Ear Cavity Research Articles

Monitoring pressure changes in the inner ear induced by middle ear pressure therapy with an EFET01 device in guinea pigs

Background As a low-cost, portable, handheld air pressure generation tool not requiring a ventilation tube, the EFET01 device has shown clinical effectiveness for intractable Ménière’s disease (MD) patients in Japan. However, no animal studies have investigated changes in inner ear pressure (PI) when applying this device. Objective To determine the PI properties in response to middle ear pressure therapy (MEPT) induced by the EFET01 in guinea pigs. Material and Methods In seven healthy guinea pigs, bi-phasic pressure pulses from −5 to 12 cm H2O were delivered to the external ear canal and transmitted to the middle and inner ear cavities with an intact tympanic membrane. Hydrostatic pressure change in the inner ear perilymphatic compartment was measured by a servo-controlled micropipette system. Results From eight successful ears, pressure changes in the middle ear slightly decreased and were instantly transferred to the inner ear. The EFET01 produces a bi-phasic positive/negative pressure pulse, which is approximately twice as large as the monophasic pressure pulse. Conclusion Our study clarified the EFET01’s ability to transmit pressure and verified its effectiveness in MD patients as observed in clinical studies. Significance The PI properties in guinea pig response to MEPT with the EFET01 device were investigated.

Automated Identification and Reconstruction of 3D Images on the Mastoid Air Cell System

The mastoid air cell system (MACS) protects the structures in the ear and regulates air pressure in the ear cavity. MACS segmentation is very difficult because of the many overlapping object characteristics in the temporal bone. This study aims to accurately identify and measure MACS areas from CT-scan images of mastoiditis patients. The data tested consisted of 128 CT images from 13 different patients. Images were taken using the Siemens SOMATOM Perspective CT Scanner model 10662260 axially. The extended Adaptive Threshold (eAT) method was developed to produce optimal threshold values for each test image. Furthermore, the eAT results are used to convert the test image into a binary image and then applied to the identification and extraction model automatically for reconstruction from 2D to 3D images. Smaller MACS sizes indicate inflammation of the mastoid bone and require intensive care. Thus, this research can be used to help doctors make the right decisions in carrying out further medical actions.

Microbial flora of mastoid cavity after canal wall down (CWD) mastoidectomy

Introduction: Many scientists have worked on microbial flora of the ear canal or middle ear in nonoperated patients, but it is not clear that what changes would be occurred in the flora of the mastoid cavity postoperatively. It can help the surgeons to choose the appropriate drugs in the perioperative period. The study was designed to investigate the microbial flora of the middle ear and mastoid cavities after canal wall down (CWD) mastoidectomy. Materials and Methods: The survey was designed as a prospective cross-sectional study. All patients with chronic otitis media who had undergone CWD mastoidectomy in a public university hospital from 2014 to 2017 were enrolled in the study. They were periodically followed up postoperatively at least for 6 months. Swab sampling from ear cavity was performed, and the samples were sent for culture and antibiogram. Each specimen was sent for bacterial and fungal analysis. If bacterial culture result was positive, the sensitivity of the cultured organisms to common antibiotics was also assessed. Results: Seventy-four patients entered into the survey. Twenty-six (35%) of samples were positive for bacteria, and 11 (14.5%) were positive for fungi. Furthermore, 3 (4%) of the studied ears were positive simultaneously for both bacterial and fungal culture. Among cultured bacteria, Staphylococcus epidermidis was the most common species (29%). Candida species was the most common fungal species (8%). Conclusions: Microbial infection is a common finding after CWD mastoidectomy. S. epidermidis and Candida species should be considered as the primary targets of treatment.

