Position Of Tympanic Membrane Research Articles

Evaluation of squeal of otitis media with effusion in children

Objectives: The aim of study is to evaluate and assess squeal of otitis media with effusion in children.
 Methods: cross sectional retrospective study was admitted to children in age range 1 to 15 years old, all children who diagnosed as otitis media with effusion. patients who came to outpatient complaining of deafness, acute or chronic rhino sinusitis, snoring, sleep apnea, atopy and diagnosed as otitis media with effusion included in this study. full otolaryngological examination done for these patients including otoscopical examination, anterior rhinoscopy and nasal endoscopy. documented cases of OME by aural otoscopy included in this study Change of color and position of tympanic membrane, fluid level, retracted tympanic membrane considered as signs of otitis media with effusion. These patient submitted to tympanometry to confirm the diagnosis of effusion. Results: 252 kids have otitis media, mean age of them 9.2 ± 3.5 years old. (70.6%) of babies are males and (29.4%) are females. (42.9%) of babies are at age group 6-10 years. According to symptoms appear; (73%) of them have bilateral effusion. (43.7%) of babies have rhinitis. Just (9.9%) of them have atopy. (25%) of them have snoring. Just (7.5%) of babies have apnea. According to management types; (79.8%) have medical treatment and (20.2%) have surgical management. There is significant association between age groups and site of effusion. There is significant association between site of effusion and snoring, medical treatment, surgical procedure and recurrent of effusion. Conclusion: In current study males’ babies are more have OM with effusion. And most age group that have OM is 6-10 years old, most OM with effusion occur bilaterally and associated with rhinitis. There is association between site of effusion and snoring, medical treatment, surgical procedure and recurrent of effusion.

Long-term Outcomes of Balloon Dilation for Persistent Eustachian Tube Dysfunction.

To gather long-term follow-up data on the efficacy of balloon dilation for treating patients with persistent Eustachian tube dysfunction (ETD). Extended follow-up study of the treatment arm of a prospective, multicenter, randomized controlled trial. Tertiary care academic center and private practice. Patients diagnosed with medically refractory persistent ETD. Balloon dilation of the Eustachian tube. The endpoints were the mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score, revision dilation rate, changes in assessments of middle ear function, and patient satisfaction. A total of 47 participants enrolled in the extended follow-up study. Mean follow-up was 29.4 months (range, 18-42 mo). There was a statistically significant mean (SD) change from baseline in the overall ETDQ-7 score (-2.5 ± 1.2; p < 0.0001). A reduction of one or more in their overall ETDQ-7 score was observed by 93.6% (44/47) participants. The revision dilation rate was 2.1% (1/47). Among participants with abnormal baseline middle ear assessments, 76.0% had normalized tympanic membrane position (p < 0.0001), 62.5% had normalization of tympanogram type (p < 0.001), and 66.7% had positive Valsalva maneuvers (p < 0.0001). Participant satisfaction was 83.0% at long-term follow-up. Balloon dilation results in durable improvements in symptoms and middle ear assessments for patients with persistent Eustachian tube dysfunction at mean follow-up of longer than 2 years.

A Randomized Controlled Trial of Balloon Dilation as a Treatment for Persistent Eustachian Tube Dysfunction With 1-Year Follow-Up

Objective:Compare Eustachian tube balloon dilation versus continued medical therapy (control) for treating persistent Eustachian tube dysfunction (ETD).Study Design:Prospective, multicenter, randomized controlled trial.Setting:Tertiary care academic center and private practice.Patients:Diagnosed with medically refractory persistent ETD.Interventions:1:1 Randomization to balloon dilation or control. After 6 weeks, control participants had the option to undergo balloon dilation if symptoms persisted.Main Outcome Measures:Primary efficacy endpoint was the comparison between treatment arms in the mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Primary safety endpoint was complication rate.Results:Sixty participants were randomized (31 balloon dilation, 29 control). Mean (SD) change in overall ETDQ-7 score at 6 weeks was −2.9 (1.4) for balloon dilation compared with −0.6 (1.0) for control: balloon dilation was superior to control (p < 0.0001). No complications were reported in either study arm. Among participants with abnormal baseline assessments, improvements in tympanogram type (p < 0.006) and tympanic membrane position (p < 0.001) were significantly better for balloon dilation than control. Technical success was 100% (91 successful dilations/91 attempts) and most procedures (72%) were completed in the office under local anesthesia. Improvements in the ETDQ-7 scores were maintained through 12 months after balloon dilation.Conclusions:Balloon dilation is a safe and effective treatment for persistent ETD. Based on improved ETDQ-7 scores, balloon dilation is superior to continued medical management for persistent ETD. Symptom improvement is durable through a minimum of 12 months. Procedures are well tolerated in the office setting under local anesthesia.

Optimizing Ossicular Prosthesis Design and Placement.

