Bone-conduction circuit model for chinchilla part I: Defining parameters by fitting to air-conduction data

NASA Astrophysics Data System (ADS)

Bowers, Peter; Rosowski, John J.

2018-05-01

An air-conduction circuit model that will serve as the basis for a model of bone-conduction hearing is developed for chinchilla. The lumped-element model is based on the classic Zwislocki model of the human middle ear. Model parameters are fit to various measurements of chinchilla middle-ear transfer functions and impedances. The model is in agreement with studies of the effects of middle-ear cavity holes in experiments that require access to the middle-ear air space.

Finite element modeling of sound transmission with perforations of tympanic membrane

PubMed Central

Gan, Rong Z.; Cheng, Tao; Dai, Chenkai; Yang, Fan; Wood, Mark W.

2009-01-01

A three-dimensional finite element (FE) model of human ear with structures of the external ear canal, middle ear, and cochlea has been developed recently. In this paper, the FE model was used to predict the effect of tympanic membrane (TM) perforations on sound transmission through the middle ear. Two perforations were made in the posterior-inferior quadrant and inferior site of the TM in the model with areas of 1.33 and 0.82 mm2, respectively. These perforations were also created in human temporal bones with the same size and location. The vibrations of the TM (umbo) and stapes footplate were calculated from the model and measured from the temporal bones using laser Doppler vibrometers. The sound pressure in the middle ear cavity was derived from the model and measured from the bones. The results demonstrate that the TM perforations can be simulated in the FE model with geometrical visualization. The FE model provides reasonable predictions on effects of perforation size and location on middle ear transfer function. The middle ear structure-function relationship can be revealed with multi-field coupled FE analysis. PMID:19603881

[The effect of OSAHS on middle ear and inner ear vestibule function advances].

PubMed

Li, K L; Li, J R

2016-05-20

Obstructive sleep apnea hypopnea syndrome(OSAHS) as a common frequentlyoccurring disease, it can cause repeated episodes of hypoxaemia and hypercapnia during sleep. With long period of hypoxaemia, obvious pathological changes and dysfunction emerged in heart，brain and lung then all kinds of clinical symptoms appear. Because of the middle ear and inner ear themselves anatomical characteristics and blood supply of regulating mechanism， they often has been damaged before the other important organ damage. As scholars have indepth study of the auditory system complications in patients with OSAHS, various influence of OSAHS on the middle ear，inner ear also gradually be known.This paper will review the effect of OSAHS on middle ear， inner ear and vestibule function, hope to have some application value for clinical work. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

In situ tissue engineering with synthetic self-assembling peptide nanofiber scaffolds, PuraMatrix, for mucosal regeneration in the rat middle-ear

PubMed Central

Akiyama, Naotaro; Yamamoto-Fukuda, Tomomi; Takahashi, Haruo; Koji, Takehiko

2013-01-01

Middle-ear mucosa maintains middle-ear pressure. However, the majority of surgical cases exhibit inadequate middle-ear mucosal regeneration, and mucosal transplantation is necessary in such cases. The aim of the present study was to assess the feasibility of transplantation of isolated mucosal cells encapsulated within synthetic self-assembling peptide nanofiber scaffolds using PuraMatrix, which has been successfully used as scaffolding in tissue engineering, for the repair of damaged middle-ear. Middle-ear bullae with mucosa were removed from Sprague Dawley (SD) transgenic rats, transfected with enhanced green fluorescent protein (EGFP) transgene and excised into small pieces, then cultured up to the third passage. After surgical elimination of middle-ear mucosa in SD recipient rats, donor cells were encapsulated within PuraMatrix and transplanted into these immunosuppressed rats. Primary cultured cells were positive for pancytokeratin but not for vimentin, and retained the character of middle-ear epithelial cells. A high proportion of EGFP-expressing cells were found in the recipient middle-ear after transplantation with PuraMatrix, but not without PuraMatrix. These cells retained normal morphology and function, as confirmed by histological examination, immunohistochemistry, and electron microscopy, and multiplied to form new epithelial and subepithelial layers together with basement membrane. The present study demonstrated the feasibility of transplantation of cultured middle-ear mucosal epithelial cells encapsulated within PuraMatrix for regeneration of surgically eliminated mucosa of the middle-ear in SD rats. PMID:23926427

In situ tissue engineering with synthetic self-assembling peptide nanofiber scaffolds, PuraMatrix, for mucosal regeneration in the rat middle-ear.

PubMed

Akiyama, Naotaro; Yamamoto-Fukuda, Tomomi; Takahashi, Haruo; Koji, Takehiko

2013-01-01

Middle-ear mucosa maintains middle-ear pressure. However, the majority of surgical cases exhibit inadequate middle-ear mucosal regeneration, and mucosal transplantation is necessary in such cases. The aim of the present study was to assess the feasibility of transplantation of isolated mucosal cells encapsulated within synthetic self-assembling peptide nanofiber scaffolds using PuraMatrix, which has been successfully used as scaffolding in tissue engineering, for the repair of damaged middle-ear. Middle-ear bullae with mucosa were removed from Sprague Dawley (SD) transgenic rats, transfected with enhanced green fluorescent protein (EGFP) transgene and excised into small pieces, then cultured up to the third passage. After surgical elimination of middle-ear mucosa in SD recipient rats, donor cells were encapsulated within PuraMatrix and transplanted into these immunosuppressed rats. Primary cultured cells were positive for pancytokeratin but not for vimentin, and retained the character of middle-ear epithelial cells. A high proportion of EGFP-expressing cells were found in the recipient middle-ear after transplantation with PuraMatrix, but not without PuraMatrix. These cells retained normal morphology and function, as confirmed by histological examination, immunohistochemistry, and electron microscopy, and multiplied to form new epithelial and subepithelial layers together with basement membrane. The present study demonstrated the feasibility of transplantation of cultured middle-ear mucosal epithelial cells encapsulated within PuraMatrix for regeneration of surgically eliminated mucosa of the middle-ear in SD rats.

Modeling Analysis of Biomechanical Changes of Middle Ear and Cochlea in Otitis Media

NASA Astrophysics Data System (ADS)

Gan, Rong Z.; Zhang, Xiangming; Guan, Xiying

2011-11-01

A comprehensive finite element (FE) model of the human ear including the ear canal, middle ear, and spiral cochlea was developed using histological sections of human temporal bone. The cochlea was modeled with three chambers separated by the basilar membrane and Reissner's membrane and filled with perilymphatic fluid. The viscoelastic material behavior was applied to middle ear soft tissues based on dynamic measurements of tissues in our lab. The model was validated using the experimental data obtained in human temporal bones and then used to simulate various stages of otitis media (OM) including the changes of morphology, mechanical properties, pressure, and fluid level in the middle ear. Function alterations of the middle ear and cochlea in OM were derived from the model and compared with the measurements from temporal bones. This study indicates that OM can be simulated in the FE model to predict the hearing loss induced by biomechanical changes of the middle ear and cochlea.

Replication of type 5 adenovirus promotes middle ear infection by Streptococcus pneumoniae in the chinchilla model of otitis media

PubMed Central

Murrah, Kyle A.; Turner, Roberta L.; Pang, Bing; Perez, Antonia C.; Reimche, Jennifer L.; King, Lauren B.; Wren, John; Gandhi, Uma; Swords, W. Edward; Ornelles, David A.

2015-01-01

Adenoviral infection is a major risk factor for otitis media. We hypothesized that adenovirus promotes bacterial ascension into the middle ear through the disruption of normal function in the Eustachian tubes due to inflammation-induced changes. An intranasal infection model of the chinchilla was used to test the ability of type 5 adenovirus to promote middle ear infection by Streptococcus pneumoniae. The hyperinflammatory adenovirus mutant dl327 and the nonreplicating adenovirus mutant H5wt300ΔpTP were used to test the role of inflammation and viral replication, respectively, in promotion of pneumococcal middle ear infection. Precedent infection with adenovirus resulted in a significantly greater incidence of middle ear disease by S. pneumoniae as compared to nonadenovirus infected animals. Infection with the adenovirus mutant dl327 induced a comparable degree of bacterial ascension into the middle ear as did infection with the wild-type virus. By contrast, infection with the nonreplicating adenovirus mutant H5wt300ΔpTP resulted in less extensive middle ear infection compared to the wild-type adenovirus. We conclude that viral replication is necessary for adenoviral-induced pneumococcal middle ear disease. PMID:25251686

Better late than never: effective air-borne hearing of toads delayed by late maturation of the tympanic middle ear structures.

PubMed

Womack, Molly C; Christensen-Dalsgaard, Jakob; Hoke, Kim L

2016-10-15

Most vertebrates have evolved a tympanic middle ear that enables effective hearing of airborne sound on land. Although inner ears develop during the tadpole stages of toads, tympanic middle ear structures are not complete until months after metamorphosis, potentially limiting the sensitivity of post-metamorphic juveniles to sounds in their environment. We tested the hearing of five species of toads to determine how delayed ear development impairs airborne auditory sensitivity. We performed auditory brainstem recordings to test the hearing of the toads and used micro-computed tomography and histology to relate the development of ear structures to hearing ability. We found a large (14-27 dB) increase in hearing sensitivity from 900 to 2500 Hz over the course of ear development. Thickening of the tympanic annulus cartilage and full ossification of the middle ear bone are associated with increased hearing ability in the final stages of ear maturation. Thus, juvenile toads are at a hearing disadvantage, at least in the high-frequency range, throughout much of their development, because late-forming ear elements are critical to middle ear function at these frequencies. We discuss the potential fitness consequences of late hearing development, although research directly addressing selective pressures on hearing sensitivity across ontogeny is lacking. Given that most vertebrate sensory systems function very early in life, toad tympanic hearing may be a sensory development anomaly. © 2016. Published by The Company of Biologists Ltd.

Acoustical transmission-line model of the middle-ear cavities and mastoid air cells.

PubMed

Keefe, Douglas H

2015-04-01

An acoustical transmission line model of the middle-ear cavities and mastoid air cell system (MACS) was constructed for the adult human middle ear with normal function. The air-filled cavities comprised the tympanic cavity, aditus, antrum, and MACS. A binary symmetrical airway branching model of the MACS was constructed using an optimization procedure to match the average total volume and surface area of human temporal bones. The acoustical input impedance of the MACS was calculated using a recursive procedure, and used to predict the input impedance of the middle-ear cavities at the location of the tympanic membrane. The model also calculated the ratio of the acoustical pressure in the antrum to the pressure in the middle-ear cavities at the location of the tympanic membrane. The predicted responses were sensitive to the magnitude of the viscothermal losses within the MACS. These predicted input impedance and pressure ratio functions explained the presence of multiple resonances reported in published data, which were not explained by existing MACS models.

Audiometric Predictions Using SFOAE and Middle-Ear Measurements

PubMed Central

Ellison, John C.; Keefe, Douglas H.

2006-01-01

Objective The goals of the study are to determine how well stimulus-frequency otoacoustic emissions (SFOAEs) identify hearing loss, classify hearing loss as mild or moderate-severe, and correlate with pure-tone thresholds in a population of adults with normal middle-ear function. Other goals are to determine if middle-ear function as assessed by wideband acoustic transfer function (ATF) measurements in the ear canal account for the variability in normal thresholds, and if the inclusion of ATFs improves the ability of SFOAEs to identify hearing loss and predict pure-tone thresholds. Design The total suppressed SFOAE signal and its corresponding noise were recorded in 85 ears (22 normal ears and 63 ears with sensorineural hearing loss) at octave frequencies from 0.5 – 8 kHz using a nonlinear residual method. SFOAEs were recorded a second time in three impaired ears to assess repeatability. Ambient-pressure ATFs were obtained in all but one of these 85 ears, and were also obtained from an additional 31 normal-hearing subjects in whom SFOAE data were not obtained. Pure-tone air-and bone-conduction thresholds and 226-Hz tympanograms were obtained on all subjects. Normal tympanometry and the absence of air-bone gaps were used to screen subjects for normal middle-ear function. Clinical decision theory was used to assess the performance of SFOAE and ATF predictors in classifying ears as normal or impaired, and linear regression analysis was used to test the ability of SFOAE and ATF variables to predict the air-conduction audiogram. Results The ability of SFOAEs to classify ears as normal or hearing impaired was significant at all test frequencies. The ability of SFOAEs to classify impaired ears as either mild or moderate-severe was significant at test frequencies from 0.5 to 4 kHz. SFOAEs were present in cases of severe hearing loss. SFOAEs were also significantly correlated with air-conduction thresholds from 0.5 to 8 kHz. The best performance occurred using the SFOAE signal-to-noise ratio (S/N) as the predictor, and the overall best performance was at 2 kHz. The SFOAE S/N measures were repeatable to within 3.5 dB in impaired ears. The ATF measures explained up to 25% of the variance in the normal audiogram; however, ATF measures did not improve SFOAEs predictors of hearing loss except at 4 kHz. Conclusions In common with other OAE types, SFOAEs are capable of identifying the presence of hearing loss. In particular, SFOAEs performed better than distortion-product and click-evoked OAEs in predicting auditory status at 0.5 kHz; SFOAE performance was similar to that of other OAE types at higher frequencies except for a slight performance reduction at 4 kHz. Because SFOAEs were detected in ears with mild to severe cases of hearing loss they may also provide an estimate of the classification of hearing loss. Although SFOAEs were significantly correlated with hearing threshold, they do not appear to have clinical utility in predicting a specific behavioral threshold. Information on middle-ear status as assessed by ATF measures offered minimal improvement in SFOAE predictions of auditory status in a population of normal and impaired ears with normal middle-ear function. However, ATF variables did explain a significant fraction of the variability in the audiograms of normal ears, suggesting that audiometric thresholds in normal ears are partially constrained by middle-ear function as assessed by ATF tests. PMID:16230898

Age-related full-field motion change in baboon tympanic membrane

NASA Astrophysics Data System (ADS)

Gan, Rong Z.; Jiang, Shangyuan; Pineda, Mario

2018-05-01

Clinical observations indicate that the structure and function of the middle ear change from newborn to adult. However, due to the lack of young children's temporal bones for investigators, characterizations of the pediatric middle ear function and tissue mechanical properties are limited. Higher primates such as olive baboons (Papio anubis) ear specimens may provide alternative testing sources whose properties are likely to closely resemble those of humans. This paper reports our recent study on measurement of the tympanic membrane (TM) surface motion of baboon temporal bones in the age range from 6 months to young adult using the scanning laser Doppler vibrometry (SLDV). The full-field TM motion and the umbo displacement show that the mobility of the TM at frequencies below 2 kHz increased as age increases and the middle ear input impedance decreased with the age increase. The traveling-wave-like vibration modes in adult TMs started appearing at lower frequencies than that of young baboons. The results show the age-dependent middle ear function changes in baboons which may open a new research dimension to provide urgently needed data for biomechanical properties of young children ears.

Chinchilla middle ear transmission matrix model and middle-ear flexibilitya)

PubMed Central

Ravicz, Michael E.; Rosowski, John J.

2017-01-01

The function of the middle ear (ME) in transforming ME acoustic inputs and outputs (sound pressures and volume velocities) can be described with an acoustic two-port transmission matrix. This description is independent of the load on the ME (cochlea or ear canal) and holds in either direction: forward (from ear canal to cochlea) or reverse (from cochlea to ear canal). A transmission matrix describing ME function in chinchilla, an animal commonly used in auditory research, is presented, computed from measurements of forward ME function: input admittance YTM, ME pressure gain GMEP, ME velocity transfer function HV, and cochlear input admittance YC, in the same set of ears [Ravicz and Rosowski (2012b). J. Acoust. Soc. Am. 132, 2437–2454; (2013a). J. Acoust. Soc. Am. 133, 2208–2223; (2013b). J. Acoust. Soc. Am. 134, 2852–2865]. Unlike previous estimates, these computations require no assumptions about the state of the inner ear, effectiveness of ME manipulations, or measurements of sound transmission in the reverse direction. These element values are generally consistent with physical constraints and the anatomical ME “transformer ratio.” Differences from a previous estimate in chinchilla [Songer and Rosowski (2007). J. Acoust. Soc. Am. 122, 932–942] may be due to a difference in ME flexibility between the two subject groups. PMID:28599566

Chinchilla middle ear transmission matrix model and middle-ear flexibility.

PubMed

Ravicz, Michael E; Rosowski, John J

2017-05-01

The function of the middle ear (ME) in transforming ME acoustic inputs and outputs (sound pressures and volume velocities) can be described with an acoustic two-port transmission matrix. This description is independent of the load on the ME (cochlea or ear canal) and holds in either direction: forward (from ear canal to cochlea) or reverse (from cochlea to ear canal). A transmission matrix describing ME function in chinchilla, an animal commonly used in auditory research, is presented, computed from measurements of forward ME function: input admittance Y TM , ME pressure gain G MEP , ME velocity transfer function H V , and cochlear input admittance Y C , in the same set of ears [Ravicz and Rosowski (2012b). J. Acoust. Soc. Am. 132, 2437-2454; (2013a). J. Acoust. Soc. Am. 133, 2208-2223; (2013b). J. Acoust. Soc. Am. 134, 2852-2865]. Unlike previous estimates, these computations require no assumptions about the state of the inner ear, effectiveness of ME manipulations, or measurements of sound transmission in the reverse direction. These element values are generally consistent with physical constraints and the anatomical ME "transformer ratio." Differences from a previous estimate in chinchilla [Songer and Rosowski (2007). J. Acoust. Soc. Am. 122, 932-942] may be due to a difference in ME flexibility between the two subject groups.

The comparative anatomy of the pig middle ear cavity: a model for middle ear inflammation in the human?

PubMed Central

PRACY, J. P.; WHITE, A.; MUSTAFA, Y.; SMITH, D.; PERRY, M. E.

1998-01-01

This study was undertaken to develop a functional model of otitis media with effusion (OME) in the pig (Sus scrofa), with the purpose of investigating the origin of lymphocytes populating the middle ear during the course of an inflammatory process. The relevance of the model to the human condition of OME is to a large extent dependent on the anatomical and physiological similarities between the middle ear cavity and the pharyngeal lymphoid tissue of the pig and man. Anatomical specimens were collected from 7 young Large White pigs to determine the gross anatomy of the middle ear cavity and the histological characteristics of the middle ear mucosa. It was found that the anatomy of the 3 parts of the middle ear cavity in man and in the pig is broadly similar, although some minor differences were observed. The porcine eustachian tube was seen to be cartilaginous throughout its length in contrast to the part osseous, part cartilaginous structure found in man; the porcine ossicles were slightly different in shape to those of man and the air cell system was situated inferior to the tympanic cavity in the pig as opposed to posteriorly in man. This paper describes the structure and morphology of the pig middle ear cavity and compares and contrasts it with that of man. The minor differences observed are of anatomical importance but do not diminish the usefulness of the pig middle ear cleft as a potential model for human middle ear disorders. PMID:9688502

A prediction of the minke whale (Balaenoptera acutorostrata) middle-ear transfer function.

PubMed

Tubelli, Andrew A; Zosuls, Aleks; Ketten, Darlene R; Yamato, Maya; Mountain, David C

2012-11-01

The lack of baleen whale (Cetacea Mysticeti) audiograms impedes the assessment of the impacts of anthropogenic noise on these animals. Estimates of audiograms, which are difficult to obtain behaviorally or electrophysiologically for baleen whales, can be made by simulating the audiogram as a series of components representing the outer, middle, and inner ear (Rosowski, 1991; Ruggero and Temchin, 2002). The middle-ear portion of the system can be represented by the middle-ear transfer function (METF), a measure of the transmission of acoustic energy from the external ear to the cochlea. An anatomically accurate finite element model of the minke whale (Balaenoptera acutorostrata) middle ear was developed to predict the METF for a mysticete species. The elastic moduli of the auditory ossicles were measured by using nanoindentation. Other mechanical properties were estimated from experimental stiffness measurements or from published values. The METF predicted a best frequency range between approximately 30 Hz and 7.5 kHz or between 100 Hz and 25 kHz depending on stimulation location. Parametric analysis found that the most sensitive parameters are the elastic moduli of the glove finger and joints and the Rayleigh damping stiffness coefficient β. The predicted hearing range matches well with the vocalization range.

The Effects of Age at Cleft Palate Repair on Middle Ear Function and Hearing Level.

PubMed

Lou, Qun; Zhu, Hongping; Luo, Yi; Zhou, Zhibo; Ma, Lian; Ma, Xiaoran; Fu, Yuan

2018-05-01

To investigate the age effects of cleft palate repair on middle ear function and hearing level in patients who underwent cleft palate repair at different ages by audiologic examination. Medical histories were gathered in detail, and audiologic tests (ie, tympanometry and pure tone hearing threshold) were conducted in 126 patients after palatoplasty. The patients were divided into the following 4 groups according to their ages when they underwent cleft palate repair: group I (0-3 years, 73 patients), group II (4-7 years, 29 patients), group III (8-11 years, 16 patients), and group IV (12 years and older, 8 patients). The data regarding tympanograms, hearing levels, and the average hearing thresholds of each group were analyzed using chi-square tests. The prevalence of middle ear dysfunction and hearing loss in the patients who underwent palatoplasty before 3 years old (27.4% and 2.0% respectively) was significantly lower than that in patients who underwent palatopalsty at 12 years or older (75.0% and 43.7%, respectively). Linear-by-linear association revealed that the prevalences of middle ear dysfunction and hearing loss among the 4 groups were significantly different ( P < .05). The prevalence of middle ear dysfunction and hearing loss tended to increase with advancing age at the time of cleft palate repair. From an audiologist's perspective, palatoplasty at an early age is very beneficial in helping children with cleft palates acquire better middle ear function and hearing level.

The Effects of Middle Ear Pressure on Hearing.

DTIC Science & Technology

1984-04-30

Miller, J,M.: Choline salicylate : Effects on cochlear function. Arch. Otolaryngol. 99: 304-308, 1974. *12. Miller, J.M. and Holmquist, J.: An animal model...for study of eustachian tube and middle ear function. Scand. Audiol. 3: 63-68, 1974. 13. McPherson, D. and Miller, J.: Salicylate ototoxicity in the

Human middle-ear model with compound eardrum and airway branching in mastoid air cells

PubMed Central

Keefe, Douglas H.

2015-01-01

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25–13 kHz), equivalent input impedance at the eardrum (0.25–11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1–11 kHz), and reverse middle-ear impedance (0.25–8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold. PMID:25994701

Human middle-ear model with compound eardrum and airway branching in mastoid air cells.

PubMed

Keefe, Douglas H

2015-05-01

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25-13 kHz), equivalent input impedance at the eardrum (0.25-11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1-11 kHz), and reverse middle-ear impedance (0.25-8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold.

Age and Gender Effects on Wideband Absorbance in Adults with Normal Outer and Middle Ear Function

ERIC Educational Resources Information Center

Mazlan, Rafidah; Kei, Joseph; Ya, Cheng Li; Yusof, Wan Nur Hanim Mohd; Saim, Lokman; Zhao, Fei

2015-01-01

Purpose: This study examined the effects of age and gender on wideband energy absorbance in adults with normal middle ear function. Method: Forty young adults (14 men, 26 women, aged 20-38 years), 31 middle-aged adults (16 men, 15 women, aged 42-64 years), and 30 older adults (20 men, 10 women, aged 65-82 years) were assessed. Energy absorbance…

Effects of Consecutive Wideband Tympanometry Trials on Energy Absorbance Measures of the Middle Ear

ERIC Educational Resources Information Center

Burdiek, Laina M.; Sun, Xiao-Ming

2014-01-01

Purpose: Wideband acoustic immittance (WAI) is a new technique for assessing middle ear transfer function. It includes energy absorbance (EA) measures and can be acquired with the ear canal pressure varied, known as "wideband tympanometry" (WBTymp). The authors of this study aimed to investigate effects of consecutive WBTymp testing on…

The effect of continuous positive airway pressure on middle ear pressure.

PubMed

Lin, Fred Y; Gurgel, Richard K; Popelka, Gerald R; Capasso, Robson

2012-03-01

While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures. Retrospective review of normal tympanometry values and a prospective cohort evaluation of subjects' tympanometric values while using CPAP at distinct pressure levels. A total of 3,066 tympanograms were evaluated to determine the normal range of middle ear pressures. Ten subjects with no known history of eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 0, 5, 10, and 15 cm H(2)O. The percentage of normal control patients with middle ear pressures above 40 daPa was 0.03%. In the study population, prior to a swallowing maneuver to open the eustachian tube, average middle ear pressures were 21.67 daPa, 22.63 daPa, 20.42, daPa, and 21.58 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2) 0, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2)0, respectively. The postswallow Pearson correlation coefficient correlating CPAP and middle ear pressures was 0.783 (P < 0.001). Middle ear air pressure is directly proportional to CPAP air pressure in subjects with normal eustachian tube function. Middle ear pressure reaches supraphysiologic levels at even minimal CPAP levels. Although further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependent. These findings may also influence the perioperative practice of otologic and skull base surgeons. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Ototoxicity of boric acid powder in a rat animal model.

PubMed

Salihoglu, Murat; Dogru, Salim; Cesmeci, Enver; Caliskan, Halil; Kurt, Onuralp; Kuçukodaci, Zafer; Gungor, Atila

2017-04-22

Boric acid, which has antiseptic and acidic properties, is used to treat external and middle ear infections. However, we have not found any literature about the effect of boric acid powder on middle ear mucosa and inner ear. The purpose of this study is to investigate possible ototoxic effects of boric acid powder (BAP) on cochlear outer hair cell function and histological changes in middle ear mucosa in a rat animal model. Twenty healthy, mature Wistar albino rats were used in this study. The rats were divided into two groups, Group A and Group B, each of which consisted of 10 rats. Initially, the animals in each group underwent distortion product otoacoustic emissions (DPOAE) testing of their right and left ears. After the first DPOAE test, a surgical microscope was used to make a small perforation in both ears of the rats in each group, and a second DPOAE test was used to measure both ears in all of the rats. BAP was applied to the right middle ear of the rats using tympanic membrane perforation, and the DPOAEs were measured immediately after the BAP application. The histological changes and DPOAEs were evaluated three days later in Group A and 40 days later in Group B. No significant differences were found at all of the DPOAE frequencies. In Group A, mild inflammation of the middle ear mucosa was found on the third day after BAP application. In Group B, BAP caused mild inflammatory changes on the 40th day, which declined over time. Those changes did not lead to significant fibrosis within the mucosa. In rats, BAP causes mild inflammation in middle ear mucosa and it has no ototoxic effects on cochlear outer hair cell function in the inner ear of rats. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Oral pseudoephedrine decreases the rate of transmucosal nitrous oxide exchange for the middle ear.

PubMed

Teixeira, Miriam S; Alper, Cuneyt M; Martin, Brian S; Doyle, Brendan M Cullen; Doyle, William J

2015-09-01

Determine if oral treatment with a vasoconstrictor decreases the blood to middle ear exchange rate of the perfusion-limited gas, nitrous oxide (N2O). Randomized, double-blind, crossover study. Ten adult subjects with and 10 without past middle ear disease completed paired experimental sessions, identical except for oral treatment with either pseudoephedrine hydrochloride or lactose placebo. At each session, subjects were fitted with a nonrebreathing mask and breathed room air for 20 minutes (acclimation period), 50% N2O:50% O2 for 20 minutes (experimental period), and 100% O2 for 10 minutes (recovery period). Throughout, heart rate, blood pressure, and O2 saturation were monitored, and bilateral middle ear pressures were recorded by tympanometry every minute. The primary outcome was the slope of the middle ear pressure-time function for the experimental period, which estimates the volume N2O exchange rate. Using repeated measures analysis of variance, the effects of group (disease history), treatment (active vs. placebo), and period (1 vs. 2) on the recorded vital signs, and of group, treatment, and ear (left/right) on the middle ear pressure-time slope were evaluated for statistical significance. Statistically significant effects of period on O2 saturation (period 2 > period 1) and of treatment on heart rate (active > placebo) were documented. Only treatment was statistically significant for the middle ear pressure-time slope, with a shallower slope characterizing the active treatment session. The volume exchange rate across the middle ear mucosa of perfusion-limited gases can be modulated pharmacologically. Theoretically, similar drugs can be used to reduce the requisite eustachian tube opening efficiency for adequate middle ear pressure regulation. 1b. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Oral Pseudoephedrine Decreases the Rate of Trans-mucosal Nitrous Oxide Exchange for the Middle Ear

PubMed Central

Teixeira, Miriam S.; Alper, Cuneyt M.; Martin, Brian S; Cullen Doyle, Brendan M.; Doyle, William J.

2015-01-01

Objective Determine if oral pretreatment with a vasoconstrictor decreases the blood to middle-ear exchange-rate of the perfusion-limited gas, Nitrous Oxide (N2O). Study Design Randomized, double-blind, crossover study. Methods Ten adult subjects with and 10 without past middle-ear disease completed paired experimental sessions, identical but for oral pretreatment with either pseudoephedrine HCL or lactose placebo. At each session, subjects were fitted with a non-rebreathing mask and breathed room air for 20 minutes (acclimation period), 50% N2O:50% O2 for 20 minutes (experimental period) and 100% O2 for 10 minutes (recovery period). Throughout, heart-rate, blood-pressure and O2 saturation were monitored and bilateral middle-ear pressures were recorded by tympanometry every minute. The primary outcome was the slope of the middle-ear pressure-time function for the experimental period which estimates the volume N2O exchange-rate. Using repeated measures ANOVA, the effects of Group (disease history), Treatment (active vs. placebo) and Period (1 vs. 2) on the recorded vital signs, and of Group, Treatment and Ear (left/right) on the middle-ear pressure-time slope were evaluated for statistical significance. Results Statistically significant effects of Period on O2 saturation (Period 2>Period 1) and of Treatment on heart-rate (Active>Placebo) were documented. Only Treatment was statistically significant for the middle-ear pressure-time slope with a shallower slope characterizing the active treatment session. Conclusion The volume exchange-rate across the middle-ear mucosa of perfusion-limited gases can be modulated pharmacologically. Theoretically, similar drugs can be used to reduce the requisite Eustachian tube opening efficiency for adequate middle-ear pressure regulation. PMID:26152838

Continuous 24-hour measurement of middle ear pressure.

PubMed

Tideholm, B; Jönsson, S; Carlborg, B; Welinder, R; Grenner, J

1996-07-01

A new method was developed for continuous measurement of the middle ear pressure during a 24-h period. The equipment consisted of a piezo-electric pressure device and a digital memory. To allow continuous pressure recordings during normal every-day activities the equipment was made light and portable. The measurement accuracy of the equipment as well as the base-line and temperature stability were tested and found to meet to our requirements satisfactorily. In 4 volunteers with different middle ear conditions, a small perforation was made through the tympanic membrane. A rubber stopper containing a small polyethylene tube was fitted into the external ear canal. Tubal function tests were made to establish the equipment's ability to monitor fast pressure changes. The tests were well in accordance with other methods of direct pressure measurements. The equipment was carried by the volunteers for 24 h to monitor any slow or rapid dynamic pressure changes in the middle ear. Four continuous 24-h measurements are presented. The method was found to be suitable for valid measurements of dynamic pressure changes in the middle ear during normal every-day activities. It may become a useful instrument in the search for a better understanding of the development of chronic middle ear disease.

Cilia distribution and polarity in the epithelial lining of the mouse middle ear cavity

PubMed Central

Luo, Wenwei; Yi, Hong; Taylor, Jeannette; Li, Jian-dong; Chi, Fanglu; Todd, N. Wendell; Lin, Xi; Ren, Dongdong; Chen, Ping

2017-01-01

The middle ear conducts sound to the cochlea for hearing. Otitis media (OM) is the most common illness in childhood. Moreover, chronic OM with effusion (COME) is the leading cause of conductive hearing loss. Clinically, COME is highly associated with Primary Ciliary Dyskinesia, implicating significant contributions of cilia dysfunction to COME. The understanding of middle ear cilia properties that are critical to OM susceptibility, however, is limited. Here, we confirmed the presence of a ciliated region near the Eustachian tube orifice at the ventral region of the middle ear cavity, consisting mostly of a lumen layer of multi-ciliated and a layer of Keratin-5-positive basal cells. We also found that the motile cilia are polarized coordinately and display a planar cell polarity. Surprisingly, we also found a region of multi-ciliated cells that line the posterior dorsal pole of the middle ear cavity which was previously thought to contain only non-ciliated cells. Our study provided a more complete understanding of cilia distribution and revealed for the first time coordinated polarity of cilia in the epithelium of the mammalian middle ear, thus illustrating novel structural features that are likely critical for middle ear functions and related to OM susceptibility. PMID:28358397

Effect of cochlear implantation on middle ear function: A three-month prospective study.

PubMed

Wasson, Joseph D; Campbell, Luke; Chambers, Scott; Hampson, Amy; Briggs, Robert J S; O'Leary, Stephen J

2018-05-01

To determine if cochlear implantation has a delayed effect on the middle ear conductive hearing mechanism by measuring laser Doppler vibrometry (LDV) of the tympanic membrane (TM) in both implanted and contralateral control ears preoperatively and 3 months postoperatively, and then comparing the relative change in LDV outcome measures between implanted and control ears. Prospective cohort study. Eleven preoperative adult unilateral cochlear implant recipients in previously unoperated ears with normal anatomy and aerated temporal bones were included in this study. The magnitude and phase angle of umbo velocity transfer function in response to air- conduction (AC) stimulus, and the magnitude of umbo velocity in response to bone- conduction (BC) stimulus were measured in the implant ear and the contralateral control ear preoperatively and 3 months postoperatively and compared. No significant changes in the magnitude or phase angle of TM velocity in response to either AC or BC stimulus were observed in the implanted ear relative to the contralateral control ear 3 months following cochlear implantation. From the results of LDV measurements, it can be said that cochlear implantation has no significant delayed effect on the middle ear conductive mechanism. 4. Laryngoscope, 128:1207-1212, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Middle-ear velocity transfer function, cochlear input immittance, and middle-ear efficiency in chinchilla.

PubMed

Ravicz, Michael E; Rosowski, John J

2013-10-01

The transfer function H(V) between stapes velocity V(S) and sound pressure near the tympanic membrane P(TM) is a descriptor of sound transmission through the middle ear (ME). The ME power transmission efficiency (MEE), the ratio of sound power entering the cochlea to power entering the middle ear, was computed from H(V) measured in seven chinchilla ears and previously reported measurements of ME input admittance Y(TM) and ME pressure gain G(MEP) [Ravicz and Rosowski, J. Acoust. Soc. Am. 132, 2437-2454 (2012); J. Acoust. Soc. Am. 133, 2208-2223 (2013)] in the same ears. The ME was open, and a pressure sensor was inserted into the cochlear vestibule for most measurements. The cochlear input admittance Y(C) computed from H(V) and G(MEP) is controlled by a combination of mass and resistance and is consistent with a minimum-phase system up to 27 kHz. The real part Re{Y(C)}, which relates cochlear sound power to inner-ear sound pressure, decreased gradually with frequency up to 25 kHz and more rapidly above that. MEE was about 0.5 between 0.1 and 8 kHz, higher than previous estimates in this species, and decreased sharply at higher frequencies.

Middle-ear velocity transfer function, cochlear input immittance, and middle-ear efficiency in chinchilla

PubMed Central

Ravicz, Michael E.; Rosowski, John J.

2013-01-01

The transfer function HV between stapes velocity VS and sound pressure near the tympanic membrane PTM is a descriptor of sound transmission through the middle ear (ME). The ME power transmission efficiency (MEE), the ratio of sound power entering the cochlea to power entering the middle ear, was computed from HV measured in seven chinchilla ears and previously reported measurements of ME input admittance YTM and ME pressure gain GMEP [Ravicz and Rosowski, J. Acoust. Soc. Am. 132, 2437–2454 (2012); J. Acoust. Soc. Am. 133, 2208–2223 (2013)] in the same ears. The ME was open, and a pressure sensor was inserted into the cochlear vestibule for most measurements. The cochlear input admittance YC computed from HV and GMEP is controlled by a combination of mass and resistance and is consistent with a minimum-phase system up to 27 kHz. The real part Re{YC}, which relates cochlear sound power to inner-ear sound pressure, decreased gradually with frequency up to 25 kHz and more rapidly above that. MEE was about 0.5 between 0.1 and 8 kHz, higher than previous estimates in this species, and decreased sharply at higher frequencies. PMID:24116422

Measurement of mucociliary function of the eustachian tube

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nuutinen, J.; Kaerjae, J.; Karjalainen, P.

1983-10-01

Mucociliary function of the eustachian tube was measured with a radioisotopic method; 0.01 mL of a human serum albumin labeled with technetium 99m was instilled into the anterior part of the middle ear cavity either through a perforation or by puncturing the tympanic membrane, and its course was followed by a gamma-camera. In the normal eustachian tube, the velocity of the mucociliary transport was 0.7 to 1.1 mm/min. The mucociliary function was totally absent in chronic otitis media, in untreated secretory otitis media, and in the ear with a moist perforation of the tympanic membrane. The mucociliary transport returned tomore » normal when the ear was clinically healed. It is assumed that the impairment of the mucociliary function of the eustachian tube and middle ear plays an important role in the pathogenesis of secretory otitis media and chronic ear discharge.« less

Lumped parametric model of the human ear for sound transmission.

PubMed

Feng, Bin; Gan, Rong Z

2004-09-01

A lumped parametric model of the human auditoria peripherals consisting of six masses suspended with six springs and ten dashpots was proposed. This model will provide the quantitative basis for the construction of a physical model of the human middle ear. The lumped model parameters were first identified using published anatomical data, and then determined through a parameter optimization process. The transfer function of the middle ear obtained from human temporal bone experiments with laser Doppler interferometers was used for creating the target function during the optimization process. It was found that, among 14 spring and dashpot parameters, there were five parameters which had pronounced effects on the dynamic behaviors of the model. The detailed discussion on the sensitivity of those parameters was provided with appropriate applications for sound transmission in the ear. We expect that the methods for characterizing the lumped model of the human ear and the model parameters will be useful for theoretical modeling of the ear function and construction of the ear physical model.

Optical measurement of the weak non-linearity in the eardrum vibration response to auditory stimuli

NASA Astrophysics Data System (ADS)

Aerts, Johan

The mammalian hearing organ consists of the external ear (auricle and ear canal) followed by the middle ear (eardrum and ossicles) and the inner ear (cochlea). Its function is to convert the incoming sound waves and convert them into nerve pulses which are processed in the final stage by the brain. The main task of the external and middle ear is to concentrate the incoming sound waves on a smaller surface to reduce the loss that would normally occur in transmission from air to inner ear fluid. In the past it has been shown that this is a linear process, thus without serious distortions, for sound waves going up to pressures of 130 dB SPL (˜90 Pa). However, at large pressure changes up to several kPa, the middle ear movement clearly shows non-linear behaviour. Thus, it is possible that some small non-linear distortions are also present in the middle ear vibration at lower sound pressures. In this thesis a sensitive measurement set-up is presented to detect this weak non-linear behaviour. Essentially, this set-up consists of a loud-speaker which excites the middle ear, and the resulting vibration is measured with an heterodyne vibrometer. The use of specially designed acoustic excitation signals (odd random phase multisines) enables the separation of the linear and non-linear response. The application of this technique on the middle ear demonstrates that there are already non-linear distortions present in the vibration of the middle ear at a sound pressure of 93 dB SPL. This non-linear component also grows strongly with increasing sound pressure. Knowledge of this non-linear component can contribute to the improvement of modern hearing aids, which operate at higher sound pressures where the non-linearities could distort the signal considerably. It is also important to know the contribution of middle ear non-linearity to otoacoustic emissions. This are non-linearities caused by the active feedback amplifier in the inner ear, and can be detected in the external and middle ear. These signals are used for diagnostic purposes, and therefore it is important to have an estimate the non-linear middle ear contribution to these emissions.

Middle-Ear Pressure Gain and Cochlear Partition Differential Pressure in Chinchilla

PubMed Central

Ravicz, Michael E.; Slama, Michaël C.C.; Rosowski, John J.

2009-01-01

An important step to describe the effects of inner-ear impedance and pathologies on middle- and inner-ear mechanics is to quantify middle- and inner-ear function in the normal ear. We present middle-ear pressure gain GMEP and trans-cochlear-partition differential sound pressure ΔPCP in chinchilla from 100 Hz to 30 kHz derived from measurements of intracochlear sound pressures in scala vestibuli PSV and scala tympani PST and ear-canal sound pressure near the tympanic membrane PTM. These measurements span the chinchilla's auditory range. GMEP had constant magnitude of about 20 dB between 300 Hz and 20 kHz and phase that implies a 40-μs delay, values with some similarities to previous measurements in chinchilla and other species. ΔPCP was similar to GMEP below about 10 kHz and lower in magnitude at higher frequencies, decreasing to 0 dB at 20 kHz. The high-frequency rolloff correlates with the audiogram and supports the idea that middle-ear transmission limits high-frequency hearing, providing a stronger link between inner-ear macromechanics and hearing. We estimate the cochlear partition impedance ZCP from these and previous data. The chinchilla may be a useful animal model for exploring the effects of nonacoustic inner-ear stimulation such as “bone conduction” on cochlear mechanics. PMID:19945521

Anatomy, Physiology and Function of the Auditory System

NASA Astrophysics Data System (ADS)

Kollmeier, Birger

The human ear consists of the outer ear (pinna or concha, outer ear canal, tympanic membrane), the middle ear (middle ear cavity with the three ossicles malleus, incus and stapes) and the inner ear (cochlea which is connected to the three semicircular canals by the vestibule, which provides the sense of balance). The cochlea is connected to the brain stem via the eighth brain nerve, i.e. the vestibular cochlear nerve or nervus statoacusticus. Subsequently, the acoustical information is processed by the brain at various levels of the auditory system. An overview about the anatomy of the auditory system is provided by Figure 1.

Biocompatibility of Liposome Nanocarriers in the Rat Inner Ear After Intratympanic Administration

NASA Astrophysics Data System (ADS)

Zou, Jing; Feng, Hao; Sood, Rohit; Kinnunen, Paavo K. J.; Pyykko, Ilmari

2017-05-01

Liposome nanocarriers (LPNs) are potentially the future of inner ear therapy due to their high drug loading capacity and efficient uptake in the inner ear after a minimally invasive intratympanic administration. However, information on the biocompatibility of LPNs in the inner ear is lacking. The aim of the present study is to document the biocompatibility of LPNs in the inner ear after intratympanic delivery. LPNs with or without gadolinium-tetra-azacyclo-dodecane-tetra-acetic acid (Gd-DOTA) were delivered to the rats through transtympanic injection. The distribution of the Gd-DOTA-containing LPNs in the middle and inner ear was tracked in vivo using MRI. The function of the middle and inner ear barriers was evaluated using gadolinium-enhanced MRI. The auditory function was measured using auditory brainstem response (ABR). The potential inflammatory response was investigated by analyzing glycosaminoglycan and hyaluronic acid secretion and CD44 and TLR2 expression in the inner ear. The potential apoptosis was analyzed using terminal transferase (TdT) to label the free 3'OH breaks in the DNA strands of apoptotic cells with TMR-dUTP (TUNEL staining). As a result, LPNs entered the inner ear efficiently after transtympanic injection. The transtympanic injection of LPNs with or without Gd-DOTA neither disrupted the function of the middle and inner ear barriers nor caused hearing impairment in rats. The critical inflammatory biological markers in the inner ear, including glycosaminoglycan and hyaluronic acid secretion and CD44 and TLR2 expression, were not influenced by the administration of LPNs. There was no significant cell death associated with the administration of LPNs. The transtympanic injection of LPNs is safe for the inner ear, and LPNs may be applied as a drug delivery matrix in the clinical therapy of sensorineural hearing loss.

Flexibility in the mouse middle ear: A finite element study of the frequency response

NASA Astrophysics Data System (ADS)

Gottlieb, Peter; Puria, Sunil

2018-05-01

The mammalian middle ear is comprised of three distinct ossicles, connected by joints, and suspended in an air-filled cavity. In most mammals, the ossicular joints are mobile synovial joints, which introduce flexibility into the ossicular chain. In some smaller rodents, however, these joints are less mobile, and in the mouse in particular, the malleus is additionally characterized by a large, thin plate known as the transversal lamina, which connects the manubrium to the incus-malleus joint (IMJ). We hypothesize that this feature acts as a functional joint, maintaining the benefits of a flexible ossicular chain despite a less-mobile IMJ, and tested this hypothesis with a finite element model of the mouse middle ear. The results showed that while fusing the ossicular joints had a negligible effect on sound transmission, stiffening the ossicular bone significantly reduced sound transmission, implying that bone flexibility plays a critical role in the normal function of the mouse middle ear.

Vibration of middle ear with shape memory prosthesis - Experimental and numerical study

NASA Astrophysics Data System (ADS)

Rafal, Rusinek; Szymanski, Marcin; Lajmert, Pawel

2018-01-01

The paper presents experimental investigations of ossicular chain vibrations using a Laser Doppler Vibrometer (LDV) for the intact middle ear and a reconstructed one by means of the new designed shape memory prosthesis. Vibrations of the round window are measured with the Laser Doppler vibrometer and studied classically by the transfer function analysis. Moreover, the recurrence plot technique and the Hilbert vibration decomposition method are used to extend the classical analysis. The new methods show additional vibrations components and provide more information about middle ear behaviour.

Effects of middle ear quasi-static stiffness on sound transmission quantified by a novel 3-axis optical force sensor.

PubMed

Dobrev, Ivo; Sim, Jae Hoon; Aqtashi, Baktash; Huber, Alexander M; Linder, Thomas; Röösli, Christof

2018-01-01

Intra-operative quantification of the ossicle mobility could provide valuable feedback for the current status of the patient's conductive hearing. However, current methods for evaluation of middle ear mobility are mostly limited to the surgeon's subjective impression through manual palpation of the ossicles. This study investigates how middle ear transfer function is affected by stapes quasi-static stiffness of the ossicular chain. The stiffness of the middle ear is induced by a) using a novel fiber-optic 3-axis force sensor to quantify the quasi-static stiffness of the middle ear, and b) by artificial reduction of stapes mobility due to drying of the middle ear. Middle ear transfer function, defined as the ratio of the stapes footplate velocity versus the ear canal sound pressure, was measured with a single point LDV in two conditions. First, a controlled palpation force was applied at the stapes head in two in-plane (superior-inferior or posterior-anterior) directions, and at the incus lenticular process near the incudostapedial joint in the piston (lateral-medial) direction with a novel 3-axis PalpEar force sensor (Sensoptic, Losone, Switzerland), while the corresponding quasi-static displacement of the contact point was measured via a 3-axis micrometer stage. The palpation force was applied sequentially, step-wise in the range of 0.1-20 gF (1-200 mN). Second, measurements were repeated with various stages of stapes fixation, simulated by pre-load on the stapes head or drying of the temporal bone, and with severe ossicle immobilization, simulated by gluing of the stapes footplate. Simulated stapes fixation (forced drying of 5-15 min) severely decreases (20-30 dB) the low frequency (<1 kHz) response of the middle ear, while increasing (5-10 dB) the high frequency (>4 kHz) response. Stapes immobilization (gluing of the footplate) severely reduces (20-40 dB) the low and mid frequency response (<4 kHz) but has lesser effect (<10 dB) at higher frequencies. Even moderate levels of palpation force (<3gF, <30 mN), regardless of direction, have negative effect (10-20 dB) on the low frequency (<2 kHz) response, but with less significant (5-10 dB) effect at higher frequencies. Force-displacement measurements around the incudostapedial joint showed quasi-static stiffness in the range of 200-500 N/m for normal middle ears, and 1000-2500 N/m (5-8-fold increase) after artificially (through forced drying) reducing the middle ear transfer function with 10-25 dB at 1 kHz. Effects of the palpation force level and direction, as well as stapes fixation and immobilization have been analyzed based on the measurement of the stapes footplate motion, and controlled application of 3D force and displacement. Copyright © 2017 Elsevier B.V. All rights reserved.

The Impact of Otitis Media with Effusion on Infant Phonetic Perception

ERIC Educational Resources Information Center

Polka, Linda; Rvachew, Susan

2005-01-01

The effect of prior otitis media with effusion (OME) or current middle ear effusion (MEE) on phonetic perception was examined by testing infants' discrimination of "boo" and "goo" syllables in 2 test sessions. Middle ear function was assessed following each perception test using tympanometry. Perceptual performance was compared…

Long-term evaluation of the effect of middle ear effusion on the vestibular system in children.

PubMed

Pazdro-Zastawny, Katarzyna; Pośpiech, Lucyna; Zatoński, Tomasz

2018-06-01

Otitis media with effusion (OME) is one of the most common clinical conditions in childhood. Fluid accumulation in the middle ear may impact inner ear. The purpose of this random sample cohort study was to investigate whether the past history of middle ear effusion has a long-term negative impact on the vestibular system in children. The study was carried out on 22 children aged 7-15 years who had undergone drainage of the middle ear 5 years before evaluation. The control group consisted of 29 healthy children aged 4-17 years. Vestibular function was examined using sway posturography and electronystagmography (ENG). The stabilogram parameters of the study group and the control group were compared. The field of developed area (FDA) and the average body sway velocity (ASV) were analyzed. Elevated stabilogram parameters of FDA and ASV, both with eyes open and eyes closed, were found in the study group. Statistically significant values (p < 0.05) were present for ASV with eyes open and with eyes closed. The ENG recordings were analyzed in both groups. In the study group, spontaneous nystagmus was observed in 40.9% of the children and positional nystagmus occurred in 63.6% of the children. According to tests, eye tracking test was impaired in 27.3% of cases. Rotatory chair testing revealed asymmetry in 18.2% of the children. The presence of effusion in the middle ear in the past has a negative impact on the vestibular part of the inner ear. Clinicians should be aware of the possible negative impact of middle ear effusion on the vestibular function in children with a history of otitis media with effusion. With seeimingly asymptomatic children clinicians should inquire parents about symptoms of dysequlibrium and imbalance. Copyright © 2018 Elsevier B.V. All rights reserved.

Simulations and Measurements of Human Middle Ear Vibrations Using Multi-Body Systems and Laser-Doppler Vibrometry with the Floating Mass Transducer.

PubMed

Böhnke, Frank; Bretan, Theodor; Lehner, Stefan; Strenger, Tobias

2013-10-22

The transfer characteristic of the human middle ear with an applied middle ear implant (floating mass transducer) is examined computationally with a Multi-body System approach and compared with experimental results. For this purpose, the geometry of the middle ear was reconstructed from μ-computer tomography slice data and prepared for a Multi-body System simulation. The transfer function of the floating mass transducer, which is the ratio of the input voltage and the generated force, is derived based on a physical context. The numerical results obtained with the Multi-body System approach are compared with experimental results by Laser Doppler measurements of the stapes footplate velocities of five different specimens. Although slightly differing anatomical structures were used for the calculation and the measurement, a high correspondence with respect to the course of stapes footplate displacement along the frequency was found. Notably, a notch at frequencies just below 1 kHz occurred. Additionally, phase courses of stapes footplate displacements were determined computationally if possible and compared with experimental results. The examinations were undertaken to quantify stapes footplate displacements in the clinical practice of middle ear implants and, also, to develop fitting strategies on a physical basis for hearing impaired patients aided with middle ear implants.

Influence of different boundary conditions at the tympanic annulus on finite element models of the human middle ear

NASA Astrophysics Data System (ADS)

Lobato, Lucas; Paul, Stephan; Cordioli, Júlio

2018-05-01

The tympanic annulus is a fibrocartilage ligament that supports the tympanic membrane in a sulcus at the end of the outer ear canal. Among many FE models of the middle ear found in literature, the effect of different boundary conditions at tympanic annulus on middle ear mechanics was not found. In order to investigate the influence of different representations of this detail in FE models, three different ways to connect the tympanic annulus to the outer ear canal were modelled in a reduced middle ear system. This reduced system includes tympanic membrane, tympanic annulus, manubrium, malleus and anterior ligament of malleus. The numerical frequency response function Humbo (umbo velocity vs sound pressure at tympanic membrane) was analyzed through the different boundary conditions and compared to numerical and experimental data from the literature. Also a numerical modal analysis was performed to improve the analysis. It was found that the boundary conditions used to represent the connection between Tympanic Annulus and Outer Ear Canal can change the global stiffness of the system and its natural frequencies as well as change the modal shape of high order modes.

Surgical anatomy and pathology of the middle ear.

PubMed

Luers, Jan Christoffer; Hüttenbrink, Karl-Bernd

2016-02-01

Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis-unrelated factors work against this intent. Surgery is always individualized to the case and there is no one-fits-all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life-threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him- or herself intensively on temporal bones before performing surgery on a patient. © 2015 Anatomical Society.

An overview of changes in pressure values of the middle ear using impedance audiometry among diver candidates in a hyperbaric chamber before and after a pressure test

NASA Astrophysics Data System (ADS)

Anoraga, J. S.; Bramantyo, B.; Bardosono, S.; Simanungkalit, S. H.; Basiruddin, J.

2017-08-01

Impedance audiometry is not yet routinely used in pressure tests, especially in Indonesia. Direct exposure to pressure in a hyperbaric chamber is sometimes without any assessment of the middle ear or the Eustachian tube function (ETF) of ventilation. Impedance audiometry examinations are important to assess ETF ventilation. This study determined the middle ear pressure value changes associated with the ETF (ventilation) of prospective divers. This study included 29 prospective divers aged 20-40 years without conductive hearing loss. All subjects underwent a modified diving impedance audiometry examination both before and after the pressure test in a double-lock hyperbaric chamber. Using the Toynbee maneuver, the values obtained for changes of pressure in the middle ear were significant before and after the pressure test in the right and left ears: p < 0.001 and p = 0.018, respectively. The impedance audiometry examination is necessary for the selection of candidate divers undergoing pressure tests within a hyperbaric chamber.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects.

PubMed

Canali, Inesângela; Petersen Schmidt Rosito, Letícia; Siliprandi, Bruno; Giugno, Cláudia; Selaimen da Costa, Sady

The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p=0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p≥0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Missing links in some curious auditory phenomena: a tale from the middle ear.

PubMed

Carpenter, Michelle S; Cacace, Anthony T; Mahoney, Marty J

2012-02-01

Broadband middle ear power reflectance (BMEPR) is an emerging noninvasive electroacoustic measure that evaluates transmission/reflection properties of the middle ear in high resolution. It is applicable over the entire age continuum and is rapid to perform. However, it remains to be determined if BMEPR is just an incremental step in the evolution of middle ear assessment or a major advance in the way middle ear function can be evaluated. To evaluate effects of age, gender, ear, and frequency on BMEPR measurements in adults without a history of middle ear disease and to assess whether these factors require consideration in test development; to review how these data may influence active physiologic process within the inner ear; to consider how they reconcile with previously published results; and to suggest applications for future research. Prospective, cross-sectional, multivariate analysis to evaluate the effects of age, gender, ear, and frequency on BMEPR in humans without a history of middle ear disease and no air-bone gaps exceeding 10 dB for any frequency. Fifty-six adults in two age groups (Group 1: 18-25 yr, n = 28; Group 2: ≥50 and <66 yr, n = 28). Each age group was stratified by ear and gender in a balanced design. Pure tone air conduction and bone-conduction audiometry was conducted in a commercial sound booth, using a clinical audiometer with standard earphones enclosed in supra-aural ear cushions, and a standard bone-conduction oscillator and headband to evaluate for air-bone gaps. Broadband middle ear power reflectance was measured using a calibrated, commercially available computer-controlled system that incorporated a high quality probe assembly to transduce stimuli and record acoustic responses from the ear canal. Data were analyzed with a four-way (2 × 2 × 2 × 16) repeated measures analysis-of-variance (ANOVA) to evaluate the effects of age group (young vs. old), gender (male vs. female), ear (left vs. right), and frequency (258 to 5040 Hz) on BMEPR. The ANOVA revealed a significant main effect of frequency. There were also gender × ear, gender × frequency, and age × gender × ear interactions. The three-way, age × gender × ear interaction captured the essence of results and revealed lowest power reflectance values in younger females and for right ears. This trend partially reversed in the older age group where higher power reflectance values were observed only in right ears of older females. The significant effects of age, gender, ear, and frequency on BMEPR parallel ear- and gender-related differences in hearing sensitivity, ear, and gender differences in the prevalence of spontaneous otoacoustic emissions (OAEs), gender differences in the magnitude of transient evoked OAEs, and ear differences in transient evoked contralateral OAE suppression effects reported in the literature. While original discussions of these aforementioned effects focused primarily on endocochlear and olivocochlear mechanisms, the BMEPR measurements reported herein suggest that middle ear transmission characteristics may also play a role. American Academy of Audiology.

[Effect size on resonance of the outer ear canal by simulation of middle ear lesions using a temporal bone preparation].

PubMed

Scheinpflug, L; Vorwerk, U; Begall, K

1995-01-01

By means of a model of the external and the middle ear it is possible to simulate various, exactly defined pathological conditions of the middle ear and to describe their influence on ear canal resonance. Starting point of the investigations are fresh postmortem preparations of 8 human temporal bones with an intact ear drum and a retained skin of the ear canal. The compliance of the middle ear does not significantly differ from the clinical data of probands with healthy ears. After antrotomy it is possible to simulate pathological conditions of the middle ear one after the other at the same temporal bone. The influence of the changed middle ear conditions on ear drum compliance, ear canal volume and on the resonance curve of the external ear canal was investigated. For example, the middle ear was filled with water to create approximately the same conditions as in acute serous otitis media. In this middle ear condition a significant increase of the sound pressure amplification was found, on an average by 4 decibels compared to the unchanged temporal bone model. A small increase in resonance frequency was also measured. The advantages of this model are the approximately physiological conditions and the constant dimensions of the external and middle ear.

Determinants of Change in Air-Bone Gap and Bone Conduction in Patients Operated on for Chronic Otitis Media.

PubMed

Wiatr, Maciej; Wiatr, Agnieszka; Składzień, Jacek; Stręk, Paweł

2015-08-11

Middle ear surgery aims to eliminate pathology from the middle ear, improve drainage and ventilation of the postoperative cavity, and reconstruct the tympanic membrane and ossicles. The aim of this work is to define the factors that affect ABG (air-bone gap) and bone conduction in the patients operated on due to chronic otitis media. A prospective analysis of patients operated on due to diseases of the middle ear during 2009-2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were analyzed. The analysis encompassed patients who had undergone middle ear surgery. The patients were divided into several groups taking into account the abnormalities of the middle ear mucous and damage of the ossicular chain observed during otosurgery. A significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a PORP was used in the reconstruction. Granulation tissue was an unfavorable factor of hearing improvement following tympanoplasty. A significant improvement of bone conduction was observed in the patients with dry perforation without other lesions in the middle ear. The elimination of granulation lesions was a positive factor for the future improvement of the function of the inner ear. The presence of granuloma-related lesions in the middle ear spaces is likely to impede hearing improvement. Damage to the ossicular chain rules out the possibility of bone conduction improvement after surgery. The prognosis on tube-related simple chronic otitis media after myringoplasty, with the preserved continuity of the ossicular chain, consists of closing the ABG and leads to significant improvement of bone conduction.

Conductive hearing loss and middle ear pathology in young infants referred through a newborn universal hearing screening program in Australia.

PubMed

Aithal, Sreedevi; Aithal, Venkatesh; Kei, Joseph; Driscoll, Carlie

2012-10-01

Although newborn hearing screening programs have been introduced in most states in Australia, the prevalence of conductive hearing loss and middle ear pathology in the infants referred through these programs is not known. This study was designed to (1) evaluate the prevalence of conductive hearing loss and middle ear pathology in infants referred by a newborn hearing screening program in north Queensland, (2) compare prevalence rates of conductive hearing loss and middle ear pathology in indigenous and nonindigenous infants, and (3) review the outcomes of those infants diagnosed with conductive hearing loss and middle ear pathology. Retrospective chart review of infants referred to the Audiology Department of The Townsville Hospital was conducted. Chart review of 234 infants referred for one or both ears from a newborn hearing screening program in north Queensland was conducted. A total of 211 infants attended the diagnostic appointment. Review appointments to monitor hearing status were completed for 46 infants with middle ear pathology or conductive hearing loss. Diagnosis of hearing impairment was made using an age-appropriate battery of audiological tests. Results were analyzed for both initial and review appointments. Mean age at initial diagnostic assessment was 47.5 days (SD = 31.3). Of the 69 infants with middle ear pathology during initial diagnostic assessment, 18 had middle ear pathology with normal hearing, 47 had conductive hearing loss, and 4 had mixed hearing loss. Prevalence of conductive hearing loss in the newborns was 2.97 per 1,000 while prevalence of middle ear pathology (with or without conductive hearing loss) was 4.36 per 1,000. Indigenous Australians or Aboriginal and Torres Strait Islander (ATSI) infants had a significantly higher prevalence of conductive hearing loss and middle ear pathology than non-ATSI infants (35.19 and 44.45% vs 17.83 and 28.66%, respectively). ATSI infants also showed poor resolution of conductive hearing loss over time with 66.67% of ATSI infants reviewed showing persistent conductive hearing loss compared to 17.86% of non-ATSI infants. Medical management of 17 infants with persistent conductive hearing loss included monitoring, antibiotic treatment, examination under anesthesia, and grommet insertion. Conductive hearing loss was found to be a common diagnosis among infants referred through screening. ATSI infants had significantly higher rates of middle ear pathology and conductive hearing loss at birth and showed poor resolution of middle ear pathology over time compared to non-ATSI infants. Future research using a direct measure of middle ear function as an adjunct to the automated auditory brainstem response screening tool to distinguish conductive from sensorineural hearing loss may facilitate prioritization of infants for assessment, thus reducing parental anxiety and streamlining the management strategies for the respective types of hearing loss. American Academy of Audiology.

Anomalies of the middle and inner ear.

PubMed

Rodriguez, Kimsey; Shah, Rahul K; Kenna, Margaret

2007-02-01

The development of the middle and inner ear highlights the intricacy of embryology. As early as 3 weeks after fertilization, the inner ear begins taking form. This process, along with development of the middle ear, continues throughout gestation. At birth, the middle ear, inner ear, and associated structures are almost adult size. An understanding of the embryologic development of the ear serves as a foundation for evaluating and managing congenital malformations of these structures. The focus of this article is the normal, abnormal, and arrested development of the middle and inner ear, with a clinical emphasis on malformed middle and inner ear structures and a discussion of associated syndromes.

Mechanisms of Cochlear Stimulation Through the Round Window

NASA Astrophysics Data System (ADS)

Lukashkin, Andrei N.; Weddell, Thomas; Russell, Ian J.

2011-11-01

The round window membrane (RW) functions as a pressure relief valve in conventional hearing allowing structures of the middle ear to move. Investigations in recent years have shown that middle ear implants can be used to stimulate the cochlea via the RW. Isolated clinical uses of this technique have been applied but more thorough theoretical and empirical studies are required. Using guinea pigs as test subjects we have investigated physiological effects of RW stimulation using a simulation of active middle ear prosthesis, a cylindrical neodymium iron boron disk magnet placed upon the RW which can be stimulated by an electromagnetic coil positioned in close proximity to the magnet.

A prediction of the minke whale (Balaenoptera acutorostrata) middle-ear transfer functiona)

PubMed Central

Tubelli, Andrew A.; Zosuls, Aleks; Ketten, Darlene R.; Yamato, Maya; Mountain, David C.

2012-01-01

The lack of baleen whale (Cetacea Mysticeti) audiograms impedes the assessment of the impacts of anthropogenic noise on these animals. Estimates of audiograms, which are difficult to obtain behaviorally or electrophysiologically for baleen whales, can be made by simulating the audiogram as a series of components representing the outer, middle, and inner ear (Rosowski, 1991; Ruggero and Temchin, 2002). The middle-ear portion of the system can be represented by the middle-ear transfer function (METF), a measure of the transmission of acoustic energy from the external ear to the cochlea. An anatomically accurate finite element model of the minke whale (Balaenoptera acutorostrata) middle ear was developed to predict the METF for a mysticete species. The elastic moduli of the auditory ossicles were measured by using nanoindentation. Other mechanical properties were estimated from experimental stiffness measurements or from published values. The METF predicted a best frequency range between approximately 30 Hz and 7.5 kHz or between 100 Hz and 25 kHz depending on stimulation location. Parametric analysis found that the most sensitive parameters are the elastic moduli of the glove finger and joints and the Rayleigh damping stiffness coefficient β. The predicted hearing range matches well with the vocalization range. PMID:23145610

Microbiomes of the normal middle ear and ears with chronic otitis media.

PubMed

Minami, Shujiro B; Mutai, Hideki; Suzuki, Tomoko; Horii, Arata; Oishi, Naoki; Wasano, Koichiro; Katsura, Motoyasu; Tanaka, Fujinobu; Takiguchi, Tetsuya; Fujii, Masato; Kaga, Kimitaka

2017-10-01

The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media. Prospective multicenter cohort study. All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan). In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears. The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation. 2b. Laryngoscope, 127:E371-E377, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Middle Ear Infections (For Parents)

MedlinePlus

... Staying Safe Videos for Educators Search English Español Middle Ear Infections KidsHealth / For Parents / Middle Ear Infections What's ... en español Infecciones del oído medio What Are Middle Ear Infections? Ear infections happen when viruses or bacteria ...

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis).

PubMed

Alper, Cuneyt M; Luntz, Michal; Takahashi, Haruo; Ghadiali, Samir N; Swarts, J Douglas; Teixeira, Miriam S; Csákányi, Zsuzsanna; Yehudai, Noam; Kania, Romain; Poe, Dennis S

2017-04-01

Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.

Analysis of subtle auditory dysfunctions in young normal-hearing subjects affected by Williams syndrome.

PubMed

Paglialonga, Alessia; Barozzi, Stefania; Brambilla, Daniele; Soi, Daniela; Cesarani, Antonio; Spreafico, Emanuela; Tognola, Gabriella

2014-11-01

To assess if young subjects affected by Williams syndrome (WS) with normal middle ear functionality and normal hearing thresholds might have subtle auditory dysfunctions that could be detected by using clinically available measurements. Otoscopy, acoustic reflexes, tympanometry, pure-tone audiometry, and distortion product otoacoustic emissions (DPOAEs) were measured in a group of 13 WS subjects and in 13 age-matched, typically developing control subjects. Participants were required to have normal otoscopy, A-type tympanogram, normal acoustic reflex thresholds, and pure-tone thresholds≤15 dB HL at 0.5, 1, and 2 kHz bilaterally. To limit the possible influence of middle ear status on DPOAE recordings, we analyzed only data from ears with pure-tone thresholds≤15 dB HL across all octave frequencies in the range 0.25-8 kHz, middle ear pressure (MEP)>-50 daPa, static compliance (SC) in the range 0.3-1.2 cm3, and ear canal volume (ECV) in the range 0.2-2 ml, and we performed analysis of covariance to remove the possible effects of middle ear variables on DPOAEs. No differences in mean hearing thresholds, SC, ECV, and gradient were observed between the two groups, whereas significantly lower MEP values were found in WS subjects as well as significantly decreased DPOAEs up to 3.2 kHz after adjusting for differences in middle ear status. Results revealed that WS subjects with normal hearing thresholds (≤15 dB HL) and normal middle ear functionality (MEP>-50 daPa, SC in the range 0.3-1.2 cm3, ECV in the range 0.2-2 ml) might have subtle auditory dysfunctions that can be detected by using clinically available methods. Overall, this study points out the importance of using otoacoustic emissions as a complement to routine audiological examinations in individuals with WS to detect, before the onset of hearing loss, possible subtle auditory dysfunctions so that patients can be early identified, better monitored, and promptly treated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Transmission matrix analysis of the chinchilla middle ear

PubMed Central

Songer, Jocelyn E.; Rosowski, John J.

2008-01-01

Despite the common use of the chinchilla as an animal model in auditory research, a complete characterization of the chinchilla middle ear using transmission matrix analysis has not been performed. In this paper we describe measurements of middle-ear input admittance and stapes velocity in ears with the middle-ear cavity opened under three conditions: intact tympano-ossicular system and cochlea, after the cochlea has been drained, and after the stapes has been fixed. These measurements, made with stimulus frequencies of 100–8000 Hz, are used to define the transmission matrix parameters of the middle ear and to calculate the cochlear input impedance as well as the middle-ear output impedance. This transmission characterization of the chinchilla middle ear will be useful for modeling auditory sensitivity in the normal and pathological chinchilla ear. PMID:17672642

Ear-Canal Reflectance, Umbo Velocity and Tympanometry in Normal Hearing Adults

PubMed Central

Rosowski, John J; Nakajima, Hideko H.; Hamade, Mohamad A.; Mafoud, Lorice; Merchant, Gabrielle R.; Halpin, Christopher F.; Merchant, Saumil N.

2011-01-01

Objective This study compares measurements of ear-canal reflectance (ECR) to other objective measurements of middle-ear function including, audiometry, umbo velocity (VU), and tympanometry in a population of strictly defined normal hearing ears. Design Data were prospectively gathered from 58 ears of 29 normal hearing subjects, 16 female and 13 male, aged 22–64 years. Subjects met all of the following criteria to be considered as having normal hearing. (1) No history of significant middle-ear disease. (2) No history of otologic surgery. (3) Normal tympanic membrane (TM) on otoscopy. (4) Pure-tone audiometric thresholds of 20 dB HL or better for 0.25 – 8 kHz. (5) Air-bone gaps no greater than 15 dB at 0.25 kHz and 10 dB for 0.5 – 4 kHz. (6) Normal, type-A peaked tympanograms. (7) All subjects had two “normal” ears (as defined by these criteria). Measurements included pure-tone audiometry for 0.25 – 8 kHz, standard 226 Hz tympanometry, Ear canal reflectance(ECR) for 0.2 – 6 kHz at 60 dB SPL using the Mimosa Acoustics HearID system, and Umbo Velocity (VU ) for 0.3 – 6 kHz at 70–90 dB SPL using the HLV-1000 laser Doppler vibrometer (Polytec Inc). Results Mean power reflectance (|ECR|2) was near 1.0 at 0.2– 0.3 kHz, decreased to a broad minimum of 0.3 to 0.4 between 1 and 4 kHz, and then sharply increased to almost 0.8 by 6 kHz. The mean pressure reflectance phase angle (∠ECR) plotted on a linear frequency scale showed a group delay of approximately 0.1 ms for 0.2 – 6 kHz. Small significant differences were observed in |ECR|2 at the lowest frequencies between right and left ears, and between males and females at 4 kHz. |ECR|2 decreased with age, but reached significance only at 1 kHz. Our ECR measurements were generally similar to previous published reports. Highly significant negative correlations were found between |ECR|2 and VU for frequencies below 1 kHz. Significant correlations were also found between the tympanometrically determined peak total compliance and |ECR|2 and The results suggest that middle-ear compliance VU at frequencies below 1 kHz. contributes significantly to the measured power reflectance and umbo velocity at frequencies below 1 kHz, but not at higher frequencies. Conclusions This study has established a database of objective measurements of middle ear function (ear-canal reflectance, umbo velocity, tympanometry) in a population of strictly defined normal hearing ears. The data will promote our understanding of normal middle ear function, and will serve as a control for comparison to similar measurements made in pathological ears. PMID:21857517

[Transitory evoked otoacoustic emissions and distortion product emissions in disorders of middle ear ventilation].

PubMed

Schmuziger, N; Hauser, R; Probst, R

1996-06-01

Both the amplitude and power spectra of otoacoustic emissions are affected by the transfer properties of the middle ear. This prospective study examined the influence of eustachian tube dysfunction on transiently evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs). In all, 18 ears were studied that exhibited negative middle ear pressures with or without middle ear fluid. Measurements were performed at the time of diagnosis during the recovery stage, and after the middle ear became normally ventilated. Findings showed that TEOAE and DPOAE levels increased while airbone gaps were reduced by an average of 8 dB after negative middle ear pressures returned from -400 daPa to a normal state. There was a tendency for negative middle ear pressure to affect DPOAEs more in the 1-kHz region than in higher frequencies. By contrast, TEOAEs and airbone gaps were more uniformly affected across the entire frequency range. These results for ears with eustachian tube dysfunction were somewhat different from those results of studies obtained in healthy ears tested during experimental changes in middle ear pressure.

Age and Gender Effects on Wideband Absorbance in Adults With Normal Outer and Middle Ear Function.

