Middle Ear Involvement Research Articles

Evaluation of Zepp’s Procedure in Management of Chronic Otitis Externa in Dogs

The study was conducted on 10 dogs presented at VCC, VSR, CVAS Bikaner with the owner complaint of consistent shaking of head and scratching of ear, rubbing of ear to hard object, purulent foul smelling discharge from ear and also had history of long medicinal treatment using NSAIDS, steroids and antibiotics. Clinical otoscopic examination of the ears revealed purulent odoriferous discharge, with stenosis and calcification of lateral ear canal in some cases. For definitive diagnosis ear exudate was collected in sterile swabs inserted in lateral ear canal using otoscope, and it was evaluated for parasites, bacteria, fungi, yeast. Skull radiography was performed to evaluate calcification in the ear canal and involvement of middle ear. After thorough examination it was concluded that the animals were suffered from chronic otitis externa and decided to perform zepps procedure (lateral ear canal resection) to increase drainage, facilitate ventilation of ear canal and easy placement of topical agents into horizontal ear canal. Zepp’s procedure was performed under general anaesthesia; post-operative care was done using regular application of topical steroids, nonsteroidal anti-inflammatory drugs and antibiotics along with systemic antibiotics. After one month of post-operative care four ear showed excellent healing and dryness of the ear, Infection subsided in three ears and no improvement was seen in three ears. Microbiology suggested mixed bacterial infection in 6 dogs. Zepp’s procedure is a conservative surgical operation found to be a choice of surgical management in cases of early stages of otitis externa which has not been progressed to otitis media.

Comparison of Preoperative Computerized Tomograghic Scan of Temporal Bone Findings with Intra Operative Findings in Patients with Chronic Otitis Media Undergoing Tympanomastoidectomy: A Descriptive Study

Background: Since ancient times, chronic suppurative otitis media (CSOM) has been a significant contributor to middle ear illness. Antibiotics have been extremely helpful, but (CSOM) is still a frequent condition, and its consequences present a challenge to both otologists and radiologists. Due to the intricate anatomical nature of the middle ear and inner ear, radiological assessment of the temporal bone is challenging.
 Aim of the Study: To compare between preoperative CT scan findings of the temporal bone with the operative findings in patients with CSOM undergoing tympanomastoidectomy.
 Methodology: A Descriptive cross-sectional prospective has been adopted and 35 patients with Chronic Suppurative Otitis Media were admitted at the Department of Otolaryngology/ Alsulaymaniyah Teaching Hospital of Otolaryngology, Head and Neck Surgery, and Zhian Hospital during the period from February to December 2015. A detailed history and careful physical examination, clinical tests revealed that all of the patients had Chronic Suppurative Otitis Media, typically with discharge from the ear and hearing loss. Each patient had their clinical history collected, and they all underwent a thorough ear, nose, and throat examination as well as an attentive otoscopic and microscopic ear examination. Additionally, all patients underwent an audiological evaluation that included pure tone audiometry, tympanometry, and HRCT.
 Results: Thirty -five patients were included in this study. The mean age of the patients was 33 years; 51.4% were males and 48.6% were females. The most common presenting symptom was aural discharge in 71.4%; the second one was hearing loss in 28.6%. Mastoid pneumatization was found in 82.9% by CT while by surgery, it was found in 17.1%. CT findings showed that middle ear involvement in 11.4%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 54.3%, and EAC, mastoid, and middle ear involvement in 17.1%. While the surgical findings showed middle ear disease in 20%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 57.1%, and EAC, mastoid and middle ear involvement in 11.4%. The CT findings for eroded Malleus, Incus integrity, and stapes in 31.4%, 37.1%, not visualized while surgical findings showed eroded Malleus, Incus, and stapes integrity that 28.6%, 54.3%, and 28.6% respectively. The CT findings for an eroded facial canal, the lateral semicircular canal, the posterior external auditory canal wall, and sigmoid sinus plate integrity were 12.4%, 8.6%, 22.9%, and 11.4% in that order, while the surgical findings of the eroded facial canal, the lateral semicircular canal, and the posterior external auditory canal wall were found in 20.0%, 5.7%, 17.1%, and 14.2% respectively. Both CT and surgical findings of Integrity of the tegmen showed that 32 patients (91.4%) were found to have intact tegmen, and 3 patients (8.6%) had eroded tegmen and both showed that the eroded scutum found in 25.7%.
 Conclusions: The current study concluded a positive correlation between CT and surgical findings that has many advantages in preoperative planning for the eradication of the disease, choosing the best approach & has a very important role in the orientation of the surgeon during the surgery to avoid any possible complications.

