Classification of facial nerve aberration in congenital malformation of middle ear:Implications for surgery of hearing restoration

Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.Methods: A retrospective study involving review of clinical data of 227 patients(256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography(CT) data, surgical records and videos.Results: Aberration involving intratemporal facial nerve was found in 82/256 ears(32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window(50/82 ears, 60.98%), bifurcation(3/82 ears, 3.66%) and transverse over the promontory(3/82 ears, 3.66%), counting for 68.29%(56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears(92.68%) and atresia or stenosis of the oval window in 27/82 ears(32.93%). In 9/82 ears(10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis(TORP) implantation and Vibrant Soundbridge(VSB) implantation.Conclusion: The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.

Capillary Hemangioma of the Middle Ear and External Auditory Canal:a Case Report

We report a case of capillary hemangiomsa that involved the entire middle ear space,external auditory canal(EAC) and tympanic antrum.Symptoms in the case included ear fullness,hearing loss,otalgia and otorrhea.The case was misdiagnosed as recurrent chronic otitis media with granulation preoperatively.A diagnosis of capillary hemangioma was established by postoperative histological examination.The management of capillary hemangioma of the middle ear and external auditory canal is discussed,with a review of the literature.Because of its variable and sometimes misleading clinical presentation,hemangioma can initially be misdiagnosed as other lesions.Therefore,a high index of suspicion is necessary for early and accurate diagnosis.

First branchial cleft cyst accompanied by external auditory canal atresia and middle ear malformation:A case report

BACKGROUND We report a rare case of first branchial cleft anomaly(FBCA)accompanied by bony atresia of the external auditory canal,middle ear malformation,and location malformation of the facial nerve according to the intraoperative findings.CASE SUMMARY A 19-year-old male patient presented to our department with a mass behind the right earlobe and recurrent postauricular swelling and pain since childhood,he also had severe hearing loss in the right ear since birth.The patient underwent surgery including mass removal,mastoidectomy,and simultaneous meatoplasty and ossiculoplasty under microscopy.No facial palsy or recurrence was noted during postoperative follow-up.CONCLUSION FBCAs are rare,and to our knowledge,this is the first report of FBCA accompanied by external auditory canal bony atresia,middle ear malformation,and location malformation of the facial nerve.An effective postauricular approach under microscopy facilitated complete lesion removal and simultaneous otologic reconstruction.

Survival in Primary Carcinoma of the External and Middle Ear Is Strongly Dependent on Stage at Diagnosi

Conclusion: Early-stage detection of temporal bone carcinoma improves the survival rate. When detected at an advanced stage, predicted prognosis is poor even with a combination of surgery, radiotherapy and chemotherapy. Objectives: We evaluated treatment strategies and survival rates in cases of carcinomas of the external and middle ear. Method: Retrospective review of patients treated at Ehime University Hospital during the 32 years from 1977 to 2008. Subjects were 41 patients, consisting of 21 men and 20 women with a mean age of 63.2 years. Modified Pittsburgh staging system: stage I in 11 cases (27%), stage II in 4 (10%), stage III in 6 (15%) and stage IV in 20 (49%). Histopathology: squamous cell carcinoma (SCC) in 35 cases, adenoid cystic carcinoma (ACC) in 3, and adenocarcinoma (AC) in 3. Thirty-eight patients were treated by surgery. Radiation was added postoperatively in 23 patients. Three patients were treated by chemoradiotherapy. Results: The survival rate of carcinomas detected at an advanced stage was poor with a disease-specific 5-year survival rate of 100% in early-stage disease (stage I and II) versus 20.8% in stage III and 27.5% in stage IV disease, irrespective of histopathology of the tumor.

Chromsome and pedigree analysis of congenital malformation of external and middle ear

Objective:Using chromosome analysis of a Chinese pedigree to investigate the genetic relationship between chromosome and congenital malformation of the external and middle ear combined with pre-auricular fistula.Methods: Clinical data of all members from 3 family with congenital malformation of the external and middle ear combined with pre-auricular fistula were collected. A pedigrees chart of each family was draw Venous blood samples of all participants were taken for karyotype analysis.Results: A total of 21 members in three generations from three families were screened. Chromosomal abnormalities were detected in 9 people, including 3 patients and 6 carriers. The carriers were fathers and paternal grandparents. Structural abnormalities in chromosomes 1, 2 and 11 were identified.Conclusion:The genetic patterns of congenital malformation of the external and middle ear combined with the pre- auricular fistula in these three families are consistent with autosomal recessive inheritance. Family survey is helpful for further study of this disease.

