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PubMed1985

[Development of pressure in the middle ear after nasal operations].

The middle ear pressure was determined by tympanometry on 46 patients (92 middle ears) before and after rhinoplasty. Abnormal tympanograms and pathological negative pressure in the middle ear space was found in about a quarter of all cases. In the first two days after the operation a high negative pressure developed in about 70%. The negative pressure was equalized after the packing was removed and 5 days after the rhinoplasty we found normal middle ear pressure in 94% of patients. Reasons for development of negative intratympanic pressure are discussed. The conclusion from our investigation is that tympanoplasty and rhinoplasty surgery should not be performed on the same day.

Acoustic Impedance Tests↗

PubMed2006

Middle ear atelectasis: what causes it and how is it corrected?

Many options are available to manage a patient who has atelectatic ears. Establishing normal middle ear ventilation and aeration is the cornerstone to successful control of these ears. Often, medical management with nasal steroids and decongestants is all that is needed. If recurrent infections have weakened the tympanic membrane progressively, or the middle ear environment is so severe that medical management does not correct the problem, then surgical correction is often necessary. This article explores the pathogenesis of middle ear atelectasis and explains a classification system to help the clinician determine the best course of management.

Ear Diseases↗

PubMed1993

Congenital perilymphatic fistula and associated middle ear abnormalities.

To specifically determine the frequency and type of middle ear abnormalities associated with perilymphatic fistula (PLF), a retrospective chart review was performed of 94 patients (117 ears) who underwent exploratory tympanotomy for PLF from 1980 to 1989. Of the 117 ears explored, 80 (68.4%) had a PLF, and in 65 (81.3%) of these ears, a middle ear malformation was associated with the PLF. Of these 65 ears in which a congenital middle ear abnormality was observed, a malformed stapes was the most common abnormality seen (39 ears, 60%), followed by a deformed round window (20 ears, 30.8%), a deformed incus (11 ears, 16.9%), and a deformed promontory (2 ears, 3%). Often these malformations coexisted amongst themselves or with inner ear abnormalities. Sixteen children (25 ears) had an inner ear malformation identified on computed tomography (CT); all of these children had a PLF found at the time of surgery. This study demonstrated that 86.3% of the ears found to have a PLF had a deformity of the middle ear, inner ear, or both. A malformation of the stapes, most frequently identified as a deformity of its superstructure (and presumably also the anterior footplate), was the most common congenital middle ear abnormality found to be associated with PLF in children.

Adolescent↗

PubMed1994

[Differential diagnosis of benign middle ear tumors].

Adenomas of the middle ear are quite rare tumours of the ear and of recent recognition. Two cases of adenomatous neoplasms confined to the middle ear are presented. Usually these tumours are located on the promontorium or in the hypotympanon. The unique feature of the first described case is based on its origin in the epitympanic pouch of the tympanic membrane. The second case originated from the mucosa in the hypotympanon. The third case is a tumour-like lesion which was not distinguishable on clinical grounds from a jugulo-tympanic paraganglioma or a middle ear adenoma. The adenomas of the middle ear are histopathologically characterised by differentiated glandular structures within fibrous tissue and recurrences are rarely observed. Surgical removal by the endaural route gives an excellent prognosis as shown by the literature and our own clinical cases.

Adenoma↗

PubMed1989

Pneumatization and mesenchyme in the human middle ear.

The normal pneumatization in human middle ears from Wittmaack's temporal bone collection (ENT Clinic, University of Hamburg Medical School) is investigated by means of light microscopy and compared with electron-microscopic findings in the rat. The fetal middle ear in man and rats is completely filled with mesenchyme. The compartmentalization of the middle ear by the associated mucosal folds of the ossicular chain and the middle ear pneumatization are results of the resorption of the mesenchyme present. Ultrastructural findings in the rat's middle ear reinforce light-microscopic studies and provide evidence of the fibrillogenesis which characterizes the transformation of the mesenchyme into the tunica propria of the middle ear mucosa. The microtopography of mesenchymal remnants in middle ears of neonates and in children during the first year of life, and their relevance as to the pathogenesis of the primary acquired keratoma (cholesteatoma) are discussed.

Adult↗

PubMed1976

Middle ear effusion in children.

