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A Novel Surgery Classification for Endoscopic Approaches to middle ear Cholesteatoma

Current Medical Science 2020年第1期40卷 9-17页

作者： Yu SUN En-hao WANG Jin-tao YU Gang ZHONG Li-xin ZHU-Yi WANG Niu XUN Hong YU Wen ZHOU Zhen XIE Kun ZHANG Guo-run FAN Yi ZHONG Hong-jun XIAO Wei-jia KONG Department of Otorhinolaryngology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear *** retrospectively analyzed the surgical approaches and outcomes of patients with middle ear *** ear cholesteatoma surgeries were divided into four types and two special types as follows:type I,attic retraction pocket,which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction;typeⅡ,cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions,including type Ⅱa,requiring only use of a curette,and type Ⅱ b,requiring use of an electric drill or chisel;type Ⅲ,cholesteatoma not limited to the attic,in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions,requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and"Canal Wall Up"mastoidectomy;type Ⅳ,extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications,removal of which can only be performed under a microscope for"Canal Wall Down"*** addition,there were two special types:"difficult external auditory canal"and congenital cholesteatoma in *** our system,type I and type U middle ear cholesteatoma surgery was completely performed under an endoscope ***,estimating the extent of the lesions,determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear *** classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.

关键词： otologic surgical procedure endoscopy cholesteatoma middle ear

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

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Journal of Otology 2012年第1期7卷 25-27页

作者： ZHOU Shui-Hong WANG Qin-Ying WANG Shen-Qing Department of Otolaryngology The First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiang310003China

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

关键词： foreign body cholesteatoma external auditory canal middle ear

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Hearing loss due to urate deposition in the middle ear:A case report and literature review

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Journal of Otology 2022年第1期17卷 50-53页

作者： M.Hoste M.Cabri-Wiltzer S.Hassid J.-C.Degols J.Vilain ENT and Head and Neck Surgery Department Clinique Saint PierreOttigniesBelgium Department of Radiology Clinique Saint PierreOttigniesBelgium ENT and Head and Neck Surgery Department CHU UCLNamenBelgium

Gout is the most common cause of monoarthritis in men occurring classically in the great toe and the ***-articular gout manifestations are *** a few cases of head and neck urate crystals deposits have been described in the *** in the middle ear cause conductive hearing loss with common otoscopic anomalies and difficult imaging *** report a case of a healthy 58-years-old man with a middle ear urate deposit causing a progressive hearing loss as the very first symptom of *** nature of the deposit was unsure on computer tomography(CT)due to atypical *** final diagnosis was revealed after surgical procedure and histologic examination.A review of the literature is also *** cases of middle ear urate deposit as the first symptom of gout were found and *** conductive hearing loss in middle-aged patients with abnormal otoscopy and middle ear atypical density mass on CT scan must lead to a minimal surgical procedure with a histologic examination to exclude urate crystals deposits.

关键词： Hearing loss Urate deposit Gout middle ear Otoscopy

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Congenital cholesteatoma of the middle ear-a report of 10 cases

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Journal of Otology 2007年第2期2卷 119-123页

作者： SHEN Wei-dong, HAN Wei-ju, YANG Shi-ming, DAI Pu, LIU Liang-fa, FENG Bo, WANG Jia-ling, ZHOU Qi-you, HAN Dong-yi Department of Otolaryngology, head and Neck Surgery, PLA General Hospital, Beijing, China 100853 Department of Otolaryngology head and Neck Surgery PLA General Hospital Beijing China 100853

Objectives To study clinical, imaging features and treatment outcomes of congenital cholesteatoma of middle ear (CCME). Methods This is a retrospective review of 10 CCME cases selected from 952 cholesteatoma cases treated between January 1995 and December 2005 at the Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital. The main outcome measures were the site of origin, clinical features, surgical findings, imaging characteristics and hearing results. Results The mean age of the 10 patients was 16 years(ranged from 10 to 24 years), with 6 being older than 18 years. There were 7 males and 3 females. The average delay to diagnosis was longer than 2 years. The mean preoperative PTA was 55 dB HL, with a mean ABG of 45 dB. Typical cholesteatomas were seen behind the tympanic membrane in the superoposterior quadrant on otoscopy only in 2 patients. High resolution CT was completed in all patients. Most of the patients(8/10) were diagnosed with otosclerosis or ossicular abnormality before operation. All patients underwent a one-stage tympanoplasty following transmeatal explorative tympanotomy and complete cholesteatoma removal, except one, who underwent a CWU mastoidectomy due to extensive cholesteatoma involvement. The choleasteatoma lesion was confined to the superoposterior mesotympanum in all patients. The mean postoperative PTA was 20 dB HL. All patients were followed-up for at least 1.5 years postoperatively. Revision procedures were performed in 2 patients for hearing deterioration. No residual or recurrence of cholesteatoma was found. Conclusion CCME is a rare disease that often gets delayed diagnosis. Residual lesions and the prognosis mainly depend on the extent of the lesion.

