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PubMed1990

Reliability of conventional ear swabs in tubotympanic CSOM.

Conventional external ear swab cultures were compared with cultures obtained from the middle ear, in 25 cases of tubotympanic type ('safe'), chronic suppurative otitis media. These cultures were identical in 22 of the 25 cases. Anaerobic organisms were isolated in only one case. Mixed infections of both gram-positive and gram-negative organisms were seen in nine cases (36 per cent). Staphylococcus aureus was the commonest single agent isolated (16 cases). Multidrug resistance was seen in 12 of these isolates.

Adolescent↗
PubMed1983

Carcinoma of the middle ear and external auditory canal.

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. One Ewing's sarcoma and 3 rhabdomyosarcomas occurred in an age group of one to 10 years. 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. The treatment modalities employed depended on the extent of disease and the patient's general condition. Eighty percent of patients with carcinoma limited to EAC were alive 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. Surgery or radiotherapy alone is not sufficient for most of the cases of carcinoma of the middle ear, since these patients often present with advanced disease. We recommend combined therapy, especially postoperative radiotherapy, except for early lesions that do not involve the mastoid or petrous bone. Other series suggest radiotherapy would be adequate and more effective than surgery for early lesions. Surgery will provide the diagnosis, determine the extent of disease, offer adequate drainage of infected material and relieve most pain before radiation therapy.

Adult↗
PubMed1995

Microtia grade as an indicator of middle ear development in aural atresia.

OBJECTIVE: To correlate the appearance of the external ear with the development of the middle ear in patients with congenital aural atresia. DESIGN: Retrospective analysis of patients with congenital aural atresia. Obtain the microtia grades assigned to affected ears and correlate them with atresia scores that describe the degree of the middle ear malformation. SETTING: University of Texas-Houston Otolaryngology Clinic (1988 to 1992). PATIENTS: A total of 199 ears with congenital microtia and aural atresia and 25 ears with canal stenosis without microtia were identified, all of which had been previously evaluated by high-resolution computed tomography of the temporal bone, and then assigned an atresia score. Patients with Treacher Collins syndrome were not included in our study. RESULTS: The average atresia score in cases with grade I microtia was 8.5; grade II microtia, 7.2; and grade III microtia, 5.9. In cases with canal stenosis without microtia, the average atresia score was 8.3. CONCLUSION: The better developed the external ear, the better developed the middle ear.

Child↗
PubMed1987

A bacteriological study of otitis media with effusion. Concurrent coagulase-negative staphylococcal infections in the middle ear.

We investigated the bacteriology of 50 chronic middle ear effusions from 30 children (mean age, 5 years 4 months) and compared this with the microorganisms present in the external ear canals and adenoids of each patient to distinguish pure middle ear bacteria from probable contaminations. Coagulase-negative staphylococci (CS), formerly considered to be non-pathogens, were the most frequently isolated bacteria in the middle ear effusions and were followed in incidence by alpha-hemolytic streptococci and group D streptococci. CS were found in 24% of all effusions and in 44% of the infected effusions. Most of the CS strains belonged to the species of Staphylococcus epidermidis. Although the majority of CS isolated from the middle ear effusions studied proved not to be contaminants, the populations of CS in the middle ear and external ear canal showed similar biochemical reaction patterns, antimicrobial susceptibilities, and in vitro production of mucus. No correlation was found between the bacteria present in adenoidal tissue and middle ear effusions.

Adolescent↗
PubMed1997

Sound-power collection by the auditory periphery of the Mongolian gerbil Meriones unguiculatus: III. Effect of variations in middle-ear volume.

The effects of variations in middle-ear cavity size on hearing sensitivity in the Mongolian gerbil are predicted by computing the effect on acoustic power input to the middle ear. Acoustic power collection from a diffuse sound field was computed from measurements of the middle-ear input impedance and external-ear radiation impedance and mathematical models of the middle and external ear presented in the first two papers of this series [J. Acoust. Soc. Am. 92, 157-177 (1992); J. Acoust. Soc. Am. 99, 3044-3063 (1996)]. A reduction in middle-ear cavity volume to 1/4 its normal value is predicted to cause a frequency-selective elevation in auditory threshold of as much as 12 dB, with the largest elevation occurring in the 1-2 kHz range. Greater reductions produce larger threshold elevations. Increases in cavity volume cause decreases in the predicted threshold of at most 12 dB. Threshold predictions for volumes equal to those of the smaller hamster and the larger kangaroo-rat middle-ear cavity volumes resemble threshold functions measured in those animals. Results are consistent with the idea that large middle-ear cavities evolved in gerbil to improve hearing sensitivity below 3 kHz and thereby improve the animal's chances for survival.

Animals↗
PubMed2005

Otoplasty: sequencing the operation for improved results.

LEARNING OBJECTIVES: : After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.

Bandages↗
PubMed2006

Ear reconstruction after cancer excision.

Cancers which involve the external ear are difficult to eradicate and recur and develop metastases more often than tumours in other areas of the skin. The anatomy of the external ear presents a difficult reconstructive challenge so that various surgical techniques have been described for its reconstruction, but many of these are complex procedures and are inappropriate in the older population suffering from skin tumours. We carried out a retrospective study of the patient who underwent ear reconstruction after cancer excision analyzing the data concerning the type of cancer, the surgical procedures and the follow up. We conclude that all major defects involving one-quarter or more of the auricle can be repaired with a combination of skin flaps and a chondrocutaneous flap from the affected auricle. Sentinel node biopsy may be a useful tool in diagnosing early lymphatic spread.

