Potentialities of temporal bone computed tomography in the identification of causes of hypoacusis of postinflammatory genesis

Temporal bone computed tomography (CT) was used to examine 64 patients with impaired hearing due to inflammatory diseases of the middle year. In 21 patients, the pathological process was bilateral. A total of 85 series of temporal bone CT scans were analyzed. The patients' age ranged from 2 to 66 years. CT verified adhesive otitis media in 62 cases, otosclerosis in 7, local malformation of the auditory ossicles and/or the labyrinthine fenestrae in 11. No CT changes were revealed in 5 cases. The CT symptoms of adhesive otitis media were identified. These included soft tissue bands and/or soft tissue-density portions that fix the auditory ossicles or block the niches of the labyrinthine fenestrae (31 temporal bones); sclerosis or ossification of the ligaments and tendons of the middle ear (7 temporal bones); calcification foci in the tympanic cavity (9 cases); osteosclerotic changes in the epitympanus (2 cases); cicatricial changes in the tympanic membrane (24 cases); destructive changes in the auditory ossicles (19 temporal bones). There has been evidence that CT may be used for the differential diagnosis of adhesive otitis media from otosclerosis and congenital malformations of the structures of the middle ear.     

Potentialities of temporal bone CT in the diagnosis of chronic purulent otitis media and its complications

Temporal bone CT was used to examine a group of 87 patients with chronic purulent otitis media (103 temporal bones). The patients' age ranged from 2 to 74 years. A scheme was developed and proposed to evaluate the temporal bone by CT. The CT signs of chronic purulent otitis media uncomplicated by cholesteatoma and those of cholesteatomic purulent otitis were identified. The CT symptomatology of chronic purulent otitis includes: sclerotic changes in the bone tissue of the mastoid process, impaired pneumatization of the cavities of the middle ear, including the tympanic cavity, destructive changes in auditory ossicles, carious changes in the walls of the cavities of the middle ear. The CT semiotics of cholesteatoma depends on its site and spread into the temporal bone and includes as follows: deformation of the epitympanum due to soft tissue mass-induced destruction of the lateral wall; the dilated entrance into the antrum; the presence of a cavity with the sclerosed walls in the antromastoid area; carious changes in the auditory ossicles; the displacement of a chain of ossicles medially or laterally in relation to the initial site of cholesteatoma. CT reflects carious changes in the walls of the cavities of the middle ear, including the roof and labyrinthine wall of the tympanum, which allows labyrinthine fistula and intracranial cholesteatomic complications. The study of the temporal bone by the proposed scheme may reveal anomalies and the specific features of its structure: the presentation of the sigmoid sinus, the high elevation of the bulb of the jugular vein, diverticulum of the latter, the low standing of the bottom of the ACH.     

儿童腺样体肥大程度与分泌性中耳炎发生的相关性研究(英文)

目的:探讨儿童腺样体肥大程度与分泌性中耳炎发生及预后的相关性,指导临床医师对分泌性中耳炎作出早期诊断和治疗。方法:239例住院手术切除腺样体的儿童,常规行鼻咽侧位片、声导抗检查;部分伴耳部症状、声导抗显示C型曲线或查体可疑鼓室积液征者行颞骨CT检查或术中行鼓室穿刺。经统计学分析,比较分泌性中耳炎与腺样体肥大程度及咽鼓管咽口情况的相关性。结果:在239例腺样体肥大儿童中,经鼓室穿刺证实合并分泌性中耳炎者34例(63耳,14.2%),其中鼓室曲线呈B型者33耳(52.4%),C型(-200 dapa)者10耳(15.9%),C型(-200 dapa)者20耳(31.7%)。结果表明分泌性中耳炎的发生与腺样体肥大程度及咽鼓管园枕受压迫的程度呈正相关。结论:声导抗检查不能作为分泌性中耳炎诊断的金标准,必要时可行颞骨CT明确诊断;对腺样体肥大伴分泌性中耳炎的儿童鼻内镜下腺样体切除为其主要疗法,配合鼓室穿刺多可治愈,对反复发作的分泌性中耳炎行鼓室置管术,避免术后并发症的发生。     

Potentialities of temporal bone computed tomography in the study of the facial nerve and in the diagnosis of peripheral pareses of thr 7th pair of cranial nerves

Computed tomography (CT) was used to examine 200 patients (400 temporal bones) aged 3 to 74 years who had no signs of facial nerve lesion and 28 patients who had clinical manifestations of peripheral paresis of the facial nerve of varying genesis. Multipositional CT of the temporal bone is the most informative mode of visualization of the fallopian canal which is embodied on tomographic scans in 100% of cases irrespective of the age of a patient. CT data indicate that the formation of the facial nerve canal brings to completion by the age of 6 years. The following causes of n. facialis paresis were identified: facial neuroma; sarcoma of the temporal bone sarcoma; dehiscence of the canal wall in otitis media acuta; destruction of the tympanic wall of the canal in otitis nedia chronica, fractures of the temporal bone, anomalies of the fallopian canal in temporal bone malformations; stenosis of the canal in fibrous dysplasia. The detected alterations of the n. facialis canal permits further policy of management of a patient to be defined.     