Evaluation of the Effect of Nasal Septal Deviation on the Middle Ear with Wideband Acoustic Immitancemetry

Objectives: This study aimed to objectively reveal the effects of nasal septal deviation (NSD) and its subgroups on normal middle ear physiology by wideband acoustic immitancemetry (WAI), (it is also known as Wideband Tympanometry). Methods: Eighty-five participants with normal hearing were included in the study. Types of NSD finalized with the paranasal CT. The group without NSD was taken as the control group. Wideband absorbance and resonance frequency values were measured at ambient pressure and in the frequency range of 0.25–8.0 kHz. Results: Normal WAI results were obtained in 20 (31%) participants in the NSD group, compared to 13 (72%) in the Control group. The peak pressure values, resonance frequencies, and absorbance at ambient pressure were significantly different between the NSD and the control groups. Conclusion: WAI may be used as an objective method to evaluate middle ear involvement in patients with NSD problems.

Evaluation of middle ear and hearing status of ankylosing spondylitis patients with wideband tympanometry and pure tone audiometry tests.

The aim of this study was to evaluate the middle and inner ear function and hearing status of Ankylosing spondylitis (AS) patients. One hundred twenty-four ears of 62 patients with AS and 90 ears (control group) of 45 healthy subjects were included in the study. The hearing levels of the participants were assessed with pure tone and high-frequency audiometry at the octave frequency between 250 and 16,000Hz. The absorbance rates and resonance frequencies of middle ear were measured with the wideband tympanometry (WBT) test. AS group was divided into subgroups based on the disease activity, duration of follow-up, medications used for AS, and the subgroups were compared according to hearing status and absorbance and resonance frequencies of middle ears. A statistically significant difference was found between the AS and control groups in terms of air and bone conduction thresholds at frequencies of 250, 500, 1000, 2000, and 4000Hz and the mean PTA1, PTA2, and PTA3 values (p < 0.05). In contrast, no statistically significant difference was observed between two groups in terms of high-frequency thresholds (8000-16,000Hz). Although the middle ear resonance frequency obtained from the WBT test was higher in the AS group compared to the control group, no significant difference was observed (p > 0.05). The severity of disease adversely affected the hearing threshold at 250, and 500Hz for air conduction, at 500Hz for bone conduction threshold, and at PTA1 (p < 0.05). The duration and severity of disease did not affect absorbance values of WBT (p > 0.05). To our knowledge, this is the first study to demonstrate the effects of AS patients on the middle ear function with WBT and to report middle ear absorbance values and resonance frequency changes in AS patients. The higher resonance frequency values found by WBT in AS patients may be due to the stiffness that develops as a result of middle ear involvement. According to pure tone and high-frequency audiometry findings, it has been seen that AS leads to SNHL especially at low frequencies.

Clinical and biochemical footprints of inherited metabolic diseases. IX. Metabolic ear disease.

Damages to the ear are very diverse and can depend on the type of inherited metabolic diseases (IMD). Indeed, IMDs can affect all parts of the auditory system, from the outer ear to the central auditory process. We have identified 219 IMDs associated with various types of ear involvement which we classified into five groups according to the lesion site of the auditory system: congenital external ear abnormalities, acquired external ear abnormalities, middle ear involvement, inner ear or retrocochlear involvement, and unspecified hearing loss. This represents the ninth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.

Correlation of hearing outcome in otic capsule sparing temporal bone fractures using temporal bone sub-site classification: a cross-sectional descriptive study

BackgroundHead injury most commonly occur following road traffic accidents. Often hearing loss and other otological injuries are missed in view of serious head injury or other visible bodily injuries, leading to delayed recognition of problems. There is a need for early clinical and radiological indicators which can predict adverse outcome. Early diagnosis of otological injury during initial evaluation of the head injury has given some clues regarding the severity of hearing outcomes and such correlation has been attempted in this study. Two-year cross-sectional study involving head injury patients with radiological evidence of temporal bone fracture were assessed for hearing impairment.ResultsThirty-seven patients who satisfied the inclusion criteria were assessed. Fifty-one percent patients had conductive hearing loss. 35.14% of the patients had involvement of mastoid, external auditory canal, and middle ear involvement. A weakly positive correlation was noted between otic capsule sparing fracture and hearing loss. (R value + 0.2064).ConclusionWeak correlation was observed between temporal bone sub-site classification and severity of hearing loss in otic capsule sparing temporal bone fractures.