Middle ear foreign body causing cholesteatoma and external auditory canal granuloma: a case report

Objective Patients with unilateral ear discharge and hearing loss often have external or middle ear diseases. We present a 55-year-old man who suffered from persistent ear discharge and hearing loss in the left ear. Local findings showed that his left ear canal was filled with a large amount of granulation tissue, with purulent, foul-smelling discharge. Computed tomography indicated left middle ear cholesteatoma and mass shadow in the left external auditory canal. Modified radical mastoidectomy was performed. A piece of white plastic stick was found in the middle ear during the operation. Foreign body-induced cholesteatoma and external auditory canal granuloma in adults are very rare. We present this rare case so that these conditions can be better recognized and understood.

A CLINICAL OBSERVATION ON CORONARY HEART DISEASE TREATED BY OTOPUNCTURE AT HEART OTOPOINT

In the clinical study of acupuncture for treatment of coronary heart disease, body acupuncture was primarily used, and otopuncture was seldom used. Under the premise of guarantee of therapeutic effects, screening out relatively specific acupoint for treatment of coronary disease is a

六步行为认知法对先天性外中耳畸形修复患儿负性情绪及应对方式的影响

目的:探究六步行为认知法对先天性外中耳畸形修复患儿负性情绪及应对方式的影响。方法:选取2021年1月-2023年1月笔者医院进行先天性外中耳畸形修复的98例患儿为研究对象,根据随机数字表法分为研究组(n=49)和对照组(n=49)。研究组围术期实施六步行为认知法干预,对照组实施常规护理干预。比较干预前后两组患儿焦虑状态[改良版耶鲁围手术期焦虑量表(The modified yale preoperative anxiety scale,mYPAS)]、应对方式[慢性病儿童应对方式量表(Coping with a disease,CODI)]、自信心评分(儿童自信心评定量表)、护理满意度及并发症情况变化。结果:干预实施后,两组患儿各指标均有改善,且研究组mYPAS评分低于对照组,CODI评分优于对照组,儿童自信心评分高于对照组,护理满意度也高于对照组,差异均有统计学意义(P<0.05)。结论:六步行为认知法有利于改善先天性外中耳畸形修复患儿焦虑状态,增强患儿自信心,提高积极应对方式与护理满意度,减少并发症。

Isolated Adenoma with Neuroendocrine Differentiation Involving Both the Facial Nerve and Parotid Gland

Objective: To report an extremely rare case of neuroendocrine tumour with simultaneous involvement of both the facial nerve and the deep lobe of parotid gland. Method: case report and English language literature review concerning neuroendocrine neoplasm involving the facial nerve with emphasis on clinical presentation. Results: We report a unique case of adenoma with neuroendocrine differentiation which involved both the mastoid segment of the right facial nerve and also the deep lobe of the parotid gland on the ipsilateral side. Both tumours were not contiguous and were anatomically separate from each other. A CT scan of the whole body revealed no other neuroendocrine tumours. Conclusion: To the best of our knowledge, this is the first report in the English language literature of a neuroendocrine tumour to involve both the vertical mastoid segment of the facial nerve with simultaneous involvement of the deep lobe of parotid gland as a separate lesion.

先天性外中耳畸形整形再造与功能重建诊疗体系的建设与进展

先天性外中耳畸形是头面部最常见的出生缺陷之一,临床主要表现为耳廓外观异常,常伴发传导性或混合性听力损失,除需关注外中耳畸形的诊断分类及整形再造外,还要同时考虑听觉功能的评估和重建。本文将从耳廓畸形的分类、耳模矫正、耳整形、耳廓再造、外耳道与中耳畸形的成形和再造以及功能性耳再造技术等方面,具体阐述先天性外中耳畸形功能耳再造诊疗体系的发展、建设历程以及相关技术进展。

