Computed tomography in the diagnosis of exudative otitis media

Temporal bone computed tomography (CT) was used to examine 37 patients aged 2 to 55 years who had exudative otitis media; in 27 patients of them, a pathological process was bilateral. An analysis of 58 temporal bone CT scans identified the CT signs of chronic exudative otitis media. These included a partial or complete block of the osseous foramen of the auditory tube; impaired pneumatization of the tympanic cavity, mastoid process fenestrae, and antrum; pathological drawing-in of the tympanic membrane. The preservation of the auditory ossicles and the absence of destructive changes in the walls of the cavities of the middle ear were observed in most cases. Repeated temporal bone CT study was performed in 10 patients (14 temporal bones) in different periods (from 2 months to 3 years) after surgery. The results of tympanostomy were visually assessed. These included recovered pneumatization of middle ear cavities (7 temporal bones), a cicatricial process in the tympanic cavity (5 temporal bones), recurrence of the CT manifestations of exudative otitis media (2 temporal bones).     

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.     

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.     

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.     

A REVIEW OF OPERATIONS ON THE TEMPORAL BONE

The majority of temporal bone operations are performed for treatment of acute or chronic middle ear and mastoid infection, otosclerosis and perforations of the tympanic membrane.Far from being a thing of the past, temporal bone surgery is an expanding field in the antibiotic age.Since treatment with antibiotics may temporarily allay the symptoms of serious disease of the ear, great care must be taken in examination of patients with a suspicious history.     

Study of age-related changes in Middle ear transfer function

Abstract

Osteoporosis (OP) is common with advancing age. Several studies have shown a strong correlation between OP and otosclerosis. However, no studies have investigated OP of the malleus, incus or stapes in the human middle ear, its effect on middle ear transfer function. Here, we investigate whether these three ossicles develop OP, and how this affects middle ear transfer function. The effect of OP on middle ear transfer function was investigated in simulations based on a finite element (FE) method. First, the FE model used in our previous study was refined, and optimized by introducing viscoelastic properties to selected soft tissues of the middle ear. Then, the FE model was used to simulate OP of the three ossicles and assess its influence on middle ear transfer function. Other possible age-related changes, such as stiffness of the joints or ligaments in the middle ear, were also investigated. The results indicated that OP of the ossicles could increase the high frequency displacement of both the umbo and stapes footplate (FP). However, the stiffness of the middle ear soft tissue can lead to the decrease of middle ear gain at lower frequencies. Furthermore, loosening of these joints or ligaments could increase displacement of the umbo and stapes FP. In conclusion, although age-related hearing loss is most commonly conceived of as sensorineural hearing loss (SNHL), we found that age-related changes may also include OP and changes in joint stiffness, but these will have little effect on middle ear transfer function in elderly people.     

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。     

Bapx1 regulates patterning in the middle ear: altered regulatory role in the transition from the proximal jaw during vertebrate evolution

The middle ear apparatus is composed of three endochondrial ossicles (the stapes, incus and malleus) and two membranous bones, the tympanic ring and the gonium, which act as structural components to anchor the ossicles to the skull. Except for the stapes, these skeletal elements are unique to mammals and are derived from the first and second branchial arches. We show that, in combination with goosecoid (Gsc), the Bapx1 gene defines the structural components of the murine middle ear. During embryogenesis, Bapx1 is expressed in a discrete domain within the mandibular component of the first branchial arch and later in the primordia of middle ear-associated bones, the gonium and tympanic ring. Consistent with the expression pattern of Bapx1, mouse embryos deficient for Bapx1 lack a gonium and display hypoplasia of the anterior end of the tympanic ring. At E10.5, expression of Bapx1 partially overlaps that of Gsc and although Gsc is required for development of the entire tympanic ring, the role of Bapx1 is restricted to the specification of the gonium and the anterior tympanic ring. Thus, simple overlapping expression of these two genes appears to account for the patterning of the elements that compose the structural components of the middle ear and suggests that they act in concert. In addition, Bapx1 is expressed both within and surrounding the incus and the malleus. Examination of the malleus shows that the width, but not the length, of this ossicle is decreased in the mutant mice. In non-mammalian jawed vertebrates, the bones homologous to the mammalian middle ear ossicles compose the proximal jaw bones that form the jaw articulation (primary jaw joint). In fish, Bapx1 is responsible for the formation of the joint between the quadrate and articular (homologues of the malleus and incus, respectively) enabling an evolutionary comparison of the role of a regulatory gene in the transition of the proximal jawbones to middle ear ossicles. Contrary to expectations, murine Bapx1 does not affect the articulation of the malleus and incus. We show that this change in role of Bapx1 following the transition to the mammalian ossicle configuration is not due to a change in expression pattern but results from an inability to regulate Gdf5 and Gdf6, two genes predicted to be essential in joint formation.     

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.     

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.     

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.     

