Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

A Simple Egg Membrane Patch Bridging Method for Repairing Tympanic Membrane Perforation

Objective:To analyze the clinical effect of a simple egg membrane patch bridging method in repairing tympanic membrane perforation.Methods:A total of 93 tympanic membrane perforation patients admitted to the hospital between September 2022 and October 2023 were selected and divided into two groups according to the random number table method.The control group implemented the conventional treatment(n=46 cases),and the patch group adopted the simple egg membrane patch bridging method(n=47 cases).The healing rate of the tympanic membrane,the air-bone gap,the air conduction hearing threshold,the dry ear rate,and the incidence of complications in both groups were compared before and after treatment.Results:The healing rate of the tympanic membrane in the patch group was significantly higher than that of the control group(95.75%vs.76.09%),with P<0.05;there was no difference in the air-bone gap and air conduction hearing threshold levels between the two groups before treatment(P>0.05),and the hearing indexes of the patch group were significantly lower than those of the control group 3 months after treatment(P<0.05);the dry ear rate in the patch group was significantly higher than that of the control group after treatment(85.11%vs.67.39%),and the total incidence of complications was also significantly lower than that of the control group(6.38%vs.21.74%),with P<0.05.Conclusion:The simple egg membrane patch bridging method is effective in repairing tympanic membrane perforation,which can effectively improve patients’hearing levels and reduce the occurrence of post-treatment complications.Thus,it is worth popularizing and applying in the clinic.

Post Blast Tympanic Perforations, Clinical and Paraclinical Study at Six Yaounde Hospitals

Introduction: Post-blast tympanic perforations represent an entity of traumatic perforations;various mechanisms are at the origin of the latter, and the increase in conflicts and acts of violence are increasing the studies on this subject, but few data are available in our context. Objective: This paper aims to study post-blast tympanic perforations in Yaounde, specifically the epidemiological, clinical, and paraclinical aspects. Methodology: We conducted a descriptive cross-sectional study with retrospective and prospective data collection in six Yaounde hospitals over 63 months from January 1, 2018, to March 31, 2023. All patients with at least one post-blast tympanic perforation were included. Socio-demographic, clinical and paraclinical data were collected on a questionnaire and analysed using SPSS 28 software. Results: We included 124 patients. The prevalence of post-blast tympanic perforations was 0.1% of the consultations in the departments. 71 The average age was 28.6 ± 9.1 years, with extremes ranging from 7 to 49 years. The median consultation time was five days. The most frequent injury circumstances were physical aggression (81.45%) and armed conflict (10.5%). The injury mechanisms were slaps (75%), punches (21.74%) and grenades (4.8%). The main symptoms on admission were hearing loss (63.7%), tinnitus (58.1%) and otalgia (57.3%). The tympanic perforations were unilateral in all cases, the anterior-inferior location was more characteristic, and the deafness was conductive in 58.3% of cases, followed by mixed deafness in 23.3% of cases. Conclusion: Post-blast tympanic perforations are rare in consultation. The population is primarily male and from the second decade of life. The main circumstance is aggression.

Per-Operative Discovery of Tympanic Paraganglioma: A Case Report

Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar spine. Primary symptoms of tympanic locations include hearing loss and pulsatile tinnitus. Otoscopy often shows a retrotympanic reddish mass, causing tympanic bulging. Computerized tomography scan findings include a tissue density regular mass located at the promontory and limited within the middle ear cavity. Surgical management comprises tumour excision with control of bleeding, with or without prior embolization. Aim: The aim of this presentation is to report an unusual case of tympanic paraganglioma. Case Presentation: We report the case of a 56-year-old patient whose clinical and paraclinical presentations were consistent with cholesteatoma, though a tympanic paraganglioma was discovered per-operatively. Conclusion: In some rare cases, tympanic paraganglioma can be present like a cholesteatoma.

Does central tympanic membrane perforation affect infrared tympanic thermometer measurements in adults?

Objective: Infrared Tympanic Thermometer(ITT) is one of the most useful instruments for accurately measuring temperature. The effects of ear pathologies on ITT measurement remain unclear. The purpose of this study is to determine if tympanic membrane perforation(TMP) affects ITT measurements in adult patients.Material and methods: A total of 90 adult patients with monaural central TMP were enrolled in this study.Patients were categorized into three subgroups according to perforation size(1-3 mm, 4-7 mm, and 8-10 mm).The tympanic temperatures of the affected and unaffected sites, and subgroups were compared with each other.Results: This study contained 54(60%) males and 36(40%) females ranging from 20 to 58 years of age(mean age: 30.74 ± 9.61 years). The mean tympanic temperature of the side affected with TMP was 36.34 oC ± 0.61 oC.The mean tympanic temperature of the unaffected side with healthy and intact tympanic membrane was 36.33 oC ± 0.6 oC. The Pearson correlation score for the tympanic temperatures and the size of TMP was 0.22 which was not significant(r=-0.12).Conclusion: TMP and perforation size do not affect ITT measurements in adult patients.