Staged Surgery for Intra-Extracranial Communicating Jugular Foramen Paraganglioma: A Case Report and Systematic Review

Staged surgery strategy was preferred for patients with intra-extracranial communicating jugular foramen paraganglioma (IECJFP). A female patient who presented mild tinnitus, headache, and dizziness, together with preoperative related imaging, was diagnosed with a left intra-extracranial communicating jugular foramen lesion in November 2015 and accepted an initial operation for the intracranial tumor by retrosigmoid approach. The pathologic report was paraganglioma. In November 2021, a subtotal resection of the extracranial tumor was conducted for prominent lower cranial nerves (LCNs) deficit and middle ear involvement by infratemporal approach. In patients with IECJFP accompanied by LCNs deficit and middle ear involvement, an initial surgery for extracranial lesion and a second procedure for intracranial tumor were appropriate. However, the first operation for the intracranial lesion was preferred in IECJFP cases without LCNs deficit and middle ear involvement, as it could remove compression to the neurovascular structure and brain stem, clarify a pathological diagnosis, avoid a CSF leak, and prevent a severe neurological disorder from extracranial lesion excision. Subtotal resection of the extracranial tumor would be performed when lesion became larger combined with obvious LCNs disorder and tympanic cavity involvement. Consideration of specific staged surgical strategy for IECJFP in accordance with preoperative LCNs deficit and tympanic cavity involvement could prevent critical postoperative neurological deficit and improve quality of life in the long term.

Hearing Loss, Congenital HIV, and Medulloblastoma: A Case Report

Hearing Loss, Congenital HIV, and Medulloblastoma: A Case Report

A Systematic Review of Auditory Loss and Its Management

Auditory loss is a highly under recognised undermined issue which needs to be studied in extensive detail, as according to World Health Organisation, more than 45% of the global population has loss of auditory. The high percentage can be lowered if auditory enhancement techniques such as auditory aids or implants of cochlea were not underused. In order to increase the usage of these devices we must first understand the inner workings of the ear and the pathologies that may cause it to malfunction and then move on to proper management. Auditory loss as defined by WHO as the inability to hear as well as someone with normal auditory, these are persons having auditory thresholds of 20 dB or better than 20 dB in both ears. Auditory loss is often classified into two types, conductive auditory loss and sensorineural auditory loss which is a broad classification into which we can separate the various pathologies which bring about same outcomes. In conductive auditory loss, there is often involvement of external or middle ear where there is obstruction in relay of sound waves, hence, quite literally a problem with the conduction. Conductive auditory loss can be both congenital or acquired but most often can be resolved in a manner which will result in recovery of auditory. Sensorineural auditory loss occurs when there is dysfunction in the inner ear which often leads to progressive and permanent auditory loss. Though it can be congenital, it is most often acquired, especially when it is age related more commonly known as presbycusis which affects a large amount of the aging population. The management can be done through various processes including oral medications, surgical interventions and other manual procedures. Various assistive technologies like auditory aids and cochlear implants are also vital in preservation of auditory.

Evidence of air-conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications.

Objectives(1) To establish evidence of the transmission pathway of venous pulsatile tinnitus (PT) associated with sigmoid sinus wall anomalies (SSWAs) and (2) quantify the efficacy of transtemporal surgery.MethodsThis retrospective study included 33 surgical cases of PT associated with SSWAs and 15 controls with venous PT without SSWAs. Quantitative water occlusion test (q‐WOT) and imaging data were acquired for preoperative evaluation prior to strategized transtemporal osteovascular reconstruction surgery. A condenser microphone and hydrophone were intraoperatively deployed to assess and monitor in vivo amplitude variations of the PT in eight participants.ResultsA total of 23 (69.6%) participants with SSWA responded to the q‐WOT with a median solution volume of 1.3 (1.1/1.6), which significantly differed from that observed in controls (p < 0.01). The change in the operative peak amplitude of the acoustic data was statistically significant (p < 0.01), from a median of 57.6 (55.5/57.9) dB SPL to 34.3 (33.4/38.8) dB SPL.ConclusionIntraoperative application of acoustic sensors revealed that PT associated with SSWAs is predominantly transmitted via the air‐conduction pathway. If objective findings such as q‐WOT and sensing applications suggest that the transmission of venous PT is involved in middle ear air conduction, the reconstruction technique should be prioritized; if less involvement of middle ear air‐conduction is indicated, addressing flow pathologies may be imperative for resolving venous PT.Level of Evidence4