Middle ear hearing reconstruction is unpredictable. Difficulties arise because of host factors, such as ventilation or scarring, surgical technique factors, such as prosthesis placement and stabilization, and design and mechanical factors influencing the properties of the prosthesis. Often there is a balancing act between choosing optimal stability, and maximizing the mechanical vibrations of the prosthesis. We review our and other investigators' work, in design and ideal placement of middle ear prostheses. Middle ear prostheses need to be rigid enough to deliver acoustic forces without bending. Prosthesis mass has a modest effect at higher frequencies. A key point is that rotational movements of the prosthesis have to be constrained. Prosthesis head size and cartilage interposition, within reason, have little effect on vibration transmission. Reconstruction to the malleus may have some small mechanical advantage; however this is not clearly proven. Similarly, there is no proven advantage in reconstructing to the stapes head instead of the footplate. The most important factor for good long term results is probably the stability of the prosthesis, both to acute inertial forces such as trauma, and to slower term changes such as tympanic membrane position and scarring contractures.

Radiologic Analysis of High Jugular Bulb by Computed Tomography

Many previous studies of high jugular bulb (HJB) have limitations, such as focusing simply on the incidence or having a relatively small number of subjects. The objective of this article was to investigate the overall incidence of HJB and bony dehiscence in HJB on a large scale using high-resolution temporal bone computed tomography. The other purpose was to measure the horizontal distance from the tympanic annulus and the height above the annulus. The next step was to classify HJBs according to relative levels compared with surrounding structures. Temporal bone computed tomographic images from January 2005 to April 2010 at Pusan National University Hospital, a tertiary care center, were reviewed retrospectively. Exclusion criteria were patients younger than 10 years, a previously operated ear, cholesteatoma with bony destruction, adhesive otitis media with unclear position of tympanic membrane, and congenital anomalies of the ear. We investigated the incidence of HJB, the bony dehiscence of the HJB, horizontal distance, vertical height of HJB, and classified HJB in relation to neighboring structures. We used the cochlear basal turn and the lateral semicircular canal as criteria for classification because they were readily seen in most cases: group A, above the inferior bony annulus of the tympanic membrane and below the cochlear basal turn; group B, above the cochlear basal turn and below the lateral semicircular canal; and group C, above the lateral semicircular canal. Total 2,299 cases (4,598 ears) were finally examined. The study group consisted of 1025 male and 1,274 female patients, aged 11 to 90 years (mean, 48.0 yr). Of the 2,299 patients, 298 (13.0%) had HJB. HJB was observed in 435 (9.5%) of 4598 ears. HJB was more prominent on the right (right:left = 1.88:1; p < 0.01). Of the 435 HJB cases, 121 (27.8%) had bony dehiscence. HJB with bony dehiscence also was more prominent on the right (right:left = 2.03:1; p < 0.01). The average horizontal distance between HJB and the inferior bony annulus of the tympanic membrane was 2.2 ± 1.8 mm. HJB in contact with the tympanic membrane was seen in 47 ears (47/435, 10.8%). The average vertical height between the HJB and the inferior bony annulus of the tympanic membrane was 59.1 ± 27.4 mm. In the classification, group B was most common (62.1%). A meaningful proportion of HJB ears had bony dehiscence contact with the tympanic membrane. In planning ear surgery and other interventions, physicians should keep in mind the possibility of HJB and its bony dehiscence, which can lead to inadvertent injuries.

Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection.

acute otitis media (AOM) often occurs as a complication of upper respiratory tract infection (URI). to describe otoscopic findings during URI, the full clinical spectrum of AOM, and outcome of cases managed with watchful waiting. : In a prospective study of 294 healthy children (6 months-3 years), characteristics of AOM complicating URI were studied. Otoscopic findings were categorized by tympanic membrane (TM) position, color, translucency, and mobility. Otoscopic score was assigned based on McCormick otoscopy scale (OS)-8 scale. during days 1 to 7 of URI, otoscopic findings at 1114 visits were consistent with AOM in 22%; myringitis (inflamed TM, no fluid) was diagnosed in 7%. In AOM episodes diagnosed within 28 days of URI onset, TM position was described as: nonbulging (19%), mild bulging (45%), bulging (29%), and TM perforation occurred in (6%). OS-8 scale showed mild TM inflammation (OS, 2-3) in 6%, moderate (OS, 4-5) in 59%, and severe (OS, 6-8) in 35%. In 54% of 126 bilateral AOM episodes, inflammation of both TMs was at different stages. Of 28 cases of nonsevere AOM managed with watchful waiting, 4 progressed and 3 later required an antibiotic. AOM is a spectrum of infection that may present at various stages, even in the same child with bilateral disease. During URI, otoscopic changes are observed from the first day of onset. Understanding the wide clinical spectrum of AOM is needed to help with future clinical trial design and development of a scoring system to establish treatment criteria that will minimize antibiotic use.