The middle ear function of over 100 school children has been observed for more than seven years with the aid of an electroacoustic impedance instrument. The technique readily demonstrates middle ear abnormalities. A few children may have middle ear malfunction for considerable periods without this being detected by those responsible for their health care. The presence of fluid in the middle ear is not necessarily an indication for treatment. The concept of acoustic impedance screening is advocated with suitable safeguards to prevent over-referral.

Audiometry↗

PubMed1993

Abnormalities of the neonatal ear: otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid.

It is unknown whether childhood ear disease could be present long before symptoms provoke an initial otoscopic examination. A newborn middle ear might or might not start in a pristine, privileged state. The clinician evaluating later infant and childhood ear disease is often unaware of the status of a patient's ear from the neonatal period, the earliest time at which the tympanic membrane can be evaluated. Adding to the physician's handicap, normative otoscopic and histologic data on the neonatal ear are incomplete. In order to test the hypothesis that disease in the neonatal middle ear may be more common than is generally appreciated, the population of critically ill neonates was selected for study since this group can provide both clinical as well as histologic data. This manuscript is divided into three parts. Clinically, otoscopic observations were analyzed on infants in an intensive care unit. Histologically, neonatal temporal bones were studied for normal anatomy and pathology of the middle ear and antrum. Experimentally, an animal study was performed to evaluate the potential effect of amniotic fluid cellular contents aspirated into the middle ear. I. Clinical Otoscopic Observations. Daily otoscopic examination was conducted on 44 neonates in an intensive care unit. Specific parameters of the otoscopic examination were evaluated to compare with the normal, translucent tympanic membrane of the older child. The otoscopic appearance was found to be abnormal in 97.7% of neonatal ears. Of the otoscopic parameters evaluated, right ears averaged 2.6 abnormalities and left ears averaged 2.5 otoscopic abnormalities. The otoscopic appearance of the neonate in the neonatal intensive care unit is nearly universally abnormal. II. Temporal Bone Histologic Observations. One hundred eleven temporal bones from 56 neonates were collected for histologic study by light microscopy. Mesenchyme filling more than 60% of the middle ear space was found in 13 bones. Amniotic fluid cellular content was detected in 90 bones. Purulent otitis media was detected in 24 bones. Varying amounts of blood were found in the middle ear space of 34 bones. Only 7 of the bones had no significant middle ear abnormality. It is concluded that in the critically ill neonate, the middle ear and antrum usually contain cellular or fluid material, often in significant volume, that would not be considered normal in the older patient. III. An Animal Model Simulating Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗

PubMed1992

Possible role of interleukin 1 alpha and interleukin 1 beta in the pathogenesis of cholesteatoma of the middle ear.

Cholesteatoma of the middle ear is characterized by the presence of hyperproliferative keratinizing squamous epithelium in the middle ear cavity and destruction of adjacent bone. Interleukin 1 (IL-1) is an autocrine growth factor for normal keratinocytes and is capable of inducing bone degradation. The distribution of two molecular species of IL-1, IL-1 alpha and IL-1 beta, was investigated immunohistochemically in the hyperproliferative epithelium of cholesteatoma, in normal epidermis of the auditory canal and of the retroauricular region, and in nonkeratinizing tonsillar epithelium. In all squamous epithelia examined, IL-1 alpha and IL-1 beta were present in comparable amounts. The IL-1 content of cholesteatoma epithelium was clearly increased in relation to normal skin keratinocytes. All cellular layers of cholesteatoma epithelium stained strongly and uniformly for Il-1 alpha and IL-1 beta, whereas the keratin layer was negative for IL-1. No particularly strong reaction with basal cells was detected. In the connective tissue under the squamous epithelium of cholesteatoma, intensely positive cells were scattered between negative stromal cells. Our results suggest that IL-1 could be liberated from disintegrating keratinocytes and cells of the monocyte-macrophage lineage, stimulate the proliferation of the cholesteatoma epithelium in an autocrine manner, and contribute to the enhancement of bone destruction in the presence of cholesteatoma.

Cholesteatoma↗

PubMed2006

Primary carcinoid tumor of the middle ear: a potentially metastasizing tumor.

The concept of a carcinoid tumor in the gastrointestinal tract and lung is well established; less often, patients develop carcinoid tumors in the head and neck region. One particularly uncommon site of origin of carcinoid tumors in the head and neck area is the middle ear. Middle ear carcinoids have previously been approached as benign entities, lacking any capacity for metastasizing. A critical review of the literature, however, disclosed a small number of cases in which middle ear carcinoid tumors have given rise to regional (cervical node) metastases. This in turn suggests that, as is the case with pulmonary carcinoid tumors, middle ear carcinoids should be thought of as low-grade malignancies which, while relatively slow-growing, nevertheless possess a limited capacity for spreading to regional lymph nodes. To date, distant metastases have not been associated with middle ear carcinoid tumors.

