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PubMed1993

Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction.

In this study, audiological assessments of the 57 patients with temporomandibular joint dysfunction and 57 controls were made. The analyses of audiograms, tympanograms and Eustachian tube functions showed no significant differences statistically. A slight increase in compliance peak in 48 female patients suggests that the sound conducting structures of the middle ear could be influenced by the reflex spasm of the tensor tympani muscle to a minor degree. This change does not seem to cause a major dysfunction either in the middle ear or in the Eustachian tube.

Acoustic Impedance Tests↗

PubMed1975

Eustachian tubal function: changes throughout childhood and neuro-muscular control.

The anatomy of the cartilaginous Eustachian tube is the key to function and malfunctions. Serial sections of the tube at various ages show that there are very considerable anatomical changes throughout childhood during which period the tensor palati is the muscle of prime importance. It is suggested that both tensor palati and tensor tympani are functionally tubal muscles and might, perhaps, be termed "extrinsic muscles of the ear". Together they largely control tubal opening. Some clinical implications may be drawn from these anatomical observations.

Age Factors↗

PubMed1994

Management of middle ear myoclonus.

Tinnitus produced by synchronous repetitive contraction of the middle ear muscles (middle ear myoclonus) is a rare condition. We present six cases of middle ear myoclonus in whom different management regimes were successful. In two patients, the tinnitus was controlled by conservative measures. In one patient, whose tinnitus was associated with blepharospasm, significant improvement occurred following botulinum toxin injection into the ipsilateral orbicularis oculi. Three patients were cured by tympanotomy with stapedial and tensor tympani tendon section. The aetiology of this type of myoclonus remains unclear. The diagnosis is based on the history of involuntary and rhythmic clicking or buzzing tinnitus which is invariably unilateral. The primary differential diagnosis is palatal myoclonus whilst other local aural pathologies must be excluded by careful clinical assessment. Surgical section of these muscles via tympanotomy brings guaranteed relief when conservative measures fail.

Adult↗

PubMed2000

Main trajectories of nerves that traverse and surround the tympanic cavity in the rat.

To guide surgery of nerves that traverse and surround the tympanic cavity in the rat, anatomical illustrations are required that are topographically correct. In this study, maps of this area are presented, extending from the superior cervical ganglion to the otic ganglion. They were derived from observations that were made during dissections using a ventral approach. Major blood vessels, bones, transected muscles of the tongue and neck and supra and infrahyoid muscles serve as landmarks in the illustrations. The course of the mandibular, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves with their branches, and components of the sympathetic system, are shown and discussed with reference to data available in the literature. Discrepancies in this literature can be clarified and new data are presented on the trajectories of several nerves. The course of the tympanic nerve was established. This nerve originates from the glossopharyngeal nerve, enters the tympanic cavity, crosses the promontory, passes the tensor tympani muscle dorsally, and continues its route intracranially to the otic ganglion as the lesser petrosal nerve after intersecting with the greater petrosal nerve. Auricular branches of the glossopharyngeal and of the vagus nerve were noted. We also observed a pterygopalatine branch of the internal carotid nerve, that penetrates the tympanic cavity and courses across the promontory.

Accessory Nerve↗

PubMed2000

[Histopathological studies of intratemporal growth behavior of middle ear carcinoma].