The human otitis media with effusion: a numerical-based study

Otitis media is a group of inflammatory diseases of the middle ear. Acute otitis media and otitis media with effusion (OME) are its two main types of manifestation. Otitis media is common in children and can result in structural alterations in the middle ear which will lead to hearing losses. This work studies the effects of an OME on the sound transmission from the external auditory meatus to the inner ear. The finite element method was applied on the present biomechanical study. The numerical model used in this work was built based on the geometrical information obtained from The visible ear project. The present work explains the mechanisms by which the presence of fluid in the middle ear affects hearing by calculating the magnitude, phase and reduction of the normalized umbo velocity and also the magnitude and phase of the normalized stapes velocity. A sound pressure level of 90 dB SPL was applied at the tympanic membrane. The harmonic analysis was performed with the auditory frequency varying from 100 Hz to 10 kHz. A decrease in the response of the normalized umbo and stapes velocity as the tympanic cavity was filled with fluid was obtained. The decrease was more accentuated at the umbo.     

Computed tomography of the temporal bones in children with developmental anomalies of the external and middle ear]

Computed polypositional high-resolution tomography (CT) was provided to 45 children with dysplasia of the external acoustic meatus (EAM). The computed tomograms were analyzed in accordance with the scheme which included the evaluation of the following structures: atresia or stenosis area, pneumatized mastoid process, tympanic cavity, ant rum, osteal opening of the Eustachian tube, chain of auditory ossicles, windows of the labyrinth, internal ear, facial nerve canal, and large vessels. Preoperative CT of the temporal bones allows for the evaluation of the above-listed structures, which is of paramount importance for the planning of the patient management policy. Also, CT enables the assessment of the risk of surgical intervention associated with a potential injury to the facial nerve, large vessels, and temporomandibular articulation. CT is to be an indispensable diagnostic modality for examination of children presenting with EAM dysplasia.     

化脓性中耳炎病原菌感染的研究进展

化脓性中耳炎是耳鼻喉科临床常见疾病,可导致听力下降、鼓膜充血、鼓膜穿孔、耳鸣、耳痛及流脓等。化脓性中耳炎主要由微生物进入中耳引起感染,使中耳黏膜发生化脓性病变,且不同患者感染的病原菌不同。本文从化脓性中耳炎的发病机制、病原菌及其耐药性和治疗方法等几个方面进行综述,以期为临床化脓性中耳炎的诊断及合理用药提供参考。     

Temporal bone CT in the diagnosis of acquired diseases of the external auditory canal

CT was used to examine 50 patients (100 temporal bones) aged 10 days to 60 years who had no signs of lesion of the external auditory canal (EAC) and 23 patients (27 temporal bones) aged 13 to 65 years who had clinical manifestations of acquired stenosis or obturation of the EAC. Polypositional CT of the temporal bone is the most informative technique of visualization of the osseous part of the EAC, at the same time the anterior and posterior EAC walls were evaluated in the axial projection and the upper and lower EAC walls were assessed in the coronary projection. According to CT data, formation of the osseous part of the EAC occurs within the first 7 years of a child's life. In the presence of EAC changes, CT may assess their pattern (a soft tissue or osseous one), their magnitude and location along the walls of the canal, the tympanic membrane, and other structures of the temporal bone. CT reveals the causes of acquired EAC obturation, stenosis, and atresia: osteocartilaginous exostoses, osteomas, polyps of the EAC, tumors of the temporal bone, as well as obturative keratosis and posttraumatic stenosis of the EAC. The detected EAC changes determine further management policy in a patient.     

Preoperative computed tomography of temporal bones and its use in selecting patients with sensorineural deafness for cochlear implantation

Cochlear implantation (CI) involves the insertion of electrode systems in the inner ear in order to restore hearing in patients with sensorineural deafness. Positive CI results are closely related with careful selection of candidates. Preoperative computed tomography (CT) and its results are decisive in this selection. Temporal bone CT was made in 40 patients aged 1 to 57 years who had sensorineural deafness. The following changes were detected: malformations of the inner ear, the inner auditory canal, meningititis-induced cochlear obliteration, post-traumatic temporal bone changes, local auditory ossicle malformation, inflammatory middle ear changes, the high position of the jugular vein bulb, and its diverticula. Temporal bone CT plays an important role in selecting candidates for CI and circumvents potential difficulties and complications at CI.     