关键词： congenital cholesteatoma middle ear surgery

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Inflammatory responses to Hydroxyapatite implants in middle ear in rats

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Journal of Otology 2008年第1期3卷 24-28页

作者： YE Qing 1, 2, JIANG Yi 1, 2, WANG Xiao-yan1, 2, ZHENG Ke-fei 1, 2 1 Department of Otolaryngology, Fujian Provincial Hospital, Fuzhou 350001, China 2 Department of Otolaryngology, Fujian Medical University, Fuzhou 350001, China Department of Otolaryngology Fujian Provincial Hospital Fuzhou 350001 China Department of Otolaryngology Fujian Medical University Fuzhou 350001 China

Objective To study local inflammatory response after implantation of hydroxyapatite synthetic ossicular prosthesis. Methods Hydroxyapatite granules were implanted in the bulla in 32 rats. Sham surgical procedures were performed in 10 rats as the control. Animals were sacrificed at 1 to 300 days after surgery. Bulla sections, stained with HE and Mallory’s azan, were examined for numbers and percentages of various inflammatory cell types. Results Slightly more inflammatory reaction was seen in animals with the implant than in the controls, mostly during the early stage following the implantation procedure. Few inflammatory cells were observed at later times. There were satisfactory fibrosis in both implanted and control ears. Conclusion The results indicate that hydroxyapatite synthetic prosthesis is a biocompatible implantation material in the middle ear. Nonetheless, the presence of inflammatory reaction immediately following implantation implies that control of infection is important in the early times after the implantation procedure.

关键词： middle ear Hydroxyapatite Synthetic auditory prosthesis inflammatory response

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Carcinoid Tumors in the middle ear:a Case Report and Literature Review

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Journal of Otology 2006年第1期1卷 57-60页

作者： WANG Entong,1 GONG Weixi,1 DA Jiping21. Department of Otolaryngology, Head and Heck Surgery, 36 Fucheng Road, Beijing 100036, China 2. Department of Pathology, 36 Fucheng Road, Beijing 100036, China Department of Otolaryngology Head and Heck Surgery 36 Fucheng Road Beijing 100036 China Department of Pathology 36 Fucheng Road Beijing 100036 China

middle ear carcinoid tumor (MEC T) is rare. Only 46 cases of MECT have been reported in the literature since the first case of MECT was described in 1980. We present here a case of primary MECT initially diagnosed as inflammatory aural polyp. The case was a 43-year-old women complaining of right ear chronic otorrhea and hearing loss over a period of five years, with a blockage sensation in the right ear for two years. Audiometry showed conductive hearing loss in the right ear. Physical examination and CT scans showed a mass in the right external auditory canal and middle ear, surrounding the ossicular chain. Pathologic study of surgically removed specimen revealed features of carcinoid tumor with positive staining to chromogranin A and synaptophysin in tumor cells. Local radiation of 60 Gy was applied. The patient has been followed up for more than one year. Postoperative histopathological examination showed no evidence of MECT recurrence one year after surgery, but inflammatory changes in the middle ear. Relevant literatures were reviewed. Clinical, histopathological, immunohistochemical and ultrastructural features of MECT, and strategies in MECT diagnosis and management are discussed.

关键词： carcinoid tumor middle ear diagnosis surgery

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Neuroendocrine carcinoma in the auditory canal and middle ear

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Chinese Medical Journal 2012年第18期125卷 3357-3358页

作者： WANG Lin-e ZHANG Dao-xing LI Yu-jie WANG Wei Department of Otorhinolaryngology Head and Neck Surgery Beijing Friendship Hospital Capital Medical University China Beijing100050

Neuroendocrine carcinoma （NEC） is a malignant tumor characterized by amine precursor uptake andsecretion of amine and polypeptide hormones through decarboxylization, NEC is a rare disease,2 with NECs in the aural re... 详细信息

关键词： neuroendocrine carcinoma auditory canal middle ear

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Modification of closed tympanoplasty in middle ear cholesteatoma

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Chinese Medical Journal 2010年第4期123卷 447-451页

作者： ZHANG Zhi-gang LIU Xiang CHEN Sui-jun CHEN Bin ZHENG Yi-qing Department of Otorhinolaryngology Head and Neck Surgery Second Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510120 China

Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma. Methods Eighty-three patients were recruited in this study based on the following two criteria： each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis （TORP） or partial ossicular replacement prosthesis （PORP） and membrane repair with conchal cartilage-perichondral complex. Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence （6.02%）. Function tests after one postoperative year exhibited an improvement of pure tone audiometry （PTA） in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement. Conclusions The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.