BACKGROUND: Otological hemorrhage otorrhea, and pain are amongst the first clinical signs of the middle ear carcinoma, which is usually diagnosed in advanced stages. Sudden deafness, facial nerve paralysis, and other symptoms of inner ear damage may be observed in the final stage. However, middle ear carcinoma is diagnosed extremely seldom in its early stages. The clinical management of this pathology is based on the knowledge of the tumor's pathways and its anatomic behavior. METHODS: Our study investigated 20 cases of middle ear carcinomas from the Wittmaack temporal bone bank (14 squamous cell carcinomas, 5 adenocarcinomas, and 1 adenoidcystic carcinoma) to analyze the behavior of the tumor growth and its influence on clinical symptoms. The aim was to determine criteria for early clinical diagnosis. RESULTS: The tumor arises in different regions of the temporal bone, and varying symptoms will subsequently reflect its pathway. When the tumor is confined to the middle ear area, its main location is the hypotympanum from which tumor spreads into the eustachian tube and, via infiltration of the adjacent bone structures (anterior wall of the middle ear), into the tensor tympani muscle and the sympathetic plexus of the internal carotid artery. Destruction of the ossicles was observed in the mid-tympanic cavity, and often only a thin layer of fibrous tissue from the Fallopian canal separated the tumor from the facial nerve (this nerve was rarely affected directly). The medial wall (labyrinthine wall) of the tympanic cavity remained intact in the majority of examined cases. The tympanic sinus, the round window niche, and the oval window niche did not show tumor infiltration. In the epitympanum, the tumor grew and infiltrated the adjacent mastoid. Larger tumors affected the internal auditory canal and infiltrated the acoustic nerve and the labyrinth. CONCLUSION: Improving the poor prognosis of middle ear carcinoma requires early diagnosis based on axial computed tomography (CT). Important factors in patient selection include age (50-70 years), sex (mostly women), and especially clinical symptoms (otorrhea, pain, hearing loss).

Adenocarcinoma↗

PubMed2003

Do middle ear muscles trigger attacks of Menière's disease?

OBJECTIVE: Current surgical methods for treating Ménière's disease (MD), e.g. endolymphatic sac surgery, mastoidectomy or insertion of middle ear ventilation tubes, only improve vertigo and fail to influence the hearing threshold. In this retrospective study we examined the long-term effects of tenotomy on the symptoms of MD. MATERIAL AND METHODS: A total of 45 patients suffering from definite MD underwent middle ear muscle tenotomy, a treatment that is very rarely considered nowadays. Of these 45 patients, 20 were observed postoperatively for a period of > 2 years. The disease was scored pre- and postoperatively and the results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy for MD. RESULTS: Sectioning of the tensor tympani and stapedius muscle tendons significantly reduced the frequency and intensity of vertigo and improved both the functional profile and tinnitus. Pure-tone audiometry at frequencies between 500 and 3000 Hz substantiated the improvement in hearing threshold, as did the pure-tone average. The therapeutical outcome was stable in cases where both tendons remained persistently disconnected. Intratympanal inflammatory reactions were observed in most patients during surgery. CONCLUSION: Our results prove that tenotomy is a successful and enduring therapeutic approach for treating the auditory and vestibular symptoms of MD and strongly suggest that it should be reconsidered as a promising surgical treatment for the symptoms of MD.

Adult↗

PubMed1999

The presence of ganglion cells in the human middle ear: a histological survey.

A histological survey of 871 previously sectioned temporal bones from the Ear Pathology Research Laboratory (EPRL) of the University of Toronto was undertaken to determine the presence of ganglion cell and ganglion cell rests within the human middle ear. The presence of ganglion cells within the middle ear was a common finding noted in 52.3% of temporal bones surveyed. So-called 'ectopic' ganglion cells were identified most often in the greater superficial petrosal nerve (38.7%), the lesser superficial petrosal nerve (12.4%) and on the promontory (11.4%). They were also identified in the main trunk of the intratemporal facial nerve, but in smaller numbers (3%), and for the first time in the tensor tympani muscle. Their consistent presence implies that they should not be considered an abnormal anatomic variant, and further questions accepted conventional anatomic descriptions of middle ear innervation.

Ear, Middle↗

PubMed2006

Acoustic shock injury (ASI).