An attempt at comparing CT images of petrous bone with analogical sections of anatomical specimens

The purpose of the paper was to present comparative laminar anatomy of human temporal bone on the basis of cross-sections of autopsy specimens and CT scans made in identical thin layers. The investigations were made on 20 temporal bones taken during anatomopathological dissections of cadavers of men and women (aged 40 to 60 a) without visible pathological changes in the skull. The CT examinations were made by means of a Siemens Somatom DR 2 apparatus, using high resolution programme, on 10 patients who had pathological changes in the ear. The obtained scans were compared with temporal bone cross-sections, schemas of regular anatomical relation of 8 layers corresponding to routine CT examinations were worked out.     

Clinical morphological picture of the mucosa of the middle ear in experimental chronic otitis media in rabbits treated with combined antibiotic aerosol preparations]

An new method of treating chronic purulent middle otitis with combined aerosol drugs (oxycyclosol, polysol, levovinylsol, vinysol) was developed at the USSR Research Institute on Antibiotics and tested experimentally on 20 Shinshilla rabbits. A 0.3 ml volume of microbial suspensition: Staphylococcus (group I), Ps. aeruginosa (group II), Proteus vulgaris (group III) and mixed microbial flora (group IV) were administered into the cavities of the middle ear of the rabbits from both sides. The acute process was made chronic by using decreased daily food ration and repeated putting of the rabbit extremeties into cool water. After that the rabbits were subjected to treatment with the above drugs for a week. Damages in the drum cavity mucosa with dystrophy, necrosis and cell separation were observed in the control (not treated) animals. Analogous changes were found also in the auditory tube. Signs of necrosis followed by decomposition were detected in the bone tissue. Only some thickening of the mucosa and bone wall of the drum cavity in the ears and single lymphoid and plasmic cells were recorded in the rabbits subjected to the treatment with the aerosol drugs.     

上鼓室重建对慢性中耳炎开放式鼓室成形术作用的临床研究

目的：观察在开放式鼓室成形术中,重建上鼓室对慢性中耳炎治疗的临床疗效。方法：86例（86耳）慢性中耳炎患者随机均分两组：两组均行开放式鼓室成形术,其中实验组应用自体乳突骨粉联合耳后肌骨膜瓣缩窄乳突根治腔,并垫高上鼓室内壁;对照组不行乳突根治腔缩窄术。回顾性观察两组患者在鼓膜状态（内陷及穿孔）、干耳时间、听力提高,头晕头痛、肉芽增生等几个方面的恢复情况。结果：通过对两组病例进行随访和疗效分析,在鼓膜状态、干耳时间、头晕头痛等方面,其临床疗效差异有显著性（P〈0．05）;而在术后听力提高及肉芽增生方面无显著性差异（P〉0．05）。结论：在慢性中耳炎开放式鼓室成形术中,自体材料的应用缩短了千耳时间、提高了手术疗效,减少了手术相关的并发症。     

Auditory ossicles from southwest Asian Mousterian sites

The present study describes and analyzes new Neandertal and early modern human auditory ossicles from the sites of Qafzeh and Amud in southwest Asia. Some methodological issues in the measurement of these bones are considered, and a set of standardized measurement protocols is proposed. Evidence of erosive pathological processes, most likely attributed to otitis media, is present on the ossicles of Qafzeh 12 and Amud 7 but none can be detected in the other Qafzeh specimens. Qafzeh 12 and 15 extend the known range of variation in the fossil H. sapiens sample in some metric variables, but morphologically, the new specimens do not differ in any meaningful way from living humans. In most metric dimensions, the Amud 7 incus falls within our modern human range of variation, but the more closed angle between the short and long processes stands out. Morphologically, all the Neandertal incudi described to date show a very straight long process. Several tentative hypotheses can be suggested regarding the evolution of the ear ossicles in the genus Homo. First, the degree of metric and morphological variation seems greater among the fossil H. sapiens sample than in Neandertals. Second, there is a real difference in the size of the malleus between Neandertals and fossil H. sapiens, with Neandertals showing larger values in most dimensions. Third, the wider malleus head implies a larger articular facet in the Neandertals, and this also appears to be reflected in the larger (taller) incus articular facet. Fourth, there is limited evidence for a potential temporal trend toward reduction of the long process within the Neandertal lineage. Fifth, a combination of features in the malleus, incus, and stapes may indicate a slightly different relative positioning of either the tip of the incus long process or stapes footplate within the tympanic cavity in the Neandertal lineage.     