中耳胆脂瘤乳突改良根治术中面神经裸露的相关危险因素分析及关联性研究

目的探讨中耳胆脂瘤乳突改良根治术中面神经裸露情况,并分析相关危险因素,为临床医师提供手术参考。方法回顾性分析2016年1月至2023年9月因“中耳胆脂瘤”于广东省梅州市人民医院行乳突改良根治术的296例(301耳)患者的临床资料。采用单因素分析和多因素logistic回归分析探讨性别、年龄、病程、手术耳、外半规管瘘、硬脑膜暴露、乙状窦暴露、外耳道后壁破坏、乳突气化类型、镫骨破坏以及盾板破坏与面神经裸露的关联性。结果301耳中耳胆脂瘤乳突改良根治术中有118耳发现有面神经裸露,发生率为39.2%,最常见发生部位是鼓室段83.1%(98/118)。单因素分析显示:面神经裸露(+)组和面神经裸露(-)组的外半规管瘘、硬脑膜暴露、镫骨破坏、乙状窦暴露、外耳道后壁破坏、盾板破坏比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:外半规管瘘(β=0.993,OR=2.700,95%CI=1.380~5.279)、镫骨破坏(β=1.794,OR=6.014,95%CI=3.453~10.477)、外耳道后壁破坏(β=1.124,OR=3.078,95%CI=1.587~5.971)为面神经裸露的危险因素(P<0.05)。同时随着共存危险因素个数增加,出现面神经裸露的风险随之增高,特别是当外半规管瘘+镫骨破坏+外耳道后壁破坏三个危险因素累积共存时,面神经裸露的风险提高了16.3倍(β=2.791,OR=16.290,95%CI=3.704~71.643)。结论中耳胆脂瘤面神经裸露率为39.2%,好发于鼓室段。外半规管瘘、镫骨破坏、外耳道后壁破坏为面神经裸露的危险因素,当上述多个危险因素累积时,面神经裸露风险进一步增加。

自体移植外耳道后壁重建联合鼓室成形术治疗中耳胆脂瘤的效果观察

目的:探讨中耳胆脂瘤患者采用自体移植外耳道后壁重建联合鼓室成形术治疗的临床效果。方法:抽取我院耳鼻咽喉头颈外科2019年6月—2023年6月收治的中耳胆脂瘤患者108例为研究对象,采用随机数表法分为对照组和试验组,各54例。对照组行完壁式乳突切除+鼓室成形术治疗,试验组行自体移植外耳道后壁重建+鼓室成形术治疗。评估两组治疗效果,观察两组炎症因子、听力指标变化情况及并发症发生情况。结果:(1)试验组术后3个月白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组,差异均有统计学意义(P<0.05);(2)试验组术后3个月0.25~4.0kHz频率下气导听阈水平显著低于对照组,差异均有统计学意义(P<0.05);(3)试验组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05);(4)两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:针对中耳胆脂瘤患者给予自体移植外耳道后壁重建联合鼓室成形术治疗,可改善炎症因子水平,促进听力恢复,提高疗效,且该术式并发症少、安全性高。

先天性外耳道闭锁症手术方法的选择

目的探讨先天性外耳道闭锁症的中耳畸形特点、治疗方法及其效果。方法回顾性总结分析1999年1月—2003年12月在我科接受外耳道及鼓室成形术,且有完整随访资料的先天性骨性外耳道闭锁64耳。结果41耳采取直入式径路即前上径路,23耳采用乳突径路。64耳中,有3耳未找到鼓室。61耳中,鼓室及听小骨存在不同程度的发育异常;同时,术中发现面神经畸形或异常共40耳(65.57%)。术后随访1￣5年。61耳中,49耳术后(语频平均)听力提高>30dBHL(80.33%),气骨导差缩小至15dBHL以内者32耳(52.46%)。61耳中有6耳于术后3月￣2年出现外耳道狭窄而需行再次外耳道成形术,4例术后效果良好,2例拒绝再次手术;2例术后出现鼓膜外侧愈合,听力提高不理想,均因另耳听力尚可亦拒绝再次手术;术后有3耳出现面瘫,2￣6月后完全恢复。术后2例出现术腔感染。结论外耳道区内为骨化型和松质型者可作为直入式径路的适应证,而混合型或气房型最好采用乳突径路。手术步骤无固定术式,须视术中所见,灵活机动处理。

