Malleus Handle Research Articles

Pathologic Status of Tissue Around the Malleus Handle Tip in Endoscopic Tympanoplasty: Potential Impact on Surgical Decisions.

Objectives: To avoid postoperatively acquired cholesteatoma, whether there was any squamous epithelial tissues residue around the tip of the malleus handle, and the need to remove these tissues were explored. Methods: This prospective study enrolled 197 patients who underwent endoscopic tympanoplasty. A postoperative pathological evaluation of the tissue around the tip of the malleus handle was performed to determine the presence of squamous epithelium. Analyzed correlation of epithelial remnants with exposure of malleus handle and microbial infection of middle ear. Results: The detection rate of squamous epithelial retention around the tip of the malleus handle differed significantly among patients with adhesive otitis media (AdOM), acquired cholesteatoma, and chronic suppurative otitis media (CSOM). The detection rate was significantly higher in the acquired cholesteatoma group than in the AdOM and CSOM groups (P < .001). The rate of squamous epithelial retention around the tip of the malleus handle was not significantly associated with microbial infection of the middle ear, the surgical side (P = .672), dry or wet ear status (P = .702), or exposure of the malleus handle (P = .06). Conclusions: In patients with acquired cholesteatoma, AdOM, or COM with severe tympanic sclerosis, the tissue around the tip of the malleus handle should be removed completely. For patients with simple COM, that is, without tympanic sclerosis or keratinizing stratified squamous epithelium at the edge of the perforation, the tissue can be retained.

Analysis of the effect of reconstructing the ossicular chain under otoendoscopy with and without a stapes superstructure

Background Numerous studies have been conducted on the effect of the stapes superstructure after ossicular chain reconstruction, but the findings are not uniform. Objective To compare the hearing outcomes of ossicular chain reconstruction with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) under otoendoscopy. Materials and methods The records of 111 patients diagnosed with chronic suppurative otitis media were retrospectively analyzed. These patients were divided into PORP group (n = 57) and TORP group (n = 54). They were further subdivided into subgroups PORP-a (with a malleus handle) and PORP-b (without a malleus handle), subgroups TORP-a and TORP-b. Pre- and postoperative audiometric results were analyzed. Results The mean postoperative air conduction hearing thresholds improvement, mean air–bone gap improvement, and the success rate of reconstruction were significantly higher in the PORP group than in the TORP group (p < .05). The mean postoperative air conduction hearing thresholds improvement and the success rate of reconstruction were significantly higher in the PORP-a group than in the TORP-a group (p < .05); and similar results were concluded in comparison of the PORP-b group and the TORP-b group. Conclusions and significance The stapes superstructure has an important positive effect on the postoperative outcome of endoscopic ossicular chain reconstruction.

A Comparative Study of Button Hole Technique Versus Underlay Technique in Type 1 Tympanoplasty.

Tympanoplasty is the most common operation performed by an Otolaryngologist worldwide.Type 1 tympanoplasty involves repair of pars tensa of tympanic membrane, when the middle ear is normal. The most widely used method is underlay technique using temporalis facia. In buttonhole tympanoplasty, the temporalis fascia is anchored to the handle of malleus through the buttonhole. To compare and analyze graft uptake and hearing outcome in button hole technique and underlay technique. It is a comparative study done at tertiary care center, where patients suffering from tubotympanic type of chronic otitis media with medium sized perforation with moderate conductive hearing loss, within age group of 18-60 years,were selected. In Button hole tympanoplasty group the mean hearing gain was 9.3dB, and 8.17 dB in Underlay tympanoplasty group which was statistically significant (p < 0.05) but P value between Button hole and Underlay tympanoplasty was not statistically significant.With regard to graft uptake 96.7% showed graft uptake in Buttonhole tympanoplasty group and in underlay tympanoplasty the graft uptake was 93.3%. Buttonhole technique is better in terms of graft uptake since the graft is anchored to the handle of malleus, and postoperatively medialisation of graft and other complications like lateralization of graft, epithelial pearl formation and anterior blunting is prevented. Both techniques are good in terms of hearing improvement for chronic otitis media with medium sized perforation with moderateconductive hearing loss.

Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle.

We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle. Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.

Comparative Study of Temporalis Fascial Graft Medial or Lateral to Handle of Malleus in Tympanoplasty

Objective: To asses and compare the hearing outcome and healing of Temporalis fascia graft in both groups by placing the graft medial (underlay technique) or lateral to the handle of malleus (over- underlay technique). Method: This retrospective study conducted for a period January,2018 to December 2019- Two years period in Specialized ENT Hospital (SENTH) of SAHIC (Society for assistance to hearing impaired Children), Dhaka. It includes 104 patients, Group-A 59 patients (Underlay technique) and Group-B 45 patients (Over-underlay technique). Result: Graft success rate overall 84.62%, Group-A- 84.75% (Medial to malleus) and Group-B- 84.44% (lateral to malleus). Pre- and post- operative air- bone gap of two groups were compared. Conclusion: Both techniques (medial or lateral to malleus handle) has a high rate of success for the closure of TM perforation with significant improvement in air-bone gap. Bangladesh J Otorhinolaryngol 2023; 29(1): 17-23

Comparative Study of Graft Placement Between Medial and Lateral to Malleus in Tympanoplasty

Abstract&#x0D; Introduction&#x0D; Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. In tympanoplasty graft can be by overlay or underlay technique. In underlay technique the graft material can be placed either medial or lateral to the handle of malleus.&#x0D; Objective: To compare the outcome of the surgery when the temporalis fascia graft is placed medial or lateral to the handle of malleus, in terms of complete take up of the graft and hearing improvement after the surgery.&#x0D; Materials &amp; methods&#x0D; A prospective and comparative hospital-based study was done in the Otorhinolaryngology (ENT) department of a tertiary referral hospital of Kolkata, from 1st January, 2021 to 30th June, 2022 (18 months). 60 patients were included in the study.&#x0D; Results&#x0D; We found that association of tympanic membrane status with group was not statistically significant after 1 month of surgery (p=1.0000) and after 3 months of surgery (p=0.6711). Distribution of mean postoperative hearing gain after 3 months of surgery with group was not statistically significant (p=0.3020).&#x0D; Conclusion&#x0D; We found both the techniques are equally effective in terms of complete graft take up and post operative hearing gain after 3 months follow up.

Morphometric Comparison of Tympanic Membrane in Unilateral Mucosal Chronic Otitis Media.

descriptive. hospital based. 84 patients with unilateral mucosal chronic otitis media. each patient underwent Otoendoscopy and the findings were recorded through a camera connected to a laptop. Using image j software these images were analysed. Participants were of mean age of 35years with left preponderance, and no gender preponderance was found. In our study, majority of the perforations were small sized perforations. The malleus handle foreshortening was about 92.6% compared to unaffected ear which was statistically insignificant. There was a significant inter group difference in the distance between the tip of the manubrium and the inferior annulus-which was decreased in affected ears and in the distance from the lateral process to the anterior tympanic ring-which was increased in affected ears. There was no difference in the malleo scutal angles. These differences were not dependent on the site or size of the perforation. The differences we found between ears were unexpected. The significance of the differences in the shape of the tympanic membrane between affected and unaffected ears in unilateral mucosal COM need further study. We did not find a statistically significant difference in the malleo-scutal angles between ears.

Comparison of Results of Myringoplasty with Temporalis Fascia and Perichondrial: Cartilage Composite Graft in High Risk Perforations