PubMed

Mazlan, Rafidah; Kei, Joseph; Ya, Cheng Li; Yusof, Wan Nur Hanim Mohd; Saim, Lokman; Zhao, Fei

2015-08-01

This study examined the effects of age and gender on wideband energy absorbance in adults with normal middle ear function. Forty young adults (14 men, 26 women, aged 20-38 years), 31 middle-aged adults (16 men, 15 women, aged 42-64 years), and 30 older adults (20 men, 10 women, aged 65-82 years) were assessed. Energy absorbance (EA) data were collected at 30 frequencies using a prototype commercial instrument developed by Interacoustics. Results showed that the young adult group had significantly lower EA (between 400 and 560 Hz) than the middle-aged group. However, the middle-aged group showed significantly lower EA (between 2240 and 5040 Hz) than the young adult group. In addition, the older adult group had significantly lower EA than the young adult group (between 2520 and 5040 Hz). No significant difference in EA was found at any frequency between middle-aged and older adults. Across age groups, gender differences were found with men having significantly higher EA values than women at lower frequencies, whereas women had significantly higher EA at higher frequencies. This study provides evidence of the influence of gender and age on EA in adults with normal outer and middle ear function. These findings support the importance of establishing age- and gender-specific EA norms for the adult population.

Effect of middle ear fluid on sound transmission and auditory brainstem response in guinea pigs.

PubMed

Guan, Xiying; Gan, Rong Z

2011-07-01

Combined measurements of middle ear transfer function and auditory brainstem response (ABR) in live guinea pigs with middle ear effusion (MEE) are reported in this paper. The MEE model was created by injecting saline into the middle ear cavity. Vibrations of the tympanic membrane (TM), the tip of the incus, and the round window membrane (RWM) were measured with a laser vibrometer at frequencies of 0.2-40 kHz when the middle ear fluid increased from 0 to 0.2 ml (i.e., full fill of the cavity). The click and pure tone ABRs were recorded as the middle ear fluid increased. Fluid introduction reduced mobility of the TM, incus and RWM mainly at high frequencies (f > 1 kHz). The magnitude of this reduction was related to the volume of fluid. The displacement transmission ratio of the TM to incus varied with frequency and fluid level. The volume displacement ratio of the oval window to round window was approximately 1.0 over most frequencies. Elevation of ABR thresholds and prolongation of ABR latencies were observed as fluid level increased. Reduction of TM displacement correlated well with elevation of ABR threshold at 0.5-8 kHz. Alterations in the ratio of ossicular displacements before and after fluid induction are consistent with fluid-induced changes in complex ossicular motions. Copyright © 2011 Elsevier B.V. All rights reserved.

Mastoiditis and facial paralysis as initial manifestations of temporal bone systemic diseases - the significance of the histopathological examination.

PubMed

Maniu, Alma Aurelia; Harabagiu, Oana; Damian, Laura Otilia; Ştefănescu, Eugen HoraŢiu; FănuŢă, Bogdan Marius; Cătană, Andreea; Mogoantă, Carmen Aurelia

2016-01-01

Several systemic diseases, including granulomatous and infectious processes, tumors, bone disorders, collagen-vascular and other autoimmune diseases may involve the middle ear and temporal bone. These diseases are difficult to diagnose when symptoms mimic acute otomastoiditis. The present report describes our experience with three such cases initially misdiagnosed. Their predominating symptoms were otological with mastoiditis, hearing loss, and subsequently facial nerve palsy. The cases were considered an emergency and the patients underwent tympanomastoidectomy, under the suspicion of otitis media with cholesteatoma, in order to remove a possible abscess and to decompress the facial nerve. The common features were the presence of severe granulation tissue filling the mastoid cavity and middle ear during surgery, without cholesteatoma. The definitive diagnoses was made by means of biopsy of the granulation tissue from the middle ear, revealing granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) in one case, middle ear tuberculosis and diffuse large B-cell lymphoma respectively. After specific associated therapy facial nerve functions improved, and atypical inflammatory states of the ear resolved. As a group, systemic diseases of the middle ear and temporal bone are uncommon, but aggressive lesions. After analyzing these cases and reviewing the literature, we would like to stress upon the importance of microscopic examination of the affected tissue, required for an accurate diagnosis and effective treatment.

Distortion product otoacoustic emission suppression tuning and acoustic admittance in human infants: Birth through 6 months

PubMed Central

Abdala, Carolina; Keefe, Douglas H.; Oba, Sandra I.

2009-01-01

Previous work has reported non-adultlike distortion product otoacoustic emission (DPOAE) suppression in human newborns at f2 =6000 Hz, indicating an immaturity in peripheral auditory function. In this study, DPOAE suppression tuning curves (STCs) were recorded as a measure of cochlear function and acoustic admittance/reflectance (YR) in the ear canal recorded as a measure of middle-ear function, in the same 20 infants at birth and through 6 months of age. DPOAE STCs changed little from birth through 6 months, showing excessively narrow and sharp tuning throughout the test period. In contrast, several middle-ear indices at corresponding frequencies shifted systematically with increasing age, although they also remained non-adultlike at 6 months. Linear correlations were conducted between YR and DPOAE suppression features. Only two correlations out of 76 were significant, and all but three YR variables accounted for <10% of the variance in DPOAE suppression tuning. The strongest correlation was noted between admittance phase at 5700 Hz and STC tip-to-tail (R=0.49). The association between middle-ear variables and DPOAE suppression may be stronger during other developmental time periods. Study of older infants and children is needed to fully define postnatal immaturity of human peripheral auditory function. PMID:17552713

Semiautomated Middle Ear Volume Measurement as a Predictor of Postsurgical Outcomes for Congenital Aural Atresia.

PubMed

Kabadi, S J; Ruhl, D S; Mukherjee, S; Kesser, B W

2018-02-01

Middle ear space is one of the most important components of the Jahrsdoerfer grading system (J-score), which is used to determine surgical candidacy for congenital aural atresia. The purpose of this study was to introduce a semiautomated method for measuring middle ear volume and determine whether middle ear volume, either alone or in combination with the J-score, can be used to predict early postoperative audiometric outcomes. A retrospective analysis was conducted of 18 patients who underwent an operation for unilateral congenital aural atresia at our institution. Using the Livewire Segmentation tool in the Carestream Vue PACS, we segmented middle ear volumes using a semiautomated method for all atretic and contralateral normal ears on preoperative high-resolution CT imaging. Postsurgical audiometric outcome data were then analyzed in the context of these middle ear volumes. Atretic middle ear volumes were significantly smaller than those in contralateral normal ears ( P < .001). Patients with atretic middle ear volumes of >305 mm 3 had significantly better postoperative pure tone average and speech reception thresholds than those with atretic ears below this threshold volume ( P = .01 and P = .006, respectively). Atretic middle ear volume incorporated into the J-score offered the best association with normal postoperative hearing (speech reception threshold ≤ 30 dB; OR = 37.8, P = .01). Middle ear volume, calculated in a semiautomated fashion, is predictive of postsurgical audiometric outcomes, both independently and in combination with the conventional J-score. © 2018 by American Journal of Neuroradiology.

Middle Ear Infection (Chronic Otitis Media) and Hearing Loss

MedlinePlus

... You Middle Ear Infection (Chronic Otitis Media) and Hearing Loss Middle Ear Infection (Chronic Otitis Media) and ... loss. How does otitis media affect a child’s hearing? All children with middle ear infection or fluid ...

Mass distribution and rotational inertia of "microtype" and "freely mobile" middle ear ossicles in rodents.

PubMed

Lavender, Danielle; Taraskin, Sergei N; Mason, Matthew J

2011-12-01

The middle ears of seven species of rodents, including four hamster species, were examined under light microscopy and through micro-CT imaging. Hamsters were found to possess a spectrum of ossicular morphologies ranging from something approaching "freely mobile" (Mesocricetus) to something nearer the "microtype" (Cricetulus), although no hamster has an orbicular apophysis of the malleus. Rats, mice and Calomyscus were found to have typically microtype ossicles. To explore the functional effects of these morphological differences, CT scan data were used to calculate the magnitudes of the moments of inertia and positions of the centres of mass and principal rotational axes for the malleus-incus complexes. Microtype species were found to have much greater ossicular inertias, relative to size, about the "anatomical axis" extending between anterior process of the malleus and short process of the incus; ossicular centres of mass were displaced further from this axis. Calculated inertial values were then put into an existing model of middle ear function (Hemilä et al., 1995), in order to see whether the more accurate data would improve predictions of upper hearing limits. For the rat and mouse they did, but this was not so for the hamster Mesocricetus. This might indicate that the inner rather than the middle ear limits hearing in this species, or might simply reflect other shortcomings of the model. Functional differences appear to exist even among rodent ears of the same general type, but the adaptive significance of these differences remains enigmatic. Copyright © 2011 Elsevier B.V. All rights reserved.

Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media

PubMed Central

Teschner, Magnus

2016-01-01

Evidence-based medicine is an approach to medical treatment intended to optimize patient-oriented decision-making on the basis of empirically proven effectiveness. For this purpose, a classification system has been established to categorize studies – and hence therapy options – in respect of associated evidence according to defined criteria. The Eustachian tube connects the nasopharynx with the middle ear cavity. Its key function is to ensure middle ear ventilation. Compromised ventilation results in inflammatory middle ear disorders. Numerous evidence-based therapy options are available for the treatment of impaired middle ear ventilation and otitis media, the main therapeutic approach being antibiotic treatment. More recent procedures such as balloon dilation of the Eustachian tube have also shown initial success but must undergo further evaluation with regard to evidence. There is, as yet, no evidence for some of the other long-established procedures. Owing to the multitude of variables, the classification of evidence levels for various treatment approaches calls for highly diversified assessment. Numerous evidence-based studies are therefore necessary in order to evaluate the evidence pertaining to existing and future therapy solutions for impaired middle ear ventilation and otitis media. If this need is addressed, a wealth of implications can be expected for therapeutic approaches in the years to come. PMID:28025605

Vestibular evoked myogenic potential according to middle ear condition in chronic otitis media with tympanic membrane perforation.

PubMed

Lee, Jun Seok; Lee, Sun Kyu; Shin, Il Ho; Yeo, Seung Geun; Park, Moon Suh; Byun, Jae Yong

2014-01-01

Vestibular evoked myogenic potential (VEMP) function results can vary between individuals with different middle ear conditions. Therefore, by analyzing VEMP results after paper patching, we can predict the condition of the middle ear in chronic otitis media (COM) patients. VEMP responses decrease with impairment of sound transmission, such as in conductive hearing loss (CHL). COM with tympanic membrane (TM) perforation is a common disorder that causes various degrees of CHL. The aim of this study was to evaluate and clarify the VEMP responses in patients with COM with different middle ear pathology. This study included 50 patients with unilateral COM with TM perforation. Initial pure-tone audiometry (PTA) and VEMP responses were recorded. After paper patching, PTA and VEMP were re-performed. Each VEMP response was compared with those of the healthy controls. Moreover, VEMP responses between pre- and post-paper patching were compared. There was a positive correlation between normalizing of VEMP parameters, such as p13 and VEMP asymmetry ratio (VAR), and reduction of air-bone gap in patients with COM after paper patching. The VEMP response in patients with COM with intact ossicle and clean mucosa was more normalized compared with those in patients with COM with different middle ear conditions.

Numerical evaluation of implantable hearing devices using a finite element model of human ear considering viscoelastic properties.

PubMed

Zhang, Jing; Tian, Jiabin; Ta, Na; Huang, Xinsheng; Rao, Zhushi

2016-08-01

Finite element method was employed in this study to analyze the change in performance of implantable hearing devices due to the consideration of soft tissues' viscoelasticity. An integrated finite element model of human ear including the external ear, middle ear and inner ear was first developed via reverse engineering and analyzed by acoustic-structure-fluid coupling. Viscoelastic properties of soft tissues in the middle ear were taken into consideration in this model. The model-derived dynamic responses including middle ear and cochlea functions showed a better agreement with experimental data at high frequencies above 3000 Hz than the Rayleigh-type damping. On this basis, a coupled finite element model consisting of the human ear and a piezoelectric actuator attached to the long process of incus was further constructed. Based on the electromechanical coupling analysis, equivalent sound pressure and power consumption of the actuator corresponding to viscoelasticity and Rayleigh damping were calculated using this model. The analytical results showed that the implant performance of the actuator evaluated using a finite element model considering viscoelastic properties gives a lower output above about 3 kHz than does Rayleigh damping model. Finite element model considering viscoelastic properties was more accurate to numerically evaluate implantable hearing devices. © IMechE 2016.

The LuxS/AI-2 Quorum-Sensing System of Streptococcus pneumoniae Is Required to Cause Disease, and to Regulate Virulence- and Metabolism-Related Genes in a Rat Model of Middle Ear Infection.

PubMed

Yadav, Mukesh K; Vidal, Jorge E; Go, Yoon Y; Kim, Shin H; Chae, Sung-Won; Song, Jae-Jun

2018-01-01

Objective: Streptococcus pneumoniae colonizes the nasopharynx of children, and from nasopharynx it could migrate to the middle ear and causes acute otitis media (AOM). During colonization and AOM, the pneumococcus forms biofilms. In vitro biofilm formation requires a functional LuxS/AI-2 quorum-sensing system. We investigated the role of LuxS/AI-2 signaling in pneumococcal middle ear infection, and identified the genes that are regulated by LuxS/AI-2 during pneumococcal biofilm formation. Methods: Streptococcus pneumoniae D39 wild-type and an isogenic D39Δ luxS strain were utilized to evaluate in vitro biofilm formation, and in vivo colonization and epithelial damage using a microtiter plate assay and a rat model of pneumococcal middle ear infection, respectively. Biofilm structures and colonization and epithelial damage were evaluated at the ultrastructural level by scanning electron microscopy and confocal microscopy. Microarrays were used to investigate the global genes that were regulated by LuxS/AI-2 during biofilm formation. Results: The biofilm biomass and density of D39Δ luxS were significantly ( p < 0.05) lower than those of D39 wild-type. SEM and confocal microscopy revealed that D39Δ luxS formed thin biofilms in vitro compared with D39 wild-type. The in vivo model of middle ear infection showed that D39Δ luxS resulted in ~60% less ( p < 0.05) bacterial colonization than the wild-type. SEM analysis of the rat middle ears revealed dense biofilm-like cell debris deposited on the cilia in wild-type D39-infected rats. However, little cell debris was deposited in the middle ears of the D39Δ luxS -inoculated rats, and the cilia were visible. cDNA-microarray analysis revealed 117 differentially expressed genes in D39Δ luxS compared with D39 wild-type. Among the 66 genes encoding putative proteins and previously characterized proteins, 60 were significantly downregulated, whereas 6 were upregulated. Functional annotation revealed that genes involved in DNA replication and repair, ATP synthesis, capsule biosynthesis, cell division, the cell cycle, signal transduction, transcription regulation, competence, virulence, and carbohydrate metabolism were downregulated in the absence of LuxS/AI-2. Conclusion: The S. pneumoniae LuxS/AI-2 quorum-sensing system is necessary for biofilm formation and the colonization of the ear epithelium, and caused middle ear infection in the rat model. LuxS/AI-2 regulates the expression of the genes involved in virulence and bacterial fitness during pneumococcal biofilm formation.

Prenatal evaluation of the middle ear and diagnosis of middle ear hypoplasia using MRI.

PubMed

Katorza, Eldad; Nahama-Allouche, Catherine; Castaigne, Vanina; Gonzales, Marie; Galliani, Eva; Marlin, Sandrine; Jouannic, Jean-Marie; Rosenblatt, Jonathan; le Pointe, Hubert Ducou; Garel, Catherine

2011-05-01

Analysis of the middle ear with fetal MRI has not been previously reported. To show the contribution of fetal MRI to middle ear imaging. The tympanic cavity was evaluated in 108 fetal cerebral MRI examinations (facial and/or cerebral malformation excluded) and in two cases, one of Treacher Collins syndrome (case 1) and the other of oculo-auriculo-vertebral (OUV) spectrum (case 2) with middle ear hypoplasia identified by MRI at 27 and 36 weeks' gestation, respectively. In all 108 fetuses (mean gestational age 32.5 weeks), the tympanic cavity and T2 hypointensity related to the ossicles were well visualised on both sides. Case 1 had micro/retrognathia and bilateral external ear deformity and case 2 had retrognathism with a left low-set and deformed ear. MRI made it possible to recognize the marked hypoplasia of the tympanic cavity, which was bilateral in case 1 and unilateral in case 2. Both syndromes are characterized by craniofacial abnormalities including middle ear hypoplasia, which cannot be diagnosed with US. The middle ear cavity can be visualized with fetal MRI. We emphasize the use of this imaging modality in the diagnosis of middle ear hypoplasia.

Chirp-Evoked Otoacoustic Emissions and Middle Ear Absorbance for Monitoring Ototoxicity in Cystic Fibrosis Patients.

PubMed

Garinis, Angela C; Keefe, Douglas H; Hunter, Lisa L; Fitzpatrick, Denis F; Putterman, Daniel B; McMillan, Garnett P; Gold, Jeffrey A; Feeney, M Patrick

The goal of this study was to investigate the use of transient-evoked otoacoustic emissions (TEOAEs) and middle ear absorbance measurements to monitor auditory function in patients with cystic fibrosis (CF) receiving ototoxic medications. TEOAEs were elicited with a chirp stimulus using an extended bandwidth (0.71 to 8 kHz) to measure cochlear function at higher frequencies than traditional TEOAEs. Absorbance over a wide bandwidth (0.25 to 8 kHz) provides information on middle ear function. The combination of these time-efficient measurements has the potential to identify early signs of ototoxic hearing loss. A longitudinal study design was used to monitor the hearing of 91 patients with CF (median age = 25 years; age range = 15 to 63 years) who received known ototoxic medications (e.g., tobramycin) to prevent or treat bacterial lung infections. Results were compared to 37 normally hearing young adults (median age = 32.5 years; age range = 18 to 65 years) without a history of CF or similar treatments. Clinical testing included 226-Hz tympanometry, pure-tone air-conduction threshold testing from 0.25 to 16 kHz and bone conduction from 0.25 to 4 kHz. Experimental testing included wideband absorbance at ambient and tympanometric peak pressure and TEOAEs in three stimulus conditions: at ambient pressure and at tympanometric peak pressure using a chirp stimulus with constant incident pressure level across frequency and at ambient pressure using a chirp stimulus with constant absorbed sound power across frequency. At the initial visit, behavioral audiometric results indicated that 76 of the 157 ears (48%) from patients with CF had normal hearing, whereas 81 of these ears (52%) had sensorineural hearing loss for at least one frequency. Seven ears from four patients had a confirmed behavioral change in hearing threshold for ≥3 visits during study participation. Receiver operating characteristic curve analyses demonstrated that all three TEOAE conditions were useful for distinguishing CF ears with normal hearing from ears with sensorineural hearing loss, with an area under the receiver operating characteristic curve values ranging from 0.78 to 0.92 across methods for frequency bands from 2.8 to 8 kHz. Case studies are presented to illustrate the relationship between changes in audiometric thresholds, TEOAEs, and absorbance across study visits. Absorbance measures permitted identification of potential middle ear dysfunction at 5.7 kHz in an ear that exhibited a temporary hearing loss. The joint use of TEOAEs and absorbance has the potential to explain fluctuations in audiometric thresholds due to changes in cochlear function, middle ear function, or both. These findings are encouraging for the joint use of TEOAE and wideband absorbance objective tests for monitoring ototoxicity, particularly, in patients who may be too ill for behavioral hearing tests. Additional longitudinal studies are needed in a larger number of CF patients receiving ototoxic drugs to further evaluate the clinical utility of these measures in an ototoxic monitoring program.

Fixation and detachment of superior and anterior malleolar ligaments in human middle ear: Experiment and modeling

PubMed Central

Dai, Chenkai; Cheng, Tao; Wood, Mark W.; Gan, Rong Z.

2007-01-01

The aim of this study is to investigate the function of the superior malleolar ligament (SML) and the anterior malleolar ligament (AML) in human middle ear for sound transmission through simulations of fixation and detachment of these ligaments in human temporal bones and a finite element (FE) ear model. Two laser vibrometers were used to measure the vibrations of the tympanic membrane (TM) and stapes footplate. A 3-D FE ear model was used to predict the transfer function of the middle ear with ligament fixation and detachment. The results demonstrate that fixations and detachments of the SML and AML had different effects on TM and stapes footplate movements. Fixation of the SML resulted in a reduction of displacement of the TM (umbo) and the footplate at low frequencies (f < 1000 Hz), but also caused a shift of displacement peak to higher frequencies. Fixation of both SML and AML caused a reduction of 15 dB at umbo or stapes at low frequencies. Detachment of the SML had almost no effect on TM and footplate mobility, but AML detachment had a minor effect on TM and footplate movement. The FE model was able to predict the effects of SML and AML fixation and detachment. PMID:17517484

A short-wave infrared otoscope for middle ear disease diagnostics (Conference Presentation)

NASA Astrophysics Data System (ADS)

Carr, Jessica A.; Valdez, Tulio; Bruns, Oliver; Bawendi, Moungi

2016-02-01

Otitis media, a range of inflammatory conditions of the middle ear, is the second most common illness diagnosed in children. However, the diagnosis can be challenging, particularly in pediatric patients. Otitis media is commonly over-diagnosed and over-treated and has been identified as one of the primary factors in increased antibiotic resistance. We describe the development of a short-wave infrared (SWIR) otoscope for objective middle ear effusion diagnosis. The SWIR otoscope can unambiguously detect the presence of middle ear fluid based on its strong light absorption in the SWIR. This absorption causes a stark, visual contrast between the presence and absence of fluid behind the tympanic membrane. Additionally, when there is no middle ear fluid, the deeper tissue penetration of SWIR light allows the SWIR otoscope to better visualize middle ear anatomy through the tympanic membrane than is possible with visible light. We demonstrate that in healthy, adult human ears, SWIR otoscopy can image a range of middle ear anatomy, including landmarks of the entire ossicular chain, the promontory, the round window niche, and the chorda tympani. We suggest that SWIR otoscopy can provide valuable diagnostic information complementary to that provided by visible pneumotoscopy in the diagnosis of middle ear effusions, otitis media, and other maladies of the middle ear.

Prevalence of clinical abnormalities in cats found to have nonneoplastic middle ear disease at necropsy: 59 cases (1991-2007).

PubMed

Schlicksup, Michael D; Van Winkle, Thomas J; Holt, David E

2009-10-01

To determine the prevalence of nonneoplastic middle ear disease among cats undergoing necropsy and the prevalence of clinical abnormalities in cats in which nonneoplastic middle ear disease was identified. Retrospective case series. 59 cats that underwent necropsy between January 1991 and August 2007. Medical records were searched to identify cats in which nonneoplastic middle ear disease was identified at necropsy. For cats included in the study, data that were recorded included signalment, initial complaint, whether the cat had any clinical signs of middle or external ear disease, whether the cat had upper respiratory tract disease, necropsy diagnosis, gross appearance of the bullae, and reason for euthanasia. Signs of middle ear disease that were considered included unilateral peripheral vestibular disease without motor deficits, Horner syndrome, and facial nerve paralysis. Of the 3,442 cats that underwent necropsy during the study period, 59 (1.7%) had nonneoplastic middle ear disease. Six of the 59 (10%) cats, including 1 cat that was affected bilaterally, had clinical signs of middle ear disease. Of these, 5 had signs of unilateral peripheral vestibular disease, and 1 had Horner syndrome. Results suggested that most cats with nonneoplastic middle ear disease did not have associated clinical signs. Findings may be of clinical relevance for cats in which middle ear disease is identified as an incidental finding during computed tomography or magnetic resonance imaging for unrelated diseases.

Update on Middle Ear Barotrauma after Hyperbaric Oxygen Therapy—Insights on Pathophysiology

PubMed Central

Lima, Marco Antônio Rios; Farage, Luciano; Cury, Maria Cristina Lancia; Bahamad, Fayez

2014-01-01

Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention. Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear. Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma. Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation. PMID:25992091

[Advances in genetics of congenital malformation of external and middle ear].

PubMed

Wang, Dayong; Wang, Qiuju

2013-05-01

Congenital malformation of external and middle ear is a common disease in ENT department, and the incidence of this disease is second only to cleft lip and palate in the whole congenital malformations of the head and face. The external and middle ear malformations may occur separately, or as an important ear symptom of the systemic syndrome. We systematically review and analysis the genetic research progress of congenital malformation of external and middle ear, which would be helpful to understand the mechanism of external and middle ear development, and to provide clues for the further discovery of new virulence genes.

Desmoplastic small round cell tumor of the middle ear: A case report.

PubMed

Xu, Jing; Yao, Mengwei; Yang, Xinxin; Liu, Tao; Wang, Shaohua; Ma, Dengdian; Li, Xiaoyu

2018-04-01

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive and malignant tumor. This report describes a case involving DSRCT of the middle ear which no case has been reported in the literature till date. A 59-year-old Chinese man with a 40-year history of repeated suppuration of his right ear and 1-year history of drooping of the angle of mouth. The CT of the middle ear and brain scan and enhanced MRI showed space occupying lesion in the right middle ear. Desmoplastic small round cell tumor of the middle ear. After relevant examinations, radical mastoidectomy and subtotal temporal bone resection were performed on the right ear under general anesthesia. The patient underwent postoperative adjuvant chemoradiation therapy. The patient was counterchecked regularly,there was norecurrence of DSRCT of the middle ear. Four years after surgery, the CT and MRI of the middle ear mastoid showed right middle ear soft tissue shadow,but postoperative pathological results showed proliferative fibrous and vascular tissues with chronic inflammatory cell infiltration and necrosis. DSRCT is a relatively aggressive, malignant mesenchymal tumor, with a very poor prognosis.The diagnosis of DSRCT relies on immunohistological data. Early diagnosis, radical surgery, chemotherapy, and radiotherapy are considered a reasonable way to prolong survival.

Ear asymmetries in middle-ear, cochlear, and brainstem responses in human infants

PubMed Central

Keefe, Douglas H.; Gorga, Michael P.; Jesteadt, Walt; Smith, Lynette M.

2008-01-01

In 2004, Sininger and Cone-Wesson examined asymmetries in the signal-to-noise ratio (SNR) of otoacoustic emissions (OAE) in infants, reporting that distortion-product (DP)OAE SNR was larger in the left ear, whereas transient-evoked (TE)OAE SNR was larger in the right. They proposed that cochlear and brainstem asymmetries facilitate development of brain-hemispheric specialization for sound processing. Similarly, in 2006 Sininger and Cone-Wesson described ear asymmetries mainly favoring the right ear in infant auditory brainstem responses (ABRs). The present study analyzed 2640 infant responses to further explore these effects. Ear differences in OAE SNR, signal, and noise were evaluated separately and across frequencies (1.5, 2, 3, and 4 kHz), and ABR asymmetries were compared with cochlear asymmetries. Analyses of ear-canal reflectance and admittance showed that asymmetries in middle-ear functioning did not explain cochlear and brainstem asymmetries. Current results are consistent with earlier studies showing right-ear dominance for TEOAE and ABR. Noise levels were higher in the right ear for OAEs and ABRs, causing ear asymmetries in SNR to differ from those in signal level. No left-ear dominance for DPOAE signal was observed. These results do not support a theory that ear asymmetries in cochlear processing mimic hemispheric brain specialization for auditory processing. PMID:18345839

Antibodies Mediate Formation of Neutrophil Extracellular Traps in the Middle Ear and Facilitate Secondary Pneumococcal Otitis Media

PubMed Central

Short, Kirsty R.; von Köckritz-Blickwede, Maren; Langereis, Jeroen D.; Chew, Keng Yih; Job, Emma R.; Armitage, Charles W.; Hatcher, Brandon; Fujihashi, Kohtaro; Reading, Patrick C.; Hermans, Peter W.

2014-01-01

Otitis media (OM) (a middle ear infection) is a common childhood illness that can leave some children with permanent hearing loss. OM can arise following infection with a variety of different pathogens, including a coinfection with influenza A virus (IAV) and Streptococcus pneumoniae (the pneumococcus). We and others have demonstrated that coinfection with IAV facilitates the replication of pneumococci in the middle ear. Specifically, we used a mouse model of OM to show that IAV facilitates the outgrowth of S. pneumoniae in the middle ear by inducing middle ear inflammation. Here, we seek to understand how the host inflammatory response facilitates bacterial outgrowth in the middle ear. Using B cell-deficient infant mice, we show that antibodies play a crucial role in facilitating pneumococcal replication. We subsequently show that this is due to antibody-dependent neutrophil extracellular trap (NET) formation in the middle ear, which, instead of clearing the infection, allows the bacteria to replicate. We further demonstrate the importance of these NETs as a potential therapeutic target through the transtympanic administration of a DNase, which effectively reduces the bacterial load in the middle ear. Taken together, these data provide novel insight into how pneumococci are able to replicate in the middle ear cavity and induce disease. PMID:24191297

The ototoxic effect of intratympanic terbinafine applied in the middle ear of rats

PubMed Central

2013-01-01

Background Otomycosis is defined as an infection of the external ear canal with fungal agents. The treatment of the disease is cleansing and drying of the external ear canal, identification and treatment of any predisposing factors and application of topical antifungal agents. Terbinafine is used as an antifungal agent to treat otomycosis. We proposed to investigate the probable ototoxic effect of terbinafine solution on auditory brain stem response (ABR) and distortion product otoacoustic emission (DPOAE) when applied intratympanically in the middle ear of rats. Methods The experiment was performed on 30 female Wistar albino rats. Thirty animals were divided into three groups of 10 animals each. 1% terbinafine solution was administered to the first group (group T). The second group (group G) was administered 40 mg/ml gentamicin solution (ototoxic control). The third group (group S) was administered saline solution (negative control). Baseline DPOAE measurements and ABR testing from the left ears were obtained from the animals in all groups under general anesthesia. Ear solutions were applied in the middle ear intratympanically with a dental needle. Treatment was initiated after baseline measurements and repeated once every two days for fifteen days. Results Pre and post-treatment DPOAE responses for all tested frequencies of group T and Group S showed no statistically significant difference. However, the group G demonstrated a significant change in ABR thresholds and DPOAE responses. Conclusions Terbinafine solution is a broad spectrum antifungal agent effective in the treatment of otomycosis. The present study demonstrated that its direct administration in the middle ear of rats does not affect inner ear function as measured by ABR and DPOAE responses. PMID:23663536

Finite element modelling of human auditory periphery including a feed-forward amplification of the cochlea.

PubMed

Wang, Xuelin; Wang, Liling; Zhou, Jianjun; Hu, Yujin

2014-08-01

A three-dimensional finite element model is developed for the simulation of the sound transmission through the human auditory periphery consisting of the external ear canal, middle ear and cochlea. The cochlea is modelled as a straight duct divided into two fluid-filled scalae by the basilar membrane (BM) having an orthotropic material property with dimensional variation along its length. In particular, an active feed-forward mechanism is added into the passive cochlear model to represent the activity of the outer hair cells (OHCs). An iterative procedure is proposed for calculating the nonlinear response resulting from the active cochlea in the frequency domain. Results on the middle-ear transfer function, BM steady-state frequency response and intracochlear pressure are derived. A good match of the model predictions with experimental data from the literatures demonstrates the validity of the ear model for simulating sound pressure gain of middle ear, frequency to place map, cochlear sensitivity and compressive output for large intensity input. The current model featuring an active cochlea is able to correlate directly the sound stimulus in the ear canal with the vibration of BM and provides a tool to explore the mechanisms by which sound pressure in the ear canal is converted to a stimulus for the OHCs.

Application of the Vibrant Soundbridge middle-ear implant for aural atresia in patients with Treacher Collins syndrome.

PubMed

Lesinskas, E; Stankeviciute, V; Petrulionis, M

2012-12-01

To present results for the auditory rehabilitation of patients with Treacher Collins syndrome with bilateral osseous atresia, using middle-ear implantation with a Vibrant Soundbridge. Three patients underwent vibroplasty for aural atresia with moderate to severe conductive hearing loss. The pre-operative Jahrsdoerfer radiological score was 4 for all patients. Patients underwent active middle-ear implantation of a Vibrant Soundbridge implant (coupling the floating mass transducer to the rudimentary stapes or footplate distally, and positioning it adjacent to the round window membrane proximally), with audiological analysis as follow up. After implant activation, the mean air conduction threshold ± standard deviation decreased to 22.8 ± 5.5 dB HL, representing a mean functional gain of 44.5 dB. The mean word recognition score (for bisyllabic words at 65 dB SPL) increased from 0 to 97 per cent. Vibrant Soundbridge implantation is an effective hearing rehabilitation procedure in patients with Treacher Collins syndrome with bilateral osseous atresia. This is a versatile implant which can achieve coupling even in cases of severe middle-ear malformation.

Benefits of active middle ear implants in mixed hearing loss: Stapes versus round window.

PubMed

Lee, Jeon Mi; Jung, Jinsei; Moon, In Seok; Kim, Sung Huhn; Choi, Jae Young

2017-06-01

We compared the audiologic benefits of active middle ear implants with those of passive middle ear implants with hearing aids in mixed hearing loss, and also compared the outcomes of stapes vibroplasty with those of round window vibroplasty. Retrospective chart review. Thirty-four patients with mixed hearing loss due to chronic otitis media were treated with a middle ear implant. Of these, 15 were treated with a passive middle ear implant (conventional ossiculoplasty with a partial ossicular replacement prosthesis), nine with an active middle ear implant coupling to the stapes, and 10 with an active middle ear implant coupling to the round window. Patients underwent pure-tone/free-field audiograms and speech discrimination tests before surgery and 6 months after surgery, and the results of these tests were compared. The active middle ear implant resulted in better outcomes than the passive middle ear implant with hearing aids at mid to high frequencies (P < .05). Patients who received either a stapes vibroplasty or a round window vibroplasty showed comparable hearing gain except at 8,000 Hz (48.9 dB vs. 31.0 dB, P < .05). Patients who received a stapes vibroplasty showed an improvement even in bone conduction at 1,000 Hz and 2,000 Hz (both P < .05). Active middle ear implantation could be a better option than treatment with passive middle ear implants with hearing aids for achieving rehabilitation in patients with mixed hearing loss. Vibroplasty via either oval window or round window stimulation shares similar good results. 4 Laryngoscope, 127:1435-1441, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Ear malformations, hearing loss and hearing rehabilitation in children with Treacher Collins syndrome.

PubMed

Rosa, Francisco; Coutinho, Miguel Bebiano; Ferreira, João Pinto; Sousa, Cecilia Almeida

2016-01-01

The aim of this study was to assess the main ear malformations, hearing loss and auditory rehabilitation in children with Treacher Collins syndrome. We performed a retrospective study of 9 children with Treacher Collins syndrome treated in a central hospital between January 2003 and January 2013. This study showed a high incidence of malformations of the outer and middle ear, such as microtia, atresia or stenosis of the external auditory canal, hypoplastic middle ear cavity, dysmorphic or missing ossicular chain. Most patients had bilateral hearing loss of moderate or high degree. In the individuals studied, there was functional improvement in patients with bone-anchored hearing aids in relation to conventional hearing aids by bone conduction. Treacher Collins syndrome is characterized by bilateral malformations of the outer and middle ear. Hearing rehabilitation in these children is of utmost importance, and bone-anchored hearing aids is the method of choice. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease

PubMed Central

MANIU, ALMA; CATANA, IULIU V.; HARABAGIU, OANA; PETRI, MARIA; COSGAREA, MARCEL

2013-01-01

Aim The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted. Methods Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope Results Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum. Conclusions The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani. PMID:26527977

Middle ear function and cochlear input impedance in chinchilla

PubMed Central

Slama, Michaël C. C.; Ravicz, Michael E.; Rosowski, John J.

2010-01-01

Simultaneous measurements of middle ear-conducted sound pressure in the cochlear vestibule PV and stapes velocity VS have been performed in only a few individuals from a few mammalian species. In this paper, simultaneous measurements of PV and VS in six chinchillas are reported, enabling computation of the middle ear pressure gain GME (ratio of PV to the sound pressure in the ear canal PTM), the stapes velocity transfer function SVTF (ratio of the product of VS and area of the stapes footplate AFP to PTM), and, for the first time, the cochlear input impedance ZC (ratio of PV to the product of VS and AFP) in individuals. |GME| ranged from 25 to 35 dB over 125 Hz–8 kHz; the average group delay between 200 Hz and 10 kHz was about 52 μs. SVTF was comparable to that of previous studies. ZC was resistive from the lowest frequencies up to at least 10 kHz, with a magnitude on the order of 1011 acoustic ohms. PV, VS, and the acoustic power entering the cochlea were good predictors of the shape of the audiogram at frequencies between 125 Hz and 2 kHz. PMID:20329840

Postganglionic horner syndrome in three patients with coincident middle ear infection.

PubMed

Spector, Robert H

2008-09-01

Three patients developed a postganglionic Horner syndrome during the course of an ipsilateral uncomplicated middle ear infection. The mechanism may be an effect on the middle ear caroticotympanic sympathetic plexus, for which there is considerable anatomic and physiologic evidence. Why Horner syndrome does not occur more often after middle ear infection is a mystery.

Effects of consecutive wideband tympanometry trials on energy absorbance measures of the middle ear.

PubMed

Burdiek, Laina M; Sun, Xiao-Ming

2014-10-01

Wideband acoustic immittance (WAI) is a new technique for assessing middle ear transfer function. It includes energy absorbance (EA) measures and can be acquired with the ear canal pressure varied, known as wideband tympanometry (WBTymp). The authors of this study aimed to investigate effects of consecutive WBTymp testing on EA. Data were collected in 29 young adults with normal hearing and middle ear status. Before and after 8 successive WBTymp runs, EA was also measured at ambient pressure. Subsequently, two 226-Hz tympanometry tests were performed. EA systematically changed over the WBTymp trials in a frequency-specific manner: increase for low frequencies (below 1.5 kHz) and decrease for high frequencies (around 2 kHz and 5 to 6 kHz). The changes, although small, were significant. Much larger EA changes were measured at ambient pressure. The test-retest difference of 226-Hz tympanogram measures was much smaller than previously reported. Consecutive tympanometry testing alters EA measures of the middle ear. This phenomenon could be mainly attributed to change in stiffness at the eardrum, called tympanometric preconditioning. This also has effects on baseline WBTymp outcomes. This effect should be taken into account as a procedural variable in both research and clinical applications of WAI measurements.

Eustachian Tube Opening Measured by Sonotubometry is Poorer in Adults with a History of Past Middle Ear Disease

PubMed Central

Teixeira, Miriam S.; Banks, Juliane; Swarts, J. Douglas; Alper, Cuneyt M.; Doyle, William J.

2014-01-01

Objective Test the hypothesis that active Eustachian tube opening efficiency as measured by sonotubometry is higher in adults with no extant middle-ear disease and no history of previous otitis media (Group-1) when compared to adults with no middle-ear disease but a positive history for otitis media (Group-2). Methods Eustachian tube function for 1 ear of 33 otherwise healthy adult subjects, 16 assigned to Group-1 and 17 to Group-2, was tested by sonotubometry using a standard protocol. For each test, the sound envelopes for 3 swallows were abstracted independently by 2 observers from the data stream and 7 descriptive parameters related to sound envelope “shape” were calculated. Interrelatedness among the values for the parameters was explored using correlation analysis. The contributions of swallow, observer and group to the variance in each parameter were evaluated for significance using a General Linear Model. Results The shape parameters reflecting envelope height, area and rise and fall rates were highly inter-correlated, but those reflecting envelope widths were not. There was no effect of “swallow” on any of the parameters; but there was a significant “observer” effect on all measures of envelope width, greater for observer-2, and a significant “group” effect for 5 of the 7 shape parameters, all greater in Group-1. Conclusions Quantifiable measures of the sound signal “shape” recorded by sonotubometry during swallowing were significantly different between the 2 groups of subjects. This is interpretable as evidencing a more efficient Eustachian tube opening-function in adults with healthy middle ears who do not have a previous history of otitis media when compared to similar adults with a history of prior otitis media. Inefficient Eustachian tube function as children may not be completely resolved by adulthood increasing adult otitis media risk when Eustachian tube function is down-graded by extant upper respiratory diseases that provoke nasopharyngeal inflammation. PMID:24491807

Nasal Allergy and Otitis Media

PubMed Central

Passali, Desiderio; Passali, Giulio C.; Lauriello, Maria; Romano, Antonio; Bellussi, Luisa; Passali, Francesco M.

2014-01-01

Objectives: The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. Methods: The study included 100 atopic children (52 boys, 48 girls) aged 5–9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed. Results: The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001). Conclusion: There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms. PMID:24516755

Otopolyposis With Middle Ear Allergic Mucin in a Patient With Allergic Fungal Rhinosinusitis.

PubMed

Kumar, Manvinder S; Panella, Nicholas J; Magliocca, Kelly R; Vivas, Esther X

2016-10-01

The purpose of this study is to report a case of otopolyposis and middle ear allergic mucin in a patient with allergic fungal rhinosinusitis (AFRS) and no history of middle ear disease and introduce these as possible otologic manifestations of the AFRS. A case of a 31-year-old female with the aforementioned findings is reported. A review of the pertinent literature was performed. We report a case of a 31-year-old female with a history of AFRS but no history of middle ear disease or hearing loss who presented to our institution complaining of aural fullness. Physical exam was significant for middle ear masses of unknown etiology. Surgical exploration revealed the presence of allergic mucin and middle ear polyposis histologically identical to tissue sampled during prior sinonasal surgeries at the same institution. Aspiration of the middle ear space did not resolve the otologic symptoms. Otopolyposis and middle ear allergic mucin are extremely rare but possible otologic manifestations of AFRS. We encourage otolaryngologists to consider this in the clinical differential diagnosis of patients with a history of AFRS with new onset otologic symptoms. © The Author(s) 2016.

Active middle ear implant after lateral petrosectomy and radiotherapy for ear cancer.

PubMed

Cristalli, Giovanni; Sprinzl, Georg M; Wolf-Magele, Astrid; Marchesi, Paolo; Mercante, Giuseppe; Spriano, Giuseppe

2014-04-01

Tumor of the temporal bone is a rare disease with a very poor prognosis. Surgery and postoperative radiotherapy are usually the recommended treatments for squamous cell carcinoma (SCC) of the external and middle ear, which may cause conductive hearing loss. The purpose of this study was to evaluate the audiologic results and compliance of active middle ear implant (AMEI) and establish the feasibility of the procedure in a patient treated for middle ear cancer. A 73-year-old patient treated with lateral petrosectomy, neck dissection, reconstruction/obliteration by pedicled pectoralis major myocutaneous flap, and postoperative full dose radiotherapy for external and middle ear SCC was selected for AMEI. Preoperative audiometric and speech audiometry tests were performed on both ears before and after the activation. Pure tone free field audiometry. Binaural free field speech audiogram. Aided pure tone free field audiometry AMEI results show an increase in air conduction. Speech audiogram showed better discrimination scores in AMEI-aided situations. No complications were observed. AMEI after surgery followed by radiotherapy for middle ear cancer is feasible. Acoustic results in obliterated ear are satisfactory.

The middle ear mass: a rare but important diagnosis.

PubMed

Pankhania, Miran; Rourke, Thomas; Draper, Mark R

2011-12-02

The authors report a rare case of primary intracranial meningioma presenting as a middle ear mass with conductive hearing loss. The authors aim to highlight the importance of diagnosing a middle ear mass, which although rare, may have a substantial impact on ongoing patient management. A discussion of other middle ear pathologies is made in order to demonstrate the subtle differences in presentation.

Wideband acoustic reflex test in a test battery to predict middle-ear dysfunction

PubMed Central

Keefe, Douglas H.; Fitzpatrick, Denis; Liu, Yi-Wen; Sanford, Chris A.; Gorga, Michael P.

2013-01-01

A wideband (WB) aural acoustical test battery of middle-ear status, including acoustic-reflex thresholds (ARTs) and acoustic-transfer functions (ATFs, i.e., absorbance and admittance) was hypothesized to be more accurate than 1-kHz tympanometry in classifying ears that pass or refer on a newborn hearing screening (NHS) protocol based on otoacoustic emissions. Assessment of middle-ear status may improve NHS programs by identifying conductive dysfunction and cases in which auditory neuropathy exists. Ipsilateral ARTs were assessed with a stimulus including four broadband-noise or tonal activator pulses alternating with five clicks presented before, between and after the pulses. The reflex shift was defined as the difference between final and initial click responses. ARTs were measured using maximum likelihood both at low frequencies (0.8–2.8 kHz) and high (2.8–8 kHz). The median low-frequency ART was elevated by 24 dB in NHS refers compared to passes. An optimal combination of ATF and ART tests performed better than either test alone in predicting NHS outcomes, and WB tests performed better than 1-kHz tympanometry. Medial olivocochlear efferent shifts in cochlear function may influence ARs, but their presence would also be consistent with normal conductive function. Baseline clinical and WB ARTs were also compared in ipsilateral and contralateral measurements in adults. PMID:19772907

Biomechanical Modeling and Measurement of Blast Injury and Hearing Protection Mechanisms

DTIC Science & Technology

2015-10-01

12 software into Workbench V. 15 in CFX/ANSYS; 2) building the geometry of the ear model with ossicular chain and cochlear load in CFX; 3...the ear canal to middle ear. The model consists of the ear canal, TM, middle ear ossicles and suspensory ligaments, middle ear cavity, and cochlear ...the TM, ossicles, and ligaments/muscle tendons with the cochlear load applied on the stapes footplate. 17 Fig. 21. Time-history plots of

The Surgical Challenge of Carotid Artery and Fallopian Canal Dehiscence in Chronic Ear Disease: A Pitfall for Endoscopic Approach

PubMed Central

Pauna, Henrique F.; Monsanto, Rafael C.; Schachern, Patricia A.; Costa, Sady S.; Kwon, Geeyoun; Paparella, Michael M.; Cureoglu, Sebahattin

2016-01-01

Objective Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals. Design Comparative human temporal bone study. Setting Otopathology laboratory. Participants We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma, and then compared those 2 groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease. Main outcome measures We analyzed the middle ear, carotid artery canal, and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy. Results We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease. Conclusion The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery. Level of Evidence N/A. PMID:27455393

Tuberculous otitis media: a difficult diagnosis and report of four cases.

PubMed

Vital, Victor; Printza, Athanasia; Zaraboukas, Thomas

2002-01-01

Tuberculous otitis media is a rare disease. Due to the condition's rarity and its usually indolent course, the diagnosis is often delayed. This can lead to irreversible complications, such as permanent hearing loss or facial nerve paralysis. Tuberculosis of the middle ear cleft, as this disease's first presentation, is indeed very rare. Surgery may be carried out prior to diagnosis occasionally, i.e., middle ear exploration for chronic middle ear disease. We present four cases of tuberculous otitis media which occurred as the first presentation of the disease. The patients did not present with the classic symptoms of middle ear tuberculosis. The diagnosis was based on the histology following middle ear exploration for chronic middle ear disease. None of the patients presented any other systemic involvement. We present a review of this disease's clinical symptoms and the diagnostic tests available.

Ultrasound characterization of middle ear effusion.

PubMed

Seth, Rahul; Discolo, Christopher M; Palczewska, Grazyna M; Lewandowski, Jan J; Krakovitz, Paul R

2013-01-01

To further enhance and assess the ability to characterize middle ear effusion (MEE) using non-invasive ultrasound technology. This is a prospective unblinded comparison study. Fifty-six children between the ages of 6 months and 17 years scheduled to undergo bilateral myringotomy with pressure equalization tube placement were enrolled. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings of middle ear contents were analyzed by computer algorithm. Middle ear fluid was collected during myringotomy and analyzed for bacterial culture and viscosity. Ultrasound waveforms yielded a computer algorithm interpretation of middle ear contents in 66% of ears tested. When a result was obtained, the sensitivity and specificity for successfully characterizing middle ear fluid content as either void of fluid, thick fluid (mucoid), or thin fluid (serous or purulent) were at least 94%. Mucoid effusions had higher measured viscosity values (P=.002). Viscosity measures were compared to culture result, and those with low viscosity (thin consistency) had a higher likelihood of having a positive culture (P=.048). The device sensitivity and specificity for fluid detection were 94% or greater among interpretable waveforms (66% of those tested). Although this technology provides important information of the middle ear effusion presence and characteristic, further technological improvements are needed. Copyright © 2013 Elsevier Inc. All rights reserved.

Ultrasound Characterization of Middle Ear Effusion

PubMed Central

Seth, Rahul; Discolo, Christopher M; Palczewska, Grazyna M; Lewandowski, Jan J; Krakovitz, Paul R

2012-01-01

Purpose To further enhance and assess the ability to characterize middle ear effusion (MEE) using non-invasive ultrasound technology. Materials and Methods This is a prospective unblinded comparison study. Fifty-six children between the ages of 6 months and 17 years scheduled to undergo bilateral myringotomy with pressure equalization tube placement were enrolled. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings of middle ear contents were analyzed by computer algorithm. Middle ear fluid was collected during myringotomy and analyzed for bacterial culture and viscosity. Results Ultrasound waveforms yielded a computer algorithm interpretation of middle ear contents in 66% of ears tested. When a result was obtained, the sensitivity and specificity for successfully characterizing middle ear fluid content as either void of fluid, thick fluid (mucoid), or thin fluid (serous or purulent) was at least 94%. Mucoid effusions had higher measured viscosity values (P=0.002). Viscosity measures were compared to culture result, and those with low viscosity (thin consistency) had a higher likelihood of having a positive culture (P=0.048). Conclusion The device sensitivity and specificity for fluid detection was 94% or greater among interpretable waveforms (66% of those tested). Although this technology provides important information of the middle ear effusion presence and characteristic, further technological improvements are needed. PMID:23084430

Local treatment of the inner ear: a study of three different polymers aimed for middle ear administration.

PubMed

Engmér Berglin, Cecilia; Videhult Pierre, Pernilla; Ekborn, Andreas; Bramer, Tobias; Edsman, Katarina; Hultcrantz, Malou; Laurell, Göran

2015-01-01

A formulation based on sodium hyaluronate (NaHYA) was the most promising candidate vehicle for intra-tympanic drug administration regarding conductive hearing loss, inflammatory reactions, and elimination. Recent advances in inner ear research support the idea of using the middle ear cavity for drug administration to target the inner ear. This paper presents rheological and safety assessments of three candidate polymer formulations for intra-tympanic drug administration. The formulations were based on sodium carboxymethyl cellulose (NaCMC), sodium hyaluronate (NaHYA), and poloxamer 407 (POL). Rheological studies were performed with a controlled rate instrument of the couette type. Safety studies were performed in guinea pigs subjected to an intra-tympanic injection of the formulations. Hearing function was explored with ABR before and 1, 2, and 3 weeks after the injection. Elimination of the formulations marked with coal was explored with an endoscopic digital camera 1, 2, and 3 weeks after injection. Middle and inner ear morphology was examined with light microscopy 6 days after injection. The results speak in favor of NaHYA, since it did not cause prolonged hearing threshold elevations. The results of the elimination and morphological investigations support the conclusion of NaHYA being the most promising candidate for intra-tympanic administration.

Histologic characterization of the cat middle ear: in sickness and in health.

PubMed

Sula, M M; Njaa, B L; Payton, M E

2014-09-01

The purpose of this study was to establish microscopic normal in the middle ear of the cat while concurrently characterizing gross and microscopic lesions reflecting spontaneous otitis media. Both ears from 50 cats were examined grossly and processed for histologic examination of the external, middle, and internal ear on a single slide. Gross lesions of the middle ear were present in 14 of 100 (14%) and included turbid fluid, frank pus, hemorrhage, and fibrous thickening of the auricular mucoperiosteum. Histologically, 48 of 100 (48%) ears had evidence of ongoing or previous inflammatory middle ear disease, including proteinaceous fluid; vascular ectasia; expansion of the auricular mucoperiosteum by neutrophils, lymphocytes, and macrophages; cholesterol clefts; hemorrhage; fibrin; granulation tissue; membranous pseudo-glands; fibrosis; proliferation and/or osteolysis of the tympanic and septum bullae. Histologic lesions were identified in 34 of 100 ears (34%) lacking gross evidence of disease. Ears were classified histologically as either normal (52/100 [52%]) or diseased (48/100 [48%]). Diseased ears were further classified as mild to moderate (37/100 [37%]) or severely (11/100 [11%]) affected. Internal ear involvement was present in 11 of 100 (11%) ears. Histologic evidence of middle ear disease in cats is far greater than gross lesions or clinical literature suggests; further investigation and correlation of clinical and histologic disease are warranted. With minimal additional preparation, diagnostic specimens may be readily prepared and evaluated for this integral sensing organ. © The Author(s) 2013.

Temporal and spatial expression patterns of Hedgehog receptors in the developing inner and middle ear.

PubMed

Shin, Jeong-Oh; Ankamreddy, Harinarayana; Jakka, Naga Mahesh; Lee, Seokwon; Kim, Un-Kyung; Bok, Jinwoong

2017-01-01

The mammalian inner ear is a complex organ responsible for balance and hearing. Sonic hedgehog (Shh), a member of the Hedgehog (Hh) family of secreted proteins, has been shown to play important roles in several aspects of inner ear development, including dorsoventral axial specification, cochlear elongation, tonotopic patterning, and hair cell differentiation. Hh proteins initiate a downstream signaling cascade by binding to the Patched 1 (Ptch1) receptor. Recent studies have revealed that other types of co-receptors can also mediate Hh signaling, including growth arrest-specific 1 (Gas1), cell-adhesion molecules-related/down-regulated by oncogenes (Cdon), and biregional Cdon binding protein (Boc). However, little is known about the role of these Hh co-receptors in inner ear development. In this study, we examined the expression patterns of Gas1, Cdon, and Boc, as well as that of Ptch1, in the developing mouse inner ear from otocyst (embryonic day (E) 9.5) until birth and in the developing middle ear at E15.5. Ptch1, a readout of Hh signaling, was expressed in a graded pattern in response to Shh signaling throughout development. Expression patterns of Gas1, Cdon, and Boc differed from that of Ptch1, and each Hh co-receptor was expressed in specific cells and domains in the developing inner and middle ear. These unique and differential expression patterns of Hh co-receptors suggest their roles in mediating various time- and space-specific functions of Shh during ear development.

Role of Laryngopharyngeal Reflux in the Pathogenesis of Otitis Media with Effusion.

PubMed

Doğru, Mehmet; Kuran, Gökhan; Haytoğlu, Süheyl; Dengiz, Ramazan; Arıkan, Osman Kürşat

2015-04-01

To determine whether there is an association between otitis media with effusion and laryngopharyngeal reflux in children. This study included 31 children with otitis media with effusion. The pepsinogen level in the middle ear fluid of all patients was measured by sandwich enzyme-linked immunosorbent assay. Each patient's middle ear fluid was investigated for Helicobacter pylori (H. pylori) using the Campylobacter-like organism (CLO) test. The middle ear pepsinogen levels were compared with those in the serum. The correlation between pepsinogen levels and H. pylori positivity in the middle ear fluid was investigated. The mean middle ear pepsinogen level (211.69 ng/mL) was significantly higher than that in the serum (24.18 ng/mL) in patients with otitis media with effusion. The middle ear aspirates of six patients (19%) were positive for H. pylori, and the correlation between H. pylori positivity and increased pepsinogen levels in the middle ear fluid was statistically significant in patients with otitis media with effusion. We detected higher pepsinogen levels and H. pylori positivity rates in the middle ear fluid than in the serum of patients with otitis media with effusion. These results support the role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion.

Into the dark: patterns of middle ear adaptations in subterranean eulipotyphlan mammals

NASA Astrophysics Data System (ADS)

Koyabu, Daisuke; Hosojima, Misato; Endo, Hideki

2017-09-01

Evolution of the middle ear ossicles was a key innovation for mammals, enhancing the transmission of airborne sound. Radiation into various habitats from a terrestrial environment resulted in diversification of the auditory mechanisms among mammals. However, due to the paucity of phylogenetically controlled investigations, how middle ear traits have diversified with functional specialization remains unclear. In order to identify the respective patterns for various lifestyles and to gain insights into fossil forms, we employed a high-resolution tomography technique and compared the middle ear morphology of eulipotyphlan species (moles, shrews and hedgehogs), a group that has radiated into various environments, such as terrestrial, aquatic and subterranean habitats. Three-dimensional geometric morphometric analysis was conducted within a phylogenetically controlled framework. Quantitative shapes were found to strongly reflect the degree of subterranean lifestyle and weakly involve phylogeny. Our analyses demonstrate that subterranean adaptation should include a relatively shorter anterior process of the malleus, an enlarged incus, an enlarged stapes footplate and a reduction of the orbicular apophysis. These traits arguably allow improving low-frequency sound transmission at low frequencies and inhibiting the low-frequency noise which disturbs the subterranean animals in hearing airborne sounds.

Expression of calcium-binding proteins S100A8, S100A9 and S100A12 in otitis media.

PubMed

Hong, Wenzhou; Khampang, Pawjai; Samuels, Tina L; Kerschner, Joseph E; Yan, Ke; Simpson, Pippa

2017-10-01

Calgranulins (calcium-binding proteins S100A8, S100A9 and S100A12) are predominant cytoplasmic proteins of neutrophils and produced by various cells, playing multiple functions in innate immunity and the inflammatory process. Although up-regulated expression of S100A8 and S100A9 genes were observed in an animal model of otitis media (OM), their expressions have not been studied in human middle ear epithelial cells in response to the OM pathogen or in patients with recurrent or chronic OM (recurrent OM/RecOM or chronic OM with effusion/COME). Gene expressions were compared between Streptococcus pneumoniae (SP)-infected and non-infected human middle ear epithelial cells (HMEECs) as well as between chronic OM patients and control patients (CI). Gene expressions were profiled by quantitative real time PCR (qPCR). S100 proteins in OM patient and CI middle ear biopsies were detected by immunostaining. S100A8, S100A9 and S100A12 gene expressions were elevated in SP-infected HMEECs in time-dependent manner. S100A8 and S100A9 but not S100A12 gene expression was significantly elevated in the middle ear mucosa of OM patients. S100A8 and S100A9 protein were observed in middle ear mucosa of OM, but not CI patients. Minimal co-localization was observed between S100A8 and S100A9 with neutrophil elastase and cytokeratin in ME sections of OM patients. Elevated S100A8 and S100A9 gene expression in SP-infected HMEECs and in the middle ear mucosa of OM, minor co-localized with neutrophil markers suggests that middle ear epithelial cell secretion of S100A8 and S100A9 may play a role in the pathogenesis of recurrent and chronic OM. Copyright © 2017 Elsevier B.V. All rights reserved.

Ear Infection (Middle Ear)

MedlinePlus

... secretions from the middle ear Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory ... your baby for at least six months. Breast milk contains antibodies that may offer protection from ear ...

Schneiderian-Type Papilloma of the Middle Ear: A Review of the Literature

PubMed Central

Schaefer, Nathan; Chong, Jessica; Griffin, Aaron; Little, Andrew; Gochee, Peter; Dixon, Natalie

2015-01-01

Schneiderian-type papilloma of the middle ear is a rare finding. We present a 46-year-old Aboriginal man with a large tympanic membrane perforation and a Schneiderian-type papilloma filling the middle ear. The aim of this study is to familiarize clinicians with this uncommon disease through discussion of its clinical presentation, diagnostic considerations and management. A search of English-language peer-reviewed literature was undertaken using the key words “Schneiderian-type papilloma,” “inverted papilloma,” and “middle ear.” A total of 29 cases (including the present case) of Schneiderian-type papilloma involving the middle ear were reviewed. Common presenting symptoms include hearing loss, otalgia, and otorrhea. Middle ear disease is associated with higher rates of recurrence and malignant transformation than its sinonasal counterpart. Radical surgical resection is the only curative treatment. Schneiderian-type papilloma is a benign, but locally aggressive, epithelial neoplasm most commonly arising in the sinonasal tract. Whilst involvement of the middle ear is extremely rare, knowledge of this condition is important due to its propensity to recur and the high rate of malignant transformation. PMID:25564042

Oxidative metabolic products released from polymorphonuclear leukocytes in middle ear fluid during experimental pneumococcal otitis media.

PubMed Central

Kawana, M; Kawana, C; Yokoo, T; Quie, P G; Giebink, G S

1991-01-01

To determine whether oxidative metabolic products of phagocytic cells are present in the middle ear during experimental pneumococcal otitis media, we measured the concentration of myeloperoxidase (MPO) in middle ear fluid (MEF) and the capacity of neutrophils isolated from MEF and peripheral blood to produce MPO and superoxide anion (O2-) after in vitro stimulation. Free MPO in MEF was significantly increased 24 and 48 h after either viable or nonviable pneumococci were inoculated into the middle ear. In vitro-stimulated production of MPO and O2- from middle ear neutrophils was significantly less than that from peripheral blood neutrophils 24 h after nonviable pneumococci were inoculated but similar to it after 48 h. Twenty-four hours after viable pneumococci were inoculated, middle ear neutrophils stimulated in vitro produced less MPO but the same amount of O2- as did blood neutrophils. Oxidative metabolic products, therefore, are released from phagocytic cells into the MEF during pneumococcal otitis media, and future studies will need to define the contribution of these products to acute and chronic middle ear tissue injury. PMID:1657782

Schneiderian-Type Papilloma of the Middle Ear: A Review of the Literature.

PubMed

Schaefer, Nathan; Chong, Jessica; Griffin, Aaron; Little, Andrew; Gochee, Peter; Dixon, Natalie

2015-06-01

Schneiderian-type papilloma of the middle ear is a rare finding. We present a 46-year-old Aboriginal man with a large tympanic membrane perforation and a Schneiderian-type papilloma filling the middle ear. The aim of this study is to familiarize clinicians with this uncommon disease through discussion of its clinical presentation, diagnostic considerations and management. A search of English-language peer-reviewed literature was undertaken using the key words "Schneiderian-type papilloma," "inverted papilloma," and "middle ear." A total of 29 cases (including the present case) of Schneiderian-type papilloma involving the middle ear were reviewed. Common presenting symptoms include hearing loss, otalgia, and otorrhea. Middle ear disease is associated with higher rates of recurrence and malignant transformation than its sinonasal counterpart. Radical surgical resection is the only curative treatment. Schneiderian-type papilloma is a benign, but locally aggressive, epithelial neoplasm most commonly arising in the sinonasal tract. Whilst involvement of the middle ear is extremely rare, knowledge of this condition is important due to its propensity to recur and the high rate of malignant transformation.

Comparison of packing material in an animal model of middle ear trauma.

PubMed

Perez, Enrique; Hachem, Ralph Abi; Carlton, Daniel; Bueno, Isabel; Vernon, Stephen; Van De Water, Thomas R; Angeli, Simon I

2016-01-01

To compare the performance of absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma. Using a randomized, controlled and blinded study design fifteen guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS while the contralateral ear remained untreated and used as non-packed paired controls. Auditory brainstem response (ABR) thresholds were measured pre-operatively and repeated at 1, 2, and 6weeks postoperatively. Histological analysis of middle ear mucosa was done in each group to evaluate the inflammatory reaction and wound healing. Another eighteen animals underwent middle ear wounding and packing in one ear while the contralateral ear was left undisturbed as control. Twelve guinea pigs were euthanized at 2weeks postoperatively, and six were euthanized at 3days post-operatively. Mucosal samples were collected for analysis of TGF-β1 levels by enzyme-linked immunosorbent assay. ABR recordings demonstrate that threshold level changes from baseline were minor in PUF packed and control ears. Threshold levels were higher in the AGS packed ears compared with both control and PUF packed ears for low frequency stimuli. Histological analysis showed persistence of packing material at 6weeks postoperatively, inflammation, granulation tissue formation, foreign body reaction and neo-osteogenesis in both AGS and PUF groups. TGF-β1 protein levels did not differ between groups. PUF and AGS packing cause inflammation and neo-osteogenesis in the middle ear following wounding of the mucosa and packing. Copyright © 2016 Elsevier Inc. All rights reserved.

Sound transmission in archaic and modern whales: anatomical adaptations for underwater hearing.

PubMed

Nummela, Sirpa; Thewissen, J G M; Bajpai, Sunil; Hussain, Taseer; Kumar, Kishor

2007-06-01

The whale ear, initially designed for hearing in air, became adapted for hearing underwater in less than ten million years of evolution. This study describes the evolution of underwater hearing in cetaceans, focusing on changes in sound transmission mechanisms. Measurements were made on 60 fossils of whole or partial skulls, isolated tympanics, middle ear ossicles, and mandibles from all six archaeocete families. Fossil data were compared with data on two families of modern mysticete whales and nine families of modern odontocete cetaceans, as well as five families of noncetacean mammals. Results show that the outer ear pinna and external auditory meatus were functionally replaced by the mandible and the mandibular fat pad, which posteriorly contacts the tympanic plate, the lateral wall of the bulla. Changes in the ear include thickening of the tympanic bulla medially, isolation of the tympanoperiotic complex by means of air sinuses, functional replacement of the tympanic membrane by a bony plate, and changes in ossicle shapes and orientation. Pakicetids, the earliest archaeocetes, had a land mammal ear for hearing in air, and used bone conduction underwater, aided by the heavy tympanic bulla. Remingtonocetids and protocetids were the first to display a genuine underwater ear where sound reached the inner ear through the mandibular fat pad, the tympanic plate, and the middle ear ossicles. Basilosaurids and dorudontids showed further aquatic adaptations of the ossicular chain and the acoustic isolation of the ear complex from the skull. The land mammal ear and the generalized modern whale ear are evolutionarily stable configurations, two ends of a process where the cetacean mandible might have been a keystone character. 2007 Wiley-Liss, Inc.

Numerical analysis of ossicular chain lesion of human ear

NASA Astrophysics Data System (ADS)

Liu, Yingxi; Li, Sheng; Sun, Xiuzhen

2009-04-01

Lesion of ossicular chain is a common ear disease impairing the sense of hearing. A comprehensive numerical model of human ear can provide better understanding of sound transmission. In this study, we propose a three-dimensional finite element model of human ear that incorporates the canal, tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, middle ear cavity and inner ear fluid. Numerical analysis is conducted and employed to predict the effects of middle ear cavity, malleus handle defect, hypoplasia of the long process of incus, and stapedial crus defect on sound transmission. The present finite element model is shown to be reasonable in predicting the ossicular mechanics of human ear.

Expression of macrophage migration inhibitory factor and CD74 in the inner ear and middle ear in lipopolysaccharide-induced otitis media.

PubMed

Ishihara, Hisashi; Kariya, Shin; Okano, Mitsuhiro; Zhao, Pengfei; Maeda, Yukihide; Nishizaki, Kazunori

2016-10-01

Significant expression of macrophage migration inhibitory factor and its receptor (CD74) was observed in both the middle ear and inner ear in experimental otitis media in mice. Modulation of macrophage migration inhibitory factor and its signaling pathway might be useful in the management of inner ear inflammation due to otitis media. Inner ear dysfunction secondary to otitis media has been reported. However, the specific mechanisms involved are not clearly understood. The aim of this study is to investigate the expression of macrophage migration inhibitory factor and CD74 in the middle ear and inner ear in lipopolysaccharide-induced otitis media. BALB/c mice received a transtympanic injection of either lipopolysaccharide or phosphate-buffered saline (PBS). The mice were sacrificed 24 h after injection, and temporal bones were processed for polymerase chain reaction (PCR) analysis, histologic examination, and immunohistochemistry. PCR examination revealed that the lipopolysaccharide-injected mice showed a significant up-regulation of macrophage migration inhibitory factor in both the middle ear and inner ear as compared with the PBS-injected control mice. The immunohistochemical study showed positive reactions for macrophage migration inhibitory factor and CD74 in infiltrating inflammatory cells, middle ear mucosa, and inner ear in the lipopolysaccharide-injected mice.

The effect of high flow nasal cannula oxygen therapy on middle ear pressure.

PubMed

Piastro, Kristina; Chaskes, Mark; Agarwal, Jay; Parnes, Steven

2016-01-01

To investigate the effect of high flow nasal cannula oxygen therapy (HFOT) on middle ear pressure. Ten patients (eight males and two females) with oxygen desaturations requiring HFOT were recruited with 19 ears available for our study. The study group was aged 29-90years (mean 65.3±16.5). All patients underwent a review of medical history, questioned about subjective hearing loss and underwent a standard otologic exam, with middle ear pressures measured with a GSI TympStar tympanometer. The middle ear peak pressures in our study group ranged from 25 to -200daPa (mean -13.7±56.3daPa). Volume of HFOT was delivered at 20-40L (mean 30.5±9L) and fraction of inspired oxygen required was 30-70% (mean 58±13%). There was a positive correlation between liters of oxygen delivery and middle ear pressure with a Pearson coefficient (R) of 0.436, although lacking statistical significance (p=0.06). Previous studies have shown that HFOT delivered in the range of 35-40L/min produces pharyngeal pressures at or above 5cm H2O. Since pharyngeal pressures of 5cm H2O produced via CPAP have shown to produce middle ear pressures above 40daPa, we expected HFOT to result in similar middle ear pressures of 35-40L/min. However, although our results show an increase in middle ear pressures with flow volume, HFOT did not produce significant increases in middle ear pressures. This may make HFOT an appropriate option of oxygen delivery to patients who require otologic procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Major evolutionary transitions and innovations: the tympanic middle ear

PubMed Central

2017-01-01

One of the most amazing transitions and innovations during the evolution of mammals was the formation of a novel jaw joint and the incorporation of the original jaw joint into the middle ear to create the unique mammalian three bone/ossicle ear. In this review, we look at the key steps that led to this change and other unusual features of the middle ear and how developmental biology has been providing an understanding of the mechanisms involved. This starts with an overview of the tympanic (air-filled) middle ear, and how the ear drum (tympanic membrane) and the cavity itself form during development in amniotes. This is followed by an investigation of how the ear is connected to the pharynx and the relationship of the ear to the bony bulla in which it sits. Finally, the novel mammalian jaw joint and versatile dentary bone will be discussed with respect to evolution of the mammalian middle ear. This article is part of the themed issue ‘Evo-devo in the genomics era, and the origins of morphological diversity’. PMID:27994124

Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

PubMed

Zou, Jing; Hannula, Markus; Misra, Superb; Feng, Hao; Labrador, Roberto Hanoi; Aula, Antti S; Hyttinen, Jari; Pyykkö, Ilmari

2015-01-27

Silver nanoparticles (Ag NPs) displayed strong activities in anti-bacterial, anti-viral, and anti-fungal studies and were reportedly efficient in treating otitis media. Information on distribution of AgNPs in different compartments of the ear is lacking. To detect distribution of Ag NPs in the middle and inner ear and transportation pathways after transtympanic injection. Contrast effect of Ag NPs in the micro CT imaging was assessed in a phantom. AgNPs at various concentrations (1.85 mM, 37.1 mM, and 370.7 mM) were administered to rat middle ear using transtympanic injection and cadaver heads were imaged using micro CT at several time points. The lowest concentration of Ag NPs that could be visualized using micro CT was 37.1 mM. No difference was observed between the solvents, deionized H2O and saline. Ag NPs at 37.1 mM were visible in the middle ear on 7 d post-administration. Ag NPs at 370.7 mM generated signals in the middle ear, ossicular chain, round window membrane, oval window, scala tympani, and Eustachian tube for both 4 h and 24 h time points. A gradient distribution of Ag NPs from the middle ear to the inner ear was detected. The pathways for Ag NPs to be transported from the middle ear into the inner ear are round and oval windows. This study provided the imaging evidence that Ag NPs are able to access the inner ear in a dose-dependent manner after intratympanic administration, which is relevant to design the delivery concentration in the future clinic application in order to avoid adverse inner ear effect.

Phonemic Awareness and Middle-Ear Disease among Bedouin Arabs in Israel.

ERIC Educational Resources Information Center

Abu-Rabia, Salim

2002-01-01

Investigates the effect of middle-ear infections on phonemic awareness on first-grade Bedouin Arab elementary school children in northern Israel. Divides 49 children who were screened according to their infant medical records into two groups: one with repeated middle-ear infection and one without. Indicates a nonsignificant effect of middle-ear…

Wideband acoustic immittance for assessing middle ear functioning for preterm neonates in the neonatal intensive care unit.

