Ossicular Chain Injury Research Articles

Evaluation of Outcomes Related to Hearing and Tinnitus After Ossicular Chain Reconstruction.

The aim of this study was to evaluate both audiological and tinnitus related results in patients with tinnitus undergoing ossicular chain reconstruction (OCR) for ossicular chain injury. Between January 2015 and January 2019, patients who underwent OCR due to ossicular chain pathology and developed tinnitus symptoms were included in the study group. Middle ear pathologies were standardized using the middle ear risk index (MERI) scoring system and the tinnitus handicap inventory (THI) was used to determine the severity of tinnitus. The surgical methods used for reconstruction were partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the patient's pathology. The study group consisted of 43 patients aged between 34 and 65 years. Mean MERI score of the patients was 6.42 ± 2.52. When assessed categorically, 18.6% of the study group was identified in the 'mild', 46.5% were in the 'moderate', and 34.5% were in the 'severe' MERI category. Patients in the TORP group and those who were undergoing second session OCR had higher MERI and preop THI scores. Post-operative tinnitus levels were higher in patients who had OCR in the second session and were in the severe risk group. The ABG and tinnitus scores of patients were found to improve with OCR. In patients who underwent TORP, both ABG and tinnitus scores decreased significantly. Whereas, in patients who underwent PORP, only ABG values decreased significantly. After OCR, both ABG value and tinnitus scores significantly decreased compared to pre-operative results. ABG recovery rate was 100% in the study group. It can be said that OCR positively changes both audiological parameters and tinnitus levels in ossicular chain pathologies.

Clinical application of HRCT three-dimensional reconstruction in traumatic ossicular chain interruption

Objective:To investigate the clinical value of HRCT three-dimensional reconstruction technique in traumatic auditory chain traumatic fracture. Method:The clinical data of 14 patients with traumatic ear ossicular chain interruption were analyzed retrospectively. To evaluate the injury site and degree of the auditory chain before surgery, all the 14 patients underwent,HRCT scanning and three-dimensional reconstruction. The reconstructed auditory chain was observed from multiple angles and compared with the surgical exploration results under microscope. Result:The coincidence rate between ossicular chain injury observed by temporal bone HRCT scan before operation and ossicular chain injury observed during surgery was only 28.57%, the coincidence rate between ossicular chain injury observed during surgery and ossicular chain injury observed by three-dimensional reconstruction is 85.71%.Therefore, three-dimensional reconstruction imaging technique could give the doctor more clearly and stereoscopic images for the destruction of ossicular chain. Conclusion:Preoperative three-dimensional reconstruction can display and diagnosis of auditory ossicular chain destruction more clearly. It can be used to accurately evaluate auditory ossicular chain pathological changes, to develop individualized surgical plans and assess the risk of surgery.

The relationship between post-traumatic ossicular injuries and conductive hearing loss: A 3D-CT study

PurposeAfter a trauma, the conductive ossicular chain may be disrupted by ossicular luxation or fracture. Recent developments in 3D-CT allow a better understanding of ossicular injuries. In this retrospective study, we compared patients with post-traumatic conductive hearing loss (CHL) with those referred without CHL to evaluate the relationship between ossicular injuries and CHL. We also assessed the added value of 3D reconstructions on 2D-CT scan to detect ossicular lesions in patients surgically managed. MethodsThe CT scans were performed using a 40-section spiral CT scanner in 49 patients with post-traumatic CHL (n=29) and without CHL (n=20). Three radiologists performed independent blind evaluations of 2D-CT and 3D reconstructions to detect ossicular chain injury. We used the t-test to explore differences regarding the number of subjects with ossicular injury in the two groups. We also estimated the diagnostic accuracy and the inter-rater agreement of the 3D-CT reconstructions associated to 2D-CT scan. ResultsWe identified ossicular abnormality in 14 patients out of 29 and in one patient out of 20 in the CHL and non-CHL groups respectively. There was a significant difference regarding the number of subjects with ossicular lesions between the two groups (P≤0.01). The diagnostic sensitivity of 3D-CT reconstructions associated with 2D-CT ranged from 66% to 100% and the inter-reader agreement ranged from 0.85 to 1, depending of the type of lesion. ConclusionThe relationship between ossicular lesion and the presence of CHL tightly correlated. 3D-CT reconstructions of the temporal bone are useful to assess patients in a post-traumatic context.

Feasibility of ossicular chain reconstruction with resin cement

IntroductionDisjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium. ObjectiveBecause of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation. MethodsTwo anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method. ResultsA total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed. ConclusionResin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.

Avulsion of malleoincudal complex with dislocation: A rare ossicular chain injury by using an indigenous claw-like ear hook with review of literature

Direct ear trauma through external auditory canal causing an avulsion injury of malleoincudal complex is a grievous injury that can happen during ear cleaning with indigenous ear hook. One such case of avulsion injury is presented here with its symptomatology, investigation, and management with the review of available literature because of its rarity. Various locally designed indigenous ear hooks are available in street side markets and even online for purchase and used by many without knowing its ill effects on health. Injury caused by these types of hooks may lead to a severe hearing disability, if not properly treated. This presentation is to highlight the fact that indigenous ear hooks; rampantly available online for purchase can cause a potentially major injury leading to hearing disability and thereafter poor quality of life. Reporting and highlighting of such incidents among the ENT community can help increase the public awareness; thereby, eliminating such disastrous consequences. Wikipedia, PubMed, and Google search engine has been used for our data collection and analysis.

