[Analysis of abnormality of the middle ear in infant and young children]

OBJECTIVE

To discuss the diagnosis of middle ear abnormality in infants and young children.

METHODS

To analyze retrospectively the data of audiology (including ABR, tympanometry) and CT scanning in 31 infants and young children who presented middle ear abnormality.

RESULTS

Wave I latencies of ABR were delayed in 38 of 62 ears and not delayed in 15 ears, but CT scanning showed high density in 6 ears of these 15 ears. Wave I could not be elicited in 9 ears. Tympanometries were tested in 16 cases and were abnormal in 17 ears. CT scanning was carried out in 15 cases who's ABR and tympanometries showed abnormal. High signal intensity was present in mastoids and middle ear cavities in both ears of 12 cases and unilateral ear of 3 cases. Wave I latency of ABR was delayed and High signal intensity was present in mastoids and middle ear cavities in CT scanning of 13 ears. Wave I latency of ABR was normal, but high signal intensity was present in mastoids and middle ear cavities in CT scanning of 4 ears, there was no any ear which Wave I latency was delayed but CT scanning was normal. And disaccord among ABR, Tympanometry and CT scanning were showed. A typical case was reported.

CONCLUSIONS

The most abnormality of the middle ear could be found used the tympanometry and I latency of ABR in infant and young children, but still there were some abnormality of the middle ear could not be showed. Some quandaries were existed and more sensitivity tests were needed in the diagnosis of abnormality in middle ears of infant and young children.

[Evaluation of the infants' hearing loss in hearing screening]

OBJECTIVE

To analyze the confusing factors and clinical and audiological characteristics of ABR and tympanometry in infants who failed the first and second hearing screening.

METHOD

Between August 2005 and November 2007, 94 infants (144 ears) with detailed birth record and hearing screening record were reviewed in the study. The age of this series ranged from 48 days to 6 months. They received hearing screening with otoacoustic emissions (OAE), and all failed in the first and second hearing screening. The birth history, high-risk factors of hearing-impaired during newborn period and pregnancy history of subjects were fully detailed. Subjects were classified according to the age: 1 to 3 months old infants were considered as group 1, while 4 to 6 months old infants were considered as group 2. Auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE) and acoustic immittance measurement were examined.

RESULT

(1) The 226 Hz tympanograms of 144 ears showed type A of a single-peaked tympanogram in 77 ears (53.4%), a double-peaked tympanogram in 23 ears (16.0%), type Ad of a single-peaked tympanogram in 20 ears (13.9%), type As of a single-peaked tympanogram in 16 ears (11.1%), a flat-shaping tympanogram (type B) in 6 ears (4.2%), and others shapes (including C and D type) in 2 ears (1.4%). (2) The results of ABR showed that there were 64 ears (44.4%) with normal hearing (according to the threshold of ABR), 58 ears (40.3%) with mild hearing loss, 12 ears (8.3%) with moderate hearing loss, 3 ears (2.1%) with severe hearing loss, 7 ears (4.9%) with profound hearing loss. And the proportion of mild hearing loss was increased in the group, while the proportion of moderate and severe hearing loss was decreased. (3) The proportion of type A tympanogram was 50% (32 ears) in normal hearing subjects, which implied that the 226 Hz probe tones to record tympanogram would lead to a high false negative rate. And type proportion of type B tympanogram was higher in normal (4.7%) and mild hearing loss (3.4%) groups than in moderate and severe group.

CONCLUSION

Middle ear function and development of auditory system in infants may be confusing factors in hearing screening. The 226 Hz probe tones to record tympanogram are unreliable for accurate assessment of middle ear status of infants. Therefore the results of hearing screening should be interpreted appropriately.