Black fungus due to covid-19: audiological assessment of middle ear functioning

Background and Aim: A rare fungal infection, mucormycosis, has become more common in patients recovering from COVID in its second wave in India. The proximity and easy access to the middle ear through the Eustachian tube from paranasal sinuses alarms the need for early detec­tion of middle ear involvement. Hence, the study was carried out to determine the influence of mucormycosis on Immittance and otoacoustic emissions. Methods: eleven rhino orbital mucormycosis patients aged 40-60 years participated in the study. Middle ear evaluation was carried out with the help of Immittance and otoacoustic emissi­ons. Results: It was found that 4/11 (36.36%) parti­cipants had abnormal Immittance and absent oto­acoustic emissions, indicating middle ear dys­function. 3/4 participants had middle ear dys­function in the ear ipsilateral to the side of the infection. Conclusion: The study results reveal a rare cha­nce of middle ear involvement in mucormycosis patients, which calls for the crucial role of the audiologist in the early detection of middle ear dysfunction. Keywords: Mucormycosis; immittance; otoacoustic emissions

Inner ear decompression sickness in Finland: a retrospective 20-year multicenter study

Introduction: Inner ear decompression sickness (IEDCS) is a condition from which only a minority of patients recover completely, the majority ending up with mild to moderate residual symptoms. IEDCS has been reported after deep technical dives using mixed breathing gases, and moderate recreational dives with compressed air as the breathing gas. Considering this and the high proportion of technical diving in Finland, a comparison between IEDCS cases resulting from technical and recreational dives is warranted. Methods: This is a retrospective examination of IEDCS patients treated at Hyperbaric Center Medioxygen or National Hyperbaric Centre of Turku University Hospital from 1999 to 2018. Patients were included if presenting with hearing loss, tinnitus, or vertigo and excluded if presenting only with symptoms of middle ear or cerebellar involvement. Patients were divided into technical and recreational divers, based on incident dive. Results: A total of 89 (15.6%) of all DCS patients presented with IEDCS, two-thirds treated during the latter decade. The most common predisposing factors were consecutive days of diving (47.2%), multiple dives per day (53.9%), and factors related to an increase in intrathoracic pressure (27.0%). The symptoms were cochlear in 19.1% and vestibular in 93.3% of cases, symptoms being more common and severe in technical divers. Complete recovery was achieved in 64.5% of technical and 71.4% of recreational divers. Conclusion: The incidence of IEDCS in Finland is increasing, most likely due to changing diving practices. A comprehensive examination should be carried out after an incident of IEDCS in all cases, irrespective of clinical recovery.

Symptoms: Middle Ear Mass and Hearing Loss

Symptoms: Middle Ear Mass and Hearing Loss

Malassezia otitis unresponsive to primary care: outcome in 59 dogs.

Otitis externa (OE) is a common disorder in dogs. Infection by the commensal yeast, Malassezia pachydermatis, may result in chronic disease that does not respond to standard primary care. Chronic infectious OE may be associated with otitis media (OM). To report medical management, clinical outcomes and frequency of middle ear involvement, in dogs with Malassezia otitis unresponsive to primary care. Fifty-nine dogs from one referral veterinary hospital from January 2007 to September 2018. Retrospective analysis of medical records of dogs referred with chronic otitis and treated for Malassezia otitis at a referral veterinary hospital. Chronic Malassezia OE was treated successfully in 91% of ears, in 87% of these cases with one ear flush intervention. Median time-to-resolution was 27days after ear flush intervention. Neither duration of otitis, presence of neutrophils in aural discharge nor administration of oral itraconazole affected clinical outcome. Malassezia OM occurred concurrently in 17% of ears. These findings assist clinicians and carers of affected dogs in decision-making, by documenting that most cases of canine Malassezia otitis that have not resolved with standard primary care, can be treated successfully with a well-staged and intense medical treatment plan. Malassezia OM should be suspected to occur concurrently in around a fifth of affected ears.

Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear.

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.

A Case of Temporal Bone Cholesterol Granuloma Extending to Posterior Cranial Fossa without Middle Ear Involvement

Cholesterol granulomas of the temporal bone can occur in the petrous apex, middle ear, and mastoid cavity. Although cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulomas in the middle ear and mastoids rarely invade the cranial cavity with bony erosion. We report a case of a large cholesterol granuloma involving the posterior cranial fossa with pneumatic mastoid and not affecting the middle ear. The patient had no otologic or neurologic symptoms, and the mass was found incidentally on a brain MRI included in a regular medical checkup. The mass was removed via a combined transmastoid and suboccipital approach without complications, and characteristic pathology findings demonstrated a cholesterol granuloma.

Management of Foreign Bodies in the Ear: A Retrospective Review of 123 Cases in Nigeria.

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.

A Hospital based study of High Resolution Computed Tomography and Conventional Radiography for Evaluation of Pathologies of Temporal Bone

Background: Many imaging modalities have been in use for the evaluation of temporal bone lesions. Plain X-rays are cost-effective however; they provide limited details and hence sometimes may result in an inaccurate diagnosis. With the advent of HRCT, the method of imaging of temporal bone has evolved with special algorithms and multiplanar formats. In the present study, we tried to evaluate the different pathologies of the temporal bone with X-ray and HRCT. Methods: The study was conducted in the Departments of Otorhinolaryngology and Radiology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of n=40 patients were identified and selected based on their symptoms and clinical findings suggestive of a lesion involving the temporal bone such as Otalgia, Otorrhoea, And Sensorineuronal deafness, pulsatile tinnitus, vertigo, and giddiness. These patients were subjected to high resolution computed tomography of the temporal bone on the 128 Slice CT Scanner (PHILIPS INGENUITY). The patients also underwent plain Radiography of temporal bone (CARESTREAM DRX-1 System). Results: Of the total n=40 patients studied the most common temporal bone disease was due to inflammation 85% and tumors were found in 15% of the patients. The common site of involvement of middle ear and mastoid air cells in chronic otitis media was epitympanum in n=30(90%) of cases, Mesotympanum in n=20(60%) of cases. In diseased ears, radiographs of the mastoids revealed pneumatised mastoid in 6(15%), diploic in 6(15%), and sclerosed mastoid in 28(70%) cases. HRCT temporal bone revealed pneumatised mastoid in 9(22.5%), diploic in 5(12.5%) and sclerosed mastoid in 26(65%) cases. Conclusion: The role of plain radiography is found to be limited to know the type of mastoid pneumatisation. It can also as Original Article detect bony erosion in few cases. Because of the ability to see temporal bone structures with great clarity, HRCT can be recommended not only in cases suspected with potential complications but also in all cases of temporal bone pathologies to know the extent of disease, inter-relationships of the tympanomastoid compartment with adjacent neurovascular structures, varied pneumatisation and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.

Comparative Study of Hearing Results in Various Types of Tympanoplasties.

This study mainly focus on hearing loss pattern in CSOM patients undergoing tympanoplasty surgery or tympanomastoidectomy pre-operatively and analysis of the outcome of the surgery in terms of improvement in hearing (air-bone gap) after 3months of the surgery. All patients of age 15-65years reporting to ENT OPD with ear discharge and decreased hearing were screened with detailed history, clinical examination and microscopic examination.110 cases of tympanic membrane perforation who were fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy. Our study shows that postoperative air-bone gap closure is maximum for cortical mastoidectomy type I tympanoplasty (14.03dB), followed with cortical mastoidectomy with type II (12.2dB), Type I tympanoplasty (11dB), cortical mastoidectomy with type III (7.72dB). Procedures combined with modified radical mastoidectomy showed a very poor mean improvement in our study. It is very difficult to predict the results preoperatively because outcome will depend on extent of involvement of middle ear cleft by the disease process which can only be assessed intraoperatively.

Role of CT in Documenting the Extent of Temporal Bone and Middle Ear Involvement among Patients with Chronic Otitis Media

Role of CT in Documenting the Extent of Temporal Bone and Middle Ear Involvement among Patients with Chronic Otitis Media