Ossicular Injury Caused by A Knitting Needle

Ossicular chain injury is a complication of trauma caused to temporal bone, but rarely, it can also occur due to direct trauma caused to ossicular chain by a penetrating injury. Patients usually suffering from conductive hearing loss and vertigo, although a facial nerve injury is also a possibility. We are describing here a case of young male who presented with a penetrating trauma to the left ear, caused by a metallic knitting needle, that resulted in ossicular chain disruption. The patient suffered from severe vertigo and conductive hearing loss. He was advised complete bed rest and vertin for controlling vertigo, after which he recovered. Computed tomography is the investigation of choice for detecting and characterizing such injuries, for proper management of patients. Penetrating middle ear trauma differs from blunt trauma, as the mechanism of injury is distinct. The injury is usually isolated and an urgent repair may be needed. Hearing results after an immediate or a delayed ossiculoplasty are apparently satisfying, although late cases are assumed to be associated with adhesions or fibrosis.

Temporal bone fracture with ossicular dislocation caused by a blow to the opposite side of the head

We report an indirect temporal bone fracture with ossicular chain injury occurring only on the side opposite a facial bone fracture caused by a direct blow. A 45-year-old female was referred to our clinic complaining of right hearing loss. She had suffered a left facial bone fracture in a traffic accident 6 months earlier. Her right hearing impairment was conductive. Exploration of her right middle ear revealed a temporal bone fracture, with ossicular chain separation and a dislocated stapes with a perilymphatic fistula. These injuries were considered to be caused by an indirect force following a blow to the face on the opposite side. Well-developed mastoid cells are composed of sparse, light bone in contrast to the compact bone of the bony canal, ossicles, and otic capsule, and therefore their mechanical compliance may differ.

Ossicular Chain Dislocation with Normal Hearing

We report a unique case of an ossicular chain injury in a young man. Despite the fact that the patient's incus was dislocated into the external auditory canal while remaining attached to the stapes, his hearing was not affected and remained nearly normal. We discuss the patient's presenting features and our diagnostic and management strategy in this case.

The Value of Methylprednisolone in the Treatment of an Experimental Sensorineural Hearing Loss Following Drill-induced Ossicular Chain Injury: A Randomized, Blinded Study in Guinea-Pigs

In a previously established animal model a standardized drill-induced injury to the body of the incus was applied, and the effects on hearing were characterized by electrocochleography. In a placebo-controlled, randomized, blinded study methylprednisolone showed no protective effect in reducing or improving the auditory threshold shifts, which occurred within seconds after drilling and remained stable throughout the 5-week observation period. Therefore the otologic surgeon must pay close attention to avoiding any contact of a rotating burr with an ossicle in an intact ossicular chain.

Experimental Sensorineural Hearing Loss Following Drill-induced Ossicular Chain Injury

In a guinea pig model, a standardized drill-induced injury to the body of the incus was applied, and the effects on hearing were characterized by electrocochleography. Drilling resulted in a threshold shift within seconds, and after 15min it averaged 35.7 dB for clicks, 35 dB nHL for 4 kHz bursts, 36.7 dB nHL for 6 kHz bursts and 39 dB nHL for 8 kHz bursts. The deterioration of the threshold shift remained stable throughout the 5-week post-operative observation period. In five animals a disarticulation of the incudostapedial joint was performed prior to drilling, but this did not reduce the threshold shift. Caution is mandatory during drilling around an intact ossicular chain to avoid a permanent sensorineural hearing loss, and disarticulation of the incudostapedial joint prior to driling has no protective value.

Clinical views of cases with discontinuity of the ossicular chain

It is well known that reconstruction for discontinuity of the ossicular chain, without inflammatory disease, has a good prognosis. Eleven cases of congenital ossicular chain malformation without ossicular fixation and 6 cases of ossicular chain injury due to the head trauma or an earpick , were treated surgically. The method of reconstruction and the prognoses, according to short-term and long-term follow up, were studied in these 17 cases. The following results were obtained: 1) In almost all cases, the pure tone audiograms were flat or slightly rising types, and the mean air conductive hearing loss was about 60 dB. Only 2 cases showed the falling type with conductive hearing loss. Connective tissue was observed at the incudo-stapedial joint intraoperatively in these two cases. 2) Mean hearing improvement was in 31.8 dB in the low frequency region (125, 250, 500 Hz), 22.7 dB in the middle frequency region (500, 1000, 2000 Hz), and 12.9 dB in the high frequency region (2000, 4000, 8000 Hz), within 3 weeks after operation, in all 17 cases. 3) No clear changes in hearing level were seen postoperatively, for the four periods evaluated; 1-3 weeks, 1-3 months, 4-6 months and over 7 months in all cases. 4) The cases in whom the reconstruction was performed between the incus and stapes, especially the foot plate of the stapes, showed poor hearing recovery. 5) There was no relation between hearing recovery and the prostheses used in reconstructions. However, it was thought that pieces of the patient's own cartilage or bone should be used whenever possible.

Ossicular chain injury due to the head trauma

Nineteen cases of ossicular chain separation and ossicular dislocation due to head injury were presented. These cases were operated at an early stage after the trauma.The malleus was almost always involved in ossicular chain injury, while the incus was involved in 42% of our cases. The stapes was involved in 21%. The incudo-mallear joint is always separated while the incudo-stapedial joint is separated less than 50% of our cases.We thought that the incudo-mallear joint suffered some damage from the dynamic action due to the warp of temporal bone fracture and the shock given to the tympanic membrane transmitted to the malleus directly.The surface of incudo-mallear joint is wide, therefore, complete separation of this joint is thought to hardly occur. The malleus does not dislocate so widely because it is fixed with tympanicmembrane and the tensor tympanic muscle. We get the different results from the past reports. By doing early surgery, we could observe the change of the ossicular chains before natural recovery occured.