Animal models of tinnitus

There are few physiological data available on the origin and nature of tinnitus. It is not even known whether tinnitus associated with cochlear pathology is a manifestation of increased or decreased activity in the cochlear nerve. In previous investigations of cochlear pathology, the spontaneous neural activity has generally been found to be depressed. In the present experiments, an animal model has been established by the administration of sodium salicylate in doses producing blood concentrations that evoke tinnitus in humans. Under these conditions, changes occur in cochlear nerve-fibre thresholds and tuning, similar to those obtained in other types of cochlear pathology. However, under salicylate, the distribution of spontaneous discharge shifts significantly to higher rates than normal. These changes are accompanied in some, but not all, fibres by changes in the temporal patterns of discharge suggestive of excitation. In the second animal model studied, a normal guinea-pig that had a naturally occurring continuous tonal emission, analogous to that recently recorded in human "physiological" tinnitus, was investigated in detail. The emitted signal was recorded in the ear-canal acoustic pressure and in the round-window potential. Several lines of evidence point to the signal as being cochlear in origin, including: its resistance to muscular paralysis and section of the stapedius muscle; the effects of changes in middle-ear pressure; its reversible elimination by hypoxia; and its suppression by tones of higher frequency.

Acoustic correlates of tonal tinnitus

A sensitive microphone has been developed which can pick up tonal signals (spontaneous acoustic emissions) in the sealed ear-canal of certain subjects. Various properties of these frequency components suggest that they arise from an active, frequency-selective self-limiting feedback process within the cochlea and that they rely on internal reflection from the middle ear. An external tone can synchronize, frequency-lock, suppress of frequency-shift the acoustic component. These interactions are frequency-dependent in a way suggestive of cochlear tuning properties. Positive or negative middle-ear pressure can also influence the components by increasing their frequency and in some cases can enhance one component at the expense of a neighbouring one. Some subjects hear these components as tinnitus and can report on the measured changes. Other subjects do not hear the measured signals, which otherwise behave similarly. A third group of subjects have tinnitus but no objective sound can be detected. In this last group there are, nevertheless, sometimes notches or other discontinuities in the audiogram which correspond to their tinnitus pitch-matches. It appears likely that the recordable type of tinnitus is essentially non-pathological and represents hypersensitivity of the system, whereas the non-recordable type might be associated with local pathological changes at the end-organ or more centrally.

Physiologically active cochlear micromechanics--one source of tinnitus

Spontaneous oscillatory vibrations within the cochlea exist in many normal ears and can become audible, providing one source of mild tonal tinnitus. These vibrations have been studied experimentally using an acoustic ear-canal recording technique. The spontaneous oscillations are directly related to stimulated acoustic emissions (cochlear echoes). They arise because of the development of strong cochlear resonances by a feedback process. With the aid of cochlear resonance theory the bandwidths of spontaneous cochlear mechanical activity can be used to determine intracochlear broad-band noise levels. Ways of modifying cochlear mechanical activity have been explored. Activity can be increased or decreased by changes in middle-ear mobility or by brief overstimulation. In the latter case a biphasic recovery cycle has been identified which also seems to be relevant to temporary noise-induced tinnitus and temporary threshold shift. Tinnitus due to spontaneous cochlear vibrations is here called cochlear mechanical tinnitus. Identification criteria are given for such tinnitus involving cochlear mechanical resonance. This form is mild and likely to be found in normally hearing people with tinnitus and in those with only middle-ear disorders. It is speculated that localized oscillation of mechanically isolated cochlear elements could induce much higher levels of tinnitus without producing any externally detectable vibration.

Acoustic Immittance in children without otoacoustic emissions

Considering the hypothesis that middle ear changes can impair the recording of otoacoustic emissions, it is possible that absent otoacoustic emissions in infants could be associated with a light tympanometric change.

Aim

To study the association between transient otoacoustic emissions and changes in acoustic immittance measurements with 226Hz probe tone in neonates.