English

BACKGROUND Chronic suppurative otitis media (CSOM) is defined as a chronic inflammation of the middle ear and mastoid cavity. The disease usually begins in childhood. We need to study the prevalence and risk factors of chronic suppurative otitis media in a teaching hospital in Telangana. METHODS This was a cross sectional study done among patients with CSOM attending the Department of ENT for a duration of one year from January 2019 to December 2019. Detailed history, otoscopic examination and culture sensitivity tests of ear discharge were done. RESULTS The sample size was 150. The prevalence of CSOM was reported to be 7.5 %. Majority of the cases were in the 11 - 15 years age group, i.e., 56.6 %. Tubotympanic type was most commonly reported and accounted for 80 % (100 / 150) whereas atticoantral type was 20 %. Pseudomonas aeruginosa was the most commonly isolated organism from the ear discharge. Most of the CSOM cases presented with upper respiratory tract infection i.e., 20 %. CONCLUSIONS The prevalence of CSOM in our study was 7.5 % and it was more common in the younger age group. CSOM was more common in the lower socioeconomic class. Upper respiratory tract infection is a frequent mode of presentation of CSOM. KEYWORDS CSOM, Ear Discharge, Tubotympanic CSOM, Atticoantral CSOM

Computed tomography and cross-sectional anatomy of the head in the giant anteater (Myrmecophaga tridactyla).

The aim of this study was to identify the anatomical structures in the head region of the giant anteater (Myrmecophaga tridactyla) using computed tomography. For this, three giant anteater corpses, adult and female, were used. The tomographic analysis was performed in sequential order in rostrocaudal direction. Subsequently, the heads of these animals were sectioned in cross sections of approximately 1.5cm each. Tomographic images were compared with anatomical sections. The association between computed tomography and anatomical sections allowed the visualization of anatomical structures found in the nasal, oral, cranial, pharyngeal and ear cavities. An elongated oral cavity delimited by the elongated mandible was observed. The oral cavity was mainly occupied by a thin and elongated tongue formed mainly by the union of the sternoglossal muscles. The nasopharynx and oropharynx extended up to the neck at the level of the fifth cervical vertebra. The findings of this study suggest that the giant anteater has a head with structures morphologically adapted to its feeding habits, such as an elongated skull, tongue, styloid bones and mandible. In addition, based on the results of this study, it is possible to suggest that computed tomography is a pivotal tool for the veterinary routine of wild animals, since it allowed the identification of anatomical structures found in the head of the giant anteater.

DIAGNOSTICS OFPATIENTS WITH THROMBOEMBOLIC COMPLICATIONS OF THE VISUAL ORGAN OF RHINOSINUSOGENIC ETIOLOGY AT COVID 19

Cavernous sinus thrombosis is one of the most severe infections of the face, orbit, ear, paranasal sinuses and oral cavity. The studyaims to analyse clinical cases of carotid-cavernous sinus thrombosis in patients with complications of COVID 19. An analysis of 2 clinicalcases with a diagnosis of cavernous sinus thrombosis in the presence of COVID 19 was carried out. General ophthalmic research methods (visometry, external examination, the study of pupillary reactions, ophthalmoscopy, palpation measurement of intraocular pressure), MRI, MSCT of the brain and chest,general blood test, coagulogram, biochemical blood test. These clinical examples show that cavernous sinus thrombosis develops as a complication of coronavirus infection. The cause of cavernous sinus thrombosis was inflammation of the paranasal sinuses, dry blood, diabetes mellitus. The cause of death was the development of multiple organ failure due to concomitant diseases and a decrease in patients' immune status

Reconstruction of the external auditory canal using full-thickness rolled-up skin graft after lateral temporal bone resection for T1 and T2 external auditory canal cancer

ObjectiveTo present our results of the external auditory canal (EAC) reconstruction procedure using rolled-up full-thickness skin graft with tympanoplasty after lateral temporal bone resection (LTBR) for early-stage EAC carcinoma. Patients and MethodsA retrospective review of 15 patients who had undergone LTBR with reconstruction of the EAC for T1 and T2 EAC cancer between 2016 and 2020. ResultsPostoperative mean air-bone gap was 30.7 decibel hearing level. Although a few patients experienced chronic granulation, persistent otorrhea, and/or laterization of the tympanic membrane, most patients showed no serious complications related to the EAC reconstruction. ConclusionEAC reconstruction using a full-thickness skin graft in combination with tympanoplasty is useful for minimizing the hearing loss, maintaining the cosmetic appearance, and facilitating the observation into the ear cavity.

Accelerating in vivo fast spin echo high angular resolution diffusion imaging with an isotropic resolution in mice through compressed sensing.