PubMed

Gouws, Nandel; Swanepoel, De Wet; De Jager, Leigh Biagio

2017-06-28

The primary aim of newborn hearing screening is to detect permanent hearing loss. Because otoacoustic emissions (OAEs) and automated auditory brainstem response (AABR) are sensitive to hearing loss, they are often used as screening tools. On the other hand, false-positive results are most often because of transient outer- and middle ear conditions. Wideband acoustic immittance (WAI), which includes physical measures known as reflectance and absorbance, has shown potential for accurate assessment of middle ear function in young infants. The main objective of this study was to determine the feasibility of WAI as a diagnostic tool for assessing middle ear functioning in preterm neonates in the neonatal intensive care unit (NICU) designed for premature and ill neonates. A further objective was to indicate the difference between the reflectance values of tones and click stimuli. Fifty-six at-risk neonates (30 male and 26 female), with a mean age at testing of 35.6 weeks (range: 32-37 weeks) and a standard deviation of 1.6 from three private hospitals, who passed both the distortion product otoacoustic emission (DPOAE) and AABR tests, were evaluated prior to discharge from the NICU. Neonates who presented with abnormal DPOAE and AABR results were excluded from the study. WAI was measured by using chirp and tone stimuli. In addition to reflectance, the reflectance area index (RAI) values were calculated. Both tone and chirp stimuli indicated high-power reflectance values below a frequency of 1.5 kHz. Median reflectance reached a minimum of 0.67 at 1 kHz - 2 kHz but increased to 0.7 below 1 kHz and 0.72 above 2 kHz for the tone stimuli. For chirp stimuli, the median reflectance reached a minimum of 0.51 at 1 kHz - 2 kHz but increased to 0.68 below 1 kHz and decreased to 0.5 above 2 kHz. A comparison between the present study and previous studies on WAI indicated a substantial variability across all frequency ranges. These WAI measurements conducted on at-risk preterm NICU neonates (mean age at testing: 35.6 weeks, range: 32-37 weeks) identified WAI patterns not previously reported in the literature. High reflective values were obtained across all frequency ranges. The age of the neonates when tested might have influenced the results. The neonates included in the present study were very young preterm neonates compared to the ages of neonates in previous studies. WAI measured in at-risk preterm neonates in the NICU was variable with environmental and internal noise influences. Transient conditions affecting the sound-conduction pathway might have influenced the results. Additional research is required to investigate WAI testing in ears with and without middle ear dysfunction. The findings of the current study imply that in preterm neonates it was not possible to determine the feasibility of WAI as a diagnostic tool to differentiate between ears with and without middle ear pathology.

An in vitro model of murine middle ear epithelium.

PubMed

Mulay, Apoorva; Akram, Khondoker M; Williams, Debbie; Armes, Hannah; Russell, Catherine; Hood, Derek; Armstrong, Stuart; Stewart, James P; Brown, Steve D M; Bingle, Lynne; Bingle, Colin D

2016-11-01

Otitis media (OM), or middle ear inflammation, is the most common paediatric disease and leads to significant morbidity. Although understanding of underlying disease mechanisms is hampered by complex pathophysiology it is clear that epithelial abnormalities underpin the disease. There is currently a lack of a well-characterised in vitro model of the middle ear (ME) epithelium that replicates the complex cellular composition of the middle ear. Here, we report the development of a novel in vitro model of mouse middle ear epithelial cells (mMECs) at an air-liquid interface (ALI) that recapitulates the characteristics of the native murine ME epithelium. We demonstrate that mMECs undergo differentiation into the varied cell populations seen within the native middle ear. Proteomic analysis confirmed that the cultures secrete a multitude of innate defence proteins from their apical surface. We showed that the mMECs supported the growth of the otopathogen, nontypeable Haemophilus influenzae (NTHi), suggesting that the model can be successfully utilised to study host-pathogen interactions in the middle ear. Overall, our mMEC culture system can help to better understand the cell biology of the middle ear and improve our understanding of the pathophysiology of OM. The model also has the potential to serve as a platform for validation of treatments designed to reverse aspects of epithelial remodelling that underpin OM development. © 2016. Published by The Company of Biologists Ltd.

Separating the contributions of olivocochlear and middle ear muscle reflexes in modulation of distortion product otoacoustic emission levels.

PubMed

Wolter, Nikolaus E; Harrison, Robert V; James, Adrian L

2014-01-01

Mediated by the medial olivocochlear system (MOCS), distortion product otoacoustic emission (DPOAE) levels are reduced by presentation of contralateral acoustic stimuli. Such acoustic signals can also evoke a middle ear muscle reflex (MEMR) that also attenuates recorded DPOAE levels. Our aim is to clearly differentiate these two inhibitory mechanisms and to analyze each separately, perhaps allowing the development of novel tests of hearing function. DPOAE were recorded in real time from chinchillas with normal auditory brainstem response thresholds and middle ear function. Amplitude reduction and its onset latency caused by contralateral presentation of intermittent narrow-band noise (NBN) were measured. Stapedius and tensor tympani muscle tendons were divided without disturbing the ossicular chain, and DPOAE testing was repeated. Peak reduction of (2f1 - f2) DPOAE levels occurred when the center frequency of contralateral NBN approximated the primary tone f2, indicating an f2-frequency-specific response. For a 4.5-kHz centered NBN, DPOAE (f2 = 4.4 kHz) inhibition was 0.1 dB (p < 0.001). This response remained present after tendon division, consistent with an MOCS origin. Low-frequency NBN (center frequency: 0.5 kHz) reduced otoacoustic emission levels (0.1 dB, p < 0.001) across a wide range of DPOAE frequencies. This low-frequency response was abolished by division of the middle ear muscle tendons, clearly indicating MEMR involvement. Following middle ear muscle tendon division, DPOAE inhibition by contralateral stimuli approximating the primary tone f2 persists, whereas responses evoked by lower contralateral frequencies are abolished. This distinguishes the different roles of the MOCS (f2 frequency specific) and MEMR (low frequency only) in contralateral modulation of DPOAE. This analysis helps clarify the pathways involved in an objective test that might have clinical benefit in the testing of neonates.

Continuous long-term measurements of the middle ear pressure in subjects without a history of ear disease.

PubMed

Tideholm, B; Carlborg, B; Jönsson, S; Bylander-Groth, A

1998-06-01

A new method was used for continuous measurement of the middle ear (ME) pressure during a 24-h period. In 10 subjects without a history of ear disease a small perforation was made through the tympanic membrane. A tight rubber stopper containing a small polyethylene tube was fitted into the external ear canal. Conventional tubal function tests were performed. The equipment was then carried by the subjects for 24 h of normal activity to monitor any slow or rapid dynamic pressure change in the ME. Body position was found to be the most important factor affecting ME pressure variation, during the 24-h continuous pressure measurements. A significant pressure rise occurred in the recumbent position in all but one subject. Few rapid pressure equilibrations were seen during the recordings, indicating few tubal openings. This implies that the pressure changes in the ME seen in this study were mainly the result of gas exchange over the mucosa. The investigation might be a base for reference when investigating different kinds of pathologic conditions in the ear.

Long-Term Effects of Otitis Media a Ten-Year Cohort Study of Alaskan Eskimo Children

ERIC Educational Resources Information Center

Kaplan, Gary J.; And Others

1973-01-01

Histories of ear disease, otoscopic examinations, and audiologic, intelligence, and achievement tests were obtained from a cohort of 489 Alaskan Eskimo children, followed through the first 10 years of life, to determine whether otitis media (middle ear inflammation) deleteriously affected intellectual functioning and achievement in school.…

Association of microRNA 146 with middle ear hyperplasia in pediatric otitis media.

PubMed

Samuels, Tina L; Yan, Justin; Khampang, Pawjai; MacKinnon, Alexander; Hong, Wenzhou; Johnston, Nikki; Kerschner, Joseph E

2016-09-01

Toll-like receptor signaling activated by bacterial otitis media pathogens in the middle ear has been shown to play a key role in OM susceptibility, pathogenesis and recovery. Recent studies implicate microRNA 146 (miR-146) in regulation of inflammation via negative feedback of toll-like receptor signaling (TLR) in a wide variety of tissues, however its involvement in otitis media is unknown. Human middle ear epithelial cells were stimulated with proinflammatory cytokines, interleukin 1 beta or tumor necrosis factor alpha, for two to twenty-four hours. Middle ear biopsies were collected from children with otitis media with effusion (n = 20), recurrent otitis media (n = 9), and control subjects undergoing cochlear implantation (n = 10). miR-146a, miR-146b expression was assayed by quantitative PCR (qPCR). Expression of miR-146 targets involved in TLR signaling, IRAK1 and TRAF6, was assayed by qPCR in middle ear biopsies. Middle ear biopsies were cryosectioned and epithelial thickness measured by a certified pathologist. Proinflammatory cytokines induced expression of miR-146 in middle ear epithelial cells in vitro. Middle ear miR-146a and miR-146b expression was elevated in otitis media patients relative to control subjects and correlated with middle ear epithelial thickness. A trend towards inverse correlation was observed between miR-146 and TRAF6 expression in the clinical population. This report is the first to assess miRNA expression in a clinical population with OM. Findings herein suggest miR-146 may play a role in OM. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Further studies on the effects of magnetic resonance imaging fields on middle ear implants.

PubMed

Applebaum, E L; Valvassori, G E

1990-10-01

We investigated the effects of magnetic resonance imaging (MRI) fields on 21 stapedectomy prostheses and other middle ear implants and two different receiver-stimulator modules from 22-channel cochlear implants. None of the middle ear implants was displaced by the magnetic field, except for one platinum-stainless steel stapedectomy piston. Magnetism was not induced in any of the middle ear implants subjected to prolonged exposure in the MRI scanner. We conclude that MRI could pose a hazard to patients who have had stapedectomy using certain platinum-stainless steel piston prostheses and to patients with cochlear implants. Magnetic resonance imaging should pose no hazard to patients who have had the other middle ear implants reported on in this and our previous investigation.

Identification of Actinomyces meyeri actinomycosis in middle ear and mastoid by 16S rRNA analysis.

PubMed

Kakuta, Risako; Hidaka, Hiroshi; Yano, Hisakazu; Miyazaki, Hiromitsu; Suzaki, Hiroshi; Nakamura, Yasuhiro; Kanamori, Hajime; Endo, Shiro; Hirakata, Yoichi; Kaku, Mitsuo; Kobayashi, Toshimitsu

2013-08-01

Actinomycosis of the middle ear and mastoid is extremely rare. Here, we report a unique case of actinomycosis of the middle ear and mastoid caused by Actinomyces meyeri diagnosed by 16S rRNA gene sequence analysis.

New optical tomographic & topographic techniques for biomedical applications

NASA Astrophysics Data System (ADS)

Buytaert, Jan

The mammalian middle ear contains the eardrum and the three auditory ossicles, and forms an impedance match between sound in air and pressure waves in the fluid of the inner ear. Without this intermediate system, with its unsurpassed efficiency and dynamic range, we would be practically deaf. Physics-based modeling of this extremely complex mechanical system is necessary to help our basic understanding of the functioning of hearing. Highly realistic models will make it possible to predict the outcome of surgical interventions and to optimize design of ossicle prostheses and active middle ear implants. To obtain such models and with realistic output, basic input data is still missing. In this dissertation I developed and used two new optical techniques to obtain two essential sets of data: accurate three-dimensional morphology of the middle ear structures, and elasticity parameters of the eardrum. The first technique is a new method for optical tomography of macroscopic biomedical objects, which makes it possible to measure the three-dimensional geometry of the middle ear ossicles and soft tissues which are connecting and suspending them. I made a new and high-resolution version of this orthogonal-plane fluorescence optical sectioning method, to obtain micrometer resolution in macroscopic specimens. The result is thus a complete 3-D model of the middle (and inner) ear of gerbil in unprecedented quality. On top of high-resolution morphological models of the middle ear structures, I applied the technique in other fields of research as well. The second device works according to a new optical profilometry technique which allows to measure shape and deformations of the eardrum and other membranes or objects. The approach is called projection moire profilometry, and creates moire interference fringes which contain the height information. I developed a setup which uses liquid crystal panels for grid projection and optical demodulation. Hence no moving parts are present and the setup is entirely digitally controlled. This measurement method is developed to determine the elasticity parameters of the eardrum in-situ. Other surface shapes however can also be measured.

Forgotten T-tube in the middle ear.

PubMed

Shakeel, Muhammad; Trinidade, Aaron; Khan, Imran; Ah-See, Kim Wong

2012-05-01

Retention within the middle ear cleft is an unusual complication of T-tube insertion. A 40-year-old woman with Kartagener's Syndrome presented with hearing impairment in the right ear. She was found to have a previously inserted Goode T-tube lying within the middle ear behind an intact drum. She underwent successful removal of the T-tube via a myringotomy, and a new tube was re-inserted. Migration of a T-tube into the middle ear cleft should always be kept in mind in patients who present with otological symptoms and have a history of T-tube insertion, even in the presence of an intact drum.

[Cochlear implantation through the middle fossa approach].

PubMed

Szyfter, W; Colletti, V; Pruszewicz, A; Kopeć, T; Szymiec, E; Kawczyński, M; Karlik, M

2001-01-01

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

Influenza Virus Induces Bacterial and Nonbacterial Otitis Media

PubMed Central

Diavatopoulos, Dimitri A.; Thornton, Ruth; Pedersen, John; Strugnell, Richard A.; Wise, Andrew K.; Reading, Patrick C.; Wijburg, Odilia L.

2011-01-01

Otitis media (OM) is one of the most common childhood diseases. OM can arise when a viral infection enables bacteria to disseminate from the nasopharynx to the middle ear. Here, we provide the first infant murine model for disease. Mice coinfected with Streptococcus pneumoniae and influenza virus had high bacterial load in the middle ear, middle ear inflammation, and hearing loss. In contrast, mice colonized with S. pneumoniae alone had significantly less bacteria in the ear, minimal hearing loss, and no inflammation. Of interest, infection with influenza virus alone also caused some middle ear inflammation and hearing loss. Overall, this study provides a clinically relevant and easily accessible animal model to study the pathogenesis and prevention of OM. Moreover, we provide, to our knowledge, the first evidence that influenza virus alone causes middle ear inflammation in infant mice. This inflammation may then play an important role in the development of bacterial OM. PMID:21930608

Clinical investigation and mechanism of air-bone gaps in large vestibular aqueduct syndrome.

PubMed

Merchant, Saumil N; Nakajima, Hideko H; Halpin, Christopher; Nadol, Joseph B; Lee, Daniel J; Innis, William P; Curtin, Hugh; Rosowski, John J

2007-07-01

Patients with large vestibular aqueduct syndrome (LVAS) often demonstrate an air-bone gap at the low frequencies on audiometric testing. The mechanism causing such a gap has not been well elucidated. We investigated middle ear sound transmission in patients with LVAS, and present a hypothesis to explain the air-bone gap. Observations were made on 8 ears from 5 individuals with LVAS. The diagnosis of LVAS was made by computed tomography in all cases. Investigations included standard audiometry and measurements of umbo velocity by laser Doppler vibrometry (LDV) in all cases, as well as tympanometry, acoustic reflex testing, vestibular evoked myogenic potential (VEMP) testing, distortion product otoacoustic emission (DPOAE) testing, and middle ear exploration in some ears. One ear with LVAS had anacusis. The other 7 ears demonstrated air-bone gaps at the low frequencies, with mean gaps of 51 dB at 250 Hz, 31 dB at 500 Hz, and 12 dB at 1,000 Hz. In these 7 ears with air-bone gaps, LDV showed the umbo velocity to be normal or high normal in all 7; tympanometry was normal in all 6 ears tested; acoustic reflexes were present in 3 of the 4 ears tested; VEMP responses were present in all 3 ears tested; DPOAEs were present in 1 of the 2 ears tested, and exploratory tympanotomy in 1 case showed a normal middle ear. The above data suggest that an air-bone gap in LVAS is not due to disease in the middle ear. The data are consistent with the hypothesis that a large vestibular aqueduct introduces a third mobile window into the inner ear, which can produce an air-bone gap by 1) shunting air-conducted sound away from the cochlea, thus elevating air conduction thresholds, and 2) increasing the difference in impedance between the scala vestibuli side and the scala tympani side of the cochlear partition during bone conduction testing, thus improving thresholds for bone-conducted sound. We conclude that LVAS can present with an air-bone gap that can mimic middle ear disease. Diagnostic testing using acoustic reflexes, VEMPs, DPOAEs, and LDV can help to identify a non-middle ear source for such a gap, thereby avoiding negative middle ear exploration. A large vestibular aqueduct may act as a third mobile window in the inner ear, resulting in an air-bone gap at low frequencies.

Comparison of high-resolution microendoscope images and histopathological sections in ex vivo middle ear cholesteatomas and surrounding tissue

NASA Astrophysics Data System (ADS)

Bradley, James; Levy, Lauren; Richards-Kortum, Rebecca; Sikora, Andrew G.; Smouha, Eric

2013-03-01

Objective: To investigate the concordance between optical images obtained with high-resolution microendoscopy (HRME) and conventional histopathology for ex vivo cholesteatoma specimens and surrounding middle ear epithelium. Methods: After resection of cholesteatoma and surrounding middle ear epithelium from surgical patients, tissues were stained with a contrast agent, proflavine, and the HRME fiberoptic scope was placed directly on each tissue specimen. 4- 10 short movie clips were recorded for both the cholesteatoma and surrounding middle ear epithelium specimens. The imaged areas were sent for standard histopathology, and the stained specimens were correlated with the HRME images. IRB approval was obtained, and each patient was consented for the study. Results: Ten cholesteatoma specimens and 9 middle ear specimens were collected from 10 patients. In each case, cholesteatoma was easily discriminated from normal middle ear epithelium by its hyperfluorescence and loss of cellular detail. Qualitative analysis for concordance between HRME images and histological images from the same surgical specimen yielded a strong correlation between imaging modalities. Conclusions: Keratinizing cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Loss of cellular detail and hyperfluorescence with proflavine are the hallmark characteristics of cholesteatoma which allow for differentiation from normal middle ear epithelium. Real-time optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease. We anticipate performing an in vivo study to test this hypothesis.

Middle Ear Pressures in Wind Instrument Musicians.

PubMed

Osborne, Max Sallis; Morris, Simon; Clark, Matthew P; Begg, Philip

2018-05-22

This study aimed to assess if playing wind instruments leads to a measurable increase in middle ear pressure during note generation and to provide evidence to clinicians to advise musicians undergoing middle ear surgery. An observational cohort study of 40 volunteers in 7 different wind instrument categories underwent tympanometry at rest and during note production. Community. Recreational musicians aged over 18 years recruited from the student body attending Birmingham University, UK. None. Tympanometry is used as a noninvasive measure of middle ear pressure. The pressure at which peak compliance occurred was taken as an indirect measure of middle ear pressure. The data produced at rest and during note production was statistically analysed with paired t testing and significance set at a p value less than 0.01. Overall a statistically significant increase in middle ear pressure change of 0.63 mm Hg (p = 0.0001) during note production was identified. Musicians playing the oboe and trumpet demonstrate the largest increase in middle ear pressure of 1.46 mm Hg (p = 0.0053) and 0.78 mm Hg (p = 0.0005) respectively. The data provided by this study gives evidence for the first time that playing wind instruments does increase middle ear pressure. Although the clinical significance of this is yet to be determined the authors would advise that musicians who undergo otological procedures should refrain from playing their instruments until full recovery has been achieved as advised by their clinician following direct microscopic review.

Ear Tubes

MedlinePlus

... of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, ... specialist) may be warranted if you or your child has experienced repeated ... fluid in the middle ear, barotrauma, or have an anatomic abnormality that ...

A new malleostapedotomy prosthesis. Experimental analysis by laser doppler vibrometer in fresh cadaver temporal bones.

PubMed

Vallejo, Luis A; Manzano, María T; Hidalgo, Antonio; Hernández, Alberto; Sabas, Juan; Lara, Hugo; Gil-Carcedo, Elisa; Herrero, David

One of the problems with total ossicular replacement prostheses is their stability. Prosthesis dislocations and extrusions are common in middle ear surgery. This is due to variations in endo-tympanic pressure as well as design defects. The design of this new prosthesis reduces this problem by being joined directly to the malleus handle. The aim of this study is to confirm adequate acoustic-mechanical behaviour in fresh cadaver middle ear of a new total ossicular replacement prosthesis, designed using the finite elements method. Using the doppler vibrometer laser, we analysed the acoustic-mechanical behaviour of a new total ossicular replacement prosthesis in the human middle ear using 10 temporal bones from fresh cadavers. The transfer function of the ears in which we implanted the new prosthesis was superimposed over the non-manipulated ear. This suggests optimum acoustic-mechanical behaviour. The titanium prosthesis analysed in this study demonstrated optimum acoustic-mechanical behaviour. Together with its ease of implantation and post-surgical stability, these factors make it a prosthesis to be kept in mind in ossicular reconstruction. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Wideband energy reflectance findings in presence of normal tympanogram in children with Down's syndrome.

PubMed

Kaf, Wafaa A

2011-02-01

The prevalence of middle ear disorders in children with Down syndrome is higher than normal children due to the associated craniofacial abnormalities. The goal of this study is to evaluate middle ear function using wideband energy reflectance at ambient pressure in 14 young children with Down syndrome and matched control group (2½-5 years old; N=19 ears per group) who each have a normal 226Hz tympanogram. All children underwent otoscopic examination, hearing screening using play audiometry (500-4000Hz), and middle ear testing using 226Hz tympanometry and wideband energy reflectance. The chirp signals for the wideband energy reflectance were presented to the child's ear at 65dB SPL stimulus level and the recording was done over 220-8000Hz range. The measured energy reflectance represents the ratio of the sound energy reflected from the tympanic membrane to the incident sound energy transmitted to the middle ear at a specific frequency. Paired Samples t-test was computed for the mean, 95th, 75th, 25th, and 5th percentile data of each frequency of the two groups. Despite the presence of normal tympanometric findings in both groups, results revealed abnormal wideband energy reflectance findings in 63% of the children with Down syndrome compared to the normal wideband energy reflectance findings in the control group. The mean energy reflectance ratio of the Down syndrome group was abnormally lower than that of the control at 5700-8000Hz (p<0.0005). The 5th and 95th percentile ratios of the Down syndrome group fell outside the 5th and 95th percentile of the control group (p<0.0005). Abnormally low energy reflectance ratios above 4000Hz in the presence of normal tympanograms in the Down syndrome group may suggest associated congenital middle ear anomalies in children with DS. The present findings suggest that wideband energy reflectance has the potential to be of more practical value in children with DS than tympanometry. Further research with a larger number of Down syndrome children will illuminate the potential of wideband energy reflectance in diagnosing middle ear disorders in children with Down syndrome. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Requirement for Jagged1-Notch2 signaling in patterning the bones of the mouse and human middle ear.

PubMed

Teng, Camilla S; Yen, Hai-Yun; Barske, Lindsey; Smith, Bea; Llamas, Juan; Segil, Neil; Go, John; Sanchez-Lara, Pedro A; Maxson, Robert E; Crump, J Gage

2017-05-31

Whereas Jagged1-Notch2 signaling is known to pattern the sensorineural components of the inner ear, its role in middle ear development has been less clear. We previously reported a role for Jagged-Notch signaling in shaping skeletal elements derived from the first two pharyngeal arches of zebrafish. Here we show a conserved requirement for Jagged1-Notch2 signaling in patterning the stapes and incus middle ear bones derived from the equivalent pharyngeal arches of mammals. Mice lacking Jagged1 or Notch2 in neural crest-derived cells (NCCs) of the pharyngeal arches display a malformed stapes. Heterozygous Jagged1 knockout mice, a model for Alagille Syndrome (AGS), also display stapes and incus defects. We find that Jagged1-Notch2 signaling functions early to pattern the stapes cartilage template, with stapes malformations correlating with hearing loss across all frequencies. We observe similar stapes defects and hearing loss in one patient with heterozygous JAGGED1 loss, and a diversity of conductive and sensorineural hearing loss in nearly half of AGS patients, many of which carry JAGGED1 mutations. Our findings reveal deep conservation of Jagged1-Notch2 signaling in patterning the pharyngeal arches from fish to mouse to man, despite the very different functions of their skeletal derivatives in jaw support and sound transduction.

How do tympanic-membrane perforations affect human middle-ear sound transmission?

PubMed

Voss, S E; Rosowski, J J; Merchant, S N; Peake, W T

2001-01-01

Although tympanic-membrane (TM) perforations are common sequelae of middle-ear disease, the hearing losses they cause have not been accurately determined, largely because additional pathological conditions occur in these ears. Our measurements of acoustic transmission before and after making controlled perforations in cadaver ears show that perforations cause frequency-dependent loss that: (1) is largest at low frequencies; (2) increases as perforation size increases; and (3) does not depend on perforation location. The dominant loss mechanism is the reduction in sound-pressure difference across the TM. Measurements of middle-ear air-space sound pressures show that transmission via direct acoustic stimulation of the oval and round windows is generally negligible. A quantitative model predicts the influence of middle-ear air-space volume on loss; with larger volumes, loss is smaller.

Oval window transport of Gd-dOTA from rat middle ear to vestibulum and scala vestibuli visualized by in vivo magnetic resonance imaging.

PubMed

Zou, Jing; Poe, Dennis; Ramadan, Usama Abo; Pyykkö, Ilmari

2012-02-01

We tested our hypothesis that the oval window (OW) potentially functions as a route to carry substances from the middle ear to the vestibulum and then the scala vestibuli through the annular ligament across the stapediovestibular joint. Gd-DOTA was either injected into the lateral attic compartment of rats with a high-performance polyimide tube in a selective OW delivery group, or administered to the middle ear cavity of two groups of rats in which the OW was either sealed or not sealed. The dynamic uptake of Gd-DOTA in the inner ear was visualized with a 4.7-T magnetic resonance imaging machine. In the selective OW delivery group, Gd-DOTA appeared in the vestibulum and in the basal turn of the scala vestibuli but not in the scala tympani on T1-weighted images acquired at 10 minutes after Gd-DOTA administration (the earliest available time point of magnetic resonance imaging). In the sealed-OW group, immediate uptake of Gd-DOTA was absent in the vestibulum and scala vestibuli. Measurement of the signal ratio of the vestibulum to that of the scala tympani showed that selective OW delivery induced the greatest signal ratio and that sealing of the OW induced the lowest signal ratio. The OW is a genuine and efficient pathway to transport Gd-DOTA from the middle ear to the vestibulum.

Design and experimental analysis of a new malleovestibulopexy prosthesis using a finite element model of the human middle ear.

PubMed

Vallejo Valdezate, Luis A; Hidalgo Otamendi, Antonio; Hernández, Alberto; Lobo, Fernando; Gil-Carcedo Sañudo, Elisa; Gil-Carcedo García, Luis M

2015-01-01

Many designs of prostheses are available for middle ear surgery. In this study we propose a design for a new prosthesis, which optimises mechanical performance in the human middle ear and improves some deficiencies in the prostheses currently available. Our objective was to design and assess the theoretical acoustic-mechanical behaviour of this new total ossicular replacement prosthesis. The design of this new prosthesis was based on an animal model (an iguana). For the modelling and mechanical analysis of the new prosthesis, we used a dynamic 3D computer model of the human middle ear, based on the finite elements method (FEM). The new malleovestibulopexy prosthesis design demonstrates an acoustical-mechanical performance similar to that of the healthy human middle ear. This new design also has additional advantages, such as ease of implantation and stability in the middle ear. This study shows that computer simulation can be used to design and optimise the vibroacoustic characteristics of middle ear implants and demonstrates the effectiveness of a new malleovestibulopexy prosthesis in reconstructing the ossicular chain. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

Earache

MedlinePlus

... tube drains fluid that is made in the middle ear. If the eustachian tube becomes blocked, fluid can ... of lying down can reduce pressure in the middle ear. Over-the-counter ear drops can be used ...

Handheld tympanometer measurements in conscious dogs for the evaluation of the middle ear and auditory tube.

PubMed

Strain, George M; Fernandes, Asia J

2015-06-01

Otitis externa is frequently accompanied by otitis media, yet it can be difficult to evaluate the tympanum, middle ear and auditory tube without the use of advanced radiographic imaging. The objective was to develop techniques for tympanometry testing in conscious dogs and to present normative data for clinical use of this equipment to enable assessment of the tympanum, middle ear and auditory tube. Sixteen hounds (14 female) from a school teaching colony. Dogs were gently restrained in a standing position. After cleaning of the ear canal, a tympanometer probe tip extension was placed in the vertical canal and automated testing performed using a handheld device. Both ears were tested in all dogs. Acceptable recordings were obtained from both ears of 13 dogs, from one ear in each of two dogs and from neither ear of one dog, resulting in data from 28 of 32 (88%) ears. Otoscopic examination confirmed the absence of inflammation or any other obvious explanation for the noncompliant dogs. No significant differences were seen between ears for any measure. Normative data are reported for peak compliance, peak compliance pressure, gradient and ear canal volume. Tympanograms can be recorded in conscious dogs to assist in the evaluation of the middle ear structures. © 2015 ESVD and ACVD.

Chinchilla middle-ear admittance and sound power: High-frequency estimates and effects of inner-ear modifications

PubMed Central

Ravicz, Michael E.; Rosowski, John J.

2012-01-01

The middle-ear input admittance relates sound power into the middle ear (ME) and sound pressure at the tympanic membrane (TM). ME input admittance was measured in the chinchilla ear canal as part of a larger study of sound power transmission through the ME into the inner ear. The middle ear was open, and the inner ear was intact or modified with small sensors inserted into the vestibule near the cochlear base. A simple model of the chinchilla ear canal, based on ear canal sound pressure measurements at two points along the canal and an assumption of plane-wave propagation, enables reliable estimates of YTM, the ME input admittance at the TM, from the admittance measured relatively far from the TM. YTM appears valid at frequencies as high as 17 kHz, a much higher frequency than previously reported. The real part of YTM decreases with frequency above 2 kHz. Effects of the inner-ear sensors (necessary for inner ear power computation) were small and generally limited to frequencies below 3 kHz. Computed power reflectance was ∼0.1 below 3.5 kHz, lower than with an intact ME below 2.5 kHz, and nearly 1 above 16 kHz. PMID:23039439

Finite-Element Modelling of the Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear.

PubMed

Motallebzadeh, Hamid; Maftoon, Nima; Pitaro, Jacob; Funnell, W Robert J; Daniel, Sam J

2017-02-01

Admittance measurement is a promising tool for evaluating the status of the middle ear in newborns. However, the newborn ear is anatomically very different from the adult one, and the acoustic input admittance is different than in adults. To aid in understanding the differences, a finite-element model of the newborn ear canal and middle ear was developed and its behaviour was studied for frequencies up to 2000 Hz. Material properties were taken from previous measurements and estimates. The simulation results were within the range of clinical admittance measurements made in newborns. Sensitivity analyses of the material properties show that in the canal model, the maximum admittance and the frequency at which that maximum admittance occurs are affected mainly by the stiffness parameter; in the middle-ear model, the damping is as important as the stiffness in influencing the maximum admittance magnitude but its effect on the corresponding frequency is negligible. Scaling up the geometries increases the admittance magnitude and shifts the resonances to lower frequencies. The results suggest that admittance measurements can provide more information about the condition of the middle ear when made at multiple frequencies around its resonance.

Comparison of Middle Ear Visualization With Endoscopy and Microscopy.

PubMed

Bennett, Marc L; Zhang, Dongqing; Labadie, Robert F; Noble, Jack H

2016-04-01

The primary goal of chronic ear surgery is the creation of a safe, clean dry ear. For cholesteatomas, complete removal of disease is dependent on visualization. Conventional microscopy is adequate for most dissection, but various subregions of the middle ear are better visualized with endoscopy. The purpose of the present study was to quantitatively assess the improved visualization that endoscopes afford as compared with operating microscopes. Microscopic and endoscopic views were simulated using a three-dimensional model developed from temporal bone scans. Surface renderings of the ear canal and middle ear subsegments were defined and the percentage of visualization of each middle ear subsegment, both with and without ossicles, was then determined for the microscope as well as for 0-, 30-, and 45-degree endoscopes. Using this information, we analyzed which mode of visualization is best suited for dissection within a particular anatomical region. Using a 0-degree scope provides significantly more visualization of every subregion, except the antrum, compared with a microscope. In addition, angled scopes permit visualizing significantly more surface area of every subregion of the middle ear than straight scopes or microscopes. Endoscopes offer advantages for cholesteatoma dissection in difficult-to-visualize areas including the sinus tympani and epitympanum.

Effects of Smoking on Eustachian Tube and Hearing.

PubMed

Pezzoli, Matteo; Lofaro, Denise; Oliva, Alessandro; Orione, Monica; Cupi, Daniela; Albera, Andrea; Bongioannini, Guido; Albera, Roberto

2017-12-01

The purpose of this study was to evaluate the effect of tobacco use on the Eustachian tube and inner ear function. Case-control study. Thirty-one nonsmoking volunteers and 34 smoking subjects recruited in an University Hospital, submitted to an audiological evaluation including pure tone audiometry, basal tympanogram, stapedial reflexes analysis, and nine-step eustachian tube (ET) function test. Pure Tone Average (PTA) threshold at all frequencies tested was 12.5 dB in smokers and 3.7 in nonsmoking subjects. Nine smokers (27%) presented some degree of hearing loss versus none in the nonsmoker group. Linear regression analysis showed a higher degree of sensorineural hearing loss with age in smokers. Among the smokers, 20 subjects (59%) presented an impaired tubal function for the nine-step inflation/deflation tympanometric test, while only 6 (19%) subjects in the group of nonsmokers showed a tubal dysfunction. Tobacco use may reduce the ability to hear, mainly causing a sensorineural hearing loss for higher frequencies. We also found the presence of a high number of smokers suffering from tubal dysfunction. This has an important clinical relevance, not only because smoking increases the incidence of middle ear diseases, but also because tubal dysfunction may cause nonspecific symptoms characterised by ear fullness and difficulties in middle ear equalisation.

Amplification options in unilateral aural atresia: an active middle ear implant or a bone conduction device?

PubMed

Agterberg, Martijn J H; Frenzel, Henning; Wollenberg, Barbara; Somers, Thomas; Cremers, Cor W R J; Snik, Ad F M

2014-01-01

There is no consensus on treatment of patients with congenital unilateral aural atresia. Currently, 3 intervention options are available, namely, surgical reconstruction, application of a bone-conduction device (BCD), or application of a middle ear implant. The present study aims to compare the BCD with the application of a middle ear implant. We hypothesized that cross-hearing (stimulating the cochlea by means of bone conduction contralateral to the implanted side) would cause BCD users to have difficulty performing localization tasks. Audiologic data of 4 adult patients with a middle ear implant coupled directly to the cochlea were compared with data of 4 adult patients fitted with an osseointegrated BCD. All patients were fitted during adulthood. The emphasis of this study is on directional hearing. The middle ear implant and the BCD improved sound localization of patients with congenital unilateral aural atresia. Unaided scores demonstrate a large variation. Our results demonstrate that there was no advantage of the middle ear implant over the BCD for directional hearing in patients who had no amplification in childhood. The BCD users had the best bandwidth.

[The modern approaches to the evaluation of the importance of chronic inflammation in the mucous membrane of the middle ear].

PubMed

Pal'chun, V T; Gurov, A V; Mikhaleva, L M; Gordienko, M V

Despite the ever growing progress in antibiotic therapy and the advent of the new methods for this purpose, the number of patients suffering from chronic focal infection of the ENT organs has not decreased during the last decades which turns the problem of chronization of inflammation into a serious challenge for the physicians as exemplified by chronic inflammation in the mucous membrane of the middle ear. Pathological changes in the middle ear make up a large fraction of ENT diseases of importance not only for otorhinolaryngologists but also for the specialists in the related medical disciplines. The present article is an overview of etiological, pathogenetic, and pathomorphological aspects of chronization of the inflammation process that are known to occur in the mucous membrane of the middle ear. In the overwhelming majority of the cases, the main cause of the conversion of acute inflammation in the middle ear into the chronic condition is the inadequate (incorrect), inopportune or incomplete treatment of the acute inflammatory process in the middle ear.

Neutrophil Extracellular Traps and Fibrin in Otitis Media: Analysis of Human and Chinchilla Temporal Bones.

PubMed

Schachern, Patricia A; Kwon, Geeyoun; Briles, David E; Ferrieri, Patricia; Juhn, Steven; Cureoglu, Sebahattin; Paparella, Michael M; Tsuprun, Vladimir

2017-10-01

Bacterial resistance in acute otitis can result in bacterial persistence and biofilm formation, triggering chronic and recurrent infections. To investigate the middle ear inflammatory response to bacterial infection in human and chinchilla temporal bones. Six chinchillas underwent intrabullar inoculations with 0.5 mL of 106 colony-forming units (CFUs) of Streptococcus pneumoniae, serotype 2. Two days later, we counted bacteria in middle ear effusions postmortem. One ear from each chinchilla was processed in paraffin and sectioned at 5 µm. The opposite ear was embedded in epoxy resin, sectioned at a thickness of 1 µm, and stained with toluidine blue. In addition, we examined human temporal bones from 2 deceased donors with clinical histories of otitis media (1 with acute onset otitis media, 1 with recurrent infection). Temporal bones had been previously removed at autopsy, processed, embedded in celloidin, and cut at a thickness of 20 µm. Sections of temporal bones from both chinchillas and humans were stained with hematoxylin-eosin and immunolabeled with antifibrin and antihistone H4 antibodies. Histopatological and imminohistochemical changes owing to otitis media. Bacterial counts in chinchilla middle ear effusions 2 days after inoculation were approximately 2 logs above initial inoculum counts. Both human and chinchilla middle ear effusions contained bacteria embedded in a fibrous matrix. Some fibers in the matrix showed positive staining with antifibrin antibody, others with antihistone H4 antibody. In acute and recurrent otitis media, fibrin and neutrophil extracellular traps (NETs) are part of the host inflammatory response to bacterial infection. In the early stages of otitis media the host defense system uses fibrin to entrap bacteria, and NETs function to eliminate bacteria. In chronic otitis media, fibrin and NETs appear to persist.

Dynamic Properties of Human Tympanic Membrane Based on Frequency-Temperature Superposition

PubMed Central

Zhang, Xiangming; Gan, Rong Z.

2012-01-01

The human tympanic membrane (TM) transfers sound in the ear canal into the mechanical vibration of the ossicles in the middle ear. The dynamic properties of TM directly affect the middle ear transfer function. The static or quasi-static mechanical properties of TM were reported in the literature, but the dynamic properties of TM over the auditory frequency range are very limited. In this paper, a new method was developed to measure the dynamic properties of human TM using the Dynamic-Mechanical Analyzer (DMA). The test was conducted at the frequency range of 1 to 40 Hz at three different temperatures: 5°, 25° and 37°C. The frequency-temperature superposition was applied to extend the testing frequency range to a much higher level (at least 3800 Hz). The generalized linear solid model was employed to describe the constitutive relation of the TM. The storage modulus E’ and the loss modulus E” were obtained from 11 specimens. The mean storage modulus was 15.1 MPa at 1 Hz and 27.6 MPa at 3800 Hz. The mean loss modulus was 0.28 MPa at 1 Hz and 4.1 MPa at 3800 Hz. The results show that the frequency-temperature superposition is a feasible approach to study the dynamic properties of the ear soft tissues. The dynamic properties of human TM obtained in this study provide a better description of the damping behavior of ear tissues. The properties can be transferred into the finite element (FE) model of the human ear to replace the Rayleigh type damping. The data reported here contribute to the biomechanics of the middle ear and improve the accuracy of the FE model for the human ear. PMID:22820983

[Facial nerve monitoring during middle ear surgery: Results of a French survey].

PubMed

Mazzaschi, O; Juvanon, J-M; Mondain, M; Lavieile, J-P; Ayache, D

2014-01-01

Facial nerve injury is a rare complication of middle ear surgery. To date there is no widely accepted consensus on the use of intraoperative facial nerve monitoring during middle ear surgery, whereas its use has been proved as a valuable adjunct in neurotologic surgery. The purpose of our study was to identify introperative facial nerve monitoring practice patterns in France for middle ear surgery. A 19-item survey has been made up by three experienced otologists under the auspices of the French Otology and Neurotology Association. With the support of the French Society of Otolaryngology--Head and Neck Surgery, the survey was electronically sent by email to 1249 practicing ENT with a valid email address. Answers were analyzed two months later. Among 1249 email sent, 299 were opened (24%) and 83 answers were collected (6,6%). Of the respondents, 66% had access to intraoperative facial nerve monitoring. Otolaryngologists involved in academic setting were influenced by their teaching duty in 27%. Intraoperative facial nerve monitoring should not be required for stapes surgery, ossiculoplasty, myringoplasty for, respectively, 92%, 93 % and 98% of the respondents. In cochlear implantation, 78% of ear surgeons used facial nerve monitoring. Answers were more controversial for chronic ear surgery, ear atresia and middle ear implant. Revision surgery and CT scan can influence answers. Despite a low response rate, results of this national survey revealed interesting findings. For most of the respondents, intraoperative facial nerve monitoring was not indicated in stapes surgery, myringoplasty and ossiculoplasty. The use of intraoperative facial nerve monitoring for cochlear implantation was supported by the majority of respondents. Variations in response rate were more significant for chronic ear surgery, including middle ear cholesteatoma, and for ear atresia surgery.

Clinical Investigation and Mechanism of Air-Bone Gaps in LargeVestibular Aqueduct Syndrome

PubMed Central

Merchant, Saumil N.; Nakajima, Hideko H.; Halpin, Christopher; Nadol, Joseph B.; Lee, Daniel J.; Innis, William P.; Curtin, Hugh; Rosowski, John J.

2008-01-01

Objectives Patients with large vestibular aqueduct syndrome (LVAS) often demonstrate an air-bone gap at the low frequencies on audiometric testing. The mechanism causing such a gap has not been well elucidated. We investigated middle ear sound transmission in patients with LVAS, and present a hypothesis to explain the air-bone gap. Methods Observations were made on 8 ears from 5 individuals with LVAS. The diagnosis of LVAS was made by computed tomography in all cases. Investigations included standard audiometry and measurements of umbo velocity by laser Doppler vibrometry (LDV) in all cases, as well as tympanometry, acoustic reflex testing, vestibular evoked myogenic potential (VEMP) testing, distortion product otoacoustic emission (DPOAE) testing, and middle ear exploration in some ears. Results One ear with LVAS had anacusis. The other 7 ears demonstrated air-bone gaps at the low frequencies, with mean gaps of 51 dB at 250 Hz, 31 dB at 500 Hz, and 12 dB at 1,000 Hz. In these 7 ears with air-bone gaps, LDV showed the umbo velocity to be normal or high normal in all 7; tympanometry was normal in all 6 ears tested; acoustic reflexes were present in 3 of the 4 ears tested; VEMP responses were present in all 3 ears tested; DPOAEs were present in 1 of the 2 ears tested, and exploratory tympanotomy in 1 case showed a normal middle ear. The above data suggest that an air-bone gap in LVAS is not due to disease in the middle ear. The data are consistent with the hypothesis that a large vestibular aqueduct introduces a third mobile window into the inner ear, which can produce an air-bone gap by 1) shunting air-conducted sound away from the cochlea, thus elevating air conduction thresholds, and 2) increasing the difference in impedance between the scala vestibuli side and the scala tympani side of the cochlear partition during bone conduction testing, thus improving thresholds for bone-conducted sound. Conclusions We conclude that LVAS can present with an air-bone gap that can mimic middle ear disease. Diagnostic testing using acoustic reflexes, VEMPs, DPOAEs, and LDV can help to identify a non–middle ear source for such a gap, thereby avoiding negative middle ear exploration. A large vestibular aqueduct may act as a third mobile window in the inner ear, resulting in an air-bone gap at low frequencies. PMID:17727085

Eustachian Tube Function.

PubMed

Ars, Bernard; Dirckx, Joris

2016-10-01

The fibrocartilaginous eustachian tube is part of a system of contiguous organs including the nose, palate, rhinopharynx, and middle ear cleft. The middle ear cleft consists of the tympanic cavity, which includes the bony eustachian tube (protympanum) and the mastoid gas cells system. The tympanic cavity and mastoid gas cells are interconnected and allow gaseous exchange and pressure regulation. The fibrocartilaginous eustachian tube is a complex organ consisting of a dynamic conduit with its mucosa, cartilage, surrounding soft tissue, peritubal muscles (ie, tensor and levator veli palatine, salpingopharyngeus and tensor tympani), and superior bony support (the sphenoid sulcus). Copyright © 2016 Elsevier Inc. All rights reserved.

Laser-assisted tympanostomy (LAT) in adult individuals

NASA Astrophysics Data System (ADS)

Prokopakis, E. P.; Lachanas, V. A.; Helidonis, Emmanuel S.; Velegrakis, G.

2004-06-01

Objectives: To assess outcome, in adult individuals undergone Laser Assisted Tympanostomy (LAT) without ventilation tube placement. Method: LAT was performed on a total of 95 ears (72 individuals). Indications included serous otitis media with effusion (44 ears/31 patients), eustachian tube dysfunction (32 ears/24 patients), acute otitis media (13 ears/11 patients), and endoscopic visualization of the middle ear (6 ears/6 patients). Results: Middle ear disease was resolved after the closure of tympanostomy in 48% of patients with serous otitis media with effusion. In 78% of patients with Eustachian tube dysfunction symptoms were diminished. All patients with acute otitis media had a satisfactory outcome. LAT was found quite effective in patients undergoing middle ear endoscopy. Conclusion: LAT without ventilation tubes provides a safe alternative surgical option in adult patients in certain cases. The selection criteria for this procedure are addressed in detail.

Animal models of middle ear cholesteatoma.

PubMed

Yamamoto-Fukuda, Tomomi; Takahashi, Haruo; Koji, Takehiko

2011-01-01

Middle ear acquired cholesteatoma is a pathological condition associated with otitis media, which may be associated with temporal bone resorption, otorrhea and hearing loss, and occasionally various other complications. Cholesteatoma is characterized by the enhanced proliferation of epithelial cells with aberrant morphologic characteristics. Unfortunately, our understanding of the mechanism underlying its pathogenesis is limited. To investigate its pathogenesis, different animal models have been used. This paper provides a brief overview of the current status of research in the field of pathogenesis of middle ear acquired cholesteatoma, four types of animal models previously reported on, up-to-date cholesteatoma research using these animal models, our current studies of the local hybrid ear model, and the future prospect of new animal models of middle ear cholesteatoma.

Animal Models of Middle Ear Cholesteatoma

PubMed Central

Yamamoto-Fukuda, Tomomi; Takahashi, Haruo; Koji, Takehiko

2011-01-01

Middle ear acquired cholesteatoma is a pathological condition associated with otitis media, which may be associated with temporal bone resorption, otorrhea and hearing loss, and occasionally various other complications. Cholesteatoma is characterized by the enhanced proliferation of epithelial cells with aberrant morphologic characteristics. Unfortunately, our understanding of the mechanism underlying its pathogenesis is limited. To investigate its pathogenesis, different animal models have been used. This paper provides a brief overview of the current status of research in the field of pathogenesis of middle ear acquired cholesteatoma, four types of animal models previously reported on, up-to-date cholesteatoma research using these animal models, our current studies of the local hybrid ear model, and the future prospect of new animal models of middle ear cholesteatoma. PMID:21541229

The association of middle ear effusion with trigeminal nerve mass lesions in dogs.

PubMed

Wessmann, A; Hennessey, A; Goncalves, R; Benigni, L; Hammond, G; Volk, H A

2013-11-09

The trigeminal nerve is involved in the opening of the pharyngeal orifice of the Eustachian tube by operating the tensor veli palatini muscle. The hypothesis was investigated that middle ear effusion occurs in a more severe disease phenotype of canine trigeminal nerve mass lesions compared with dogs without middle ear effusion. Three observers reviewed canine MRIs with an MRI-diagnosis of trigeminal nerve mass lesion from three institutions. Various parameters describing the musculature innervated by the trigeminal nerve were scored and compared between dogs with and without middle ear effusion. Nineteen dogs met the inclusion criteria. Ipsilateral middle ear effusion was observed in 63 per cent (95% CI 48.4 per cent to 77.6 per cent) of the dogs. The size of the trigeminal nerve mass lesions was positively correlated with the severity of masticatory muscle mass loss (Spearman r=0.5, P=0.03). Dogs with middle ear effusion had a significantly increased generalised masticatory muscle mass loss (P=0.02) or tensor veli palatini muscle loss score (P=0.03) compared with those without. Larger trigeminal nerve mass lesions were associated with a greater degree of masticatory muscle mass loss. Masticatory muscle mass and, importantly, tensor veli palatini muscle mass was more severely affected in dogs with middle ear effusion suggesting an associated Eustachian tube dysfunction.

[Atypical inflammation of the middle ear].

PubMed

Garov, E V; Kryukov, A I; Zelenkova, V N; Sidorina, N G; Kaloshina, A S

The objective of the present study was to characterize the patients presenting with atypical inflammation of the middle ear and consider the currently available methods for their examination. A total of 20 patients at the age from 16 to 66 years were admitted to the Department of Ear Microsurgery during the period from 2008 and 2016 for the treatment of atypical inflammation of the middle ear. Eleven of them (18 ears) were found to have tuberculous lesions (TL) of the middle ear while the remaining 9 patients (11 ears) suffered giant cell vasculitis (GCV). All the patients underwent the general clinical and otorhinolaryngological examination, computed tomography of the temporal bones and the thoracic cavity organs, cytological, bacteriological, pathomorphological, and molecular-genetic studies including PCR diagnostics, rheumatological tests, as well as counseling by a phthisiotherapist and rheumatologist. The primary localization of TL in the middle ear was documented in 6 patients including its association with lung lesions in 5 cases. The clinical picture of the disease in 5 patients was that of smoldering exudative pathology and in 6 ones was accompanied by suppurative perforative otitis media. According to the laboratory analyses, bacteriological diagnostics proved efficient in 9% of the patients, pathomorphological and cytological diagnostics in 18% and 27.3% of the cases respectively while the effectiveness of PCR diagnostics was estimated at 55%. The diagnosis in individual patients was established within the period from 1 month to 1.5 years after they first sought medical advice in connection with complaints of the ear disease. Tuberculosis of the middle ear began to develop as exudative middle otitis that acquired the form of bilateral pathology in 4 patients. Three patients had a concomitant pulmonary disease. In 4 patuents, the diagnois of middle ear tuberculosis was established based on the presence of the specific antibodies and in 5 ones based on the results of the pathomorphological study. All the studies were carried out in duplicate. The period between the beginning of the disease and the establishment of the definitive diagnosis varied from 1 month to 1 year.

Intracochlear pressure measurements during acoustic shock wave exposure.

PubMed

Greene, Nathaniel T; Alhussaini, Mohamed A; Easter, James R; Argo, Theodore F; Walilko, Tim; Tollin, Daniel J

2018-05-19

Injuries to the peripheral auditory system are among the most common results of high intensity impulsive acoustic exposure. Prior studies of high intensity sound transmission by the ossicular chain have relied upon measurements in animal models, measurements at more moderate sound levels (i.e. < 130 dB SPL), and/or measured responses to steady-state noise. Here, we directly measure intracochlear pressure in human cadaveric temporal bones, with fiber optic pressure sensors placed in scala vestibuli (SV) and tympani (ST), during exposure to shock waves with peak positive pressures between ∼7 and 83 kPa. Eight full-cephalic human cadaver heads were exposed, face-on, to acoustic shock waves in a 45 cm diameter shock tube. Specimens were exposed to impulses with nominal peak overpressures of 7, 28, 55, & 83 kPa (171, 183, 189, & 192 dB pSPL), measured in the free field adjacent to the forehead. Specimens were prepared bilaterally by mastoidectomy and extended facial recess to expose the ossicular chain. Ear canal (EAC), middle ear, and intracochlear sound pressure levels were measured with fiber-optic pressure sensors. Surface-mounted sensors measured SPL and skull strain near the opening of each EAC and at the forehead. Measurements on the forehead showed incident peak pressures approximately twice that measured by adjacent free-field and EAC entrance sensors, as expected based on the sensor orientation (normal vs tangential to the shock wave propagation). At 7 kPa, EAC pressure showed gain, calculated from the frequency spectra, consistent with the ear canal resonance, and gain in the intracochlear pressures (normalized to the EAC pressure) were consistent with (though somewhat lower than) previously reported middle ear transfer functions. Responses to higher intensity impulses tended to show lower intracochlear gain relative to EAC, suggesting sound transmission efficiency along the ossicular chain is reduced at high intensities. Tympanic membrane (TM) rupture was observed following nearly every exposure 55 kPa or higher. Intracochlear pressures reveal lower middle-ear transfer function magnitudes (i.e. reduced gain relative to the ear canal) for high sound pressure levels, thus revealing lower than expected cochlear exposure based on extrapolation from cochlear pressures measured at more moderate sound levels. These results are consistent with lowered transmissivity of the ossicular chain at high intensities, and are consistent with our prior report measuring middle ear transfer functions in human cadaveric temporal bones with high intensity tone pips. Copyright © 2018 Elsevier B.V. All rights reserved.

Passage of albumin from the middle ear to the inner ear in otitis media in the chinchilla

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goldberg, B.; Goycoolea, M.V.; Schleivert, P.M.

1981-08-01

A study of the permeability of the middle ear-inner ear interface for macromolecules was carried out in chinchillas with open and obstructed eustachian tubes utilizing tritiated human serum albumin and immunoelectrophoresis. Tritiated albumin was placed in the round window niche area or normal animals and animals in which the eustachian tubes had been obstructed for 24 hours or 14 days. The tritiated albumin was allowed to remain in the middle ear cavity for 24 hours, Samples of middle ear effusion, perilymph, blood and cerebrospinal fluid were collected and measured for radioactivity. Radioactivity was demonstrated in the perilymph. Samples of middlemore » ear effusions and perilymph were also studied by immunoelectrophoresis with goat antihuman albumin. Albumin placed in the round window niche of an experimental animal could be recovered unchanged in the perilymph. The results suggest a pathophysiologic explanation for the association of otitis media and sensorineural hearing loss or endolymphatic hydrops.« less

Procedures for ambient-pressure and tympanometric tests of aural acoustic reflectance and admittance in human infants and adults

PubMed Central

Keefe, Douglas H.; Hunter, Lisa L.; Feeney, M. Patrick; Fitzpatrick, Denis F.

2015-01-01

Procedures are described to measure acoustic reflectance and admittance in human adult and infant ears at frequencies from 0.2 to 8 kHz. Transfer functions were measured at ambient pressure in the ear canal, and as down- or up-swept tympanograms. Acoustically estimated ear-canal area was used to calculate ear reflectance, which was parameterized by absorbance and group delay over all frequencies (and pressures), with substantial data reduction for tympanograms. Admittance measured at the probe tip in adults was transformed into an equivalent admittance at the eardrum using a transmission-line model for an ear canal with specified area and ear-canal length. Ear-canal length was estimated from group delay around the frequency above 2 kHz of minimum absorbance. Illustrative measurements in ears with normal function are described for an adult, and two infants at 1 month of age with normal hearing and a conductive hearing loss. The sensitivity of this equivalent eardrum admittance was calculated for varying estimates of area and length. Infant-ear patterns of absorbance peaks aligned in frequency with dips in group delay were explained by a model of resonant canal-wall mobility. Procedures will be applied in a large study of wideband clinical diagnosis and monitoring of middle-ear and cochlear function. PMID:26723319

Middle ear infection (otitis media) (image)

MedlinePlus

Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is ... which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked ...

Clearance by the mucociliary system in 'simple chronic otitis media'.

PubMed

Hadas, E; Sadé, J

1979-08-01

This is a study of the rate of middle ear clearance in chronic otitis media and atelectatic ears. The clearance rate was measured with the aid of non-soluble saccharin, introduced into the middle ear through an existing perforation in 'chronic ears', or through a ventilating tube in atelectatic ears. Cholesteatomatous ears were excluded. Altogether 122 ears were examined and about two-thirds of the subjects felt the sweet taste in their mouths thereafter. The average time it took for the saccharin to be transported from the middle ear to the taste buds was 33' 22" minutes in non-infected (i.e. dry) chronic ears (38 patients or 66 per cent). Wet or infected ears with chronic otitis media (30 patients, or 58 per cent) showed a slower transport rate, averaging 54' 22" minutes--the difference was significant at the 0.01 level. 8 (63 per cent) of the atelectatic ears transported the saccharin at an average rate of 50' 25". This study demonstrated that most ears with 'simple' chronic otitis media and atelectatic ears have a patent eustachian tube and that their mucociliary system can transport foreign particles through it. When the ear is infected, transport tends to be slowed down.

The microbiome of otitis media with effusion.

PubMed

Chan, Chun Ling; Wabnitz, David; Bardy, Jake Jervis; Bassiouni, Ahmed; Wormald, Peter-John; Vreugde, Sarah; Psaltis, Alkis James

2016-12-01

The adenoid pad has been considered a reservoir for bacteria in the pathogenesis of otitis media with effusion. This study aimed to characterize the middle ear microbiota in children with otitis media with effusion and establish whether a correlation exists between the middle ear and adenoid microbiota. Prospective, controlled study. Middle ear aspirates adenoid pad swabs were collected from 23 children undergoing ventilation tube insertion. Adenoid swabs from patients without ear disease were controls. Samples were analyzed using 16S rRNA sequencing on the Illumina MiSeq platform. Thirty-five middle ear samples were collected. The middle ear effusion microbiota was dominated by Alloiococcus otitidis (23% mean relative abundance), Haemophilus (22%), Moraxella (5%), and Streptococcus (5%). Alloiococcus shared an inverse correlation with Haemophilus (P = .049) and was found in greater relative abundance in unilateral effusion (P = .004). The microbiota of bilateral effusions from the same patient were similar (P < .001). However, the otitis media with effusion microbiota were found to be dissimilar to that of the adenoid (P = .01), whereas the adenoid microbiota of otitis media with effusion and control patients were similar (P > .05) (permutational multivariate analysis of the variance). Dissimilarities between the local microbiota of the adenoid and the middle ear question the theory that the adenoid pad is a significant reservoir to the middle ear in children with otitis media with effusion. A otitidis had the greatest cumulative relative abundance, particularly in unilateral effusions, and shares an inverse correlation with the relative abundance of Haemophilus. NA Laryngoscope, 126:2844-2851, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Noninvasive in vivo optical detection of biofilm in the human middle ear.

PubMed

Nguyen, Cac T; Jung, Woonggyu; Kim, Jeehyun; Chaney, Eric J; Novak, Michael; Stewart, Charles N; Boppart, Stephen A

2012-06-12

Otitis media (OM), a middle-ear infection, is the most common childhood illness treated by pediatricians. If inadequately treated, OM can result in long-term chronic problems persisting into adulthood. Children with chronic OM or recurrent OM often have conductive hearing loss and communication difficulties and require surgical treatment. Tympanostomy tube insertion, the placement of a small drainage tube in the tympanic membrane (TM), is the most common surgical procedure performed in children under general anesthesia. Recent clinical studies have shown evidence of a direct correspondence between chronic OM and the presence of a bacterial biofilm within the middle ear. Biofilms are typically very thin and cannot be recognized using a regular otoscope. Here we report the use of optical coherent ranging techniques to noninvasively assess the middle ear to detect and quantify biofilm microstructure. This study involves adults with chronic OM, which is generally accepted as a biofilm-related disease. Based on more than 18,537 optical ranging scans and 742 images from 13 clinically infected patients and 7 normal controls using clinical findings as the gold standard, all middle ears with chronic OM showed evidence of biofilms, and all normal ears did not. Information on the presence of a biofilm, along with its structure and response to antibiotic treatment, will not only provide a better fundamental understanding of biofilm formation, growth, and eradication in the middle ear, but also may provide much-needed quantifiable data to enable early detection and quantitative longitudinal treatment monitoring of middle-ear biofilms responsible for chronic OM.

Noninvasive in vivo optical detection of biofilm in the human middle ear

PubMed Central

Jung, Woonggyu; Kim, Jeehyun; Chaney, Eric J.; Novak, Michael; Stewart, Charles N.; Boppart, Stephen A.

2012-01-01

Otitis media (OM), a middle-ear infection, is the most common childhood illness treated by pediatricians. If inadequately treated, OM can result in long-term chronic problems persisting into adulthood. Children with chronic OM or recurrent OM often have conductive hearing loss and communication difficulties and require surgical treatment. Tympanostomy tube insertion, the placement of a small drainage tube in the tympanic membrane (TM), is the most common surgical procedure performed in children under general anesthesia. Recent clinical studies have shown evidence of a direct correspondence between chronic OM and the presence of a bacterial biofilm within the middle ear. Biofilms are typically very thin and cannot be recognized using a regular otoscope. Here we report the use of optical coherent ranging techniques to noninvasively assess the middle ear to detect and quantify biofilm microstructure. This study involves adults with chronic OM, which is generally accepted as a biofilm-related disease. Based on more than 18,537 optical ranging scans and 742 images from 13 clinically infected patients and 7 normal controls using clinical findings as the gold standard, all middle ears with chronic OM showed evidence of biofilms, and all normal ears did not. Information on the presence of a biofilm, along with its structure and response to antibiotic treatment, will not only provide a better fundamental understanding of biofilm formation, growth, and eradication in the middle ear, but also may provide much-needed quantifiable data to enable early detection and quantitative longitudinal treatment monitoring of middle-ear biofilms responsible for chronic OM. PMID:22645342

A microbiome case-control study of recurrent acute otitis media identified potentially protective bacterial genera.

PubMed

Lappan, Rachael; Imbrogno, Kara; Sikazwe, Chisha; Anderson, Denise; Mok, Danny; Coates, Harvey; Vijayasekaran, Shyan; Bumbak, Paul; Blyth, Christopher C; Jamieson, Sarra E; Peacock, Christopher S

2018-02-20

Recurrent acute otitis media (rAOM, recurrent ear infection) is a common childhood disease caused by bacteria termed otopathogens, for which current treatments have limited effectiveness. Generic probiotic therapies have shown promise, but seem to lack specificity. We hypothesised that healthy children with no history of AOM carry protective commensal bacteria that could be translated into a specific probiotic therapy to break the cycle of re-infection. We characterised the nasopharyngeal microbiome of these children (controls) in comparison to children with rAOM (cases) to identify potentially protective bacteria. As some children with rAOM do not appear to carry any of the known otopathogens, we also hypothesised that characterisation of the middle ear microbiome could identify novel otopathogens, which may also guide the development of more effective therapies. Middle ear fluids, middle ear rinses and ear canal swabs from the cases and nasopharyngeal swabs from both groups underwent 16S rRNA gene sequencing. The nasopharyngeal microbiomes of cases and controls were distinct. We observed a significantly higher abundance of Corynebacterium and Dolosigranulum in the nasopharynx of controls. Alloiococcus, Staphylococcus and Turicella were abundant in the middle ear and ear canal of cases, but were uncommon in the nasopharynx of both groups. Gemella and Neisseria were characteristic of the case nasopharynx, but were not prevalent in the middle ear. Corynebacterium and Dolosigranulum are characteristic of a healthy nasopharyngeal microbiome. Alloiococcus, Staphylococcus and Turicella are possible novel otopathogens, though their rarity in the nasopharynx and prevalence in the ear canal means that their role as normal aural flora cannot be ruled out. Gemella and Neisseria are unlikely to be novel otopathogens as they do not appear to colonise the middle ear in children with rAOM.

In vivo over-expression of KGF mimic human middle ear cholesteatoma.

PubMed

Yamamoto-Fukuda, Tomomi; Akiyama, Naotaro; Shibata, Yasuaki; Takahashi, Haruo; Ikeda, Tohru; Koji, Takehiko

2015-10-01

We reported previously that keratinocyte growth factor (KGF), a mesenchymal cell-derived paracrine growth factor, plays an important role in middle ear cholesteatoma formation, which is characterized by marked proliferation of epithelial cells. Here, we investigated whether KGF, the main factor that induces cholesteatoma, overexpression in vivo results in the formation of cholesteatoma. Flag-hKGF cDNA driven by CMV14 promoter was transfected through electroporation into the external auditory canal (EAC) of rats once (short-term model) or five times on every fourth day (long-term model). Ears transfected with empty vector were used as controls. Successful transfection of plasmids into epithelial and stromal cells was confirmed by Flag immunohistochemistry. In the short-term model, the intensity of KGF protein was the strongest in hKGF transfected ear at day 4. KGF expression induced epithelial cell proliferation, reaching a peak level at day 4 and then decreased later, while in the long-term model, KGF expression in the EAC led to middle ear cholesteatoma formation. In conclusion, we described here a new experimental model of human middle ear cholesteatoma, and demonstrated that KGF and KGF receptor paracrine action play an essential role in middle ear cholesteatoma formation in an in vivo model.

Altered Expression of Middle and Inner Ear Cytokines in Mouse Otitis Media

PubMed Central

MacArthur, Carol J.; Pillers, De-Ann M.; Pang, Jiaqing; Kempton, J. Beth; Trune, Dennis R.

2010-01-01

Objectives/Hypothesis The inner ear is at risk for sensorineural hearing loss in both acute and chronic otitis media (OM), but the underlying mechanisms underlying sensorineural hearing loss are unknown. Previous gene expression array studies showed cytokine genes might be upregulated in the cochleas of mice with acute and chronic otitis media. This implies that the inner ear could manifest a direct inflammatory response to OM that may cause sensorineural damage. Therefore, to better understand inner ear cytokine gene expression during OM, quantitative RT-PCR and immunohistochemistry were performed on mouse models to evaluate middle and inner ear inflammatory and remodeling cytokines. Study Design Basic science experiment. Methods An acute OM model was created in Balb/c mice by a transtympanic injection of S. pneumoniae in one ear; the other ear used as a control. C3H/HeJ mice were screened for unilateral chronic OM with the non-infected ear serving as control. Results Both acute and chronic OM caused both the middle ear and inner tissues in these two mouse models to over express numerous cytokine genes related to tissue remodeling (TNFα, FGF, BMP) and angiogenesis (VEGF), as well as inflammatory cell proliferation (IL-1α,β, IL-2, IL-6). Immunohistochemistry confirmed that both the middle ear and inner ear tissues expressed these cytokines. Conclusion Cochlear tissues are capable of expressing cytokine mRNA that contributes to the inflammation and remodeling that occur in association with middle ear disease. This provides a potential molecular basis for the transient and permanent sensorineural hearing loss often reported with acute and chronic OM. Level of Evidence N/A PMID:21271590

Health Information in Ukrainian (українська )

MedlinePlus

... Health Information Translations E Expand Section Ear Infections Middle Ear Infection - English PDF Middle Ear Infection - українська (Ukrainian) Bilingual PDF Health Information Translations ...

Sonotubometry, a useful tool for the evaluation of the Eustachian tube ventilatory function

PubMed Central

Borangiu, A; Popescu, CR; Purcarea, VL

2014-01-01

From the three Eustachian tube (ET) functions: middle ear protection, secretion clearance and middle ear ventilation, the ventilatory function is unanimously considered the most important one, because proper hearing is established only when tympanic membrane compliance is normal. This requires equilibrium between the middle ear and ambient gas pressure, which makes the normal functioning of active ET opening of critical importance. There are several methods and tests that can assess such a complex and variable mechanism. Sonotubometry is one such method; despite the fact that it has been continuously improved in the last 20 years, it is not yet systematically used to evaluate the ET ventilatory function, because its measurement pattern, context mapping (patient, clinic data, medication, treatment), validation, reproducibility and value for clinic practice, have not yet been fully consolidated and integrated in a knowledge-based, service-oriented system, that can provide decision support or even diagnostic. The paper reviews the role of tubal sonometry as a non-invasive, physiologic and easy to use method in assessing the ventilatory function and investigates the validity and reproducibility of a measuring pattern and test in a group of children. The paper describes the test pattern used, and the computer-based platform based on: (1) Digital Signal Processing (DSP) for sound acquisition and low-level processing; (2) Artificial Intelligence techniques to extract significant sound features from sonotubograms and learn a manifold context database. Results are reported from test series carried out in healthy children; a similar study between tests is included in the final Discussions section. PMID:25713631

How minute sooglossid frogs hear without a middle ear.

PubMed

Boistel, Renaud; Aubin, Thierry; Cloetens, Peter; Peyrin, Françoise; Scotti, Thierry; Herzog, Philippe; Gerlach, Justin; Pollet, Nicolas; Aubry, Jean-François

2013-09-17

Acoustic communication is widespread in animals. According to the sensory drive hypothesis [Endler JA (1993) Philos Trans R Soc Lond B Biol Sci 340(1292):215-225], communication signals and perceptual systems have coevolved. A clear illustration of this is the evolution of the tetrapod middle ear, adapted to life on land. Here we report the discovery of a bone conduction-mediated stimulation of the ear by wave propagation in Sechellophryne gardineri, one of the world's smallest terrestrial tetrapods, which lacks a middle ear yet produces acoustic signals. Based on X-ray synchrotron holotomography, we measured the biomechanical properties of the otic tissues and modeled the acoustic propagation. Our models show how bone conduction enhanced by the resonating role of the mouth allows these seemingly deaf frogs to communicate effectively without a middle ear.

High-resolution microendoscope images of middle ear cholesteatoma and surrounding tissue: evaluation of interobserver concordance.

PubMed

Bradley, James; Jiang, Nancy; Levy, Lauren; Richards-Kortum, Rebecca; Sikora, Andrew; Smouha, Eric

2014-04-01

Investigate how accurately otolaryngologists could differentiate between images obtained with high-resolution microendoscopy (HRME) of ex vivo cholesteatoma specimens and surrounding middle ear epithelium. HRME images of surgically resected cholesteatoma and middle ear epithelium were obtained and otolaryngologists classified these images. Tertiary medical center. Resected cholesteatoma and middle ear epithelium were stained with a contrast agent, proflavine, and HRME images were captured. Specimens were sent for standard histopathology and compared with HRME images. Quality-controlled images were used to assemble a training set. After viewing training images, otolaryngologists without prior cholesteatoma HRME experience reviewed and classified test images. Ten cholesteatoma and 9 middle ear specimens were collected, of which 17 representative cholesteatoma and 19 middle ear epithelium images were extracted for a testing set. Qualitative analysis for concordance between HRME images and histological images yielded a strong correlation between modalities. The mean accuracy of all reviewers in correctly identifying images was 95% (95% confidence interval [CI], 92%-98%). The sensitivity to correctly detect cholesteatoma images was 98% (95% CI, 93%-100%), and the specificity was 92% (95% CI, 87%-97%). The Fleiss kappa interrater reliability score was 0.83, (95% CI, 0.77-0.89). Medical professionals can quickly be trained to accurately distinguish between HRME images of cholesteatoma and normal middle ear epithelium, both of which have distinct imaging characteristics. Real-time HRME optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease.

High frequency bone conduction auditory evoked potentials in the guinea pig: Assessing cochlear injury after ossicular chain manipulation.

PubMed

Bergin, M J; Bird, P A; Vlajkovic, S M; Thorne, P R

2015-12-01

Permanent high frequency (>4 kHz) sensorineural hearing loss following middle ear surgery occurs in up to 25% of patients. The aetiology of this loss is poorly understood and may involve transmission of supra-physiological forces down the ossicular chain to the cochlea. Investigating the mechanisms of this injury using animal models is challenging, as evaluating cochlear function with evoked potentials is confounded when ossicular manipulation disrupts the normal air conduction (AC) pathway. Bone conduction (BC) using clinical bone vibrators in small animals is limited by poor transducer output at high frequencies sensitive to trauma. The objectives of the present study were firstly to evaluate a novel high frequency bone conduction transducer with evoked auditory potentials in a guinea pig model, and secondly to use this model to investigate the impact of middle ear surgical manipulation on cochlear function. We modified a magnetostrictive device as a high frequency BC transducer and evaluated its performance by comparison with a calibrated AC transducer at frequencies up to 32 kHz using the auditory brainstem response (ABR), compound action potential (CAP) and summating potential (SP). To mimic a middle ear traumatising stimulus, a rotating bur was brought in to contact with the incudomalleal complex and the effect on evoked cochlear potentials was observed. BC-evoked potentials followed the same input-output function pattern as AC potentials for all ABR frequencies. Deterioration in CAP and SP thresholds was observed after ossicular manipulation. It is possible to use high frequency BC to evoke responses from the injury sensitive basal region of the cochlea and so not rely on AC with the potential confounder of conductive hearing loss. Ongoing research explores how these findings evolve over time, and ways in which injury may be reduced and the cochlea protected during middle ear surgery. Copyright © 2015 Elsevier B.V. All rights reserved.

A comparison of tympanometry with 226 Hz and 1000 Hz probe tones in children with Down syndrome.