Methods

Cross-sectional contemporary cohort study. 20 infants with no transient otoacoustic emissions (study group) and 101 infants with transient otoacoustic emissions (control group), with ages ranged from birth to eight months, were assessed. Infants were submitted to: admittance tympanometry; contralateral acoustic reflex threshold with stimulus of 0.5, 1, 2, 4 kHz and broad band noise; transient and distortion product otoacoustic emissions. The auditory brain response was used to study the threshold in neonates without transient otoacoustic emissions.

Results

Significant statistical differences were observed between the groups (p < 0.005), characterized by reduction in tympanometric configuration and increase acoustic reflex thresholds in the study group. These data suggest the occurrence of middle ear mild impairment in infants without transient otoacoustic emissions associated with normal auditory brain response.

Conclusion

tympanometry associated with acoustic reflex adds accuracy to the diagnosis of middle ear abnormalities.

Medical treatment of otosclerosis: rationale for use of bisphosphonates

Otosclerosis is a bony dyscrasia characterized by histopathological findings of osteoclast production. Osteoclastogenesis explains the pathogenesis of otosclerosis. Basic science research in the experimental animal otic capsule has given insight into the process of evolution of otosclerosis. The normal otic capsule is preserved with very little bone turnover as a result of the production of osteoprotegerin (OPG) by the membranous inner ear that prevents the activation of osteoclasts. Animals genetically unable to produce OPG demonstrated the production of hearing loss and histopathology of the temporal bones consistent with that seen in otosclerosis. Applying the understanding of osteoclastogenesis to the treatment of otosclerosis has led to the clinical use of the class of drugs called bisphosphonates. The bisphosphonate group of drugs specifically targets osteoclasts by reducing production of osteoclasts and accelerating their early cell death. The rationale for use of bisphosphonates to treat the sensorineural hearing loss of otosclerosis is explained, with cases that illustrate the bisphosphonates treatment algorithms and the response to treatment.

Effect of static middle-ear and intracranial pressure changes on differential electrocochleographic response

In an animal model, we examined the extratympanic electrocochleographic response to static pressure changes (middle-ear pressure and intracranial pressure [ICP]) with attention to the summating potential (SP), action potential (AP), and the SP/AP ratio. With a closed middle ear, raised or lowered middle-ear pressure and raised or lowered ICP resulted in congruent increases of the SP and the SP/AP ratio, while the AP remained at a steady voltage. With a closed middle ear, raising or lowering ICP by positioning also had the effect of raising or lowering middle-ear pressure. With an open middle ear, raising or lowering middle-ear pressure resulted in congruent increases of the SP and the SP/AP ratio and, though the AP remained steady, it showed much higher voltage values. With an open middle ear, the baseline SP and baseline SP/AP ratio were reduced, but the reduction of the SP/AP ratio was mainly due to an increased AP. With an open middle ear, the SP, the SP/AP ratio, and the AP did not change appreciably during positioning-induced ICP changes. This suggests that ICP changes by positioning are not very effective in the rat when the middle ear is open. Thus, the effect of ICP changes with the middle ear closed are mainly due to positioning-induced pressure changes in the middle ear. Our findings confirm that static middle-ear pressure is critical for the cochlea and that good eustachian tube function is essential to keeping the pressure gradient across the round-window membrane as small as possible, the latter possibly assisted by a Windkessel function of the round-window membrane. However, relatively small pressure changes in the middle ear can overwhelm it, which suggests a very limited Windkessel function. In Ménière's disease, sensitivity to static pressure changes is possibly exaggerated. The insertion of a middle-ear ventilation tube, as practiced in treating selected cases of Ménière's disease, could restore Windkessel function. It has a stabilizing effect, as the inner ear appears less pressure-sensitive. This effect decreases Ménière's disease symptoms, but it is not without consequences. After the insertion of a middle-ear ventilation tube, a reduced SP/AP ratio is no evidence of improved inner-ear function. Its consequences are enlarged AP voltages, very likely loss of middle-ear dampening, and possible increased ringing.