Echo planar imaging (EPI) is commonly used to acquire the many volumes needed for high angular resolution diffusion Imaging (HARDI), posing a higher risk for artifacts, such as distortion and deformation. An alternative to EPI is fast spin echo (FSE) imaging, which has fewer artifacts but is inherently slower. The aim is to accelerate FSE such that a HARDI data set can be acquired in a time comparable to EPI using compressed sensing. Compressed sensing was applied in either q-space or simultaneously in k-space and q-space, by undersampling the k-space in the phase-encoding direction or retrospectively eliminating diffusion directions for different degrees of undersampling. To test the replicability of the acquisition and reconstruction, brain data were acquired from six mice, and a numerical phantom experiment was performed. All HARDI data were analyzed individually using constrained spherical deconvolution, and the apparent fiber density and complexity metric were evaluated, together with whole-brain tractography. The apparent fiber density and complexity metric showed relatively minor differences when only q-space undersampling was used, but deteriorate when k-space undersampling was applied. Likewise, the tract density weighted image showed good results when only q-space undersampling was applied using 15 directions or more, but information was lost when fewer volumes or k-space undersampling were used. It was found that acquiring 15 to 20 diffusion directions with a full k-space and reconstructed using compressed sensing could suffice for a replicable measurement of quantitative measures in mice, where areas near the sinuses and ear cavities are untainted by signal loss.

Modern approaches to the diagnosis of vestibulopathy in patients with chronic suppurative otitis media

Chronic suppurative otitis media (CSOM), according to statistics, is one of the most common diseases in otorhinolaryngological practice, accounting for, on average, from 5.8 to 20.7% of all ENT pathology. The incidence of CSOM in the Republic of Uzbekistan is up to 6.5%. The pathological process in CSOM leads to the destruction of the bone structures of the middle ear and progressive hearing loss, and in some cases - to an increase in vestibular symptoms. Purpose of the study: vestibular disorders in chronic purulent otitis media using modern diagnostic methods. Materials and methods: In order to study the features of cochleovestibular disorders in CSOM, in the Department of Congenital and Acquired ENT Diseases at the Republican Specialized Scientific and Practical Medical Center of Pediatrics of the Ministry of Health of the Republic of Uzbekistan were examined 13 patients with CSOM with labial complications . All patients underwent a set of standard examinations: ENT examination, otoscopy with video recording, stato coordination tests, complex vestibulometry using modern computer video nystagmography, a set of audiometric tests, computed tomography of the temporal bones. Results: 38.4% of patients complained of dizziness, but when using the method of active survey complaints of dizziness were detected in 61.5% of cases. The analysis of the results of stato-coordination tests in 30.7% of patients revealed a deviation towards the affected ear, in 61.5% of cases - spontaneous nystagmus. Conclusions: the results allow us to conclude that the main complaint of patients with CSOM are of hearing loss (100%), discharge from the ear cavity (100%), complaints of vestibular manifestations were present in 30 to 55% of subjects. Detection of mixed deafness in 53.8% of patients during audiological examination indicates involvement in the process of the inner ear, hence all patients with CSOM, regardless of the duration and stage of the inflammatory process, should conduct a comprehensive vestibulometric examination to determine vestibular status, the degree of involvement of inner ear structures , prognosis, choice of treatment tactics and prevention of complications.

Cone-Beam Computed Tomography Incidental Findings in Individuals With Cleft Lip and Palate.

The use of cone-beam computed tomography (CBCT) is well-established in clinical practice. This study seeks to categorize and quantify the incidental finding (IF) rate on CBCT in patients with cleft lip and palate (CLP) prior to orthodontic or surgical treatment. This is systematic retrospective review of head and neck CBCTs in patients with nonsyndromic CLP taken between 2012 and 2019 at a single tertiary referral center. All assessments were performed independently by 4 observers (a head and neck radiologist and 3 orthodontists, including 2 fellowship-trained cleft-craniofacial orthodontists ). The images were divided into 9 anatomical areas and screened using serial axial slices and 3D reconstructions. The absolute number of IFs was reported for each area and statistical analysis was performed. Incidental findings were found in 106 (95.5%) of the 111 patients. The most common sites were the maxilla (87.4%, principally dental anomalies), paranasal sinuses (46.8%, principally inflammatory opacification), and inner ear cavities (18.9%, principally inflammatory opacification). Eleven patients had skull malformations. Thirty-three patients had IFs in 1 anatomical area, 49 patients in 2 anatomical areas, 19 patients in 3 areas, and 5 patients presented with IFs in 4 of the 9 anatomical areas. In patients with CLP, IFs on CBCT exam were present in the majority of cases. Most patients with IFs had them in multiple anatomical areas of the head and neck. The maxillary dental-alveolar complex was the most common area. Inflammatory changes in the inner ear cavities and paranasal sinuses were also common; however, cervical spine and skull abnormalities were also identified. Clinicians caring for patients with CLP should be aware of IFs, which may warrant further investigation and treatment.