PubMed

Lewis, Meagan P; Bradford Bell, Elizabeth; Evans, Adele K

2011-12-01

For children with Down syndrome, the incidence of hearing loss may be as high as 78% [1], therefore the American Academy of Pediatrics recommends regular screening for the presence of hearing abnormalities. Tympanometry is used as an indication of middle ear pathology. In our experience, Down's patients' tympanograms do not always correlate with otoscopic findings. Down's patients have joint laxity, small ear canals, anterior tympanic membrane orientation and softer tissue composition, all factors thought to affect tympanogram results in infants. Because the use of the 1000 Hz tympanometry is widely recognized as standard procedure in the evaluation of infants aged 0-6 months, we propose it may have greater reliability in testing patients with Down syndrome. Compare the results of visual inspection of the tympanic membrane by a Pediatric Otolaryngologist to the results of tympanometry at traditional probe tone (226 Hz) and at the infant probe tone (1000 Hz). Institutional Review Board - approved prospective study of 26 subject-ears in patients with Down syndrome aged 6 months-18 years but recent stable middle ear/Eustachian tube function using physical examination and tympanometric probe tones at 226 Hz and 1000 Hz. Subject-ears were examined with record of "clear of effusion," showed the presence of "fluid," or were to be "excluded." Blinded to ear exam results, tympanometry was then completed with record of which Jerger classification tympanogram was found at each frequency. Although the sensitivity of each test was 1, the specificity of the 1000 Hz tympanometry (100%) in this study was markedly improved compared to the specificity of the 226 Hz tympanometry (71%) (p=0.016). This pilot study demonstrated evidence that tympanometry in children with Down syndrome may be more reliable at 1000 Hz than at 226 Hz in detecting the presence of middle ear effusion beyond infancy. Use of the 1000 Hz probe tone yielded fewer false positives for disease (type B tympanograms in the setting of absent middle ear disease). Further studies of a larger patient population are needed to corroborate these results. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Antiadhesive effect of bioresorbable polylactide film in abraded middle ear mucosa.

PubMed

Jang, Chul Ho; Jo, Si Young; Cho, Yong Beom; Choi, Cheol Hee; Jung, Won Kyo

2014-12-01

Polylactide film (PLF) is used to prevent postoperative peridural adhesion in spinal surgery. Up until now, the antiadhesive effect of bioresorbable PLF in ear middle surgery has not been reported. The purpose of this study is to evaluate the antiadhesive effect of PLF in guinea pigs serving as a model for middle ear mucosal trauma. The animals were divided into two groups: the PLF group and the silastic sheeting group. There were seven guinea pigs (fourteen ears) in both groups. Under aseptic conditions, the middle ear mucosa was abraded using a pick inserted transbullaly. A PLF or silicone sheet was then placed into the guinea pigs' middle ear cavities. The auditory brainstem responses (ABRs) were assessed preoperatively and at three weeks postoperatively while the animals were under general anesthesia. A histopathological study was performed 3 weeks after the operation. The difference between the ABR results before the operation and three weeks postoperatively were not statistically significant. The adhesion formation did not appeared in either group. Prominent fibrous capsule formation and inflammation were observed in the silastic sheeting group, but not in the PLF group. Mild fibrous thickening of regenerated mucosa was observed in the PLF group. From our results, bioresorbable PLF is nonototoxic and biocompatible with the guinea pig's middle ear cavity by short-term evaluation. Further long-term evaluation study is necessary before clinical application. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Gerbil middle-ear sound transmission from 100 Hz to 60 kHz1

PubMed Central

Ravicz, Michael E.; Cooper, Nigel P.; Rosowski, John J.

2008-01-01

Middle-ear sound transmission was evaluated as the middle-ear transfer admittance HMY (the ratio of stapes velocity to ear-canal sound pressure near the umbo) in gerbils during closed-field sound stimulation at frequencies from 0.1 to 60 kHz, a range that spans the gerbil’s audiometric range. Similar measurements were performed in two laboratories. The HMY magnitude (a) increased with frequency below 1 kHz, (b) remained approximately constant with frequency from 5 to 35 kHz, and (c) decreased substantially from 35 to 50 kHz. The HMY phase increased linearly with frequency from 5 to 35 kHz, consistent with a 20–29 μs delay, and flattened at higher frequencies. Measurements from different directions showed that stapes motion is predominantly pistonlike except in a narrow frequency band around 10 kHz. Cochlear input impedance was estimated from HMY and previously-measured cochlear sound pressure. Results do not support the idea that the middle ear is a lossless matched transmission line. Results support the ideas that (1) middle-ear transmission is consistent with a mechanical transmission line or multiresonant network between 5 and 35 kHz and decreases at higher frequencies, (2) stapes motion is pistonlike over most of the gerbil auditory range, and (3) middle-ear transmission properties are a determinant of the audiogram. PMID:18646983

Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial.

PubMed

Stephen, Anna T N; Leach, Amanda J; Morris, Peter S

2013-07-08

To measure the impact of 4 weeks of daily swimming on rates of ear discharge among Aboriginal children with a tympanic membrane perforation (TMP) and on the microbiology of the nasopharynx and middle ear. A randomised controlled trial involving 89 Aboriginal children (aged 5-12 2013s) with a TMP, conducted in two remote Northern Territory Aboriginal communities from August to December 2009. 4 school weeks of daily swimming lessons (45 minutes) in a chlorinated pool. Proportions of children with ear discharge and respiratory and opportunistic bacteria in the nasopharynx and middle ear. Of 89 children randomly assigned to the swimming or non-swimming groups, 58 (26/41 swimmers and 32/48 non-swimmers) had ear discharge at baseline. After 4 weeks, 24 of 41 swimmers had ear discharge compared with 32 of 48 non-swimmers (risk difference, - 8% (95% CI, - 28% to 12%). There were no statistically significant changes in the microbiology of the nasopharynx or middle ear in swimmers or non-swimmers. Streptococcus pneumoniae and non-typeable Haemophilus influenzae were the dominant organisms cultured from the nasopharynx, and H. influenzae, Staphylococcus aureus and Pseudomonas aeruginosa were the dominant organisms in the middle ear. Swimming lessons for Aboriginal children in remote communities should be supported, but it is unlikely that they will substantially reduce rates of chronic suppurative otitis media and associated bacteria in the nasopharynx and middle ear. However, swimming was not associated with increased risk of ear discharge and we found no reason to discourage it. Australian New Zealand Clinical Trials Registry ACTRN12613000634774.

Immunohistological analysis of eotaxin and RANTES in the model animal of eosinophilic otitis media.

PubMed

Kudo, Naomi; Matsubara, Atsushi; Nishizawa, Hisanori; Miura, Tomoya

2017-05-01

The most crucial clinical problem of Eosinophilic Otitis Media (EOM) is sensorineural hearing loss. A previous report revealed that repeated antigen stimulation of middle ear causes eosinophilic inflammation not only in the middle ear but also in the inner ear. The purpose of the present study was to elucidate the mechanism of eosinophil infiltration to the inner ear in the animal model of EOM. Continuous OVA stimulation to the middle ear of guinea pigs was performed for 7 days, 14 days, and 28 days. Histological observation was made for eosinophil infiltration and morphological change of the inner ear. Immunostaining for eotaxin and RANTES was performed to study immunoreactivity of those chemokines. In the 7-day stimulation side, a few eosinophils were found in the scala tympani, without obvious morphological damage of the inner ear. Moreover, immunoreactivity of both eotaxin and RANTES was significantly higher in the OVA stimulation sides than control sides. For both eotaxin and RANTES, the number of immunopositive cells was significantly increased in the 14-day stimulation side over the 7-day stimulation side. Eotaxin and RANTES seem to play some important roles for the eosinophil infiltration in the middle and inner ear of model animal of EOM.

Role of the middle ear muscle apparatus in mechanisms of speech signal discrimination

NASA Technical Reports Server (NTRS)

Moroz, B. S.; Bazarov, V. G.; Sachenko, S. V.

1980-01-01

A method of impedance reflexometry was used to examine 101 students with hearing impairment in order to clarify the interrelation between speech discrimination and the state of the middle ear muscles. Ability to discriminate speech signals depends to some extent on the functional state of intraaural muscles. Speech discrimination was greatly impaired in the absence of stapedial muscle acoustic reflex, in the presence of low thresholds of stimulation and in very small values of reflex amplitude increase. Discrimination was not impeded in positive AR, high values of relative thresholds and normal increase of reflex amplitude in response to speech signals with augmenting intensity.

Earless toads sense low frequencies but miss the high notes.

PubMed

Womack, Molly C; Christensen-Dalsgaard, Jakob; Coloma, Luis A; Chaparro, Juan C; Hoke, Kim L

2017-10-11

Sensory losses or reductions are frequently attributed to relaxed selection. However, anuran species have lost tympanic middle ears many times, despite anurans' use of acoustic communication and the benefit of middle ears for hearing airborne sound. Here we determine whether pre-existing alternative sensory pathways enable anurans lacking tympanic middle ears (termed earless anurans) to hear airborne sound as well as eared species or to better sense vibrations in the environment. We used auditory brainstem recordings to compare hearing and vibrational sensitivity among 10 species (six eared, four earless) within the Neotropical true toad family (Bufonidae). We found that species lacking middle ears are less sensitive to high-frequency sounds, however, low-frequency hearing and vibrational sensitivity are equivalent between eared and earless species. Furthermore, extratympanic hearing sensitivity varies among earless species, highlighting potential species differences in extratympanic hearing mechanisms. We argue that ancestral bufonids may have sufficient extratympanic hearing and vibrational sensitivity such that earless lineages tolerated the loss of high frequency hearing sensitivity by adopting species-specific behavioural strategies to detect conspecifics, predators and prey. © 2017 The Author(s).

KGFR as a possible therapeutic target in middle ear cholesteatoma.

PubMed

Yamamoto-Fukuda, Tomomi; Akiyama, Naotaro; Shibata, Yasuaki; Takahashi, Haruo; Ikeda, Tohru; Kohno, Michiaki; Koji, Takehiko

2014-11-01

We demonstrated that repression of keratinocyte growth factor (KGF) receptor (KGFR) could be a potentially useful strategy in the conservative treatment of middle ear cholesteatoma. Recently, the use of a selective inhibitor of the KGFR, SU5402, in an in vitro experiment resulted in the inhibition of the differentiation and proliferation of epithelial cells through KGF secretion by fibroblasts isolated from the cholesteatoma. In this study, we investigated the effects of the KGFR inhibitor during middle ear cholesteatoma formation in vivo. Based on the role of KGF in the development of cholesteatoma, Flag-hKGF cDNA driven by CMV14 promoter was transfected through electroporation into the external auditory canal of rats five times on every fourth day. Ears transfected with empty vector were used as controls. KGFR selective inhibitor (SU5402) or MEK inhibitor (PD0325901) was administered in the right ear of five rats after vector transfection. In the control, 2% DMSO in PBS was administered in the other ears after vector transfection. The use of a selective KGFR inhibitor, SU5402, completely prevented middle ear cholesteatoma formation in the rats.

A Comparative Study of Drug Delivery Methods Targeted to the Mouse Inner Ear: Bullostomy Versus Transtympanic Injection

PubMed Central

Cediel, Rafael; Celaya, Adelaida M.; Lassaletta, Luis; Varela-Nieto, Isabel; Contreras, Julio

2017-01-01

We present two minimally invasive microsurgical techniques in rodents for specific drug delivery into the middle ear so that it may reach the inner ear. The first procedure consists of perforation of the tympanic bulla, termed bullostomy; the second one is a transtympanic injection. Both emulate human clinical intratympanic procedures. Chitosan-glycerophosphate (CGP) and Ringer´s Lactate buffer (RL) were used as biocompatible vehicles for local drug delivery. CGP is a nontoxic biodegradable polymer widely used in pharmaceutical applications. It is a viscous liquid at RT but it congeals to a semi solid phase at body temperature. RL is an isotonic solution used for intravenous administrations in humans. A small volume of this vehicle is precisely placed on the Round Window (RW) niche by means of a bullostomy. A transtympanic injection fills the middle ear and allows less control but broader access to the inner ear. The safety profiles of both techniques were studied and compared by using functional and morphological tests. Hearing was evaluated by registering the Auditory Brainstem Response (ABR) before and several times after microsurgery. The cytoarchitecture and preservation level of cochlear structures were studied by conventional histological techniques in paraformaldehyde-fixed and decalcified cochlear samples. In parallel, unfixed cochlear samples were taken and immediately frozen to analyze gene expression profiles of inflammatory markers by quantitative Reverse Transcriptase Polymerase Chain Reaction (qRT-PCR). Both procedures are suitable as drug delivery methods into the mouse middle ear, although transtympanic injection proved to be less invasive compared to bullostomy. PMID:28362376

Thermal effects of endoscopy in a human temporal bone model: Implications for endoscopic ear surgery

PubMed Central

Kozin, Elliott D.; Lehmann, Ashton; Carter, Margaret; Hight, Ed; Cohen, Michael; Nakajima, Hideko Heidi; Lee, Daniel J.

2015-01-01

Objective Although the theoretical risk of elevated temperatures during endoscopic ear surgery has been reported previously, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we measure temperature changes during rigid middle ear endoscopy in a human temporal bone model and investigate whether suction can act as a significant cooling mechanism. Study Design Human temporal bone model of endoscopic middle ear surgery. Methods Fresh human temporal bones were maintained at body temperature (~36°C). Temperature fluctuations were measured as a function of 1) distance between the tip of a 3mm 0° Hopkins rod and round window membrane, and 2) intensity of the light source. Infrared imaging determined the thermal gradient. For suction, a #20 French was utilized. Results We found: 1) an endoscope maximally powered by a xenon or LED light source resulted in a rapid temperature elevation up to 46°C within 0.5–1mm from the tip of the endoscope within 30–124 seconds; 2) elevated temperatures occurred up to 8mm from the endoscope tip; and 3) temperature decreased rapidly within 20–88 seconds of turning off the light source or applying suction. Conclusion Our findings have direct implications for avoiding excessive temperature elevation in endoscopic ear surgery. We recommend: 1) using submaximal light intensity, 2) frequent repositioning of the endoscope, and 3) removing the endoscope to allow tissue cooling. Use of suction provides rapid cooling of the middle ear space and may be incorporated in the design of new instrumentation for prolonged dissection. PMID:24604692

Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions.

PubMed

Keefe, Douglas H; Archer, Kelly L; Schmid, Kendra K; Fitzpatrick, Denis F; Feeney, M Patrick; Hunter, Lisa L

2017-10-01

Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic. Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications. American Academy of Audiology

First Branchial Cleft Fistula Associated with External Auditory Canal Stenosis and Middle Ear Cholesteatoma

PubMed Central

Abdollahi fakhim, Shahin; Naderpoor, Masoud; Mousaviagdas, Mehrnoosh

2014-01-01

Introduction: First branchial cleft anomalies manifest with duplication of the external auditory canal. Case Report: This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection. Conclusion: It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear. PMID:25320705

First branchial cleft fistula associated with external auditory canal stenosis and middle ear cholesteatoma.

PubMed

Abdollahi Fakhim, Shahin; Naderpoor, Masoud; Mousaviagdas, Mehrnoosh

2014-10-01

First branchial cleft anomalies manifest with duplication of the external auditory canal. This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection. It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear.

DISCUSSION ON THE EFFECTS OF MIDDLE-EAR DISEASE ON EFFICIENCY IN CIVIL AND MILITARY LIFE

PubMed Central

1928-01-01

(1) Introductory.—(2) Symptoms and complications of middle-ear disease and their effects on efficiency.—(3) Service views on the disposal of men suffering from middle-ear disease.—(4) Comparison of the disability caused by middle-ear disease in civil and military life.—(5) Are the aural recruiting and invaliding standards of to-day too exacting?—(6) Aural disease in recruiting and invaliding—tables.—(7) Advantages of rigorous standards of recruiting.—(8) Attainment of aural efficiency in the Services.—(9) Is any relaxation of standards ever justifiable?—(10) Importance of civil and military co-operation. PMID:19986558

Mucin Production and Mucous Cell Metaplasia in Otitis Media

PubMed Central

Lin, Jizhen; Caye-Thomasen, Per; Tono, Tetsuya; Zhang, Quan-An; Nakamura, Yoshihisa; Feng, Ling; Huang, Jianmin; Ye, Shengnan; Hu, Xiaohua; Kerschner, Joseph E.

2012-01-01

Otitis media (OM) with mucoid effusion, characterized by mucous cell metaplasia/hyperplasia in the middle ear cleft and thick fluid accumulation in the middle ear cavity, is a subtype of OM which frequently leads to chronic OM in young children. Multiple factors are involved in the developmental process of OM with mucoid effusion, especially disorders of mucin production resulting from middle ear bacterial infection and Eustachian tube dysfunction. In this review, we will focus on several aspects of this disorder by analyzing the cellular and molecular events such as mucin production and mucous cell differentiation in the middle ear mucosa with OM. In addition, infectious agents, mucin production triggers, and relevant signaling pathways will be discussed. PMID:22685463

A longitudinal study of hearing and middle ear status of individuals with cleft palate with and without additional malformations/syndromes.

PubMed

Flynn, Traci; Persson, Christina; Moller, Claes; Lohmander, Anette; Magnusson, Lennart

2014-09-01

Objective : To describe and compare the middle ear status and hearing sensitivity in adolescence with isolated cleft palate plus additional malformations and/or syndromes with those with only an isolated cleft palate. Design : Retrospective and longitudinal. Two groups of individuals with isolated cleft palate were compared. Participants : A cohort of individuals born over 4 years in the western region of Sweden. The cohort was divided into one group with isolated cleft palate (n = 31; ICP) and one group with isolated cleft palate plus additional malformations and/or syndromes (n = 37; ICP+). Methods : Middle ear status and hearing thresholds were collected from the medical records at 7, 10, 13, and 16 years of age, examined, and compared within and between groups over time. Results : The ICP+ group demonstrated a significantly higher prevalence of abnormal middle ear status and elevated hearing thresholds as compared with the ICP group. As the individuals aged, the prevalence of abnormal middle ear status decreased. The hearing levels in both groups decreased in the low to middle frequencies as individuals aged; however, the hearing in the high frequencies did not. Conclusions : Individuals with cleft palate need to be followed routinely for middle ear status and hearing thresholds to ensure optimal audiological rehabilitation, with particular attention to those with additional malformations and/or syndromes.

Interaction Between Allergy and Middle Ear Infection.

PubMed

Oh, Jeong-Hoon; Kim, Woo Jin

2016-09-01

Recent studies have attempted to identify interactions among the causes of otitis media with effusion (OME). This review discusses the interaction between allergy and infection with regard to host and environmental factors in terms of the development of OME. Protection of the upper airway against microbial invasion requires active interaction between the defense mechanisms of the respiratory epithelium, including innate and adaptive immunity, and mechanical factors. The impairment of these defenses due to allergy and/or increased bacterial resistance may lead to increased susceptibility to infectious organisms in the respiratory tract and middle ear mucosa. Recent genetic studies have provided valuable information about the association of Toll-like receptor signaling variations with clinical phenotypes and the risk of infection in the middle ear. Among the causal factors of OME, allergy not only induces an inflammatory reaction in the middle ear cavity but also facilitates the invasion of infectious pathogens. There is also evidence that allergy can affect the susceptibility of patients to infection of the upper respiratory tract, including the middle ear cavity.

In vivo imaging of middle-ear and inner-ear microstructures of a mouse guided by SD-OCT combined with a surgical microscope

PubMed Central

Cho, Nam Hyun; Jang, Jeong Hun; Jung, Woonggyu; Kim, Jeehyun

2014-01-01

We developed an augmented-reality system that combines optical coherence tomography (OCT) with a surgical microscope. By sharing the common optical path in the microscope and OCT, we could simultaneously acquire OCT and microscope views. The system was tested to identify the middle-ear and inner-ear microstructures of a mouse. Considering the probability of clinical application including otorhinolaryngology, diseases such as middle-ear effusion were visualized using in vivo mouse and OCT images simultaneously acquired through the eyepiece of the surgical microscope during surgical manipulation using the proposed system. This system is expected to realize a new practical area of OCT application. PMID:24787787

Activation of NLRP3 inflammasome in human middle ear cholesteatoma and chronic otitis media.

PubMed

Kariya, Shin; Okano, Mitsuhiro; Zhao, Pengfei; Kataoka, Yuko; Yoshinobu, Junko; Maeda, Yukihide; Ishihara, Hisashi; Higaki, Takaya; Nishizaki, Kazunori

2016-01-01

The nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome plays an important role in the pathogenesis of middle ear diseases. Modulation of inflammasome-mediated inflammation may be a novel therapeutic strategy for cholesteatoma and chronic otitis media. NLRP3 inflammasome is a critical molecule mediating interleukin (IL)-1β responses. However, the expression of NLRP3 in the pathogenesis of cholesteatoma and chronic otitis media has not been fully examined. This study sought to assess the expression of NLRP3, ASC (apoptosis-associated speck-like protein containing a caspase recruitment domain and a pyrin domain), and caspase-1 in middle ear tissues in patients with cholesteatoma or chronic otitis media. Middle ear tissue samples were obtained from patients with cholesteatoma or chronic otitis media. Control middle ear samples were collected during cochlear implant surgery of patients without middle ear inflammation. The expression of NLRP3, ASC, and caspase-1 were examined by reverse transcription polymerase chain reaction (RT-PCR) assay and immunohistochemical study. The levels of mRNA of NLRP3, ASC, and caspase-1 were significantly elevated in cholesteatoma and chronic otitis media as compared with that of normal controls. The proteins of NLRP3, ASC, and caspase-1 were observed in infiltrating inflammatory cells in cholesteatoma and chronic otitis media.

Penicillin treatment accelerates middle ear inflammation in experimental pneumococcal otitis media.

PubMed Central

Kawana, M; Kawana, C; Giebink, G S

1992-01-01

Most Streptococcus pneumoniae strains are killed by very low concentrations of penicillin and other beta-lactam antibiotics, yet middle ear inflammation and effusion persist for days to weeks after treatment in most cases of pneumococcal otitis media. To study the effect of beta-lactam antibiotic treatment on pneumococci and the middle ear inflammatory response during pneumococcal otitis media, we measured concentrations of pneumococci, inflammatory cells, and lysozyme in middle ear fluid (MEF) by using the chinchilla model. Procaine penicillin G given intramuscularly 12 and 36 h after inoculation of pneumococci into the middle ear caused a significant acceleration in the MEF inflammatory cell concentration compared with that in untreated controls, with a significant peak in the inflammatory cell concentration 24 h after pneumococcal inoculation. The lysozyme concentration in MEF also increased more rapidly in treated than in control animals. Viable pneumococci were not detected in MEF after the second dose of penicillin, but the total pneumococcal cell concentration remained unchanged for at least 45 days. Therefore, penicillin treatment accelerated middle ear inflammation while killing pneumococci, but treatment did not accelerate clearance of the nonviable pneumococcal cells from MEF. Further studies will need to define the contribution of these responses to acute and chronic tissue injury. PMID:1563782

Middle Ear Fluid Cytokine and Inflammatory Cell Kinetics in the Chinchilla Otitis Media Model

PubMed Central

Sato, Katsuro; Liebeler, Carol L.; Quartey, Moses K.; Le, Chap T.; Giebink, G. Scott

1999-01-01

Streptococcus pneumoniae is the most frequent microbe causing middle ear infection. The pathophysiology of pneumococcal otitis media has been characterized by measurement of local inflammatory mediators such as inflammatory cells, lysozyme, oxidative metabolic products, and inflammatory cytokines. The role of cytokines in bacterial infection has been elucidated with animal models, and interleukin (IL)-1β, IL-6, and IL-8 and tumor necrosis factor alpha (TNF-α) are recognized as being important local mediators in acute inflammation. We characterized middle ear inflammatory responses in the chinchilla otitis media model after injecting a very small number of viable pneumococci into the middle ear, similar to the natural course of infection. Middle ear fluid (MEF) concentrations of IL-1β, IL-6, IL-8, and TNF-α were measured by using anti-human cytokine enzyme-linked immunosorbent assay reagents. IL-1β showed the earliest peak, at 6 h after inoculation, whereas IL-6, IL-8, and TNF-α concentrations were increasing 72 h after pneumococcal inoculation. IL-6, IL-8, and TNF-α but not IL-1β concentrations correlated significantly with total inflammatory cell numbers in MEF, and all four cytokines correlated significantly with MEF neutrophil concentration. Several intercytokine correlations were significant. Cytokines, therefore, participate in the early middle ear inflammatory response to S. pneumoniae. PMID:10085040

Cartilage island on stapes: autologous PORP in the hypoventilated middle ear.

PubMed

Hess-Erga, Jeanette; Engelen, Bart Lambertus Henricus Jozef; Vassbotn, Flemming Slinning

2017-04-01

The most common technique in sound restoration of the middle ear is prosthetic surgery. Hypoventilation of the middle ear may cause adhesive otitis or atelectasis resulting in a higher risk of prosthetic extrusion rate and recurrence of the underlying cholesteatoma. We report long-term results using an island of tragal cartilage as an autologous PORP in selected patients with poor middle ear ventilation. Retrospective chart reviews were performed for procedures involving 52 patients between year 2000 and 2009. All patients that underwent surgery using tragal cartilage interposed between the suprastructure of the stapes and the tympanic membrane were included in this study. Audiological parameters using four frequencies, 0.5, 1, 2 and 3 kHz, according to AAO-HNS guidelines, were assessed pre-and postoperatively. The hearing results on different PTA frequencies were also investigated. We report long-term follow-up of patients with hypoventilated middle ear with a success rate of 71% (ABG <20%). With regards to the ABG, the low frequency component (5 and 1 kHz) showed a significantly (p < 0.05) larger improvement of mean values after surgery as compared to the high-frequency component (2 and 3 kHz). Cartilage island PORP on stapes is a stable and efficient method for selected patients with chronic middle ear disease.

Better than fish on land? Hearing across metamorphosis in salamanders.

PubMed

Christensen, Christian Bech; Lauridsen, Henrik; Christensen-Dalsgaard, Jakob; Pedersen, Michael; Madsen, Peter Teglberg

2015-03-07

Early tetrapods faced an auditory challenge from the impedance mismatch between air and tissue in the transition from aquatic to terrestrial lifestyles during the Early Carboniferous (350 Ma). Consequently, tetrapods may have been deaf to airborne sounds for up to 100 Myr until tympanic middle ears evolved during the Triassic. The middle ear morphology of recent urodeles is similar to that of early 'lepospondyl' microsaur tetrapods, and experimental studies on their hearing capabilities are therefore useful to understand the evolutionary and functional drivers behind the shift from aquatic to aerial hearing in early tetrapods. Here, we combine imaging techniques with neurophysiological measurements to resolve how the change from aquatic larvae to terrestrial adult affects the ear morphology and sensory capabilities of salamanders. We show that air-induced pressure detection enhances underwater hearing sensitivity of salamanders at frequencies above 120 Hz, and that both terrestrial adults and fully aquatic juvenile salamanders can detect airborne sound. Collectively, these findings suggest that early atympanic tetrapods may have been pre-equipped to aerial hearing and are able to hear airborne sound better than fish on land. When selected for, this rudimentary hearing could have led to the evolution of tympanic middle ears. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Middle ear application of a sodium hyaluronate gel loaded with neomycin in a Guinea pig model.

PubMed

Saber, Amanj; Laurell, Göran; Bramer, Tobias; Edsman, Katarina; Engmér, Cecilia; Ulfendahl, Mats

2009-02-01

Establishing methods for topical administration of drugs to the inner ear have great clinical relevance and potential even in a relatively short perspective. To evaluate the efficacy of sodium hyaluronate (HYA) as a vehicle for drugs that could be used for treatment of inner ear disorders. The cochlear hair cell loss and round window membrane (RWM) morphology were investigated after topical application of neomycin and HYA into the middle ear. Sixty-five albino guinea pigs were used and divided into groups depending on the type of the treatment. Neomycin was chosen as tracer for drug release and pharmacodynamic effect. HYA loaded with 3 different concentrations of neomycin was injected to the middle ear cavity of guinea pigs. Phalloidin stained surface preparations of the organ of Corti were used to estimate hair cell loss induced by neomycin. The thickness of the midportion of the RWM was measured and compared with that of controls using light and electron microscopy. All animal procedures were pe rformed in accordance with the ethical standards of Karolinska Institutet. Neomycin induced a considerable hair cell loss in guinea pigs receiving a middle ear injection of HYA loaded with the drug, demonstrating that neomycin was released from the gel and delivered to the inner ear. The resulting hair cell loss showed a clear dose-dependence. Only small differences in hair cell loss were noted between animals receiving neomycin solution and animals exposed to neomycin in HYA suggesting that the vehicle neither facilitated nor hindered drug transport between the middle ear cavity and the inner ear. One week after topical application, the thickness of the RWM had increased and was dependent upon the concentration of neomycin administered to the middle ear. At 4 weeks the thickness of the RWM had returned to normal. HYA is a safe vehicle for drugs aimed to pass into the inner ear through the RWM. Neomycin was released from HYA and transported into the inner ear as evidenced by hair cell loss.

Healthy-side dominance of middle- and long-latency neuromagnetic fields in idiopathic sudden sensorineural hearing loss.

PubMed

Li, L P H; Shiao, A S; Chen, L F; Niddam, D M; Chang, S Y; Lien, C F; Lee, S K; Hsieh, J C

2006-08-01

Any lesion along the neural axis may induce a subsequent functional reorganization at the level above. The present study used magnetoencephalography to investigate auditory-evoked magnetic fields [a component of the middle-latency auditory evoked fields peaking at approximately 50 ms (P50m) and a component of the long-latency auditory evoked fields peaking at approximately 100 ms (N100m)] on stimulation of both healthy and affected ears in patients with acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) of moderate degree in order to elucidate the functional plasticity of the auditory system. Sixteen right-handed, previously untreated adult patients with acute unilateral left (n = 8) or right (n = 8) ISSNHL of moderate degree were studied. Sixteen right-handed healthy volunteers with normal hearing served as control. Auditory neuromagnetic responses, measured by a whole-head 306-channel neuromagnetometer, were detected by monaural tone stimulation applied to affected and healthy ears, respectively, in different sessions. Intragroup and intergroup interhemispheric differences of peak dipole strengths and latencies of P50m and N100m, respectively, to monaural tones were evaluated. Healthy-side amplitude dominance of both P50m and N100m was found in ISSNHL, i.e. contralateral dominance was preserved on affected-ear stimulation but ipsilateral dominance was seen on healthy-ear stimulation. The phenomena could be attributed to the combined contralateral attenuation and ipsilateral enhancement of P50m and N100m activity in response to healthy-ear stimulation. Our findings confirmed that functional modulation can occur within the first few tens of milliseconds of evoked response at the auditory cortex in ISSNHL. The mechanisms of healthy-side dominance might be ascribed to a functional retune of auditory pathways, i.e. conjoined contralateral inhibition and ipsilateral excitation of the auditory pathway in response to healthy-ear stimulation. The effect could be registered in cortical responses.

Tissue-specific roles of Tbx1 in the development of the outer, middle and inner ear, defective in 22q11DS patients

PubMed Central

Arnold, Jelena S.; Braunstein, Evan M.; Ohyama, Takahiro; Groves, Andrew K.; Adams, Joe C.; Brown, M. Christian; Morrow, Bernice E.

2007-01-01

Most 22q11.2 deletion syndrome (22q11DS) patients have middle and outer ear anomalies, whereas some have inner ear malformations. Tbx1, a gene hemizygously deleted in 22q11DS patients and required for ear development, is expressed in multiple tissues during embryogenesis. To determine the role of Tbx1 in the first pharyngeal pouch (PPI) in forming outer and middle ears, we tissue-specifically inactivated the gene using Foxg1-Cre. In the conditional mutants, PPI failed to outgrow, preventing the middle ear bone condensations from forming. Tbx1 was also inactivated in the otic vesicle (OV), resulting in the failure of inner ear sensory organ formation, and in duplication of the cochleovestibular ganglion (CVG). Consistent with the anatomical defects, the sensory genes, Otx1 and Bmp4 were downregulated, whereas the CVG genes, Fgf3 and NeuroD, were upregulated. To delineate Tbx1 cell-autonomous roles, a more selective ablation, exclusively in the OV, was performed using Pax2-Cre. In contrast to the Foxg1-Cre mutants, Pax2-Cre conditional mutant mice survived to adulthood and had normal outer and middle ears but had the same inner ear defects as the Tbx1 null mice, with the same gene expression changes. These results demonstrate that Tbx1 has non-cell autonomous roles in PPI in the formation of outer and middle ears and cell-autonomous roles in the OV. Periotic mesenchymal markers, Prx2 and Brn4 were normal in both conditional mutants, whereas they were diminished in Tbx1−/− embryos. Thus, Tbx1 in the surrounding mesenchyme in both sets of conditional mutants cannot suppress the defects in the OV that occur in the null mutants. PMID:16600992

[The endoscopic anatomy of the middle ear (a dissection study)].

PubMed

Rzaev, R M; Rzaev, R R

The objective of the present work was to study the specific endoscopic anatomical features of the middle ear using the dissected temporal bones with the intact tympanic membrane. The 18 cm long endoscopes 4 mm in diameter with a visual angle from 0 to 45 degrees in the combination with some other microinstruments, such as ear pincers, needles, curettes, elevators, and suction tubes, were used during the examination. It was shown that endomeato-transtympanic endosopy provides a panoramic view of almost all structures of the middle ear. After the resection of the posterior bone edge of 'annulus tympanicus', the use of the 45o endoscope ensured the panoramic view not only of certain structures of the middle ear (e.g. the tympanic chord, the stapedius muscle tendon, the entire pyramidal process) but also of the structures of the retrotympanic and anterior epitympanic spaces.

Middle ear abnormalities in Van Maldergem syndrome.

PubMed

Verheij, Emmy; Thomeer, Henricus G X M; Pameijer, Frank A; Topsakal, Vedat

2017-01-01

Van Maldergem syndrome (VMS) is a very rare syndrome that was first described in 1992. The main features of this syndrome comprise intellectual disability, blepharo-naso-facial malformation, and hand anomalies. Almost all nine described patients have been shown to be affected by conductive hearing impairment attributed to microtia, and atresia of the outer ear canal. Here, we present a VMS patient with congenital malformations of the middle ear as the main reason for severe conductive bilateral hearing impairment. To our knowledge, this is the first report to describe middle ear abnormalities in VMS. These malformations were seen on high resolution Computed Tomography scanning and during an exploratory tympanotomy. Due to the severity of the middle ear abnormalities and the risk for facial nerve damage, the patient was not offered an ossicular chain reconstruction but a bone conduction device after this exploratory tympanotomy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Increased susceptibility to otitis media in a Splunc1-deficient mouse model

PubMed Central

Bartlett, Jennifer A.; Meyerholz, David K.; Wohlford-Lenane, Christine L.; Naumann, Paul W.; Salzman, Nita H.; McCray, Paul B.

2015-01-01

ABSTRACT Otitis media (inflammation of the middle ear) is one of the most common diseases of early childhood. Susceptibility to otitis is influenced by a number of factors, including the actions of innate immune molecules secreted by the epithelia lining the nasopharynx, middle ear and Eustachian tube. The SPLUNC1 (short palate, lung, nasal epithelial clone 1) protein is a highly abundant secretory product of the mammalian nasal, oral and respiratory mucosa that is thought to play a multifunctional role in host defense. In this study we investigated Splunc1 expression in the ear of the mouse, and examined whether this protein contributes to overall host defense in the middle ear and/or Eustachian tube. We found that Splunc1 is highly expressed in both the surface epithelium and in submucosal glands in these regions in wild-type mice. In mice lacking Splunc1, we noted histologically an increased frequency of otitis media, characterized by the accumulation of leukocytes (neutrophils with scattered macrophages), proteinaceous fluid and mucus in the middle ear lumens. Furthermore, many of these mice had extensive remodeling of the middle ear wall, suggesting a chronic course of disease. From these observations, we conclude that loss of Splunc1 predisposes mice to the development of otitis media. The Splunc1−/− mouse model should help investigators to better understand both the biological role of Splunc1 as well as host defense mechanisms in the middle ear. PMID:25765466

Inner Ear Barotrauma After Underwater Pool Competency Training Without the Use of Compressed Air Case and Review.

PubMed

McIntire, Sean; Boujie, Lee

2016-01-01

Inner ear barotrauma can occur when the gas-filled chambers of the ear have difficulty equalizing pressure with the outside environment after changes in ambient pressure. This can transpire even with small pressure changes. Hypobaric or hyperbaric environments can place significant stress on the structures of the middle and inner ear. If methods to equalize pressure between the middle ear and other connected gas-filled spaces (i.e., Valsalva maneuver) are unsuccessful, middle ear overpressurization can occur. This force can be transmitted to the fluid-filled inner ear, making it susceptible to injury. Damage specifically to the structures of the vestibulocochlear system can lead to symptoms of vertigo, hearing loss, and tinnitus. This article discusses the case of a 23-year-old male Marine who presented with symptoms of nausea and gait instability after performing underwater pool competency exercises to a maximum depth of 13 feet, without breathing compressed air. Diagnosis and management of inner ear barotrauma are reviewed, as is differentiation from inner ear decompression sickness. 2016.

Correlative mRNA and Protein Expression of Middle and Inner Ear Inflammatory Cytokines during Mouse Acute Otitis Media

PubMed Central

Trune, Dennis R.; Kempton, Beth; Hausman, Frances A.; Larrain, Barbara E.; MacArthur, Carol J.

2015-01-01

Although the inner ear has long been reported to be susceptible to middle ear disease, little is known of the inflammatory mechanisms that might cause permanent sensorineural hearing loss. Recent studies have shown inner ear tissues are capable of expressing inflammatory cytokines during otitis media. However, little quantitative information is available concerning cytokine gene expression in the inner ear and the protein products that result. Therefore, this study was conducted of mouse middle and inner ear during acute otitis media to measure the relationship between inflammatory cytokine genes and their protein products with quantitative RT-PCR and ELISA, respectively. Balb/c mice were inoculated transtympanically with heat-killed Haemophilus influenzae and middle and inner ear tissues collected for either quantitative RT-PCR microarrays or ELISA multiplex arrays. mRNA for several cytokine genes was significantly increased in both the middle and inner ear at 6 hours. In the inner ear, these included MIP-2 (448 fold), IL-6 (126 fold), IL-1β (7.8 fold), IL-10 (10.7 fold), TNFα (1.8 fold), and IL-1α (1.5 fold). The 24 hour samples showed a similar pattern of gene expression, although generally at lower levels. In parallel, the ELISA showed the related cytokines were present in the inner ear at concentrations higher by 2 to 122 fold higher at 18 hours, declining slightly from there at 24 hours. Immunohistochemistry with antibodies to a number of these cytokines demonstrated they occurred in greater amounts in the inner ear tissues. These findings demonstrate considerable inflammatory gene expression and gene products in the inner ear following acute otitis media. These higher cytokine levels suggest one potential mechanism for the permanent hearing loss seen in some cases of acute and chronic otitis media. PMID:25922207

Correlative mRNA and protein expression of middle and inner ear inflammatory cytokines during mouse acute otitis media.

PubMed

Trune, Dennis R; Kempton, Beth; Hausman, Frances A; Larrain, Barbara E; MacArthur, Carol J

2015-08-01

Although the inner ear has long been reported to be susceptible to middle ear disease, little is known of the inflammatory mechanisms that might cause permanent sensorineural hearing loss. Recent studies have shown inner ear tissues are capable of expressing inflammatory cytokines during otitis media. However, little quantitative information is available concerning cytokine gene expression in the inner ear and the protein products that result. Therefore, this study was conducted of mouse middle and inner ear during acute otitis media to measure the relationship between inflammatory cytokine genes and their protein products with quantitative RT-PCR and ELISA, respectively. Balb/c mice were inoculated transtympanically with heat-killed Haemophilus influenzae and middle and inner ear tissues collected for either quantitative RT-PCR microarrays or ELISA multiplex arrays. mRNA for several cytokine genes was significantly increased in both the middle and inner ear at 6 h. In the inner ear, these included MIP-2 (448 fold), IL-6 (126 fold), IL-1β (7.8 fold), IL-10 (10.7 fold), TNFα (1.8 fold), and IL-1α (1.5 fold). The 24 h samples showed a similar pattern of gene expression, although generally at lower levels. In parallel, the ELISA showed the related cytokines were present in the inner ear at concentrations higher by 2-122 fold higher at 18 h, declining slightly from there at 24 h. Immunohistochemistry with antibodies to a number of these cytokines demonstrated they occurred in greater amounts in the inner ear tissues. These findings demonstrate considerable inflammatory gene expression and gene products in the inner ear following acute otitis media. These higher cytokine levels suggest one potential mechanism for the permanent hearing loss seen in some cases of acute and chronic otitis media. Copyright © 2015 Elsevier B.V. All rights reserved.

Caffeic acid phenethyl ester inhibits diesel exhaust particle-induced inflammation of human middle ear epithelial cells via NOX4 inhibition.

PubMed

Jo, Sun-Young; Lee, Naree; Hong, Sung-Moon; Jung, Hak Hyun; Chae, Sung-Won

2013-09-01

Otitis media is one of the most common diseases in pediatric populations. Recent research on its pathogenesis has focused on air pollution. Chronic exposure to particulate air pollution is associated with the impairment of middle ear function. However, the mechanisms and the underlying inhibitory pathways, especially in the human middle ear, remain unknown. Caffeic acid phenethyl ester (CAPE) is a biologically active ingredient of propolis, a product of honeybee hives, which has anti-oxidative and anti-inflammatory activities. The aim of this study was to evaluate the inhibitory effect of CAPE on diesel exhaust particle (DEP)-induced inflammation of human middle ear epithelial cells and to determine the underlying pathway of the action of CAPE. The inflammatory damage caused by DEPs and the anti-inflammatory effects of CAPE were determined by measuring the levels of tumor necrosis factor alpha and nicotinamide adenine dinucleotide phosphate oxidase (NOX) 4 with real-time reverse transcription polymerase chain reaction and Western blot analysis. The oxidative stress induced by DEPs and the anti-oxidative effects of CAPE were directly evaluated by measuring reactive oxygen species production by use of flow cytometric analysis of 2',7'-dichlorofluorescein diacetate. The effects of CAPE were compared with those of N-acetyl-L-cysteine, which has anti-oxidative and anti-inflammatory effects. Use of CAPE significantly inhibited DEP-induced up-regulation of tumor necrosis factor alpha and NOX4 expression in a dose- and time-dependent manner. The accumulation of reactive oxygen species induced by DEPs was decreased by pretreatment with CAPE. The anti-inflammatory and anti-oxidative effects of CAPE were similar to those of N-acetyl-L-cysteine. The inflammation induced by DEP is reduced by CAPE via the inhibition of NOX4 expression. These findings suggest that CAPE might be used as a therapeutic agent against DEP-induced inflammation of human middle ear epithelial cells.

Middle ear impedance measurements in large vestibular aqueduct syndrome.

PubMed

Bilgen, Cem; Kirkim, Günay; Kirazli, Tayfun

2009-06-01

To assess the effect of inner ear pressure on middle ear impedance in patients with large vestibular aqueduct syndrome (LVAS). Data from admittance tympanometry and multifrequency tympanometry on 8 LVAS patients and control subjects were studied. Static acoustic compliance (SAC) values for the ears with stable sensorineural hearing loss (SNHL) were within the limits of the mean values of control groups except for two ears. The resonance frequency (RF) values of the ears with stable SNHL were lower than the mean values of control groups except for three ears. SAC values for the two ears with fluctuating SNHL were lower and the RF values were higher than the mean values of control groups. Decreased SAC values and increased RF values found in the ears with fluctuating SNHL might be an indirect indicator of increased inner ear pressure, while low RF values in the ears with stable SNHL might reflect the decreased inner ear impedance.

Recovery time for inflamed middle ear mucosa in chronic otitis media.

PubMed

Pakır, Onur; Dinç, Aykut Erdem; Damar, Murat; Akyıldız, İlker; Eliçora, Sultan Şevik; Erdem, Duygu

2016-01-01

The present study shows that 2-3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months. To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM. In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10-14 days medical treatment, at presentation, after 10 days and 1 month. The ET-MCT was 8.63 ± 1.32 min in group 1 and 28.96 ± 8.19 min in group 2 at presentation; and the difference was statistically significant (p < 0.001). The ET-MCT was 14.76 ± 5.11 min after 10 days and 9.31 ± 2.33 min after 1 month in group 2. The ET-MCT was indifferent between groups 1 and 2 after 1 month (p = 0.235).

Sensitive high frequency hearing in earless and partially eared harlequin frogs (Atelopus).

PubMed

Womack, Molly C; Christensen-Dalsgaard, Jakob; Coloma, Luis A; Hoke, Kim L

2018-04-19

Harlequin frogs, genus Atelopus , communicate at high frequencies despite most species lacking a complete tympanic middle ear that facilitates high frequency hearing in most anurans and other tetrapods. Here we test whether Atelopus are better at sensing high frequency acoustic sound compared to other eared and earless species in the Bufonidae family, determine whether middle ear variation within Atelopus affects hearing sensitivity, and test potential hearing mechanisms in Atelopus We determine that at high frequencies (2000-4000 Hz) Atelopus are 10-34 dB more sensitive than other earless bufonids but are relatively insensitive to mid-range frequencies (900-1500 Hz) compared to eared bufonids. Hearing among Atelopus species is fairly consistent, evidence that the partial middle ears present in a subset of Atelopus species do not convey a substantial hearing advantage. We further demonstrate that Atelopus hearing is not likely facilitated by vibration of the skin overlying the normal tympanic membrane region or the body lung wall, leaving the extratympanic hearing pathways in Atelopus enigmatic. Together these results show Atelopus have sensitive high frequency hearing without the aid of a tympanic middle ear and prompt further study of extratympanic hearing mechanisms in anurans. © 2018. Published by The Company of Biologists Ltd.

Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements

PubMed Central

Nguyen, Cac T.; Robinson, Sarah R.; Jung, Woonggyu; Novak, Michael A.; Boppart, Stephen A.; Allen, Jont B.

2013-01-01

Children with chronic otitis media (OM) often have conductive hearing loss which results in communication difficulties and requires surgical treatment. Recent studies have provided clinical evidence that there is a one-to-one correspondence between chronic OM and the presence of a bacterial biofilm behind the tympanic membrane (TM). Here we investigate the acoustic effects of bacterial biofilms, confirmed using optical coherence tomography (OCT), in adult ears. Non-invasive OCT images are collected to visualize the cross-sectional structure of the middle ear, verifying the presence of a biofilm behind the TM. Wideband measurements of acoustic reflectance and impedance (0.2 to 6 [kHz]) are used to study the acoustic properties of ears with confirmed bacterial biofilms. Compared to known acoustic properties of normal middle ears, each of the ears with a bacterial biofilm has an elevated power reflectance in the 1 to 3 [kHz] range, corresponding to an abnormally small resistance (real part of the impedance). These results provide assistance for the clinical diagnosis of a bacterial biofilm, which could lead to improved treatment of chronic middle ear infection and further understanding of the impact of chronic OM on conductive hearing loss. PMID:23588039

Systematic review of middle ear implants: do they improve hearing as much as conventional hearing AIDS?

PubMed

Tysome, James R; Moorthy, Ram; Lee, Ambrose; Jiang, Dan; O'Connor, Alec Fitzgerald

2010-12-01

A systematic review to determine whether middle ear implants (MEIs) improve hearing as much as hearing aids. Databases included MEDLINE, EMBASE, DARE, and Cochrane searched with no language restrictions from 1950 or the start date of each database. Initial search found 644 articles, of which 17 met the inclusion criteria of MEI in adults with a sensorineural hearing loss, where hearing outcomes and patient-reported outcome measures (PROMs) compared MEI with conventional hearing aids (CHAs). Study quality assessment included whether ethical approval was gained, the study was prospective, eligibility criteria specified, a power calculation made and appropriate controls, outcome measures, and analysis performed. Middle ear implant outcome analysis included residual hearing, complications, and comparison to CHA in terms of functional gain, speech perception in quiet and in noise, and validated PROM questionnaires. Because of heterogeneity of outcome measures, comparisons were made by structured review. The quality of studies was moderate to poor with short follow-up. The evidence supports the use of MEI because, overall, they do not decrease residual hearing, result in a functional gain in hearing comparable to CHA, and may improve perception of speech in noise and sound quality. We recommend the publication of long-term results comparing MEI with CHA, reporting a minimum of functional gain, speech perception in quiet and in noise, complications, and a validated PROM to guide the engineering of the new generation of MEI in the future.

Sheep as a large animal ear model: Middle-ear ossicular velocities and intracochlear sound pressure.

PubMed

Péus, Dominik; Dobrev, Ivo; Prochazka, Lukas; Thoele, Konrad; Dalbert, Adrian; Boss, Andreas; Newcomb, Nicolas; Probst, Rudolf; Röösli, Christof; Sim, Jae Hoon; Huber, Alexander; Pfiffner, Flurin

2017-08-01

Animals are frequently used for the development and testing of new hearing devices. Dimensions of the middle ear and cochlea differ significantly between humans and commonly used animals, such as rodents or cats. The sheep cochlea is anatomically more like the human cochlea in size and number of turns. This study investigated the middle-ear ossicular velocities and intracochlear sound pressure (ICSP) in sheep temporal bones, with the aim of characterizing the sheep as an experimental model for implantable hearing devices. Measurements were made on fresh sheep temporal bones. Velocity responses of the middle ear ossicles at the umbo, long process of the incus and stapes footplate were measured in the frequency range of 0.25-8 kHz using a laser Doppler vibrometer system. Results were normalized by the corresponding sound pressure level in the external ear canal (P EC ). Sequentially, ICSPs at the scala vestibuli and tympani were then recorded with custom MEMS-based hydrophones, while presenting identical acoustic stimuli. The sheep middle ear transmitted most effectively around 4.8 kHz, with a maximum stapes velocity of 0.2 mm/s/Pa. At the same frequency, the ICSP measurements in the scala vestibuli and tympani showed the maximum gain relative to the P EC (24 dB and 5 dB, respectively). The greatest pressure difference across the cochlear partition occurred between 4 and 6 kHz. A comparison between the results of this study and human reference data showed middle-ear resonance and best cochlear sensitivity at higher frequencies in sheep. In summary, sheep can be an appropriate large animal model for research and development of implantable hearing devices. Copyright © 2017 Elsevier B.V. All rights reserved.

The measurement of Eustachian tube function in a hyperbaric chamber using an ear canal microphone.

PubMed

Fischer, Hans-Georg; Koch, Andreas; Kähler, Wataru; Pohl, Michael; Pau, Hans-Wilhelm; Zehlicke, Thorsten

2016-03-01

The purpose of this study was to further the understanding of the opening of the Eustachian tube in relation to changes in barometric pressure. An ear canal microphone was used to measure the specific sounds related to tube opening and possible eardrum movements. Five subjects with normal tube function were examined in a hyperbaric chamber (up to 304 kPa). All active and passive equalization events were recorded and correlated with the subjectively perceived pressure regulation in the measured ear. The signals recorded were clear and reproducible. The acoustic analysis distinguished between the different kinds of equalization. Subjective impressions were confirmed by the recorded frequency of acoustic phenomena (clicks). During compression, the sequence of active equalization manoeuvres was in a more regular and steady pattern than during decompression, when the click sounds varied. The study established a simple technical method for analyzing the function of the Eustachian tube and provided new information about barometric pressure regulation of the middle ear.

A comparison of patterns of disease extension in keratosis obturans and external auditory canal cholesteatoma.

PubMed

Shinnabe, Akihiro; Hara, Mariko; Hasegawa, Masayo; Matsuzawa, Shingo; Kanazawa, Hiromi; Yoshida, Naohiro; Iino, Yukiko

2013-01-01

To investigate the different pathways of progression to the middle ear in keratosis obturans (KO) and external auditory canal cholesteatoma (EACC). Retrospective case review. Referral hospital otolaryngology department. Patients with KO or EACC and middle ear disease who underwent surgical management were included. Four ears of 4 patients (mean age, 41.25 yr) were the KO group, and 5 ears of 4 patients (mean age, 49.5 yr) were the EACC group. Intraoperative findings of the middle ear cavity were investigated in KO and EACC groups. In the KO group, 3 patients had a perforated tympanic membrane and cholesteatoma in the tympanic cavity. The other patient had preoperative right facial palsy. Removal of the keratin plug revealed an adherent tympanic membrane. In intraoperative findings, the tympanic segment of the fallopian canal was found to be eroded because of inflammation. No case initially progressed to the mastoid cavity. Four patients had external auditory canal cholesteatoma with middle ear disease. In EACC group, all patients had initial progression to the mastoid cavity. KO tends to progress initially to the tympanic cavity via a diseased tympanic membrane. EACC tends to progress to the mastoid cavity via destruction of the posterior bony canal. This is the first report to investigate differences in pathway of progression to the middle ear cavity in these 2 diseases.

Validation of normalized pulse volume in the outer ear as a simple measure of sympathetic activity using warm and cold pressor tests: towards applications in ambulatory monitoring.

PubMed

Lee, Jihyoung; Matsumura, Kenta; Yamakoshi, Takehiro; Rolfe, Peter; Tanaka, Naoto; Kim, Kyungho; Yamakoshi, Ken-ichi

2013-03-01

Normalized pulse volume (NPV) derived from the ear has the potential to be a practical index for monitoring daily life stress. However, ear NPV has not yet been validated. Therefore, we compared NPV derived from an index finger using transmission photoplethysmography as a reference, with NPV derived from a middle finger and four sites of the ear using reflection photoplethysmography during baseline and while performing cold and warm water immersion in ten young and six middle-aged subjects. The results showed that logarithmically-transformed NPV (lnNPV) during cold water immersion as compared with baseline values was significantly lower, only at the index finger, the middle finger and the bottom of the ear-canal. Furthermore, lnNPV reactivities (ΔlnNPV; the difference between baseline and test values) from an index finger were significantly related to ΔlnNPV from the middle finger and the bottom of the ear-canal (young: r = 0.90 and 0.62, middle-aged: r = 0.80 and 0.58, respectively). In conclusion, these findings show that reflection and transmission photoplethysmography are comparable methods to derive NPV in accordance with our theoretical prediction. NPV derived from the bottom of the ear-canal is a valid approach, which could be useful for evaluating daily life stress.

Viability and virulence of pneumolysin, pneumococcal surface protein A, and pneumolysin/pneumococcal surface protein A mutants in the ear.

PubMed

Schachern, Patricia A; Tsuprun, Vladimir; Goetz, Sarah; Cureoglu, Sebahattin; Juhn, Steven K; Briles, David E; Paparella, Michael M; Ferrieri, Patricia

2013-09-01

Understanding how pneumococcal proteins affect the pathology of the middle ear and inner ear is important for the development of new approaches to prevent otitis media and its complications. To determine the viability and virulence of Streptococcus pneumoniae mutants deficient in pneumolysin (Ply-) and pneumococcal surface protein A (PspA-) in the chinchilla middle ear. Bullae of chinchillas were inoculated bilaterally with wild-type (Wt), Ply-, PspA-, and Ply-/PspA- strains. Bacterial colony-forming units (CFUs) in middle ear effusions were counted at 48 hours. The CFUs of the PspA- group were also counted at 6 to 36 hours after inoculation. Temporal bone histopathological results were compared. Twenty-seven chinchillas in an academic research laboratory. Chinchilla middle ears were inoculated with S pneumoniae to produce sufficient volumes of effusions and noticeable histopathological changes in the ears. The CFU counts in the middle ear effusions and histopathological changes were compared to determine the effect of pneumococcal protein mutations on chinchilla ears. At 48 hours, CFUs in middle ears were increased for the Wt and Ply-/PspA- strains, but Ply- remained near inoculum level. No bacteria were detected in the PspA- group. The CFUs of PspA- decreased over time to a low level at 30 to 36 hours. In vitro, PspA- in Todd-Hewitt broth showed an increase in bacterial growth of 2 logs at 43 hours, indicating PspA- susceptibility to host defenses in vivo. The PspA- and Ply- groups had fewer pathologic findings than the Wt or Ply-/PspA- groups. Histopathological analysis showed significant differences in the number of bacteria in the scala tympani in the Wt group compared with the Ply-, PspA-, and Ply-/PspA- groups. The PspA- strain was the least virulent. The PspA- mutant was much less viable and less virulent in the ear than the Wt, Ply-, and Ply-/PspA- strains. There was no significant attenuation in the viability and virulence of the Ply-/PspA- mutant compared with the Wt or single mutants. The viability and virulence of pneumococcal mutants seemed to be protein and organ specific.

Influence of the middle ear anatomy on the performance of a membrane sensor in the incudostapedial joint gap.

PubMed

Koch, Martin; Seidler, Hannes; Hellmuth, Alexander; Bornitz, Matthias; Lasurashvili, Nikoloz; Zahnert, Thomas

2013-07-01

There is a great demand for implantable microphones for future generations of implantable hearing aids, especially Cochlea Implants. An implantable middle ear microphone based on a piezoelectric membrane sensor for insertion into the incudostapedial gap is investigated. The sensor is designed to measure the sound-induced forces acting on the center of the membrane. The sensor mechanically couples to the adjacent ossicles via two contact areas, the sensor membrane and the sensor housing. The sensing element is a piezoelectric single crystal bonded on a titanium membrane. The sensor allows a minimally invasive and reversible implantation without removal of ossicles and without additional sensor fixation in the tympanic cavity. This study investigates the implantable microphone sensor and its implantation concept. It intends to quantify the influence of the sensor's insertion position on the achievable microphone sensitivity. The investigation considers anatomical and pathological variations of the middle ear geometry and its space limitations. Temporal bone experiments on a laboratory model show that anatomical and pathological variations of the middle ear geometry can prevent the sensor from being placed optimally within the incudostapedial joint. Beyond scattering of transfer functions due to anatomic variations of individual middle ears there is the impact of variations in the sensor position within the ossicular chain that has a considerable effect on the transfer characteristics of the middle ear microphone. The centering of the sensor between incus and stapes, the direction of insertion (membrane to stapes or to incus) and the effect of additional contact points with surrounding anatomic structures affect the signal yield of the implanted sensor. The presence of additional contact points has a considerably impact on the sensitivity, yet the microphone sensitivity is quite robust against small changes in the positioning of the incus on the sensor. Signal losses can be avoided by adjusting the position of the sensor within the joint. The findings allow the development of an improved surgical insertion technique to ensure maximally achievable signal yield of the membrane sensor in the ISJ and provides valuable knowledge for a future design considerations including sensor miniaturization and geometry. Measurements of the implanted sensor in temporal bone specimens showed a microphone sensitivity in the order of 1 mV/Pa. This article is part of a special issue entitled "MEMRO 2012". Copyright © 2012 Elsevier B.V. All rights reserved.

The expression and correlation of Hsp 70 and Hsp 27 in serous middle ear effusion fluids of pediatric patients-a preliminary study.

PubMed

Min, Hyun Jin; Choe, Ji Won; Chang, Moon Young; Kim, Kyung Soo; Lee, Sei Young; Mun, Seog-Kyun

2017-10-01

Several cytokines and innate immune-associated molecules are present in middle ear effusions, but damage-associated molecular patterns (DAMPs) in middle ear effusion have not been studied. Therefore, we evaluated the role of heat shock proteins (Hsps) in the development of otitis media with effusion (OME). Serous middle ear effusions from 22 pediatric patients who were diagnosed with OME and underwent ventilation tube insertion from June 2015 to March 2017 were evaluated in our study. The levels of Hsp 90, 70, 27, IL-8, and TNF-α in effusion fluids were evaluated by enzyme-linked immunosorbent assays. The associations between the levels of these molecules and the degree of tympanic membrane inflammation were statistically evaluated. Finally, the relationships among these molecules were also evaluated. Hsp 70 and Hsp 27 were detected in all middle ear effusions, but Hsp 90 was detected in only five effusion fluid samples. IL-8 was also detected in all middle ear effusions, but TNF-α was detected in only four effusion fluid samples. When we compared the degree of tympanic membrane inflammation with the levels of Hsp 70, Hsp 27, and IL-8, which were detected in all effusion fluids, we could not find statistical significance. However, Hsp 70, Hsp 27, and IL-8 were significantly associated with each other (p < 0.05). Hsp 70 and Hsp 27 were expressed in middle ear effusions. Furthermore, the levels of Hsp 70 and Hsp 27 were positively correlated with each other, and were also positively associated with the neutrophil chemoattractant, IL-8. Our findings suggested that Hsp 70 and Hsp 27 might be involved in the pathophysiology of pediatric OME. Copyright © 2017 Elsevier B.V. All rights reserved.

High-resolution computed tomography of the middle ear and mastoid. Part II. Tubotympanic disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Swartz, J.D.; Goodman, R.S.; Russell, K.B.

1983-08-01

Of more than 200 patients who underwent high-resolution computed tomography (CT) of the middle ear, the vast majority had tubotympanic disease in one of its forms: middle ear effusion, tympanosclerosis, granulation tissue, tympanic membrane retractions, or acquired cholesteatoma. The CT appearance of each of these conditions is discussed and illustrated. Emphasis is placed on the differential diagnosis of tubotympanic disease by determining dependent from nondependent soft-tissue opacity using two CT projections.

Verrucous carcinoma of the middle ear.

PubMed

Woodson, G E; Jurco, S; Alford, B R; McGavran, M H

1981-01-01

A case of a highly destructive, cytologically nondysplastic squamous epithelial lesion of the middle ear is presented. The cranial nerve involvement and bone destruction are more extensive than has been seen in cholesteatoma. Cultures are negative for Pseudomonas, and the patient does not have the reported diathesis for malignant otitis externa. The gross and microscopic features are those of verrucous carcinoma. To our knowledge, the middle ear has not been previously reported as a site of involvement by verrucous carcinoma.

Non-invasive optical assessment of viscosity of middle ear effusions in otitis media.

PubMed

Monroy, Guillermo L; Pande, Paritosh; Shelton, Ryan L; Nolan, Ryan M; Spillman, Darold R; Porter, Ryan G; Novak, Michael A; Boppart, Stephen A

2017-03-01

Eustachian tube dysfunction can cause fluid to collect within the middle ear cavity and form a middle ear effusion (MEE). MEEs can persist for weeks or months and cause hearing loss as well as speech and learning delays in young children. The ability of a physician to accurately identify and characterize the middle ear for signs of fluid and/or infection is crucial to provide the most appropriate treatment for the patient. Currently, middle ear infections are assessed with otoscopy, which provides limited and only qualitative diagnostic information. In this study, we propose a method utilizing cross-sectional depth-resolved optical coherence tomography to noninvasively measure the diffusion coefficient and viscosity of colloid suspensions, such as a MEE. Experimental validation of the proposed technique on simulated MEE phantoms with varying viscosity and particulate characteristics is presented, along with some preliminary results from in vivo and ex vivo samples of human MEEs. In vivo Optical Coherence Tomography (OCT) image of a human tympanic membrane and Middle Ear Effusion (MEE) (top), with a CCD image of the tympanic membrane surface (inset). Below is the corresponding time-lapse M-mode OCT data acquired along the white dotted line over time, which can be analyzed to determine the Stokes-Einstein diffusion coefficient of the effusion. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Introversion and individual differences in middle ear acoustic reflex function.

PubMed

Bar-Haim, Yair

2002-10-01

A growing body of psychophysiological evidence points to the possibility that individual differences in early auditory processing may contribute to social withdrawal and introverted tendencies. The present study assessed the response characteristics of the acoustic reflex arc of introverted-withdrawn and extraverted-sociable individuals. Introverts displayed a greater incidence of abnormal middle ear acoustic reflexes and lower acoustic reflex amplitudes than extraverts. These findings were strongest for stimuli presented at a frequency of 2000 Hz. Results are discussed in light of the controversy concerning the anatomic loci (peripheral vs. central neuronal activity) of the individual differences between introverts and extraverts in early auditory processing. Copyright 2002 Elsevier Science B.V.

Hearing with an atympanic ear: good vibration and poor sound-pressure detection in the royal python, Python regius.

PubMed

Christensen, Christian Bech; Christensen-Dalsgaard, Jakob; Brandt, Christian; Madsen, Peter Teglberg

2012-01-15

Snakes lack both an outer ear and a tympanic middle ear, which in most tetrapods provide impedance matching between the air and inner ear fluids and hence improve pressure hearing in air. Snakes would therefore be expected to have very poor pressure hearing and generally be insensitive to airborne sound, whereas the connection of the middle ear bone to the jaw bones in snakes should confer acute sensitivity to substrate vibrations. Some studies have nevertheless claimed that snakes are quite sensitive to both vibration and sound pressure. Here we test the two hypotheses that: (1) snakes are sensitive to sound pressure and (2) snakes are sensitive to vibrations, but cannot hear the sound pressure per se. Vibration and sound-pressure sensitivities were quantified by measuring brainstem evoked potentials in 11 royal pythons, Python regius. Vibrograms and audiograms showed greatest sensitivity at low frequencies of 80-160 Hz, with sensitivities of -54 dB re. 1 m s(-2) and 78 dB re. 20 μPa, respectively. To investigate whether pythons detect sound pressure or sound-induced head vibrations, we measured the sound-induced head vibrations in three dimensions when snakes were exposed to sound pressure at threshold levels. In general, head vibrations induced by threshold-level sound pressure were equal to or greater than those induced by threshold-level vibrations, and therefore sound-pressure sensitivity can be explained by sound-induced head vibration. From this we conclude that pythons, and possibly all snakes, lost effective pressure hearing with the complete reduction of a functional outer and middle ear, but have an acute vibration sensitivity that may be used for communication and detection of predators and prey.

Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2 mixture versus air-oxygen mixture.

PubMed

Apan, A; Muluk, N Bayar; Güler, S; Budak, B

2013-01-01

The aim of this study was to investigate the effects of N2O-O2 mixture (Inspired O2 30%) on middle ear pressure (MEP) in children compared with the effects of an air-oxygen mixture (Inspired O2 50%). The study included thirty child patients who underwent general anaesthesia for different reasons, with the exception of ENT problems and ear interventions. They were randomly divided into two groups. Group 1 (15 children: 10 male and 5 female) received a N2O-O2 mixture (Inspired O2 30%); and group 2 (15 children: 10 male and 5 female) were given an air-oxygen mixture (Inspired O2 50%). MEP was measured using a portable impedance analyser before the operation (PreO),10 minutes after intubation (10AEn), 30 minutes after intubation (30AEn), 10 minutes before extubation (10BEx), 15 minutes after the operation (PO15), 30 minutes after the operation (PO30), 1 hour after the operation (PO1h) and 6 hours after the operation (PO6h). The pressure and compliance values were the same in groups 1 and 2. The pressure-time graphs for the two groups were different: in Group 2, MEP rose quickly at 10AEn and positive pressure values were seen in the middle ear. MEP then fell rapidly until the end of the surgery and lower and negative pressures (Mean -50 daPa) were observed at PO6h. In Group 1, MEP was elevated at 10AEn and positive pressure was found (but not as high as in Group 2). MEP then fell more slowly. In other words, positive pressure in the middle ear persisted longer and the middle ear was subjected to positive pressure and nitrogen over a longer period. Separate analyses were made in Groups 1 and 2 of pressure differences and of compliance values at eight measurement points using the Friedman test. Differences in pressure values were found to be statistically significant in both Group 1 (p = 0.000) and Group 2 (p = 0.000). In Group 1, all the 10AEn and 30AEn values were significantly higher than the PreO, PO30, PO1h and PO6h values. The 10BEx value was significantly higher than the PreO and PO1h values. The PO15 value was significantly higher than the PreO value. In Group 2, the PO6h value was significantly lower than the 10BEx, 10AEn and 30AEn values. The PO1h value was significantly lower than the 30AEn values. The MEP values increased in Group 1 in younger and taller children and in children receiving anaesthesia for shorter periods. MEP values increased in Group 2 in younger and taller children, and in heavier children. MEP values fell with the length of anaesthesia. In brief anaesthesia, nitrogen was not removed from the middle ear quickly in Group 1: middle ear pressure values were higher. The nitrous oxide remained in the middle ear longer and so the possibility of ear toxicity may increase. In Group 2, 50% O2 was rapidly absorbed and removed from the middle ear and so middle ear pressure was not as high. It may be concluded that air-oxygen mixture (Inspired O2 50%) anaesthesia should be recommended as being more reliable in tympanoplasties and other middle ear interventions than a N2O-O2 mixture (Inspired O2 30%).

Defects in middle ear cavitation cause conductive hearing loss in the Tcof1 mutant mouse.

PubMed

Richter, Carol A; Amin, Susan; Linden, Jennifer; Dixon, Jill; Dixon, Michael J; Tucker, Abigail S

2010-04-15

Conductive hearing loss (CHL) is one of the most common forms of human deafness. Despite this observation, a surprising gap in our understanding of the mechanisms underlying CHL remains, particularly with respect to the molecular mechanisms underlying middle ear development and disease. Treacher Collins syndrome (TCS) is an autosomal dominant disorder of facial development that results from mutations in the gene TCOF1. CHL is a common feature of TCS but the causes of the hearing defect have not been studied. In this study, we have utilized Tcof1 mutant mice to dissect the developmental mechanisms underlying CHL. Our results demonstrate that effective cavitation of the middle ear is intimately linked to growth of the auditory bulla, the neural crest cell-derived structure that encapsulates all middle ear components, and that defects in these processes have a profoundly detrimental effect on hearing. This research provides important insights into a poorly characterized cause of human deafness, and provides the first mouse model for the study of middle ear cavity defects, while also being of direct relevance to a human genetic disorder.

Arterial chemoradiotherapy for carcinomas of the external auditory canal and middle ear.

PubMed

Fujiwara, Masayuki; Yamamoto, Satoshi; Doi, Hiroshi; Takada, Yasuhiro; Odawara, Soichi; Niwa, Yasue; Ishikura, Reiichi; Kamikonya, Norihiko; Terada, Tomonori; Uwa, Nobuhiro; Sagawa, Kosuke; Hirota, Shozo

2015-03-01

The purpose of this study was to estimate the efficacy of superselective arterial chemoradiotherapy for locally advanced carcinomas of the external auditory canal and middle ear. A retrospective study of clinical data for consecutive patients with locally advanced carcinomas of the external auditory canal and middle ear. Thirteen patients with locally advanced carcinomas of the external auditory canal and middle ear (T3: one patient, T4: 12 patients) were reviewed. The median follow-up duration in the living patients was 33 months. The total dose of radiation therapy was 60 Gy using conventional fractionation. Four, five, or six courses of a superselective arterial infusion (cisplatin 50 mg) were given weekly. The overall survival and progression-free survival rates at 2 years, calculated by the Kaplan-Meier method, were 58.7% and 53.8%, respectively. No late-phase adverse effects due to chemoradiation and no adverse effects due to catheterization were observed. These results suggest that superselective arterial chemoradiation can be a treatment option for locally advanced carcinomas of the external auditory canal and middle ear. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Single-Stage Ear Reconstruction and Hearing Restoration Using Polyethylene Implant and Implantable Hearing Devices.

PubMed

Hempel, John Martin

2015-12-01

The use of porous polyethylene in reconstructive surgery of the auricle is becoming increasingly accepted. This is a single-stage procedure providing pleasing cosmetic rehabilitation. Further advantages are the possibility of early implantation and the lack of complications caused by harvesting costal cartilage. Additional hearing restoration using middle ear implants allows functional rehabilitation at an early stage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A New Acoustic Portal into the Odontocete Ear and Vibrational Analysis of the Tympanoperiotic Complex

DTIC Science & Technology

2010-08-01

are credited. Funding: Fleet Industrial Supply Center (FISC). Grant# N00244-08-1-0025. The funding flows from the Chief of Naval Operations...34, 35, 36 and 37). Middle Ear Function McCormick [22] studied hearing in the bottlenose dolphin (Tursiops truncatus) by measuring cochlear potentials...tympanic ligament attenuated the cochlear potentials by 18 dB with respect to the level obtained during preliminary tests, whereas removing the

An overview of pharmacology and clinical aspects concerning the therapy of cochleo-vestibular syndromes by intratympanic drug delivery

PubMed Central

CHIRTEŞ, FELICIAN; ALBU, SILVIU

2013-01-01

Intratympanic drug delivery refers to drug administration in the middle ear, the main advantage being direct diffusion of substances in the inner ear through the round window membrane with subsequent high intralabiryntine drug concentration and very low systemic side effects. The article is a review of literature concerning the inner ear barrier systems, the physiology of inner ear fluids, intralabirinthine pharmacokinetics and the commonest drugs applied in the middle ear for the treatment of cochleo-vestibular syndromes. PMID:26527944

The architecture of the middle ear in the small Indian mongoose (Herpestes Javanicus).

PubMed

Kamali, Y; Gholami, S; Ahrari-Khafi, M S; Rasouli, B; Shayegh, H

The small Indian mongoose (Herpestes javanicus) is native to the Middle East, Iran and much of southern Asia. For this study the middle ears of a total of 6 adult small Indian mongooses, both fresh and museum samples were explored by using of dissection and plain radiography. On the one hand, at least in some species of the mongoose vocalisations and hearings play a critical role in coordinating behaviours. On the other hand, the ear region has provided useful character relevant for mammalian phylogeny. So, the aim of the present study is a brief discussion of the various anatomic particularities of the middle ear based on a combination of existing data and the results of the authors' study in the small Indian mongoose.

Characterizing the ear canal acoustic reflectance and impedance by pole-zero fitting

PubMed Central

Robinson, Sarah R.; Nguyen, Cac T.; Allen, Jont B.