Self-monitoring of the tympanic membrane:An opportunity for telemedicine during times of COVID-19 and beyond

The interest for telemedicine has increased since the COVID-19 pandemic because of the risk of infection.Recently,commercial companies started selling digital USB-otoscopes(DUO)that can be connected to a mobile phone.These DUOs are inexpensive(costing approximately$6e35 each)and make it possible to visualize the whole tympanic membrane.Here,we illustrate the case of a patient who had operative correction of a tympanic membrane retraction,and who self-monitored the tympanic membrane in the course of time.Additionally,we discuss the use of DUOs in otolaryngology telemedicine practice.The use of simple digital USB otoscopes provides a promising method to assess and monitor the tympanic membrane remotely.However,more research is needed to establish the role of DUOs in telemedicine.

Transcanal endoscopic excision of tympanic paraganglioma: A three-case series

Paragangliomas are rare neuroendocrine tumors that arise in sympathetic and parasympathetic paraganglion system,derived from neural crest cells.Tympanic paraganglioma is a type of head and neck paraganglioma involving the middle ear cleft.Endoscopic transcanal approach is currently in vogue for the excision of tympanic paragangliomas that is limited to middle ear cleft.We present a series of 3 cases who underwent endoscopic excision of tympanic paraganglioma.

Disagreement in middle ear volume estimation between tympanometry and three-dimensional volume reconstruction in the context of tympanic membrane perforation

Introduction: Middle ear volume(MEV) is a clinically relevant parameter across middle ear diseases. MEV values between these techniques have never before been tested for agreement in ears with perforated tympanic membranes(TMs).Methods: Middle ears were identified from 36 patients ranging 18-89 years of age with TM perforations who underwent tympanometry and temporal bone computed tomography(CT) between 2005 and 2015. MEVs calculated by both tympanometry and three-dimensional volume reconstruction(3DVR) were analyzed for agreement using Bland Altman plots. The differences between tympanometric and 3DVR MEV values for each given middle ear were characterized across MEV quartiles(1= smallest; 4= largest) and across increasing states of middle ear disease using Kruskale Wallis and Wilcoxon testing with Bonferroni correction.Results: Bland Altman plots demonstrated significant disagreement between MEV measurement techniques. Differences between tympanometric(T) and 3DVR MEV values were significantly greater with increasing average(i.e.(Tt3DVR)/2)) MEV per linear regression(p < 0.0001). Significance was demonstrated between fourth and first average MEV quartiles(p= 0.0024), fourth and second quartiles(p= 0.0024), third and first quartiles(p= 0.0048), and third and second quartiles(p= 0.048). Absolute MEV difference was not significantly different across varying states of middle ear disease(p= 0.44).Conclusion: Statistically and clinically significant disagreement was demonstrated between tympanometric and 3DVR MEV values. Studies that vary in MEV estimation techniques may be expected to demonstrate significantly different results. These preliminary results suggest that clinicians should endeavor to seek further confirmation when interpreting high tympanometric MEV values.

Chronic model of tympanic perforation in rats with mitomycin C and dexamethasone

A rat model of chronic tympanic membrane perforation was developed to be used in the search of new materials for the sealing of these perforations. A longitudinal study was carried out in rats subjected to incisional myr-ingotomy followed by the application of mitomycin C alone or with dexamethasone. Rats were checked at days 3, 7,1 0,1 4 and weekly thereafter until perforation closure, for up to 6 months. The addition of dexamethasone is a key component in order to obtain a chronic opening. Myringotomies treated w ith saline had a mean healing time of 8.5 days. At 8 weeks, between 62.5% and 77.7% of tympanic membranes treated w ith mitomycin C and dexamethasone remained perforated and at 6 months this number fell to 21.4%. This technique is able to maintain most tympanic membrane perforations patent for at least 8 weeks. This rat model is adequate for its use in preclinical or translational research.

Geometrical Reconstruction and CNC Process of Spurious Tympanic Membrane Based on Reverse Engineering

Perforation of tympanic membrane is one of the main reasons for both deafness and dyssaudia.We could improve and restore audition by restoring or replacing the tympanic membrane.So,whether you can make the spurious tympanic membrane successfully is one of the keys to a successful operation.Utilizing CMM (Coordinate Measuring Machine) measurement equipment, we measured tympanic membrane model precisely and digitally.We also analysed the measured data by point to surface and we have successfully reconstructed the CAD model of the spurious tympanic membrane.Using the model we have got,we schemed out the mold of spurious tympanic membrane.In addition,we utilized MasterCAM compiling CNC (Computerized Numerical Con- trol) code and simulating the course of working.Ultimately,we obtained the mold of spurious tympanic membrane.Our research in this article has great significance to the success of spurious tympanic membrane grafting operation.

Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report

BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.

New Tympanic Membrane Temperature Shows Good Correlation with the Esophageal Temperature <br/>—Accuracy of a Noncontact Continuous Tympanic Thermometer

Background: An ear-fitting thermometer probe “NIPRO CE THERMO?” (Nipro Corporation, Osaka, Japan, new CE thermo) for both ears was newly developed in 2017. Since new release, we have never investigated about an accuracy of the new CE thermo. In this time, the accuracy of the CE thermo was investigated. Methods: The correlation between the tympanic membrane temperature, measured using the new CE thermo, and the esophageal temperature of 30 patients (right ear: 16 patients, left ear: 14 patients) was measured in the prospective observational study. Results: A good correlation (r = 0.721) and no measurement error (within 1?C in mean ± 2SD) between the two temperatures were observed using Bland-Altman analysis. The correlation and measurement error for each ear yielded the same results. Conclusion: The tympanic membrane temperature, measured using the new CE thermo, showed good correlation with the esophageal temperature and could be used as a central temperature in the perioperative period.

Clinical anatomy of the tympanic nerve: A review

The tympanic （Jacobson’s） nerve is a useful anatomi-cal structure in the middle ear with both practical and physiological functions extending beyond its origin. The paper reviews its clinical anatomy in adults and its surgical signifcance. English language articles from 5 major databases and Google scholar search engine were used to identify papers outlining the anatomy of the tympanic nerve, associated pathology and surgical relevance. In the majority of cases the tympanic nerve arises from the inferior ganglion of the glossopharyn-geal nerve traversing through the tympanic canaliculus into the middle ear. On the promontory it coalesces with sympathetic fbres from the carotid chain forming the tympanic plexus which has individual variability. Functionally, as well as giving off parasympathetic fbres to the parotid gland via the lesser petrosal nerve, it is a useful anatomical landmark for cochlear implantation. The surgical importance of the tympanic nerve is not only restricted to middle ear surgery; it also extends to salivary gland disorders. The tympanic nerve remains clinically relevant to the modern otolaryngologist and as such a detailed understanding of its anatomy is crucial.

A Working Classification of Retraction for the Whole Tympanic Membrane

Objective: To formulate a reliable classification of tympanic membrane retraction which is easy to use but capable of detecting small differences in retraction. Study Design: Prospective study. Methods: The classification was developed from observations dividing the drum into 3 areas: the pars tensa anterior to the malleus, type I, posterior to the malleus (subdivided into upper and lower) type II, and attic type III. The subclassification on paper is more complicated but using a database it is easy to use. The classification is automatically calculated by the database which can also be converted to numerical form. The classification also allows documentation of active disease in retractions. Photographs of seven retracted ear drums were incorporated into the database and ten otolaryngologists asked to classify them. Five were asked to reclassify the retractions in the same way after 3 months. Results: Intra class correlation was significantly high (>0.9) for pars tensa, attic, and for bony erosion. Cronbach’s alpha values were also high (>0.9) in all groups. Retest values were evaluated with Wilcoxon’s signed rank sum test establishing that there was no significant difference in results. Conclusion: The classification shows reliabiliy and validity allowing detection of small changes in tympanic membrane retraction especially affecting the pars tensa but allows classification of the whole tympanic membrane.

A Rare Case of Tarceva Resulting in Tympanic Membrane Necrosis

Objective: To report a novel case of Tarceva? treatment for small cell lung carcinoma resulting in tympanic membrane necrosis. Patient: A 49-year-old male with tympanic membrane necrosis and presumed resistant acute otitis externa and chronic inflammation of the left ear. Patient is status post chemotherapy and radiation diagnosed with non-small cell lung cancer in December 2008 with on-going therapy with Tarceva? for residual disease. Intervention: Tympanoplasty of left ear. Results: Improvement of symptoms of irritation and improvement of hearing and speech reception thresholds. All acid fast bacilli, fungal and bacterial cultures of the intra-op specimen were negative. Conclusions: The possibility that long term Tarceva? therapy could have caused the tympanic membrane necrosis and acute otitis media like symptoms is feasible since Tarceva? is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase. Upon activation of EGFRs it undergoes a transition from inactive monomeric form to active homodimer or hertodimer with another member of the ErbB receptor family. This then initiates several signal transduction cascades, leading to DNA synthesis and cell proliferation. Activation of the receptor is important in the innate immune response in human skin. Some of the common side effects include an aceiform skin rash but this is the first reported link between tympanic membrane necrosis and Tarceva?.