In vitro tympanic membrane position identification with a co-axial fiber-optic otoscope

Otitis media diagnosis can be assisted by measuring the shape of the tympanic membrane. We have developed an ear speculum for an otoscope, including spatially distributed source and detector optical fibers, to generate source-detector intensity matrices (SDIMs), representing the curvature of surfaces. The surfaces measured were a model ear with a latex membrane and harvested temporal bones including intact tympanic membranes. The position of the tympanic membrane was shifted from retracted to bulging by air pressure and that of the latex membrane by water displacement. The SDIM was normalized utilizing both external (a sheared flat plastic cylinder) and internal references (neutral position of the membrane). Data was fitted to a two-dimensional Gaussian surface representing the shape by its amplitude and offset. Retracted and bulging surfaces were discriminated for the model ear by the sign of the Gaussian amplitude for both internal and external reference normalization. Tympanic membranes were separated after a two-step normalization: first to an external reference, adjusted for the distance between speculum and the surfaces, and second by comparison with an average normally positioned SDIM from tympanic membranes. In conclusion, we have shown that the modified otoscope can discriminate between bulging and retracted tympanic membranes in a single measurement, given a two-step normalization.

Microscopic versus otoendoscopic examination of the tympanic membrane using digital imaging and objective assessment

Objectives. The microscope and oto-endoscope are the standard tools for clinical assessment of the tympanic membrane (TM). We aim to compare the adequacy of the tympanic membrane visualisation between methods. Method. Healthy adult volunteers with no previously known ear pathology were recruited following ethical committee approval. The senior author conducted the examinations. We used an operating microscope fixed to magnification ×4, and a 0 degree oto-endoscope connected to a Storz Tricam wired to a computer desktop with digital imaging capture software. Video clips were recorded until the clinician ensured complete clinical examination. Three different assessors conducted assessment using objective criteria and scoring system of the video clips separately. Results. 42 ears were examined in 21 subjects producing 84 video clips. Statistical analysis was conducted using SPSS 12. The inter-observer reliability measured using Cronbach's alpha co-efficient is 0.831, showing reliable agreement between the different 3 assessors. There was near complete agreement on the visualisation of the posterior ½ of the TM in all the clips. The whole TM and the anterior½ measured by Fisher's exact test showed significant difference 0.001 and 0.001 in favour of the oto-endoscope. There was no significant difference in assessment of TM position. Although the microscopes now have built in camera systems, we accept that the three dimensional view through binocular microscopy is projected as a flat two-dimensional view on the monitor and video clip. Conclusions. In the assessment of normal ears, the oto-endoscope provides a more complete visualisation of the eardrum than the microscope.

The character and consequences of disturbing sound sensations in retraction type middle ear disease

Objective: Transient sound disturbances are common but neglected symptoms in retraction type middle ear disease (R-MED). The aim of this study was to explore and describe their character, their individual consequences, and their role in the development of tympanic membrane retractions. Methods: Fifty-three subjects with manifest retractions and experiences of disturbing sound and ear sensations were interviewed. A qualitative method was used for analysis of the transcribed interviews. Results: Two different patterns emerged from the interviews. 1. Too weak sound was the least common and most tolerable disturbance. It occurred in 45% and was eliminated by Valsalva’s inflation. 2. Sudden and transient sensations of too loud and piercing sound, and intermittent autophony frequently caused intense and intolerable discomfort, which might in turn cause loss of control of speech and conversation. These types occurred in 74% and 60%, respectively, and were eliminated by evacuating the middle ear, for example by sniffing. Subjects who described too loud sound or intermittent autophony commonly preferred a retracted tympanic membrane position. This may explain why pressure equalization by swallowing, and inflation by Valsalva’s manoeuvre often elicited discomfort. Conclusions: Transient experiences of too loud sound or intermittent autophony may indicate a shift of sound preference towards the sound experienced at negative middle ear pressure, and an unreliable tubal function in the sense that it fails to stay closed to protect the ear from sounds and pressure variations in the nasopharynx. Such experiences of altered sound may trigger evacuation of the middle ear, which eliminates the sound disturbance. It is crucial to identify, interpret, and explain the disturbances correctly in the therapy and prevention of retractions, since habitual evacuation exposes the tympanic membrane to strong negative pressure loads and a subsequent risk of developing retraction.

The Comparison of Otoscopic Findings and Impedance Measurements

Otomicroscopic visual observations including the use of the pneumatic otoscope were compared with impedance measurements: middle ear pressure, compliance, and stapedius reflex threshold. The tympanic membrane position, appearance, and mobility were used for an attempt to suggest an actual middle ear pressure in otomicroscopy. This was achieved by prior exercises connecting the pneumatic otoscope to the impedance bridge and monitoring different pressures. Audiological findings were in good agreement with previous similar investigations in the same age groups. A retracted ear drum always correlated with a negative middle ear pressure. Contrarily, bulging ear drums did not deviate from normal findings. Tympanic membranes with decreased motion correlated with a negative middle ear pressure. Flaccid ear drums demonstrated a considerable increase in compliance. The suggested middle ear pressure in otomicroscopy showed high agreement with subsequent impedance measurements. There was a marked tendency to higher n...