Background: The objectives of this study were to compare the graft uptake and post-operative hearing results of underlay myringoplasty with temporalis fascia and perichondrial-cartilage composite graft in high risk perforations. Materials &amp; Methods: Patients of ages of 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforations undergoing myringoplasty were included. Criteria of high risk were &gt;50% perforation of tympanic membrane, revision cases, absent/eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal perforation of any size. Pure tone audiometry was done within 1 week before surgery. Seventy cases included for myringoplasty were randomly allocated by lottery method into two groups with 35 cases each in temporalis fascia group and perichondrial - cartilage composite graft group. After 6 weeks graft uptake results were assessed and post-operative hearing was evaluated and compared within and between the groups. Results: Graft uptake rates in temporalis fascia group and perichodrial - cartilage composite graft group were 88.57% and 91.43%, respectively with no statistically significant difference between the groups (p = 0.69). The mean pre- and post-operative air bone gaps in temporalis fascia group were 31.81 ± 10.49 dB and 17.87 ± 7.96 dB. The mean pre- and post-operative air bone gaps in perichondrial - cartilage composite group were 35.19 ±7.26 dB and 22.62 ± 8.77 dB. These differences in both the groups were statistically highly significant (p &lt; 0.001) showing improvement in the hearing after surgery. The mean post-operative ABG gains were 13.94 ± 8.36 dB and 12.57 ± 8.21 dB in temporalis fascia and perichondrial - cartilage composite groups respectively.&#x0D; Conclusion: The graft uptake rates and hearing results after perichondrial - cartilage composite graft are similar to those of temporalis fascia graft. Perichondrial- cartilage composite graft even though more rigid and thicker than temporalis fascia did not affect post-operative hearing results adversely

A Case of Idiopathic Malleus Handle Fracture

The most common injury of the ossicle chain is traumatic incudostapedial joint dislocation. Cases of fracture of the incus or stapes have also been reported, but malleus fracture without injury of the tympanic membrane or other ossicles is rare. Our patient was a 56-year-old man who presented to our outpatient department with an 8-day history of right hearing loss at the time of waking up. On examination, the anterior part of the right tympanic membrane looked dark purple. Pure-tone audiogram showed mid-to-high frequency conductive hearing loss on the right side. A temporal bone CT showed no obvious fracture of the ossicles, but an opacity was noted anterior to the malleus handle, suggesting middle ear hemorrhage. Eight months later, endoscopic ear surgery was performed. The fracture was located near the lateral process of the malleus, and a tragus cartilage graft was placed between the malleus and the tympanic membrane. Postoperatively, the right conductive hearing loss improved. Although isolated malleus handle fracture is rare, it is necessary to keep in mind the possibility of such ossicular bone injuries in daily practice.

Comparative Study Of Placement Of Graft Medial Or Lateral To Handle Of Malleus In Inlay Technique Of Myringoplasty: A Retrospective And Prospective Study

Thisrandomized triple blindedretrospective and prospective study,was studied in terms of graft take-up rate, hearing improvement and complications and get more fruitful way for myringoplasty surgery. This studyof 180 patients were divided in two groups. Group A (51 patients) in whom graft was placed medial and in group B (129 patients) graft was placed lateral to the handle of malleus in modified inlay technique of myringoplasty.The results were compared at 3 weeks, 3- and 6-month follow-up. Pre- and post-operative air conduction (AC), bone conduction (BC) and air-bone gap (ABG) were compared. KEYWORDS Chronic otitis media, Myringoplasty, Inlay technique, Air Bone Gap, Conductive hearing Loss

Chorda tympani nerve course and feasibility of its preservation during atresiaplasty for congenital aural atresia.

The association between the chorda tympani nerve (CTN) and atresiaplasty has not been investigated. This study aimed to describe the course of the CTN observed during atresiaplasty for congenital aural atresia (CAA) and explore the feasibility of CTN preservation. In this retrospective study, six consecutive patients who underwent atresiaplasty in a tertiary academic center were included. The course of the tympanic segment of the CTN and its preservation feasibility were evaluated. Atresiaplasty was performed using an anterior approach. The average Jahrsdoerfer score was 8.7 points (range, 8-9 points). The CTN was located in the atretic plate in all patients. It emerged from an average of 5.6 mm (range, 5.2-6.1) inferior to the incus buttress and crossed the middle ear in an anterior-superior direction. The distance between the neck of the malleus and the CTN varied in the absence of the malleus handle. However, when the malleus handle developed, the CTN passed between the incus and the malleus handle. The CTN was preserved in two of the six patients. They had a Jahrsdoerfer score of 9 and grade I microtia. The CTN was located in the atretic plate, emerging from an average distance of 5.6 mm inferior to the incus buttress. The incus buttress might serve as a good anatomical landmark to identify and preserve the CTN. CTN preservation is feasible in atresiaplasty candidates with a Jahrsdoerfer score of 9 and auricular deformity of grade I. 4.

