Left Tympanic Membrane Research Articles

Endoscopic Tympanoplasty in Chronic Otitis Media with Inactive Mucosal Disease

<i>Background:</i> Chronic otitis media (COM) is a condition usually seen in patients attending the ENT department. Chronic inactive mucosal disease (CIMD) is characterized by tympanic membrane (TM) perforation with hearing loss. Endoscopic tympanoplasty (ET) is a surgical method to repair TM perforation with minimal invasion. <i>Objective:</i> The present analysis was done to find out the outcome of ET surgeries in CIMD. <i>Methods:</i> Retrospective data analysis was done in 30 patients underwent ET with endoscopic under-lay technique at Al-Ameen medical college, Vijapur, India. <i>Results:</i> Average age of patients was 34.17±9.52 years. Majority (40%) patients were from 18-30 years of age group. There were 12 (40%) males and 18 (60%) females. Right-side and left-side CIMD was equally distributed in 30 patients. Sixteen (53.3%) and 14 (46.7%) patients were having right and left TM perforation, respectively. TM perforation size was small, medium and large in 43.3%, 30% and 26.7% of patients, respectively. Twenty-eight (93.3%) patients had temporalis fascia and 2 (6.7%) patients had tragal cartilage as graft material. Two (6.7%) patients had graft rejection without improvement in hearing. No patient had complication or any miscellaneous issues. Eighteen (60.0%), 11 (36.7%) and 1 (3.3%) pre-operative patient with pure-tone average (PTA) had mild, moderate, and severe conductive hearing loss (CHL), respectively. All patients with PTA were improved after surgery. <i>Conclusion: </i>ET is an effective, minimally invasive, and less painful surgical technique for repair of central TM perforations in CIMD.

A Case of Middle Ear Adenomatous Neuroendocrine Tumors: Proposal of a Staging System

A 49-year-old man visited a local otolaryngology clinic with left hearing loss. He was diagnosed as left middle ear tumor and referred to us. The tumor was protruding from the left tympanic membrane. Computed tomography (CT) revealed thickening of the tympanic membrane, space-occupying lesions in the middle ear cavity and mastoid air cells, and no bone destruction in the left middle ear. Magnetic resonance imaging confirmed the CT findings, and the lesions were hyperintense on T1- and T2-weighted imaging. He was diagnosed as middle ear adenomatous neuroendocrine tumor (MEANT) with a pathological result. The patient underwent postauricular approach and canal wall-down mastoidectomy. The tumor occupied the mastoid air cells and extended into the middle ear mucosa. To prevent perilymphatic fistula, the tumor was excised as extensively as possible, while preserving the tumor around and adjacent to the stapes footplate. MEANT is extremely rare and long-term follow-up is necessary due to be potential for tumor regrowth or recurrence. Herein, we propose a new staging system for MEANT.

Canalplasty using osteotome in a unilateral ear auditory exostoses (EAE) without cold water exposure: a case report

Background: Ear auditory exostoses (EAE) or surfer’s ear is a slow benign bony growth within the external auditory canal (EAC). The exact etiology of EAE remains unclear but it is commonly associated with chronic exposure to cold water or wind. The technique of surgery can be transcanal, endaural, or postauricular approach, based on the surgeon's experience. To our knowledge, this is the first documented report of a patient with recurrent EAE without cold water exposure. The purpose of this study is to present a rare case report about a woman with unilateral EAE without cold water exposure with transcanal osteotome surgical approach. Case presentation: A 29-years-old woman was referred to the Ear, Nose, and Throat Department, West Nusa Tenggara General Hospital, Mataram, Indonesia with left ear fullness since one week ago. The patient was told that she had a lump within the ear canal since 2013 but she had no symptoms. There was no history of recurrent ear infection or participating in water activities. Otoscopy of the left ear revealed a lump rising from EAC that covers 90% of EAC. We could not visualize the left tympanic membrane. The CT scan of her temporal bone demonstrated a hard density mass in the left EAC. The patient was done surgically with a transcanal approach. Indication for this patient was the occlusion of more than 80% of EAC. Transcanal with osteotome was chosen because of its less complication than others. Conclusion: It is unusual that our patient developed EAE without the usual precipitating factor. The surgery was done with a transcanal approach with an osteotome to prevent complications postoperative. Future experimental studies should be performed.