Biopsy, Needle↗

PubMed1992

[Interleukin-1-containing cells in cholesteatoma of the middle ear].

Cholesteatoma of the middle ear and the adjacent temporal bone consists of hyperproliferative keratinizing squamous epithelium in the middle ear cavity, and is capable of destroying the bone. Interleukin-1 (IL-1), an autocrine growth factor for epithelial keratinocytes, is characterized by its capacity to initiate bone absorption. Using immunohistochemical methods, the distribution of two different species of interleukin, IL-1 alpha and IL-1 beta, in cholesteatoma tissue (Fig. 2), the skin of the external ear canal, and the retroauricular region was investigated (Fig. 1). Comparable amounts of both IL-1-species were found in all squamous epithelia examined, but interleukin in cholesteatoma epithelium was increased in comparison with normal epidermis. All cellular layers stained uniformly and equally strongly for IL-1 alpha and IL-1 beta, whereas the dead cells of the keratin layer were negative for both. Some intensely stained cells were found scattered in the connective tissue underlying the basal layer of the cholesteatoma (Fig 4). Using double staining techniques these cells were shown to be mainly macrophages (Fig 6). Our results suggest that IL-1 could be liberated from disintegrating keratinocytes and cells of the monocyte-/macrophage lineage, and stimulate the proliferation of the cholesteatoma epithelium in an autocrine manner, thus contributing to the increased bone destruction seen in cholesteatoma.

Cholesteatoma↗

PubMed1990

Middle ear ventilation mechanism.

The ventilation mechanism of the middle ear is very important as regards the pathogenesis of middle ear disease, but its mode of function is still obscure. Therefore, we tried to measure the ventilation and clearance of the middle ear using radio-isotope imaging techniques and 133Xe in order to gain a clearer picture of the ventilation mechanism. In normal Eustachian tube cases, approximately 10% of the initially insufflated gas immediately entered into the middle ear cavity and mastoid air cells. The gas introduced into the middle ear diminished at a rate of 8% of volume per hour in the normal resting state. Two hours after the first procedure, air was insufflated, and gas volume in the middle ear cavity immediately diminished by 30%. In stenotic tube cases, it proved difficult to insufflate the gas into the middle ear, however, its diminishing rate with the passage of time was slightly faster than in normal tube cases. From this data, it was evident that air could easily and quickly enter into even the periphery of the mastoid air cells by insufflation via the Eustachian tube, despite the fact that the middle ear and mastoid air cells form a closed cavity. In the resting state, moreover, the air in the middle ear was thought to be absorbed mainly into the middle ear mucosa at a regular rate. It was confirmed that the insufflation procedure as a therapy for tubal stenosis and OME is very useful for the ventilation of the middle ear.

Air↗

PubMedDate not supplied

Anatomical effects of sudden middle ear pressure changes.

Acute middle ear (ME) and inner ear changes following brief unilateral phasic ME pressure changes (up to +/- 6000/mm H2O) were studied in the guinea pig. Middle ear findings included perforation of the tympanic membrane, serous and serosanguinous exudate and hemorrhage of tympanic membrane and periosteal vessels. Changes were related to magnitude of applied pressure. Perforation and hemorrhage were more commonly seen with negative rather than positive pressure. Air bubbles behind the round window were seen with positive pressures. Occasional distortion, but never perforation of the round window, was noted. Hemorrhage of the scala tympani was observed with both positive and negative pressures; scala vestibuli hemorrhage was found with negative ME pressure. In some instances pressure direction and magnitude related changes were seen in the contralateral ear.

Animals↗

PubMed1988

Anatomy and physiology of eustachian tube and middle ear related to otitis media.

The middle ear is part of a functional system composed of the nasopharynx and the eustachian tube (anteriorly) and the mastoid air cells (posteriorly). The only active muscle that opens the eustachian tube is the tensor veli palatini, which promotes ventilation of the middle ear. The eustachian tube also functions to protect the middle ear from excessive sound pressure, and nasopharyngeal secretions. The eustachian tube helps drain the middle ear during opening and closing by pumping secretions from the middle ear; clearance of secretions also occurs. An understanding of the anatomy and physiology of the system can aid the clinician in understanding the role of eustachian tube dysfunction in the cause and pathogenesis of middle ear disease and the possible contribution of allergy to this disease.