Hearing Results in Patients With No Ossicular Chain Reconstruction and Factors Influencing the Outcome.

Ossiculoplasty is aimed at improving or maintaining the conductive portion of hearing in patients subjected to otologic surgery. However, satisfying hearing is frequently observed after tympanoplasty even in the absence of ossicular chain reconstruction. Aims of this article would be to evaluate hearing outcomes, in terms of pure tone average air-bone gap (PTA-ABG), in patients subjected to tympanoplasty for middle ear disease whose ossicular chain has not been reconstructed, and then to investigate factors influencing those outcomes. Retrospective chart review of patients who underwent ear surgery from year 2003 to 2021 at the Otolaryngology-Head and Neck surgery department of the University Hospital of Modena was performed. Audiometric test results from patients who did not receive any ossicular chain reconstruction were collected and analyzed. Tertiary University referral center. The mean patients' follow-up was 34.1 months. Overall, mean PTA-ABG in the study population was 23.5 dB. Integrity of stapes superstructure, malleus handle and malleus head, together with the use of tragal cartilage graft over autologous temporalis fascia to reconstruct the tympanic membrane were found to be significantly associated with better hearing outcomes, as demonstrated by lower PTA-ABG values. Stapes superstructure was found to be associated with more favorable outcomes in multivariate analysis, net of confounding factors. Good hearing performance can be obtained in patients subjected to middle ear surgery, even if the ossicular chain is not reconstructed. Presence of ossicular chain remnants and the use of a rigid material for tympanic membrane reconstruction are the factors that seem to most favorably influence hearing outcomes after surgery for middle ear disease.

Morphological and morphometrical anatomy of the auditory ossicles in roe deer (Capreolus capreolus)

The study provides a series of distinctive morphological features of the auditory ossicles alongside comparative morphometric data, bringing facts in respect to morphology and some morpho-functional elements of the auditory ossicles in this little-studied species. The most relevant features noted are evident conical shape of muscular process of malleus and triangular aspect of the handle of malleus. For the incus, a short body of the bone and the direct continuation is mentioned, with no clear distinction as an individualized piece for the lenticular process. As for the stapes, the clear profiling of the muscular tubercle for the stapedial muscle and elliptic shape of the foot of the stapes is noted. A series of comparative measurements and indices are also calculated in the attempt of profiling differences from the domestic couterspecies- sheep and goat.

Endoscopic Tympanoplasty: The Fringed Shield Technique

Introduction: Endoscopic tympanoplasty has become popular in the past few years. To reach anterior quadrants of the middleear for adequate graft setting and complete perforation closure, most surgeons detach the remaining tympanic membrane from the umbus. This maneuver may cause elevation of the anterior tympanomeatal angle and result in blunting and worse audiometric thresholds. Objectives: Describe a tympanoplasty endoscopic technique with a modified full thickness cartilage graft that allows its positioning without the need to detach the malleus handle from the tympanic membrane. Data Synthesis: Because endoscopic ear surgery is an one-handed procedure, the graft needs to be stiff and easy to manipulate to facilitate its positioning and complete closure of the tympanic perforation. We describe a full thickness tragal cartilage graft shaped as an oval island with a wedge to accommodate the malleus handle and with the anterior and posterior edges fringed. This design allows its positioning in an underlay technique without the need to detach the malleus handle from the tympanic membrane. Thereby, without this maneuver, it is possible to prevent blunting and, consequently, reduce the odds of hearing loss. Conclusion: The fringed shield technique is a promising endoscopic approach with good hearing results. Although the hearing outcomes presented in this paper are not exclusive for the fringed shield technique, we would not expect different results since we have applied full thickness cartilage graft in most cases. Nevertheless, a larger series of patients submitted exclusively to the fringed shield graft would be necessary to confirm these data.