ORAL MANIFESTATIONS OF KOSTMANN SYNDROME: CASE REPORT

Kostmann syndrome (KS), or severe congenital neutropenia, is a rare autosomal recessive genetic disorder with a mutation in the HAX1 gene, located on chromosome 1 q21.3. The typical symptoms are abscesses located on various parts of the body: ear, cutis, lung, and oral cavity. The decrease in the number of neutrophils alters the host defense capacity, causing periodontal disease to manifest at an early age, with gingival inflammation, aggressive periodontal destruction, edema, periodontal pouches, and tooth mobility. The aim of this report is to describe the most typical signs of this pathology in the oral cavity presenting the case of a 15-year-old adolescent girl diagnosed as having congenital neutropenia with generalized early-onset periodontitis aggravated by this systemic condition and recurrent oral infections, generalized bleeding, and early dental loss.

Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram

Background: Chronic Suppurative Otitis Media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity, which presents with recurrent ear discharge or otorrhoea through a tympanic perforation. According to WHO, the prevalence of CSOM in India is more than 4% and it falls among those countries where urgent attention is needed. It can be caused by various bacteria, fungus and viruses. Bacterial origin of CSOM is more common than other etiologies. Aims and Objectives: The present study is aimed to detect common organisms which are responsible for CSOM, most common organism responsible for the complications and to determine the antibiotic sensitivity pattern of the organisms isolated from CSOM. Results: Ear swabs were taken from 100 clinically diagnosed cases of CSOM attending department of ear, nose and throat, MBS hospital and NMCH and were subjected to culture and antibiotic susceptibility. 104 (88.13%) among 118 ear swabs from total 100 patients were culture positive and 14 (11.87%) were culture negative. The most frequently isolated organisms in CSOM patients were Pseudomonas aeruginosa (42 (40.38%)), followed by Staphylococcus aureus (36 (34.6%)), Klebsiella pneumoniae (12 (11.53%)), Escherichia coli (08 (7.69%)) and Proteus mirabilis (06 (5.76%)). Most effective and favorable drug in our study for Pseudomonas aeruginosa was piperacillin-tazobactum, followed by cefepime. Staphylococcus aureus were 100% sensitive to Vancomycin and Linezolid, and 61.11% were MRSA. Conclusion: This study highlights the need for active diagnosis and management of CSOM. Judicious use of antibiotics is recommended and also the patient must complete a course of treatment as prescribed, because inadequate treatment may cause the emergence of resistant microorganisms. Keywords: CSOM, bacterial, gram positive, gram negative Cite this Article Anita E. Chand, Charu Sharma. Isolation and Identification of Bacteria Causing Chronic Suppurative Otitis Media and Its Antibiogram. Research & Reviews: A Journal of Microbiology and Virology. 2019; 9(3): 1–5p.

Clinical trials of treatment of woman menopause insomnia due to disharmony between heart and kidney by body and auricular acupuncture

To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney. A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group (n＝55, body acupoints plus auricular points) and control group (n＝56, body acupoints). For control group, Shenmen (HT7), Sanyinjiao (SP6), Anmian, Zhaohai (KI6), Shenmai (BL62), Sishencong (EX-HN1), Xinshu (BL15) and Shenshu (BL21) were needled with filiform needles, and HT7, SP6, Anmian, BL15 and BL21 were also stimulated with electroacupuncture (EA) for 30 min, once every other day, 3 times a week for 3 weeks. For the treatment group, auricular points as Kidney, Shenmen, Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group. The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index (PSQI) scale before and after the treatment. The symptom scores of traditional Chinese medicine (TCM) and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM" (formulated by Chinese Ministry of Health, 1997). After the treatment, the scores of sleep quantity and effective rate of PSQI scale, and those of insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, paplpitation and irritability, fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment (P<0.05). Of the 56 and 55 cases in the control and treatment groups, 18 (32.1%) and 30 (54.5%) experienced a marked improvement in their symptoms, 28 (50.0%) and 22 (40.0%) were effective, and 10 (17.9%) and 3 (5.5%) failed, with the effective rate being 82.1% and 94.5%, respectively. The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale, insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, dizziness and tinninus, paplpitation and irritability, and tital fever and night sweating of TCM, as well as the effective rate (P<0.05). Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney, and the two combined treatment was evidently better.