Adult↗

PubMed1976

[Experiences with polyethylene ventilation tubes in children with recurrent middle ear inflammation (author's transl)].

Middle-ear ventilation tubes (of the Sheehy modification) were placed in 401 ears of 209 children under 16 years of age as treatment for recurrent middle-ear infection. The same procedure was later required in 26% of the cases studied because of further recurrence of middle-ear infection. In four per cent of all patients studied, the ventilating tube failed to cure middle ear disease in spite of controlled concomitant antibacterial therapy. In these cases, an early extrusion of the tube was commonly found. Among all patients, the tube was spontaneously extruded in 76 per cent of the ears, whereas the intubation time was longer than half a year in 53 per cent of the cases. No complications from insertion of the ventilation tubes was seen in the present series of patients. The tympanic membrane was found to be normal in 71 per cent of all cases when follow-up examination was obtained three months after completion in intubation. However, a permanent tympanic membrane perforation was found in five ears (1% of patients). The present study has confirmed the usefulness of middle-ear ventilation tubes, particularly in patients with recurrent middle-ear infections.

Adolescent↗

PubMed2005

A huge osteoma of the middle ear.

Osteomas of the middle ear are rare benign neoplasms. Most of the cases caused conductive hearing loss and others were asymptomatic and diagnosed incidentally. We report a case of a huge middle ear osteoma along with compatible radiological findings filling the whole tympanum and the Eustachian tube, which caused intermittent otorrhea and conductive hearing loss.

Adolescent↗

PubMed2003

Possible involvement of keratinocyte growth factor and its receptor in enhanced epithelial-cell proliferation and acquired recurrence of middle-ear cholesteatoma.

Middle-ear cholesteatoma is characterized by enhanced proliferation of epithelial cells and granular tissue formation. However, the molecular mechanism underlying these pathological changes is largely unknown. Keratinocyte growth factor (KGF) is a mesenchymal cell-derived paracrine growth factor that specifically stimulates epithelial cell proliferation. In the present study, we investigated the possible involvement of KGF and its receptor, KGFR, in the pathogenesis of cholesteatoma using in situ hybridization and immunohistochemistry, respectively. We examined 56 cholesteatoma specimens, and 8 normal skin areas as control. KGF and KGFR expression was examined by immunohistochemistry using rabbit anti-human KGF and anti-human KGFR polyclonal antisera raised in our laboratories against synthetic peptides corresponding to parts of human KGF and KGFR, respectively. KGF protein and mRNA were detected exclusively in stromal fibroblasts and infiltrating T lymphocytes in 80% of cholesteatoma cases, whereas KGFR protein and mRNA were localized in the epithelium in 72% of cases. Assessment of the proliferative activity of cholesteatoma using the labeling index for Ki-67 showed a significantly higher Ki-67 labeling index (66%) in KGF+/KGFR+ cases than other cases. There was a significant correlation between KGF+/KGFR+ expression and recurrence. Our results indicate the possible involvement of both KGF and KGFR in enhanced epithelial cell proliferative activity and recurrence of cholesteatoma.

Antibody Specificity↗

PubMed1998

Continuous, high-frequency objective tinnitus caused by middle ear myoclonus.

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.

Adult↗

PubMed1991

[Pressure changes in the middle ear during nitrous oxide anesthesia].

We studied middle ear pressure variations in 17 patients with mild upper airways or middle ear diseases, during nitrous oxide anaesthesia. We observed a significant increase in middle ear pressure during the administration of nitrous oxide, and a significant decrease after nitrous oxide was discontinued. Nine patients showed periodical reductions of the middle ear pressure during the inhalation of nitrous oxide, due to passive openings of the eustachian tube. In the remaining 8 patients (47%) this mechanism has not been effective. A comparison between these two groups shows significantly higher levels of middle ear pressure in the group of patients with abnormal function of the eustachian tube, both during and after the administration of nitrous oxide. Our results demonstrate that patients with mild upper airways or middle ear diseases are likely to show an impaired tubal function. Therefore, nitrous oxide should be used with caution in the presence of such diseases. Moreover, nitrous oxide is generally controindicated in middle ear surgery, as the pressure gradients between middle and external ear can jeopardize the success of the operation.

Adult↗