改良乳突根治术联合后上壁重建对上鼓室胆脂瘤型中耳炎患者听力改善及复发率的影响

摘要 目的：探讨改良乳突根治术联合后上壁重建对上鼓室胆脂瘤型中耳炎患者听力改善及复发率的影响。方法：选取本院2015年5月-2020年10月收治的62例上鼓室胆脂瘤型中耳炎患者作为研究对象,随机将其分为改良组（n=31）和对照组（n=31）。改良组采用改良乳突根治术联合后上壁重建进行治疗,对照组采用乳突根治术进行治疗,对比两组患者手术前后听力情况、术后干耳所需时间等指标。结果：治疗前两组患者的气骨导差、气导听阀对比无明显差异（P>0.05）,治疗后均降低,并且改良组低于对照组（P＜0.05）;改良组患者术后并发症发生率较对照组低（P＜0.05）;改良组患者的术后2周、4周、8周干耳率较对照组高（P＜0.05）,术后干耳所需时间低于对照组（P＜0.05）;改良组治疗总有效率较对照组高（P＜0.05）。结论：将改良乳突根治术联合后上壁重建应用于上鼓室胆脂瘤型中耳炎患者当中,可提高患者听力,降低并发症,还可提高患者干耳率,缩短干耳时间,降低复发率,提高临床疗效,本研究值得临床借鉴。     

Probable diphyletic formation of the mammalian middle ear: Monotremata and Theria

The first steps in the formation of the middle ear of the mammalian type, with the tympanum and three auditory ossicles, have only been passed by higher cynodonts. They have an incipient malleus, which developed from the anterior process of the articulare rather than the retroarticular process, which is rudimentary in cynodonts. The tympanic bone is formed of the anterior projections of the angulare. In some gorgonopians, the retroarticular process is elongated and curved anteriorly, resembling the malleus of mammals; however, this is only convergent similarity.     

Details of human middle ear morphology based on micro‐CT imaging of phosphotungstic acid stained samples

A multitude of morphological aspects of the human middle ear (ME) were studied qualitatively and/or quantitatively through the postprocessing and interpretation of micro‐CT (micro X‐ray computed tomography) data of six human temporal bones. The samples were scanned after phosphotungstic acid staining to enhance soft‐tissue contrast. The influence of this staining on ME ossicle configuration was shown to be insignificant. Through postprocessing, the image data were converted into surface models, after which the approaches diverged depending on the topics of interest. The studied topics were: the ME ligaments; morphometric and mechanical parameters of the ossicles relating to inertia and the ossicular lever arm ratio; the morphology of the distal incus; the contact surface areas of the tympanic membrane (TM) and of the stapes footplate; and the thickness of the TM, round window of the cochlea, ossicle joint spaces, and stapedial annular ligament. Some of the resulting insights are relevant in ongoing discussions concerning ME morphology and mechanical functions, while other results provide quantitative data to add to existing data. All findings are discussed in the light of other published data and many are relevant for the construction of mechanical finite element simulations of the ME. J. Morphol. 276:1025–1046, 2015. © 2015 Wiley Periodicals, Inc.     

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.     

The middle and inner ears of the Palaeogene golden mole Namachloris: A comparison with extant species

Many living species of golden moles (Chrysochloridae) have greatly enlarged middle ear ossicles, believed to be used in the detection of ground vibrations through inertial bone conduction. Other unusual features of chrysochlorids include internally coupled middle ear cavities and the loss of the tensor tympani muscle. Our understanding of the evolutionary history of these characteristics has been limited by the paucity of fossil evidence. In this article, we describe for the first time the exquisitely preserved middle and inner ears of Namachloris arenatans from the Palaeogene of Namibia, visualised using computed tomography, as well as ossicles attributed to this species. We compare the auditory region of this fossil golden mole, which evidently did not possess a hypertrophied malleus, to those of three extant species with similarly sized ear ossicles, Amblysomus hottentotus, Calcochloris obtusirostris, and Huetia leucorhinus. The auditory region of Namachloris shares many common features with the living species, including a pneumatized, trabeculated basicranium and lateral skull wall, arteries and nerves of the middle ear contained in bony tubes, a highly coiled cochlea, a secondary crus commune, and no identifiable canaliculus cochleae for the perilymphatic duct. However, Namachloris differs from extant golden moles in the apparent absence of a basicranial intercommunication between the right and left ears, the possession of a tensor tympani muscle and aspects of ossicular morphology. One Namachloris skull showed what may be pneumatization of some of the dorsal cranial bones, extending right around the brain. Although the ossicles are small in absolute terms, one of the Huetia leucorhinus specimens had a more prominent malleus head than the other. This potentially represents a previously unrecognised subspecific difference.     

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.     

两种手术方式对慢性中耳炎听力改善的临床分析

目的：研究慢性中耳炎患者术后听力改善及其可能相关影响因素。方法：随访自2010年3月至2012年5月于本院耳鼻喉科进行慢性中耳炎手术的患者,将随访资料的病例行回顾性分析。结果：84例置入PORP病例术后气导听阈平均39．6±14．9dB,较术前,提高平均为13．9±13．2dB（P〈0．001）;平均气骨导差为20．5±8．5dB,气骨导差改变平均为8．8±10．7dB（P〈0．001）。术后气导听阈改善在0．5KHz,1KHz,2KHz三个频率上无明显差异（P〉0．05）,而气骨导差改善显示2KHz的改善不及0．5KHz,1KHz的气骨导差改善（（P〈0．001）。6例行颞肌筋膜鼓膜成型术病例术后气导听阈平均21．1±4.3dB,较之术前提高平均为13．6±7．2dB（P〈0．05）,平均气骨导差为11．1±4．2dB,气骨导差改变平均为6．7±4．2dB（P〈0．05）。结论：置入PORP、颞肌筋膜鼓膜成型术均可明显改善听力。慢性中耳炎手术治疗效果令人满意,羟基磷灰石假体听骨对于听力改善效果肯定。