2013-01-01

This study characterizes middle ear complex acoustic reflectance (CAR) and impedance by fitting poles and zeros to real-ear measurements. The goal of this work is to establish a quantitative connection between pole-zero locations and the underlying physical properties of CAR data. Most previous studies have analyzed CAR magnitude; while the magnitude accounts for reflected power, it does not encode latency information. Thus, an analysis that studies the real and imaginary parts of the data together could be more powerful. Pole-zero fitting of CAR data is examined using data compiled from various studies, dating back to Voss and Allen (1994). Recent CAR measurements were taken using a middle ear acoustic power analyzer (MEPA) system (HearID, Mimosa Acoustics), which makes complex acoustic impedance and reflectance measurements in the ear canal over the 0.2 to 6.0 kHz frequency range. Pole-zero fits to measurements over this range are achieved with an average RMS relative error of less than 3% using 12 poles. Factoring the reflectance fit into its all-pass and minimum-phase components approximates the effect of the ear canal, allowing for comparison across measurements. It was found that individual CAR magnitude variations for normal middle ears in the 1 to 4 kHz range often give rise to closely-placed pole-zero pairs, and that the locations of the poles and zeros in the s-plane may differ between normal and pathological middle ears. This study establishes a methodology for examining the physical and mathematical properties of CAR using a concise parametric model. Pole-zero modeling shows promise for precise parameterization of CAR data and for identification of middle ear pathologies. PMID:23524141

Extracellular and intracellular melanin in inflammatory middle ear disease.

PubMed

Fritz, Mark A; Roehm, Pamela C; Bannan, Michael A; Lalwani, Anil K

2014-06-01

Melanin is a pigmented polymer with a known role in dermal solar protection. In vertebrates, melanogenesis has been reported in leukocyte populations, suggesting a potential role in innate immunity. In this study, we report the novel finding of melanin associated with chronic inflammation and speculate on its potential role in the middle ear and mastoid. Retrospective review of case series. Medical records of six patients who demonstrated melanin in the ear were reviewed. Six patients from 1 to 63 years of age were identified with extracellular melanin and melanin-laden histiocytes within the middle ear and/or mastoid air cells at time of surgery. Concurrent intraoperative findings included cholesteatoma (n = 3), chronic suppurative otitis media (n = 2), and coalescent mastoiditis (n = 1). Histologically, extracellular melanin and melanin-laden histiocytes were identified by Fontana-Masson stain; absence of melanocytes was confirmed by the absence of Melan-A staining. One patient had a positive stain for CD163 (a marker for macrophages). This case series is the first demonstration of melanin within middle ear mucosa without melanocytes in immediate proximity or metastatic melanocytic lesions. Melanin's presence in the setting of inflammation suggests that there may be a heretofore unreported link between the pigmentary and immune systems in the middle ear. 4.

Development of wide-band middle ear transmission in the Mongolian gerbil

NASA Astrophysics Data System (ADS)

Overstreet, Edward H.; Ruggero, Mario A.

2002-01-01

Stapes vibrations were measured in deeply anesthetized adult and neonatal (ages: 14 to 20 days) Mongolian gerbils. In adult gerbils, the velocity magnitude of stapes responses to tones was approximately constant over the entire frequency range of measurements, 1 to 40 kHz. Response phases referred to pressure near the tympanic membrane varied approximately linearly as a function of increasing stimulus frequency, with a slope corresponding to a group delay of 30 μs. In neonatal gerbils, the sensitivity of stapes responses to tones was lower than in adults, especially at mid-frequencies (e.g., by about 15 dB at 10-20 kHz in gerbils aged 14 days). The input impedance of the adult gerbil cochlea, calculated from stapes vibrations and published measurements of pressure in scala vestibuli near the oval window [E. Olson, J. Acoust. Soc. Am. 103, 3445-3463 (1998)], is principally dissipative at frequencies lower than 10 kHz. Conclusions: (a) middle-ear vibrations in adult gerbils do not limit the input to the cochlea up to at least 40 kHz, i.e., within 0.5 oct of the high-frequency cutoff of the behavioral audiogram; and (b) the results in both adult and neonatal gerbils are inconsistent with the hypothesis that mass reactance controls high-frequency ossicular vibrations and support the idea that the middle ear functions as a transmission line.

Distortion product otoacoustic emissions upon ear canal pressurization.

PubMed

Zebian, Makram; Schirkonyer, Volker; Hensel, Johannes; Vollbort, Sven; Fedtke, Thomas; Janssen, Thomas

2013-04-01

The purpose of this study was to quantify the change in distortion product otoacoustic emission (DPOAE) level upon ear canal pressurization. DPOAEs were measured on 12 normal-hearing human subjects for ear canal static pressures between -200 and +200 daPa in (50 ± 5) daPa steps. A clear dependence of DPOAE levels on the pressure was observed, with levels being highest at the maximum compliance of the middle ear, and decreasing on average by 2.3 dB per 50 daPa for lower and higher pressures. Ear canal pressurization can serve as a tool for improving the detectability of DPOAEs in the case of middle-ear dysfunction.

Ear abnormalities in patients with oculo-auriculo-vertebral spectrum (Goldenhar syndrome).

PubMed

Rosa, Rafael Fabiano Machado; Silva, Alessandra Pawelec da; Goetze, Thayse Bienert; Bier, Bianca de Almeida; Almeida, Sheila Tamanini de; Paskulin, Giorgio Adriano; Zen, Paulo Ricardo Gazzola

2011-01-01

Oculo-auriculo-vertebral spectrum (OAVS) is a rare condition characterized by the involvement of the first branchial arches. To investigate the ear abnormalities of a sample of patients with OAVS. The sample consisted of 12 patients with OAVS seen at the Clinical Genetics Unit, UFCSPA/CHSCPA. The study included only patients who underwent mastoid computed tomography and with normal karyotype. We performed a review of its clinical features, giving emphasis to the ear findings. Nine patients were male, the ages ranged from 1 day to 17 years. Ear abnormalities were observed in all patients and involved the external (n = 12), middle (n = 10) and inner ear (n = 3). Microtia was the most frequent finding (n = 12). The most common abnormalities of the middle ear were: opacification (n = 2), displacement (n = 2) and malformation of the ossicular chain. Agenesis of the internal auditory canal (n = 2) was the most frequent alteration of the inner ear. Ear abnormalities are variable in patients with OAVS and often there is no correlation between findings in the external, middle and inner ear. The evaluation of these structures is important in the management of individuals with OAVS.

High-resolution computed tomography of the middle ear and mastoid. Part III. Surgically altered anatomy and pathology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Swartz, J.D.; Goodman, R.S.; Russell, K.B.

1983-08-01

High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.

A 3-D analysis of the protympanum in human temporal bones with chronic ear disease.

PubMed

Pauna, Henrique F; Monsanto, Rafael C; Schachern, Patricia; Paparella, Michael M; Cureoglu, Sebahattin

2017-03-01

Eustachian tube dysfunction is believed to be an important factor to cholesteatoma development and recurrence of disease after surgical treatment. Although many studies have described prognostic factors, evaluation methods, or surgical techniques for Eustachian tube dysfunction, they relied on the soft tissues of its structure; little is known about its bony structure-the protympanum-which connects the Eustachian tube to the tympanic cavity, and can also be affected by several inflammatory conditions, both from the middle ear or from the nasopharynx. We studied temporal bones from patients with cholesteatoma, chronic otitis media (with and without retraction pockets), purulent otitis media, and non-diseased ears, looking for differences between the volume of the protympanum, the diameter of the Eustachian tube isthmus, and the distance between the anterior tympanic annulus and the promontory. Light microscopy and 3-D reconstruction software were used for the measurements. We observed a decrease of volume in the lumen of the four middle ear diseased ears compared to the control group. We observed a significant decrease in the volume of the protympanic space in the cholesteatoma group compared to the chronic otitis media group. We also observed a decrease in the bony space (protympanum space) in cholesteatoma, chronic otitis media with retraction pockets, and purulent otitis media compared to the control group. We found a correlation in middle ear diseases and a decrease in the middle ear space. Our findings may suggest that a smaller bony volume in the protympanic area may trigger middle ear dysventilation problems.

Help with Hearing

MedlinePlus

... This test helps to identify problems in the space just behind the eardrum (middle ear), such as ... This equalizes the pressure in the middle ear space with the outside air pres- sure, or effectively “ ...

Middle ear microbiome differences in indigenous Filipinos with chronic otitis media due to a duplication in the A2ML1 gene.

PubMed

Santos-Cortez, Regie Lyn P; Hutchinson, Diane S; Ajami, Nadim J; Reyes-Quintos, Ma Rina T; Tantoco, Ma Leah C; Labra, Patrick John; Lagrana, Sheryl Mae; Pedro, Melquiadesa; Llanes, Erasmo Gonzalo D V; Gloria-Cruz, Teresa Luisa; Chan, Abner L; Cutiongco-de la Paz, Eva Maria; Belmont, John W; Chonmaitree, Tasnee; Abes, Generoso T; Petrosino, Joseph F; Leal, Suzanne M; Chiong, Charlotte M

2016-11-01

Previously rare A2ML1 variants were identified to confer otitis media susceptibility in an indigenous Filipino community and in otitis-prone US children. The goal of this study is to describe differences in the middle ear microbiome between carriers and non-carriers of an A2ML1 duplication variant that increases risk for chronic otitis media among indigenous Filipinos with poor health care access. Ear swabs were obtained from 16 indigenous Filipino individuals with chronic otitis media, of whom 11 carry the A2ML1 duplication variant. Ear swabs were submitted for 16S rRNA gene sequencing. Genotype-based differences in microbial richness, structure, and composition were identified, but were not statistically significant. Taxonomic analysis revealed that the relative abundance of the phyla Fusobacteria and Bacteroidetes, and genus Fusobacterium were nominally increased in carriers compared to non-carriers, but were non-significant after correction for multiple testing. We also detected rare bacteria including Oligella that was reported only once in the middle ear. These findings suggest that A2ML1-related otitis media susceptibility may be mediated by changes in the middle ear microbiome. Knowledge of middle ear microbial profiles according to genetic background can be potentially useful for therapeutic and prophylactic interventions for otitis media and can guide public health interventions towards decreasing otitis media prevalence within the indigenous Filipino community.

Middle Ear Infections and Ear Tube Surgery (For Parents)

MedlinePlus

... Infection? Swimmer's Ear Perforated Eardrum Hearing Impairment Swimmer's Ear (External ... All information on KidsHealth® is for educational purposes only. For specific medical advice, diagnoses, and treatment, ...

Optical Imaging with a High Resolution Microendoscope to Identify Cholesteatoma of the Middle Ear

PubMed Central

Levy, Lauren L.; Jiang, Nancy; Smouha, Eric; Richards-Kortum, Rebecca; Sikora, Andrew G.

2013-01-01

Objective High resolution optical imaging is an imaging modality which allows visualization of structural changes in epithelial tissue in real time. Our prior studies using contrast-enhanced microendoscopy to image squamous cell carcinoma in the head and neck demonstrated that the contrast agent, proflavine, has high affinity for keratinized tissue. Thus, high-resolution microendoscopy with proflavine provides a potential mechanism to identify ectopic keratin production, such as that associated with cholesteatoma formation and distinguish between uninvolved mucosa and residual keratin at the time of surgery. Study Design Ex vivo imaging of histopathologically-confirmed samples of cholesteatoma and uninvolved middle-ear epithelium. Methods Seven separate specimens collected from patients who underwent surgical treatment for cholesteatoma were imaged ex vivo with the fiberoptic endoscope after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin &eosin staining to allow histopathological correlation. Results Cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Keratin-bearing areas of cholesteatoma lack nuclei and appear as confluent hyperfluorescence, while nuclei are easily visualized in specimens containing normal middle ear epithelium. Hyperfluorescence and loss of cellular detail is the imaging hallmark of keratin allowing for discrimination of cholesteatoma from normal middle ear epithelium. Conclusions This study demonstrates the feasibility of high-resolution optical imaging to discriminate cholesteatoma from uninvolved middle ear mucosa, based on the unique staining properties of keratin. Use of real-time imaging may facilitate more complete extirpation of cholesteatoma by identifying areas of residual disease. PMID:23299781

Hearing aid silicone impression material as a foreign body in the middle ear.

PubMed

Lee, Hyun-Min; Yi, Keun-Ik; Jung, Jae-Hoon; Lee, Il-Woo

We report an extremely rare case of hearing aid silicone impression material as a foreign body in the middle ear. Symptoms of the patient were otorrhea and vertigo after taking of a mold impression on his only hearing ear, and the symptoms mimicked chronic otitis media. A temporal bone CT scan revealed foreign body material in the middle ear and Eustachian tube. An intact canal wall mastoidectomy with a facial recess approach and type IV tympanoplasty was performed to remove the silicone impression material. In addition to the case report, we review the literature regarding impression material foreign bodies. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of Ear-Canal Reflectance and Umbo Velocity in Patients with Conductive Hearing Loss

NASA Astrophysics Data System (ADS)

Merchant, Gabrielle R.; Nakajima, Hideko H.; Pisano, Dominic V.; Röösli, Christof; Hamade, Mohamad A.; Mafoud, Lorice; Halpin, Christopher F.; Merchant, Saumil N.; Rosowski, John J.

2011-11-01

Patients who present at hearing clinics with a conductive hearing loss (CHL) in the presence of an intact, healthy tympanic membrane create a unique challenge for otologists. While patient counseling, treatment options, and outcome vary with differing middle-ear pathologies, a non-invasive diagnostic that can differentiate between these pathologies does not currently exist. We evaluated the clinical utility and diagnostic accuracy of two non-invasive measures of middle-ear mechanics: ear-canal reflectance (ECR) and umbo velocity (VU).

Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children.

PubMed

Strachan, D P; Jarvis, M J; Feyerabend, C

1989-06-10

To assess the contribution of passive exposure to tobacco smoke to the development of middle ear underpressure and effusion. Cross sectional observational study. One third of the primary schools in Edinburgh. 892 Children aged 6 1/2 to 7 1/2 were examined, and satisfactory tympanograms were obtained in 872. Results of assay of salivary cotinine concentrations were available for 770 children, and satisfactory tympanograms were available for 736 of these. Correlation of the prevalence of middle ear underpressure and effusion with concentrations of the marker of nicotine, cotinine, in the saliva of the children. Middle ear pressure and compliance were measured in both ears by impedance tympanometry. Salivary cotinine concentrations were assayed by gas-liquid chromatography. Cotinine concentrations increased with the number of smokers in the household. Girls had higher concentrations than boys, and children living in rented housing had higher concentrations than those living in housing owned by their parents. There was a trend towards more abnormal tympanometric findings with increasing cotinine concentration, the odds ratio for a doubling of the cotinine concentration being 1.14 (95% confidence interval 1.03 to 1.27). After adjustment for the sex of the child and housing tenure the odds ratio for a doubling of the cotinine concentration was 1.13 (1.00 to 1.28). The results of this study are consistent with those of case-control studies of children attending for an operation to relieve middle ear effusion. They indicate that the disease should be added to the list of recognised hazards associated with passive smoking. About one third of the cases of middle ear effusion in this study were statistically attributable to exposure to tobacco smoke.

COMPARISON BETWEEN COMPUTED TOMOGRAPHIC CHARACTERISTICS OF THE MIDDLE EAR IN NONBRACHYCEPHALIC AND BRACHYCEPHALIC DOGS WITH OBSTRUCTIVE AIRWAY SYNDROME.

PubMed

Salgüero, Raquel; Herrtage, Michael; Holmes, Mark; Mannion, Paddy; Ladlow, Jane

2016-01-01

Prevalence of subclinical middle ear lesions in dogs that undergo computed tomography (CT) and magnetic resonance imaging of the head has been reported up to 41%. A predisposition in brachycephalics has been suggested, however evidence-based studies are lacking. Aims of this retrospective cross-sectional study were to compare CT characteristics of the middle ear in groups of nonbrachycephalic and brachycephalic dogs that underwent CT of the head for conditions unrelated to ear disease, and test associations between thickness of the soft palate and presence of subclinical middle ear lesions. One observer recorded CT findings for each dog without knowledge of group status. A total of 65 dogs met inclusion criteria (25 brachycephalic, 40 nonbrachycephalic). Brachycephalic dogs had a significantly thicker bulla wall (P = 2.38 × 10(-26)) and smaller luminal volume (P = 5.74 × 10(-20)), when compared to nonbrachycephalic dogs. Soft palate thickness was significantly greater in the brachycephalic group (P = 2.76 × 10(-9)). Nine of 25 brachycephalic dogs had material in the lumen of the tympanic cavity, compared to zero of 45 of nonbrachycephalics. Within the brachycephalic group, a significant difference in mean soft palate thickness was identified for dogs with material in the middle ear (12.2 mm) vs. air-filled bullae (9 mm; P = 0.016). Findings from the current study supported previous theories that brachycephalic dogs have a greater prevalence of subclinical middle ear effusion and smaller bulla luminal size than nonbrachycephalic dogs. Authors recommend that the bulla lumen volume formula previously developed for mesaticephalic dogs, (-0.612 + 0.757 [lnBW]) be adjusted to 1/3(-0.612 + 0.757 [lnBW]) for brachycephalic breeds. © 2016 American College of Veterinary Radiology.

Tuberculous otitis media with mastoiditis and central nervous system involvement.

PubMed

Mongkolrattanothai, Kanokporn; Oram, Ronda; Redleaf, Miriam; Bova, Judy; Englund, Janet A

2003-05-01

Tuberculosis of the middle ear and mastoid is currently a rare disease in developed countries, but this disease still occurs and may cause serious consequences. We report a case of disseminated tuberculosis involving the middle ear, mastoid, lung and central nervous system. Tuberculosis should be considered in the differential diagnosis of chronic ear drainage, especially in young children.

[Effect of the middle ear status on the recording of vestibular evoked myogenic potential--VEMP].

PubMed

Kurzyna, Agnieszka; Hassmann-Poznańska, Elzbieta; Topolska, Małgorzata Maria

2005-01-01

The aim of this study was to assess the effect of the middle ear status on the recording of air- and bone-conducted vestibular evoked myogenic potential. Forty eight children were included in the study, ranging in age from 4 to 10 years. All of the children underwent otoscopy, pure tone audiometry, tympanometry and air- and bone-conducted VEMP in response to click. There were 3 groups according to the condition of the middle ear: group I--52 ears (type A and C1 tympanogram, pure tone average < or = 20 dB), group II--23 ears (type C2 and B tympanogram, pure tone average < or = 20 dB), group III--21 (type B tympanogram, pure tone average > 20 dB). The threshold, presence of correct waveform morphology of the response and latency was evaluated. The condition of the middle ear has no significant effect on the recording of VEMP and mean level of the response threshold with bone stimulation, based on the performed studies. However, with air stimulation it has effect on the recording of VEMP, increase of the mean threshold response and shortening of latency p13 and n23.

Barotrauma vis-a-vis the "chronic otitis media syndrome": two conditions with middle ear gas deficiency Is secretory otitis media a contraindication to air travel?

PubMed

Sadé, Jacob; Ar, Amos; Fuchs, Camil

2003-03-01

We compared 17 patients (29 ears) with barotrauma with 171 patients suffering from "chronic ears" (secretory otitis media, atelectasis, or previously operated cholesteatoma). The patients with "chronic ears" were followed up prospectively, and none were found to suffer from barotrauma after flying on a commercial airplane. The mastoid pneumatization (seen on lateral mastoid radiographs) was significantly larger in ears with barotrauma, averaging 16.85 cm2, versus 12.9 cm2 in normal controls, whereas in "chronic ears" it was only 3.6 cm2. During flight on a commercial airplane, the middle ear has to equalize about 20% of its gas volume with the ambient pressure. This equalization must happen within 15 to 20 minutes of ascent and descent in order to avoid barotrauma. This 20% is a fivefold greater task for ears with a large mastoid pneumatization than for ears with an undeveloped pneumatization; "chronic ears" usually have an undeveloped mastoid pneumatization. The smaller the middle ear (mastoid) volume, the smaller the volume of gas needed to pass through the eustachian tube in order to equalize pressure changes during flying. This factor may explain why "chronic ears" rarely suffer from barotrauma. It also implies that eustachian tubes of secretory otitis, atelectatic, and cholesteatomatous ears have little problem in equalizing large pressure differences (over 2,000 mm H2O) within 15 to 20 minutes of landing, in contrast to what has been traditionally believed. Individuals with "chronic ears" can be advised that they can fly safely.

Extratympanic observation of middle ear structure using a refractive index matching material (glycerol) and an infrared camera.

PubMed

Kong, Soo-Keun; Chon, Kyong-Myong; Goh, Eui-Kyung; Lee, Il-Woo; Wang, Soo-Geun

2014-05-01

High-resolution computed tomography has been used mainly in the diagnosis of middle ear disease, such as high-jugular bulb, congenital cholesteatoma, and ossicular disruption. However, certain diagnoses are confirmed through exploratory tympanotomy. There are few noninvasive methods available to observe the middle ear. The purpose of this study was to investigate the effect of glycerol as a refractive index matching material and an infrared (IR) camera system for extratympanic observation. 30% glycerol was used as a refractive index matching material in five fresh cadavers. Each material was divided into four subgroups; GN (glycerol no) group, GO (glycerol out) group, GI (glycerol in) group, and GB (glycerol both) group. A printed letter and middle ear structures on the inside tympanic membrane were observed using a visible and IR ray camera system. In the GB group, there were marked a transilluminated letter or an ossicle on the inside tympanic membrane. In particular, a footplate of stapes was even transilluminated using the IR camera system in the GB group. This method can be useful in the diagnosis of diseases of the middle ear if it is clinically applied through further studies.

Extratympanic observation of middle ear structure using a refractive index matching material (glycerol) and an infrared camera

NASA Astrophysics Data System (ADS)

Kong, Soo-Keun; Chon, Kyong-Myong; Goh, Eui-Kyung; Lee, Il-Woo; Wang, Soo-Geun

2014-05-01

High-resolution computed tomography has been used mainly in the diagnosis of middle ear disease, such as high-jugular bulb, congenital cholesteatoma, and ossicular disruption. However, certain diagnoses are confirmed through exploratory tympanotomy. There are few noninvasive methods available to observe the middle ear. The purpose of this study was to investigate the effect of glycerol as a refractive index matching material and an infrared (IR) camera system for extratympanic observation. 30% glycerol was used as a refractive index matching material in five fresh cadavers. Each material was divided into four subgroups; GN (glycerol no) group, GO (glycerol out) group, GI (glycerol in) group, and GB (glycerol both) group. A printed letter and middle ear structures on the inside tympanic membrane were observed using a visible and IR ray camera system. In the GB group, there were marked a transilluminated letter or an ossicle on the inside tympanic membrane. In particular, a footplate of stapes was even transilluminated using the IR camera system in the GB group. This method can be useful in the diagnosis of diseases of the middle ear if it is clinically applied through further studies.

Choristoma of the middle ear: a component of a new syndrome?

PubMed

Buckmiller, L M; Brodie, H A; Doyle, K J; Nemzek, W

2001-05-01

Salivary choristoma of the middle ear is a rare entity. The authors report the 26th known case, which is unique in several respects: the patient had abnormalities of the first and second branchial arches, as well as the otic capsule and facial nerve in ways not yet reported. Our patient presented with bilateral preauricular pits, conchal bands, an ipsilateral facial palsy, and bilateral Mondini-type deformities. A review of the literature revealed salivary choristomas of the middle ear to be frequently associated with branchial arch abnormalities, most commonly the second, as well as abnormalities of the facial nerve. All 25 cases were reviewed and the results reported with respect to clinical presentation, associated abnormalities, operative findings, and hearing results. It has been proposed that choristoma of the middle ear may represent a component of a syndrome along with unilateral hearing loss, abnormalities of the incus and/or stapes, and anomalies of the facial nerve. Eighty-six percent of the reported patients with choristoma have three or four of the four criteria listed to designate middle ear salivary choristoma as part of a syndrome. In the remaining four patients, all of the structures were not assessed.

Tuboimpedance: A New Test of Eustachian Tube Function.

PubMed

Smith, Matthew E; Zou, Charlie C; Blythe, Andrew J C; Tysome, James R

2017-04-01

Objective Eustachian tube (ET) dysfunction is most frequently caused by a failure of the ET to adequately open; however, there is currently no reliable method of assessing this. Tubomanometry has recently shown good interindividual repeatability as a measure of ET function by measuring middle ear pressure after the application of regulated nasopharyngeal pressures during swallowing. We present the first reports of a novel test: middle ear impedance measurements during standard nasopharyngeal pressure application (tuboimpedance). We assess repeatability in healthy ears and any advantages over tubomanometry. Study Design Exploratory cohort diagnosis study. Setting Tertiary referral center. Subjects Twenty screened, healthy ears (10 volunteers). Methods Tubomanometry and tuboimpedance tests were performed while individuals swallowed with applied nasopharyngeal pressures of 20, 30, 40, and 50 mbar. Eustachian tube opening detection rate and test repeatability (measured by intraclass correlation coefficient [ICC]) for immediate and delayed repeats at each pressure were compared. Results ET opening was detected more frequently using tuboimpedance, with a 100% detection rate using a nasopharyngeal pressure of 30 mbar or more, compared to 88% to 96% with tubomanometry. Detection of ET opening at 20 mbar was possible with tuboimpedance. Repeatability of both tests was mostly strong (ICC >0.7) for both immediate and delayed repeats. Repeatability for the tubomanometry R value was only fair to moderate. Conclusion Tuboimpedance may provide a repeatable measure of ET opening that is easier to perform due to lower nasopharyngeal pressures required and fewer issues with poor ear-probe sealing. Further assessment in patients with different forms of ET dysfunction is required.

Tobacco Harm to Kids

MedlinePlus

... media (an acute or chronic inflammation of the middle ear) that result in office visits each year. 14 ... Bischoff, CE & Sauve, RS, “Environmental Tobacco Smoke and Middle Ear Disease in Preschool-Age Children,” Archives of Pediatric ...

Impact of xylomethazoline on eustachian tube function in healthy participants.

PubMed

Meyer, Moritz F; Mikolajczak, Stefanie; Korthäuer, Christine; Jumah, Masen D; Hahn, Moritz; Grosheva, Maria; Lüers, Jan-Christoffer; Hüttenbrink, Karl-Bernd; Beutner, Dirk

2015-06-01

The use of decongestants is common in otitis media eustachian tube (ET) dysfunction. However, the underlying mechanism and the type of action on the complex middle ear pressure equalization system are poorly understood. Here, by use of the pressure chamber, we investigated the impact of intranasal decongestive therapy (xylomethazoline) on ET function. Thirty healthy participants (60 ears) were exposed to a predetermined profile of phases of compression and decompression in a hypobaric and hyperbaric pressure chamber. ET opening pressure, ET opening duration, ET opening frequency, and ET closing pressure were determined before and after intranasal application of xylomethazoline. A significantly higher number of ET openings (ET opening frequency) in passive equalization condition could be measured after application of decongestants than before. No significant difference could be found in the values of ET opening pressure, ET opening duration, and ET closing pressure parameters before in comparison with the values after application of xylomethazoline. We conclude that xylomethazoline might only have a minor effect during active and passive middle ear pressure equalization. Larger cohorts and targeted application of decongestants should be tested to confirm these preliminary data and to find new evidence on the effects of decongestants.

Biomechanical Analysis of Hearing in Whales Using Nanoindentation and the Finite Element Method

NASA Astrophysics Data System (ADS)

Tubelli, Andrew A.; Zosuls, Aleks; Ketten, Darlene R.; Mountain, David C.

2011-11-01

The detailed biomechanics of hearing in baleen whales are almost entirely unknown. As a first step to predicting the audiogram for these species, a linear three-dimensional finite-element model of the minke whale (Balaenoptera acutorostrata) middle ear was developed. A reconstruction of the ear was made from CT scans and imported into a finite element solver. Young's modulus of the bone was estimated via nanoindentation. The middle-ear transfer function was estimated by applying a pressure to the glove finger (the thick, everted equivalent of the tympanic membrane) with velocity calculated at the stapes footplate. It was found that the most sensitive frequencies corresponded with vocalization frequencies. For all frequencies tested, the malleus-incus complex flexed about the anterior process of the malleus and the stapes rotated within the oval window. Results indictae that finite element modeling is a useful approach for studying the mechanics of hearing in species that are difficult to study in vivo.

Ear discharge

MedlinePlus

... swabs or other small objects into the ear Middle ear infection Other causes of ear discharge include: Eczema ... tube surgery - what to ask your doctor Images Ear anatomy Eardrum repair - series References Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Flint PW, Haughey BH, Lund V, et ...

The effect of continuous positive airway pressure on middle ear pressure.

PubMed

Sivri, Bekir; Sezen, Ozan Seymen; Akbulut, Sevtap; Coskuner, Temel

2013-05-01

To investigate the effect of continuous positive airway pressure (CPAP) on middle ear pressure in patients with obstructive sleep apnea syndrome (OSAS). Prospective clinical case-control study. Seventy-eight patients with moderate and severe OSAS (the mean apnea-hypopnea indexes were 22.70 ± 3.59 and 48.59 ± 12.50, respectively) using CPAP (study group) and 60 patients with no sleep apnea syndrome (control group) were included in the study. Forty-two of the patients were female and 96 were male. The mean age in the study group was 47.38 ± 6.23, whereas it was 46.10 ± 11.96 in the control group (P > .05). The middle ear pressure of all study subjects was evaluated with tympanometry at the beginning of the study and 6 months later. Tympanometric measurements of both groups were compared. Furthermore, the same data for the study group were also evaluated according to CPAP pressure levels. The middle ear peak pressure values of the patients in the study group were significantly increased from -63.04 ± 55.82 daPa to -39.6 ± 27.72 daPa after 6 months (P < .01). The middle ear pressure in the control group was found to be -13.26 ± 22.60 daPa at the beginning of the study and -13.60 ± 38.82 daPa after 6 months (P > .05). The mean middle ear pressure level was significantly higher in patients using CPAP at 12 to 14 cm H2 O pressure than in those using CPAP at 8 to 10 cm H2 O pressure (P < .05). There was a significant increase in the middle ear pressure of patients using CPAP regularly for 6 months. This increase was proportional to the pressure level of the CPAP device. 3b. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Factors Affecting Loss of Tympanic Membrane Mobility in Acute Otitis Media Model of Chinchilla

PubMed Central

Guan, Xiying; Chen, Yongzheng; Gan, Rong Z.

2014-01-01

Recently we reported that middle ear pressure (MEP), middle ear effusion (MEE), and ossicular changes each contribute to the loss of tympanic membrane (TM) mobility in a guinea pig model of acute otitis media (AOM) induced by S. pneumoniae (Guan and Gan, 2013). However, it is not clear how those factors vary along the course of the disease and whether those effects are reproducible in different species. In this study, a chinchilla AOM model was produced by transbullar injection of Haemophilus influenzae. Mobility of the TM at the umbo was measured by laser vibrometry in two treatment groups: 4 days (4D) and 8 days (8D) post inoculation. These time points represent relatively early and later phases of AOM. In each group, the vibration of the umbo was measured at three experimental stages: unopened, pressure-released, and effusion-removed ears. The effects of MEP and MEE and middle ear structural changes were quantified in each group by comparing the TM mobility at one stage with that of the previous stage. Our findings show that the factors affecting TM mobility do change with the disease time course. The MEP was the dominant contributor to reduction of TM mobility in 4D AOM ears, but showed little effect in 8D ears when MEE filled the tympanic cavity. MEE was the primary factor affecting TM mobility loss in 8D ears, but affected the 4D ears only at high frequencies. After the release of MEP and removal of MEE, residual loss of TM mobility was seen mainly at low frequencies in both 4D and 8D ears, and was associated with middle ear structural changes. Our findings establish that the factors contributing to TM mobility loss in the chinchilla ear were similar to those we reported previously for the guinea pig ears with AOM. Outcomes did not appear to differ between the two major bacterial species causing AOM in these animal models. PMID:24406734

Malformations of the middle and inner ear on CT imaging in 22q11 deletion syndrome.

PubMed

Loos, Elke; Verhaert, Nicolas; Willaert, Annelore; Devriendt, Koenraad; Swillen, Ann; Hermans, Robert; Op de Beeck, Katya; Hens, Greet

2016-11-01

The 22q11 deletion syndrome (22q11DS), the most frequent microdeletion syndrome in humans, presents with a large variety of abnormalities. A common abnormality is hearing impairment. The exact pathophysiological explanation of the observed hearing loss remains largely unknown. The aim of this study was to analyze the middle and inner ear malformations as seen on computer tomographic imaging in patients with 22q11DS. We retrospectively reviewed the charts of 11 22q11DS patients who had undergone a CT of the temporal bone in the past. Of the 22 examined ears, two showed an abnormal malleus and incus, 10 presented with a dense stapes superstructure, and three ears had an abnormal orientation of the stapes. With regard to the inner ear, 12 ears showed an incomplete partition type II with a normal vestibular aqueduct. In four ears the vestibule and lateral semicircular canal were composed of a single cavity, in 14 ears the vestibule was too wide, and three ears had a broadened lateral semicircular canal. These findings suggest that malformations of the stapes, cochlea, vestibule, and lateral semicircular canal are frequent in 22q11DS. To our knowledge, the current study involves the largest case series describing middle and inner ear malformations in 22q11DS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Trials Against Conqueror Tanks with Additional Ballistic Protection. Part 2: The Use of Large Hollow-Charge Warheads

DTIC Science & Technology

1957-05-01

4 Ears. Ism could not be examined on account of bilateral chronic suppurative otitis media (C. SO.M.). (The middle ear full of thick pus and drum, if...examined on account of chronic suppurative otitis media (C. S.0. K.). (Middle ear full of thick ps.) Would have survived. Driver’s Seat Upper Rabbit

Fetal development of the elastic-fiber-mediated enthesis in the human middle ear.

PubMed

Takanashi, Yoshitaka; Shibata, Shunichi; Katori, Yukio; Murakami, Gen; Abe, Shinichi; Rodríguez-Vázquez, Jose Francisco; Kawase, Tetsuaki

2013-10-01

In the human middle ear, the annular ligament of the incudostapedial joint and the insertions of the tensor tympani and stapedius muscles contain abundant elastic fibers; i.e., the elastic-fiber-mediated entheses. Hyaluronan also coexists with the elastic fibers. In the present study using immunohistochemistry, we demonstrated the distribution of elastin not only in the incudostapedial joint but also in the other two joints of the middle ear in adults and fetuses. In adults, the expression of elastin did not extend out of the annular ligament composed of mature elastic fibers but clearly overlapped with it. Electron microscopic observations of the annular ligament demonstrated a few microfibrils along the elastic fibers. Thus, in contrast to the vocal cord, the middle ear entheses seemed not to contain elaunin and oxytalan fibers. In mid-term fetuses (at approximately 15-16 weeks of gestation) before opening of the external acoustic meatus, the incudostapedial joint showed abundant elastic fibers, but the incudomalleolar and stapediovestibular joints did not. At this stage, hyaluronan was not colocalized, but distributed diffusely in loose mesenchymal tissues surrounding the ear ossicles. Therefore, fetal development of elastin and elastic fibers in the middle ear entheses is unlikely to require acoustic oscillation. In late-stage fetuses (25-30 weeks), whose ear ossicles were almost the same size as those in adults, we observed bundling and branching of elastic fibers. However, hyaluronan expression was not as strong as in adults. Colocalization between elastic fibers and hyaluronan appeared to be a result of postnatal maturation of the entheses. Copyright © 2013 Elsevier GmbH. All rights reserved.

Aural symptoms in patients with temporomandibular joint disorders: multiple frequency tympanometry provides objective evidence of changes in middle ear impedance.

PubMed

Riga, Maria; Xenellis, John; Peraki, Eleni; Ferekidou, Elisa; Korres, Stavros

2010-12-01

The association of temporomandibular joint (TMJ) disorders with aural symptoms, such as tinnitus, otic fullness, and subjective decrease of hearing acuity, is a well-established clinical observation. Although several hypotheses have been made about the otic-conductive origin of these complaints, conventional 226-Hz tympanometry has failed to demonstrate any middle ear abnormalities. The aim of this study was to evaluate patients with TMJ disorders with multiple frequency tympanometry (MFT). Prospective clinical study. Outpatient clinic. The population of this study consisted of 40 patients with unilateral TMJ disorders diagnosed for longer than 1 month. After verifying that there were no abnormal otoscopic findings, 226-Hz tympanometry, conventional pure-tone audiometry, brainstem auditory evoked potentials, and MFT were performed. Resonant frequency (RF) values. With the exception of MFT, no abnormal audiologic findings were revealed. The ear ipsilateral to the lesion demonstrated significantly higher (p = 0.002) RF values in comparison to the contralateral ear. The difference in RF values was more obvious in patients aged 45 years or younger. The results of this study imply an increase in the stiffness of the middle ear, which has not been detected by conventional tympanometry. This represents the first concrete documentation of minor alterations in the conductive properties of the middle ear and seems to support the various hypotheses on the middle-ear origin of aural complaints in patients with TMJ disorders. Further studies are needed before a clear insight on the presumably multifactorial pathophysiology of these complaints can finally be reached.

Mature middle and inner ears express Chd7 and exhibit distinctive pathologies in a mouse model of CHARGE syndrome.

PubMed

Hurd, Elizabeth A; Adams, Meredith E; Layman, Wanda S; Swiderski, Donald L; Beyer, Lisa A; Halsey, Karin E; Benson, Jennifer M; Gong, Tzy-Wen; Dolan, David F; Raphael, Yehoash; Martin, Donna M

2011-12-01

Heterozygous mutations in the gene encoding chromodomain-DNA-binding-protein 7 (CHD7) cause CHARGE syndrome, a multiple anomaly condition which includes vestibular dysfunction and hearing loss. Mice with heterozygous Chd7 mutations exhibit semicircular canal dysgenesis and abnormal inner ear neurogenesis, and are an excellent model of CHARGE syndrome. Here we characterized Chd7 expression in mature middle and inner ears, analyzed morphological features of mutant ears and tested whether Chd7 mutant mice have altered responses to noise exposure and correlated those responses to inner and middle ear structure. We found that Chd7 is highly expressed in mature inner and outer hair cells, spiral ganglion neurons, vestibular sensory epithelia and middle ear ossicles. There were no obvious defects in individual hair cell morphology by prestin immunostaining or scanning electron microscopy, and cochlear innervation appeared normal in Chd7(Gt)(/+) mice. Hearing thresholds by auditory brainstem response (ABR) testing were elevated at 4 and 16 kHz in Chd7(Gt)(/+) mice, and there were reduced distortion product otoacoustic emissions (DPOAE). Exposure of Chd7(Gt)(/+) mice to broadband noise resulted in variable degrees of hair cell loss which inversely correlated with severity of stapedial defects. The degrees of hair cell loss and threshold shifts after noise exposure were more severe in wild type mice than in mutants. Together, these data indicate that Chd7(Gt)(/+) mice have combined conductive and sensorineural hearing loss, correlating with changes in both middle and inner ears. Copyright © 2011 Elsevier B.V. All rights reserved.

Mature middle and inner ears express Chd7 and exhibit distinctive pathologies in a mouse model of CHARGE syndrome

PubMed Central

Hurd, Elizabeth A.; Adams, Meredith E.; Layman, Wanda S.; Swiderski, Donald L.; Beyer, Lisa A.; Halsey, Karin E.; Benson, Jennifer M.; Gong, Tzy-Wen; Dolan, David F.; Raphael, Yehoash; Martin, Donna M.

2011-01-01

Heterozygous mutations in the gene encoding chromodomain-DNA-binding-protein 7 (CHD7) cause CHARGE syndrome, a multiple anomaly condition which includes vestibular dysfunction and hearing loss. Mice with heterozygous Chd7 mutations exhibit semicircular canal dysgenesis and abnormal inner ear neurogenesis, and are an excellent model of CHARGE syndrome. Here we characterized Chd7 expression in mature middle and inner ears, analyzed morphological features of mutant ears and tested whether Chd7 mutant mice have altered responses to noise exposure and correlated those responses to inner and middle ear structure. We found that Chd7 is highly expressed in mature inner and outer hair cells, spiral ganglion neurons, vestibular sensory epithelia and middle ear ossicles. There were no obvious defects in individual hair cell morphology by Prestin immunostaining or scanning electron microscopy, and cochlear innervation appeared normal in Chd7Gt/+ mice. Hearing thresholds by auditory brainstem response (ABR) testing were elevated at 4 and 16 kHz in Chd7Gt/+ mice, and there were reduced distortion product otoacoustic emissions (DPOAE). Exposure of Chd7Gt/+ mice to broadband noise resulted in variable degrees of hair cell loss which inversely correlated with severity of stapedial defects. The degrees of hair cell loss and threshold shifts after noise exposure were more severe in wild type mice than in mutants. Together, these data indicate that Chd7Gt/+ mice have combined conductive and sensorineural hearing loss, correlating with changes in both middle and inner ears. PMID:21875659

Magnetically driven middle ear ossicles for optical measurement of vibrations in an ear with opened tympanic membrane

NASA Astrophysics Data System (ADS)

Peacock, J.; von Unge, M.; Dirckx, J.

2013-12-01

Vibrations of the middle ear ossicles are easily measured by means of laser vibrometry. However, laser vibrometry requires free visual access to the object under investigation, and acquiring free visual access to the ossicles through the ear canal requires the removal of the tympanic membrane (TM), with the result that the ossicles can no longer be stimulated acoustically. To overcome this, we devised a new setup in which the ossicles can be driven magnetically. After measuring the response of the TM to an acoustic signal, we then remove it and attach a small magnet to the exposed manubrium (a part of the most lateral auditory ossicle, the malleus, which is normally attached to the TM). An electromagnetic excitation coil is then used to drive the magnet, and the output to the coil adjusted until the vibration of the manubrium, as measured by the vibrometer, matches that measured in response to the acoustic signal. Such a setup may have uses in research on middle ear mechanics, such as the measurement of nonlinearities in their response, as well as applications in the diagnosis of middle ear conditions such as the fixation of the ossicles by otosclerosis or in chronic otitis media. We describe our setup and discuss the viability of our method and its future clinical potential by presenting some measurements on an artificially fixated ear.

Auditory Brainstem Circuits That Mediate the Middle Ear Muscle Reflex

PubMed Central

Mukerji, Sudeep; Windsor, Alanna Marie; Lee, Daniel J.

2010-01-01

The middle ear muscle (MEM) reflex is one of two major descending systems to the auditory periphery. There are two middle ear muscles (MEMs): the stapedius and the tensor tympani. In man, the stapedius contracts in response to intense low frequency acoustic stimuli, exerting forces perpendicular to the stapes superstructure, increasing middle ear impedance and attenuating the intensity of sound energy reaching the inner ear (cochlea). The tensor tympani is believed to contract in response to self-generated noise (chewing, swallowing) and nonauditory stimuli. The MEM reflex pathways begin with sound presented to the ear. Transduction of sound occurs in the cochlea, resulting in an action potential that is transmitted along the auditory nerve to the cochlear nucleus in the brainstem (the first relay station for all ascending sound information originating in the ear). Unknown interneurons in the ventral cochlear nucleus project either directly or indirectly to MEM motoneurons located elsewhere in the brainstem. Motoneurons provide efferent innervation to the MEMs. Although the ascending and descending limbs of these reflex pathways have been well characterized, the identity of the reflex interneurons is not known, as are the source of modulatory inputs to these pathways. The aim of this article is to (a) provide an overview of MEM reflex anatomy and physiology, (b) present new data on MEM reflex anatomy and physiology from our laboratory and others, and (c) describe the clinical implications of our research. PMID:20870664

Hearing and whistling in the deep sea: depth influences whistle spectra but does not attenuate hearing by white whales (Delphinapterus leucas) (Odontoceti, Cetacea).

PubMed

Ridgway, S H; Carder, D A; Kamolnick, T; Smith, R R; Schlundt, C E; Elsberry, W R

2001-11-01

Hearing is attenuated in the aerial ear of humans and other land mammals tested in pressure chambers as a result of middle ear impedance changes that result from increased air density. We tested the hypothesis, based on recent middle ear models, that increasing the density of middle ear air at depth might attenuate whale hearing. Two white whales Delphinapterus leucas made dives to a platform at a depth of 5, 100, 200 or 300 m in the Pacific Ocean. During dives to station on the platform for up to 12 min, the whales whistled in response to 500 ms tones projected at random intervals to assess their hearing threshold at each depth. Analysis of response whistle spectra, whistle latency in response to tones and hearing thresholds showed that the increased hydrostatic pressure at depth changed each whale's whistle response at depth, but did not attenuate hearing overall. The finding that whale hearing is not attenuated at depth suggests that sound is conducted through the head tissues of the whale to the ear without requiring the usual ear drum/ossicular chain amplification of the aerial middle ear. These first ever hearing tests in the open ocean demonstrate that zones of audibility for human-made sounds are just as great throughout the depths to which these whales dive, or at least down to 300 m.

Inner ear manifestations in CHARGE: Abnormalities, treatments, animal models, and progress toward treatments in auditory and vestibular structures.

PubMed

Choo, Daniel I; Tawfik, Kareem O; Martin, Donna M; Raphael, Yehoash

2017-12-01

The inner ear contains the sensory organs for hearing and balance. Both hearing and balance are commonly affected in individuals with CHARGE syndrome (CS), an autosomal dominant condition caused by heterozygous pathogenic variants in the CHD7 gene. Semicircular canal dysplasia or aplasia is the single most prevalent feature in individuals with CHARGE leading to deficient gross motor skills and ambulation. Identification of CHD7 as the major gene affected in CHARGE has enabled acceleration of research in this field. Great progress has been made in understanding the role of CHD7 in the development and function of the inner ear, as well as in related organs such as the middle ear and auditory and vestibular neural pathways. The goals of current research on CHD7 and CS are to (a) improve our understanding of the pathology caused by CHD7 pathogenic variants and (b) to provide better tools for prognosis and treatment. Current studies utilize cells and whole animals, from flies to mammals. The mouse is an excellent model for exploring mechanisms of Chd7 function in the ear, given the evolutionary conservation of ear structure, function, Chd7 expression, and similarity of mutant phenotypes between mice and humans. Newly recognized developmental functions for mouse Chd7 are shedding light on how abnormalities in CHD7 might lead to CS symptoms in humans. Here we review known human inner ear phenotypes associated with CHD7 pathogenic variants and CS, summarize progress toward diagnosis and treatment of inner ear-related pathologies, and explore new avenues for treatment based on basic science discoveries. © 2017 Wiley Periodicals, Inc.

Optical imaging with a high-resolution microendoscope to identify cholesteatoma of the middle ear.

PubMed

Levy, Lauren L; Jiang, Nancy; Smouha, Eric; Richards-Kortum, Rebecca; Sikora, Andrew G

2013-04-01

High-resolution optical imaging is an imaging modality that allows visualization of structural changes in epithelial tissue in real time. Our prior studies using contrast-enhanced microendoscopy to image squamous cell carcinoma in the head and neck demonstrated that the contrast agent, proflavine, has high affinity for keratinized tissue. Thus, high-resolution microendoscopy with proflavine provides a potential mechanism to identify ectopic keratin production, such as that associated with cholesteatoma formation, and distinguish between uninvolved mucosa and residual keratin at the time of surgery. Ex vivo imaging of histopathologically confirmed samples of cholesteatoma and uninvolved middle ear epithelium. Seven separate specimens collected from patients who underwent surgical treatment for cholesteatoma were imaged ex vivo with the fiberoptic endoscope after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. Cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Keratin-bearing areas of cholesteatoma lack nuclei and appear as confluent hyperfluorescence, whereas nuclei are easily visualized in specimens containing normal middle ear epithelium. Hyperfluorescence and loss of cellular detail is the imaging hallmark of keratin, allowing for discrimination of cholesteatoma from normal middle ear epithelium. This study demonstrates the feasibility of high-resolution optical imaging to discriminate cholesteatoma from uninvolved middle ear mucosa based on the unique staining properties of keratin. Use of real-time imaging may facilitate more complete extirpation of cholesteatoma by identifying areas of residual disease. Laryngoscope, 2012. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

Prevention and management of vascular complications in middle ear and cochlear implant surgery.

PubMed

Di Lella, Filippo; Falcioni, Maurizio; Piccinini, Silvia; Iaccarino, Ilaria; Bacciu, Andrea; Pasanisi, Enrico; Cerasti, Davide; Vincenti, Vincenzo

2017-11-01

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.

Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear.

PubMed

Altuna, Xabier; Navarro, Juan José; García, Leire; Ugarte, Ane; Thomas, Izaskun

Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Tympanostomy Tubes: A Rational Clinical Treatment for Middle Ear Disease.

ERIC Educational Resources Information Center

Roland, Peter S.; Brown, Orval

1990-01-01

The use of tympanostomy tubes to treat middle ear disease including otitis media is discussed with sections on the eustachian tube; acute otitis media; persistent effusion; changes in the tympanic membrane; special populations; and complications. (DB)

Postoperative granuloma after stapedectomy: is it destiny or avoidable?

PubMed

Batman, C; Oztürk, O; Ramadan, S S

2007-01-01

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. 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. 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. 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.

Pressure transfer function and absorption cross section from the diffuse field to the human infant ear canal.

PubMed

Keefe, D H; Bulen, J C; Campbell, S L; Burns, E M

1994-01-01

The diffuse-field pressure transfer function from a reverberant field to the ear canal of human infants, ages 1, 3, 6, 12, and 24 months, has been measured from 125-10700 Hz. The source was a loudspeaker using pink noise, and the diffuse-field pressure and the ear-canal pressure were simultaneously measured using a spatial averaging technique in a reverberant room. The results in most subjects show a two-peak structure in the 2-6-kHz range, corresponding to the ear-canal and concha resonances. The ear-canal resonance frequency decreases from 4.4 kHz at age 1 month to 2.9 kHz at age 24 months. The concha resonance frequency decreases from 5.5 kHz at age 1 month to 4.5 kHz at age 24 months. Below 2 kHz, the diffuse-field transfer function shows effects due to the torsos of the infant and parent, and varies with how the infant is held. Comparisons are reported of the diffuse-field absorption cross section for infants relative to adults. This quantity is a measure of power absorbed by the middle ear from a diffuse sound field, and large differences are observed in infants relative to adults. The radiation efficiencies of the infant and the adult ear are small at low frequencies, near unity at midfrequencies, and decrease at higher frequencies. The process of ear-canal development is not yet complete at age 24 months. The results have implications for experiments on hearing in infants.

Mice Haploinsufficient for Ets1 and Fli1 Display Middle Ear Abnormalities and Model Aspects of Jacobsen Syndrome.

PubMed

Carpinelli, Marina R; Kruse, Elizabeth A; Arhatari, Benedicta D; Debrincat, Marlyse A; Ogier, Jacqueline M; Bories, Jean-Christophe; Kile, Benjamin T; Burt, Rachel A

2015-07-01

E26 transformation-specific 1 (ETS1) and friend leukemia integration 1 (FLI1) are members of the ETS family of transcription factors, of which there are 28 in humans. Both genes are hemizygous in Jacobsen syndrome, an 11q contiguous gene deletion disorder involving thrombocytopenia, facial dysmorphism, growth and mental retardation, malformation of the heart and other organs, and hearing impairment associated with recurrent ear infections. To determine whether any of these defects are because of hemizygosity for ETS1 and FLI1, we characterized the phenotype of mice heterozygous for mutant alleles of Ets1 and Fli1. Fli1(+/-) mice displayed mild thrombocytopenia, as did Ets1(+/-)Fli1(+/-) animals. Fli1(+/-) and Ets1(+/-)Fli1(+/-) mice also displayed craniofacial abnormalities, including a small middle ear cavity, short nasal bone, and malformed interface between the nasal bone process and cartilaginous nasal septum. They exhibited hearing impairment, otitis media, fusions of ossicles to the middle ear wall, and deformed stapes. Hearing impairment was more penetrant and stapes malformations were more severe in Ets1(+/-)Fli1(+/-) mice than in Fli1(+/-) mice, indicating partial functional redundancy of these transcription factors during auditory development. Our findings indicate that the short nose, otitis media, and hearing impairment in Jacobsen syndrome are likely because of hemizygosity for ETS1 and FLI1. Copyright © 2015 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

FGF23 Deficiency Leads to Mixed Hearing Loss and Middle Ear Malformation in Mice

PubMed Central

Lysaght, Andrew C.; Yuan, Quan; Fan, Yi; Kalwani, Neil; Caruso, Paul; Cunnane, MaryBeth; Lanske, Beate; Stanković, Konstantina M.

2014-01-01

Fibroblast growth factor 23 (FGF23) is a circulating hormone important in phosphate homeostasis. Abnormal serum levels of FGF23 result in systemic pathologies in humans and mice, including renal phosphate wasting diseases and hyperphosphatemia. We sought to uncover the role FGF23 plays in the auditory system due to shared molecular mechanisms and genetic pathways between ear and kidney development, the critical roles multiple FGFs play in auditory development and the known hearing phenotype in mice deficient in klotho (KL), a critical co-factor for FGF23 signaling. Using functional assessments of hearing, we demonstrate that Fgf mice are profoundly deaf. Fgf mice have moderate hearing loss above 20 kHz, consistent with mixed conductive and sensorineural pathology of both middle and inner ear origin. Histology and high-voltage X-ray computed tomography of Fgf mice demonstrate dysplastic bulla and ossicles; Fgf mice have near-normal morphology. The cochleae of mutant mice appear nearly normal on gross and microscopic inspection. In wild type mice, FGF23 is ubiquitously expressed throughout the cochlea. Measurements from Fgf mice do not match the auditory phenotype of Kl −/− mice, suggesting that loss of FGF23 activity impacts the auditory system via mechanisms at least partially independent of KL. Given the extensive middle ear malformations and the overlap of initiation of FGF23 activity and Eustachian tube development, this work suggests a possible role for FGF23 in otitis media. PMID:25243481

Ear Problems

MedlinePlus

... may have OTITIS MEDIA, an infection of the middle ear. Self CareSee your doctor. Many ear infections will ... half-alcohol, half-white vinegar solution in the ear before and after swimming or ... JOINT (TMJ) SYNDROME, a disorder that affects the jaw joint, may ...

Middle ear muscle contractions and their relation to pulse and echo evoked potentials in the bat

NASA Technical Reports Server (NTRS)

Henson, O. W., Jr.; Henson, M. M.

1972-01-01

An analysis is made of pulse and echo orientation cries of the Mustache Bat. That bat's cries are characterized by a long, 60 to 30 msec, pure tone component and brief beginning and terminal FM sweeps. In addition to obvious echo overlap and middle ear muscle contractions, the following are examined: (1) characteristics of pulse- and echo-evoked potential under various conditions, (2) evidence of changes in hearing sensitivity during and after pulse emission, and (3) the role of the middle ear muscles in bringing about these changes.

Middle and inner ear malformations in two siblings exposed to valproic acid during pregnancy: a case report.

PubMed

Van Houtte, Evelyne; Casselman, Jan; Janssens, Sandra; De Kegel, Alexandra; Maes, Leen; Dhooge, Ingeborg

2014-11-01

Valproic acid (VPA) is a known teratogenic drug. Exposure to VPA during the pregnancy can lead to a distinct facial appearance, a cluster of major and minor anomalies and developmental delay. In this case report, two siblings with fetal valproate syndrome and a mild conductive hearing loss were investigated. Radiologic evaluation showed middle and inner ear malformations in both children. Audiologic, vestibular and motor examination was performed. This is the first case report to describe middle and inner ear malformations in children exposed to VPA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Live Attenuated Influenza Virus Increases Pneumococcal Translocation and Persistence Within the Middle Ear

PubMed Central

Mina, Michael J.; Klugman, Keith P.; Rosch, Jason W.; McCullers, Jonathan A.

2015-01-01

Background. Infection with influenza A virus (IAV) increases susceptibility to respiratory bacterial infections, resulting in increased bacterial carriage and complications such acute otitis media, pneumonia, bacteremia, and meningitis. Recently, vaccination with live attenuated influenza virus (LAIV) was reported to enhance subclinical bacterial colonization within the nasopharynx, similar to IAV. Although LAIV does not predispose to bacterial pneumonia, whether it may alter bacterial transmigration toward the middle ear, where it could have clinically relevant implications, has not been investigated. Methods. BALB/c mice received LAIV or phosphate-buffered saline 1 or 7 days before or during pneumococcal colonization with either of 2 clinical isolates, 19F or 7F. Middle ear bacterial titers were monitored daily via in vivo imaging. Results. LAIV increased bacterial transmigration to and persistence within the middle ear. When colonization followed LAIV inoculation, a minimum LAIV incubation period of 4 days was required before bacterial transmigration commenced. Conclusions. While LAIV vaccination is safe and effective at reducing IAV and coinfection with influenza virus and bacteria, LAIV may increase bacterial transmigration to the middle ear and could thus increase the risk of clinically relevant acute otitis media. These data warrant further investigations into interactions between live attenuated viruses and naturally colonizing bacterial pathogens. PMID:25505300

Otoscopic examinations reveal high prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.

PubMed

Phanguphangu, Mukovhe Chad

2017-04-01

To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa. Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed. Medical folders of 1089 pupils. Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046). This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

Influenza A Virus Alters Pneumococcal Nasal Colonization and Middle Ear Infection Independently of Phase Variation

PubMed Central

Wren, John T.; Blevins, Lance K.; Pang, Bing; King, Lauren B.; Perez, Antonia C.; Murrah, Kyle A.; Reimche, Jennifer L.; Alexander-Miller, Martha A.

2014-01-01

Streptococcus pneumoniae (pneumococcus) is both a widespread nasal colonizer and a leading cause of otitis media, one of the most common diseases of childhood. Pneumococcal phase variation influences both colonization and disease and thus has been linked to the bacteria's transition from colonizer to otopathogen. Further contributing to this transition, coinfection with influenza A virus has been strongly associated epidemiologically with the dissemination of pneumococci from the nasopharynx to the middle ear. Using a mouse infection model, we demonstrated that coinfection with influenza virus and pneumococci enhanced both colonization and inflammatory responses within the nasopharynx and middle ear chamber. Coinfection studies were also performed using pneumococcal populations enriched for opaque or transparent phase variants. As shown previously, opaque variants were less able to colonize the nasopharynx. In vitro, this phase also demonstrated diminished biofilm viability and epithelial adherence. However, coinfection with influenza virus ameliorated this colonization defect in vivo. Further, viral coinfection ultimately induced a similar magnitude of middle ear infection by both phase variants. These data indicate that despite inherent differences in colonization, the influenza A virus exacerbation of experimental middle ear infection is independent of the pneumococcal phase. These findings provide new insights into the synergistic link between pneumococcus and influenza virus in the context of otitis media. PMID:25156728

Anatomical study of the pigs temporal bone by microdissection.

PubMed

Garcia, Leandro de Borborema; Andrade, José Santos Cruz de; Testa, José Ricardo Gurgel

2014-01-01

Initial study of the pig`s temporal bone anatomy in order to enable a new experimental model in ear surgery. Dissection of five temporal bones of Sus scrofa pigs obtained from UNIFESP - Surgical Skills Laboratory, removed with hole saw to avoid any injury and stored in formaldehyde 10% for better conservation. The microdissection in all five temporal bone had the following steps: inspection of the outer part, external canal and tympanic membrane microscopy, mastoidectomy, removal of external ear canal and tympanic membrane, inspection of ossicular chain and middle ear. Anatomically it is located at the same position than in humans. Some landmarks usually found in humans are missing. The tympanic membrane of the pig showed to be very similar to the human, separating the external and the middle ear. The middle ear`s appearance is very similar than in humans. The ossicular chain is almost exactly the same, as well as the facial nerve, showing the same relationship with the lateral semicircular canal. The temporal bone of the pigs can be used as an alternative for training in ear surgery, especially due the facility to find it and its similarity with temporal bone of the humans.

Prevalence of ear disease in dogs undergoing multidetector thin-slice computed tomography of the head.

PubMed

Foster, Allison; Morandi, Federica; May, Elizabeth

2015-01-01

Previous reports describing the prevalence of ear diseases in dogs have primarily been based on dogs presenting with clinical signs of disease. The prevalence of subclinical ear disease remains unknown. The purpose of this cross-sectional retrospective study was to describe the prevalence of lesions consistent with middle and external ear disease in dogs presented for multidetector computed tomography (CT) of the head and/or cranial cervical spine at our hospital during the period of July 2011 and August 2013. For each included dog, data recorded were signalment, CT findings, diagnosis, and treatment. A total of 199 dogs met inclusion criteria. Nineteen dogs (9.5%) were referred for evaluation of suspected ear disease and 27 dogs (13.5%) had histories or physical examination findings consistent with otitis externa. A total of 163 dogs (81.9%) had CT lesions consistent with external ear disease (i.e. ear canal mineralization, external canal thickening, and/or narrowing of the external canal). Thirty-nine dogs (19.5%) had CT lesions consistent with middle ear disease (i.e. soft tissue attenuating/fluid material in the tympanic bullae, bulla wall thickening or lysis, and/or periosteal proliferation of the temporal bone). Findings from this study indicated that the prevalence of external and middle ear disease in dogs could be higher than that previously reported. © 2014 American College of Veterinary Radiology.

Computed tomographic findings in 205 dogs with clinical signs compatible with middle ear disease: a retrospective study.

PubMed

Belmudes, Audrey; Pressanti, Charline; Barthez, Paul Y; Castilla-Castaño, Eloy; Fabries, Lionel; Cadiergues, Marie C

2018-02-01

Computed tomography (CT) is considered to be the reference method to evaluate middle ear structures. To evaluate the presence and severity of CT changes in the middle ear and establish if any specific clinical presentations are associated with otitis media. Medical records of animals referred for CT with history and clinical signs consistent with middle ear disease. Retrospective evaluation of CT examinations of tympanic bullae performed over a six year period. Medical records were reviewed for signalment, clinical signs and cytological evaluation of the external ear canal. Dogs were divided into three clinical groups: chronic otitis externa (Group 1), peripheral vestibular disorder (Group 2) and other clinical presentations (Group 3). Group 1 - Of 214 ears, 87 (40.7%) had CT abnormalities: 38 of 87 (17.7%) had material-filled bullae, 42 of 87 (19.6%) had thickened bullae walls and seven of 87 (3.2%) had lysis of the bulla. Abnormalities were significantly more frequent in dogs with suppurative otitis than in erythemato-ceruminous otitis (57% and 23%, respectively; P = 0.003). Proliferative otitis, particularly in French bulldogs, was associated with severe otitis media. Group 2 - Of the 106 ears, 91 (85.8%) had normal tympanic bullae. Group 3 - Of the 26 ears from deaf dogs, 17 had filled bullae; all nine affected dogs were Cavalier King Charles spaniels. All dogs with Claude Bernard Horner syndrome or head tilt had normal tympanic bullae. CT is useful for canine chronic otitis externa, particularly in suppurative or proliferative otitis, even in the absence of associated neurological signs. © 2017 ESVD and ACVD.

Roles of autolysin and pneumolysin in middle ear inflammation caused by a type 3 Streptococcus pneumoniae strain in the chinchilla otitis media model.

PubMed Central

Sato, K; Quartey, M K; Liebeler, C L; Le, C T; Giebink, G S

1996-01-01

Streptococcus pneumoniae cell wall and pneumolysin are important contributors to pneumococcal pathogenicity in some animal models. To further explore these factors in middle ear inflammation caused by pneumococci, penicillin-induced inflammatory acceleration was studied by using three closely related pneumococcal strains: a wild-type 3 strain (WT3), its pneumolysin-negative derivative (P-1), and into autolysin-negative derivative (A-1). Both middle ears of chinchillas were inoculated with one of the three pneumococcal strains. During the first 12 h, all three strains grew in vivo at the same rate, and all three strains induced similar inflammatory cell responses in middle ear fluid (MEF). Procaine penicillin G was given as 12 h to one-half of the animals in each group, and all treated chinchillas had sterile MEF at 24 h. Penicillin significantly accelerated MEF inflammatory cell influx into WT3-and P-1-infected ears at 18 and 24 h in comparison with the rate for penicillin-treated A-1-infected ears. Inflammatory cell influx was slightly, but not significantly, greater after treatment of WT3 infection than after treatment of P-1 infection. Interleukin (IL)-1beta and IL-6, but not IL-8, concentrations in MEF at 24 h reflected the penicillin effect on MEF inflammatory cells; however, differences between treatment groups were not significant. Results suggest that pneumococcal otitis media pathogenesis is triggered principally by the inflammatory effects of intact and lytic cell wall products in the middle ear, with at most a modes additional pneumolysin effect. Investigation strategies that limit the release of these products or neutralize them warrant further investigation. PMID:8606070

Radiological differences between HIV-positive and HIV-negative children with cholesteatoma.

PubMed

McGuire, J K; Fagan, J J; Wojno, M; Manning, K; Harris, T

2018-07-01

HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at our institute over a 6 year period. Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to opacification of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma. Copyright © 2018. Published by Elsevier B.V.

Genetics Home Reference: granulomatosis with polyangiitis

MedlinePlus

... other regions of the body, including the eyes, middle and inner ear structures, skin, joints, nerves, heart, and brain. Depending ... involved, additional symptoms can include skin rashes, inner ear pain, swollen and ... is most common in middle-aged adults, although it can occur at any ...

The transcriptome of a complete episode of acute otitis media.

PubMed

Hernandez, Michelle; Leichtle, Anke; Pak, Kwang; Webster, Nicholas J; Wasserman, Stephen I; Ryan, Allen F

2015-04-03

Otitis media is the most common disease of childhood, and represents an important health challenge to the 10-15% of children who experience chronic/recurrent middle ear infections. The middle ear undergoes extensive modifications during otitis media, potentially involving changes in the expression of many genes. Expression profiling offers an opportunity to discover novel genes and pathways involved in this common childhood disease. The middle ears of 320 WBxB6 F1 hybrid mice were inoculated with non-typeable Haemophilus influenzae (NTHi) or PBS (sham control). Two independent samples were generated for each time point and condition, from initiation of infection to resolution. RNA was profiled on Affymetrix mouse 430 2.0 whole-genome microarrays. Approximately 8% of the sampled transcripts defined the signature of acute NTHi-induced otitis media across time. Hierarchical clustering of signal intensities revealed several temporal gene clusters. Network and pathway enrichment analysis of these clusters identified sets of genes involved in activation of the innate immune response, negative regulation of immune response, changes in epithelial and stromal cell markers, and the recruitment/function of neutrophils and macrophages. We also identified key transcriptional regulators related to events in otitis media, which likely determine the expression of these gene clusters. A list of otitis media susceptibility genes, derived from genome-wide association and candidate gene studies, was significantly enriched during the early induction phase and the middle re-modeling phase of otitis but not in the resolution phase. Our results further indicate that positive versus negative regulation of inflammatory processes occur with highly similar kinetics during otitis media, underscoring the importance of anti-inflammatory responses in controlling pathogenesis. The results characterize the global gene response during otitis media and identify key signaling and transcription factor networks that control the defense of the middle ear against infection. These networks deserve further attention, as dysregulated immune defense and inflammatory responses may contribute to recurrent or chronic otitis in children.

Effects of Continuous Positive Airway Pressure on Middle Ear Pressure and Acoustic Stapedial Reflex.

PubMed

Li, Jinrang; Li, Keliang

2016-08-01

This study investigated the effects of continuous positive airway pressure (CPAP) on middle ear pressure and acoustic stapedial reflex and the correlation between CPAP and middle ear pressure. Prospective cohort study. Tertiary hospitals. Fifty patients with obstructive sleep apnea-hypopnea syndrome were assigned to the study group, and 50 healthy volunteers were assigned to the control group. The subjects underwent standard tympanometry while wearing a CPAP device (ie, simulated CPAP treatment), which was set to 0, 5, 10, and 15 cm H2O, respectively. Tympanometry was performed before and after swallowing at each pressure of CPAP treatment. The mean middle ear pressures were 21.2, 22.6, 22.7, and 23.4 daPa (before swallowing) and 21.6, 42.6, 81.4, and 118.6 daPa (after swallowing) in the study group and 17.6, 18.7, 19.5, and 20.8 daPa (before swallowing) and 17.7, 44.2, 85.6, and 120.5 daPa (after swallowing) in the control group at the CPAPs of 0, 5, 10, and 15 cm H2O, respectively. While the CPAPs were at 0 and 15 cm H2O, the stapedial muscle reflex at 1.0 kHz did not have a significant difference between the 2 groups (χ(2) = 0.521, P = .470). The Pearson correlation coefficient of the CPAP pressure and the middle ear pressure after swallowing was 0.812 (P < .001). CPAP affected middle ear pressure and was directly proportional to the pressure of the CPAP. However, CPAP treatment had no significant effect on stapedial muscle reflex. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

NOD2/RICK-Dependent β-Defensin 2 Regulation Is Protective for Nontypeable Haemophilus influenzae-Induced Middle Ear Infection

PubMed Central

Woo, Jeong-Im; Oh, Sejo; Webster, Paul; Lee, Yoo Jin; Lim, David J.; Moon, Sung K.

2014-01-01

Middle ear infection, otitis media (OM), is clinically important due to the high incidence in children and its impact on the development of language and motor coordination. Previously, we have demonstrated that the human middle ear epithelial cells up-regulate β-defensin 2, a model innate immune molecule, in response to nontypeable Haemophilus influenzae (NTHi), the most common OM pathogen, via TLR2 signaling. NTHi does internalize into the epithelial cells, but its intracellular trafficking and host responses to the internalized NTHi are poorly understood. Here we aimed to determine a role of cytoplasmic pathogen recognition receptors in NTHi-induced β-defensin 2 regulation and NTHi clearance from the middle ear. Notably, we observed that the internalized NTHi is able to exist freely in the cytoplasm of the human epithelial cells after rupturing the surrounding membrane. The human middle ear epithelial cells inhibited NTHi-induced β-defensin 2 production by NOD2 silencing but augmented it by NOD2 over-expression. NTHi-induced β-defensin 2 up-regulation was attenuated by cytochalasin D, an inhibitor of actin polymerization and was enhanced by α-hemolysin, a pore-forming toxin. NOD2 silencing was found to block α-hemolysin-mediated enhancement of NTHi-induced β-defensin 2 up-regulation. NOD2 deficiency appeared to reduce inflammatory reactions in response to intratympanic inoculation of NTHi and inhibit NTHi clearance from the middle ear. Taken together, our findings suggest that a cytoplasmic release of internalized NTHi is involved in the pathogenesis of NTHi infections, and NOD2-mediated β-defensin 2 regulation contributes to the protection against NTHi-induced otitis media. PMID:24625812

Morphology and function of Neandertal and modern human ear ossicles

PubMed Central

David, Romain; Gunz, Philipp; Schmidt, Tobias; Spoor, Fred; Hublin, Jean-Jacques

2016-01-01

The diminutive middle ear ossicles (malleus, incus, stapes) housed in the tympanic cavity of the temporal bone play an important role in audition. The few known ossicles of Neandertals are distinctly different from those of anatomically modern humans (AMHs), despite the close relationship between both human species. Although not mutually exclusive, these differences may affect hearing capacity or could reflect covariation with the surrounding temporal bone. Until now, detailed comparisons were hampered by the small sample of Neandertal ossicles and the unavailability of methods combining analyses of ossicles with surrounding structures. Here, we present an analysis of the largest sample of Neandertal ossicles to date, including many previously unknown specimens, covering a wide geographic and temporal range. Microcomputed tomography scans and 3D geometric morphometrics were used to quantify shape and functional properties of the ossicles and the tympanic cavity and make comparisons with recent and extinct AMHs as well as African apes. We find striking morphological differences between ossicles of AMHs and Neandertals. Ossicles of both Neandertals and AMHs appear derived compared with the inferred ancestral morphology, albeit in different ways. Brain size increase evolved separately in AMHs and Neandertals, leading to differences in the tympanic cavity and, consequently, the shape and spatial configuration of the ossicles. Despite these different evolutionary trajectories, functional properties of the middle ear of AMHs and Neandertals are largely similar. The relevance of these functionally equivalent solutions is likely to conserve a similar auditory sensitivity level inherited from their last common ancestor. PMID:27671643

The Effects of Otitis Media on Speech and Language. Final Report for 1983-1984.

ERIC Educational Resources Information Center

Roberts, Joanne Erwick; Henderson, Frederick W.

This study, part of a 4-year longitudinal project, examined the possible relationship between persistent otitis media (middle ear disease) in early childhood and speech and language functioning. Subjects were 38 black preschool children between 3 and 7 years of age who, although normal in intellectual and verbal functioning, were identified as at…

[The clinical manifestations and diagnostics of otitis media caused by tuberculosis].