265 Granulomatosis With Polyangiitis Manifesting as Acute Otitis Media: A Case Report and Review of Literature

Abstract Granulomatosis with polyangiitis (GPA) is a rare necrotising vasculitis of unknown aetiology affecting small and medium-sized vessels of the upper respiratory tract, lungs, and other organs. It is the most common anti-neutrophil-cytoplasmic-antibody (ANCA) associated vasculitis disorder. While otologic manifestations are identified in up to 70% of cases, it is occasionally misdiagnosed in this cohort of patients. We present a case of GPA which initially manifested as isolated acute otitis media. A 52-year-old female with a history of type 2 diabetes presented with a 6-week history of bilateral otalgia, otorrhea, and hearing loss. She denied facial paresis, sensory deficit, arthralgia, myalgia, visual symptoms, rashes, or diarrhoea. Examination revealed a right tympanic membrane perforation and an erythematous left tympanic membrane. The patient was treated with different courses of oral and topical antibiotics for a diagnosis of otitis media with effusion, to no avail. Subsequent serum analysis revealed a C-ANCA pattern, in keeping with GPA. The patient is being treated accordingly and is making stable progress. Less commonly, GPA may manifest as isolated otolaryngologic symptoms as seen in this case. Mindfulness of this entity helps reduce the risk of irreversible organ damage and patient morbidity.

Osteoma of the temporal bone squama: a case report and review of literature

BackgroundOsteomas are benign slow-growing tumors, which typically arise on the surface of the bone. They rarely arise from the temporal bone, accounting for 0.1–1% of all benign tumors of the skull. The external auditory canal (EAC) is the most common site for osteomas in the temporal bone. Other extra-canalicular osteomas of the temporal bone are uncommon and infrequently reported. In this case report, we discuss the clinical presentation and surgical management of osteoma of the squamous part of the temporal bone. A limited review of literature is also presented.Case presentationA 20-year-old male presented to the outpatient department (OPD) with a chief complaint of a hard swelling above his left ear, for 4 years. He had no other complaints other than cosmetic concern. On examination, there was a solitary, smooth, bony hard swelling just antero-superior to the left pinna, and the overlying skin was unremarkable. The left EAC and tympanic membrane were normal. A non-contrast computed tomography (CT) scan of the head and face with 3-D reconstruction showed a16 × 18 mm exophytic, pedunculated bony lesion arising from the squamous part of the temporal bone suggestive of an osteoma. The patient was taken up for surgical excision under general anesthesia. The bony lesion was removed from its attachment to the skull using a gouge and a mallet. The base of the tumor was drilled using a polishing burr to ensure complete removal and prevent recurrence. The histopathology was confirmatory of compact osteoma. Postoperative period was uneventful, and follow-up at 18-month post-surgery did not reveal any recurrence clinically.ConclusionOsteoma of the temporal squama is rarely reported, and surgical excision is the definitive treatment if symptomatic. This case report highlights the surgical management of this rare tumor. A limited review of literature suggests that squamous part of the temporal bone is an unusual site for extra-canalicular osteomas, and the prognosis is good after surgery.

Ramsay Hunt Syndrome with Pharyngolaryngeal Involvement Mimicking Acute Stroke: A Case Report.