Analysis of spatial location of the malleus in patients with chronic otitis media based on 10 μm otology CT

Objective: To assess the changes of the spatial location of the malleus in patients with chronic otitis media (COM) using 10 μm otology CT. Methods: Forty-five patients with COM (COM group, 45 ears) and 55 patients without external and middle ear disease (control group, 89 ears), who underwent 10 μm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to March 2021, were retrospectively collected during the same period. In the COM group, there are 20 males and 25 females, aged from 20 to 78 (40±14) years. In the control group, 29 were males and 26 were females, with age of 19 to 57 (32±11) years. The shortest distance between the malleus head and the upper wall, the distance between the outer edge of the malleus neck and the scutum, the distance between the outer edge of the malleus neck and the pars flaccida of the tympanic membrane, the shortest distance between the malleus head and the anterior wall, the shortest distance between the anterior process and the anterolateral wall, the shortest distance between the tip of the malleus handle and the promontory, and the shortest distance between the malleus head and the tympanic segment of the facial nerve were measured and compared between the two groups. Results: Compared with the control group, the head-upper wall distance (M (Q1, Q3)) (0.81 (0.48, 1.21) mm vs 0.57 (0.33, 0.90) mm) and the neck-scutum distance (1.79 (1.54, 2.13) mm vs 1.65 (1.48, 1.83) mm) were larger in the COM group (all P<0.05), and the neck-tympanic membrane distance (1.32 (1.15, 1.49) mm vs 1.45 (1.31, 1.59) mm) and the handle-promontory distance (1.56 (1.33, 2.09) mm vs 2.10 (1.74, 2.43) mm) were reduced in the COM group (all P<0.05, respectively). The neck-tympanic membrane distance on the left was larger than those on the right in the COM group (1.39 (1.19, 1.51) mm vs 1.21 (0.87, 1.31) mm, P<0.05). Conclusion: There are changes in the relative position of the malleus in patients with COM, which are helpful for further understanding the imaging manifestations in patients with COM.

Endoscopic perichondrium-cartilage button technique for repairing chronic large perforations in teenagers

ObjectiveThe objective of this study was to evaluate the graft outcome and complications of endoscopic perichondrium-cartilage button technique for repairing chronic large perforations in teenagers. Study designProspective case series. Materials and methods56 patients with chronic large perforations more than 50% of the TM who underwent endoscopic perichondrium-cartilage button technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 3, 6 and 12 months. ResultsOf the 56 ears, 3 (5.4%) patients lost follow-up, 53 (94.6%) patients were finally included in this study. The mean operation time was 37.2 ± 5.4 min. The retrograde tympanomeatal flap elevation was performed in 16 (30.2%) patients.The graft success rate was 96.2% (51/53) at postoperative 3 months and 94.3% (50/53) at postoperative 12 months. The mean preoperative ABG was 25.0 ± 3.7 dB, while the mean postoperative ABG postoperatively 6 months was 12.8 ± 3.1 dB; the difference between these values was significant. No graft-related complications (e.g., graft lateralization, significant blunting, and graft medialization) were encountered during the follow-up period. However, graft keratin pearl was noticed in 5.7% (3/53) patients, which occurred in the handle of malleus in 2 and antero-inferior margin in one. All the graft pearls were endoscopically removed in the outpatient setting. ConclusionsEndoscopic perichondrium-cartilage button technique can be achieved in every teenager patient with chronic large perforation without cholesteatoma, and, is a safe and efficient procedure.