PubMed

Kryukov, A I; Garov, E V; Ivoilov, A Yu; Shadrin, G B; Sidorina, N G; Lavrova, A S

2015-01-01

The objective of the present study was to clarify the characteristic pathognomonic features of middle ear lesions associated with tuberculosis and the approaches to their diagnostics under the present-day conditions. The study included 11 cases (18 ears) of tuberculosis otitis media and the related lesions of the mastoid process diagnosed with the use of clinical, roentgenological, cytological, bacteriological, pathomorphological, and molecular-genetic methods (including PCR diagnostics). The primary localization of tuberculosis in the middle ear was documented in 6 patients; in 5 patients, it was associated with pulmonary involvement. Five patients presented with smoldering exudative otitis media and the remaining six ones with suppurative perforating otitis media. The tuberculous process was diagnosed with the use of various methods including clinical examination, bacteriological (9%), cytological (27.3%), pathomorphological (18%) studies, and PCR diagnostics (55%). Diagnosis was made within a period from 1 month to 1.5 years after the application of the patients for medical assistance which suggests the difficulty of verification of tuberculous etiology of the disease of the middle ear. It is concluded that the high index of suspicion in the case of smoldering middle ear pathology facilitates its early diagnostics and successful treatment.

Microbiology of otitis media in Indigenous Australian children: review.

PubMed

Jervis-Bardy, J; Carney, A S; Duguid, R; Leach, A J

2017-07-01

To review research addressing the polymicrobial aetiology of otitis media in Indigenous Australian children in order to identify research gaps and inform best practice in effective prevention strategies and therapeutic interventions. Literature review. Studies of aspirated middle-ear fluid represented a minor component of the literature reviewed. Most studies relied upon specimens from middle-ear discharge or the nasopharynx. Culture-based middle-ear discharge studies have found that non-typeable Haemophilus influenzae and Streptococcus pneumoniae predominate, with Moraxella catarrhalis, Staphylococcus aureus and Streptococcus pyogenes isolated in a lower proportion of samples. Alloiococcus otitidis was detected in a number of studies; however, its role in otitis media pathogenesis remains controversial. Nasopharyngeal colonisation is a risk factor for otitis media in Indigenous infants, and bacterial load of otopathogens in the nasopharynx can predict the ear state of Indigenous children. Most studies have used culture-based methods and specimens from middle-ear discharge or the nasopharynx. Findings from these studies are consistent with international literature, but reliance on culture may incorrectly characterise the microbiology of this condition. Advances in genomic technologies are now providing microbiologists with the ability to analyse the entire mixed bacterial communities ('microbiomes') of samples obtained from Indigenous children with otitis media.

Immunolocalization of aquaporin CHIP in the guinea pig inner ear.

PubMed

Stanković, K M; Adams, J C; Brown, D

1995-12-01

Aquaporin CHIP (AQP-CHIP) is a water channel protein previously identified in red blood cells and water transporting epithelia. The inner ear is an organ of hearing and balance whose normal function depends critically on maintenance of fluid homeostasis. In this study, AQP-CHIP, or a close homologue, was found in specific cells of the inner ear, as assessed by immunocytochemistry with the use of affinity-purified polyclonal antibodies against AQP-CHIP.AQP-CHIP was predominantly found in fibrocytes in close association with bone, including most of the cells lining the bony labyrinth and in fibrocytes lining the endolymphatic duct and sac. AQP-CHIP-positive cells not directly apposing bone include cells under the basilar membrane, some type III fibrocytes of the spiral ligament, fibrocytes of the spiral limbus, and the trabecular perilymphatic tissue extending from the membranous to the bony labyrinth. AQP-CHIP was also found in the periosteum of the middle ear and cranial bones, as well as in chondrocytes of the oval window and stapes. The distribution of AQP-CHIP in the inner ear suggests that AQP-CHIP may have special significance for maintenance of bone and the basilar membrane, and for function of the spiral ligament.

Strategies of immunization against mucosal infections.

PubMed

Russell, M W; Martin, M H; Wu, H Y; Hollingshead, S K; Moldoveanu, Z; Mestecky, J

2000-12-08

The presence of secretory (S-) IgA in middle-ear fluid and localization of IgA-secreting cells in its mucosae suggest that the middle ear is an effector site of the mucosal immune system. Several strategies have been devised to induce potent, long-lasting, and recallable mucosal S-IgA antibodies, as well as circulating IgG antibodies and Th1- or Th2-type help, according to the most appropriate responses for a particular infection. Application of immunogens to inductive sites in the upper respiratory tract may be most effective for generating responses in the middle ear and nasopharynx for protection against the organisms responsible for otitis media.

Design, Kinematic Optimization, and Evaluation of a Teleoperated System for Middle Ear Microsurgery

PubMed Central

Miroir, Mathieu; Nguyen, Yann; Szewczyk, Jérôme; Sterkers, Olivier; Bozorg Grayeli, Alexis

2012-01-01

Middle ear surgery involves the smallest and the most fragile bones of the human body. Since microsurgical gestures and a submillimetric precision are required in these procedures, the outcome can be potentially improved by robotic assistance. Today, there is no commercially available device in this field. Here, we describe a method to design a teleoperated assistance robotic system dedicated to the middle ear surgery. Determination of design specifications, the kinematic structure, and its optimization are detailed. The robot-surgeon interface and the command modes are provided. Finally, the system is evaluated by realistic tasks in experimental dedicated settings and in human temporal bone specimens. PMID:22927789

Magnetically driven middle ear ossicles for optical measurement of vibrations in an ear with opened eardrum

NASA Astrophysics Data System (ADS)

Peacock, John; Von Unge, Magnus; Dirckx, Joris

2012-06-01

Vibrations of the middle ear ossicles are easily measured by means of laser vibrometry. However, exposing the ossicles requires the removal of the eardrum, with the result that the ossicles can no longer be stimulated acoustically. To overcome this we devised a new set up in which the ossicles can be driven magnetically. After measuring the response of the eardrum to an acoustic signal, we then remove the eardrum and attach a small magnet to the exposed manubrium (the part of the first auditory ossicle, the malleus, which is normally attached to the eardrum). An electromagnetic excitation coil is then used to drive the magnet, and the output to the coil adjusted until the vibration of the manubrium, as measured by the vibrometer, matches that measured in response to the acoustic signal. Such a set-up has uses in research on middle ear mechanics, such as the measurement of non-linearities in their response, as well as applications in the diagnosis of middle ear conditions such as the fixation of the ossicles by otosclerosis, or in chronic otitis media. We describe our set up in which the vibrometer unit is attached to a surgical microscope, offering accurate positioning of the laser beam. We discuss the viability of our method and its future potential by presenting some measurements on artificially fixated ears.

Using the shortwave infrared to image middle ear pathologies

PubMed Central

Valdez, Tulio A.; Bruns, Oliver T.; Bawendi, Moungi G.

2016-01-01

Visualizing structures deep inside opaque biological tissues is one of the central challenges in biomedical imaging. Optical imaging with visible light provides high resolution and sensitivity; however, scattering and absorption of light by tissue limits the imaging depth to superficial features. Imaging with shortwave infrared light (SWIR, 1–2 μm) shares many advantages of visible imaging, but light scattering in tissue is reduced, providing sufficient optical penetration depth to noninvasively interrogate subsurface tissue features. However, the clinical potential of this approach has been largely unexplored because suitable detectors, until recently, have been either unavailable or cost prohibitive. Here, taking advantage of newly available detector technology, we demonstrate the potential of SWIR light to improve diagnostics through the development of a medical otoscope for determining middle ear pathologies. We show that SWIR otoscopy has the potential to provide valuable diagnostic information complementary to that provided by visible pneumotoscopy. We show that in healthy adult human ears, deeper tissue penetration of SWIR light allows better visualization of middle ear structures through the tympanic membrane, including the ossicular chain, promontory, round window niche, and chorda tympani. In addition, we investigate the potential for detection of middle ear fluid, which has significant implications for diagnosing otitis media, the overdiagnosis of which is a primary factor in increased antibiotic resistance. Middle ear fluid shows strong light absorption between 1,400 and 1,550 nm, enabling straightforward fluid detection in a model using the SWIR otoscope. Moreover, our device is easily translatable to the clinic, as the ergonomics, visual output, and operation are similar to a conventional otoscope. PMID:27551085

Live attenuated influenza virus increases pneumococcal translocation and persistence within the middle ear.

PubMed

Mina, Michael J; Klugman, Keith P; Rosch, Jason W; McCullers, Jonathan A

2015-07-15

Infection with influenza A virus (IAV) increases susceptibility to respiratory bacterial infections, resulting in increased bacterial carriage and complications such acute otitis media, pneumonia, bacteremia, and meningitis. Recently, vaccination with live attenuated influenza virus (LAIV) was reported to enhance subclinical bacterial colonization within the nasopharynx, similar to IAV. Although LAIV does not predispose to bacterial pneumonia, whether it may alter bacterial transmigration toward the middle ear, where it could have clinically relevant implications, has not been investigated. BALB/c mice received LAIV or phosphate-buffered saline 1 or 7 days before or during pneumococcal colonization with either of 2 clinical isolates, 19F or 7F. Middle ear bacterial titers were monitored daily via in vivo imaging. LAIV increased bacterial transmigration to and persistence within the middle ear. When colonization followed LAIV inoculation, a minimum LAIV incubation period of 4 days was required before bacterial transmigration commenced. While LAIV vaccination is safe and effective at reducing IAV and coinfection with influenza virus and bacteria, LAIV may increase bacterial transmigration to the middle ear and could thus increase the risk of clinically relevant acute otitis media. These data warrant further investigations into interactions between live attenuated viruses and naturally colonizing bacterial pathogens. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Influenza A virus alters pneumococcal nasal colonization and middle ear infection independently of phase variation.

PubMed

Wren, John T; Blevins, Lance K; Pang, Bing; King, Lauren B; Perez, Antonia C; Murrah, Kyle A; Reimche, Jennifer L; Alexander-Miller, Martha A; Swords, W Edward

2014-11-01

Streptococcus pneumoniae (pneumococcus) is both a widespread nasal colonizer and a leading cause of otitis media, one of the most common diseases of childhood. Pneumococcal phase variation influences both colonization and disease and thus has been linked to the bacteria's transition from colonizer to otopathogen. Further contributing to this transition, coinfection with influenza A virus has been strongly associated epidemiologically with the dissemination of pneumococci from the nasopharynx to the middle ear. Using a mouse infection model, we demonstrated that coinfection with influenza virus and pneumococci enhanced both colonization and inflammatory responses within the nasopharynx and middle ear chamber. Coinfection studies were also performed using pneumococcal populations enriched for opaque or transparent phase variants. As shown previously, opaque variants were less able to colonize the nasopharynx. In vitro, this phase also demonstrated diminished biofilm viability and epithelial adherence. However, coinfection with influenza virus ameliorated this colonization defect in vivo. Further, viral coinfection ultimately induced a similar magnitude of middle ear infection by both phase variants. These data indicate that despite inherent differences in colonization, the influenza A virus exacerbation of experimental middle ear infection is independent of the pneumococcal phase. These findings provide new insights into the synergistic link between pneumococcus and influenza virus in the context of otitis media. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Listening to the ear

NASA Astrophysics Data System (ADS)

Shera, Christopher A.

Otoacoustic emissions demonstrate that the ear creates sound while listening to sound, offering a promising acoustic window on the mechanics of hearing in awake, listening human beings. That window is clouded, however, by an incomplete knowledge of wave reflection and transmission, both forth and back within the cochlea and through the middle ear. This thesis "does windows," addressing wave propagation and scattering on both sides of the middle ear. A summary of highlights follows. Measurements of the cochlear input impedance in cat are used to identify a new symmetry in cochlear mechanics-termed "tapering symmetry" after its geometric interpretation in simple models-that guarantees that the wavelength of the traveling wave changes slowly with position near the stapes. Waves therefore propagate without reflection through the basal turns of the cochlea. Analytic methods for solving the cochlear wave equations using a perturbative scattering series are given and used to demonstrate that, contrary to common belief, conventional cochlear models exhibit negligible internal reflection whether or not they accurately represent the tapering symmetries of the inner ear. Frameworks for the systematic "deconstruction" of eardrum and middle-ear transduction characteristics are developed and applied to the analysis of noninvasive measurements of middle-ear and cochlear mechanics. A simple phenomenological model of inner-ear compressibility that correctly predicts hearing thresholds in patients with missing or disarticulated middle-ear ossicles is developed and used to establish an upper bound on cochlear compressibility several orders of magnitude smaller than that provided by direct measurements. Accurate measurements of stimulus frequency evoked otoacoustic emissions are performed and used to determine the form and frequency variation of the cochlear traveling-wave ratio noninvasively. Those measurements are inverted to obtain the spatial distribution of mechanical inhomogeneities responsible for evoked emission. Although current models require that the periodicities found in emission spectra and threshold hearing curves originate in a corresponding corrugation in the mechanics of the cochlea, it is shown that the observed spectral periodicities can arise spontaneously through the dynamics of wave propagation and reflection and that the organ of Corti, as suggested by the anatomy, need manifest no particular translational symmetries.

Listening to the Ear

NASA Astrophysics Data System (ADS)

Shera, Christopher Alan

Otoacoustic emissions demonstrate that the ear creates sound while listening to sound, offering a promising acoustic window on the mechanics of hearing in awake, listening human beings. That window is clouded, however, by an incomplete knowledge of wave reflection and transmission, both forth and back within the cochlea and through the middle ear. This thesis "does windows," addressing wave propagation and scattering on both sides of the middle ear. A summary of highlights follows. Measurements of the cochlear input impedance in cat are used to identify a new symmetry in cochlear mechanics--termed "tapering symmetry" after its geometric interpretation in simple models--that guarantees that the wavelength of the traveling wave changes slowly with position near the stapes. Waves therefore propagate without reflection through the basal turns of the cochlea. Analytic methods for solving the cochlear wave equations using a perturbative scattering series are given and used to demonstrate that, contrary to common belief, conventional cochlear models exhibit negligible internal reflection whether or not they accurately represent the tapering symmetries of the inner ear. Frameworks for the systematic "deconstruction" of eardrum and middle-ear transduction characteristics are developed and applied to the analysis of noninvasive measurements of middle-ear and cochlear mechanics. A simple phenomenological model of inner-ear compressibility that correctly predicts hearing thresholds in patients with missing or disarticulated middle-ear ossicles is developed and used to establish an upper bound on cochlear compressibility several orders of magnitude smaller than that provided by direct measurements. Accurate measurements of stimulus -frequency evoked otoacoustic emissions are performed and used to determine the form and frequency variation of the cochlear traveling-wave ratio noninvasively. Those measurements are inverted to obtain the spatial distribution of mechanical inhomogeneities responsible for evoked emission. Although current models require that the periodicities found in emission spectra and threshold hearing curves originate in a corresponding corrugation in the mechanics of the cochlea, it is shown that the observed spectral periodicities can arise spontaneously through the dynamics of wave propagation and reflection and that the organ of Corti, as suggested by the anatomy, need manifest no particular translational symmetries.

Computed tomographic features of the osseous structures of the external acoustic meatus, tympanic cavity, and tympanic bulla of llamas (Lama glama).

PubMed

Concha-Albornoz, Ismael; Stieger-Vanegas, Susanne M; Cebra, Christopher K

2012-01-01

To evaluate the osseous structures of the external acoustic meatus, tympanic cavity, and tympanic bulla of llamas (Lama glama) by use of computed tomography (CT) and establish measurement values for use in detection of abnormalities associated with the external or middle ear in llamas. 10 adult llama heads without any evidence of ear disease. Heads of 10 healthy llamas euthanized by use of a captive bolt striking the dorsal aspect of the skull were collected. Transverse images of the heads were acquired with 1-mm slice thickness, and images were reconstructed in sagittal and dorsal planes. Measurements of the bony structures of the external and middle ear of each head were obtained. The osseous external acoustic meatus curved ventrally as it tracked medially. Its narrowest portion was located at the level of the tympanic annulus. The tympanic bulla conformation differed widely from the bubble-shaped tympanic bulla in dogs and cats. The bulla was divided by the stylohyoid fossa into a larger caudolateral and a smaller caudomedial process; its interior had a honeycombed structure with pneumatized cells similar to the honeycombed appearance of the human mastoid process. Results provided new information regarding the shape and dimensions of the osseous external and middle ear structures in adult llamas without ear disease. Specific landmarks for location of the external acoustic meatus, tympanic cavity, and tympanic bulla in relation to each other were identified. Knowledge of the CT appearance of normal structures will help clinicians to identify changes attributable to middle ear otitis, external ear canal stenosis, or congenital malformations of the ear in this species.

Computational Modeling of Blast Wave Transmission Through Human Ear.

PubMed

Leckness, Kegan; Nakmali, Don; Gan, Rong Z

2018-03-01

Hearing loss has become the most common disability among veterans. Understanding how blast waves propagate through the human ear is a necessary step in the development of effective hearing protection devices (HPDs). This article presents the first 3D finite element (FE) model of the human ear to simulate blast wave transmission through the ear. The 3D FE model of the human ear consisting of the ear canal, tympanic membrane, ossicular chain, and middle ear cavity was imported into ANSYS Workbench for coupled fluid-structure interaction analysis in the time domain. Blast pressure waveforms recorded external to the ear in human cadaver temporal bone tests were applied at the entrance of the ear canal in the model. The pressure waveforms near the tympanic membrane (TM) in the canal (P1) and behind the TM in the middle ear cavity (P2) were calculated. The model-predicted results were then compared with measured P1 and P2 waveforms recorded in human cadaver ears during blast tests. Results show that the model-derived P1 waveforms were in an agreement with the experimentally recorded waveforms with statistic Kurtosis analysis. The FE model will be used for the evaluation of HPDs in future studies.

Anatomic Malformations of the Middle and Inner Ear in 22q11.2 Deletion Syndrome: Case Series and Literature Review.

PubMed

Verheij, E; Elden, L; Crowley, T B; Pameijer, F A; Zackai, E H; McDonald-McGinn, D M; Thomeer, H G X M

2018-05-01

The 22q11.2 deletion syndrome is characterized by a heterogenic phenotype, including hearing loss. The underlying cause of hearing loss, especially sensorineural hearing loss, is not yet clear. Therefore, our objective was to describe anatomic malformations in the middle and inner ear in patients with 22q11.2 deletion syndrome. A retrospective case series was conducted in 2 tertiary referral centers. All patients with 22q11.2 deletion syndrome who had undergone CT or MR imaging of the temporal bones were included. Radiologic images were evaluated on predetermined parameters, including abnormalities of the ossicular chain, cochlea, semicircular canals, and vestibule. There were 26 patients (52 ears) with a CT or MR imaging scan available. A dense stapes superstructure was found in 18 ears (36%), an incomplete partition type II was suspected in 12 cochleas (23%), the lateral semicircular canal was malformed with a small bony island in 17 ears (33%), and the lateral semicircular canal and vestibule were fused to a single cavity in 15 ears (29%). Middle and inner ear abnormalities were frequently encountered in our cohort, including malformations of the lateral semicircular canal. © 2018 by American Journal of Neuroradiology.

Otitis Media and Learning Disabilities: More Than a Relationship?

ERIC Educational Resources Information Center

Quick, Carol; Mandell, Colleen

The relationship between recurrent otitis media (middle ear infection characterized by the presence of middle ear fluid and possibly leading to a temporary conductive hearing loss) and learning disabilities (LD) is examined. Traditional treatment approaches (antibiotic medication and surgery) are reviewed. The definition of LD is presented and the…

THE TREATMENT OF AERO-OTITIS MEDIA BY REDECOMPRESSION,

DTIC Science & Technology

The precipitating event preceding the appearance of aero- otitis media is the development of a relative vacuum within the middle ear. The aim of...obtaining normal pressure relationships between the middle ear and the environment. In 27 of a group of 33 men with severe aero- otitis media , this

How well can centenarians hear?

PubMed

Mao, Zhongping; Zhao, Lijun; Pu, Lichun; Wang, Mingxiao; Zhang, Qian; He, David Z Z

2013-01-01

With advancements in modern medicine and significant improvements in life conditions in the past four decades, the elderly population is rapidly expanding. There is a growing number of those aged 100 years and older. While many changes in the human body occur with physiological aging, as many as 35% to 50% of the population aged 65 to 75 years have presbycusis. Presbycusis is a progressive sensorineural hearing loss that occurs as people get older. There are many studies of the prevalence of age-related hearing loss in the United States, Europe, and Asia. However, no audiological assessment of the population aged 100 years and older has been done. Therefore, it is not clear how well centenarians can hear. We measured middle ear impedance, pure-tone behavioral thresholds, and distortion-product otoacoustic emission from 74 centenarians living in the city of Shaoxing, China, to evaluate their middle and inner ear functions. We show that most centenarian listeners had an "As" type tympanogram, suggesting reduced static compliance of the tympanic membrane. Hearing threshold tests using pure-tone audiometry show that all centenarian subjects had varying degrees of hearing loss. More than 90% suffered from moderate to severe (41 to 80 dB) hearing loss below 2,000 Hz, and profound (>81 dB) hearing loss at 4,000 and 8,000 Hz. Otoacoustic emission, which is generated by the active process of cochlear outer hair cells, was undetectable in the majority of listeners. Our study shows the extent and severity of hearing loss in the centenarian population and represents the first audiological assessment of their middle and inner ear functions.

Cochlear Implant Electrode Effect on Sound Energy Transfer within the Cochlea during Acoustic Stimulation

PubMed Central

Greene, Nathaniel T.; Mattingly, Jameson K.; Jenkins, Herman A.; Tollin, Daniel J.; Easter, James R.; Cass, Stephen P.

2015-01-01

Hypothesis Cochlear implants (CI) designed for hearing preservation will not alter mechanical properties of the middle and inner ear as measured by intracochlear pressure (PIC) and stapes velocity (Vstap). Background CIs designed to provide combined electrical and acoustic stimulation (EAS) are now available. To maintain functional acoustic hearing, it is important to know if a CI electrode can alter middle or inner ear mechanics, as any alteration could contribute to elevated low-frequency thresholds in EAS patients. Methods Seven human cadaveric temporal bones were prepared, and pure-tone stimuli from 120Hz–10kHz were presented at a range of intensities up to 110 dB SPL. PIC in the scala vestibuli (PSV) and tympani (PST) were measured with fiber-optic pressure sensors concurrently with VStap using laser Doppler vibrometry. Five CI electrodes from two different manufacturers, with varying dimensions were inserted via a round window approach at six different depths (16–25 mm). Results The responses of PIC and VStap to acoustic stimulation were assessed as a function of stimulus frequency, normalized to SPL in the external auditory canal (EAC), in baseline and electrode inserted conditions. Responses measured with electrodes inserted were generally within ~5 dB of baseline, indicating little effect of cochlear implant electrode insertion on PIC and VStap. Overall, mean differences across conditions were small for all responses, and no substantial differences were consistently visible across electrode types. Conclusions Results suggest that the influence of a CI electrode on middle and inner ear mechanics is minimal, despite variation in electrode lengths and configurations. PMID:26333018

Ear Tubes

MedlinePlus

... 1/20th of an inch) that could allow water to enter the middle ear, research studies show no benefit in keeping the ears dry and current guidelines do not recommend routine water precautions. Therefore, you do not need to restrict ...

Ear infection - chronic

MedlinePlus

Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Chole RA. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. ...

Auditory Neuropathy

MedlinePlus

... sound vibrations entering the inner ear from the middle ear. When hearing is working normally, the inner hair ... Examples of such disorders are Charcot-Marie-Tooth syndrome and Friedreich’s ... (ear, nose, and throat doctors), pediatricians, and audiologists —use ...

The effect of superior-canal opening on middle-ear input admittance and air-conducted stapes velocity in chinchilla

PubMed Central

Songer, Jocelyn E.; Rosowski, John J.

2009-01-01

The recent discovery of superior semicircular canal (SC) dehiscence syndrome as a clinical entity affecting both the auditory and vestibular systems has led to the investigation of the impact of a SC opening on the mechanics of hearing. It is hypothesized that the hole in the SC acts as a “third window” in the inner ear which shunts sound-induced stapes volume velocity away from the cochlea through the opening in the SC. To test the hypothesis and to understand the third window mechanisms the middle-ear input admittance and sound-induced stapes velocity were measured in chinchilla before and after surgically introducing a SC opening and after patching the opening. The extent to which patching returned the system to the presurgical state is used as a control criterion. In eight chinchilla ears a statistically significant, reversible increase in low-frequency middle-ear input admittance magnitude occurred as a result of opening the SC. In six ears a statistically significant reversible increase in stapes velocity was observed. Both of these changes are consistent with the hole creating a shunt pathway that increases the cochlear input admittance. PMID:16875223

The effect of superior-canal opening on middle-ear input admittance and air-conducted stapes velocity in chinchilla.

PubMed

Songer, Jocelyn E; Rosowski, John J

2006-07-01

The recent discovery of superior semicircular canal (SC) dehiscence syndrome as a clinical entity affecting both the auditory and vestibular systems has led to the investigation of the impact of a SC opening on the mechanics of hearing. It is hypothesized that the hole in the SC acts as a "third window" in the inner ear which shunts sound-induced stapes volume velocity away from the cochlea through the opening in the SC. To test the hypothesis and to understand the third window mechanisms the middle-ear input admittance and sound-induced stapes velocity were measured in chinchilla before and after surgically introducing a SC opening and after patching the opening. The extent to which patching returned the system to the presurgical state is used as a control criterion. In eight chinchilla ears a statistically significant, reversible increase in low-frequency middle-ear input admittance magnitude occurred as a result of opening the SC. In six ears a statistically significant reversible increase in stapes velocity was observed. Both of these changes are consistent with the hole creating a shunt pathway that increases the cochlear input admittance.

Ear Infections and Language Development.

ERIC Educational Resources Information Center

Roberts, Joanne E.; Zeisel, Susan A.

Ear infections in infants and preschoolers can cause mild or moderate temporary hearing loss, which may in turn affect a child's ability to understand and learn language. Noting that providing children with proper medical treatment for ear infections or middle ear fluid is important in preventing possible problems with language development, this…

Study of a temporal bone of Homo heildelbergensis.

PubMed

Urquiza, Rafael; Botella, Miguel; Ciges, Miguel

2005-05-01

The characteristic features of the Hh specimen conformed to those of other Pleistocene human fossils, indicating strong cranial structures and a heavy mandible. The mastoid was large and suggested a powerful sternocleidomastoid muscle. The inner ear and tympanic cavities were similar in size and orientation, suggesting that their functions were probably similar. Our observations suggest that the left ear of this Hh specimen was healthy. The large canaliculo-fenestral angle confirms that this ancestor was bipedal. It also strongly suggests that Hh individuals were predisposed to develop certain pathologies of the labyrinth capsule associated with bipedalism, in particular otosclerosis. We studied a temporal bone of Homo heidelbergensis (Hh) in order to investigate the clinical and physiological implications of certain morphological features, especially those associated with the evolutionary reorganization of the inner ear. The bone, found in a breach of a cave near MAáaga in southern Spain, together with Middle Upper Pleistocene faunal remains, is >300000 years old. Four analytical methods were employed. A 3D high-resolution surface laser scan was used for anatomical measurements. For the sectional analysis of the middle and inner ears of Hh we used high-resolution CT, simultaneously studying a normal temporal bone from Homo sapiens sapiens (Hss). To study the middle and inner ear spaces we used 3D reconstruction CT preceded by an intra-bone air shielding technique. To examine the tympanic cavities and measure the canaliculo fenestral angle, we used a special minimally invasive endoscopic procedure. The surface, sectional and 3D CT examinations showed that the Hh specimen was generally more robust and larger than the Hss specimen. It had a large glenoid fossa. The external meatus was wide and deep. The middle ear, and especially the mastoid, was large and widely pneumatized. There were no appreciable differences in the position and size of the labyrinthine spaces and tympanic cavity. The dimensions of the semicircular canals were similar to those of the Hss specimen. Endoscopy revealed normal, healthy tympanic walls and an ossicle fragment in the atticum that probably belonged to the body of the malleus. The diameters of the fallopian duct and the tympanic opening of the Eustachian tube were large. The canaliculo-fenestral angle was approximately 114 degrees

Silicone impression material foreign body in the middle ear: Two case reports and literature review.

PubMed

Suzuki, Nobuyoshi; Okamura, Koji; Yano, Takuya; Moteki, Hideaki; Kitoh, Ryosuke; Takumi, Yutaka; Usami, Shin-ichi

2015-10-01

We report two cases of impression material foreign body in the middle ear. The first case had been affected with chronic otitis media. The silicone flowed into the middle ear through a tympanic membrane perforation during the process of making an ear mold. About 4 years and 8 months after, the patient had severe vertigo and deafness. We found bone erosion of the prominence of the lateral semicircular canal and diagnosed labyrinthitis caused by silicone impression material. In the second case silicone flowed into the canal wall down mastoid cavity. Both cases required surgery to remove the foreign body. The clinical courses in such cases are variable and timing of surgery is sometimes difficult. In addition to reporting these two cases, we present here a review of the literature regarding impression material foreign bodies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Chronic Tuberculous Otomastoiditis: A Case Report.

PubMed

Bruschini, Luca; Ciabotti, Annalisa; Berrettini, Stefano

2016-08-01

Worldwide, tuberculosis is a widespread disease, with 8.7 million new cases occurring annually. Its etiologic agent, Mycobacterium tuberculosis, essentially causes pneumonia. However, this organism affects the middle ear in rare cases, accounting for 0.04-0.09% of all chronic middle ear otitis cases in Western countries. In this report, we describe the case of a young woman affected by tuberculosis of the middle ear. In our experience, empiric therapy was not beneficial. Adequate treatment was possible only after obtaining a specific diagnosis through a difficult process requiring surgical sampling for culture examination. We consider surgical sampling to be mandatory in all cases of chronic otitis media that do not respond to prolonged systemic and local therapies.

Experiments on the mechanism of underwater hearing.

PubMed

Pau, Hans Wilhelm; Warkentin, Mareike; Specht, Olaf; Krentz, Helga; Herrmann, Anne; Ehrt, Karsten

2011-12-01

The findings suggest that underwater sound perception is realized by the middle ear rather than by bone conduction, at least in shallow water conditions. To prove whether underwater sound perception is effected by bone conduction or by conduction via the middle ear. Five divers, breathing through snorkels, were tested in a swimming pool, to determine whether a sound was louder when the acoustic source placed was in front of the head in comparison with a lateral application facing the ear region. The second experiment investigated whether sound perception is influenced by ear protection plugs in underwater conditions. Also, the effect of a 5 mm thick neoprene hood was determined, with and without an additional perforation in the ear region. Sounds were louder when applied from a position laterally facing the ear, louder without than with a protection plug, louder without than with a neoprene hood on, and louder when the neoprene hood had a perforation in the region of the ear than with an intact hood.

Pneumatic low-coherence interferometry otoscope to quantify tympanic membrane mobility and middle ear pressure.

PubMed

Won, Jungeun; Monroy, Guillermo L; Huang, Pin-Chieh; Dsouza, Roshan; Hill, Malcolm C; Novak, Michael A; Porter, Ryan G; Chaney, Eric; Barkalifa, Ronit; Boppart, Stephen A

2018-02-01

Pneumatic otoscopy to assess the mobility of the tympanic membrane (TM) is a highly recommended diagnostic method of otitis media (OM), a widespread middle ear infection characterized by the fluid accumulation in the middle ear. Nonetheless, limited depth perception and subjective interpretation of small TM displacements have challenged the appropriate and efficient examination of TM dynamics experienced during OM. In this paper, a pneumatic otoscope integrated with low coherence interferometry (LCI) was adapted with a controlled pressure-generating system to record the pneumatic response of the TM and to estimate middle ear pressure (MEP). Forty-two ears diagnosed as normal (n = 25), with OM (n = 10), or associated with an upper respiratory infection (URI) (n = 7) were imaged with a pneumatic LCI otoscope with an axial, transverse, and temporal resolution of 6 µm, 20 µm, and 1 msec, respectively. The TM displacement under pneumatic pressure transients (a duration of 0.5 sec with an intensity of ± 150 daPa) was measured to compute two metrics (compliance and amplitude ratio). These metrics were correlated with peak acoustic admittance and MEP from tympanometry and statistically compared via Welch's t- test. As a result, the compliance represents pneumatic TM mobility, and the amplitude ratio estimates MEP. The presence of a middle ear effusion (MEE) significantly decreased compliance (p<0.001). The amplitude ratio of the OM group was statistically less than that of the normal group (p<0.01), indicating positive MEP. Unlike tympanometry, pneumatic LCI otoscopy quantifies TM mobility as well as MEP regardless of MEE presence. With combined benefits of pneumatic otoscopy and tympanometry, pneumatic LCI otoscopy may provide new quantitative metrics for understanding TM dynamics and diagnosing OM.

Pneumatic low-coherence interferometry otoscope to quantify tympanic membrane mobility and middle ear pressure

PubMed Central

Won, Jungeun; Monroy, Guillermo L.; Huang, Pin-Chieh; Dsouza, Roshan; Hill, Malcolm C.; Novak, Michael A.; Porter, Ryan G.; Chaney, Eric; Barkalifa, Ronit; Boppart, Stephen A.

2018-01-01

Pneumatic otoscopy to assess the mobility of the tympanic membrane (TM) is a highly recommended diagnostic method of otitis media (OM), a widespread middle ear infection characterized by the fluid accumulation in the middle ear. Nonetheless, limited depth perception and subjective interpretation of small TM displacements have challenged the appropriate and efficient examination of TM dynamics experienced during OM. In this paper, a pneumatic otoscope integrated with low coherence interferometry (LCI) was adapted with a controlled pressure-generating system to record the pneumatic response of the TM and to estimate middle ear pressure (MEP). Forty-two ears diagnosed as normal (n = 25), with OM (n = 10), or associated with an upper respiratory infection (URI) (n = 7) were imaged with a pneumatic LCI otoscope with an axial, transverse, and temporal resolution of 6 µm, 20 µm, and 1 msec, respectively. The TM displacement under pneumatic pressure transients (a duration of 0.5 sec with an intensity of ± 150 daPa) was measured to compute two metrics (compliance and amplitude ratio). These metrics were correlated with peak acoustic admittance and MEP from tympanometry and statistically compared via Welch’s t-test. As a result, the compliance represents pneumatic TM mobility, and the amplitude ratio estimates MEP. The presence of a middle ear effusion (MEE) significantly decreased compliance (p<0.001). The amplitude ratio of the OM group was statistically less than that of the normal group (p<0.01), indicating positive MEP. Unlike tympanometry, pneumatic LCI otoscopy quantifies TM mobility as well as MEP regardless of MEE presence. With combined benefits of pneumatic otoscopy and tympanometry, pneumatic LCI otoscopy may provide new quantitative metrics for understanding TM dynamics and diagnosing OM. PMID:29552381

Ectopic Mineralization in the Middle Ear and Chronic Otitis Media with Effusion Caused by RPL38 Deficiency in the Tail-short (Ts) Mouse*

PubMed Central

Noben-Trauth, Konrad; Latoche, Joseph R.

2011-01-01

Inflammation of the middle ear cavity (otitis media) and the abnormal deposition of bone at the otic capsule are common causes of conductive hearing impairment in children and adults. Although a host of environmental factors can contribute to these conditions, a genetic predisposition has an important role as well. Here, we analyze the Tail-short (Ts) mouse, which harbors a spontaneous semi-dominant mutation that causes skeletal defects and hearing loss. By genetic means, we show that the Ts phenotypes arise from an 18-kb deletion/insertion of the Rpl38 gene, encoding a ribosomal protein of the large subunit. We show that Ts mutants exhibit significantly elevated auditory-brain stem response thresholds and reduced distortion-product otoacoustic emissions, in the presence of normal endocochlear potentials and typical inner ear histology suggestive of a conductive hearing impairment. We locate the cause of the hearing impairment to the middle ear, demonstrating over-ossification at the round window ridge, ectopic deposition of cholesterol crystals in the middle ear cavity, enlarged Eustachian tube, and chronic otitis media with effusion all beginning at around 3 weeks after birth. Using specific antisera, we demonstrate that Rpl38 is an ∼8-kDa protein that is predominantly expressed in mature erythrocytes. Finally, using an Rpl38 cDNA transgene, we rescue the Ts phenotypes. Together, these data present a previously uncharacterized combination of interrelated middle ear pathologies and suggest Rpl38 deficiency as a model to dissect the causative relationships between neo-ossification, cholesterol crystal deposition, and Eustachian tubes in the etiology of otitis media. PMID:21062742

[Experimental investigations of CO2 laser application in middle ear ossicles].

PubMed

Dazert, S; Russ, D; Mlynski, R; Brors, D; Greiner, A; Aletsee, C; Helms, J

2003-07-01

During the last few years, several laser systems have been applied for procedures in middle ear surgery. In this study, we determined the technical parameters for the dissection of the middle ear ossicles with the CO(2) laser and analyzed the histological findings. The malleus necks of 16 human temporal bones were dissected under standardized conditions using a CO(2) laser with a power output between 35 and 55 kW/cm(2). The specimens were fixed and histological probes of 50- micro m thickness were prepared. The laser outputs led to crater diameters from 0.14 to 0.55 mm. As an analogy between laser energy and thermal tissue destruction, three zones of thermal damage were differentiated: a cinder zone, a carbonization zone, and a zone of dehydration. The metrical dimensions of these zones did not show any correlation to the applied laser energy. The data of this study show that commercially available CO(2) lasers are sufficient for a safe and effective partial resection of middle ear ossicles using a power output of 35 kW/cm(2).

Titanium as a biomaterial for ossicular replacement: results after implantation in the middle ear of the rabbit.

PubMed

Schwager, K

1998-01-01

The middle ear poses unique challenges when finding suitable materials for ossicular reconstruction, primarily because of its link to the external environment via the eustachian tube and, hence, its greater exposure to infectious agents. In this study, the biocompatability of titanium was examined in the middle ear of rabbits by using light and scanning electron microscopy. Implants were placed as middle ear prostheses or as free implants. These were inspected at 28 days, 84 days, 168 days, 336 days and 504 days following implantation for mucosal coverage, percent epithelization and any sign of foreign-body reaction. After 28 days, the prostheses were covered by regular mucosa. Although a majority of the free implants took up to 336 days for complete epithelialization, some of the free implants were not epithelialized even at day 504. There were no inflammatory cells observed on the surface of the material, nor were unusual amounts of fibrous tissue seen. In addition, the titanium material exhibited an affinity toward bone. The results of this animal experiment indicate that titanium is a favorable material for ossicular replacement prostheses.

Wideband reflectance in Down syndrome.

PubMed

Soares, Jordana Costa; Urosas, Juliana Granja; Calarga, Karenina Santos; Pichelli, Tathiany Silva; Limongi, Suelly Cecília Olivan; Shahnaz, Navid; Carvallo, Renata Mota Mamede

2016-08-01

Children with Down syndrome (DS) have a high incidence of middle ear disorders and congenital abnormalities of the external, middle and inner ear. Energy reflectance (ER), a wideband acoustic immittance (WAI) measurement parameter, can measure the sound energy reflected or absorbed in the ear canal over a wider range of frequencies more efficiently and faster than conventional single-tone 226 Hz tympanometry. The aim of the present study was to compare the WAI measurements of children with DS with those of typically developing, normal-hearing children according to their tympanometric findings. Four groups of children with Down syndrome (age range: 2 years and 4 months to 16 years and 3 months; mean age: 8.5 yr) with normal tympanograms (19 ears), flat tympanograms (13 ears), mild negative pressure tympanograms (6 ears between -100 and -199 daPa at the admittance peak) and severe negative pressure tympanograms (4 ears at -200 daPa or lower at the admittance peak) were assessed. All findings were compared with data obtained from 21 ears of a healthy control group (age range: 3 years and 1 month to 13 years and 11 months; mean age: 7.9 yr). The subjects underwent tympanometry with a 226-Hz probe tone frequency and ER measurements along the 200-6,000 Hz range with a chirp stimulus using the Middle-Ear Power Analyzer (MEPA3 - HearID) by Mimosa Acoustics (Champaign, IL), software, version 3.3 [38]. Statistically significant differences were observed in the ER curves for some comparisons between the studied groups. There was also a negative correlation between the static acoustic admittance at the tympanic membrane level and ER measured with a chirp stimulus at 500 and 1,000 Hz. The discriminant analysis technique, which used a chirp stimulus at 1,000 and 1,600 Hz to classify the participants' data based on ER values, achieved a correct classification rate of 59.52% for participants with DS. While groups with abnormal middle ear status, as indicated by tympanometry, showed higher ER values compared to the DS tymp A group and the control group, similar reflectance curves were observed between control group and the DS tymp A group. WAI shows promise as a clinical diagnostic tool in investigating the impact of middle ear disorders in DS group. However, further research is required to investigate this issue in narrower age range group and a larger sample size. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland.

PubMed

Lehtonen, Ville; Lithovius, Riitta H; Autio, Timo J; Sándor, George K; Ylikontiola, Leena P; Harila, Virpi; Pesonen, Paula; Koskinen, Sari; Anttonen, Vuokko

2016-04-01

Middle ear problems are common in cleft patients. This study aimed to determine the need for ventilation tubes (VTs) and complications such as tympanic perforation and cholesteatoma. Data of 156 children with clefts managed in northern Finland spanning 15 years from 1997 to 2011 were collected from 6 hospitals. The following were recorded: birth date, gender, cleft type, surgery timing, surgery type, number of tube insertions, tube material, middle ear findings, and tube placement timing. Clefts were divided into 4 groups: cleft palate (CP), cleft lip and palate (CLP), cleft lip (CL), and submucous cleft palate. The prevalence of middle ear findings was reported. Mucous secretion was noted in 96.8% of CLP patients, 69.2% of CP patients, and 13.0% of CL patients. In all, 82.7% of study group had 1 or more VTs placed during follow-up. All CLP patients required more than 1 VT placement. A total of 94.5% of CP patients required VTs compared to 13.0% of CL patients. In the presence of residual oral nasal fistula, the mean number of tube insertions was 5.3. The prevalence of tympanic perforations in clefts was 35.9% and cholesteatoma in 2.6% of patients. CLP and isolated CP patients have frequent middle ear infections requiring multiple VT placements. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Hearing rehabilitation with single-stage bilateral vibroplasty in a child with Franceschetti syndrome.

PubMed

Sargsyan, Sona; Rahne, Torsten; Kösling, Sabrina; Eichler, Gerburg; Plontke, Stefan K

2014-05-01

Hearing is of utmost importance for normal speech and social development. Even children who have mild or unilateral permanent hearing loss may experience difficulties with understanding speech, as well as problems with educational and psycho-social development. The increasing advantages of middle-ear implant technologies are opening new perspectives for restoring hearing. Active middle-ear implants can be used in children and adolescents with hearing loss. In addition to the well-documented results for improving speech intelligibility and quality of hearing in sensorineural hearing loss active middle-ear implants are now successfully used in patients with conductive and mixed hearing loss. In this article we present a case of successful, single-stage vibroplasty, on the right side with the fixation of the FMT on the stapes and PORP CLiP vibroplasty on the left side in a 6-year-old girl with bilateral mixed hearing loss and multiple dyslalia associated with Franceschetti syndrome (mandibulofacial dysostosis). CT revealed bilateral middle-ear malformations as well as an atretic right and stenotic left external auditory canal. Due to craniofacial dysmorphia airway and (post)operative, management is significantly more difficult in patients with a Franceschetti syndrome which in this case favoured a single-stage bilateral procedure. No intra- or postoperative surgical complications were reported. The middle-ear implants were activated 4 weeks after surgery. In the audiological examination 6 months after surgery, the child showed 100% speech intelligibility with activated implants on each side.

Comparison between the angle of Eustachian tube in patients with chronic suppurative otitis media and normal ears based on computed tomography scan of temporal bones in Haji Adam Malik general hospital Medan

NASA Astrophysics Data System (ADS)

Masita, S.; Zahara, D.; Aboet, A.

2018-03-01

The function of the Eustachian tube plays a significant role in increased risk chronic suppurative otitis media (CSOM). The angle of the Eustachian tube is a predisposing factor for Eustachian tube dysfunction and clearance disorder of the middle ear. The aim of this study was to compare the mean angle of a Eustachian tube of CSOM ears and normal ears. This research was a cross-sectional study consisting of 19 patients of CSOM without cholesteatoma, 19 patients of CSOM with cholesteatoma and 19 patients with normal ears. All patients were examined using CT Temporal, and the angle of the eustachian tube was measured using multiplanar reconstruction technique. The mean angle of Eustachian tube in CSOM patients without cholesteatoma was 32.82° (SD=3.82), in CSOM with cholesteatoma was 27.74° (SD=4.44) and in normal ears was 33.61° (SD=3.83). Based on Kruskal-Wallis test, there was a significant difference in the angle of a Eustachian tube of these three groups (p<0.001). There was a significant difference between the mean angle of the Eustachian tube in CSOM ears and normal ears.

Leupeptin reduces impulse noise induced hearing loss

PubMed Central

2011-01-01

Background Exposure to continuous and impulse noise can induce a hearing loss. Leupeptin is an inhibitor of the calpains, a family of calcium-activated proteases which promote cell death. The objective of this study is to assess whether Leupeptin could reduce the hearing loss resulting from rifle impulse noise. Methods A polyethelene tube was implanted into middle ear cavities of eight fat sand rats (16 ears). Following determination of auditory nerve brainstem evoked response (ABR) threshold in each ear, the animals were exposed to the noise of 10 M16 rifle shots. Immediately after the exposure, saline was then applied to one (control) ear and non-toxic concentrations of leupeptin determined in the first phase of the study were applied to the other ear, for four consecutive days. Results Eight days after the exposure, the threshold shift (ABR) in the control ears was significantly greater (44 dB) than in the leupeptin ears (27 dB). Conclusion Leupeptin applied to the middle ear cavity can reduce the hearing loss resulting from exposure to impulse noise. PMID:22206578

An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening.

PubMed

Weber, Brittany C; Whitlock, Scott M; He, Kaidi; Kimbrell, Blake S; Derkay, Craig S

2018-04-12

To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS. 85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date. At the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL. An effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation. Copyright © 2018 Elsevier Inc. All rights reserved.

Real-time automated thickness measurement of the in vivo human tympanic membrane using optical coherence tomography

PubMed Central

Hubler, Zita; Shemonski, Nathan D.; Shelton, Ryan L.; Monroy, Guillermo L.; Nolan, Ryan M.

2015-01-01

Background Otitis media (OM), an infection in the middle ear, is extremely common in the pediatric population. Current gold-standard methods for diagnosis include otoscopy for visualizing the surface features of the tympanic membrane (TM) and making qualitative assessments to determine middle ear content. OM typically presents as an acute infection, but can progress to chronic OM, and after numerous infections and antibiotic treatments over the course of many months, this disease is often treated by surgically inserting small tubes in the TM to relieve pressure, enable drainage, and provide aeration to the middle ear. Diagnosis and monitoring of OM is critical for successful management, but remains largely qualitative. Methods We have developed an optical coherence tomography (OCT) system for high-resolution, depth-resolved, cross-sectional imaging of the TM and middle ear content, and for the quantitative assessment of in vivo TM thickness including the presence or absence of a middle ear biofilm. A novel algorithm was developed and demonstrated for automatic, real-time, and accurate measurement of TM thickness to aid in the diagnosis and monitoring of OM and other middle ear conditions. The segmentation algorithm applies a Hough transform to the OCT image data to determine the boundaries of the TM to calculate thickness. Results The use of OCT and this segmentation algorithm is demonstrated first on layered phantoms and then during real-time acquisition of in vivo OCT from humans. For the layered phantoms, measured thicknesses varied by approximately 5 µm over time in the presence of large axial and rotational motion. In vivo data also demonstrated differences in thicknesses both spatially on a single TM, and across normal, acute, and chronic OM cases. Conclusions Real-time segmentation and thickness measurements of image data from both healthy subjects and those with acute and chronic OM demonstrate the use of OCT and this algorithm as a robust, quantitative, and accurate method for use during real-time in vivo human imaging. PMID:25694956

Real-time automated thickness measurement of the in vivo human tympanic membrane using optical coherence tomography.

PubMed

Hubler, Zita; Shemonski, Nathan D; Shelton, Ryan L; Monroy, Guillermo L; Nolan, Ryan M; Boppart, Stephen A

2015-02-01

Otitis media (OM), an infection in the middle ear, is extremely common in the pediatric population. Current gold-standard methods for diagnosis include otoscopy for visualizing the surface features of the tympanic membrane (TM) and making qualitative assessments to determine middle ear content. OM typically presents as an acute infection, but can progress to chronic OM, and after numerous infections and antibiotic treatments over the course of many months, this disease is often treated by surgically inserting small tubes in the TM to relieve pressure, enable drainage, and provide aeration to the middle ear. Diagnosis and monitoring of OM is critical for successful management, but remains largely qualitative. We have developed an optical coherence tomography (OCT) system for high-resolution, depth-resolved, cross-sectional imaging of the TM and middle ear content, and for the quantitative assessment of in vivo TM thickness including the presence or absence of a middle ear biofilm. A novel algorithm was developed and demonstrated for automatic, real-time, and accurate measurement of TM thickness to aid in the diagnosis and monitoring of OM and other middle ear conditions. The segmentation algorithm applies a Hough transform to the OCT image data to determine the boundaries of the TM to calculate thickness. The use of OCT and this segmentation algorithm is demonstrated first on layered phantoms and then during real-time acquisition of in vivo OCT from humans. For the layered phantoms, measured thicknesses varied by approximately 5 µm over time in the presence of large axial and rotational motion. In vivo data also demonstrated differences in thicknesses both spatially on a single TM, and across normal, acute, and chronic OM cases. Real-time segmentation and thickness measurements of image data from both healthy subjects and those with acute and chronic OM demonstrate the use of OCT and this algorithm as a robust, quantitative, and accurate method for use during real-time in vivo human imaging.

Comparison of effects of dry versus wet swallowing on Eustachian tube function via a nine-step inflation/deflation test.

PubMed

Adali, M Kemal; Uzun, Cem

2005-09-01

The aim of the present study is to evaluate the effect of swallowing type (dry versus wet) on the outcome of a nine-step inflation/deflation tympanometric Eustachian tube function (ETF) test in healthy adults. Fourteen normal healthy volunteers, between 19 and 28 years of age, were included in the study. The nine-step test was performed in two different test procedures: (1) test with dry swallows (dry test procedure) and (2) test with liquid swallows (wet test procedure). If the equilibration of middle-ear (ME) pressure was successful in all the steps of the nine-step test, ETF was considered 'Good'. Otherwise, the test was considered 'Poor', and the test was repeated at a second session. In the dry test procedure, ETF was 'Good' in 21 ears at the first session and in 24 ears after the second session (p > 0.05). However, in the wet test procedure, ETF was 'Good' in 13 ears at the first session and in 21 ears after the second session (p < 0.05). At the first session, ETF was 'Good' in 21 and 13 ears in the dry and wet test procedures, respectively. The difference was statistically significant (p < 0.05). However, after the second session, the overall number of ears with 'Good' tubal function was almost the same in both test procedures (24 ears at dry test procedures versus 21 ears at wet test procedures;p > 0.05). Dry swallowing seems to be more effective for the equilibration of ME pressure. Thus, a single-session dependent evaluation of ETF may be efficient for the dry test procedure of the nine-step test. Swallowing with water may be easier for subjects, but a repetition of the test at a second session may be necessary when the test result is 'Poor'.

Polymorphisms in Toll-like receptors 2 and 4 genes and their expression in chronic suppurative otitis media.

PubMed

Jotic, Ana; Jesic, Snezana; Zivkovic, Maja; Tomanovic, Nada; Kuveljic, Jovana; Stankovic, Aleksandra

2015-12-01

Toll-like receptors (TLRs) have a prominent role in inducing innate immune response. It has been suggested that regulation of TLRs is involved in the pathogenesis of chronic otitis media. TLR 2 and TLR 4 polymorphisms were connected with susceptibility to acute otitis and chronic otitis with effusion. The objective of this study was to establish expression of TLR 2 and 4 on middle ear mucosa in different types of chronic suppurative otitis media (CSOM), and the influence of gene polymorphisms TLR 2 Arg753Gln and TLR 4 Thr399Ile and Asp299Gly to susceptibility to CSOM. Middle ear mucosa and full blood samples were obtained from 85 patients with chronic suppurative otitis media with and without cholesteatoma. Control group for mucosal TLR expression consisted of 71 samples of middle ear mucosa taken from patients with otosclerosis, and control group for DNA polymorphism consisted of 100 full blood samples in healthy subjects. DNA polymorphism detection was done with restriction fragment length polymorphism in RT PCR. Expression of TLR 2 and 4 was determined with immunohistochemical staining. TLR 2 and TLR 4 expression on the middle ear mucosa was not influenced by age of the patients with chronic otitis media. Incidence of TLR 2 Arg753Gln polymorphism was significantly higher in patients with chronic otitis media, compared to control group. Significant association between TLR 2 Arg753Gln polymorphism and different types of mucosal changes in patients with chronic otitis media was established. TLR 2 and 4 expression on experimental group mucosa was significantly different compared to control group, where there was no expression (p=0.000). Strong dependence of TLR 2 and TLR 4 expression on middle ear mucosa with different mucosal changes and immunohistochemical activity after staining was detected. Certain polymorphisms in TLR genes could be indicative for susceptibility to chronic otitis media. Expression of TLR 2 and 4 on middle ear mucosa was more dependable on different types of mucosal changes and type of CSOM than on bacteria found in the specimens. This can indicate that the type of mucosal changes are closely correlated with TLRs activity in middle ear. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Penicillin reduces eustachian tube gland tissue changes in acute otitis media.

PubMed

Andersen, Henrik; Thomsen, Jens; Cayé-Thomasen, Per

2005-08-01

The volume of the mucous paratubal glands and the number of the mucus-producing goblet cells in the middle ear and Eustachian tube (ET) are increased after experimental acute otitis media (AOM). The present investigation examines a potential effect of penicillin on the changes in goblet cell density and gland structures of the ET during and after AOM. Middle ear inoculation of Streptococcus pneumoniae in 50 rats. Two days later, 25 rats were given penicillin V as one daily dose for 5 days. Twenty-five rats received no treatment. Five animals from each group were sacrificed on days 4, 8, 16, 90, and 180. The ET was dissected and decalcified, followed by paraffin embedding, serial transverse sectioning, and PAS/alcian blue staining. The goblet cell density and the paratubal gland composition and volume were determined in every 20th section, using a light microscope. Penicillin reduced the increase of goblet cell density from day 8 and through 6 months, whereas the increase of the paratubal mucous gland volume was unaffected by treatment. We conclude that penicillin reduces the increase of ET goblet cell density during and after acute otitis media, whereas the paratubal gland volume remains unaffected. An increased mucosal secretory capacity and indicated excessive secretion of mucus may contribute to the deteriorated ET function found after AOM and thus predispose, sustain, or aggravate middle ear disease. This may be prevented by penicillin treatment.

Finite element modelling of sound transmission from outer to inner ear.

PubMed

Areias, Bruno; Santos, Carla; Natal Jorge, Renato M; Gentil, Fernanda; Parente, Marco Pl

2016-11-01

The ear is one of the most complex organs in the human body. Sound is a sequence of pressure waves, which propagates through a compressible media such as air. The pinna concentrates the sound waves into the external auditory meatus. In this canal, the sound is conducted to the tympanic membrane. The tympanic membrane transforms the pressure variations into mechanical displacements, which are then transmitted to the ossicles. The vibration of the stapes footplate creates pressure waves in the fluid inside the cochlea; these pressure waves stimulate the hair cells, generating electrical signals which are sent to the brain through the cochlear nerve, where they are decoded. In this work, a three-dimensional finite element model of the human ear is developed. The model incorporates the tympanic membrane, ossicular bones, part of temporal bone (external auditory meatus and tympanic cavity), middle ear ligaments and tendons, cochlear fluid, skin, ear cartilage, jaw and the air in external auditory meatus and tympanic cavity. Using the finite element method, the magnitude and the phase angle of the umbo and stapes footplate displacement are calculated. Two slightly different models are used: one model takes into consideration the presence of air in the external auditory meatus while the other does not. The middle ear sound transfer function is determined for a stimulus of 60 dB SPL, applied to the outer surface of the air in the external auditory meatus. The obtained results are compared with previously published data in the literature. This study highlights the importance of external auditory meatus in the sound transmission. The pressure gain is calculated for the external auditory meatus.

Micro-endoscopic ear anatomy of guinea pig applied to experimental surgery.

PubMed

Barros, Bruno Borges de Carvalho; Andrade, José Santos Cruz de; Garcia, Leandro Borborema; Pifaia, Gustavo Ribeiro; Cruz, Oswaldo Laércio Mendonça; Onishi, Ektor Tsuneo; Penido, Norma de Oliveira

2014-01-01

To describe topographic and endoscopic anatomy of guinea pig ear for development of surgical approaches in experimental studies. Experimental study. Eight adult guinea pigs (Cavia porcellus) were used in this study. Four animals were described through endoscopic view and four animals were used to describe topographic anatomy. The main structures of middle ear were well identified through endoscopy view: oval and round window, ossicles and vascular structures. Temporal bone position, landmarks and its relations to skull are perceived with topographic description. Topographic anatomic description allowed exposition of temporal bone relations for external surgical approaches. Alternatively, grooves and middle ear structures were identified and may be used to transcanal accesses.

The effect of middle ear cavity and superior canal dehiscence on wideband acoustic immittance in fresh human cadaveric specimens

NASA Astrophysics Data System (ADS)

Masud, Salwa F.; Raufer, Stefan; Neely, Stephen T.; Nakajima, Hideko H.

2018-05-01

Superior canal dehiscence (SCD) is a hole in the bony wall of the superior semicircular canal, which can cause various auditory and/or vestibular symptoms and can result in wrong and/or delayed diagnosis. Wideband acoustic immittance (WAI) can potentially distinguish various mechanical middle-ear pathologies as well as inner-ear pathologies non-invasively. We found that in patients, SCD was commonly associated with a narrow-band decrease in power reflectance (PR, derived from WAI) near 1 kHz. Because clinical data has large variation across individual ears and because we do not know the individual "normal" state prior to SCD, we measured WAI in five fresh temporal bone specimens to determine the effects of SCD with respect to the normal state. In temporal bone, we measured PR to assess mechanical changes before and after SCD, as well as to assess the effect of an open or closed middle-ear cavity. After SCD, PR had a consistent decrease between 0.48 and 0.76 kHz, and a slight increase between 1.04 and 1.4 kHz in the open cavity condition. However, in several experiments, we observed low PR around 1 kHz in the normal state before SCD, likely due to the specimen's open middle ear cavity (MEC). Because we see effects of both SCD and open MEC around 1 kHz, some of the SCD effect can be masked by the effect of the MEC in the temporal bone specimens. To compensate for this MEC effect, we estimated the effect of SCD in a closed MEC case, but the effect did not differ significantly from the measured open MEC. This study demonstrates the limitation of temporal bone experiments with open MEC when studying inner-ear lesions with WAI.

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

PubMed Central

Voss, Susan E.; Rosowski, John J.; Merchant, Saumil N.; Peake, William T.

2008-01-01

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, PTM; (2) in the tympanic cavity lateral to the oval window, POW; and (3) near the round window, PRW. Sound transmission via the acoustic route is described by two concatenated processes: (1) coupling of sound pressure from ear canal to middle-ear cavity, HPCAV≡PCAV/PTM, where PCAV represents the middle-ear cavity pressure, and (2) sound-pressure difference between the windows, HWPD≡(POW−PRW)/PCAV. Results show that: HPCAV depends on perforation size but not perforation location; HWPD 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 HPCAV and HWPD can be interpreted in terms of a structure-based lumped-element acoustic model of the perforation and middle-ear cavities. PMID:17902851

Contralateral Dpoae Suppression in Humans at Very Low Sound Intensities

NASA Astrophysics Data System (ADS)

Janssen, T.; Gehr, D. D.; Kevanishvili, Z.

2003-02-01

Different functions are attributed to the olivo-cochlear bundle system (OCBS) such as protecting the ear from acoustic injury, improving signal detection in noise, and mediating selective attention. OCBS reflex strength can be evaluated, in animals as well as in humans, by measuring the degree of suppression of an ipsilateral DPOAE by a contralateral sound. The purpose of the study was to evaluate OCBS reflex strength depending on ipsilateral stimulus level, especially at threshold, by means of extrapolated DPOAE I/O-functions. Additionally, DPOAE was measured at near-to-threshold contralateral stimulus levels when using low-level ipsilateral stimulation for investigating possible enhancement of outer hair cell motion in the presence of low-level contralateral sound. The recording of the 2f1-f2 DPOAE in the presence or absence of contralateral sound was performed in normally hearing human subjects at f2 = 2 kHz. DPOAE I/O-functions were measured in a primary tone level range from L2 = 20 to L2 = 65 dB SPL (L1 = 0.4L2 + 39, f2/f1=1.2). Broad-band noise (BBN), narrow-band noise from 1720 to 2320 Hz (NBN), and pure tones (PT) at f2, 2f1-f2, geometric mean of f1 and f2, and 0.1oct + f2 were used for contralateral stimulation. The contralateral stimulus level (Ls) was decreased from 70 down to 10 dB SPL in 10 dB steps. DPOAE suppression was highest at the lowest primary tone level and was more pronounced for BBN and NBN than for pure tones, suggesting a more diffuse than a strong tonotopic organisation of the OCBS. The contralateral stimulus level at which significant DPOAE suppression occurred (p < 0.05) was different for the different stimuli being 20, 40, and 70 dB SPL for BBN, NBN, and pure-tone (f2), respectively. Significant DPOAE suppression to BBN and NBN occurred at Ls well below audiological middle-ear reflex threshold. DPOAE time course was different for Ls below and above middle-ear reflex threshold. Thus, middle-ear muscle contraction is suggested not to be involved in DPOAE suppression at low Ls. No enhancement of DPOAE could be found. The findings suggest the OCBS to be functioning in a more protective way than for improving signal detection in noise.

A New Intraoperative Real-time Monitoring System for Reconstructive Middle Ear Surgery: An Experimental and Clinical Feasibility Study.

PubMed

Zahnert, Thomas; Metasch, Marie-Luise; Seidler, Hannes; Bornitz, Matthias; Lasurashvili, Nicoloz; Neudert, Marcus

2016-12-01

Electromagnetical excitation of ossicular vibration is suitable for middle ear transmission measurements in the experimental and clinical setting. Thereby, it can be used as a real-time monitoring system for quality control in ossiculoplasty. Positioning and coupling of middle ear prosthesis are a precondition for good postoperative hearing results, but at the same time completely dependent upon the surgeon's subjective judgment during surgery. We evaluated an electromagnetically driven measurement system that enables for in vitro and in vivo transmission measurements and thus can be used as a real-time monitoring tool in ossicular reconstruction. For electromagnetical excitation a magnet was placed on the umbo of the malleus handle and driven by a magnetic field. The induced stapes displacement was picked up by laser Doppler vibrometry on the footplate. Measurements were performed on the intact ossicular chain in five cadaveric temporal bones and during five cochlear implant surgeries. Additionally, two ossiculoplasties were performed under real-time transmission feedback with the monitoring system. Experimentally, the equivalent sound pressure level of the electromagnetic excitation was about 70 to 80 dB which is 10 to 20 dB less than the acoustic stimulation. In the intraoperative setup the generated stapes displacements were about 5 to 20 dB smaller compared with the temporal bone experiments. Applied as real-time feedback system, an improvement in the middle ear transfer function of 4.5 dB in total and 20 dB in partial ossicular reconstruction were achieved. The electromagnetical excitation and measurement system is comparable to the gold standard with acoustical stimulation in both, the experimental setup in temporal bones as well as in vivo. The technical feasibility of the electromagnetical excitation method has been proven and it is shown that it can be used as a real-time monitoring system for ossiculoplasty in the operation room.

Pediatric Obesity and Ear, Nose, and Throat Disorders

MedlinePlus

... Although there is no proven medical link between middle ear infections and pediatric obesity there may be a behavioral association between the two conditions. Some studies have found that when a child is rubbing or massaging the infected ear the ...

PubMed Central

BOZZOLA, E.; VILLANI, A.; MARSELLA, P.

2015-01-01

SUMMARY This report focuses on tuberculous otomastoiditis treated at a third level Italian paediatric hospital. We reviewed the clinical charts of 4077 children who underwent middle ear surgery at the Audiology and Otology Unit of the Institution's ENT Department from January 1995 to December 2011. A tubercular aetiology was identified in 2 cases: a 4-year old boy who presented with primary ear involvement, i.e. with no other infected sites but the middle ear, and a 5-year old girl with secondary tuberculous otomastoidits, who was treated for pulmonary and mediastinal tuberculosis at the age of 7 months. PMID:26019398

Diagnostic and surgical challenge: middle ear dermoid cyst in 12 month old with branchio-oto-renal syndrome and multiple middle-ear congenital anomalies.

PubMed

Johnston, D R; Whittemore, K; Poe, D; Robson, C D; Perez-Atayde, A R

2011-10-01

Described is the first case report, to our knowledge, of a middle-ear dermoid in a child with branchio-oto-renal (BOR) syndrome. Radiographic, pathologic, and intraoperative figures are shown. This was a diagnostic and surgical challenge as the presentation was similar to a congenital cholesteatoma and the child had numerous significant temporal bone abnormalities. After the intraoperative findings suggested a non-destructive process, the treatment strategy was altered. This case reiterates the need for a cautious, flexible operative approach in a syndromic child. Included is a relevant review of the literature and a detailed clinical analysis. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Middle and inner ear malformations in mutation-proven branchio-oculo-facial (BOF) syndrome: case series and review of the literature.

PubMed

Carter, Melissa T; Blaser, Susan; Papsin, Blake; Meschino, Wendy; Reardon, Willie; Klatt, Regan; Babul-Hirji, Riyana; Milunsky, Jeff; Chitayat, David

2012-08-01

Hearing impairment is common in individuals with branchio-oculo-facial (BOF) syndrome. The majority of described individuals have conductive hearing impairment due to malformed ossicles and/or external canal stenosis or atresia, although a sensorineural component to the hearing impairment in BOF syndrome is increasingly being reported. Sophisticated computed tomography (CT) of the temporal bone has revealed middle and inner ear malformations in three previous reports. We present middle and inner ear abnormalities in three additional individuals with mutation-proven BOF syndrome. We suggest that temporal bone CT imaging be included in the medical workup of a child with BOF syndrome, in order to guide management. Copyright © 2012 Wiley Periodicals, Inc.

Clinical anatomy of the chorda tympani: a systematic review.

PubMed

McManus, L J; Dawes, P J D; Stringer, M D

2011-11-01

The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults. Systematic literature review. Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts. The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions. A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury.

Wideband acoustic absorbance in children with Down syndrome.

PubMed

Durante, Alessandra Spada; Santos, Mayara; Roque, Nayara M C de F; Gameiro, Marcella S; Almeida, Katia de; Sousa Neto, Osmar Mesquita de

2018-01-10

Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. With the 226Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520Hz (p=0.008) for those with normal tympanometry results, and 226-4000Hz (p<0.03) for those with a Type B tympanometry curve. The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Békésy's contributions to our present understanding of sound conduction to the inner ear.

PubMed

Puria, Sunil; Rosowski, John J

2012-11-01

In our daily lives we hear airborne sounds that travel primarily through the external and middle ear to the cochlear sensory epithelium. We also hear sounds that travel to the cochlea via a second sound-conduction route, bone conduction. This second pathway is excited by vibrations of the head and body that result from substrate vibrations, direct application of vibrational stimuli to the head or body, or vibrations induced by airborne sound. The sensation of bone-conducted sound is affected by the presence of the external and middle ear, but is not completely dependent upon their function. Measurements of the differential sensitivity of patients to airborne sound and direct vibration of the head are part of the routine battery of clinical tests used to separate conductive and sensorineural hearing losses. Georg von Békésy designed a careful set of experiments and pioneered many measurement techniques on human cadaver temporal bones, in physical models, and in human subjects to elucidate the basic mechanisms of air- and bone-conducted sound. Looking back one marvels at the sheer number of experiments he performed on sound conduction, mostly by himself without the aid of students or research associates. Békésy's work had a profound impact on the field of middle-ear mechanics and bone conduction fifty years ago when he received his Nobel Prize. Today many of Békésy's ideas continue to be investigated and extended, some have been supported by new evidence, some have been refuted, while others remain to be tested. Copyright © 2012 Elsevier B.V. All rights reserved.

Measurement of the Three-Dimensional Vibration Motion of the Ossicular Chain in the Living Gerbil

NASA Astrophysics Data System (ADS)

Decraemer, Willem F.; de La Rochefoucauld, Ombeline; Olson, Elizabeth S.

2011-11-01

In previous studies 3D motion of the middle-ear ossicles in cat and human temporal bone were explored but models for hearing research has shifted in the last decades to smaller mammals and gerbil in particular has become a hearing model of first choice. In the present study we have measured with an optical interferometer the 3D motion of the malleus and incus in anesthetized gerbil for sound of moderate intensity (90 dB SPL) in a broad frequency range. To access the malleus and incus the pars flaccida was completely removed exposing the neck and head of the malleus and the incus from the malleus-incus joint to the long process of the incus and the plate of the lenticular process. In a previous study an approach through a hole in the bullar wall was used to study the stapes motion so that we now have a complete picture of the middle ear motion. In both approaches vibration measurements were done at 6 to 7 points per ossicle while the angle of observation was varied over approximately 30 degrees to enable calculation of the 3D velocity components. Knowledge of middle ear motion is of great importance in understanding how the middle ear transforms the acoustical input from the ear canal to the cochlea.

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

PubMed Central

Christensen-Dalsgaard, Jakob; Brandt, Christian; Willis, Katie L.; Christensen, Christian Bech; Ketten, Darlene; Edds-Walton, Peggy; Fay, Richard R.; Madsen, Peter T.; Carr, Catherine E.

2012-01-01

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. PMID:22438494

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

PubMed

Christensen-Dalsgaard, Jakob; Brandt, Christian; Willis, Katie L; Christensen, Christian Bech; Ketten, Darlene; Edds-Walton, Peggy; Fay, Richard R; Madsen, Peter T; Carr, Catherine E

2012-07-22

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.

Bone conduction responses of middle ear structures in Thiel embalmed heads

NASA Astrophysics Data System (ADS)

Arnold, Andreas; Stieger, Christof; Caversaccio, Marco; Kompis, Martin; Guignard, Jérémie

2015-12-01

Thiel-embalmed human whole-head specimens offer a promising alternative model for bone conduction (BC) studies of middle ear structures. In this work we present the Thiel model's linearity and stability over time as well as its possible use in the study of a fixed ossicle chain. Using laser Doppler vibrometry (LDV), the motion of the retroauricular skull, the promontory, the stapes footplate and the round window (RW) were measured. A bone-anchored hearing aid stimulated the ears with step sinus tones logarithmically spread between 0.1 and 10 kHz. Linearity of the model was verified using input levels in steps of 10 dBV. The stability of the Thiel model over time was examined with measurements repeated after hours and weeks. The influence of a cement-fixed stapes was assessed. The middle ear elements measured responded linearly in amplitude for the applied input levels (100, 32.6, and 10 mV). The variability of measurements for both short- (2 h) and long-term (4-16 weeks) repetitions in the same ear was lower than the interindividual difference. The fixation of the stapes induced a lowered RW displacement for frequencies near 750 Hz (-4 dB) and an increased displacement for frequencies above 1 kHz (max. +3.7 dB at 4 kHz). LDV assessment of BC-induced middle ear motion in Thiel heads can be performed with stable results. The vibratory RW response is affected by the fixation of the stapes, indicating a measurable effect of ossicle chain inertia on BC response in Thiel embalmed heads.

Growth hormone treatment does not affect incidences of middle ear disease or hearing loss in infants and toddlers with Turner syndrome.