Mechanical problems in human hearing

A description of the hearing process is given using three-dimensional mechanical models. By means of simulation, normal, pathological and reconstructed situations can be investigated. The development of new concepts and prototypes as well as the optimization and the way of insertion of passive and active implants is facilitated by carrying out virtual tests. Mechanical models of spatial structures of the middle ear and its adjacent regions are established by applying multibody systems and finite element modeling approach. In particular, the nonlinear behavior of the elements is taken into account. For the determination of parameters such as coupling parameters in reconstructed ears, measurements using Laser Doppler Vibrometry (LDV) were carried out. The governing differential equations of motion allow the investigation of transient and steady state behavior by time integration and frequency domain methods. Optimization methods can be applied for determination of design parameters such as coupling stiffness and damping, the characteristics of actuator, the position of attachment and direction of actuation. Mechanical models enable non-invasive interpretation of dynamical behavior based on measurements such as LDV from umbo or multifrequency tympanometry. It is shown: The transfer behavior is depending on static pressures in the ear canal, tympanic cavity or cochlea. For reconstructed ears, the coupling conditions are governing the sound transfer substantially. Due to restricted coupling forces, the excitation of inner ear is limited and the sound transfer is distorted. Other sources of distortion are nonlinear coupling mechanisms. In reconstructions with active implants, the actuator excites the microphone whereby feedback effects may occur.

Multifield coupled finite element analysis for sound transmission in otitis media with effusion

In this paper, a newly constructed three-dimensional finite element (FE) model of the human ear based on histological sections of a left ear temporal bone is reported. The otitis media with effusion was simulated in the model with variable fluid levels in the middle ear. The interfaces among the air, structure, and fluid in the ear canal and middle ear cavity were identified and the acoustic-structure-fluid coupled FE analysis was conducted when the middle ear fluid level was varied from zero to full fill of the cavity. The results show how the displacements of the tympanic membrane and stapes footplate or the middle ear transfer function is affected by fluid in the cavity across the auditory frequencies. Comparison of model results with measured data in temporal bones indicates that this model has the capability to extend FE analysis into pathological ears such as otitis media with visualized fluid-air interfaces inside the middle ear structures.

Non-ossicular signal transmission in human middle ears: Experimental assessment of the "acoustic route" with perforated tympanic membranes

Direct acoustic stimulation of the cochlea by the sound-pressure difference between the oval and round windows (called the "acoustic route") has been thought to contribute to hearing in some pathological conditions, along with the normally dominant "ossicular route." To determine the efficacy of this acoustic route and its constituent mechanisms in human ears, sound pressures were measured at three locations in cadaveric temporal bones [with intact and perforated tympanic membranes (TMs)]: (1) in the external ear canal lateral to the TM, P(TM); (2) in the tympanic cavity lateral to the oval window, P(OW); and (3) near the round window, P(RW). Sound transmission via the acoustic route is described by two concatenated processes: (1) coupling of sound pressure from ear canal to middle-ear cavity, H(P(CAV) ) identical withP(CAV)P(TM), where P(CAV) represents the middle-ear cavity pressure, and (2) sound-pressure difference between the windows, H(WPD) identical with(P(OW)-P(RW))P(CAV). Results show that: H(P(CAV) ) depends on perforation size but not perforation location; H(WPD) depends on neither perforation size nor location. The results (1) provide a description of the window pressures based on measurements, (2) refute the common otological view that TM perforation location affects the "relative phase of the pressures at the oval and round windows," and (3) show with an intact ossicular chain that acoustic-route transmission is substantially below ossicular-route transmission except for low frequencies with large perforations. Thus, hearing loss from TM perforations results primarily from reduction in sound coupling via the ossicular route. Some features of the frequency dependence of H(P(CAV) ) and H(WPD) can be interpreted in terms of a structure-based lumped-element acoustic model of the perforation and middle-ear cavities.