Hubungan Sanitasi Lingkungan Rumah dengan Kejadian Penyakit ISPA pada Balita di Desa Tuapukan Kecamatan Kupang Timur Kabupaten Kupang

Acute Respiratory Infections (ARI) are infectious diseases that cause one and better parts of the channel (alveolus) including the adnexal tissue, such as sinuses, ear cavities, and pleura. Environmental saturation is an activity aimed at improving and maintaining standard environmental condition fundamentals that affect humans. Improper home sanitation is associated with high health problems, such as acute respiratory infections. The purpose of this study is to determine the relationship between the home environment with the incidence of ARI disease in Tuapukan Village, Kupang Timur Sub-district, Kupang District. This study uses an observational method with cross-sectional study design. The population of this study was 519 and the sample was 81. The bivariate analysis used Chi-Square statistical test with 95% significance level. The results shows that variables related to ARI occurrence were house wall (p=0,029), house ventilation (p=0,011), house lighting (p=0,003), occupancy density (p=0,021) and smoking habit (p=0.002). It is recommended that the societies should keep the cleanliness of the house so it will not be a place for the growth of germs; thus the societies are able to prevent ARI disease.

Analysis of hearing loss by pure tone audiometry in patients with chronic suppurative otitis media

Background: Chronic suppurative otitis media (CSOM) are an infection of the middle ear and mastoid cavity. Hearing loss is a consequence of CSOM; the degree of hearing loss can be analyzed by audiometry. Aims and Objectives: The objective of the study is to analyze hearing loss by pure tone audiometry in patients with CSOM. Materials and Methods: A total of 32 patients between the age group of 10–40 years, with discharging ears of >12 weeks duration were examined in outpatient clinics of ENT Department of Al Azhar Medical College and super specialty hospital. Patients were subjected for audiometric examination to assess the hearing loss. Patients were categorized based on the degree of hearing loss into five group’s mild (26–40 dB), moderate (41–55 dB), moderately severe (56–70 dB), severe (71–90 dB), and profound (>90 dB), respectively. Results: Most of the ears (85.9%) had mild-to-moderate hearing loss. Conductive hearing loss was 87.5% and mixed hearing loss was 12.5%. Average air-bone gap (ABG) was found to be 30.7 dB and 30.65 and maximum ABG was 50 and 45 dB in the right ear and left ear, respectively. Conclusion: Patients had mild-to-moderate conductive type of hearing loss. If these patients are left untreated may progress in developing mixed hearing loss. Audiometry is an important screening and diagnostic tool for assessing the degree of hearing loss. It also gives an idea for proper planning for surgery in these patients and to prevent hearing disability.

Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity

Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope. The study was done to assess and clean postoperative canal wall down mastoidectomy cavities with endoscope and compare with oto-microscopy. This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant. The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely. Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.

Application of “banana cochleostomy” and looped electrode insertion for cochlear implantation in children with common cavity malformation and cystic forms of cochlear hypoplasia

ObjectivesPatients with profound hearing loss due to inner ear malformations may benefit from cochlear implantation; however, the surgery may present a substantial problem for the cochlear implant surgeon due to anatomical variations.The authors describe a new surgical and technical advancement for implantation in patients with small inner ear cavities that make the surgery easier and safer. On the basis of experience involving five consecutive surgeries performed in four patients with inner ear malformations, we present the advantages and application possibilities of the technique. MethodsThe technique does not change the surgical approach in general; however, modification of the cochleostomy shape and looping of the cochlear implant electrode enables safe advancement of the electrode with optimal positioning in the cavity. Additionally, these modifications protect against the insertion of the electrode into the internal auditory canal minimizing the risk of gushing and extracochlear stimulation. ResultsThe present technique has been used in five cases of cystic implantable inner ear spaces in three independent institutions by different surgeons. It has proven to be a reliable, relatively easy and safe procedure performed with very good anatomic and initially functional effects (positive intraoperative neural response telemetry measurements). ConclusionsWe hope that utilization of the “banana cochleostomy” and insertion of the looped cochlear implant electrode in the implantable cystic spaces of children with malformed inner ears will facilitate and simplify the surgical technique in this difficult procedure and additionally, in revision surgical cases. To our knowledge, the looped insertion and banana-shaped cochleostomy have not been reported previously.