PubMed

Davenport, Marsha L; Roush, Jackson; Liu, Chunhua; Zagar, Anthony J; Eugster, Erica; Travers, Sharon; Fechner, Patricia Y; Quigley, Charmian A

2010-01-01

No randomized, controlled, prospective study has evaluated the effect of growth hormone (GH) on the rates of middle ear (ME) disease and hearing loss in girls with Turner syndrome (TS). A 2-year, prospective, randomized, controlled, open-label, multicenter, clinical trial ('Toddler Turner Study'; August 1999 to August 2003) was carried out. The study was conducted at 11 US pediatric endocrine centers. Eighty-eight girls with TS, aged 9 months to 4 years, were enrolled. The interventions comprised recombinant GH (50 microg/kg/day, n = 45) or no treatment (n = 43) for 2 years. The outcome measures included occurrence rates of ear-related problems, otitis media (OM) and associated antibiotic treatments, tympanometric assessment of ME function and hearing assessment by audiology. At baseline, 57% of the girls (mean age = 1.98 +/- 1.00 years) had a history of recurrent OM, 33% had undergone tympanostomy tube (t-tube) insertion and 27% had abnormal hearing. There was no significant difference between the treatment groups for annual incidence of OM episodes (untreated control: 1.9 +/- 1.4; GH-treated: 1.5 +/- 1.6, p = 0.17). A quarter of the subjects underwent ear surgeries (mainly t-tube insertions) during the study. Recurrent or persistent abnormality of ME function on tympanometry was present in 28-45% of the girls without t-tubes at the 6 postbaseline visits. Hearing deficits were found in 19-32% of the girls at the annual postbaseline visits. Most of these were conductive deficits, however, 2 girls had findings consistent with sensorineural hearing loss, which was evident before 3 years of age. Ear and hearing problems are common in infants and toddlers with TS and are not significantly influenced by GH treatment. Girls with TS need early, regular and thorough ME monitoring by their primary care provider and/or otolaryngologist, and at least annual hearing evaluations by a pediatric audiologist. Copyright 2010 S. Karger AG, Basel.

Infectious complications of pediatric cochlear implants are highly influenced by otitis media.

PubMed

Vila, Peter M; Ghogomu, Nsangou T; Odom-John, Audrey R; Hullar, Timothy E; Hirose, Keiko

2017-06-01

Determine the incidence of ear infections in cochlear implant patients, evaluate the contribution of otitis media to complications, describe the bacteriology of otitis media in the cochlear implant population, the treatment provided at our center, and the long term outcome. Data collected included age at implantation, history of otitis media or ear tubes, etiology of hearing loss, inner ear anatomy, postoperative infections, time to infection, route of antibiotic administration, and interventions for infections. Categories of infection were acute otitis media, otitis media with effusion, tube otorrhea, meningitis, scalp cellulitis, and infection at the implant site. Middle ear infections were diagnosed in 37% of implanted ears. Extension of middle ear infections into the implant site occurred in 2.8% of all implants (n = 16). Of the 16 infected devices, 10 were successfully treated with antibiotic therapy and did not require explantation. The retained implant group and explanted group both included some middle ear microbes such as Haemophilus influenzae and Streptococcus pneumoniae, as well as skin flora such as Staphylococcus aureus. Otitis media in pediatric cochlear implant patients is a common event and usually does not lead to complications of the cochlear implant. However, when the ear infection spreads to the scalp and the implant site, it is still possible to eliminate the infection using antibiotic therapy, particularly when treatment is directed to the specific organism that is recovered from the infected space and the duration and route of antibiotic treatment is carefully considered. Copyright © 2017 Elsevier B.V. All rights reserved.

Preservation of vestibular function after scala vestibuli cochlear implantation.

PubMed

Suzuki, Mitsuya; Goto, Takio; Kashio, Akinori; Yasui, Takuya; Sakamoto, Takashi; Ito, Ken; Yamasoba, Tatsuya

2011-10-01

A 58-year-old man, in whom the cochlear implant (CI) had been inserted into the left ear, had right middle-ear cancer. The CI was removed immediately before receiving subtotal removal of right temporal bone. Four months later, the CI was again inserted in his left cochlea. Because of obliterated scala tympani, the 22 active electrodes of the CI were placed into the scala vestibuli. After the surgery, the patient complained that he experienced rotary vertigo and "jumbling of vertical direction" of objects on walking. Using rotation test, we evaluated vestibular function of remaining left ear. Numerous horizontal nystagmus beats were induced during earth-vertical axis rotation, whereas vertical downbeat nystagmus was scarcely induced during off-vertical axis rotation. The horizontal vestibulo-ocular reflex (VOR) was almost normally induced by sinusoidal stimulation at 0.8Hz. These data suggest that the scala vestibuli insertion of CI would be not so invasive against the lateral semicircular canal. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Histological study of the external, middle and inner ear of horses.

PubMed

Blanke, A; Aupperle, H; Seeger, J; Kubick, C; Schusser, G F

2015-12-01

Clinical, anatomical and histological aspects of the equine acoustic organ have been poorly investigated and illustrated in literature so far. It is understood that an intact acoustic organ and hearing function are of vital importance for the well-being of flight animals like horses. The knowledge of the acoustic organ is usually transferred analogously from other mammals to horses. The purpose of this study was to provide a detailed and complete histological description of the healthy equine auditory organ, and to determine its congruity to other mammalians. Anatomical dissections and histological preparations were carried out on ten cadaver heads. Specimens of various parts of the equine acoustic organ were taken and evaluated histologically. The histological composition of external, middle and inner ear structures are predominantly congruent to those of other mammals, especially to human beings. Unique inwardly directed rete pegs within the osseous ear canal and the prominent tensor tympani muscle are described for the first time. Results obtained in this study can be employed as references for further research on the equine acoustic organ and improve the understanding of the clinical development of hearing loss, otitis externa/media/interna or tympanosclerosis. © 2014 Blackwell Verlag GmbH.

A melting method for RNA extraction from the mucosal membrane of the mouse middle ear.

PubMed

Seo, Young Joon; Kim, Sung Huhn; Moon, In Seok; Choi, Jae Young

2015-03-01

There is much confusion surrounding the methods of RNA extraction from the middle ear mucosa of mice. In this study, we worked to develop a "melting method," which is faster, purer, and more reliable than other methods in common use. Thirty-two ears were used for this study. Light microscopy with hematoxylin-eosin staining of the bullae, scanning electron microscopy (SEM), spectrophotometer analysis, and reverse transcription polymerase chain reaction were performed before and after melting the half lateral bullae, which were detached from the temporal bone by using a lateral retroauricular approach. Each resected half bulla contained a well distributed mucosal membrane. After a TRIzol melting duration of 10-30 minutes, only mucosal marker (MUC5AC) was expressed without bony marker (total osteocalcin). The same results were determined from SEM. This melting method, compared with stripping and irrigation methods, is effective and offers an easier, more robust approach to extracting RNA from the middle ear mucosal membranes of mice.

Perilymphatic fistula in cabin attendants: an incapacitating consequence of flying with common cold.

PubMed

Klokker, Mads; Vesterhauge, Søren

2005-01-01

A perilymphatic fistula (PLF) is an abnormal communication between the inner ear and the middle ear that leaks perilymph. PLF is considered rare, but is known to occur during childbirth, straining, weightlifting, head trauma, and diving with middle ear equalizing problems. It has also, anecdotally, been described in connection with flying. The symptoms are uncharacteristic vertigo and, in some cases, hearing impairment and tinnitus. This study describes four cases of PLF during a period of 6 mo in a major Scandinavian airline company employing approximately 3000 cabin attendants (CAs). None of the cases were diagnosed at the primary health care level. All were referred to the Aviation Medical Center for investigation. The PLF diagnosis was based on the case history, Platform Pressure Test (a fistula test), and other vestibular tests. Only one CA has been able to return to flying duties. The article emphasizes the risk of flying with poor middle ear equalization and the necessity of reminding crews and airline companies to "never fly with a common cold".

Petrositis

MedlinePlus

... the inner ear. It is sometimes associated with otitis media (a middle ear infection). ... Elsevier Saunders; 2016:chap 428. Chole RA. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Haughey ...

T-cell lymphoma of the tympanic bulla in a feline leukemia virus-negative cat

PubMed Central

de Lorimier, Louis-Philippe; Alexander, Suzanne D.; Fan, Timothy M.

2003-01-01

This report constitutes the first description of a T-cell lymphoma of the tympanic bulla in a cat. This feline leukemia virus (FeLV)-negative cat originally presented with signs referable to middle ear disease; it deteriorated rapidly after definitive diagnosis. Lymphoma of the middle ear is extremely rare in all species. PMID:14703086

Mosaic evolution of the mammalian auditory periphery.

PubMed

Manley, Geoffrey A

2013-01-01

The classical mammalian auditory periphery, i.e., the type of middle ear and coiled cochlea seen in modern therian mammals, did not arise as one unit and did not arise in all mammals. It is also not the only kind of auditory periphery seen in modern mammals. This short review discusses the fact that the constituents of modern mammalian auditory peripheries arose at different times over an extremely long period of evolution (230 million years; Ma). It also attempts to answer questions as to the selective pressures that led to three-ossicle middle ears and the coiled cochlea. Mammalian middle ears arose de novo, without an intermediate, single-ossicle stage. This event was the result of changes in eating habits of ancestral animals, habits that were unrelated to hearing. The coiled cochlea arose only after 60 Ma of mammalian evolution, driven at least partly by a change in cochlear bone structure that improved impedance matching with the middle ear of that time. This change only occurred in the ancestors of therian mammals and not in other mammalian lineages. There is no single constellation of structural features of the auditory periphery that characterizes all mammals and not even all modern mammals.

Power reflectance testing in newborns and infants.

PubMed

Lima, Ticianna Garambone de Cerqueira; Becker, Helena Maria Gonçalves; Becker, Celso Gonçalves; Ferreira, Daniele Barreto da Cunha; Resende, Camilo Brandão de; Guimarães, Roberto Eustáquio Santos

2015-01-01

Auditory screening in newborns allows for detection of hearing problems early in life. However, middle ear diseases can make the diagnosis more difficult. To evaluate the power reflectance test as an indicator of the middle ear disease and to compare it to tympanometry. Case study evaluating 105 newborns and infants who participated in the audiology screening in 2013. The following exams were performed: transient otoacoustic emissions, power reflectance, and tympanometry. In the optoacoustic emission evaluation, approximately 95% of the subjects passed the test. The specificity of power reflectance in all frequencies studied ranged from 75.3% to 95.9%, and that of tympanometry at 1000Hz ranged from 83% to 87.2%; there was agreement among these exams. The outcome of power reflectance tests at 2000Hz and 3000Hz showed a correlation with tympanometry and otoacoustic emissions, and these were the most appropriate frequencies to determine middle ear disease through power reflectance measurement. It was also observed that values of power reflectance above reference levels suggested the presence of fluid in the middle ear, and thus a conductive hearing loss. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Age effects in the human middle ear: Wideband acoustical measures

NASA Astrophysics Data System (ADS)

Feeney, M. Patrick; Sanford, Chris A.

2004-12-01

Studies that have examined age effects in the human middle ear using either admittance measures at 220 or 660 Hz or multifrequency tympanometry from 200 to 2000 Hz have had conflicting results. Several studies have suggested an increase in admittance with age, while several others have suggested a decrease in admittance with age. A third group of studies found no significant age effect. This study examined 226 Hz tympanometry and wideband energy reflectance and impedance at ambient pressure in a group of 40 young adults and a group of 30 adults with age >=60 years. The groups did not differ in admittance measures of the middle ear at 226 Hz. However, significant age effects were found in wideband energy reflectance and impedance. In particular, in older adults there was a comparative decrease in reflectance from 800 to 2000 Hz but an increase near 4000 Hz. The results suggest a decrease in middle-ear stiffness with age. The findings of this study hold relevance for understanding the aging process in the auditory system, for the establishment of normative data for wideband energy reflectance, for the possibility of a conductive component to presbycusis, and for the interpretation of otoacoustic emission measurements. .

Miniature, minimally invasive, tunable endoscope for investigation of the middle ear.

PubMed

Pawlowski, Michal E; Shrestha, Sebina; Park, Jesung; Applegate, Brian E; Oghalai, John S; Tkaczyk, Tomasz S

2015-06-01

We demonstrate a miniature, tunable, minimally invasive endoscope for diagnosis of the auditory system. The probe is designed to sharply image anatomical details of the middle ear without the need for physically adjusting the position of the distal end of the endoscope. This is achieved through the addition of an electrowetted, tunable, electronically-controlled lens to the optical train. Morphological imaging is enabled by scanning light emanating from an optical coherence tomography system. System performance was demonstrated by imaging part of the ossicular chain and wall of the middle ear cavity of a normal mouse. During the experiment, we electronically moved the plane of best focus from the incudo-stapedial joint to the stapedial artery. Repositioning the object plane allowed us to image anatomical details of the middle ear beyond the depth of field of a static optical system. We also demonstrated for the first time to our best knowledge, that an optical system with an electrowetted, tunable lens may be successfully employed to measure sound-induced vibrations within the auditory system by measuring the vibratory amplitude of the tympanic membrane in a normal mouse in response to pure tone stimuli.

Non-invasive biophysical measurement of travelling waves in the insect inner ear

PubMed Central

2017-01-01

Frequency analysis in the mammalian cochlea depends on the propagation of frequency information in the form of a travelling wave (TW) across tonotopically arranged auditory sensilla. TWs have been directly observed in the basilar papilla of birds and the ears of bush-crickets (Insecta: Orthoptera) and have also been indirectly inferred in the hearing organs of some reptiles and frogs. Existing experimental approaches to measure TW function in tetrapods and bush-crickets are inherently invasive, compromising the fine-scale mechanics of each system. Located in the forelegs, the bush-cricket ear exhibits outer, middle and inner components; the inner ear containing tonotopically arranged auditory sensilla within a fluid-filled cavity, and externally protected by the leg cuticle. Here, we report bush-crickets with transparent ear cuticles as potential model species for direct, non-invasive measuring of TWs and tonotopy. Using laser Doppler vibrometry and spectroscopy, we show that increased transmittance of light through the ear cuticle allows for effective non-invasive measurements of TWs and frequency mapping. More transparent cuticles allow several properties of TWs to be precisely recovered and measured in vivo from intact specimens. Our approach provides an innovative, non-invasive alternative to measure the natural motion of the sensilla-bearing surface embedded in the intact inner ear fluid. PMID:28573026

[Genetic deafness].

PubMed

Marcolla, A; Bouchetemble, P; Lerosey, Y; Marie, J-P; Dehesdin, D

2006-06-01

The aim of this study was to review the different types of genetic deafness. We describe syndromic and isolated sensorineural deafness and transmission deafness. Genetic sensorineural syndromic deafness represents 30% of cases of genetic deafness. A frequent cause is Pendred syndrome, which associates congenital sensorineural deafness with goitre and malformations of the inner ear which can be identified on computed tomography scan. Isolated deafness which is responsible for 70% of cases of genetic deafness is then outlined. Among the different types of isolated deafness, 80% are autosomal recessive disorders. A frequent form of autosomal recessive deafness is due to mutations in the connexin 26 gene. Lastly, we detail transmission deafness dominated by aplasia. Major aplasia is characterized by a malformation of the external ear associated with malformations of the middle ear whereas, minor aplasia corresponds to a malformation of the middle ear, sometimes associated with minor external ear malformations. For each type of deafness we propose a systematic assessment.

Two new cases of chronic tuberculous otomastoiditis in children.

PubMed

Scorpecci, A; Bozzola, E; Villani, A; Marsella, P

2015-04-01

This report focuses on tuberculous otomastoiditis treated at a third level Italian paediatric hospital. We reviewed the clinical charts of 4077 children who underwent middle ear surgery at the Audiology and Otology Unit of the Institution's ENT Department from January 1995 to December 2011. A tubercular aetiology was identified in 2 cases: a 4-year old boy who presented with primary ear involvement, i.e. with no other infected sites but the middle ear, and a 5-year old girl with secondary tuberculous otomastoidits, who was treated for pulmonary and mediastinal tuberculosis at the age of 7 months.

[Middle ear salivary gland choristoma related to branchio-oto-renal syndrome diagnosed by array-CGH].

PubMed

Amrhein, P; Sittel, C; Spaich, C; Kohlhase, J; Boppert, R; Kohlhof, P; Koitschev, A

2014-05-01

Branchio-oto-renal (BOR) syndrome is characterized by ear malformations associated with sensorineural or mixed hearing loss. In addition, preauricular tags, preauricular pits, branchial cleft fistulas and cysts, as well as renal dysplasia are seen. A genetic mutation on chromosome 8, either autosomal dominantly inherited or occuring as a spontaneous mutation, is the cause in the majority of cases. Using array-based comparative genomic hybridization (CGH), it is possible to detect even the smallest genetic changes. Salivary gland choristoma in the middle ear is very rare. Surgical removal and histological clarification are required.

Ofloxacin Otic

MedlinePlus

Ofloxacin otic is used to treat outer ear infections in adults and children, chronic (long-lasting) middle ear infections in adults and children with a perforated eardrum (a condition where the eardrum ...

Middle ear dynamics in response to seismic stimuli in the Cape golden mole (Chrysochloris asiatica).

PubMed

Willi, U B; Bronner, G N; Narins, P M

2006-01-01

The hypertrophied malleus in the middle ear of some golden moles has been assumed to be an adaptation for sensing substrate vibrations by inertial bone conduction, but this has never been conclusively demonstrated. The Cape golden mole (Chrysochloris asiatica) exhibits this anatomical specialization, and the dynamic properties of its middle ear response to vibrations were the subjects of this study. Detailed three-dimensional middle ear anatomy was obtained by x-ray microcomputed tomography (muCT) at a resolution of 12 microm. The ossicular chain exhibits large malleus mass, selective reduction of stiffness and displacement of the center of mass from the suspension points, all favoring low-frequency tuning of the middle ear response. Orientation of the stapes relative to the ossicular chain and the structure of the stapes footplate enable transmission of substrate vibrations arriving from multiple directions to the inner ear. With the long axes of the mallei aligned parallel to the surface, the animal's head was stimulated by a vibration exciter in the vertical and lateral directions over a frequency range from 10 to 600 Hz. The ossicular chain was shown to respond to both vertical and lateral vibrations. Resonant frequencies were found between 71 and 200 Hz and did not differ significantly between the two stimulation directions. Below resonance, the ossicular chain moves in phase with the skull. Near resonance and above, the malleus moves at a significantly larger mean amplitude (5.8+/-2.8 dB) in response to lateral vs vertical stimuli and is 180 degrees out of phase with the skull in both cases. A concise summary of the propagation characteristics of both seismic body (P-waves) and surface (R-waves) is provided. Potential mechanisms by which the animal might exploit the differential response of the ossicular chain to vertical and lateral excitation are discussed in relation to the properties of surface seismic waves.

Impact of Staphylococcus epidermidis lysates on middle ear epithelial proinflammatory and mucogenic response.

PubMed

Val, Stéphanie; Mubeen, Humaira; Tomney, Amarel; Chen, Saisai; Preciado, Diego

2015-02-01

Chronic otitis media with effusion (COME) develops after sustained inflammation and is characterized by secretory middle ear epithelial metaplasia and effusion, most frequently mucoid. Staphylococcus epidermidis, typically considered a commensal organism, is very frequently recovered in chronic middle ear fluid and in middle ear biofilms. Although it has been shown to drive inflammation in sinonasal epithelium, the impact of S. epidermidis on COME is markedly understudied. The goal of this study was to examine the in vitro effects of S. epidermidis lysates on murine and human middle ear epithelial cells. Staphylococcus epidermidis lysates were generated and used to stimulate submerged and differentiated human and murine epithelial cells (MEECs) for 24 to 48 hours. Quantitative real time-polymerase chain reaction, Western blot, enzyme-linked immunosorbent assay, and immunocytochemistry techniques were performed to interrogate the mucin gene MUC5AC and MUC5B expression and protein production, chemokine response, as well as NF-κB activation. Luciferase reporter assays were performed to further evaluate nuclear factor κB (NF-κB) activation and query specific promoter responses after S. epidermidis exposure. Staphylococcus epidermidis induced a time- and dose-dependent MUC5AC and MUC5B overexpression along with a parallel overexpression of Cxcl2 in mouse MEEC and IL-8 in human MEEC. Further investigations in mMEEC showed a 1.3 to 1.5 induction of the MUC5AC and MUC5B promoters. As potential mechanisms for these responses, induction of an oxidative stress marker, along with early nuclear translocation and activation of NF-κB, was found. Finally, chronic exposure induced marked epithelial thickening of cells differentiated at the air liquid interface. Staphylococcus epidermidis lysates activate a proinflammatory response in MEEC, including mucin gene expression and protein production. Although typically considered a nonpathogenic commensal organism in the ear, these results suggest that they may play a role in the perpetuation of an inflammatory and mucogenic response in COME.

Effects of model definitions and parameter values in finite element modeling of human middle ear mechanics.

PubMed

De Greef, Daniel; Pires, Felipe; Dirckx, Joris J J

2017-02-01

Despite continuing advances in finite element software, the realistic simulation of middle ear response under acoustic stimulation continues to be challenging. One reason for this is the wide range of possible choices that can be made during the definition of a model. Therefore, an explorative study of the relative influences of some of these choices is potentially very helpful. Three finite element models of the human middle ear were constructed, based on high-resolution micro-computed tomography scans from three different human temporal bones. Interesting variations in modeling definitions and parameter values were selected and their influences on middle ear transmission were evaluated. The models were compared against different experimental validation criteria, both from the literature and from our own measurements. Simulation conditions were restricted to the frequency range 0.1-10 kHz. Modeling the three geometries with the same modeling definitions and parameters produces stapes footplate response curves that exhibit similar shapes, but quantitative differences of 4 dB in the lower frequencies and up to 6 dB around the resonance peaks. The model properties with the largest influences on our model outcomes are the tympanic membrane (TM) damping and stiffness and the cochlear load. Model changes with a small to negligible influence include the isotropy or orthotropy of the TM, the geometry of the connection between the TM and the malleus, the microstructure of the incudostapedial joint, and the length of the tensor tympani tendon. The presented results provide insights into the importance of different features in middle ear finite element modeling. The application of three different individual middle ear geometries in a single study reduces the possibility that the conclusions are strongly affected by geometrical abnormalities. Some modeling variations that were hypothesized to be influential turned out to be of minor importance. Furthermore, it could be confirmed that different geometries, simulated using the same parameters and definitions, can produce significantly different responses. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of Learning Melodies by Ear on Performance Skills and Student Attitudes

ERIC Educational Resources Information Center

Musco, Ann Marie

2009-01-01

This study examined the effects of playing by ear in selected keys on the abilities of musicians (N = 28) to play by ear and sight-read in those keys. Middle school band students in the experimental group learned melodies by ear in one familiar and two unfamiliar keys, and did no music reading in the new keys, while students in the contact-control…

Inner ear anomalies and conductive hearing loss in children with Apert syndrome: an overlooked otologic aspect.

PubMed

Zhou, Guangwei; Schwartz, Lynn Thomas; Gopen, Quinton

2009-02-01

To identify the occurrence of inner ear structural anomalies and conductive hearing loss (CHL) in children with Apert syndrome. Retrospective review. Pediatric tertiary referral center. Twenty pediatric patients with Apert syndrome were found; all patients (38/40 ears) had inner ear anomalies. Computerized tomography of the head/temporal bone, pure-tone (including air and bone conduction) audiometry, and tympanometry. Imaging demonstrating inner ear anomalies, including malformations of the cochlea, dilated vestibule, and/or semicircular canal; audiologic findings of air-bone gap(s). Hearing loss was found in 90% of the patients with Apert syndrome, and 80% of them had CHL. Air-bone gaps were found at all frequencies, with larger gaps at low frequencies. Fifty percent (20/40) of the ears had better than 0 dB hearing level bone conduction thresholds at 250 and/or 500 Hz. Normal middle ear pressure and mobility were found in all ears with intact eardrum. Inner ear anomalies were found in all patients, and 90% of them had bilateral involvement. Most frequently observed inner ear anomalies were dilated vestibule, malformed lateral semicircular canal, and cochlear dysplasia. Children with Apert syndrome may present with significant CHL that cannot be explained by minor middle ear pathologies alone. This conductive loss may be, at least partially, attributed to the inner ear anomalies; however, these structural anomalies are usually not recognized in these patients. Failure to close air-bone gap after surgical intervention may raise the suspicion of inner ear anomalies, and computed tomographic scan of the temporal bone can provide definitive proof.

The contribution of selective dysventilation to attical middle ear pathology.

PubMed

Marchioni, Daniele; Grammatica, Alberto; Alicandri-Ciufelli, Matteo; Aggazzotti-Cavazza, Elisa; Genovese, Elisabetta; Presutti, Livio

2011-07-01

Epitympanic primary cholesteatoma represents a challenge for ENT surgeons. Its exact pathogenesis is still unknown because of the very complex anatomy of this region. Until now, only a few authors have described this region and tried to hypothesize the causes that could lead to cholesteatoma genesis. We hypothesize the existence of a selective dysventilation of the epitympanic region based on the presence of various mucosal folds occluding air ventilation from the middle ear to the epitympanum, through the epitympanic isthmus, causing a negative epitympanic pressure and consequently cholesteatoma formation. All the anatomic findings were obtained with the aid of 0° and 45° angled surgical endoscopes. From our findings, patients affected by an epitympanic cholesteatoma often have a total isthmus blockage that completely isolates the whole epitympanum from the middle ear, causing a deficit of oxygenation of the mucosa that normally should be guaranteed by the Eustachian tube and which always works physiologically in these patients. This is confirmed by the tympanogram test where we observed how the pressure at the level of the tympanic cavity was normal, whereas the epitympanic pressure was selectively negative. In conclusion, selective epitympanic dysventilation syndrome consists of the concomitant presence of a series of complete or incomplete epitympanic diaphragms and ME isthmus blockage causing negative epitympanic pressure, and leading to the formation of a retraction pocket or cholesteatoma associated with normal Eustachian tube function. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effect of laryngoscopy on middle ear pressure during anaesthesia induction.

PubMed

Degerli, Semih; Acar, Baran; Sahap, Mehmet; Horasanlı, Eyup

2013-01-01

The procedure of laryngoscopic orotracheal intubation (LOTI) has many impacts on several parts of the body. But its effect on middle ear pressure (MEP) is not known well. The purpose of this study is to evaluate the MEP changes subsequent to insertion of endotracheal tube with laryngoscope. 44 patients were included in this study with a normal physical examination of ear, nose and throat. A standard general anaesthesia induction without any inhaler agent was performed to the all patients. The MEP measurements for both ears were applied under 1 minute; before induction (BI) and after intubation (AI) with a middle ear analyzer. Also hemodynamic parameters were recorded before induction and after intubation. Of the 44 patients were 25 women and 19 men with a 43.5±15.1 mean age. A statistically significant rise in MEP was seen in all patients subsequent to insertion of endotracheal tube (P<0.05). Mean right MEPs were BI: -9.5 and AI: 18.5 daPa. Also mean left MEPs were BI: -21.7 and AI: 29.1 daPa. The amount of increases in left and right MEPs were 50 daPa and 27 daPa, respectively. 20% increase in systolic blood pressure and 19% increase in diastolic blood pressure were determined after intubation. The mean heart rate was 76/min before intubation, whereas it was 102/min after intubation with a 34% increase. In this study bilateral significant increases in MEP were determined subsequent to LOTI. Possible factors affecting MEP may be auditory tube, size and type of the blades, drugs and face masking time. But on the other hand in our opinion cardiovascular and haemodynamic response to LOTI has the most impact over the middle ear mucosa with mucosal venous congestion.

Ear Infections

MedlinePlus

... but they are less common. The infection usually affects the middle ear and is called otitis media. ... become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that ...

Mucosal Melanoma Originating From the Eustachian Tube.

PubMed

Kim, Jeong Hong; Lim, Gil-Chai; Kang, Ju Wan

2017-11-01

A 77-year-old man was referred with a 4-month history of hearing impairment and ear fullness of the left ear. Otoscopic examination revealed an effusion in the left middle ear, and nasal endoscopic examination revealed a dark polypoid lesion at the opening of the left Eustachian tube. In addition to the lesion of the Eustachian tube, a dark mucosal lesion was seen at the posterior choana and the posterior end of the nasal septum. Endoscopic biopsy was done and pathologic result was consistent with malignant melanoma. Wide surgical excision with postoperative radiotherapy was performed; multiple metastases were detected 4 months after the treatment. Mucosal melanoma originating from nasopharynx was extremely rare, but careful examination of nasopharyngeal area should be considered when the patient presents with unilateral middle ear effusion, especially in older age.

Clinical use of vestibular evoked myogenic potentials in the evaluation of patients with air-bone gaps.

PubMed

Zhou, Guangwei; Poe, Dennis; Gopen, Quinton

2012-10-01

To determine the value of vestibular evoked myogenic potential (VEMP) test in clinical evaluation of air-bone gaps. Retrospective case review. Tertiary referral center. A total of 120 patients underwent VEMP testing during clinical investigation of significant air-bone gaps in their audiograms. Otologic examination and surgeries, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and VEMP test. Imaging studies demonstrating structural anomalies in the temporal bone. Audiologic outcomes of air-bone gaps and VEMP thresholds. Surgical findings confirming imaging results. Middle ear pathologies, such as otosclerosis and chronic otitis media, were identified in 50 patients, and all of them had absent VEMP responses elicited by air-conduction stimuli. Moreover, 13 of them had successful middle ear surgeries with closures of the air-bone gaps. Abnormally low VEMP thresholds were found in 71 of 73 ears with inner ear anomalies, such as semicircular canal dehiscence and enlarged vestibular aqueduct. Seven patients with superior semicircular canal dehiscence underwent plugging procedure via middle fossa approach, and VEMP thresholds became normalized after the surgery in 3 of them. VEMP test failed to provide accurate diagnosis in only 3 cases. Air-bone gaps may be a result of various otologic pathologies, and the VEMP test is useful during clinical evaluation, better than tympanometry and acoustic reflexes. To avoid unnecessary middle ear surgery for air-bone gaps with unknown or unsure cause, VEMP test should be used in the differential diagnosis before an expensive imaging study.

Biochemical tests cannot differentiate between tonsillar and middle ear-derived infections.

PubMed

Christensen, Ann Marlene Gram; Kirkegaard, Martin Glymer; Randrup, Thomas Skov; Klug, Tejs Ehlers

2013-05-01

Infection markers are appreciated supplements in the clinical diagnosis of ear, nose and throat (ENT) infections. We aimed to examine the differential diagnostic usefulness of C-reactive protein (CRP), white blood cell count (WBC) and absolute neutrophil count (ANC) according to severity of middle ear and tonsillar infections. This was a retrospective study including all patients admitted to the ENT Department, Aarhus University Hospital, from January 2001 to December 2008 and diagnosed with acute otitis media, mastoidismus, acute mastoiditis, acute tonsillitis, peritonsillar abscess, parapharyngeal abscess and necrotizing fasciitis. A total of 1,773 patients were included. Between the tonsil subgroups, significant differences were found in CRP (p < 0.001), WBC (p < 0.001) and ANC (p < 0.001) levels. However, sensitivities and specificities related to differential diagnostics were low. In the middle ear group, no differences in CRP (p = 0.84), WBC (p = 0.46), and ANC (p = 0.72) levels were found. The number of CRP levels above the reference value was significantly higher than the corresponding number of WBC and ANC levels. A trend (non-significant) was found towards lower parameter levels in acute tonsillitis and peritonsillar abscess patients who grew Staphylococcus aureus compared with patients infected with other bacteria. CRP and ANC levels were related to severity of tonsillar-derived infections, but no such relation was found in infections with middle ear origin. None of the infection markers studied were useful for differential diagnostics. not relevant. not relevant.

Inner ear problems of Thai priest at Priest Hospital.

PubMed

Karnchanakas, Taweporn; Tantanavat, Are; Sinsakontavat, Jamjan

2008-01-01

The inner ear problems of Thai priest at Priest Hospital had never been reported previously, so Department of Ear Nose Throat try to correlate the metebotic disorder with inner ear problems. 1) To study the fasting blood sugar (FBS), total cholesterol (T. Chol), low density lipoprotein (LDL), and triglyceride (TG), the factors expected to involve in inner ear problems of priests at Priest Hospital. 2) To compare the FBS, T. Chol, HDL, LDL, and TG of priests with inner ear problems at Priest Hospital. 3) To find the percentage of abnormal from FBS, T. Chol, LDL, and TG. The study using 83 sampling of priests with inner ear problems and 107 priests as a controlled group. The research instruments used to collect data was the questionnaire which composed of general information, physical, ear-nose-throat and neurological examination, pure tone audiometry, brainstem evoke response audiometry (BERA) and the blood tests:FBS, T. Chol, TG, and LDL. The inner ear problems were composed of: 1) Dizziness 2) Hearing Loss 3) Tinnitus Aurium. The descriptive statistics were used to analyze the data from questionnaires and utilized frequency, percentage, standard deviation (S.D.) and t-test to achieve desired results. Priest at middle age and elderly with inner ear problems had greater FBS and TG than expected values of the control group. The middle age and elderly priests who had greater FBS and TG than expected values were sick with inner ear problems that causing dizziness, hearing loss and tinnitus aurium.

Antifibrotic effect of dexamethasone/alginate-coated silicone sheet in the abraded middle ear mucosa.

PubMed

Jang, Chul Ho; Ahn, Seung Hyun; Kim, Geun Hyung

2016-12-01

Silicone sheet is a material which is commonly used in middle ear surgery to prevent the formation of adhesions between the tympanic membrane and the medial bony wall of the middle ear cavity. However, silicone sheet can induce a tight and hard fibrous capsule in the region of the stapes, and this is particularly common in cases of eustachian tube dysfunction. As a result of the fibrous encapsulation around the silicone sheet, postoperative aeration of the stapes can be interrupted causing poor hearing gain. In this study, we performed an in vitro and in vivo evaluation of the antifibrotic effects of a dexamethasone and alginate (Dx/alginate) coating on silicone sheet. The Dx/alginate-coated silicone sheets were fabricated using a plasma-treatment and coating method. The Dx/alginate-coated silicone sheets effectively limited in vitro fibroblast attachment and proliferation due to the controlled release of Dx, which can be modified by manipulation of the alginate coating. For the in-vivo evaluation, guinea pigs (albino, male, weighing 250g) were divided into two groups, with the control group (n=5) implanted with silicone sheet and the test group (n=5) receiving Dx/alginate-coated silicone sheet. Animals were sacrificed 3 weeks after implantation, and histological analysis was performed using hematoxylin and eosin (H&E) and immunohistochemical staining techniques. Dx/alginate-coated silicone sheets showed marked inhibition of fibrosis in both the in vitro and in vivo studies. Silicone sheet that incorporates a Dx/alginate coating can release Dx and inhibit fibrosis in the middle ear. This material could be utilized in middle ear surgery as a means of preserving proper aeration and hearing gain following ossiculoplasty. Copyright © 2016 Elsevier B.V. All rights reserved.

Partial characterization of normal and Haemophilus influenzae-infected mucosal complementary DNA libraries in chinchilla middle ear mucosa.

PubMed

Kerschner, Joseph E; Erdos, Geza; Hu, Fen Ze; Burrows, Amy; Cioffi, Joseph; Khampang, Pawjai; Dahlgren, Margaret; Hayes, Jay; Keefe, Randy; Janto, Benjamin; Post, J Christopher; Ehrlich, Garth D

2010-04-01

We sought to construct and partially characterize complementary DNA (cDNA) libraries prepared from the middle ear mucosa (MEM) of chinchillas to better understand pathogenic aspects of infection and inflammation, particularly with respect to leukotriene biogenesis and response. Chinchilla MEM was harvested from controls and after middle ear inoculation with nontypeable Haemophilus influenzae. RNA was extracted to generate cDNA libraries. Randomly selected clones were subjected to sequence analysis to characterize the libraries and to provide DNA sequence for phylogenetic analyses. Reverse transcription-polymerase chain reaction of the RNA pools was used to generate cDNA sequences corresponding to genes associated with leukotriene biosynthesis and metabolism. Sequence analysis of 921 randomly selected clones from the uninfected MEM cDNA library produced approximately 250,000 nucleotides of almost entirely novel sequence data. Searches of the GenBank database with the Basic Local Alignment Search Tool provided for identification of 515 unique genes expressed in the MEM and not previously described in chinchillas. In almost all cases, the chinchilla cDNA sequences displayed much greater homology to human or other primate genes than with rodent species. Genes associated with leukotriene metabolism were present in both normal and infected MEM. Based on both phylogenetic comparisons and gene expression similarities with humans, chinchilla MEM appears to be an excellent model for the study of middle ear inflammation and infection. The higher degree of sequence similarity between chinchillas and humans compared to chinchillas and rodents was unexpected. The cDNA libraries from normal and infected chinchilla MEM will serve as useful molecular tools in the study of otitis media and should yield important information with respect to middle ear pathogenesis.

Partial Characterization of Normal and Haemophilus influenzae–Infected Mucosal Complementary DNA Libraries in Chinchilla Middle Ear Mucosa

PubMed Central

Kerschner, Joseph E.; Erdos, Geza; Hu, Fen Ze; Burrows, Amy; Cioffi, Joseph; Khampang, Pawjai; Dahlgren, Margaret; Hayes, Jay; Keefe, Randy; Janto, Benjamin; Post, J. Christopher; Ehrlich, Garth D.

2010-01-01

Objectives We sought to construct and partially characterize complementary DNA (cDNA) libraries prepared from the middle ear mucosa (MEM) of chinchillas to better understand pathogenic aspects of infection and inflammation, particularly with respect to leukotriene biogenesis and response. Methods Chinchilla MEM was harvested from controls and after middle ear inoculation with nontypeable Haemophilus influenzae. RNA was extracted to generate cDNA libraries. Randomly selected clones were subjected to sequence analysis to characterize the libraries and to provide DNA sequence for phylogenetic analyses. Reverse transcription–polymerase chain reaction of the RNA pools was used to generate cDNA sequences corresponding to genes associated with leukotriene biosynthesis and metabolism. Results Sequence analysis of 921 randomly selected clones from the uninfected MEM cDNA library produced approximately 250,000 nucleotides of almost entirely novel sequence data. Searches of the GenBank database with the Basic Local Alignment Search Tool provided for identification of 515 unique genes expressed in the MEM and not previously described in chinchillas. In almost all cases, the chinchilla cDNA sequences displayed much greater homology to human or other primate genes than with rodent species. Genes associated with leukotriene metabolism were present in both normal and infected MEM. Conclusions Based on both phylogenetic comparisons and gene expression similarities with humans, chinchilla MEM appears to be an excellent model for the study of middle ear inflammation and infection. The higher degree of sequence similarity between chinchillas and humans compared to chinchillas and rodents was unexpected. The cDNA libraries from normal and infected chinchilla MEM will serve as useful molecular tools in the study of otitis media and should yield important information with respect to middle ear pathogenesis. PMID:20433028

[Preoperative CT Scan in middle ear cholesteatoma].

PubMed

Sethom, Anissa; Akkari, Khemaies; Dridi, Inès; Tmimi, S; Mardassi, Ali; Benzarti, Sonia; Miled, Imed; Chebbi, Mohamed Kamel

2011-03-01

To compare preoperative CT scan finding and per-operative lesions in patients operated for middle ear cholesteatoma, A retrospective study including 60 patients with cholesteatoma otitis diagnosed and treated within a period of 5 years, from 2001 to 2005, at ENT department of Military Hospital of Tunis. All patients had computed tomography of the middle and inner ear. High resolution CT scan imaging was performed using millimetric incidences (3 to 5 millimetres). All patients had surgical removal of their cholesteatoma using down wall technic. We evaluated sensitivity, specificity and predictive value of CT-scan comparing otitic damages and CT finding, in order to examine the real contribution of computed tomography in cholesteatoma otitis. CT scan analysis of middle ear bone structures shows satisfaction (with 83% of sensibility). The rate of sensibility decrease (63%) for the tympanic raff. Predictive value of CT scan for the diagnosis of cholesteatoma was low. However, we have noticed an excellent sensibility in the analysis of ossicular damages (90%). Comparative frontal incidence seems to be less sensible for the detection of facial nerve lesions (42%). But when evident on CT scan findings, lesions of facial nerve were usually observed preoperatively (spécificity 78%). Predictive value of computed tomography for the diagnosis of perilymphatic fistulae (FL) was low. In fact, CT scan imaging have showed FL only for four patients among eight. Best results can be obtained if using inframillimetric incidences with performed high resolution computed tomography. Preoperative computed tomography is necessary for the diagnosis and the evaluation of chronic middle ear cholesteatoma in order to show extending lesion and to detect complications. This CT analysis and surgical correlation have showed that sensibility, specificity and predictive value of CT-scan depend on the anatomic structure implicated in cholesteatoma damages.

Model-oriented review and multi-body simulation of the ossicular chain of the human middle ear.

PubMed

Volandri, G; Di Puccio, F; Forte, P; Manetti, S

2012-11-01

The ossicular chain of the human middle ear has a key role in sound conduction since it transfers vibrations from the tympanic membrane to the cochlea, connecting the outer and the inner part of the hearing organ. This study reports firstly a description of the main anatomical features of the middle ear to introduce a detailed survey of its biomechanics, focused on model development, with a collection of geometric, inertial and mechanical/material parameters. The joint issues are particularly discussed from the perspective of developing a model of the middle ear both explanatory and predictive. Such a survey underlines the remarkable dispersion of data, due also to the lack of a standardization of the experimental techniques and conditions. Subsequently, a 3D multi-body model of the ossicular chain and other structures of the middle ear is described. Such an approach is justified as the ossicles were proven to behave as rigid bodies in the human hearing range and was preferred to the more widely used finite element one as it simplifies the model development and improves joint modeling. The displacement of the umbo (a reference point of the tympanic membrane) in the 0.3-6kHz frequency range was defined as input of the model, while the stapes footplate displacement as output. A parameter identification procedure was used to find parameter values for reproducing experimental and numerical reference curves taken from the literature. This simple model might represent a valid alternative to more complex models and might provide a useful tool to simulate pathological/post-surgical/post-traumatic conditions and evaluate ossicular replacement prostheses. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

[Identification of human papilloma viruses (HPV) in inflammatory states and ear neoplasms].

PubMed

Rydzewski, Bogdan; Goździcka-Józefiak, Anna; Sokalski, Jerzy; Matusiak, Monika; Durzyński, Lukasz

2007-01-01

Human Papilloma Virus has a strong relation to oropharyngeal mucosa and is considered to be responsible for a wide range of upper respiratory tract pathologies, like laryngeal papilloma. There's a hypothesis, that it plays a significant role in middle ear chronic inflammations and neoplasm's. MATERIAL AND METHODIC. The examination was carried on a group of 53 patients, 39 of which was suffering from granulation tissue chronic otitis media, 7-cholesteatomatous otitis media, 6--middle ear malignant neoplasm, and 1 middle and/or external ear benign neoplasm. The control group consisted of 5 patients operated on: otosclerosis--4 cases and post-traumatic tympanic membrane perforation--1 case. The material was postoperative tissue, like polyps, inflammatory granulation tissue, cholesteatoma masses and malignant neoplasm's tissue. In the whole group of 53 examined cases, HPV DNA was confirmed in 22 cases (41.5%), in that group oncogenic types 16 or 18 in 12 cases (22.6%), and in 14 cases (26.4%) types 6 or 11. In a group of chronic granulomatous otitis media DNA characteristic for Papilloma was identified in 12 cases (25.6%), in it in 9 cases DNA HPV type 6 or 11 was confirmed, and in 7 cases type 16 or 18. Among cholesteatomatous chronic otitis media HPV DNA types 6 or 11 was identified in 70%. In every case of middle ear malignant neoplasm a presence of high-risk DNA Papilloma types 16 or 18 was confirmed. In any case of control group HPV DNA was detected. The results has been compared with other authors examinations and it is claimed that they confirm the observation, that Human Papilloma Viruses may be a factor, that might play an important role in pathology of chronic otitis media and ear neoplasm's. It is concluded, that differences in percentages of HPV presence in chronic inflammations (70%) and ear neoplasm's may be explained by viral co-infection during bacterial c. o. m. Viral infection probably evolves carcinogenesis, which leads to a neoplastic growth.

Guide to Understanding Pfeiffer Syndrome

MedlinePlus

... sockets (orbits). Approximately 50% of children with Pfeiffer syndrome have some form of hearing loss secondary to an abnormally small ear canal and middle ear. Dental problems are also common. Visual problems ...

A defect in early myogenesis causes Otitis media in two mouse models of 22q11.2 Deletion Syndrome

PubMed Central

Fuchs, Jennifer C.; Linden, Jennifer F.; Baldini, Antonio; Tucker, Abigail S.

2015-01-01

Otitis media (OM), the inflammation of the middle ear, is the most common disease and cause for surgery in infants worldwide. Chronic Otitis media with effusion (OME) often leads to conductive hearing loss and is a common feature of a number of craniofacial syndromes, such as 22q11.2 Deletion Syndrome (22q11.2DS). OM is more common in children because the more horizontal position of the Eustachian tube (ET) in infants limits or delays clearance of middle ear effusions. Some mouse models with OM have shown alterations in the morphology and angle of the ET. Here, we present a novel mechanism in which OM is caused not by a defect in the ET itself but in the muscles that control its function. Our results show that in two mouse models of 22q11.2DS (Df1/+ and Tbx1+/−) presenting with bi- or unilateral OME, the fourth pharyngeal arch-derived levator veli palatini muscles were hypoplastic, which was associated with an earlier altered pattern of MyoD expression. Importantly, in mice with unilateral OME, the side with the inflammation was associated with significantly smaller muscles than the contralateral unaffected ear. Functional tests examining ET patency confirmed a reduced clearing ability in the heterozygous mice. Our findings are also of clinical relevance as targeting hypoplastic muscles might present a novel preventative measure for reducing the high rates of OM in 22q11.2DS patients. PMID:25452432

Optical and tomographic imaging of a middle ear malformation in the bullfrog (Rana catesbeiana).

PubMed

Horowitz, Seth S; Simmons, Andrea Megela; Ketten, Darlene R

2005-08-01

Using a combination of in vivo computerized tomography and histological staining, a middle ear anomaly in two wild-caught American bullfrogs (Rana catesbeiana) is characterized. In these animals, the tympanic membrane, extrastapes, and pars media (shaft) of the stapes are absent on one side of the head, with the other side exhibiting normal morphology. The pars interna (footplate) of the stapes and the operculum are present in their normal positions at the entrance of the otic capsule on both the affected and unaffected sides. The pattern of deformity suggests a partial failure of development of tympanic pathway tissues, but with a preservation of the opercularis pathway. While a definitive proximate cause of the condition could not be determined, the anomalies show similarities to developmental defects in mammalian middle ear formation.

Optical and tomographic imaging of a middle ear malformation in the bullfrog (Rana catesbeiana)

PubMed Central

Horowitz, Seth S.; Simmons, Andrea Megela; Ketten, Darlene R.

2005-01-01

Using a combination of in vivo computerized tomography and histological staining, a middle ear anomaly in two wild-caught American bullfrogs (Rana catesbeiana) is characterized. In these animals, the tympanic membrane, extrastapes, and pars media (shaft) of the stapes are absent on one side of the head, with the other side exhibiting normal morphology. The pars interna(footplate) of the stapes and the operculum are present in their normal positions at the entrance of the otic capsule on both the affected and unaffected sides. The pattern of deformity suggests a partial failure of development of tympanic pathway tissues, but with a preservation of theopercularis pathway. While a definitive proximate cause of the condition could not be determined, the anomalies show similarities to developmental defects in mammalian middle ear formation. PMID:16158670

Investigation of a broadband duct noise control system inspired by the middle ear mechanism

NASA Astrophysics Data System (ADS)

Wang, Chunqi; Huang, Lixi

2012-08-01

A new duct noise control device is introduced based on the mechanism of human middle ear which functions as a compact, broadband impedance transformer between the air motion in the outer ear and the liquid motion in the inner ear. The system consists of two rigid endplates, simulating the tympanic membrane and the stapes footplate, and they are connected by a single rigid rod, simulating the overall action of the ossicular chain. These three pieces are placed in a side-branch cavity, and the whole device is called an ossicular silencer. A specific configuration is investigated numerically with a two-dimensional finite element model. Results show that broadband noise attenuation can be achieved in the very low frequency regime. Typically, two or more resonance peaks are found and the transmission loss between two neighbouring peaks is maintained at a high level. The cavity length is found to be the most crucial parameter that determines the effective frequency range of the ossicular silencer. The total cavity volume, which is a major controlling factor in most existing noise control devices, becomes less influential. The fluid medium in the enclosed cavity mainly acts like an added mass, while its stiffness effect is negligible. Simplified plane wave analysis is also conducted to reveal the mechanisms of the system resonances. The first resonance is identified as of the mass-spring system with mass contributions from both fluid and the plates, while the second one is of the Herschel-Quincke (HQ) tube resonance.

Microendoscopy of the eustachian tube and the middle ear

NASA Astrophysics Data System (ADS)

Hopf, Juergen U. G.; Linnarz, Marietta; Gundlach, Peter; Scherer, Hans H.; Lutze-Koffroth, C.; Loerke, S.; Voege, Karl H.; Tschepe, Johannes; Mueller, Gerhard J.

1992-08-01

Progressive miniaturization of flexible fiberoptic instruments has made it possible to perform atraumatic endoscopy of the Eustachian tube and tympanic cavity with an intact ear drum. By means of a special set of carrier- and balloon-catheters which are partly actively steerable, flexible microendoscopes with outside diameters of 290 - 700 micrometers are inserted through the nasal cavity into the nasopharyngeal opening of the Eustachian tube and carefully advanced into the middle ear compartment under permanent direct visual control. Second generation microendoscopes with outside diameters of 750 to 1000 micrometers are equipped with a one- direction tip-steering mechanism which allows deflection up to 90 degrees. In addition to it, the use of two special types of four-function scopes (outside diameter: 1.6 mm and 1.8 mm) fitted with a one-lumen working channel are presented. This new technique of `Transnasal Tubo-Tympanoscopy' (TTT) only needs local anesthesia, normally is performed on an outpatient basis, and is indicated for the diagnosis of any disturbances of the sound conducting apparatus (ear drum and ossicular chain) like chronic otitis media and oto-sclerosis and of those sensorineural hearing disorders on which -- until today -- only the traditional surgical tympanoscopy could provide morphological information on the pathogenesis of the hearing loss, e.g., on assumed round window ruptures. By this minimal invasive and minimal traumatizing method pathological alterations of the ossicular chain as well as obstructions in the cartilaginous and the osseous part of the Eustachian tube can be directly visualized.

Development and Current Status of the “Cambridge” Loudness Models

PubMed Central

2014-01-01

This article reviews the evolution of a series of models of loudness developed in Cambridge, UK. The first model, applicable to stationary sounds, was based on modifications of the model developed by Zwicker, including the introduction of a filter to allow for the effects of transfer of sound through the outer and middle ear prior to the calculation of an excitation pattern, and changes in the way that the excitation pattern was calculated. Later, modifications were introduced to the assumed middle-ear transfer function and to the way that specific loudness was calculated from excitation level. These modifications led to a finite calculated loudness at absolute threshold, which made it possible to predict accurately the absolute thresholds of broadband and narrowband sounds, based on the assumption that the absolute threshold corresponds to a fixed small loudness. The model was also modified to give predictions of partial loudness—the loudness of one sound in the presence of another. This allowed predictions of masked thresholds based on the assumption that the masked threshold corresponds to a fixed small partial loudness. Versions of the model for time-varying sounds were developed, which allowed prediction of the masked threshold of any sound in a background of any other sound. More recent extensions incorporate binaural processing to account for the summation of loudness across ears. In parallel, versions of the model for predicting loudness for hearing-impaired ears have been developed and have been applied to the development of methods for fitting multichannel compression hearing aids. PMID:25315375

Genetics Home Reference: Burn-McKeown syndrome

MedlinePlus

... ear (sensorineural hearing loss) and changes in the middle ear (conductive hearing loss). Other features that can occur in Burn-McKeown syndrome include mild short stature and congenital heart defects ...

Sheep as a large animal model for middle and inner ear implantable hearing devices: a feasibility study in cadavers.

PubMed

Schnabl, Johannes; Glueckert, Rudolf; Feuchtner, Gudrun; Recheis, Wolfgang; Potrusil, Thomas; Kuhn, Volker; Wolf-Magele, Astrid; Riechelmann, Herbert; Sprinzl, Georg M

2012-04-01

Currently, no large animal model exists for surgical-experimental exploratory analysis of implantable hearing devices. In a histomorphometric study, we sought to investigate whether sheep or pig cochleae are suitable for this purpose and whether device implantation is feasible. Skulls of pig and sheep cadavers were examined using high-resolution 128-slice computed tomography (CT) to study anatomic relationships. A cochlear implant and an active middle ear implant could be successfully implanted into the sheep's inner and middle ear, respectively. Correct device placement was verified by CT and histology. The cochlear anatomy of the sheep was further studied by micro-CT and histology. Our investigations indicate that the sheep is a suitable animal model for implantation of implantable hearing devices. The implantation of the devices was successfully performed by access through a mastoidectomy. The histologic, morphologic, and micro-CT study of the sheep cochlea showed that it is highly similar to the human cochlea. The temporal bone of the pig was not suitable for these microsurgical procedures because the middle and inner ear were not accessible owing to distinct soft and fatty tissue coverage of the mastoid. The sheep is an appropriate large animal model for experimental studies with implantable hearing devices, whereas the pig is not.

Prediction of inertial effects due to bone conduction in a 2D box model of the cochlea

NASA Astrophysics Data System (ADS)

Halpin, Alice A.; Elliott, Stephen J.; Ni, Guangjian

2015-12-01

A 2D box model of the cochlea has been used to predict the basilar membrane, BM, velocity and the fluid flow caused by two components of bone conduction: due to inertia of the middle ear and due to inertia of the cochlear fluids. A finite difference approach has been used with asymmetric fluid chambers, that enables an investigation of the effect of varying window stiffness, due to otosclerosis for example. The BM is represented as a series of locally reacting single degree of freedom systems, with graded stiffness along the cochlea to represent the distribution of natural frequencies and with a damping representative of the passive cochlea. The velocity distributions along the passive BM are similar for harmonic excitation via the middle ear inertia or via the fluid inertia, but the variation of the BM velocity magnitude with excitation frequency is different in the two cases. Excitation via the middle ear is suppressed if the oval window is assumed to be blocked, but the excitation via the cochlear fluids is still possible. By assuming a combined excitation due to both middle ear and fluid excitation, the difference between the overall response can be calculated with a flexible and a blocked oval window, which gives a reasonable prediction of Carhart's notch.

Otoscopic diagnosis of otitis media.

PubMed

Isaacson, Glenn

2016-12-01

Accurate diagnosis of otitis media is important to prevent suffering and complications when infection is present, and unnecessary antibiotic use when infection is absent. The usual signs and symptoms of acute otitis media are unreliable guides in infants and young children. Similarly, middle ear effusions may present with little discomfort in older children. We therefore depend on examination of the tympanic membrane with an otoscope to make most diagnoses. This article aims to improve the accuracy of middle ear diagnosis by pneumatic otoscopy. It includes descriptions and photographs of the normal ear drum and illustrates the pathologic changes seen in acute otitis media, long-standing eustachian tube dysfunction and otitis media with effusion.

Radiological assessment of the sinus tympani: temporal bone HRCT analyses and surgically related findings.

PubMed

Marchioni, Daniele; Valerini, Sara; Mattioli, Francesco; Alicandri-Ciufelli, Matteo; Presutti, Livio

2015-05-01

To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma. Retrospective review of the radiologic database and surgical reports. In total, 98/296 (33.1%) middle ears presented a radiologic morphology Type A; 185/296 (62.5%) middle ears presented a radiologic morphology Type B; 13/296 (4.4%) middle ears presented a radiologic morphology Type C; HRCT showed a sensibility of 91%, specificity of 65%, PPV of 68% and negative predictive value (NPV) of 90%. ST shape and depth can influence surgical preference in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; whereas in the case of a deeper ST, a retrofacial approach is usually preferred. HRCT scans demonstrated high sensibility and NPV for ST involvement by cholesteatoma.

A Jurassic gliding euharamiyidan mammal with an ear of five auditory bones

NASA Astrophysics Data System (ADS)

Han, Gang; Mao, Fangyuan; Bi, Shundong; Wang, Yuanqing; Meng, Jin

2017-11-01

Gliding is a distinctive locomotion type that has been identified in only three mammal species from the Mesozoic era. Here we describe another Jurassic glider that belongs to the euharamiyidan mammals and shows hair details on its gliding membrane that are highly similar to those of extant gliding mammals. This species possesses a five-boned auditory apparatus consisting of the stapes, incus, malleus, ectotympanic and surangular, representing, to our knowledge, the earliest known definitive mammalian middle ear. The surangular has not been previously identified in any mammalian middle ear, and the morphology of each auditory bone differs from those of known mammals and their kin. We conclude that gliding locomotion was probably common in euharamiyidans, which lends support to idea that there was a major adaptive radiation of mammals in the mid-Jurassic period. The acquisition of the auditory bones in euharamiyidans was related to the formation of the dentary-squamosal jaw joint, which allows a posterior chewing movement, and must have evolved independently from the middle ear structures of monotremes and therian mammals.

Effect of absorbable gelatin sponge in the middle ear: in vitro and in vivo animal model.

PubMed

Goncalves, Stefania; Chiossone-Kerdel, Juan Armando; Bianco, Andrea S; Ercolino, Jose M; Hernandez-Rojas, Jorge

2015-01-01

GelitaSpon gelatin sponge (GS) showed faster reabsorption than gelfoam (GF) in vitro, and GS-packed middle ears resulted in a faster hearing recovery and less inflammation than the ears packed with GF soaked in saline. Soaking GF sponges with boric acid (BA) appeared to offset the inflammatory response of saline-soaked GF, making this inflammatory response comparable to that of GS-packed ears. To describe the reabsorption and inflammatory effects of absorbable gelatin sponge in the middle ear. For in vitro evaluation, GF and GS were used as disks immersed in saline solution or 3% BA and placed in gel. Images were captured with a microscope and processed using image processing Toolbox. For in vivo tests, 16 female albino Sprague Dawley rats were divided into four groups: bulla opening; GF + 0.9% saline; GF + BA; and GS + 0.9% saline. An anterior approach to the right bulla was used for surgery. Preoperative and postoperative auditory brainstem response thresholds were measured. In vitro, there was marked degradation of GF by day 14, while GS showed complete degradation by the third day. In vivo, hearing recovery occurred by day 21. GF produced a more severe inflammatory response, which could be reduced by treating the GF with BA.

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

PubMed

Areias, B; Parente, M P L; Santos, C; Gentil, F; Natal Jorge, R M

2017-07-01

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.

Pneumococcus: Questions and Answers

MedlinePlus

... States. Pneumococci are also a common cause of acute otitis media (middle ear infection). By age 12 ... children have had at least one episode of acute otitis media. Approximately 28%–55% of such ear ...

Genetics Home Reference: Treacher Collins syndrome

MedlinePlus

... defects of the three small bones in the middle ear, which transmit sound, or by underdevelopment of the ear canal. People with Treacher Collins syndrome usually have normal intelligence. Related Information What does ...

Unclassified congenital deformities of the external ear.

PubMed

Vathulya, Madhubari

2018-01-01

Congenital ear deformities are a common entity. They are found in isolation or as a part of syndrome in patients. They may involve the external, middle or inner ear or in any of these combinations. Three patients of different ages presented with deformities including mirror image duplication of the superior auricle, unclassified deformities of ear lobule (wavy lobule) and deformity of superior auricle with unclassified variety of lateral ear pit. This article highlights that there are further cases of ear deformities that are noticed in the general population who come for cosmetic correction, and hence, there is a need for further modifying the classification of ear deformities.

Visualization of Middle Ear Ossicles in Elder Subjects with Ultra-short Echo Time MR Imaging.

PubMed

Naganawa, Shinji; Nakane, Toshiki; Kawai, Hisashi; Taoka, Toshiaki; Suzuki, Kojiro; Iwano, Shingo; Satake, Hiroko; Grodzki, David

2017-04-10

To evaluate the visualization of middle ear ossicles by ultra-short echo time magnetic resonance (MR) imaging at 3T in subjects over 50 years old. Sixty ears from 30 elder patients that underwent surgical or interventional treatment for neurovascular diseases were included (ages: 50-82, median age: 65; 10 men, 20 women). Patients received follow-up MR imaging including routine T 1 - and T 2 -weighted images, time-of-flight MR angiography, and ultra-short echo time imaging (PETRA, pointwise encoding time reduction with radial acquisition). All patients underwent computed tomography (CT) angiography before treatment. Thin-section source CT images were correlated with PETRA images. Scan parameters for PETRA were: TR 3.13, TE 0.07, flip angle 6 degrees, 0.83 × 0.83 × 0.83 mm resolution, 3 min 43 s scan time. Two radiologists retrospectively evaluated the visibility of each ossicular structure as positive or negative using PETRA images. The structures evaluated included the head of the malleus, manubrium of the malleus, body of the incus, long process of the incus, and the stapes. Signal intensity of the ossicles was classified as: between labyrinthine fluid and air, similar to labyrinthine fluid, between labyrinthine fluid and cerebellar parenchyma, or higher than cerebellar parenchyma. In all ears, the body of the incus was visible. The head of the malleus was visualized in 36/60 ears. The manubrium of the malleus and long process of the incus was visualized in 1/60 and 4/60 ears, respectively. The stapes were not visualized in any ear. Signal intensity of the visible structures was between labyrinthine fluid and air in all ears. The body of the incus was consistently visualized with intensity between air and labyrinthine fluid on PETRA images in aged subjects. Poor visualization of the manubrium of the malleus, long process of the incus, and the stapes limits clinical significance of middle ear imaging with current PETRA methods.

Inner ear dysplasia is common in children with Down syndrome (trisomy 21).

PubMed

Blaser, Susan; Propst, Evan J; Martin, Daniel; Feigenbaum, Annette; James, Adrian L; Shannon, Patrick; Papsin, Blake C

2006-12-01

Middle and external ear anomalies are well recognized in Down syndrome (DS, trisomy 21). Inner ear anomalies are much less frequently described. This study reviews inner ear morphology on imaging to determine the prevalence of cochlear and vestibular anomalies in children with DS. The authors conducted a retrospective review of imaging features of (DS) inner ear structures. Fifty-nine sequential patients with DS with imaging of the inner ear were identified by a radiology report text search program. Quantitative biometric assessment of the inner ear was performed on patients with high-resolution computed tomography or magnetic resonance images of the petrous bone. Petrous imaging was performed for evaluation of inflammatory disease or hearing loss. Spinal imaging, which included petrous views, was performed in most cases to exclude C1 to 2 dislocation, a potential complication of DS. Measurements were compared with normative data. Inner ear dysplasia is much more common in DS than previously reported. Inner ear structures are universally hypoplastic. Vestibular malformations are particularly common and a small bony island of the lateral semicircular canal (<3 mm in diameter) appears highly typical. Additional findings in some patients were persistent lateral semicircular anlage with fusion of the lateral semicircular canal and vestibule into a single cavity, vestibular aqueduct and endolymphatic sac fossa enlargement, cochlear nerve canal hypoplasia, and stenosis or duplication of the internal auditory canal. Stenosis of the external meatus, poor mastoid pneumatization, middle ear and mastoid opacification, and cholesteatoma were common, as expected.

The role of Foxi family transcription factors in otic placode and neural crest cell development

PubMed Central

Edlund, Renée K.; Birol, Onur; Groves, Andrew K.

2015-01-01

The mammalian outer, middle and inner ears have different embryonic origins and evolved at different times in the vertebrate lineage. The outer ear is derived from first and second branchial arch ectoderm and mesoderm, the middle ear ossicles are derived from neural crest mesenchymal cells that invade the first and second branchial arches, whereas the inner ear and its associated vestibule-acoustic (VIIIth) ganglion are derived from the otic placode. In this review, we discuss recent findings in the development of these structures and describe the contributions of members of a Forkhead transcription factor family, the Foxi family to their formation. Foxi transcription factors are critical for formation of the otic placode, survival of the branchial arch neural crest, and developmental remodeling of the branchial arch ectoderm. PMID:25662269

An assessment of a conical horn waveguide to represent the human eardrum

NASA Astrophysics Data System (ADS)

Fields, Taylor N.; Schnetzer, Lucia; Brister, Eileen; Yates, Charles W.; Withnell, Robert H.

2018-05-01

This study examined a model of the acoustic input impedance of the ear that includes a waveguide model of the eardrum. The eardrum was modeled as a lossless conical-horn with rigid walls. The ear canal was modeled as a one-dimensional lossy transmission line. The output impedance of the eardrum, the middle ear, and the cochlea, was modeled as a circuit analog. The model was fit to acoustic input impedance data from human ears using a nonlinear least-squares fit. The impact of a conical-horn shape for the eardrum was quantified by comparison with the eardrum modeled as a near-flat surface. The model provided a good match to the data over the frequency range examined. A conical-horn model of the human eardrum provided gain at high frequencies, most notably above 1–2 kHz, with a broader middle-ear frequency response. This finding may suggest that eardrum shape plays an important role in sound transmission to the cochlea.

[Tuberculous Otitis media - a rare differential diagnosis in Germany].

PubMed

Teschner, M; Kramer, S; Donnerstag, F; Länger, F; Lenarz, Th; Schwab, B

2008-07-01

A 28-year-old female patient with a migrant background presented for surgery with a suspected cholesteatoma in the left ear. The patient reported having had an aural discharge for several months; otoscopic examination revealed a runny ear, and discrete granulation tissue was seen. Pure-tone audiometry showed conduction hearing loss of 30-40 dB across all frequencies in the left ear; high-resolution computed tomography of the temporal bone revealed that the mastoid and tympanic cavity were completely obscured. The intraoperative finding showed a caseous space-occupying mass that completely filled the tympanic cavity. The suspected diagnosis of tuberculosis was corroborated by pathohistological, microbiological and molecular biological tests. Tuberculostatic therapy was initiated at a different location. Although tuberculosis of the middle ear is a rare condition in Germany, it should nevertheless be considered when making a differential diagnosis, especially in high-risk patients where cholesteatoma is suspected on clinical and radiological evidence or in patients with a chronic middle ear process.

Scala vestibuli pressure and three-dimensional stapes velocity measured in direct succession in gerbil.

PubMed

Decraemer, W F; de La Rochefoucauld, O; Dong, W; Khanna, S M; Dirckx, J J J; Olson, E S

2007-05-01

It was shown that the mode of vibration of the stapes has a predominant piston component but rotations producing tilt of the footplate are also present. Tilt and piston components vary with frequency. Separately it was shown that the pressure gain between ear canal and scala vestibuli was a remarkably flat and smooth function of frequency. Is tilt functional contributing to the pressure in the scala vestibuli and helping in smoothing the pressure gain? In experiments on gerbil the pressure in the scala vestibuli directly behind the footplate was measured while recording simultaneously the pressure produced by the sound source in the ear canal. Successively the three-dimensional motion of the stapes was measured in the same animal. Combining the vibration measurements with an anatomical shape measurement from a micro-CT (CT: computed tomography) scan the piston-like motion and the tilt of the footplate was calculated and correlated to the corresponding scala vestibuli pressure curves. No evidence was found for the hypothesis that dips in the piston velocity are filled by peaks in tilt in a systematic way to produce a smooth middle ear pressure gain function. The present data allowed calculations of the individual cochlear input impedances.

Cochlear hearing loss in patients with Laron syndrome.

PubMed

Attias, Joseph; Zarchi, Omer; Nageris, Ben I; Laron, Zvi

2012-02-01

The aim of this prospective clinical study was to test auditory function in patients with Laron syndrome, either untreated or treated with insulin-like growth factor I (IGF-I). The study group consisted of 11 patients with Laron syndrome: 5 untreated adults, 5 children and young adults treated with replacement IGF-I starting at bone age <2 years, and 1 adolescent who started replacement therapy at bone age 4.6 years. The auditory evaluation included pure tone and speech audiometry, tympanometry and acoustic reflexes, otoacoustic emissions, loudness dynamics, auditory brain stem responses and a hyperacusis questionnaire. All untreated patients and the patient who started treatment late had various degrees of sensorineural hearing loss and auditory hypersensitivity; acoustic middle ear reflexes were absent in most of them. All treated children had normal hearing and no auditory hypersensitivity; most had recordable middle ear acoustic reflexes. In conclusion, auditory defects seem to be associated with Laron syndrome and may be prevented by starting treatment with IGF-I at an early developmental age.

Vibration analysis of the tympanic membrane with a ventilation tube and a perforation by holography

NASA Astrophysics Data System (ADS)

Maeta, Manabu; Kawakami, Shinichiro; Ogawara, Toshiaki; Masuda, Yu

1991-08-01

For severe otitis media with effusion, insertion of a ventilation tube is performed for the purpose of ventilation of the middle ear cavity and normalization of the eustachian tubular function and middle ear mucosa. The ventilation tube is left in place for as long as several months or even a few years. However, the influence of the indwelling tube on vibration of the tympanic membrane is unknown. Therefore, the authors observed the influence by means of time-averaged holography using human tympanic membranes. The following results were obtained. After insertion of a ventilation tube, vibration pattern of the tympanic membrane was not obviously changed, but the vibration amplitude of the tympanic membrane was decreased, especially at 500 Hz. Generally speaking, the change caused by insertion of a ventilation tube was very small. Also, the vibration pattern of perforated tympanic membrane was not changed, but the vibration amplitude of perforated tympanic membrane was decreased at the low frequency area.

Long-term hearing outcomes after recurrent acute otitis media during early childhood.

PubMed

Krakau, Mattias; Dagöö, Britta Rynnel; Hellström, Sten; Granath, Anna

2017-12-01

To survey long-term hearing outcomes and middle ear pathology in a 30-year follow-up in individuals with onset of recurrent acute otitis media (rAOM) before three years of age. 28 adults, aged 30.1-31.8 years, who originally - at the age of 12-32 months - participated in a study on rAOM between 1979 and 1983, were re-examined regarding self-reported ear problems, current tympanic membrane changes and audiology. Thirteen subjects had suffered from rAOM during early childhood and 15 subjects served as a control group. Recurrent acute otitis media subjects reported hearing problems comparable to those of the controls. Pure tone audiometry, at 125-8000 Hz, did not differ between groups. The rAOM group had a trend for impaired high-frequency (9000-14,000 Hz) threshold levels (9000-14,000 Hz); implying that their cochlear function seemed to have deteriorated. Adults, who suffered from recurrent acute otitis media as infants, did not show any clinically significant hearing loss for pure tone audiometry when compared to controls, but there was a trend for impaired results regarding extended high frequency audiometry (9-14 kHz). Children suffering from rAOM will be at low risk of developing hearing loss and severe middle ear disease.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Poston, Ted M.; Thrall, Karla D.; Penner, Jocelyn D.

I was asked to submit a response to the Protocol Review forum for the journal LabAnimal by Dr. Jerald Silverman. This forum request views and opinions on issues that are faced by research animal welfare committees. The particular issue is: Dr. John Smith, a distinguished investigator at Great Eastern University, had spent his career searching for a treatment for hearing loss. After 20 years of research, he developed a drug that potentially could improve auditory function after damage to the inner ear. The drug was administered by injection into the middle ear with the use of a fine needle insertedmore » through the eardrum. Smith submitted a protocol to the IACUC to conduct a small study on cats, proposing to treat one group of animals with the drug and another with saline, to determine if it prevented the changes in the anatomy of the inner ear that normally occur with aging.« less

Modeling microstructure of incudostapedial joint and the effect on cochlear input

NASA Astrophysics Data System (ADS)

Gan, Rong Z.; Wang, Xuelin

2015-12-01

The incudostapedial joint (ISJ) connects the incus to stapes in human ear and plays an important role for sound transmission from the tympanic membrane (TM) to cochlea. ISJ is a synovial joint composed of articular cartilage on the lenticular process and stapes head with the synovial fluid between them. However, there is no study on how the synovial ISJ affects the middle ear and cochlear functions. Recently, we have developed a 3-dimensinal finite element (FE) model of synovial ISJ and connected the model to our comprehensive FE model of the human ear. The motions of TM, stapes footplate, and basilar membrane and the pressures in scala vestibule and scala tympani were derived over frequencies and compared with experimental measurements. Results show that the synovial ISJ affects sound transmission into cochlea and the frequency-dependent viscoelastic behavior of ISJ provides protection for cochlea from high intensity sound.

Blast-related Ear Injuries among U.S. Military Personnel

DTIC Science & Technology

2013-08-01

ment outcomes. The exclusion of servicemembers with history of hearing loss and/or tinnitus before injury was a strength of this study, which allowed...and explore hearing loss and tinnitus outcomes within one year after injury. The Expeditionary Medical Encounter Database was used to identify... tinnitus . The prevalence of ear injuries was 30.7% (1,223 of 3,981). The most common ear injury diagnoses were “inner or middle ear injury involving

[Musical hallucinosis following infarction of the right middle cerebral artery].

PubMed

Augustin, J; Guegan-Massardier, E; Levillain, D; Lemarchand, M; Mihout, B; Hannequin, D

2001-03-01

A 44-year-old woman demonstrated a musical hallucinosis four months after a massive infarction in the territory of the right middle cerebral artery. This musical hallucinosis consisting of familiar tunes, was continuous and perceived by both ears. Magnetic Resonance Imaging, middle and late auditory evoked potentials suggested that right Heschl's gyrus and associative areas were imparied. Audiometry demonstrated a low right transmission deafness. The hallucinosis was persistent for seven months and stopped just after hemorrhage of the right ear. This case gives the opportunity to review the different mechanisms responsible for musical hallucinosis.