先天性外耳道闭锁中耳畸形临床分析

采用外耳道及鼓室再造术治疗先天性外耳道完全闭锁 2 9例。统计各种外、中耳畸形情况 ,比较耳廓发育程度、颞骨相当于外耳道口处有无骨性小凹、术前听力损失程度与中耳畸形的关系 ,将术前的常规横断位 CT检查结果与术中所见进行对照。结果显示 ,术前可通过耳廓发育程度、相当于外耳道口处有无骨性小凹、听力损失程度和颞骨 CT扫描来综合估计中耳畸形情况 。

耳畸形手术的面神经防护(519例手术回顾分析)

为总结耳畸形手术中面神经防护的经验，分析了１９８３年８月～１９９５年７月底５１９例耳各类耳畸形手术的临床资料。单纯中耳畸形１３０例中，面神经畸形率为６０．８％（７９／１３０），鼓索神经畸形率为５．４％（７／１３０）；外耳道狭窄伴中耳畸形７５例中，面神经畸形率为６０．０％（４５／７５），鼓索神经畸形率为１３．３％（１０／７５）；外耳道骨性闭锁伴中耳畸形３１４例中，面神经畸形率为４２．５％（１４２／３１４），鼓索神经畸形率为１００．０％（３１４／３１４）。４２８例（８２．５％）术后听力增进，其中２２１例（４２．６％）获实用听力（３０～４５ｄＢ）。远期随访１９８例，其中１５２例（７６．７％）仍保持近期听力水平。术后近期面瘫２例（０．４％）。耳畸形术中面神经保护的关键是尽早辨认面神经，采用高分辨率ＣＴ颞骨扫描，熟悉颞骨解剖标志。

中耳显微解剖标志与面神经定位

目的观察中耳手术中面神经相关的显微解剖结构,并探讨其临床应用。方法 30具(60侧颞骨)中国人成年湿性头颅标本经乳突入路对颞骨进行显微解剖,重点观察面神经并根据其周围的固定解剖标志对其进行定位。结果面神经乳突段前缘和后缘至假想定位线的距离分别为(-0.11±0.36)mm和(-0.14±0.38)mm,鼓室段面神经下缘与假想定位线的距离为(0.31±0.12)mm,砧骨短脚末端至外半规管下缘的距离为(1.73±0.24)mm,外半规管至面神经锥段上缘的距离为(2.65±0.25)mm,砧骨短脚最末端至面神经锥段上缘的距离为(2.20±0.41)mm,镫骨头上缘至面神经水平段下缘的距离为(2.24±0.23)mm等。结论外半规管、砧骨短突、鼓环、二腹肌嵴、前庭窗、匙突、卵圆窗、锥隆起和鼓索神经等是中耳显微手术的重要解剖标志,并与面神经关系极其密切和恒定。

先天性外耳和中耳畸形患者的听力学分析

目的探讨不同程度的先天性外、中耳畸形患者的听力学表现。方法对55例(双耳15例,单耳40例,共70耳)先天性外、中耳畸形患者行纯音测听、听性脑干反应(ABR)和颞骨CT检查,其中45耳行外耳或中耳成形术,10耳单纯行耳廓成形术,并结合术中所见按不同程度的畸形分组,比较其听力学改变。结果63耳纯音测听显示为传导性聋,骨导听阈正常,70耳ABR反应阈升高,耳廓和听骨链畸形严重者纯音听阈值大于70dB(其中镫骨和卵圆窗畸形严重者纯音听阈大于80dB),与畸形程度较轻者差异有统计学意义(P<0.05)。乳突气化差、外耳道骨性闭锁者纯音听阈值大于70dB(其中外耳道口处无骨性小凹者纯音听阈值大于70dB),较外耳道、乳突发育好者差异有统计学意义(P<0.05)。结论对先天性外、中耳畸形患者术前进行纯音测听、ABR检查,并结合临床和颞骨CT检查,可初步评估外耳、中耳发育程度,进而指导手术治疗。

