Short Process Of Incus Research Articles

Clinical Profile of Squamosal Chronic Otitis Media among Paediatric and Adult Patients in Rural Population of Central India: A Cross-sectional Study

Introduction: Chronic Otitis Media (COM) is one of the major preventable causes of hearing impairment, especially in children. Hearing loss in children affects speech, language, communication, auditory processing, psychosocial and cognitive development, and academic progress. Since studies addressing and comparing COM in the paediatric and adult population are few and far between, present study attempted to fill this research hiatus. Aim: To analyse and compare the clinical profile of squamosal COM in paediatric and adult populations. Materials and Methods: The present cross-sectional study was carried out in the Department of Otorhinolaryngology, Acharya Vinod Bhave Hospital, Sawangi, Wardha, Maharashtra, India, from December 2020 to December 2022. All the selected patients with squamosal COM (active or inactive) in the paediatric age group (0-15 years) and adult age group (16-60 years) was considered in this study. The study included 26 patients and was evaluated based on intraoperative and radiological findings such as grades of retraction pocket, extent of ossicular erosion, extent, and spread of granulation and cholesteatoma, and pneumatisation pattern among both age groups were carefully analysed. Chi-square test (χ2 ) of independence was used to compare data between the two groups. A p-value ≤0.05 was considered statistically significant. Results: Erosion of scutum was predominantly noted in 6 (42.9%) paediatric patients. In both age groups, attic perforation were more common than marginal perforation, which was found to be statistically significant (p-value=0.045). Grade-2 Posterosuperior Retraction Pocket (PSRP) in paediatric (2, 14.2%) and Grade-4 PSRP in adults (4, 33.3%) were commonest whereas none of the paediatric patients showed Grade-4 PSRP. This difference in PSRP grade in both age groups was found statistically significant (p-value=0.038). Short process of incus was more frequently involved in 3 (25.0%) paediatric and long process of incus in 6 (60%) adult (p-value=0.040). There was frequent involvement of protympanum in 7 (50%) paediatric patients (p-value=0.035). Diploic pattern of pneumatisation was least common in both age groups. Conclusion: Greater grades of PSRP were found among adult patients. This might be contributed to the longer duration of exposure to disease pathogenesis in adults. One of the vital features in the ossicular involvement is the total absence of incus and malleus more frequently in paediatric patients indicating its extensiveness

Speech performance and subjective satisfaction of middle ear implant in congenital aural atresia.

SUMMARYObjectivesTo evaluate the safety, speech performance in noise and subjective satisfaction of patients with congenital aural atresia (CAA) implanted with the active middle ear implant.MethodsThis retrospective study included 13 patients (15 ears) implanted with middle ear implants with different methods of floating mass transducer attachment. In 6 ears, the floating mass transducer (FMT) was coupled with the short process of incus; in 8 ears, a clip coupler was used; and in one ear, a round window coupler was used. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), Speech Reception Threshold (SRT) and Speech Discrimination Score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction.ResultsThe mean aided PTA4 using Vibrant Sound Bridge (VSB) was 26.44 4.03 dB HL compared to 61.88 ±1.53 dB HL unaided. The SDS improved significantly (p = 0.002) from 51% (± 9.17%) to 94.60% (± 4.43%). Furthermore, there was a significant improvement in SDS in noise (p = 0.008) and SSQ12 responses (p < 0.0001).ConclusionsPatients with hearing loss due to CAA can substantially benefit from VSB, with highly satisfactory subjective results and a negligible rate of complications.

Automatic Detection and Segmentation of Short Process of Incus in Different Microscopic Surgical Scenarios via Convolutional Neural Networks and Transfer Learning

Automatic Detection and Segmentation of Short Process of Incus in Different Microscopic Surgical Scenarios via Convolutional Neural Networks and Transfer Learning

Using Semantic Segmentation to Identify Short Process of Incus in Different Microscopic Surgical Scenarios Via Transfer Learning

Using Semantic Segmentation to Identify Short Process of Incus in Different Microscopic Surgical Scenarios Via Transfer Learning

Cholesteatoma Masquerading as Cerumen

Cerumen is composed of glandular secretions and desquamated epithelial cells. It protects and lubricates the external auditory canal. Impacted cerumen causes canal occlusion and pressure over the tympanic membrane, causing ear discomfort, conductive hearing loss, itching, etc. Up to 6% of the general population are affected with impacted cerumen, which includes 10% of children, more than 30% of the elderly and people with cognitive impairment. Persistent symptoms despite resolution of impaction and patient repeatedly should raise suspicion of alternative diagnosis and prompt for further evaluation. A 20-year-old female patient came with complaints of decreased hearing and ear discharge. On otoscopic examination of left ear, impacted cerumen was seen in the attic region. On removal of wax with the aid of oto-endoscopy, attic region was found to be filled with cholesteatoma debris. On pure tone audiometry, patient had mild conductive hearing loss of 30 db and computed tomography of left temporal bone revealed ill-defined soft tissue density in the middle ear (epitympanum) with erosion of head of malleus and short process of incus. Blunting of scutum was also seen. Attic reconstruction and type III tympanoplasty was performed. On histopathological examination, the section showed keratin flakes with bacterial colonies which were consistent with cholesteatoma. In conclusion, any case of impacted cerumen should not be ignored by otorhinolaryngologist. Further evaluation with thorough examination under otomicroscope/otoendoscope has to be done which can lead to different diagnosis and treatment plan.