Ramsay Hunt syndrome is a clinical manifestation of the reactivation of latent varicella zoster virus in the geniculate ganglion after acute infection. It is commonly associated with an acute peripheral facial nerve paralysis, auricular vesicular eruption and acute sensorineural hearing loss. However, in some rare cases the involvement of other cranial nerves, especially the glossopharyngeal and vagal is described. We present a 56-year-old male patient who was diagnosed with acute pharyngitis. Two days later, the patient developed dysarthria, hoarseness, and left side facial weakness. Considering a patient's history of cardiovascular events, the acute stroke was suspected. Magnetic resonance imaging ruled out an acute cerebrovascular accident. The patient's otalgia aggravated and he reported hearing loss. Clinical examination revealed facial paralysis affecting the left side of the face, erythematous rash on the left auricle, multiple vesicles present on patient's left tympanic membrane, ulcerous lesion on the left side of the soft palate and ipsilateral velopharyngeal palsy. Indirect laryngoscopy revealed ulcerous lesions in the left side of the epiglottis and left vocal cord paralysis. The patient was diagnosed with Ramsay Hunt syndrome with cranial polyneuropathy. Oral acyclovir and oral prednisolone were administered. Seven months after discharge, facial paralysis improved to lower grade and flexible laryngoscopy showed that the left vocal cord had resumed normal movement. Ramsay Hunt syndrome can be accompanied by involvement of other cranial nerves. Previous history of hypertensive crises and myocardial infarction may influence a diagnosis of Ramsay Hunt syndrome, especially when it has atypical presentation. However, this diagnosis should be considered in patients with unilateral multiple cranial nerve palsies.

Tinnitus Related to Forceful Eyelid Closure: A Case Report.

Tinnitus is a common complaint in the clinical setting and can be classified into sensorineural and objective tinnitus. The sources of objective tinnitus may either come from para-auditory structures, such as myogenic or vascular structures, or the middle ear muscles. One type of objective tinnitus of muscular origin is known as forceful eyelid closure syndrome (FECS). We present an additional case of a 22-year-old woman with unilateral FECS. The auricles and external auditory canals were normal bilaterally; we examined her tympanic membrane under an endoscope, the left tympanic membrane was retracted simultaneously with the closure of her eyelids. Both tympanograms were of type A. However, small cut trace associated with tympanic membrane movement were obtained during blinking. The patient was managed by behavioral therapy and medication treatment conservatively, and the condition became well-controlled. Here, we present this rare case and review the literature.

Nontuberculous mycobacteria otomastoiditis with facial palsy.

Nontuberculous mycobacteria otomastoiditis with facial palsy.

Gradenigo's syndrome – A Diagnostic Challenge

We report a case of a 5-year-old healthy child that presented to the emergency department with a 4-day history of prostration, headache, cervical pain, and fever. She had a history of acute otitis media 8 weeks before. She presented a hyperaemic and bulged left tympanic membrane as well as limitation of left eye abduction. Blood tests showed increased inflammatory markers. She performed a cerebral, cervical and ear region computed tomography showing the left mastoid region, left ear, and left petrous apex filled with secretions in relation with mastoiditis and petrositis. A lumbar punction was performed and treatment with ceftriaxone 100mg/kg/day was initiated. After exclusion on meningitis, the antibiotic was changed cefuroxime 150mg/Kg/day. She was submitted to a left myringotomy with tympanostomy tube placement and, after, she presented a rapid improvement of cervical pain and headache with no more documented fever. During hospitalization, she performed a magnetic resonance imaging that show signs of mastoiditis and petrositis. There was no evidence of cerebral extension of inflammatory process and all the venous sinus presented preserved flow. At discharge, she was clinically asymptomatic with normalization of inflammatory parameters. At physical examination she still presented limitation of left eye abduction. She completed a total of 6 weeks of antibiotic treatment. Due to persistent VI cranial nerve palsy one month after discharge, an injection of botulinum toxin was performed, with complete resolution.

Evaluation of Ear in Otologically Asymptomatic Patients of Chronic Rhinosinusitis.

Background: The aim of the study was to evaluate the ear in otologically asymptomatic patients of chronic rhinosinusitis and summarize the otological and audiological findings. Methods: This is a cross sectional study conducted in the Department of Otorhinolaryngology - Head & Neck Surgery, Jaipur Golden Hospital, New Delhi, from January 2019 to October 2019. 80 cases aged between 15 and 55 years with Chronic rhinosinusitis were included in the study. Detailed clinical examination and history was carried out followed by Diagnostic nasal endoscopy and Otoendoscopy. All the data collected was statistically analyzed. Results: In patients of Chronic rhinosinusitis, Nasal obstruction was the most common complaint. Out of 80 patients 47 had abnormal Tympanic Membrane finding in one or the other ear, among them Tympanosclerotic patch was the most common finding. Co-relation between Diagnostic nasal endoscopy in right and left ipsilateral nasal cavity and tympanic membrane showed statistically significant association between nasal polyp and presence of abnormal tympanic membrane. Statistically significant association between duration of chronic rhinosinusitis and presence of abnormal tympanic membrane finding on otoendoscopy was found. Conclusion: chronic rhinosinusitis affects the ears slowly and silently. Hence, the ears should always be proactively evaluated in every patient of chronic rhinosinusitis to diagnose inevident disease in ears and if necessary, initiate timely preventive and therapeutic intervention.