The Outcome of Tympanic Membrane Grafting Medial or Lateral to Malleus Handle in Type I Underlay Tympanoplasty

Aims: This study aims to study and compare the outcome of tympanic membrane grafting medial or lateral to handle of malleus in terms of graft uptake and closure of air bone gap. Materials and Methods: This prospective randomized study included 60 patients who presented in the ENT Outpatient Department of ABVIMS and Dr. Ram Manohar Lohia hospital with Inactive chronic Otitis media (COM) (tubo tympanic disease). Patients were randomly allocated to two groups of 30 patients each. Group A contained patients with graft placed medial to handle of malleus and Group B contained patients with graft placed lateral to handle of malleus. Patients were followed up at the 4th, 6th, and 12th week postoperatively for graft uptake and hearing gain were assessed. Results: There was significant mean hearing gain postoperatively compared to preoperative in pure tone audiometry, however, there is no significant difference in short-term outcomes of both the grafting techniques for graft uptake and audio metric results. Conclusion: Both medial and lateral placement of grafting material to malleus handle into type I underlay tympanoplasty are good methods for graft uptake and audiological outcome for inactive COM (Tubo tympanic disease).

English

BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft

Prevalence of middle ear malformation and outcomes of tympanoplasty and/or canalplasty in patients with and without congenital external auditory canal stenosis

ObjectiveTo compare the prevalence of middle ear malformations between patients with and without congenital external auditory canal stenosis (CEACS) and to investigate the outcomes of tympanoplasty and/or canalplasty in terms of tympanic membrane (TM) size and external auditory canal (EAC) stenosis in patients with middle ear malformation. MethodsTwenty-five patients who underwent primary tympanoplasty and/or canalplasty for middle ear malformation at a tertiary academic medical center were retrospectively reviewed. CEACS was defined as an EAC diameter of 4 mm or less. Intraoperative findings, including irregularity of the ossicles, facial nerve, or chorda tympani; size of the TM and EAC on computed tomography; and pre- and postoperative hearing level, were collected. ResultsWe included 7 and 18 patients with and without CEACS, respectively. The malleus handle defect, anterior deviation of the chorda tympani, and small TM (≤7 mm) (p-values 0.015, <0.001, and 0.003, respectively; Fisher's exact test) had significantly higher prevalence in patients with CEACS than in those without. The mean postoperative air-bone gap (ABG) in patients with CEACS was not significantly different from that in patients with normal-sized EAC (20.6 dB and 19.5 dB, respectively; p-value, 0.121; Mann–Whitney U test). No difference was observed in mean postoperative ABG between patients with small TM and those with normal-sized TM (19.2 dB and 20.0 dB, respectively; p-value, 0.469; Mann–Whitney U test). ConclusionPatients with CEACS were more likely to have malleus handle defect, anterior deviation of the chorda tympani, and small TM than those without CEACS. Hearing outcome of patients with CEACS and a malformed malleus and/or incus might be equivalent to that of patients without CEACS following tympanoplasty and/or canalplasty, regardless of the EAC or TM size.

Measurement of middle ear transfer function in temporal bones using electromagnetic excitation: Comparison to sound excitation and evaluation of influencing factors

Hearing a sound produces vibrations of the ossicles in the middle ear, which can be measured in the micrometer to nanometer range. Destruction of middle ear structures results most commonly from chronic inflammatory diseases. In these cases, passive and active middle ear implants are used for reconstruction of the ossicular chain. The positioning of the implants depends primarily on the surgeon's experience. So far, no objective assessment has been conducted to affirm if the chosen positioning is the best in each specific case.We have established a new method, allowing us to measure the middle ear transfer function (METF) intraoperatively. Using the new method, a magnet is placed on the umbo of the malleus handle and is stimulated by a coil positioned underneath the head. The resulting vibration is measured on the stapes footplate using Laser Doppler vibrometry (LDV).Acoustic and electromagnetic excitation show comparable METF in lower frequencies, which differ up to 10 dB in frequencies over 1 kHz. The position of the coil does not play a relevant part in the METF, whereas the location of the magnet on the tympanic membrane highly impacts the METF. This technique demonstrates reproducible results.Electromagnetic excitation is comparable to sound excitation and is suited for measuring the METF. A stable positioning of the magnet on the umbo is essential in order to acquire valid data.