Otomyiasis: Systematic Review.

Introduction Myiasis is a disease caused by fly larvae that grow in the tissues of animals and humans. It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise. Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues. Its management varies depending on the location, and on the preferences of the doctor that faces this challenge. Myiasis usually occurs in tropical countries, and, in many places, it is not a rare condition. The cases are rarely reported, and there are no published management protocols. Objective To review the literature regarding the most common agents, the predisposing factors and the treatment alternatives for otic myiasis, a rare form of human myiasis caused by the infestation of fly larvae in the ear cavities. Data synthesis We present a systematic review of the literature. The search in five databases (Medline, Embase, Cochrane Database of Systematic Reviews, LILACS and RedALyC) led to 63 published cases from 24 countries, in the 5 continents. The ages of the patients ranged from newborn to 65 years old. The most common agents belong to the Sarcophagidae or Calliphoridae families. Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors. The treatment alternatives are herein discussed. Conclusion The results highlight the need for monitoring, follow-up and standardization of medical approaches.

Bacterial strain changes during chronic otitis media surgery.

Cultures obtained from pre-operative middle-ear swabs from patients with chronic otitis media have traditionally been used to guide antibiotic selection. This study investigated changes in the bacterial strains of the middle ear during chronic otitis media surgery. Pre-operative bacterial cultures of otorrhoea, and peri-operative cultures of the granulation tissue in either the middle ear or mastoid cavity, were obtained. Post-operative cultures were selectively obtained when otorrhoea developed after surgery. Bacterial growth was observed in 45.5 per cent of pre-operative cultures, 13.5 per cent of peri-operative cultures and 4.5 per cent of post-operative cultures. Methicillin-resistant Staphylococcus aureus was identified as the most common bacteria in all pre-operative (32.4 per cent), peri-operative (52.4 per cent) and post-operative (71.4 per cent) tests, and the percentage of Methicillin-resistant S aureus increased from the pre- to the post-operative period. The bacterial culture results for post-operative otorrhoea showed low agreement with those for pre-operative or peri-operative culture, and strain re-identification was required.

The internal cranial anatomy of Romundina stellina Ørvig, 1975 (Vertebrata, Placodermi, Acanthothoraci) and the origin of jawed vertebrates-Anatomical atlas of a primitive gnathostome.

Placoderms are considered as the first jawed vertebrates and constitute a paraphyletic group in the stem-gnathostome grade. The acanthothoracid placoderms are among the phylogenetically most basal and morphologically primitive gnathostomes, but their neurocranial anatomy is poorly understood. Here we present a near-complete three-dimensional skull of Romundina stellina, a small Early Devonian acanthothoracid from the Canadian Arctic Archipelago, scanned with propagation phase contrast microtomography at a 7.46 μm isotropic voxel size at the European Synchrotron Radiation Facility, Grenoble, France. This is the first model of an early gnathostome skull produced using this technique, and as such represents a major advance in objectivity compared to past descriptions of placoderm neurocrania on the basis of grinding series. Despite some loss of material along an oblique crack, most of the internal structures are remarkably preserved, and most of the missing structures can be reconstructed by symmetry. This virtual approach offers the possibility to connect with certainty all the external foramina to the blood and nerve canals and the central structures, and thus identify accurate homologies without destroying the specimen. The high level of detail enables description of the main arterial, venous and nerve canals of the skull, and other perichondrally ossified endocranial structures such as the palatoquadrate articulations, the endocranial cavity and the inner ear cavities. The braincase morphology appears less extreme than that of Brindabellaspis, and is in some respects more reminiscent of a basal arthrodire such as Kujdanowiaspis.