CONCLUSION: The potential severity and persistence of ASI symptoms has significant clinical and medico-legal implications. With the rapid growth of call centres around the world, professionals providing tinnitus and hyperacusis therapy are increasingly likely to encounter some or all of the cluster of ASI symptoms in their clients. BACKGROUND: Acoustic shock injury (ASI), occurring as a result of exposure to a sudden unexpected loud sound, has been observed to cause a specific and consistent pattern of neurophysiological and psychological symptoms. These include aural pain, tinnitus, hyperacusis/phonophobia, vertigo and other unusual symptoms such as numbness or burning sensations around the ear. A range of emotional reactions including trauma, anxiety and depression can develop. Call centre staff using a telephone headset or handset are vulnerable to ASI because of the increased likelihood of exposure, close to their ear(s), of sudden unexpected loud sounds randomly transmitted via the telephone line. DISCUSSION: This paper presents an overview of a study of 103 people exposed to 123 acoustic incidents, and of the proposed neurophysiological mechanism of ASI, in particular tonic tensor tympani syndrome (TTTS). An understanding of TTTS has the potential to provide insight into the neurophysiological and psychological development of tinnitus and hyperacusis and the association with high levels of emotional trauma and anxiety. REHABILITATION: ASI rehabilitation is discussed.

Anxiety↗

PubMed2001

The trigeminal nerve. Part IV: the mandibular division.

The mandibular or third division of the trigeminal nerve is the largest of the three divisions. It is considered a mixed nerve. That is, like the ophthalmic and maxillary divisions, the mandibular conveys afferent fibers. But unlike the former two divisions, the mandibular also contains motor or efferent fibers to the muscles of mastication, the mylohyoid and anterior digastric muscles, and the tensor veli palatini and tensor tympani muscles. So intimately associated with dentistry, the mandibular nerve has also been termed the dental nerve by anatomists in the past. This extensive and complicated division of the trigeminal nerve can cause confusion to both patient and doctor. Pain is often referred within its branches and even into other trigeminal divisions, chiefly the maxillary. This fourth and last article about the trigeminal nerve will present in detail the mandibular division.

Branchial Region↗

PubMed1980

Anatomy and physiology related to cleft palate: current research and clinical implications.

The most important areas for future research related to the anatomy and physiology of cleft palate are thus: (1) the role of the tensor tympani muscle in auditory tube clearance; (2) the specific etiology of auditory tube dysfunction associated with cleft palate; (3) the nature and extent of variability in the muscular deformities associated with various types of cleft palate; (4) the nature and extent of vascular abnormalities associated with clefts of the palate; and (5) the investigation of cleft palate as one aspect of a craniofacial syndrome.

Cleft Palate↗

PubMed2000

Structure of the middle ear and auditory tube in the house musk shrew, Suncus murinus.

Anatomical features of the middle ear and auditory tube (AT) in the house musk shrew, Suncus murinus, were examined by dissection and light microscopy. The tensor veli palatini (TVP) and tensor tympani (TT) have no connections with the wall or cartilage of the AT although they are connected by the intermediate tendon. None of the levator veli palatini (LVP) muscle bundles are attached to the AT. The salpingopharyngeus (SA) alone has its origin on the caudal edge of the tubal cartilage. The origin extends to the pharyngeal two thirds of the cartilage. The SA originates perpendicular to the AT and runs caudomedialward. Some SA muscle bundles intermingle with those of the palatopharyngeus to end on the dorsal wall of the pharynx. The observations provide no evidence that the TVP, LVP and TT have any role in AT function. The only muscle affecting the AT function in S. murinus is the SA, and it would be the AT dilator.

Animals↗

PubMed1986

Ontogeny and cranial morphology of the tympanic region of the Tupaiidae, with special reference to Ptilocercus.