Effects of mobile phone exposure on time frequency fine structure of transiently evoked otoacoustic emissions

Mobile phones have become very commonly used worldwide within a short period of time. To date there is only limited knowledge about interaction between electromagnetic fields (EMFs) emitted by mobile phones and the auditory function. Moreover, there is widespread concern that there may be potential for harm. The aim of this study was to assess potential subtle changes in cochlear function by measuring the temporal and spectral fine structure of transiently evoked otoacoustic emissions (TEOAE) in normal hearing subjects after exposure to EMFs emitted by Global System for Mobile Communication (GSM) mobile phones. TEOAEs were recorded in 27 healthy young adults before and after 10 min of real or sham exposure in a double-blind design. TEOAE data were analyzed both globally (broadband analysis) and using the Wavelet Transform (analysis of the time-frequency fine structure). The broadband analysis revealed no significant effect on TEOAEs related to exposure, confirming results of previous studies; in addition, no significant change was detected in the analysis of the elementary wavelet components, suggesting that the temporal and spectral fine structure of TEOAEs is not affected by 10 min exposure to low-intensity EMFs emitted by GSM mobile phones.

The Erasmus atelectasis classification: proposal of a new classification for atelectasis of the middle ear in children

OBJECTIVES

Atelectasis presents a challenging, often progressive, problem in children. Because of the lack of a clinically practical classification, we introduce a new classification, which in our opinion is more useful in the pediatric age group. This alternative classification enables a more clinically relevant correlation between stage of disease and clinical sequelae and technical difficulty at surgery.

STUDY DESIGN

Observational study of patients seen and operated at the Sophia Children's Hospital in Rotterdam, The Netherlands between 1989 and 2005.

METHODS

Based on clinical appearance, each ear was placed into one of the five groups of the proposed classification and into one of the four stages of Sadé's classification. Preoperative air and bone conduction thresholds and air-bone gaps (ABG) were calculated using the four-tone pure-tone (500, 1,000, 2,000, and 4,000 Hz) averages for bone and air conduction.

RESULTS

: Of the 248 ears in the study group, 72 were in stage I, with an ABG of 18.2 +/- 12.3 dB. Twenty-two were in stage II, with an ABG of 12.9 +/- 9.5 dB. In stage III, there were 32 ears, with an ABG of 11.6 +/- 10.0 dB. Thirty-one ears were in stage IV, with an ABG of 16.1 +/- 11.5 dB. Eighty-five ears were in stage V, with an ABG of 26.1 +/- 13.3 dB. When grouped according to Sadé's classification, 92 ears could not be classified.

CONCLUSIONS

We found the currently proposed classification more useful in that it follows the natural progression of the disease and is more practical in determining operative procedures at each stage.

Middle ear pressure in preschool age children: influence of respiratory illness, season, and picornavirus or bacteria in the nasopharynx

CONCLUSION

Middle ear pressure was affected by respiratory illness and season; picornavirus (without illness) or pathogenic bacteria in the nasopharynx had no or minor effect.

OBJECTIVE

To examine the effect of respiratory illness, season, and nasopharyngeal microbial flora on middle ear pressure.

SUBJECTS AND METHODS

Thirteen children were followed longitudinally with daily recording of respiratory symptoms, weekly tympanometry, and weekly testing of nasal aspirate/washes for Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis by culture and for picornavirus by RT-PCR.

RESULTS

Abnormal middle ear pressure was present at 47% of 473 weekly visits by 11 preschool age (<or=5 years) vs 28% of 212 visits by 2 school age children. Symptomatic illness predicted abnormal middle ear pressure (63% of 107 ill visits in preschoolers vs 43% of 366 well visits, p<0.004). Abnormal tympanometry in preschoolers at well visits rose from 26% (80 visits) in summer to 54% (100 visits) in spring (p<or=0.03). No increase in abnormal tympanometry occurred during 18 picornavirus infections without illness. The presence of one or more of the bacterial species at ill or well visits had no effect on middle ear pressure except for a 12% increase (p=0.008) in abnormal tympanometry associated with H. influenzae at well visits in preschoolers.