Interleukin 10 is an essential modulator of mucoid metaplasia in a mouse otitis media model

PubMed Central

Tsuchiya, Katsuyuki; Komori, Masahiro; Zheng, Qing Yin; Ferrieri, Patricia; Lin, Jizhen

2009-01-01

Inflammatory cytokines are involved in the development of mucus cell metaplasia/hyperplasia (MCM) in otitis media (OM). However, which cytokines play an essential role in MCM OM is not clear at the moment. In this study, we hypothesized that interleukin-10 (IL-10) played an indispensable role in MCM of bacterial OM and used IL-10 knockout mice to test this hypothesis. In wild-type mice, both S. pneumoniae and H. influenzae triggered the development of MCM in the middle ear mucosa. In IL-10 knockout mice, the number of goblet cells and mucin-producing cells in the middle ear was significantly reduced after bacterial middle ear infection compared with that in wild-type mice. We, therefore, concluded that IL-10 plays an essential role in MCM of bacterial OM. IL-10 is a potential target for the treatment of MCM in OM. PMID:18771082

International consensus on Vibrant Soundbridge® implantation in children and adolescents.

PubMed

Cremers, Cor W R J; O'Connor, Alec Fitzgerald; Helms, Jan; Roberson, Joseph; Clarós, Pedro; Frenzel, Henning; Profant, Milan; Schmerber, Sébastien; Streitberger, Christian; Baumgartner, Wolf-Dieter; Orfila, Daniel; Pringle, Mike; Cenjor, Carlos; Giarbini, Nadia; Jiang, Dan; Snik, Ad F M

2010-11-01

Active middle ear implants augment hearing in patients with sensorineural, conductive, and mixed hearing losses with great success. However, the application of active middle ear implants has been restricted to compromised ears in adults only. Recently, active middle ear implants have been successfully implanted in patients younger than 18 years of age with all types of hearing losses. The Vibrant Soundbridge (VSB) active middle ear implant has been implanted in more than 60 children and adolescents worldwide by the end of 2008. In October 2008, experts from the field with experience in this population met to discuss VSB implantation in patients below the age of 18. A consensus meeting was organized including a presentation session of cases from worldwide centers and a discussion session in which implantation, precautions, and alternative means of hearing augmentation were discussed. At the end of the meeting, a consensus statement was written by the participating experts. The present consensus paper describes the outcomes and medical/surgical complications: the outcomes are favourable in terms of hearing thresholds, speech intelligibility in quiet and in noise, with a low incidence of intra- and postoperative complications. Taken together, the VSB offers another viable treatment for children and adolescents with compromised hearing. However, other treatment options should also be taken into consideration. The advantages and disadvantages of all possible treatment options should be weighed against each other in the light of each individual case to provide the best solution; counseling should include a.o. surgical issues and MRI compatibility. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Modeling sound transmission of human middle ear and its clinical applications using finite element analysis.

PubMed

Chen, Shou-I; Lee, Ming-Hsiao; Yao, Chih-Min; Chen, Peir-Rong; Chou, Yuan-Fang; Liu, Tien-Chen; Song, Yu-Lin; Lee, Chia-Fone

2013-03-01

We have developed a new finite element (FE) model of human right ear, including the accurate geometry of middle ear ossicles, external ear canal, tympanic cavity, and mastoid cavity. The FE model would be suitable to study the dynamic behaviors of pathological middle ear conditions, including changes of stapedial ligament stiffness, tensor tympani ligament (TTL), and tympanic membrane (TM) stiffness and thickness. Increasing stiffness of stapedial ligament has substantial effect on stapes footplate movement, especially at low frequencies, but less effect on umbo movement. Softer TTL will result in increasing umbo and stapes footplate displacement, especially at low frequencies (f<1000Hz). When the TTL was detached, the vibration amplitude of umbo increased by 6dB at 600Hz and two peaks (300 and 600Hz) were found in the vibration amplitude of stapes footplate. Increasing the stiffness of tensor tympani resulted in a slightly decreased umbo amplitude at very low frequencies (f<500Hz) and significantly decreased displacement up to 12dB at middle frequencies (1000Hz1500Hz. As (TM) thickness was increased, the umbo displacement was reduced, especially at very low frequencies (f<600Hz). Otherwise, the stapes displacement was reduced at all frequencies. Copyright © 2013. Published by Elsevier B.V.

Ciprofloxacin and Dexamethasone Otic

MedlinePlus

Ciprofloxacin and dexamethasone otic is used to treat outer ear infections in adults and children and acute (suddenly occurring) middle ear ... in a class of medications called quinolone antibiotics. Dexamethasone is in a class of medications called corticosteroids. ...

Ick Ciliary Kinase Is Essential for Planar Cell Polarity Formation in Inner Ear Hair Cells and Hearing Function.

PubMed

Okamoto, Shio; Chaya, Taro; Omori, Yoshihiro; Kuwahara, Ryusuke; Kubo, Shun; Sakaguchi, Hirofumi; Furukawa, Takahisa

2017-02-22

Cellular asymmetries play crucial roles in development and organ function. The planar cell polarity (PCP) signaling pathway is involved in the establishment of cellular asymmetry within the plane of a cell sheet. Inner ear sensory hair cells (HCs), which have several rows of staircase-like stereocilia and one kinocilium located at the vertex of the stereocilia protruding from the apical surface of each HC, exhibit a typical form of PCP. Although connections between cilia and PCP signaling in vertebrate development have been reported, their precise nature is not well understood. During inner ear development, several ciliary proteins are known to play a role in PCP formation. In the current study, we investigated a functional role for intestinal cell kinase (Ick), which regulates intraflagellar transport (IFT) at the tip of cilia, in the mouse inner ear. A lack of Ick in the developing inner ear resulted in PCP defects in the cochlea, including misorientation or misshaping of stereocilia and aberrant localization of the kinocilium and basal body in the apical and middle turns, leading to auditory dysfunction. We also observed abnormal ciliary localization of Ift88 in both HCs and supporting cells. Together, our results show that Ick ciliary kinase is essential for PCP formation in inner ear HCs, suggesting that ciliary transport regulation is important for PCP signaling. SIGNIFICANCE STATEMENT The cochlea in the inner ear is the hearing organ. Planar cell polarity (PCP) in hair cells (HCs) in the cochlea is essential for mechanotransduction and refers to the asymmetric structure consisting of stereociliary bundles and the kinocilium on the apical surface of the cell body. We reported previously that a ciliary kinase, Ick, regulates intraflagellar transport (IFT). Here, we found that loss of Ick leads to abnormal localization of the IFT component in kinocilia, PCP defects in HCs, and hearing dysfunction. Our study defines the association of ciliary transport regulation with PCP formation in HCs and hearing function. Copyright © 2017 the authors 0270-6474/17/372073-13$15.00/0.

Sensitivity analysis of pars-tensa young's modulus estimation using inverse finite-element modeling

NASA Astrophysics Data System (ADS)

Rohani, S. Alireza; Elfarnawany, Mai; Agrawal, Sumit K.; Ladak, Hanif M.

2018-05-01

Accurate estimates of the pars-tensa (PT) Young's modulus (EPT) are required in finite-element (FE) modeling studies of the middle ear. Previously, we introduced an in-situ EPT estimation technique by optimizing a sample-specific FE model to match experimental eardrum pressurization data. This optimization process requires choosing some modeling assumptions such as PT thickness and boundary conditions. These assumptions are reported with a wide range of variation in the literature, hence affecting the reliability of the models. In addition, the sensitivity of the estimated EPT to FE modeling assumptions has not been studied. Therefore, the objective of this study is to identify the most influential modeling assumption on EPT estimates. The middle-ear cavity extracted from a cadaveric temporal bone was pressurized to 500 Pa. The deformed shape of the eardrum after pressurization was measured using a Fourier transform profilometer (FTP). A base-line FE model of the unpressurized middle ear was created. The EPT was estimated using golden section optimization method, which minimizes the cost function comparing the deformed FE model shape to the measured shape after pressurization. The effect of varying the modeling assumptions on EPT estimates were investigated. This included the change in PT thickness, pars flaccida Young's modulus and possible FTP measurement error. The most influential parameter on EPT estimation was PT thickness and the least influential parameter was pars flaccida Young's modulus. The results of this study provide insight into how different parameters affect the results of EPT optimization and which parameters' uncertainties require further investigation to develop robust estimation techniques.

Systematic review to evaluate the safety, efficacy and economical outcomes of the Vibrant Soundbridge for the treatment of sensorineural hearing loss.

PubMed

Bruchhage, Karl-Ludwig; Leichtle, Anke; Schönweiler, Rainer; Todt, Ingo; Baumgartner, Wolf-Dieter; Frenzel, Henning; Wollenberg, Barbara

2017-04-01

Introduced in the late 90s, the active middle ear implant Vibrant Soundbridge (VSB) is nowadays used for hearing rehabilitation in patients with mild to severe sensorineural hearing loss (SNHL) unable to tolerate conventional hearing aids. In experienced hands, the surgical implantation is fast done, safe and highly standardized. Here, we present a systematic review, after more than 15 years of application, to determine the efficacy/effectiveness and cost-effectiveness, as well as patient satisfaction with the VSB active middle ear implant in the treatment of mild to severe SNHL. A systematic search of electronic databases, investigating the safety and effectiveness of the VSB in SNHL plus medical condition resulted in a total of 1640 papers. After removing duplicates, unrelated articles, screening against inclusion criteria and after in-depth screening, the number decreased to 37 articles. 13 articles were further excluded due to insufficient outcome data. 24 studies remained to be systematically reviewed. Data was searched on safety, efficacy and economical outcomes with the VSB. Safety-oriented outcomes included complication/adverse event rates, damage to the middle/inner ear, revision surgery/explant rate/device failure and mortality. Efficacy outcomes were divided into audiological outcomes, including hearing thresholds, functional gain, speech perception in quiet and noise, speech recognition thresholds, real ear insertion gain and subjective outcomes determined by questionnaires and patient-oriented scales. Data related to quality of life (QALY, ICER) were considered under economical outcomes. The VSB turns out to be a highly reliable and a safe device which significantly improves perception of speech in noisy situations with a high sound quality. In addition, the subjective benefit of the VSB was found to be mostly significant in all studies. Finally, implantation with the VSB proved to be a cost-effective and justified health care intervention.

Development of a finite element model of the middle ear.

PubMed

Williams, K R; Blayney, A W; Rice, H J

1996-01-01

A representative finite element model of the healthy ear is developed commencing with a description of the decoupled isotropic tympanic membrane. This model was shown to vibrate in a manner similar to that found both numerically (1, 2) and experimentally (8). The introduction of a fibre system into the membrane matrix significantly altered the modes of vibration. The first mode "remains as a piston like movement as for the isotropic membrane. However, higher modes show a simpler vibration pattern similar to the second mode but with a varying axis of movement and lower amplitudes. The introduction of a malleus and incus does not change the natural frequencies or mode shapes of the membrane for certain support conditions. When constraints are imposed along the ossicular chain by simulation of a cochlear impedance term then significantly altered modes can occur. More recently a revised model of the ear has been developed by the inclusion of the outer ear canal. This discretisation uses geometries extracted from a Nuclear Magnetic resonance scan of a healthy subject and a crude inner ear model using stiffness parameters ultimately fixed through a parameter tuning process. The subsequently tuned model showed behaviour consistent with previous findings and should provide a good basis for subsequent modelling of diseased ears and assessment of the performance of middle ear prostheses.

Infantile inflammatory pseudotumor of the facial nerve as a complication of epidermal nevus syndrome with cholesteatoma.

PubMed

Hato, Naohito; Tsujimura, Mika; Takagi, Taro; Okada, Masahiro; Gyo, Kiyofumi; Tohyama, Mikiko; Tauchi, Hisamichi

2013-12-01

The first reported case of facial paralysis due to an inflammatory pseudotumor (IPT) of the facial nerve as a complication of epidermal nevus syndrome (ENS) is herein presented. A 10-month-old female patient was diagnosed with ENS at 3 months of age. She was referred to us because of moderate left facial paralysis. Epidermal nevi of her left auricle extended deep into the external ear canal. Otoscopy revealed polypous nevi and cholesteatoma debris filling the left ear. Computed tomography showed a soft mass filling the ear canal, including the middle ear, and an enormously enlarged facial nerve. Surgical exploration revealed numerous polypous nevi, external ear cholesteatoma, and tumorous swelling of the facial nerve. The middle ear ossicles were completely lost. The facial paralysis was improved after decompression surgery, but recurred 5 months later. A second operation was conducted 10 months after the first. During this operation, facial nerve decompression was completed from the geniculate ganglion to near the stylomastoid foramen. Histological diagnosis of the facial nerve tumor was IPT probably caused by chronic external ear inflammation induced by epidermal nevi. The facial paralysis gradually improved to House-Blackmann grade III 5 years after the second operation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Optical coherence tomography for imaging the middle and inner ears: A technical review

NASA Astrophysics Data System (ADS)

Ramier, Antoine; Rosowski, John J.; Yun, Seok-Hyun

2018-05-01

Optical coherence tomography (OCT), a minimally-invasive, high-speed, high resolution imaging modality, is becoming increasingly popular in the field of hearing research and otology. This review describes the history and state of the art of OCT for applications to understanding the mechanics of hearing and visualizing pathologies in the middle and inner ears. We will also discuss some of the recent developments that may accelerate the adoption of OCT to this field.

Survey of Speech-Language Pathology Graduate Program Training in Outer and Middle Ear Screening.

PubMed

Serpanos, Yula C; Senzer, Deborah

2015-08-01

The purpose of this study was to determine the national training practices of speech-language pathology graduate programs in outer and middle ear screening. Directors of all American Speech-Language-Hearing Association-accredited speech-language pathology graduate programs (N = 254; Council on Academic Accreditation in Audiology and Speech-Language Pathology, 2013) were surveyed on instructional formats in outer and middle ear screening. The graduate speech-language pathology program survey yielded 84 (33.1%) responses. Results indicated that some programs do not provide any training in the areas of conventional screening otoscopy using a handheld otoscope (15.5%; n = 13) or screening tympanometry (11.9%; n = 10), whereas close to one half (46.4%; n = 39) reported no training in screening video otoscopy. Outcomes revealed that approximately one third or more of speech-language pathology graduate programs do not provide experiential opportunities in screening handheld otoscopy (36.9%) or tympanometry (32.1%), and most (78.6%) do not provide experiential opportunities in video otoscopy. The implication from the graduate speech-language pathology program survey findings is that some speech-language pathologists will graduate from academic programs without the acquired knowledge or experiential learning required to establish skill in 1 or more areas of screening otoscopy and tympanometry. Graduate speech-language pathology programs should consider appropriate training opportunities for students to acquire and demonstrate skill in outer and middle ear screening.

Tuberculous otitis media: a case presentation and review of the literature

PubMed Central

Aremu, S K; Alabi, B S

2010-01-01

A 42-year-old farmer being treated for pulmonary tuberculosis was referred to our clinic after developing otorrhoea and hearing loss in his right ear. Examination revealed a large subtotal perforation in the right ear in addition to a purulent discharge with right facial nerve palsy. Audiometry indicated a 35 dB conductive hearing loss at 0.5, 1 and 2 kHz with air–bone gaps of 12, 15 and 10 dB, respectively. A middle ear biopsy was performed under direct visualisation, with a middle ear lavage which was positive for allergic fungal sinusitis (AFS). The final diagnosis was tuberculous otitis media (TOM). Clinical symptoms and signs should be reviewed in every case of chronic otitis media keeping the possibility of tuberculosis in mind. Otorrhoea in a patient with known or suspected active pulmonary tuberculosis should be assumed to be TOM until proven otherwise. PMID:22798297

Tuberculous otitis media: a case presentation and review of the literature.

PubMed

Aremu, S K; Alabi, B S

2010-12-01

A 42-year-old farmer being treated for pulmonary tuberculosis was referred to our clinic after developing otorrhoea and hearing loss in his right ear. Examination revealed a large subtotal perforation in the right ear in addition to a purulent discharge with right facial nerve palsy. Audiometry indicated a 35 dB conductive hearing loss at 0.5, 1 and 2 kHz with air-bone gaps of 12, 15 and 10 dB, respectively. A middle ear biopsy was performed under direct visualisation, with a middle ear lavage which was positive for allergic fungal sinusitis (AFS). The final diagnosis was tuberculous otitis media (TOM). Clinical symptoms and signs should be reviewed in every case of chronic otitis media keeping the possibility of tuberculosis in mind. Otorrhoea in a patient with known or suspected active pulmonary tuberculosis should be assumed to be TOM until proven otherwise.

Sound localization in the alligator.

PubMed

Bierman, Hilary S; Carr, Catherine E

2015-11-01

In early tetrapods, it is assumed that the tympana were acoustically coupled through the pharynx and therefore inherently directional, acting as pressure difference receivers. The later closure of the middle ear cavity in turtles, archosaurs, and mammals is a derived condition, and would have changed the ear by decoupling the tympana. Isolation of the middle ears would then have led to selection for structural and neural strategies to compute sound source localization in both archosaurs and mammalian ancestors. In the archosaurs (birds and crocodilians) the presence of air spaces in the skull provided connections between the ears that have been exploited to improve directional hearing, while neural circuits mediating sound localization are well developed. In this review, we will focus primarily on directional hearing in crocodilians, where vocalization and sound localization are thought to be ecologically important, and indicate important issues still awaiting resolution. Copyright © 2015 Elsevier B.V. All rights reserved.

Various causes and clinical characteristics in vertigo in children with normal eardrums.

PubMed

Choung, Yun-Hoon; Park, Keehyun; Moon, Sung-Kyun; Kim, Chul-Ho; Ryu, Sang Jun

2003-08-01

The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

A double-blind, placebo-controlled clinical trial of the effect of chlorpheniramine on the response of the nasal airway, middle ear and eustachian tube to provocative rhinovirus challenge.

PubMed

Doyle, W J; McBride, T P; Skoner, D P; Maddern, B R; Gwaltney, J M; Uhrin, M

1988-03-01

This paper presents the results of a randomized, double-blind, placebo-controlled study of the efficacy of chlorpheniramine in relieving the symptoms and attenuating the pathophysiologic correlates of a rhinovirus "common cold." Forty healthy, adult, nonatopic subjects were randomly assigned to one of two treatment groups: active drug and placebo. On study Day 0, all subjects were challenged intranasally with rhinovirus type 39 (dose = 100 TCID50). Subjects were cloistered from Day 2 to Day 7, at which time they were treated with either chlorpheniramine or placebo. From 3 days before challenge to study Day 19, subjects had nasal patency assessed by rhinomanometry, eustachian tube function assessed by the 9-step test and sonotubometry, middle ear pressure assessed by tympanometry and nasal clearance assessed by the dyed-saccharin technique. Symptom diaries were maintained throughout the period of follow-up. During cloister, symptoms also were scored by interview, nasal secretions were quantified and nasal washings were performed for viral culture. Results showed that 19 (95%) subjects in the active-treatment group and 18 (90%) subjects in the placebo-treatment group shed virus. Symptomatic colds were observed in 63% of the active-treated and 83% of the placebo-treated subjects. Symptoms increased on Day 1 and peaked at Days 4 to 5. Detrimental changes in other measured functions consistent with those previously reported were observed. During the period of treatment, significant differences in the average symptom scores favoring the active-treatment group were observed for sneezing. Also, weight of expelled secretions was greater and mucociliary clearance rate less on some cloister days for the placebo-treated group. No significant differences between treatment groups in the objective measures of nasal congestion or the response of the middle ear and eustachian tube were documented.

Long-term hearing result using Kurz titanium ossicular implants.

PubMed

Hess-Erga, Jeanette; Møller, Per; Vassbotn, Flemming Slinning

2013-05-01

Titanium implants in middle ear surgery were introduced in the late 90s and are now frequently used in middle ear surgery. However, long-term studies of patient outcome are few and have only been published in subgroups of patients. We report the long-term effect of titanium middle ear implants for ossicular reconstruction in chronic ear disease investigated in a Norwegian tertiary otological referral centre. Retrospective chart reviews were performed for procedures involving 76 titanium implants between 2000 and 2007. All patients who underwent surgery using the Kurz Vario titanium implant were included in the study. Audiological parameters using four frequencies, 0.5, 1, 2, and 3 kHz, according to AAO-HNS guidelines, was assessed pre and postoperatively. Otosurgical procedures, complications, revisions, and extrusion rates were analyzed. The study had no dropouts. The partial ossicular replacement prosthesis (PORP) was used in 44 procedures and the total ossicular replacement prosthesis (TORP) in 32 procedures, respectively. Mean follow-up was 5.2 years (62 months). The ossiculoplasties were performed as staging procedures or in combination with other chronic ear surgery. The same surgeon performed all the procedures. A postoperative air-bone gap of ≤ 20 dB was obtained in 74 % of the patients, 82 % for the Bell (PORP) prosthesis, and 63 % for the Arial (TORP) prosthesis. The extrusion rate was 5 %. We conclude that titanium ossicular implants give stable and excellent long-term hearing results.

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

PubMed Central

Mittal, Rahul; Lisi, Christopher V.; Gerring, Robert; Mittal, Jeenu; Mathee, Kalai; Narasimhan, Giri; Azad, Rajeev K.; Yao, Qi; Grati, M'hamed; Yan, Denise; Eshraghi, Adrien A.; Angeli, Simon I.; Telischi, Fred F.

2015-01-01

Otitis media (OM) is an inflammation of the middle ear associated with infection. Despite appropriate therapy, acute OM (AOM) can progress to chronic suppurative OM (CSOM) associated with ear drum perforation and purulent discharge. The effusion prevents the middle ear ossicles from properly relaying sound vibrations from the ear drum to the oval window of the inner ear, causing conductive hearing loss. In addition, the inflammatory mediators generated during CSOM can penetrate into the inner ear through the round window. This can cause the loss of hair cells in the cochlea, leading to sensorineural hearing loss. Pseudomonas aeruginosa and Staphylococcus aureus are the most predominant pathogens that cause CSOM. Although the pathogenesis of AOM is well studied, very limited research is available in relation to CSOM. With the emergence of antibiotic resistance as well as the ototoxicity of antibiotics and the potential risks of surgery, there is an urgent need to develop effective therapeutic strategies against CSOM. This warrants understanding the role of host immunity in CSOM and how the bacteria evade these potent immune responses. Understanding the molecular mechanisms leading to CSOM will help in designing novel treatment modalities against the disease and hence preventing the hearing loss. PMID:26248613

Conductive Hearing Loss Caused by Third-Window Lesions of the Inner Ear

PubMed Central

Merchant, Saumil N.; Rosowski, John J.

2008-01-01

Background Various authors have described conductive hearing loss (CHL), defined as an air-bone gap on audiometry, in patients without obvious middle ear pathologic findings. Recent investigations have suggested that many of these cases are due to disorders of the inner ear, resulting in pathologic third windows. Objective To provide an overview of lesions of the inner ear resulting in a CHL due to a third-window mechanism. The mechanism of the CHL is explained along with a classification scheme for these disorders. We also discuss methods for diagnosis of these disorders. Data Sources The data were compiled from a review of the literature and recent published research on middle and inner ear mechanics from our laboratory. Conclusion A number of disparate disorders affecting the labyrinth can produce CHL by acting as a pathologic third window in the inner ear. The common denominator is that these conditions result in a mobile window on the scala vestibuli side of the cochlear partition. The CHL results by the dual mechanism of worsening of air conduction thresholds and improvement of bone conduction thresholds. Such lesions may be anatomically discrete or diffuse. Anatomically discrete lesions may be classified by location: semicircular canals (superior, lateral, or posterior canal dehiscence), bony vestibule (large vestibular aqueduct syndrome, other inner ear malformations), or the cochlea (carotid-cochlear dehiscence, X-linked deafness with stapes gusher, etc.). An example of an anatomically diffuse lesion is Paget disease, which may behave as a distributed or diffuse third window. Third-window lesions should be considered in the differential diagnosis of CHL in patients with an intact tympanic membrane and an aerated, otherwise healthy, middle ear. Clues to suspect such a lesion include a low-frequency air-bone gap with supranormal thresholds for bone conduction, and presence of acoustic reflexes, vestibular evoked myogenic responses, or otoacoustic emission responses despite the CHL. Imaging studies can help confirm the diagnosis. PMID:18223508

Carcinoma of the middle ear and external auditory canal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hahn, S.S.; Kim, J.A.; Goodchild, N.

1983-07-01

Thirty-one patients with malignant tumors of the middle ear and external auditory canal (EAC) were observed at the University of Virginia Hospital from 1956 through 1980. Of 27 patients with carcinoma, 21 had squamous cell carcinoma, 4 had basal cell carcinoma and 2 had adenoid cystic carcinoma. The 27 patients with carcinoma are reviewed with regard to clinical presentation, treatment modality, results and complications. The majority (67%) of patients had a history of chronic ear drainage, 22% had a previous mastoidectomy or polypectomy and 7% had an associated cholesteatoma. Eighty percent of patients with carcinoma limited to EAC were alivemore » and well at 5 years, compared to 43% of patients with involvement of the middle ear. Fifty-six percent of patients without invasion of the petrous bone were alive at 5 years compared to only 20% of patients with petrous bone involvement. The data strongly suggest that survival depends on the extent of disease. The corrected disease free 5 year survival rates were 14% for patients who had surgery alone and 50% for those who had surgery and radiotherapy. Of the three patients with advanced disease who received radiotherapy alone, none survived five years.« less

The influence of the mechanical behaviour of the middle ear ligaments: a finite element analysis.

PubMed

Gentil, F; Parente, M; Martins, P; Garbe, C; Jorge, R N; Ferreira, A; Tavares, João Manuel R S

2011-01-01

The interest in computer modelling of biomechanical systems, mainly by using the finite element method (FEM), has been increasing, in particular for analysis of the mechanical behaviour of the human ear. In this work, a finite element model of the middle ear was developed to study the dynamic structural response to harmonic vibrations for distinct sound pressure levels applied on the eardrum. The model includes different ligaments and muscle tendons with elastic and hyperelastic behaviour for these supportive structures. Additionally, the nonlinear behaviour of the ligaments and muscle tendons was investigated, as they are the connection between ossicles by contact formulation. Harmonic responses of the umbo and stapes footplate displacements, between 100 Hz and 10 kHz, were obtained and compared with previously published work. The stress state of ligaments (superior, lateral, and anterior of malleus and superior and posterior of incus) was analysed, with the focus on balance of the supportive structures of the middle ear, as ligaments make the link between the ossicular chain and the walls of the tympanic cavity. The results obtained in this work highlight the importance of using hyperelastic models to simulate the mechanical behaviour for the ligaments and tendons.

Surgical treatment for the aberrant internal carotid artery in the middle ear with pulsatile tinnitus.

PubMed

Honkura, Yohei; Hidaka, Hiroshi; Ohta, Jun; Gorai, Shigeki; Katori, Yukio; Kobayashi, Toshimitsu

2014-04-01

Many previous reports have indicated that pulsatile tinnitus caused by an aberrant internal carotid artery (ICA) should not be treated surgically because of the risk of infection or aneurysm formation. We herein describe a case of aberrant ICA treated by middle ear surgery for which we introduced a novel approach. An 84-year-old man was presented with a one-year history of tinnitus in his right ear. Otoscopic examination demonstrated a whitish mass in the antero-inferior quadrant of the tympanic membrane associated with rhythmic pulsation. Images obtained by CT, MRI and MRA revealed protrusion of the ICA into the tympanic cavity, making contact with the tympanic membrane. Surgery to separate the tympanic membrane from the ICA was performed in order to relieve the pulsatile tinnitus. After the operation, the patient's aural activity was preserved and the tinnitus did not recur within a follow-up period of one year. In the present case, delicate middle ear surgery was effective for relief of the tinnitus. When treating patients with aberrant IAC showing features similar to the present case, the surgical approach we have described is worth attempting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Pressure equilibration in the penguin middle ear.

PubMed

Sadé, Jacob; Handrich, Yves; Bernheim, Joelle; Cohen, David

2008-01-01

King penguins have a venous structure in the form of a corpus cavernosum (CC) in their middle ear (ME) submucosa. The CC may be viewed as a special organelle that can change ME volume for pressure equilibration during deep-sea diving it is a pressure regulating organelle (PRO). A similar CC and muscles also surround the external ear (EE) and may constrict it, isolating the tympanic membrane from the outside. A CC was previously found also in the ME of marine diving mammals and can be expected to exist in other deep diving animals, such as marine turtles. Marine animals require equalization of middle ear (ME) pressure when diving hundreds or thousands of meters to catch prey. We investigated what mechanism enables king penguins to protect their ME when they dive to great depths. Biopsies and serial sections of the ME and the EE of the deep diving king penguin (Aptenodytes patagonicus) were examined microscopically. It was demonstrated that the penguin ME has an extensive network of small and large submucosal venous sinuses. This venous formation, a corpus cavernosum, can expand and potentially 'flood' the ME almost completely on diving, thus elevating ME pressure and reducing the ME space. The EE has a similar protective mechanism.

Hearing and hearing loss: Causes, effects, and treatments

NASA Astrophysics Data System (ADS)

Schmiedt, Richard A.

2003-04-01

Hearing loss can have multiple causes. The outer and middle ears are conductive pathways for acoustic energy to the inner ear (cochlea) and help shape our spectral sensitivity. Conductive hearing loss is mechanical in nature such that the energy transfer to the cochlea is impeded, often from eardrum perforations or middle ear fluid buildup. Beyond the middle ear, the cochlea comprises three interdependent systems necessary for normal hearing. The first is that of basilar-membrane micromechanics including the outer hair cells. This system forms the basis of the cochlear amplifier and is the most vulnerable to noise and drug exposure. The second system comprises the ion pumps in the lateral wall tissues of the cochlea. These highly metabolic cells provide energy to the cochlear amplifier in the form of electrochemical potentials. This second system is particularly vulnerable to the effects of aging. The third system comprises the inner hair cells and their associated sensory nerve fibers. This system is the transduction stage, changing mechanical vibrations to nerve impulses. New treatments for hearing loss are on the horizon; however, at present the best strategy is avoidance of cochlear trauma and the proper use of hearing aids. [Work supported by NIA and MUSC.

Involvement of Ubiquitin-Editing Protein A20 in Modulating Inflammation in Rat Cochlea Associated with Silver Nanoparticle-Induced CD68 Upregulation and TLR4 Activation

NASA Astrophysics Data System (ADS)

Feng, Hao; Pyykkö, Ilmari; Zou, Jing

2016-05-01

Silver nanoparticles (AgNPs) were shown to temporarily impair the biological barriers in the skin of the external ear canal, mucosa of the middle ear, and inner ear, causing partially reversible hearing loss after delivery into the middle ear. The current study aimed to elucidate the molecular mechanism, emphasizing the TLR signaling pathways in association with the potential recruitment of macrophages in the cochlea and the modulation of inflammation by ubiquitin-editing protein A20. Molecules potentially involved in these signaling pathways were thoroughly analysed using immunohistochemistry in the rat cochlea exposed to AgNPs at various concentrations through intratympanic injection. The results showed that 0.4 % AgNPs but not 0.02 % AgNPs upregulated the expressions of CD68, TLR4, MCP1, A20, and RNF11 in the strial basal cells, spiral ligament fibrocytes, and non-sensory supporting cells of Corti's organ. 0.4 % AgNPs had no effect on CD44, TLR2, MCP2, Rac1, myosin light chain, VCAM1, Erk1/2, JNK, p38, IL-1β, TNF-α, TNFR1, TNFR2, IL-10, or TGF-β. This study suggested that AgNPs might confer macrophage-like functions on the strial basal cells and spiral ligament fibrocytes and enhance the immune activities of non-sensory supporting cells of Corti's organ through the upregulation of CD68, which might be involved in TLR4 activation. A20 and RNF11 played roles in maintaining cochlear homeostasis via negative regulation of the expressions of inflammatory cytokines.

Ear Structures of the Naked Mole-Rat, Heterocephalus glaber, and Its Relatives (Rodentia: Bathyergidae)

PubMed Central

Mason, Matthew J.; Cornwall, Hannah L.; Smith, Ewan St. J.

2016-01-01

Although increasingly popular as a laboratory species, very little is known about the peripheral auditory system of the naked mole-rat, Heterocephalus glaber. In this study, middle and inner ears of naked mole-rats of a range of ages were examined using micro-computed tomography and dissection. The ears of five other bathyergid species (Bathyergus suillus, Cryptomys hottentotus, Fukomys micklemi, Georychus capensis and Heliophobius argenteocinereus) were examined for comparative purposes. The middle ears of bathyergids show features commonly found in other members of the Ctenohystrica rodent clade, including a fused malleus and incus, a synovial stapedio-vestibular articulation and the loss of the stapedius muscle. Heterocephalus deviates morphologically from the other bathyergids examined in that it has a more complex mastoid cavity structure, poorly-ossified processes of the malleus and incus, a ‘columelliform’ stapes and fewer cochlear turns. Bathyergids have semicircular canals with unusually wide diameters relative to their radii of curvature. How the lateral semicircular canal reaches the vestibule differs between species. Heterocephalus has much more limited high-frequency hearing than would be predicted from its small ear structures. The spongy bone forming its ossicular processes, the weak incudo-stapedial articulation, the columelliform stapes and (compared to other bathyergids) reduced cochlear coiling are all potentially degenerate features which might reflect a lack of selective pressure on its peripheral auditory system. Substantial intraspecific differences were found in certain middle and inner ear structures, which might also result from relaxed selective pressures. However, such interpretations must be treated with caution in the absence of experimental evidence. PMID:27926945

Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media

PubMed Central

Han, Won Gue; Yoo, Jun; Rah, Yoon Chan; Chang, Jiwon; Im, Gi Jung; Song, Jae-Jun; Chae, Sung Won; Jung, Hak Hyun; Choi, June

2017-01-01

Objectives Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. Methods We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. Results We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). Conclusion DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests. PMID:28602066

Inner Ear Drug Delivery for Auditory Applications

PubMed Central

Swan, Erin E. Leary; Mescher, Mark J.; Sewell, William F.; Tao, Sarah L.; Borenstein, Jeffrey T.

2008-01-01

Many inner ear disorders cannot be adequately treated by systemic drug delivery. A blood-cochlear barrier exists, similar physiologically to the blood-brain barrier, which limits the concentration and size of molecules able to leave the circulation and gain access to the cells of the inner ear. However, research in novel therapeutics and delivery systems has led to significant progress in the development of local methods of drug delivery to the inner ear. Intratympanic approaches, which deliver therapeutics to the middle ear, rely on permeation through tissue for access to the structures of the inner ear, whereas intracochlear methods are able to directly insert drugs into the inner ear. Innovative drug delivery systems to treat various inner ear ailments such as ototoxicity, sudden sensorineural hearing loss, autoimmune inner ear disease, and for preserving neurons and regenerating sensory cells are being explored. PMID:18848590

Hearing Loss in a Mouse Model of 22q11.2 Deletion Syndrome

PubMed Central

Fuchs, Jennifer C.; Zinnamon, Fhatarah A.; Taylor, Ruth R.; Ivins, Sarah; Scambler, Peter J.; Forge, Andrew; Tucker, Abigail S.; Linden, Jennifer F.

2013-01-01

22q11.2 Deletion Syndrome (22q11DS) arises from an interstitial chromosomal microdeletion encompassing at least 30 genes. This disorder is one of the most significant known cytogenetic risk factors for schizophrenia, and can also cause heart abnormalities, cognitive deficits, hearing difficulties, and a variety of other medical problems. The Df1/+ hemizygous knockout mouse, a model for human 22q11DS, recapitulates many of the deficits observed in the human syndrome including heart defects, impaired memory, and abnormal auditory sensorimotor gating. Here we show that Df1/+ mice, like human 22q11DS patients, have substantial rates of hearing loss arising from chronic middle ear infection. Auditory brainstem response (ABR) measurements revealed significant elevation of click-response thresholds in 48% of Df1/+ mice, often in only one ear. Anatomical and histological analysis of the middle ear demonstrated no gross structural abnormalities, but frequent signs of otitis media (OM, chronic inflammation of the middle ear), including excessive effusion and thickened mucosa. In mice for which both in vivo ABR thresholds and post mortem middle-ear histology were obtained, the severity of signs of OM correlated directly with the level of hearing impairment. These results suggest that abnormal auditory sensorimotor gating previously reported in mouse models of 22q11DS could arise from abnormalities in auditory processing. Furthermore, the findings indicate that Df1/+ mice are an excellent model for increased risk of OM in human 22q11DS patients. Given the frequently monaural nature of OM in Df1/+ mice, these animals could also be a powerful tool for investigating the interplay between genetic and environmental causes of OM. PMID:24244619

Hearing loss in a mouse model of 22q11.2 Deletion Syndrome.

PubMed

Fuchs, Jennifer C; Zinnamon, Fhatarah A; Taylor, Ruth R; Ivins, Sarah; Scambler, Peter J; Forge, Andrew; Tucker, Abigail S; Linden, Jennifer F

2013-01-01

22q11.2 Deletion Syndrome (22q11DS) arises from an interstitial chromosomal microdeletion encompassing at least 30 genes. This disorder is one of the most significant known cytogenetic risk factors for schizophrenia, and can also cause heart abnormalities, cognitive deficits, hearing difficulties, and a variety of other medical problems. The Df1/+ hemizygous knockout mouse, a model for human 22q11DS, recapitulates many of the deficits observed in the human syndrome including heart defects, impaired memory, and abnormal auditory sensorimotor gating. Here we show that Df1/+ mice, like human 22q11DS patients, have substantial rates of hearing loss arising from chronic middle ear infection. Auditory brainstem response (ABR) measurements revealed significant elevation of click-response thresholds in 48% of Df1/+ mice, often in only one ear. Anatomical and histological analysis of the middle ear demonstrated no gross structural abnormalities, but frequent signs of otitis media (OM, chronic inflammation of the middle ear), including excessive effusion and thickened mucosa. In mice for which both in vivo ABR thresholds and post mortem middle-ear histology were obtained, the severity of signs of OM correlated directly with the level of hearing impairment. These results suggest that abnormal auditory sensorimotor gating previously reported in mouse models of 22q11DS could arise from abnormalities in auditory processing. Furthermore, the findings indicate that Df1/+ mice are an excellent model for increased risk of OM in human 22q11DS patients. Given the frequently monaural nature of OM in Df1/+ mice, these animals could also be a powerful tool for investigating the interplay between genetic and environmental causes of OM.

Effects of Acoustic Impulses on the Middle Ear

DTIC Science & Technology

2017-10-01

conditioned response; middle ear; damage-risk criteria; health hazard evaluation ACCOMPLISHMENTS: What were the major goals of the project? The...participants declined to participate after the study was described during the informed consent process. The results of V1 were used to evaluate participant...0.64 0.73 4000 Hz 0.82 0.78 0.85 0.68 0.63 0.73 1 or 2 kHz 0.93 0.90 0.95 – – – 13 Evaluation of RTs Analyses of reflexive tasks

A Mathematical Model for the Middle Ear Ventilation

NASA Astrophysics Data System (ADS)

Molnárka, G.; Miletics, E. M.; Fücsek, M.

2008-09-01

The otitis media is one of the mostly existing illness for the children, therefore investigation of the human middle ear ventilation is an actual problem. In earlier investigations both experimental and theoretical approach one can find in ([l]-[3]). Here we give a new mathematical and computer model to simulate this ventilation process. This model able to describe the diffusion and flow processes simultaneously, therefore it gives more precise results than earlier models did. The article contains the mathematical model and some results of the simulation.

Acoustic stimulation on the round window for active middle ear implants.

PubMed

Seong, Kiwoong; Lee, Kyuyup; Puria, Sunil; Cho, Jin-Ho

2018-06-01

Many clinical reports have discussed the effectiveness of stimulating the ear's round window (RW) with a tool to mitigate conductive and mixed hearing loss. The RW is one of the two openings from the middle ear into the inner ear. Various methods have been proposed to construct a highly efficient, easily implanted, and reliable RW transducer. Devices, however, such as floating mass transducers, have difficulty establishing proper contact without some degree of bone incision around the RW. Additionally, vibration energy may not be fully transmitted to the cochlea, but instead will be spread through the soft tissue around the transducer. We propose a more direct RW stimulation with very high acoustical impedance using a receiver that is a volume velocity source. We expect this source to overcome large acoustic impedance by maximizing sound pressure in a confined space, the RW niche. To verify the effectiveness of the proposed method, ear canal pressure, RW pressure, and stapes velocity are measured by acoustic RW stimulation of human temporal bones. Copyright © 2018 Elsevier Ltd. All rights reserved.

Laser Doppler vibrometry: new ENT applications

NASA Astrophysics Data System (ADS)

Stasche, Norbert; Baermann, M.; Kempe, C.; Hoermann, Karl; Foth, Hans-Jochen

1996-12-01

Common audiometry often does not really allow a reliable and objective differential diagnosis of hearing disorders such as otosclerosis, adhesive otitis, ossicular interruption or tinnitus, even though several methods might be used complementarily. In recent years, some experimental studies on middle ear mechanics established laser Doppler vibrometry (LDV) as a useful method allowing objective measurement of human tympanic membrane displacement. The present study on LDV investigated the clinical use of this new method under physiological conditions. LDV proved to be a fast, reproducible, non-invasive and very sensitive instrument to characterize ear-drum vibrations in various middle ear dysfunctions, except in tinnitus patients. For future applications, improved optical characteristics of the vibrometer might result in a better differential diagnosis of subjective and objective tinnitus, otoacoustic emissions or Morbus Meniere.

JS-X syndrome: A multiple congenital malformation with vocal cord paralysis, ear deformity, hearing loss, shoulder musculature underdevelopment, and X-linked recessive inheritance.

PubMed

Hoeve, Hans L J; Brooks, Alice S; Smit, Liesbeth S

2015-07-01

We report on a family with a not earlier described multiple congenital malformation. Several male family members suffer from laryngeal obstruction caused by bilateral vocal cord paralysis, outer and middle ear deformity with conductive and sensorineural hearing loss, facial dysmorphisms, and underdeveloped shoulder musculature. The affected female members only have middle ear deformity and hearing loss. The pedigree is suggestive of an X-linked recessive inheritance pattern. SNP-array revealed a deletion and duplication on Xq28 in the affected family members. A possible aetiology is a neurocristopathy with most symptoms expressed in structures derived from branchial arches. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Development of an ear cap in chronic suppurative otitis media using additive manufacturing and TRIZ.

PubMed

Mawale, Mahesh B; Kuthe, Abhaykumar; Mawale, Anupama M; Dahake, Sandeep W

2018-06-01

The prevalence rate of chronic suppurative otitis media is high and its treatment continues to be a challenge for the otorhinolaryngologists. Due to middle ear infection, there may be pain, hearing loss and spontaneous rupture of the eardrum which results in perforation. Infections can cause a hole in the eardrum as a side effect of otitis media. The patients suffering from ear perforation or having a hole in eardrum require preventing entry of water in the ear. This article describes the development of ear cap using additive manufacturing and TRIZ (a collaborative tool) to prevent the entry of water in the ear during chronic otitis media.

Effects of topical oxiconazole and boric acid in alcohol solutions to rat inner ears.

PubMed

Özdemir, Süleyman; Tuncer, Ülkü; Tarkan, Özgür; Akar, Funda; Sürmelioğlu, Özgür

2013-06-01

The aim of this study is to evaluate the ototoxicity of topical oxiconazole and boric acid in alcohol solutions. Prospective controlled animal study. Research laboratory. Fifty adult Wistar albino rats were divided into 5 groups consisting of 10 animals each. The right tympanic membranes were perforated, and baseline and posttreatment distortion product otoacoustic emission (DPOAE) measurements were performed. The solutions were applied through the external ear canal to the middle ear twice a day for 14 days. The rats in group I and group II received 0.1 mL of oxiconazole-containing solution drops and 4% boric acid in alcohol solution drops, respectively. Group III received gentamicin solution (40 mg/mL) (ototoxic control), group IV received saline solution, and group V was followed without any medication. The baseline DPOAE results of the right ears of all animals tested were normal. Animals in groups I, II, IV, and V showed no statistically significant change in the DPOAE amplitudes. The rats in the gentamicin group showed a significant decrease. This study demonstrates that topically used oxiconazole and boric acid in alcohol solutions to the middle ear appear to be safe on the inner ear of rats. The safety of these drugs has not yet been confirmed in humans. Caution should be taken when prescribing these drugs, especially to patients who had tympanic membrane perforation. Ear drops should be chosen more carefully in an external ear infection for patients with tympanic membrane perforation to avoid ototoxicity.

The effects of alterations in the osseous external auditory canal on perceived sound quality.

PubMed

van Spronsen, Erik; Brienesse, Patrick; Ebbens, Fenna A; Waterval, Jerome J; Dreschler, Wouter A

2015-10-01

To evaluate the perceptual effect of the altered shape of the osseous external auditory canal (OEAC) on sound quality. Prospective study. Twenty subjects with normal hearing were presented with six simulated sound conditions representing the acoustic properties of six different ear canals (three normal ears and three cavities). The six different real ear unaided responses of these ear canals were used to filter Dutch sentences, resulting in six simulated sound conditions. A seventh unfiltered reference condition was used for comparison. Sound quality was evaluated using paired comparison ratings and a visual analog scale (VAS). Significant differences in sound quality were found between the normal and cavity conditions (all P < .001) using both the seven-point paired comparison rating and the VAS. No significant differences were found between the reference and normal conditions. Sound quality deteriorates when the OEAC is altered into a cavity. This proof of concept study shows that the altered acoustic quality of the OEAC after radical cavity surgery may lead to a clearly perceived deterioration in sound quality. Nevertheless, some questions remain about the extent to which these changes are affected by habituation and by other changes in middle ear anatomy and functionality. 4 © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Mixed epithelial and stromal tumor of the middle ear: The first case report.

PubMed

Michal, Michael; Skálová, Alena; Kazakov, Dmitry V; Pecková, Květoslava; Heidenreich, Filip; Grossmann, Petr; Michal, Michal

2017-03-01

We report a tumor arising in the middle ear of a 65-year-old female patient that was composed of an ovarian-type stroma (OS) and an epithelial component. The tumor consisted of irregular, polypoid masses containing multiple variably sized cystic spaces, which were invariably surrounded by the OS. The cystic spaces were lined by flat, cuboidal, or columnar epithelial cells, in most parts showing mucinous differentiation. The epithelial lining of the cysts strongly expressed cytokeratins AE1-3, CK7, CK8, CK18, CK19, EMA, and S100 protein. The stroma expressed CD34 and smooth muscle actin. No cytological atypia or mitoses were present, and the proliferative activity was less than 1% in both components. The clonality analysis proved the clonal nature of the neoplasm. We believe that this tumor is a new member in the family of neoplasms containing the OS, and therefore we propose the term mixed epithelial and stromal tumor of the middle ear. Copyright © 2017 Elsevier Inc. All rights reserved.

Middle-ear microsurgery simulation to improve new robotic procedures.

PubMed

Kazmitcheff, Guillaume; Nguyen, Yann; Miroir, Mathieu; Péan, Fabien; Ferrary, Evelyne; Cotin, Stéphane; Sterkers, Olivier; Duriez, Christian

2014-01-01

Otological microsurgery is delicate and requires high dexterity in bad ergonomic conditions. To assist surgeons in these indications, a teleoperated system, called RobOtol, is developed. This robot enhances gesture accuracy and handiness and allows exploration of new procedures for middle ear surgery. To plan new procedures that exploit the capacities given by the robot, a surgical simulator is developed. The simulation reproduces with high fidelity the behavior of the anatomical structures and can also be used as a training tool for an easier control of the robot for surgeons. In the paper, we introduce the middle ear surgical simulation and then we perform virtually two challenging procedures with the robot. We show how interactive simulation can assist in analyzing the benefits of robotics in the case of complex manipulations or ergonomics studies and allow the development of innovative surgical procedures. New robot-based microsurgical procedures are investigated. The improvement offered by RobOtol is also evaluated and discussed.

Middle-Ear Microsurgery Simulation to Improve New Robotic Procedures

PubMed Central

Kazmitcheff, Guillaume; Nguyen, Yann; Miroir, Mathieu; Péan, Fabien; Ferrary, Evelyne; Cotin, Stéphane; Sterkers, Olivier; Duriez, Christian

2014-01-01

Otological microsurgery is delicate and requires high dexterity in bad ergonomic conditions. To assist surgeons in these indications, a teleoperated system, called RobOtol, is developed. This robot enhances gesture accuracy and handiness and allows exploration of new procedures for middle ear surgery. To plan new procedures that exploit the capacities given by the robot, a surgical simulator is developed. The simulation reproduces with high fidelity the behavior of the anatomical structures and can also be used as a training tool for an easier control of the robot for surgeons. In the paper, we introduce the middle ear surgical simulation and then we perform virtually two challenging procedures with the robot. We show how interactive simulation can assist in analyzing the benefits of robotics in the case of complex manipulations or ergonomics studies and allow the development of innovative surgical procedures. New robot-based microsurgical procedures are investigated. The improvement offered by RobOtol is also evaluated and discussed. PMID:25157373

Determination of eustachius tube ventilation functioning among benign type chronic suppurative otitis media and non-otitis media subjects using sonotubometry

NASA Astrophysics Data System (ADS)

Ikhwan, M.; Hafil, A. F.; Bramanthyo, B.

2017-08-01

The Eustachian tube (ET) is responsible for the ventilation, protection, and cleaning of the middle ear. ET dysfunction plays an important role in the pathogenesis of otitis media cases, and thus the treatment and prognosis of these cases is extremely dependent on adequate ET function, which can ultimately affect the success rate of middle ear reconstruction practices. Data research on the ET’s ventilation function is needed to ensure the success of therapy and surgery treatments in the case of Chronic Suppurative Otitis Media (CSOM) patients. This study aims to investigate ET ventilation functioning in benign type CSOM and non-otitis media subjects and to develop another modality to measure ET ventilation functioning in patients with intact and perforated tympanic membranes. A comparative cross-sectional study of 36 benign type CSOM patients and 80 non-otitis media subjects will be conducted using sonotubometry and the rated parameter measurements of ET opening frequency, amplitude and ET opening duration. Malfunctioning ventilation of the ET is more common among benign type CSOM subjects (47%) than among non-otitis media subjects (18.75%). There is a significant difference (p = 0.002) between the ET ventilation functioning of benign type CSOM subjects and non-otitis media subjects—benign type CSOM subjects have rates of malfunctioning ET ventilation that are 3.88 times higher than those of non-otitis media subjects. Patients with benign type CSOM are more likely to experience malfunctioning ET ventilation than are non-otitis media subjects.

Adenomatous tumors of the middle ear and temporal bone: clinical, morphological and tumor biological characteristics of challenging neoplastic lesions.

PubMed

Duderstadt, M; Förster, Christine; Welkoborsky, H-J; Ostertag, H

2012-03-01

Adenomatous tumors of the middle ear and temporal bone are rare tumors. In this retrospective study, we examined nine patients who underwent surgery for an adenomatous tumor of the middle ear, mastoid cavity or eustachian tube. In seven patients, a middle ear adenoma (MEA) and in two patients an aggressive papillary tumor (APT) was diagnosed. We report the clinical, radiologic, morphologic, immunohistochemical and DNA image cytometrical characteristics that can help to correctly classify these tumors. Therapy consisted of surgical excision of the tumors in eight cases. In one elderly patient, only a large biopsy was taken, because this patient suffered from cardial and kidney disorders and was not suitable for an extended surgical approach. This patient received stereotactic radiotherapy. Seven patients underwent planned second look operation. Recurrences occurred in three patients (one with APT, two with MEA), whereas in two of these cases rather a residual tumor due to initial incomplete tumor resection occurred. By image analysis, DNA cytometry MEA were considered benign, whereas the appearance of aneuploid tumor cells in APT confirmed these tumors as low grade malignant lesions. The proliferation rates were equally low in both entities. APT and MEA are tumor entities which can only be correctly classified by a synopsis of histopathology, immunohistochemistry and DNA image cytometry. The recommended therapy is the complete tumor excision. In cases of APT, von Hippel-Lindau syndrome has to be excluded.

Human middle-ear nonlinearity measurements using laser Doppler vibrometry

NASA Astrophysics Data System (ADS)

Gladiné, Kilian; Muyshondt, Pieter G. G.; Dirckx, Joris J. J.

2017-12-01

It has long been supposed that the middle-ear has near to perfect linear characteristics, and several attempts have been made to investigate this hypothesis. In conclusion, the middle-ear was regarded as a linear system at least up till sound pressure levels of 120 dB. Because of the linear relationship between Doppler shift of light and the vibration velocity of the object on which the light is reflected, laser Doppler vibrometry (LDV) is an intrinsically highly linear measurement technique. Therefore it allows straightforward detection of very small nonlinearities in a vibration response. In this paper, laser Doppler vibrometry and multisine stimulation are used to detect nonlinear distortions in the vibration response at the umbo of the tympanic membrane of seven human cadaver temporal bones. Nonlinear distortions were detected starting from sound pressure levels of 99 dB and measurements were performed up to 120 dB. These distortions can be subdivided into even degree (e.g. quadratic distortion tones) and odd degree nonlinear distortions (e.g. cubic distortion tones). We illustrate that with odd multisine stimulation the level of even and odd degree nonlinear distortions can be investigated separately. In conclusion, laser Doppler vibrometry is an adequate tool to detect nonlinear distortions in the middle-ear system and to quantify the level of such distortions even at 57 dB below the vibration response. The possibility to analyze even degree and odd degree nonlinear distortion levels separately can help in future work to pinpoint the source of the nonlinearity.

Why Cannot We have an Etiological Classification for the Patients with Granular Myringitis?

PubMed

Bansal, Mohan

2017-09-01

Though granular myringitis (GM) is not a very rare disease it does not have any classification. Its exact etiology is not known. The granulations on tympanic membrane also occur in association with other lesions of external auditory canal (EAC) and middle ear. The aims of this study were to know the etiological factors of GM and classify the disease according to its etiological factors and associated disorders of EAC and middle ear. Data were retrieved from the search of four electronic databases: PubMed, EMBASE, Cochrane Library, and Google scholar. Relevant articles were also sought by a hand search review of reference books. The databases were searched using the key words otitis externa, external otitis, granular myringitis, granular otitis externa and myringitis. Data were extracted using a pre-defined data-extraction form. The following data were recorded (1) etiological and predisposing conditions; (2) pathological features; (3) associated disorders of external and middle ear. The study proposes the etiological classification of GM. It suggests two major groups: primary and secondary. The primary GM is basically idiopathic and these patients do no have evidences of any other types of otitis media and otitis externa. In the secondary GM the cause is obvious and the patients usually have associated otitis media and/or lesions of external ear canal. Author speculates that habit of self ear cleaning/scratching is a specific etiological factor in cases of primary GM but more studies are required to confirm this theory.

The Transplantation of hBM-MSCs Increases Bone Neo-Formation and Preserves Hearing Function in the Treatment of Temporal Bone Defects - on the Experience of Two Month Follow Up.

PubMed

Školoudík, Lukáš; Chrobok, Viktor; Kočí, Zuzana; Popelář, Jiří; Syka, Josef; Laco, Jan; Filipová, Alžběta; Syková, Eva; Filip, Stanislav

2018-06-03

Temporal bone reconstruction is a persisting problem following middle ear cholesteatoma surgery. Seeking to advance the clinical transfer of stem cell therapy we attempted the reconstruction of temporal bone using a composite bioartificial graft based on a hydroxyapatite bone scaffold combined with human bone marrow-derived mesenchymal stromal cells (hBM-MSCs). The aim of this study was to evaluate the effect of the combined biomaterial on the healing of postoperative temporal bone defects and the preservation of physiological hearing functions in a guinea pig model. The treatment's effect could be observed at 1 and 2 months after implantation of the biomaterial, as opposed to the control group. The clinical evaluation of our results included animal survival, clinical signs of an inflammatory response, and exploration of the tympanic bulla. Osteogenesis, angiogenesis, and inflammation were evaluated by histopathological analyses, whereas hBM-MSCs survival was evaluated by immunofluorescence assays. Hearing capacity was evaluated by objective audiometric methods, i.e. auditory brainstem responses and otoacoustic emission. Our study shows that hBM-MSCs, in combination with hydroxyapatite scaffolds, improves the repair of bone defects providing a safe and effective alternative in their treatment following middle ear surgery due to cholesteatoma.

Comparative and developmental patterns of amphibious auditory function in salamanders.

PubMed

Zeyl, Jeffrey N; Johnston, Carol E

2016-12-01

Early amphibious tetrapods may have detected aquatic sound pressure using sound-induced lung vibrations, but their lack of tympanic middle ears would have restricted aerial sensitivity. Sharing these characteristics, salamanders could be models for the carryover of auditory function across an aquatic-terrestrial boundary without tympanic middle ears. We measured amphibious auditory evoked potential audiograms in five phylogenetically and ecologically distinct salamanders (Amphiuma means, Notophthalmus viridescens, Ambystoma talpoideum, Eurycea spp., and Plethodon glutinosus) and tested whether metamorphosis and terrestrial niche were linked to aerial sensitivity. Threshold differences between media varied between species. A. means' relative aerial sensitivity was greatest at 100 Hz and decreased with increasing frequency. In contrast, all other salamanders retained greater sensitivity up to 500 Hz, and in A. talpoideum and Eurycea, relative sensitivity at 500 Hz was higher than at 100 Hz. Aerial thresholds of terrestrial P. glutinosus above 200 Hz were similar to A. talpoideum and Eurycea, but lower than N. viridescens and A. means. Metamorphosis did not affect aerial sensitivity in N. viridescens or A. talpoideum. These results fail to support a hypothesis of terrestrial hearing specialization across ontogeny or phylogeny. We discuss methodological limitations to our amphibious comparisons and factors affecting variation in amphibious performance.

The ototoxic effect of boric acid solutions applied into the middle ear of guinea pigs.

PubMed

Oztürkcan, Sedat; Dündar, Riza; Katilmis, Hüseyin; Ilknur, Ali Ekber; Aktaş, Sinem; Haciömeroğlu, Senem

2009-05-01

This study analyzed the ototoxic effects of boric acid solutions. Boric acid solutions have been used as otologic preparations for many years. Boric acid is commonly found in solutions prepared with alcohol or distilled water but can also be found in a powder form. These preparations are used for both their antiseptic and acidic qualities in external and middle ear infections. We investigated the ototoxic effect of boric acid solutions on guinea pigs. We are unaware of any similar, previously published study of this subject in English. The study was conducted on 28 young albino guinea pigs. Prior to application of the boric acid solution under general anesthesia, an Auditory Brainstem Response (ABRs) test was applied to the right ear of the guinea pigs. Following the test, a perforation was created on the tympanic membrane of the right ear of each guinea pig and small gelfoam pieces were inserted into the perforated area. Test solutions were administered to the middle ear for 10 days by means of a transcanal route. Fifteen days after inserting the gelfoams in all of the guinea pigs, we anasthesized the guinea pigs and removed the gelfoams from the perforated region of the ear and then performed an ABRs on each guinea pig. The ABRs were within the normal range before the applications. After the application, no significant changes were detected in the ABRs thresholds in neither the saline group nor the group administered boric acid and distilled water solution; however, significant changes were detected in the ABRs thresholds of the Gentamicine and boric acid and alcohol solution groups. We believe that a 4% boric acid solution prepared with distilled water can be a more reliable preparation than a 4% boric acid solution prepared with alcohol.

Expression of keratinocyte growth factor (KGF) and its receptor in a middle-ear cavity problem.

PubMed

Yamamoto-Fukuda, Tomomi; Takahashi, Haruo; Koji, Takehiko

2012-01-01

To investigate the pathogenesis of one of the most troublesome conditions following ear surgery, a middle-ear cavity problem. Keratinocyte growth factor (KGF) and its receptor (KGFR), the ratio of proliferating epithelial cells using Ki-67, and the extent of infiltration of B cells and T cells were examined immunohistochemically in 10 ears with a cavity problem, 70 ears with cholesteatoma and 8 ears with normal skin at the retroauricular incision. KGF was positive in 40% of cavity problem specimens, 37.5% of normal skin specimens, and was positive in 88% of cholesteatoma specimens (cavity problem vs. cholesteatoma, p=0.0004). The positive rate of KGFR in the cavity problem group (33.3%) was between those in cholesteatoma (60%) and normal skin (0%). In contrast to the cholesteatoma specimens, a significantly smaller number of Ki-67 labeling index (LI) was detected in the cavity problem specimens. B cell LI was significantly higher but T cell LI was significantly lower in the cavity problem specimens than in the cholesteatoma group. Our present study indicated that the discordance of paracrine action between stromal KGF and epithelial KGFR with a large number of infiltrating B cells may play an important role in the pathogenesis of a cavity problem. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

How is sound conducted to the cochlea in toothed whales?

NASA Astrophysics Data System (ADS)

Zosuls, Aleks; Mountain, David C.; Ketten, Darlene R.

2015-12-01

Toothed whales (Odontocetes) typically have small occluded ear canals and sea water has a characteristic impedance that is much more similar to the impedance of soft tissues of the head than is the case for the air-tissue interface in terrestrial mammals. This makes it plausible that significant acoustic energy is being transmitted to their middle ear by tissue conduction. In addition, some authors have proposed that sound reaches the cochlea via bone conduction rather than via the tympanic membrane. To address these issues, we have developed a method to measure stapes velocity in response to vibrational stimulation at arbitrary locations on heads and ears harvested from stranded animals. Stapes velocity was measured with a Laser Doppler Velocimeter at the footplate with the cochlea drained. In all species tested, the transfer function of stapes velocity referenced to actuator velocity showed a high-pass characteristic. The corner frequency varied with species and experiment between 4 kHz and 60 kHz. This is similar to what is seen in odontocete audiograms but the cutoff slope is typically steeper than in the audiograms. There was no indication of high frequency cutoff within our measurement range. Disrupting the ossicles and fat bodies affected the transfer functions.

Abnormal cortical sensorimotor activity during “Target” sound detection in subjects with acute acoustic trauma sequelae: an fMRI study

PubMed Central

Job, Agnès; Pons, Yoann; Lamalle, Laurent; Jaillard, Assia; Buck, Karl; Segebarth, Christoph; Delon-Martin, Chantal

2012-01-01

The most common consequences of acute acoustic trauma (AAT) are hearing loss at frequencies above 3 kHz and tinnitus. In this study, we have used functional Magnetic Resonance Imaging (fMRI) to visualize neuronal activation patterns in military adults with AAT and various tinnitus sequelae during an auditory “oddball” attention task. AAT subjects displayed overactivities principally during reflex of target sound detection, in sensorimotor areas and in emotion-related areas such as the insula, anterior cingulate and prefrontal cortex, in premotor area, in cross-modal sensory associative areas, and, interestingly, in a region of the Rolandic operculum that has recently been shown to be involved in tympanic movements due to air pressure. We propose further investigations of this brain area and fine middle ear investigations, because our results might suggest a model in which AAT tinnitus may arise as a proprioceptive illusion caused by abnormal excitability of middle-ear muscle spindles possibly link with the acoustic reflex and associated with emotional and sensorimotor disturbances. PMID:22574285

External unit for a semi-implantable middle ear hearing device.

PubMed

Garverick, S L; Kane, M; Ko, W H; Maniglia, A J

1997-06-01

A miniaturized, low-power external unit has been developed for the clinical trials of a semi-implantable middle ear electromagnetic hearing device (SIMEHD) which uses radio-frequency telemetry to couple sound signals to the internal unit. The external unit is based on a commercial hearing aid which provides proven audio amplification and compression. Its receiver is replaced by an application-specific integrated circuit (ASIC) which: 1) adjusts the direct-current bias of the audio input according to its peak value; 2) converts the audio signal to a one-bit digital form using sigma-delta modulation; 3) modulates the sigma-delta output with a radio-frequency (RF) oscillator; and 4) drives the external RF coil and tuning capacitor using a field-effect transistor operated in class D. The external unit functions as expected and has been used to operate bench-top tests to the SIMEHD. Measured current consumption is 1.65-2.15 mA, which projects to a battery lifetime of about 15 days. Bandwidth is 6 kHz and harmonic distortion is about 2%.

Squamous cell carcinoma and consequent otitis in a Long-eared Hedgehog (Hemiechinus auritus)--case report.

PubMed

Gál, Janos; Landauer, Krisztina; Palade, Elena Alina; Ivaskevics, Katalin; Rusvai, Miklós; Demeter, Zoltán

2009-03-01

The authors describe a squamous cell carcinoma arising from the ear canal of a Long-eared Hedgehog (Hemiechinus auritus). No metastasis could be identified elsewhere in the animal. Due to the irritation caused by the tumorous proliferation the animal constantly scratched the affected area, which led to secondary bacterial infection of the middle ear accompanied by the stagnation of an increased volume of local secretions. Using routine haematoxylin and eosin and immunohistochemical staining techniques, the tumour was identified as a squamous cell carcinoma. This work constitutes the first description of such a tumour in a Long-eared Hedgehog.

Small Tympanic Membrane Perforations in the Inferior Quadrants Do Not Impact the Manubrium Vibration in Guinea Pigs

PubMed Central

Zhang, Xiuling; Dai, Yanhong; Zhang, Shuyi; She, Wandong; Du, Xiaoping; Shui, Xiuji

2012-01-01

Background It has been believed that location of the perforation has a significant impact on hearing loss. However, recent studies have demonstrated that the perforation sites had no impact on hearing loss. We measured the velocity and pattern of the manubrium vibration in guinea pigs with intact and perforated eardrum using a laser Doppler vibrometer in order to determine the effects of different location perforations on the middle ear transfer functions. Methods Two bullas from 2 guinea pigs were used to determine stability of the umbo velocities, and 12 bullas from six guinea pigs to determine the effects of different location perforations on sound transmission. The manubrium velocity was measured at three points on the manubrium in the frequencies of 0.5–8 kHz before and after a perforation was made. The sites of perforations were in anterior-inferior (AI) quadrants of left ears and posterior-inferior (PI) quadrants of right ears. Results The manubrium vibration velocity losses were noticed in the perforated ears only below 1.5 kHz. The maximum velocity loss was about 7 dB at 500 Hz with the PI perforation. No significant difference in the velocity loss was found between AI and PI perforations. The average ratio of short process velocity to the umbo velocity was approximately 0.5 at all frequencies. No significant differences were found before and after perforation at all frequencies (p>0.05) except 7 kHz (p = 0.004) for both AI and PI perforations. Conclusions The manubrium vibration velocity losses from eardrum perforation were frequency-dependent and the largest losses occur at low frequencies. Manubrium velocity losses caused by small acute inferior perforations in guinea pigs have no significant impact on middle ear sound transmission at any frequency tested. The manubrium vibration axis may be perpendicular to the manubrium below 8 kHz in guinea pigs. PMID:22238584

Mechanical Damage of Tympanic Membrane in Relation to Impulse Pressure Waveform – A Study in Chinchillas

PubMed Central

Gan, Rong Z.; Nakmali, Don; Ji, Xiao D.; Leckness, Kegan; Yokell, Zachary

2016-01-01

Mechanical damage to middle ear components in blast exposure directly causes hearing loss, and the rupture of the tympanic membrane (TM) is the most frequent injury of the ear. However, it is unclear how the severity of injury graded by different patterns of TM rupture is related to the overpressure waveforms induced by blast waves. In the present study, the relationship between the TM rupture threshold and the impulse or overpressure waveform has been investigated in chinchillas. Two groups of animals were exposed to blast overpressure simulated in our lab under two conditions: open field and shielded with a stainless steel cup covering the animal head. Auditory brainstem response (ABR) and wideband tympanometry were measured before and after exposure to check the hearing threshold and middle ear function. Results show that waveforms recorded in the shielded case were different from those in the open field and the TM rupture threshold in the shielded case was lower than that in the open field (3.4±0.7 vs. 9.1±1.7 psi or 181±1.6 vs. 190±1.9 dB SPL). The impulse pressure energy spectra analysis of waveforms demonstrates that the shielded waveforms include greater energy at high frequencies than that of the open field waves. Finally, a 3D finite element (FE) model of the chinchilla ear was used to compute the distributions of stress in the TM and the TM displacement with impulse pressure waves. The FE model-derived change of stress in response to pressure loading in the shielded case was substantially faster than that in the open case. This finding provides the biomechanical mechanisms for blast induced TM damage in relation to overpressure waveforms. The TM rupture threshold difference between the open and shielded cases suggests that an acoustic role of helmets may exist, intensifying ear injury during blast exposure. PMID:26807796

Improvement of Eustachian Tube Function by Tissue-Engineered Regeneration of Mastoid Air Cells

PubMed Central

Kanemaru, Shin-ichi; Umeda, Hiroo; Yamashita, Masaru; Hiraumi, Harukazu; Hirano, Shigeru; Nakamura, Tatsuo; Ito, Juichi

2013-01-01

Objectives/Hypothesis Most cases of chronic otitis media (OMC) are associated with poor development of the mastoid air cells (MACs) and poor Eustachian tube (ET) function. We have previously reported that MAC regeneration can effectively eliminate intractable OMC. In this study, we assessed the ability of regenerated MACs to restore normal gas exchange function and contribute to improved ET function. Study Design Clinical trial with control. Setting General hospitals. Materials and Methods Seventy-six patients with OMC, including cholesteatoma and adhesive otitis media, received tympanoplasty and MAC regeneration therapy. At the first-stage of tympanoplasty, artificial pneumatic bones and/or autologous bone fragments were implanted into the opened mastoid cavity. At the 2nd-stage operation, a nitrous oxide (N2O) gas study was performed in 10 patients to measure middle ear pressure (MEP). For the control group, MEP was measured in five patients with good MAC development during cochlear implantation or facial nerve decompression. ET function was measured twice in each patient, once before the 1st operation and 6 months after the second operation. Results At the 2nd-stage operation, in all cases with regenerated MACs and in the normal control group, MEP changed after administration of N2O. In contrast, no change in MEP was observed in cases with unregenerated MACs. In 70% (n = 37/53) of the regenerated MAC group, ET function was improved, whereas improvement of ET function was observed in only 13% (n = 3/23) of the unregenerated MAC group. Conclusions Tissue-engineered regeneration of MACs improves ET function and gas exchange in the middle ear. Laryngoscope, 2012 Level of Evidence 3b PMID:23086494

The variable clinical presentation of tuberculosis otitis media and the importance of early detection.

PubMed

Abes, Generoso T; Abes, Franco Louie L B; Jamir, Joselito C

2011-06-01

Tuberculosis (TB) is a rare cause of otitis media. This study aims to increase awareness on the clinical presentation of TB otitis media and illustrate how early detection affects treatment outcome. Chart review of 12 patients (13 ears) from a tertiary hospital in Manila, Philippines, seen from 2004 to 2009. Clinical predictors of the disease were summarized. Clinical, radiologic, and audiometric outcomes after treatment were compared between treatment groups. The 5 otoscopic presentations were multiple perforations, single perforation with refractory otorrhea and exuberant granulation tissue formation, single perforation with minimal otorrhea and no granulation tissue formation, intact tympanic membrane with middle ear effusion, and intact tympanic membrane with tumorlike tissue in the middle ear. Clinical predictors of the disease were history of pulmonary TB, work-related contamination of the infection, positive purified protein derivative test, positive chest radiographic finding and intraoperative granulation tissue with cheesy material, and temporal bone computed tomographic scan findings. Patients who had no middle ear surgery showed significantly better clinical, radiologic, and audiometric outcomes than those who were diagnosed late and had more complicated surgical procedure. The clinical presentation of TB otitis media is variable. Early detection of the early forms entail less surgical intervention and favors better treatment results.

[Barotrauma in children and adults after flying. Prevalence and treatment with Otovent].

PubMed

Stangerup, S E; Tjernström, O; Harcourt, J; Klokker, M; Stokholm, J

1998-03-16

To prevent barotitis during descent in aviation, the ears have to be cleared several times by performing the Valsalva's manoeuvre. The manoeuvre is difficult for children to perform, and they are therefore at high risk of developing barotitis. The treatment of barotitis is either inflation by a Politzer balloon or myringotomy. An alternative treatment is autoinflation using the Otovent. This prophylaxis/treatment can be performed by the child with assistance from its parents as soon as or preferably before the descent has started. The prevalence of barotitis amongst 45 children and 49 adults in transit was found to be highest in children, 28%, compared with adults, 10%. Only 6% of the children with negative middle ear pressure after flight managed a successful Valsalva manoeuvre, whereas 33% could normalise the middle ear pressure by inflating the Otovent. In conclusion we recommend autoinflation using the Otovent set by children and adults who have problems clearing their ears during flight.