Otogenic intracranial abscessation secondary to an inflammatory polyp with chronic otitis media/interna in a cat

AbstractA 2‐year‐old spayed female domestic short haired cat presented for evaluation of chronic lethargy, inappetence and otitis media/interna that developed secondary to an inflammatory polyp, which had been removed via traction a month prior to presentation. Upon presentation, the cat displayed mild vestibular ataxia and left head tilt, in addition to a bulging left tympanic membrane. Therapy with broad‐spectrum antibiotic therapy and anti‐inflammatory corticosteroids was initiated, however the cat soon developed signs of central vestibular disease and obtunded mentation. Magnetic resonance imaging revealed left‐sided otitis media/interna and cerebellar abscessation. Surgical debridement of the abscess was indicated but declined by the owner in favour of euthanasia.

Management of the association of otosclerosis and cholesteatoma: Which pathology to treat first?

Hearing loss can result from a wide range of pathologies affecting patients of all ages. It may be due to abnormalities of the outer, middle or inner ear.In this article, we present a case of a 50 years old female patient presenting to the ENT and Head & Neck surgery department of 20 August hospital, complaining of bilateral hearing loss, in whom clinical examination found right attical retraction pocket with scales and left normal tympanic membrane. Complementary investigations revealed the association of two distinct conditions, rarely described in literature: otosclerosis, and chronic otitis media with cholesteatoma in right ear and left otosclerosis.The challenge in this case was to determine the therapeutic strategy: start with left otosclerosis? the right cholesteatoma? simultaneously treat otosclerosis and cholesteatoma right?

Luc’s Abscess: The Zygomatic Route of Infection from Cholesteatoma

Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions. CASE REPORT A 23-year-old man had a three-month history of yellowish, mucoid, foul-smelling left ear discharge associated with multiple episodes of non-projectile watery vomiting (< 1 cup each) and left-sided facial paresis. These symptoms were accompanied by ipsilateral hearing loss, tinnitus and dizziness prompting consult and admission to a secondary hospital. A cranial Computed Tomographic (CT) scan showed a cholesteatoma in the left ear. The facial asymmetry improved, vomiting was resolved with intravenous antibiotics, hydration, and an anti-emetic, and he was subsequently discharged. He continued to have recurrent, foul-smelling left ear discharge and left hemifacial paresis persisted. Left-sided otorrhagia and ipsilateral hemifacial paresis were subsequently associated with left hemifacial swelling, otalgia (VAS of 7/10, described as sharp), and decreased hearing, prompting an outpatient consult with a private ENT specialist. The symptoms persisted despite 7 days of oral ciprofloxacin, this time associated with drowsiness, neck pain and febrile episodes. The patient consulted in our institution and was advised emergency admission. He was admitted drowsy, coherent with GCS 15 (E4V5M6). The left temporal area was edematous and tender, extending to the ipsilateral post-auricular area inferiorly and frontal area superiorly. (Figure 1) Otoscopy revealed yellowish, foul-smelling, copious muco-purulent discharge and near-total perforated left tympanic membrane. The right ear had unremarkable otoscopic findings. Tuning fork tests at 512 Hz were consistent with sensorineural hearing loss in the left ear with House-Brackmann IV facial nerve paresis. Brudzinski and Kernig tests were negative with no signs of dysmetria, dysdiadochokinesia or dysarthria on cerebellar testing. Gram stain and KOH smears of the left ear discharge revealed C fruendii and fungal elements. High resolution temporal bone CT scan showed otomastoid disease on the left with automastoidectomy defect, associated subperiosteal and intracerebral abscess formation on the left, with otherwise unremarkable right temporal bone. (Figure 2)