Comparison of endoscopic tympanoplasty to microscopic tympanoplasty in anterior tympanic membrane perforation

Objective:Tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and microscopic tympanoplasty(MT)in anterior tympanic membrane perforation.Methods:The clinical data of 42 patients undergoing tympanoplasty with anterior quadrants tympanic membrane perforation between January 2018 and July 2019 were retrospectively analyzed.Patients were classified into the ET group(n?22)or the MT group(n?20).Patients’demographics,clinical characteristics,surgical and functional outcomes were assessed between the two groups.Results:External auditory canal widening was not necessary in the ET group and was performed in 55.0%of patients in the MT group.The operation time of the ET group was significantly shorter than that of the MT group(61.23±11.48 min vs.78.65±11.79 min,p=0.034).The pain scale score of the ET group at 24 hours after surgery was significantly lower than that of the MT group(0.86±0.64 vs.2.40±1.14,p=0.029).The grafting success rate was 95.5%(21/22)in the ET group and 95.0%(19/20)in the MT group.In the ET group,the pre-and postoperative air-bone gap were 35.60±8.43 dB and 18.79±5.80 dB,respectively,which was a significant improvement(p=0.016).The respective values in the MT group(33.33±7.88 dB and 19.58±6.24 dB)also represented a significant improvement(p=0.004).Conclusion:ET is more beneficial for patients with anterior tympanic membrane perforations,which helps minimize the surgical trauma and reduces operation time and postoperative pain.

Glomus tympanicum removal using transcanal endoscopic assisted surgery:An experience with six cases

Objective:To evaluate an endoscopic approach in the management of glomus tumor,and also to investigate and evaluate its appropriateness and feasibility.Methods:Glomus tumors,also known as paragangliomas,are benign primary tumors of the middle ear.The advent of endoscopic ear surgery has provided new dimensions to the management of this highly vascular tumor.Retrospective analysis of six patients of glomus tympanicum,operated between July 2014 and June 2019,with modified Fisch classification Type A and B1,who were managed by a retroauricular transcanal endoscopic approach.Preoperative and postoperative analysis was done for these patients.Results:The chief complaint was pulsatile tinnitus,which disappeared in five cases and reduced in severity in one of them.Hearing was improved with reduction in air‐bone gap in all the cases.No major complications or recurrence were observed in any of the patients after 12 months of follow‐up.Conclusion:This endoscopic approach serves as a safe and reliable technique for tumor removal.It thus provides postoperative comfort for most of the patients.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

Interlayer repair with porcine small intestinal submucosa versus internal repair with tragus cartilage in endoscopic tympanoplasty

Objective Endoscopic tympanoplasty includes various surgical methods,such as internal repair,interlayer repair,and external overlay.This technique requires autologous materials,allografts,and xenografts,which are used to repair tympanic membrane(TM)perforation.To obtain good results,appropriate surgical methods and repair materials should be selected.This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa(SIS)during transcanal endoscopic type I tympanoplasty.Method A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Perforation size,tympanic status,pre-and postoperative symptoms,follow-up data,wound healing rates,and hearing improvement were analysed.Results Of the 115 patients included in the study,56 underwent interlayer repair with porcine SIS of the TM,and 59 patients underwent internal repair with tragus cartilage.No significant difference was found between the two groups at baseline in terms of age,sex,disease course,perforation side,tympanic status,underlying disease,or preoperative infection.The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07%(51 patients),and that of internal implantation with tragus cartilage was 88.14%(52 patients).No significant difference was found in terms of the graft success rate between the two surgical methods(p=0.887).Postoperative pure tone auditory(PTA)and air-bone gap(ABG)density significantly increased in both groups compared with before surgery(p<0.05).However,the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups(p>0.05).Compared to those in the internal implantation group,the patients in the interlayer group had a shorter operation duration(51.36±6.76 min vs.59.71±7.45 min,t=6.298,p<0.001)and less blood loss(11.91±2.61 mL vs.15.27±2.57 mL,t=7.019,p<0.001).Conclusions Our study suggests that the porcine SIS,as well as the tragus cartilage,has a high success rate in repairing irreversible TM perforation.Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages,including the absence of donor-site incision and scar formation,and ease of graft modification and manipulation.

耳内镜下鼓膜修补术

鼓膜穿孔临床常见,外伤及中耳炎是常见原因。我们自2003年2月~2013年5月对132例鼓膜穿孔患者在电视耳内镜下进行修补,取得满意效果,现报道如下。1.1临床资料。本组患者132例,男95例,女37例,年龄15~59岁,平均35.7岁。右耳47例,左耳85例,均为单耳。外伤性90例,单纯性中耳炎42例。纯音听力测试全部为传导性聋,言语频率平均气导听阈32.5 dB。