Developmental changes in word recognition threshold from two to five years of age in children with different middle ear status

The aims were to: (1) provide word recognition thresholds (WRTs) at 31, 43, and 61 months of age; (2) investigate developmental changes over time; (3) investigate the relationship between OME and WRT, and (4) investigate the relationship between WRT and hearing thresholds. Around 1000 children were tested longitudinally as part of the ALSPAC study, using an adaptive measure of word recognition in quiet. Mean WRTs were 28, 23, and 23 dB (A) at 31, 43, and 61 months, respectively. Normal auditory development is associated with a mean improvement in WRT of 5 dB between age 31 and 61 months. There was a mean increase in WRT of +5 dB and +15 dB when OME was present in one and two ears, respectively. Thus, both unilateral and bilateral OME results in a detrimental effect on hearing ability for speech. Additionally, early and 'persistent' OME is associated with greater disability. However by 61 months, previous OME status was not significant. To our knowledge, this is the largest longitudinal study reporting WRT in preschool children with different middle ear status.

Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty

OBJECTIVES

To examine the correlation between the middle-ear pressure-regulation functions including active eustachian tube (ET) functions and transmucosal gas exchange function, and outcome of tympanoplasty.

PATIENTS AND METHODS

Seventy five patients (78 ears) with non-cholesteatomatous chronic otitis media with eardrum perforation but without ossicular damage or middle-ear anomaly participated in this study. Before surgery, patency of the ET was examined by applying positive pressure to the middle ear through the eardrum perforation, and then the ET pressure-regulation functions were examined using the inflation-deflation test. Also their transmucosal gas exchange function was evaluated by examining the presence or absence of aeration in the mastoid on the CT before surgery or through the microscope during the surgery. All of them underwent type-I tympanoplasty, and their postoperative conditions including the hearing were followed for more than 6 months. The outcome of the surgery was judged as poor outcome when they had any of the following conditions; more than 20 dB of mean air-bone gap, spontaneous perforation within 6 months, or persistent wet condition including recurrent otorrhea.

RESULTS

First, the outcome of all the four ears of which ETs were considered mechanically obstructed was poor. Next, among the remaining 74 ears, none of the three individual parameters, including positive and negative middle-ear pressure-equalizing functions and mastoid aeration, showed significantly positive correlation with the outcome of the surgery, but significantly higher incidence of poor outcome was seen only when all the three parameters were poor.

CONCLUSIONS

These results indicated that impairment of all the middle-ear pressure-regulation functions was likely to cause poor outcome of tympanoplasty, and also allowed us reconfirm that ears with mechanically obstructed ETs were contraindicated for tympanoplasty. Therefore, assessment of mastoid condition is important as well as the ET function before tympanoplasty.

[Relationship between childhood obstructive sleep apnea-hypopnea syndrome and tympanogram]

OBJECTIVE

To explore the correlation between childhood obstructive sleep apnea-hypopnea syndrome and tympanogram.

METHOD

A prospective clinical study was carried out. Polysomnography and tympanogram were analyzed in 72 cases.

RESULT

Among the 144 ears 37 ears had type C or B tympanogram. There was no correlation between tympanogram and LSaO2. It was found correlation between tympanogram and AHI (P < 0.05).

CONCLUSION

Hypoxemia may affect middle-ear function. It was necessary to do the examination of acoustic impedance routinely in children with moderate and severe OSAHS.

Impact of Jacobson's (Tympanic) Nerve Sectioning on Middle Ear Functions

OBJECTIVE

The purpose of this study was to evaluate the influence of sectioning of the Jacobson's (tympanic) nerve on middle ear functions.

METHOD

Twenty-five adult New Zealand rabbits were included in this study. The Jacobson's nerve was cut in the left ear of the rabbits (study group), whereas only a small mucosal incision was performed while keeping the Jacobson's nerve intact in their right ear (control group). After the operation, the ears were assessed both otomicroscopically and histopathologically on Days 30, 60, and 90.