Two Cases of Toxic Shock Syndrome Developing After Ear Surgery

Two rare cases of toxic shock syndrome (TSS) that developed after ear surgery are reported in this paper. The first patient was a 44-year-old man who presented with the complaint of left ear fullness and diagnosed as having a cholesterol granuloma. Since placement of a subannular tube in his left ear drum proved ineffective, canal-down tympanoplasty was performed. Ten days after the surgery, the patient developed high fever. On the 12th postoperative day, he developed diffuse erythroderma and hypotension with a systolic blood pressure of less than 90 mmHg, liver failure, and thrombocytopenia. On the 14th postoperative day, he developed shock and respiratory failure caused by acute respiratory distress syndrome (ARDS), and was initiated on mechanical ventilation. On the 15th postoperative day, culture of the ear discharge grew methicillin-resistant Staphylococcus aureus (MRSA). Subsequently, the patient developed disseminated intravascular coagulation and renal failure, and was initiated on hemodialysis. He received adequate hydration, appropriate antibiotic therapy, and γ-globulin administration. On the 24th postoperative day, improvement of both the respiratory failure and renal insufficiency was noted.

Symptoms: Middle Ear Mass and Hearing Loss

Symptoms: Middle Ear Mass and Hearing Loss

A clinical study of traumatic tympanic membrane perforation

<p><strong>Background:</strong> Tympanic membrane (TM) which forms the partition between external auditory canal and middle ear may be ruptured by trauma. Traumatic TM perforation is a commonly observed condition. Though, several therapeutic interventions have been described, conservative follow-up until spontaneous complete recovery is the most common choice.</p><p><strong>Methods:</strong> It was a prospective cohort study conducted during a period of 10 months from July 2020 to April 2021, carried out in 30 patients who presented to outpatient department of ENT and casualty of Hassan institute of medical sciences hospital with traumatic TM perforation. After taking informed consent, detailed history was taken, thorough examination of ear was performed and characteristics of perforation were noted. Pure tone audiometry (PTA) was conducted, data was statistically analysed.</p><p><strong>Results:</strong> Mean age group was 33.1 years and 73.3% were males. Ear pain was the commonest symptom with accidental trauma being the most common cause. 70% of them had left TM perforation and posteroinferior quadrant was mostly involved.</p><p><strong>Conclusions:</strong> Traumatic TM perforation is commonly seen in young adults following accidental trauma and assault. Earache, sudden hearing loss and tinnitus are the common symptoms. Most of the cases heal spontaneously with conservative management.</p>

Refusal to Use an Upper Extremity in a 17-month-old with Facial Nerve Palsy.

1. Michelle March, MD* 2. Michael Stratton, MD*,† 3. Patricia Chambers, MD*,† 4. Adam A. Vukovic, MD, MEd*,† 1. *Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 2. †Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH A 17-month-old girl presents to the pediatric emergency department for evaluation of right-sided facial palsy and decreased movement of her right arm. One week before presentation she was evaluated for acute onset of left eye redness, left-sided facial swelling, and a low-grade fever for 1 day. Her left tympanic membrane was described as dusky and slightly erythematous. Early acute otitis media was diagnosed, and amoxicillin therapy was started. Two days later her primary care physician evaluated her for persistent facial swelling despite antibiotic therapy. Her tympanic membranes appeared normal then and her neurologic examination was significant for facial nerve palsy with inability to close the right eye, incomplete raising of the right eyebrow, and drooping of the right side of the mouth. She was diagnosed as having Bell’s palsy. Amoxicillin was discontinued, and acyclovir (20 mg/kg 3 times daily) and prednisolone (1 mg/kg once daily) were started. The parents now report that the patient is crying inconsolably and no longer using her right arm. On presentation she is febrile (rectal temperature, 102.4°F [39.1°C]), and her neurologic examination is notable for complete right-sided facial nerve paralysis with asynchronous blink, minimal forehead muscle movement, flattened nasolabial fold, and right-sided partial paralysis of the mouth. Muscle bulk and tone are normal throughout, but she demonstrates decreased spontaneous movement of the right arm at the shoulder joint. With distractibility, there is no point tenderness to palpation of the right arm. She can withdraw with distal painful stimulation. She moves briefly against gravity at the elbow joint. She has normal finger movement and grip strength. No obvious signs of trauma to her right …