The structure of the tympanic region of the skull of Ptilocercus lowii was studied in an embryo of 30 mm crown-rump length and in 5 osteocrania. As in Tupaia, the anterior wall of the bulla of Ptilocercus is not completed by a tympanic process of the alisphenoid, contrary to earlier reports. Ptilocercus resembles Tupaia in the following derived characters. The ventral wall of the tympanic cavity is formed by a rostral entotympanic and by a caudal tympanic process of the petrosal. The entotympanic develops in primary connection with the tubal cartilage. The tympanic aperture of the auditory tube is bordered by the entotympanic. The ring-shaped tympanicum is covered by the entotympanicum and is aphaneric. The musculus tensor tympani is lacking. Among mammals, these characters can be regarded as synapomorphic for the Tupaiidae, that is, to have been present in the common ancestor of the two subfamilies. From the evidence of the tympanic region, the Tupaiidae, therefore, form a monophyletic group. Besides these synapomorphies, there are remarkable differences between Ptilocercus and Tupaia in the structure of the bulla. In Ptilocercus the bulla is smaller and less pneumatized than in Tupaia. An anterior intrabullar septum, present in Tupaia, is lacking in Ptilocercus. The epitympanic wing of the alisphenoid is smaller in Ptilocercus than in Tupaia. A lateral prefacial commissure of the tegmen tympani is present in Ptilocercus, but absent in Tupaia. The caudal tympanic process of the petrosal is larger in Ptilocercus than in Tupaia. These characters are autapomorphic for the Ptilocercinae and for the Tupaiinae, respectively. They demonstrate that the auditory bulla of Ptilocercus and that of Tupaia have evolved independently to a considerable extent. An early phylogenetic separation of their respective ancestors seems likely. The tympanic region of the skull provides no evidence for close relationships of the tree shrews to the primates or to any other eutherians. The classification of the Tupaiidae in a separate order, Scandentia, is supported.

Animals↗

PubMed1984

Anatomy of the auditory pathways, with emphasis on the brain stem.

The principal auditory leading to the cerebral cortex and therewith to conscious perception passes from the cochlea, via the cochlear nuclei, the inferior colliculus and the medial geniculate body to the contralateral auditory cortex in the temporal lobe. All components of this pathway are cochleotopically organized. The fibre stream leading from the cochlear nuclei to the contralateral inferior colliculus consists of both direct and multisynaptic components. The latter are interrupted one or more times in the superior olivary complex and/or the nuclei of the lateral lemniscus, cell assemblies that lie embedded into the main ascending fibre stream. The auditory cortex receives not only impulses from the contralateral cochlea, but also from the ipsilateral cochlea. The ipsilateral projection reaches the ipsilateral inferior colliculus after a synaptic interruption in the ipsilateral superior olivary complex. Fibres conveying impulses from the contralateral side back to the ipsilateral side are probably also involved. The auditory system of the brain stem is characterized by the presence of several well-developed commissures. Most of these contain, in addition to decussating components, true commissural fibres. The various auditory centres in the brain stem are not only way stations in the ascending auditory pathways, but also serve as relays in descending auditory projections. Most important among the latter is the cortico-cochlear projection which is synaptically interrupted in the inferior colliculus and the periolivary nuclei. The final link in this descending projection is formed by the bundle of Rasmussen, the fibres of which leave the central nervous system and innervate the inner and outer hair cells in the organ of Corti. The pathways for the auditory startle response, the auditory orientation reflex and the stapedius and tensor tympani reflexes are briefly described.

Auditory Pathways↗

PubMedDate not supplied

Mucormycosis of the temporal bone.

Mucormycosis of the temporal bone is described in a 60-year-old female with uncontrolled diabetes mellitus whose symptoms related to cranial nerve palsies and hearing loss, following spread of infection from the nasopharynx. The infection spread along the eustachian tube and tensor tympani muscle to the base of the skull, involving the internal carotid artery with mycotic thrombosis and rupture. Subsequent spread occurred from this area predominantly along nerve pathways and as mycotic emboli in blood vessels of the labyrinth and middle ear. Infection also spread from the anterior middle ear wall through the oval window into the vestibule. The temporal bone changes were those of granulomatous inflammation with necrosis and ischemic infarction.