Anatomical Variation-Notch in Long Process of Incus Due to Chorda Tympani Nerve in Two Cases

Introduction: The chorda tympani nerve takes origin from the mastoid portion of the facial nerve.Then it separates from the main trunk of facial nerve approximately 4 mm proximal to the stylomastoid foramen.Among the three ear ossicles present in middle ear, Incus is most stable ossicle showing least number morphological variation. Our aim is to describe a rare anatomical variation of incus i.e. a notch in the long process of incus which fits the chorda tympani nerve. This study will help otologic surgeons while performing operative procedures in a better way by understanding the anatomical details of middle ear and preventing chorda tympani nerve to iatrogenic trauma. Method: We performed 1500 tymapnoplasties and tympanomastoid surgeries and about 500 exploratory tympanotomies for last 10 years for various otological problems in our institution Dr BAM Central Railway Hospital. Any morphological variations were noted during surgeries. Case report: We found a rare anatomical variation of chorda tympani nerve in two cases where the nerve was found to be buried into the long process of Incus. Out of different middle ear surgeries we performed in last 10 years, Incus had minimum morphological variations in the ossicles. Although there are few studies which shows the presence of notch in the short process of incus but no study shows presence of notch in long process of incus so far. Conclusion: The knowledge of these anatomical variations of incus and course of chorda tympani will help in dealing with difficulties encountered during performing the surgical procedures and thereby it will help to preserve chorda tympani nerve.

HRCT Correlation with Round Window Identification during Cochlear Implantation in Children.

Objective:To determine the accuracy of High Resolution Computer Tomography (HRCT) temporal bone measurements in predicting the actual visualization of round window niche as viewed through posterior tympanotomy (i.e. facial recess).Materials and Methods:This is a prospective study of 37 cochlear implant candidates, aged between 1and 6 years, who were referred for HRCT temporal bone during the period December 2013 to July 2014. Cochlear implantation was done in 37 children (25 in the right ear and 12 in the left ear). The distance between the short process of incus and the round window niche and the distance between the oval window and the round window niche were measured preoperatively on sub-millimeter (0.7 mm) HRCT images. We classified the visibility of round window niche based on the surgical view (i.e. through posterior tympanotomy) during surgery into three types: 1) Type 1- fully visible, 2) Type 2- partially visible, and 3) Type 3- difficult to visualize. The preoperative HRCT measurements were used to predict the type of visualization of round window niche before surgery and correlated with the findings during surgery.Results:The mean and standard deviation for the distance between the short process of incus and the round window niche and for the distance between the oval window and the round window niche for Types 1, 2, and 3 were 8.5 ± 0.2 mm and 3.2 ± 0.2 mm, 8.0 ± 0.4 mm and 3.8 ± 0.2 mm, 7.5 ± 0.2 mm and 4.4 ± 0.2 mm respectively, and showed statistically significant difference (P < 0.01) between them. The preoperative HRCT measurements had a sensitivity and specificity of 92.3% and 96.2%, respectively, in determining the actual visualization of round window niche.Conclusion:This study shows preoperative HRCT temporal bone measurements are useful in predicting the actual visualization of round window niche as viewed through posterior tympanotomy.

Can fetal ossicles be used as prosthesis in adults? A morphometric study

Objectives:The tympanic cavity contains 3 small immovable bones, the malleus, incus and stapes. Extensive studies havebeen carried out on the morphometry of the ossicles. According to some scientists, in human beings the auditory ossiclesreach there definitive size and shape in fetal periods and postnatal modifications are minimal, while there are certain studies which their contradict this claim. These contradictory claims prompted us to make an endeavor to find out the growthpattern of the ear ossicles and comparing the data with adults. Methods: Twenty-two fetal cadavers of either sex, ranging in gestational ages between 24-40 weeks, were collected fromlocal hospitals and 15 adult formalin-fixed cadavers in age groups of 20-30 years were taken. For the study, the fetuses werekept in 2 Groups of 24-28 weeks and 36-40 weeks. From the data obtained, the mean, standard deviation and percentagegain from one group to another in different dimensions of various parts of each ossicle was calculated. Results: The age periods between 40 weeks (full term fetuses) and adults, revealed spurt in the growth of diameter of headof malleus (3%), width of short process of incus (2.7%), width of footplate (5.2%) and height of stapes (13%). Thesechanges were insignificant in terms of acoustic transmission. Conclusion:It is concluded that by the end of gestation, the ear ossicles develop morphometric features comparable to adultswith no appreciable changes in the post natal period. Hence, they can be used as prosthesis in adults suffering from ossicularchain malformations and can be an easy and cheap method for treatment of this type of patients