OtoPair: Combining Right and Left Eardrum Otoscopy Images to Improve the Accuracy of Automated Image Analysis

The accurate diagnosis of otitis media (OM) and other middle ear and eardrum abnormalities is difficult, even for experienced otologists. In our earlier studies, we developed computer-aided diagnosis systems to improve the diagnostic accuracy. In this study, we investigate a novel approach, called OtoPair, which uses paired eardrum images together rather than using a single eardrum image to classify them as ‘normal’ or ‘abnormal’. This also mimics the way that otologists evaluate ears, because they diagnose eardrum abnormalities by examining both ears. Our approach creates a new feature vector, which is formed with extracted features from a pair of high-resolution otoscope images or images that are captured by digital video-otoscopes. The feature vector has two parts. The first part consists of lookup table-based values created by using deep learning techniques reported in our previous OtoMatch content-based image retrieval system. The second part consists of handcrafted features that are created by recording registration errors between paired eardrums, color-based features, such as histogram of a* and b* component of the L*a*b* color space, and statistical measurements of these color channels. The extracted features are concatenated to form a single feature vector, which is then classified by a tree bagger classifier. A total of 150-pair (300-single) of eardrum images, which are either the same category (normal-normal and abnormal-abnormal) or different category (normal-abnormal and abnormal-normal) pairs, are used to perform several experiments. The proposed approach increases the accuracy from 78.7% (±0.1%) to 85.8% (±0.2%) on a three-fold cross-validation method. These are promising results with a limited number of eardrum pairs to demonstrate the feasibility of using a pair of eardrum images instead of single eardrum images to improve the diagnostic accuracy.

Inner ear salivary gland choristoma extending to the middle ear with congenital profound hearing loss and facial palsy: a case report

BackgroundSalivary gland choristoma (SGCh) is a rare benign tumor reported in several unusual sites, such as the gastrointestinal tract, the optic nerve, and the internal auditory canal, but never reported in the inner ear.Case presentationAn 8-year-old girl with a history of left profound congenital hearing loss presented to us with ipsilateral progressive severe facial nerve palsy (House-Brackmann Grade VI). The left tympanic membrane was swollen with a pulsatile tumor. Radiological investigations revealed a multilocular tumor in the inner ear extending into the middle ear and internal auditory canal (IAC). We performed a partial resection of the tumor by transmastoid approach to preserve the anatomical structure of the facial nerve. The tumor was pathologically diagnosed as SGCh. Two years after surgery, her facial function recovered to House-Brackmann Grade II and the residual tumor did not show regrowth on MRI.ConclusionsAlthough the natural course of this rare tumor is unknown, a partial resection is an acceptable treatment procedure when functional recovery of the facial nerve is anticipated.Graphical abstract

Hyperbaric oxygen therapy caused tympanic membrane and ventricular hemorrhage: a case report

A 40-year-old male undergoing rehabilitation with hyperbaric oxygen therapy (HBOT) three months after an acute right frontal lobe cerebral infarction. On the second day of HBOT, he felt a significant blockage and pain in his left ear during and after the treatment. The endoscopic assessment of the ear and nose revealed haemorrhage in the left ear tympanic membrane and hemorrhagic effusion in the tympanic chamber. The nasal septum was found to be left deviated resulting in significant narrowing of the left nasal cavity and significant poor ventilation. Laboratory tests showed normal blood count and normal blood coagulation count. The final diagnosis of haemorrhage and fluid accumulation in the tympanic chamber of the left ear was made. After the treatment of the middle ear ball blowing once a day for 10 days, the pure tone audiometry of the left ear reached the level of the right ear, and the blockage and pain in the left ear disappeared completely. The orthoscopy inspection indicated total absorption of hemorrhagic fluid in the tympanic chamber of the left ear. This is the first report that HBOT caused tympanic membrane haemorrhage and offers new insights into the prevention of comorbidities in HBOT.