) who underwent TEES were obtained. Axial image series were rotated and reformatted −90 or +90 degrees for left and right ear surgeries, respectively, where additional rotation along the left-right axis was performed to align the transcanal series with the plane of the external auditory canal. Quantitative measurements of middle ear structures were recorded. Consecutive transcanal reformatted sections were then reviewed to identify critical middle ear anatomy and pathology with corresponding TEES cases. ResultsThe aforementioned methodology was used to create three transcanal view HRCTs. The mean left-right axis degree of rotation was 4.0 ± 2.2 degrees. In the cholesteatoma transcanal HRCT, areas of cholesteatoma involvement in middle ear compartments (e.g. epitympanum) and eroded ossicles were successfully identified in the corresponding case. In the otosclerosis transcanal HRCT, areas for potential otosclerotic involvement were visualized such as the round window as well as a low-hanging facial nerve. In the glomus tympanicum transcanal HRCT, the span of the glomus tympanicum was successfully visualized in addition to a high riding jugular bulb. ConclusionA transcanal HRCT reformat may aid preoperative planning for middle ear pathologies. This novel reformat may help highlight patient-specific anatomy.

Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope.

Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear. Three cadaveric temporal bone specimens were used in this work. Diagnostic transeustachian endoscopy of the middle ear was performed. Diagnostic image quality. A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity. A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.

Descriptive study of goat external and middle ear through computed tomography and endoscopic evaluation, compared with the human ear

ObjectiveTo describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. MethodsImages of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. ResultsThe bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. ConclusionGoat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.

Development of a 3‐Dimensional Middle Ear Model to Teach Anatomy and Endoscopic Ear Surgical Skills

Mastery of ear anatomy and otologic surgical skills is challenging for trainees, and educational resources are limited. Advancements in 3-dimensional (3D) printing have enabled the construction of complex microscopic models. Otoendoscopy provides excellent visualization and has been shown to enhance anatomic learning. Our aim was to develop a 3D model of the middle ear and external auditory canal using computed tomography images of a pediatric temporal bone for use with otoendoscopes. Resulting models are life sized, anatomically accurate, and allow for identification of relevant middle ear structures. Forty-six trainees were recruited for a pilot study and randomized to study using the model or standard resources. There were no differences in pretest, posttest, or 1-week posttest performance between groups; however, trainees assigned to the model reported higher prospective interest, satisfaction, and subjective improvement. This model may be used with otoendoscopes for anatomic and surgical training and represents an advancement in otologic surgical simulation.

Numerical investigation of the earplug contribution to the low-frequency objective occlusion effect induced by bone-conducted stimulation.

The use of earplugs is commonly associated with an increased perception of the bone-conducted part of one's own physiological noise. This phenomenon is referred to as occlusion effect and is most prominent at low frequencies. Several factors influence the occlusion effect, such as the ear anatomy; the bone-conducted stimulation; and the type of occlusion device and its fit, insertion depth, and material properties. The latter factor is of great interest to potentially reduce the occlusion effect of passive earplugs. This paper investigates the mechanism(s) of contribution of earplugs to the objective occlusion effect. A two-dimensional axi-symmetric finite element model of the outer ear is used and investigated in an electro-acoustic framework. Simulation results are shown to compare reasonably well with measurement data, which qualifies the model to study the influence of earplugs on the occlusion effect. Two mechanisms are highlighted: (i) a Poisson effect induced by the normal component of the earcanal wall vibration and (ii) a longitudinal motion caused by the tangential component of the earcanal wall vibration. By varying the geometry of the surrounding tissues, the spatial distribution of the earcanal wall vibration is shown to influence the contribution of the earplug to the occlusion effect.

АНАЛИЗ ВОЗМОЖНОСТЕЙ ПОВЫШЕНИЯ КАЧЕСТВА ОБРАЗОВАНИЯ ПУТЕМ ИСПОЛЬЗОВАНИЯ ИГРОВЫХ МЕТОДОВ ОБУЧЕНИЯ

The aim of this article was to analyze the possibilities of improving the quality of medical education by means of using game teaching methods. The article discusses the nature and causes of the crisis phenomena in higher medical schools observed during the recent decades. A comparative assessment of the proposed ways to improve the quality of medical education is given. The analysis of the existing trends in the field of increasing the efficiency of the educational process has shown that game methods of teaching, which lack excessive formalization and fully contribute to the disclosure of the creative potential of a student, can become a promising solution to this problem. Educational games simulate real clinical situations that are unattainable in the course of the educational process. The educational game provides a variety of possible decisions that have to be made in high degree of uncertainty situations. A game technique of knowledge control in the clinical anatomy of ear, nose and throat has been proposed and tested. The methodology of a game for two teams within the frames of a given game scenario with a simple and sound method of result assessment has been developed.