外中耳先天畸形的HRCT研究

目的研究外中耳先天畸形的高分辨CT(HRCT)表现,为临床诊断和治疗提供准确信息。资料与方法对临床诊断的外、中耳先天畸形35例行HRCT扫描,单纯横断位扫描5例,横断位加冠状位扫描30例。结果(1)外耳畸形32例共42耳,其中外耳道骨性闭锁30耳,显示闭锁板为完全性26耳,不完全性4耳。膜性闭锁5耳。双侧分别为不同类型闭锁1例。外耳道狭窄7耳,其中狭窄合并对侧闭锁1例。合并畸形中,面神经管垂直段明显前移22耳,下颌髁状突明显后上移25耳,乙状窦前移4耳,均见于骨性外耳道闭锁。伴发的中耳畸形主要为小鼓室及不同程度的听骨发育不全或缺如。合并内耳发育不全1例。(2)单纯性中耳畸形3例共6耳,均表现为听小骨异常。合并小鼓室1例,耳咽管和鼓室窦畸形扩大1例。结论HRCT能准确显示外中耳先天畸形的类型、程度以及合并畸形,为临床治疗方案的正确制定提供重要的参考依据。

与侧颅底手术有关的颈静脉球区解剖研究

目的 为了提高对侧颅底手术中颈静脉球空间形态的认识。方法 对 2 0具成人尸头 4 0侧颈静脉球高度、顶部骨质气化、毗邻结构进行了解剖观测。结果 发现颈静脉球与面神经垂直段最短距离为 2 .6 7± 1.2 3mm(0～ 4 .6 2mm) ,左右侧无显著差异 ;与鼓室最小间隔为 :右侧 3.12± 1.4 6mm(0～ 6 .16mm) ,左侧 4 .86± 2 .0 4mm(1.0 2～ 9.2 6mm) ,P <0 .0 5;高位颈静脉球出现率为 17.5% (7/40 ) ,右侧为 30 % (6 /2 0 ) ,左侧为 5% (1/2 0 ) ,P <0 .0 5;右侧颈静脉球高度为 9.2 9± 1.78mm(6 .58～ 14.2 6mm) ,左侧为 6 .0 4± 2 .98mm(0～ 11.84mm) ,P<0 .0 0 1;颈静脉球顶部骨质硬化时其高度为 5.33± 3.2 1mm(0～ 9.54mm ) ,非硬化时高度为8.90± 2 .0 8mm(2 .6 8～ 14.2 6 ) ,P <0 .0 0 1;颈静脉球到内耳道最短距离为 :右侧 5.82±1.6 4mm(3.16～ 8.6 2mm) ,左侧 8.0 2± 2 .38mm(4 .2 6～ 17.12mm)P <0 .0 5。结论 正常人左、右侧颈静脉球区解剖有一定规律及差异 ,熟悉颈静脉球解剖 。

耳内镜下经外耳道切除上鼓室胆脂瘤35例疗效分析

目的探讨耳内镜下经外耳道入路治疗上鼓室胆脂瘤的可行性、手术方法及疗效。方法回顾分析2014年1月～2017年1月在徐州市中心医院接受耳内镜手术的35例(35耳)中耳上鼓室胆脂瘤患者的临床资料。35例患者中男20例,女15例;年龄22～66岁,平均年龄42. 8岁;病程2～20个月,平均10个月。所有患者均在全麻耳内镜下手术,根据胆脂瘤大小决定手术范围。12例行上鼓室重建,10耳听骨链破坏或缺失者,行部分人工听骨重建(partial ossicular replacement prosthesis,PORP)。结果 35耳上鼓室胆脂瘤病灶均彻底清除,未出现面瘫及脑脊液漏等并发症。所有患者术后随访1年以上,患者鼓膜愈合良好,移植物形态良好。耳内镜检查或者颞骨薄层CT检查未见胆脂瘤复发,术后听力提高22例(62. 8%),听力无变化10例(28. 6%),听力下降3例(8. 6%),平均气导听阈与气骨导差均有改善,术后0. 5、1、2、4 k Hz平均气导听阈为(29. 234±8. 38) d B,与术前的(43. 64±8. 38) d B比较差异具有统计学意义(P <0. 05);术后0. 5、1、2、4 k Hz平均气骨导差值为(15. 27±6. 74) d B,与术前的(28. 27±5. 94) d B比较差异具有统计学意义(P <0. 05)。结论耳内镜下经外耳道上鼓室胆脂瘤切除术是有效的手术方法,复发率低,听力改善明显,与传统显微镜手术相比有优越性。