RESULTS

On otomicroscopy, retraction pockets were observed in 48 and 4% of the ears in the study and control groups, respectively (p < 0.001). Middle ear effusion was observed in 56 and 12%, respectively (p < 0.01). Histopathologically, an inflammation in the middle ear mucosa was present in all ears in the study group, whereas it was present only in 20% of the control ears (p < 0.001). Goblet cells were observed in 48 and 20% in the study and control groups, respectively (p < 0.04). In the study group, the otomicroscopic and histopathologic findings were more prominent on Day 60 compared to Day 90 (p < 0.05).

CONCLUSION

Tympanic glomus cells seem to act as middle ear chemosensory organs and are involved in the regulation of middle ear aeration. Disruption of these neural elements such as Jacobson's nerve negatively impacts on middle ear functions and may result in atelectasis.

Relation between middle ear pressure changes and postoperative nausea and vomiting in pediatric strabismus surgery

STUDY OBJECTIVE

To investigate the effects of tympanometric changes on the frequency of postoperative nausea and vomiting (PONV).

DESIGN

Prospective, observational study.

SETTING

University hospital.

PATIENTS

49 ASA physical status I, nonpremedicated children undergoing elective strabismus surgery.

INTERVENTIONS

Frequency of PONV was assessed at various time intervals (0-2, 2-6, and 6-24 hours) with a 4-point scale (0, no nausea; 1, nausea but no vomiting; 2, one episode of vomiting; 3, two or more episodes of vomiting), and correlation with tympanometric data was investigated.

MEASUREMENTS

Tympanogram was obtained before induction of standardized anesthesia and after full recovery. Fourteen (28.6%) patients had nausea, and 10 (20.4%) patients vomited. The tympanic gradient, compliance, and pressure values were found to be significantly higher in postoperative measurements than their preoperative counterparts (P < 0.05). The volumes of both ears increased postoperatively, but these differences were not statistically significant (P > 0.05). Changes in middle ear pressure, volume, compliance, and gradient did not correlate with PONV (P > 0.05).

CONCLUSIONS

Gradient, compliance, volume, and pressure changes in middle ears were not found to be related to the frequency of nausea and vomiting after strabismus surgery.

Tensor tympani muscle: strange chewing muscle

This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies common otic symptoms. It offers better tools for this shared symptomatology during therapy s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective.

Middle ear atelectasis: what causes it and how is it corrected?

Many options are available to manage a patient who has atelectatic ears. Establishing normal middle ear ventilation and aeration is the cornerstone to successful control of these ears. Often, medical management with nasal steroids and decongestants is all that is needed. If recurrent infections have weakened the tympanic membrane progressively, or the middle ear environment is so severe that medical management does not correct the problem, then surgical correction is often necessary. This article explores the pathogenesis of middle ear atelectasis and explains a classification system to help the clinician determine the best course of management.

Microtraumatic stapedotomy

Several modifications have been introduced during the 35 years following the first stapedectomy. The size of the footplate fenestration into the vestibule defines the type of the surgical technique, varying from total stapedectomy to partial stapedectomy or small fenestra stapedotomy. This paper presents a new microtraumatic modification of stapedotomy. After the incudostapedial joint is separated and following the fracture of the stapes crura, the stapes superstructure with the stapes tendon intact is left lying or bending on the promontory. Then, a 4.5-mm-long Schuknecht prosthesis is inserted and the oval window is sealed with small pieces of connective tissue filling the oval window niche and the area between the stapes crura. The results of the new microtraumatic technique with regard to hearing were similar to the standard small fenestra stapedotomy (closure of the air-bone gap). However, multifrequency tympanometry revealed that the new technique provides the patient with a complete physiological middle ear function postoperatively, which was not the case when the other stapedotomy techniques were used. This was reflected in a better hearing quality and less loud-noise intolerance reported by the patients who had been operated on with the new microtraumatic technique.