Ear, Middle↗

PubMedDate not supplied

Myofascial pain-dysfunction syndrome: the role of nonmasticatory muscles in 91 patients.

Ninety-one new patients with myofascial pain-dysfunction (MPD) syndrome were studied prospectively. The patients experienced aural fullness, tinnitus, vertigo, odynophagia, and headache in addition to the cardinal symptoms of otalgia, muscle tenderness, temporomandibular joint (TMJ) click, and trismus. Some nonmasticatory muscles were found to be tender as frequently as the masticatory muscles. It is proposed that MPD syndrome as seen clinically involves more than just the masticatory musculature and is a composite of several head and neck myofascial pain syndromes including tensor tympani syndrome, muscle tension headache, cervical syndrome, and hyoid syndrome.

Adult↗

PubMed1990

The petrous carotid artery: anatomic relationships in skull base surgery.

Advanced transcranial lesions may be successfully resected through a variety of contemporary skull base approaches. The identification and isolation of the internal carotid artery throughout its petrous course is essential in most of these surgical techniques. Anatomic landmarks normally used to identify this vital structure, however, may be severely distorted by tumor involvement or previous operative dissection. In an effort to define surgical landmarks that may be used in the identification of the petrous carotid artery, histologic sections of 100 temporal bones from adults were examined and microscopic measurements were recorded from the anatomic dissection of 10 fresh cadaver halfheads. On the basis of these studies, structures we have found useful in identification of the vertical petrous carotid artery during lateral skull base approaches include the: base of the styloid process, bony vascular crest, basal turn of the cochlea, medial wall of the eustachian tube, and the cochleariform process. Identification of the horizontal segment can be achieved by the preliminary delineation of the middle meningeal artery, greater petrosal nerve, tensor tympani muscle, mandibular and maxillary divisions of the trigeminal nerve, and the eustachian tube. Specific anatomic relationships with associated measurements are detailed and correlated with selected, illustrative cases.

Carotid Arteries↗

PubMed1990

Enzymes of transmitter and energy metabolism in cat middle ear muscles.

Activities of the enzymes choline acetyltransferase (ChAT) and acetylcholinesterase (AChE), which metabolize the neuromuscular transmitter acetylcholine, and malate and lactate dehydrogenase (MDH and LDH), enzymes of oxidative and glycolytic energy metabolism, respectively, were measured in the middle ear muscles of the cat. For comparison, the same enzyme activities were measured in extraocular muscle tissue and in three hindlimb muscles rich in either slow oxidative (soleus), fast glycolytic (white part of vastus lateralis), or fast oxidative glycolytic (plantaris) muscle fibers. ChAT and AChE activities were much higher in middle ear muscles than in hindlimb muscles, consistent with a denser neuromuscular innervation, as in extraocular muscles. By contrast, MDH and LDH activities were remarkably low in the middle ear muscles, lower than in any of the hindlimb muscles or the extraocular muscles. Denervation of the stapedius muscle by peripheral transection of the facial nerve resulted in decreases in all four enzyme activities without associated changes in the tensor tympani. Surgical ablation of the peripheral facial nerve supply to the stapedius muscle appears to be a feasible option for producing its denervation. The results suggest some rather specialized chemical characteristics for the middle ear muscles.

Acetylcholinesterase↗

PubMed2000

Middle-ear myoclonus.

Tinnitus produced by repetitive contraction of the middle-ear muscles is a rare condition. We present an interesting case of bilateral middle-ear myoclonus causing incapacitating tinnitus in a patient with multiple sclerosis. Otological examination demonstrated rhythmic involuntary movement of the tympanic membrane. These movements correlated with a rhythmic 'rushing wind' noise perceived by the patient. Oropharyngeal examination showed no evidence of palatal myoclonus. Impedance audiometry confirmed rhythmic change in the middle-ear volume. Medical management was unsuccessful. The patient's tinnitus was subsequently cured with bilateral sectioning of the tensor tympani and stapedial tendons.

Adult↗