Middle Ear Cavity Morphology Is Consistent with an Aquatic Origin for Testudines

The position of testudines in vertebrate phylogeny is being re-evaluated. At present, testudine morphological and molecular data conflict when reconstructing phylogenetic relationships. Complicating matters, the ecological niche of stem testudines is ambiguous. To understand how turtles have evolved to hear in different environments, we examined middle ear morphology and scaling in most extant families, as well as some extinct species, using 3-dimensional reconstructions from micro magnetic resonance (MR) and submillimeter computed tomography (CT) scans. All families of testudines exhibited a similar shape of the bony structure of the middle ear cavity, with the tympanic disk located on the rostrolateral edge of the cavity. Sea Turtles have additional soft tissue that fills the middle ear cavity to varying degrees. When the middle ear cavity is modeled as an air-filled sphere of the same volume resonating in an underwater sound field, the calculated resonances for the volumes of the middle ear cavities largely fell within testudine hearing ranges. Although there were some differences in morphology, there were no statistically significant differences in the scaling of the volume of the bony middle ear cavity with head size among groups when categorized by phylogeny and ecology. Because the cavity is predicted to resonate underwater within the testudine hearing range, the data support the hypothesis of an aquatic origin for testudines, and function of the middle ear cavity in underwater sound detection.     

Specialization for underwater hearing by the tympanic middle ear of the turtle, Trachemys scripta elegans

Turtles, like other amphibious animals, face a trade-off between terrestrial and aquatic hearing. We used laser vibrometry and auditory brainstem responses to measure their sensitivity to vibration stimuli and to airborne versus underwater sound. Turtles are most sensitive to sound underwater, and their sensitivity depends on the large middle ear, which has a compliant tympanic disc attached to the columella. Behind the disc, the middle ear is a large air-filled cavity with a volume of approximately 0.5 ml and a resonance frequency of approximately 500 Hz underwater. Laser vibrometry measurements underwater showed peak vibrations at 500-600 Hz with a maximum of 300 μm s(-1) Pa(-1), approximately 100 times more than the surrounding water. In air, the auditory brainstem response audiogram showed a best sensitivity to sound of 300-500 Hz. Audiograms before and after removing the skin covering reveal that the cartilaginous tympanic disc shows unchanged sensitivity, indicating that the tympanic disc, and not the overlying skin, is the key sound receiver. If air and water thresholds are compared in terms of sound intensity, thresholds in water are approximately 20-30 dB lower than in air. Therefore, this tympanic ear is specialized for underwater hearing, most probably because sound-induced pulsations of the air in the middle ear cavity drive the tympanic disc.     

Computerized x-ray tomography of fossil hominid skulls

The newest generation of Computerized Tomography (CT) scanning appears to provide x-ray pictures of the internal structures of a rather heavily mineralized Homo erectus skull, i.e., Pithecanthropus IV, notably of its temporal bones, that reveal more details than traditional x-ray procedures. An analysis of the right temporal bone shows that it is extremely pneumatized, that the oval shape of the external meatus does not result from fractures as previously suggested, and that the middle ear and the internal auditory meatus have probably been damaged during restoration. Labyrinthine structures can be seen, and the facial nerve canal appears to be of a relative small size.     

Role of Toll-like receptor 4 in innate immune responses in a mouse model of acute otitis media

Nontypeable Haemophilus influenzae (NTHi) is considered a major pathogen underlying middle ear infection. This study characterized the role of Toll-like receptor 4 in the innate immune responses to acute otitis media induced by NTHi in mice. We used C3H/HeJ mice, which have nonfunctional Toll-like receptor 4, and normal wild-type C3H/HeN mice. NTHi were injected into the tympanic bulla, and middle ear effusions and tissues were collected. In C3H/HeN mice, the severity of acute otitis media decreased promptly with a significant reduction in bacterial recovery from middle ear effusions 48 h after injection. In contrast, all C3H/HeJ mice had otitis media at all time points examined, and increasing bacterial counts from middle ear effusions were detected in C3H/HeJ mice 72 h after injection. Expression of intracellular adhesion molecule-1 by the middle ear mucosa paralleled the number of polymorphonuclear cells in the middle ear in both strains. The findings of transmission electron microscopy revealed that phagocytosis and phagosome maturation of polymorphonuclear cells was impaired in C3H/HeJ mice. Our findings indicate that Toll-like receptor 4 plays a part in the early accumulation and functional promotion of polymorphonuclear cells in the middle ear for eradicating NTHi infection.     

Role of the pro-inflammatory cytokines tumor necrosis factor-alpha,interleukin-1 beta,interleukin-6 and interleukin-8 in the pathogenesis of the otitis media with effusion

Inflammation in the middle ear mucosa, caused usually by bacterial and viral pathogens, is the primary event in the middle ear predisposing the development of otitis media with effusion (OME). Numerous inflammatory mediators have been identified in OME. However, cytokines play a central role as initiators, mediators and regulators of middle ear inflammation and subsequent molecular-pathological processes in middle ear tissues, leading to histopathological changes in the middle ear cavity and the pathogenesis of OME. In this article, we aim to present an overview of current research developments in the pro-inflammatory cytokine involvement in the aetiology of otitis media with effusion.