Postoperative granuloma after stapedectomy: is it destiny or avoidable?

OBJECTIVE

The aims of this study were (1) to investigate the pathophysiological characteristics of the middle ear mucoperiosteum against the caustic nature of the gastric content (GC), which consists largely of acid and pepsin components, and (2) to investigate the possible role of gastroesophageal reflux and postoperative vomiting (POV) in the etiology of poststapedectomy granuloma.

METHODS

40 Spraque-Dawley rats of either sex and with a body weight of 200-300 g were used, and divided into different study groups: group 1: GC administration to the middle ear (n = 8); group 2: phosphate-buffered saline administration to the middle ear (n = 8); group 3: GC (pH: 2) administration in the presence of a Teflon piston (TP) (n = 6); group 4: phosphate-buffered saline administration in the presence of a TP (n = 6); group 5: GC administration in the presence of a wired piston (WP) (n = 6); group 6: phosphate- buffered saline administration in the presence of a WP (n = 6). GC was administrated to the middle ear cavities by way of the eustachian tube (ET). In order to overcome the pressure of the ET, a pump mechanism was used. The increased nasopharyngeal pressure caused a passive opening of the ET, and transferred a bolus to the middle ear. The animals were decapitated after 1 week, and the bullae were isolated. The tympanic bullae were serially cut and examined with light microscopy.

RESULTS

In the saline controls, there was only a mild amount of polymorphonuclear cell (PMN) infiltration in the mildly thickened subepithelial space, indicating a less pronounced inflammation as compared to the gastric acid group. In the GC group, in addition to focal hemorrhage and severe subepithelial infiltration of PMNs, the middle ear mucosa was dramatically thickened with subepithelial edema and dilated capillaries. In the subepithelial tissue, retention cysts and granulation tissue were present. In the piston groups (TP and WP), there was extensive subepithelial inflammation and edema after GC and saline administrations. Granulation tissue filling the entire bulla around the piston segments was detected.

CONCLUSION

The relationship between the administration of GC and middle ear inflammation, and the possible role of POV in the etiology of poststapedectomy granuloma are emphasized with our experimental study. The length of the TP may be considerably important to prevent POV which may lead to gastric reflux to the middle ear.

[Middle ear overpressure with Meniett in Menière disease: indications, results at short and middle terms in 53 cases]

OBJECTIVES

To expose the results obtained at short and middle terms and the tolerance of over pressure treatment with Meniett in Menière disease.

MATERIALS AND METHODS

A pressure treatment using Meniett device was initiated for 53 patients suffering of unilateral or bilateral active Menière's disease, despite medical treatment and physiotherapy.

RESULTS

Retrospective analysis of the data demonstrate i) no complications due to the tympanostomy tube, ii) with a 4 months follow up after the treatment, a total control or reduction of vertigo in respectively 65% and 24.5% of the initially treated patients.

CONCLUSION

The overpressure treatment with Meniett has been well tolerated. It can be repeated in case of recurrence of the symptoms. It is an interesting alternative for the treatment of Menière disease.

Middle ear admittance and hearing abnormalities in individuals with osteoarthritis

In osteoarthritis, the joint cartilage breaks down. Cartilage exists within the incudomalleolar and incudostapedial joints. In addition, the cartilage-covered base of the stapes footplate is bound to the cartilage-covered rim of the oval window by the annular ligament. Thus, higher prevalence of middle ear abnormalities and hearing loss can be expected in osteoarthritis due to degeneration of the cartilage and the subsequent abnormal repair response. In this study, tympanometric and audiometric data were obtained from 15 individuals diagnosed with osteoarthritis and 15 gender- and age-matched individuals without the diagnosis of arthritis. Results showed a significantly higher prevalence of middle ear abnormalities and hearing loss in ears with arthritis when compared to the control group. Interestingly, osteoarthritis and hearing loss are considered among the top chronic health concerns in older individuals although the connection between these two conditions has not been previously reported.