关键词： mastoidectomy tympanoplasty cholesteatoma cartilage middle ear

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Systematic review of animal models of middle ear surgery

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World Journal of Otorhinolaryngology 2013年第3期3卷 71-88页

作者： Michael Bergin Srdjan Vlajkovic Philip Bird Peter Thorne Department of Physiology Faculty of Medical and Health Sciences University of Auckland Auckland 1142New Zealand Department of Physiology and Centre for Brain Research Faculty of Medical and Health Sciences University of Auckland Auckland 1142 New Zealand Department of Otolaryngology Head and Neck Surgery Christchurch Hospital Christchurch School of MedicineUniversity of Otago Christchurch 8011 New Zealand Section of Audiology Department of Physiology and Centre for Brain Research Faculty of Medicine and Health SciencesUniversity of Auckland Auckland 1142 New Zealand

Animal models of middle ear surgery help us to explore disease processes and intervention outcomes in a manner not possible in patients. This review begins with an overview of animal models of middle ear surgery which outlines the advantages and limitations of such models. Procedures of interest include myringoplasty/tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and active middle ear implants. The most important issue is how well the model reflects the human response to surgery. Primates are most similar to humans with respect to anatomy; however, such studies are uncommon now due to expense and ethical issues. Conversely, small animals are easily obtained and housed, but experimental findings may not accurately represent what happens in humans. We then present a systematic review of animal models of middle ear surgery. Particular attention is paid to any distinctive anatomical features of the middle ear, the method of accessing the middle ear and the chosen outcomes. These outcomes are classified as either physiological in live animals,(e.g., behavioural or electrophysiological responses), or anatomical in cadaveric animals,(e.g., light or electron microscopy). Evoked physiological measures are limited by the disruption of the evoking air-conducted sound across the manipulated middle ear. The eleven identified species suitable as animal models are mouse, rat, gerbil, chinchilla, guinea pig, rabbit, cat, dog, sheep, pig and primate. Advantages and disadvantages of each species as a middle ear surgical model are outlined, and a suggested framework to aid in choosing a particular model is presented.

关键词： Otologic surgical procedures middle ear Animal models Electrophysiology Microscopy

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Finite Element Dynamics of Human ear System Comprising middle ear and Cochlea in Inner ear

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Journal of Biomedical Science and Engineering 2016年第13期9卷 597-610页

作者： Hidayat Shingo Okamoto Jae Hoon Lee Naohito Hato Hiroyuki Yamada Daiki Takagi Graduate School of Science and Engineering Ehime University Matsuyama Japan Mechanical Engineering Department State Polytechnic of Samarinda Samarinda Indonesia Department of Otorhinolaryngology Head and Neck Surgery Ehime University School of Medicine Matsuyama Japan

A human middle ear consists of an eardrum and three ossicles which are linked by each other, and connect with the eardrum and an inner ear. The inner ear consists of a cochlea and a vestibular system. An abnormality of the human middle ear such as ossicular dislocation may cause conductive hearing loss. The conductive hearing loss is generally treated by surgery using artificial ossicles. The treatments of conductive hearing loss require a better understanding of characteristics and dynamic behaviors of the human middle ear when the sounds transmit from outer inner to inner ear. The purpose of this research is to simulate the dynamic behaviors of a human ear system comprising the middle ear and the cochlea in the inner ear using the finite element method (FEM). Firstly, the eigen-value analysis was performed to obtain the natural frequencies and vibration modes of the total ear system. Secondly, the frequency response analysis was carried out. Thirdly, the time history response analyses were performed using human voices as the external forces. In the time history response analyses, the sounds created as input sound pressures were used. Human voices, for example vowels “I”, “u” and “e” as input sound pressures were created by using the sound pressures downloaded from the opening samples of human voices as wav files in a website. Then it was clarified that the high frequency components of sounds are reduced by the middle ear system.

关键词： eardrum middle ear Dynamics Human Voice Finite Element Method

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