Study of demonstrating main operative section of facial recess approach using double oblique multiplanar reconstruction on multislice CT

Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.Methods Similarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation. Key words: Temporal bone; Tomography, X-ray computed; Anatomy, regional; Otologic surgical procedures

Computed Tomography in Chronic Suppurative Otitis Media: Value in Surgical Planning

The present study was conducted prospectively to evaluate how accurately high resolution computed tomography scanning could define the extent and severity of the underlying disease in patients with chronic suppurative ear disease, thus, helping convert a surgical exploration into a planned procedure. Sixty adult consecutive cases of chronic suppurative otitis media underwent a detailed high resolution computed tomography by a single radiologist. The recorded radiological findings in various heads were then compared to the surgical findings during mastoid exploration of these patients by a single otologist and the two statistically compared. The presence and distribution of soft tissue in the middle ear cleft and mastoid could confidently be predicted using this modality. The malleus, body and short process of incus were well visualized, but not the long process of incus and the stapes suprastructure. Lateral semicircular canal fistulae could be demonstrated with an acceptable degree of accuracy. It was possible to detect facial nerve dehiscence and defects in tegmen tympani in significant number of cases although, statistical values were low for these structures. High resolution scanning is a modality which can accurately image the pathological anatomy in unsafe chronic suppurative otitis media. Otologists should use it more often, especially in complicated cases as an adjunct to better preoperative assessment, and thus, the surgical outcome. Its accuracy is likely to improve with larger studies and better experience, wherein its routine use may become justifiable.

Osteoma of the incus with congenital cholesteatoma: A case report

Osteomas of the middle ear are rare benign tumors. They commonly arise from the promontory. To date, a total of three cases of osteomas of the ossicles, inseparable from malleus and incus, have been described in the English literature. Among them, only one case osteoma with congenital cholesteatoma has been reported. Recently a 6-year-old boy with osteoma associated with congenital cholesteatoma presented to our service. The osteoma and congenital cholesteatoma were removed successfully by canal wall up mastoidectomy with staging operation. A rock-hard mass was separated from the footplate. The malleus and short process of incus were intact. Histopathological examination confirmed the presence of the osteoma.

Congenital anomalies of the ossicles without deformities of the external ear

Anomaly of the ossicles is frequently seen in a patient with congenital anomalies of the head or face, such as congenital obstruction of the external ear canal, Treacher Collins syndrome or cephalopathy. Congenital anomaly of the ossicles however is not a rare occurrence even in a patient without anomalies of the head or face.Here, we would present our own experience with six cases of congenital anomalies of the ossicles and with one case of congenital deformity of the round window. The patients with anomalies of the ossicles had non-progressive hearing impairment of purely conductive type, except for one case which had been accompanied by otosclerotic changes and had a bone conduction loss.Case 1. 24-year-old male.An exploratory operation of the left ear had revealed that there were a bony fusion of the short process of incus with the horizontal semicircular canal and a dislocation of the long process of incus, resulting in separation of the incudostapedial joint. The bony bridge was removed and the separated joint was reconstructed by means of a polyethylene tube strut. The acoustic gain was 42db.Case 2. 41-year-old male.Congenital anomaly of the left middle ear was found to be a bony fusion of the short process of incus with the horizontal semicircular canal. The bony bridge was removed, resulting in a hearing improvement. But his hearing became wor se after several months, probably due to recurrence of ankylosis.Case 3. 21-year-old male (left ear)Case 4. 24-year-old male (left ear)Both cases had congenital separation of the incudostapedial joints, due to maldevelopment of the long process of incus. These separated joints were reconstructed by means of a polyethylene tube strut. Hearing improvement were considerable in both cases.Case 5. 31-year-old male.Congenital absence of the head and crus of the stapes was found in his left ear. The foot-plate was movable. A polyethylene tube collumela was introduced between the long process of incus and the foot-plate. Hearing gain was about 30db.Case 6. 38-year-old female.The patient had otosclerosis in both ears. Congeaital separation of the incudostapedial joint was seen in the left ear. Following a stapes mobilization operation, the ossicular chain was reconstructed by means of a polyethylene tube strut. Hearing gain was considerable.Case 7. 25-year-old female (right ear).The round window niche was remarkably narrow.