Adult↗
PubMed2001

A model of echolocation of multiple targets in 3D space from a single emission.

Bats, using frequency-modulated echolocation sounds, can capture a moving target in real 3D space. The process by which they are able to accomplish this, however, is not completely understood. This work offers and analyzes a model for description of one mechanism that may play a role in the echolocation process of real bats. This mechanism allows for the localization of targets in 3D space from the echoes produced by a single emission. It is impossible to locate multiple targets in 3D space by using only the delay time between an emission and the resulting echoes received at two points (i.e., two ears). To locate multiple targets in 3D space requires directional information for each target. The frequency of the spectral notch, which is the frequency corresponding to the minimum of the external ear's transfer function, provides a crucial cue for directional localization. The spectrum of the echoes from nearly equidistant targets includes spectral components of both the interference between the echoes and the interference resulting from the physical process of reception at the external ear. Thus, in order to extract the spectral component associated with the external ear, this component must first be distinguished from the spectral components associated with the interference of echoes from nearly equidistant targets. In the model presented, a computation that consists of the deconvolution of the spectrum is used to extract the external-ear-dependent component in the time domain. This model describes one mechanism that can be used to locate multiple targets in 3D space.

Animals↗
PubMed1998

Otologic management in children with the CHARGE association.

OBJECTIVES: To characterize otologic management of two patient groups, those with the CHARGE association and those not strictly labeled as CHARGE but with several features of the disorder (CHARGE-like), in order to determine: (1) the clinical validity and utility of managing CHARGE-like children in a similar manner to patients with the strictly defined CHARGE association, (2) the progression and prognosis of hearing loss and (3) the identification of factors that may predict the degree of hearing loss. DESIGN: Case series. SETTING: Tertiary care urban children's hospital. PATIENTS: 37 children, 22 in the CHARGE group and 15 in the CHARGE-like group. INTERVENTIONS: Otorhinolaryngologic and audiologic management. MAIN OUTCOME MEASURES: Otorhinolaryngologic and audiologic evaluation. RESULTS: All patients required otologic and/or audiologic care. Bilateral hearing loss was found in 32 patients (86%) and unilateral hearing loss in five patients (14%) when hearing was assessed in the absence of otitis media. Among the 32 patients with bilateral hearing loss, 31 (97%) were able to be fit with useful hearing aids. External ear anomalies were present in 25/37 (68%) patients, and middle ear and ossicular anomalies were identified in four cases (4/37, 11%), 36/37 (97%) patients required surgical management of otitis media. Three patients (3/37, 8%) exhibited radiographic evidence of inner ear deformity. Facial nerve dysfunction was noted in the records of 14/37 (38%) patients. No statistically significant difference was found when CHARGE and CHARGE-like patients were compared for degree of hearing loss (P = 0.5964), type of hearing loss (P = 0.2657), worsening of hearing level (P = 0.7908), or anomalies of the external ear (P = 0.6921), ossicles (P = 0.7908), inner ear (P = 0.7908) or facial nerve (P = 0.6409). Patients with external ear anomalies did not exhibit statistically different degrees (P = 0.3125) or types (P = 0.1515) of hearing loss from patients without auricular anomalies. The presence of facial nerve anomaly correlated significantly (P = 0.0021) with profound hearing loss. CONCLUSIONS: Children who are CHARGE-like may be may be considered equivalent in terms of otologic and audiologic management to children strictly defined as CHARGE patients. These children all require otologic care due to the high prevalence of middle ear disease and the underlying permanent hearing loss that is both stable and aidable. The degree of hearing loss cannot be predicted by external ear morphology, but may be predicted by facial nerve palsy.

Abnormalities, Multiple↗
PubMed2006

Reconstruction of the anterior surface of the ear using a postauricular pull-through neurovascular island flap.

The auricular conchal cavity is a shallow structure in the central part of the ear. It is not only 3-dimensional, but it is a gateway to the external ear canal. Many methods have been described for reconstruction of the defect of concha-antihelix: split- or full-thickness skin grafts, regional skin, chondrocutaneous and musculocutaneous flaps, but none of the authors have described this flap with neurovascular pedicle. We used postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches to the skin color, thickness and texture; scars are well hidden, and there is no donor-site morbidity. Moreover, it has a constant and reliable neurovascular pedicle. The flap edema which was present in the early postoperative period began to resolve gradually after 3 weeks and disappeared in a few months. The esthetic results were excellent in all of the patients and very satisfying for the patients, too. The sensibility was positive by light touch, pin-prick, temperature and static 2-point discrimination in the postoperative control. The static 2-point discriminations in the transferred flap and in the other ear, which corresponds to the same area, were measured. The results were nearly the same as normal values. We advocate postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches the skin color, thickness and texture; scars are well hidden, and there is no donor site morbidity. Moreover, it has a constant and reliable neurovascular pedicle.

Aged↗
PubMed1996

[Familial occurrence of oculoauricolovertebral dysplasia and Franceschetti syndrome].

Oculoauriculovertebral dysplasia (OAV) and the Franceschetti syndrome (FS) are well-known complexes of anomalies that have dysplasias of the external ear as a common occurrence. In this study the specific patterns of symptoms and familial occurrences of 100 patients with external ear dysplasias were examined (88 patients with OAV dysplasia and 12 patients with FS). Analyzing the pedigree data of the probands, we ascertained the relatives with striking symptoms and associated anomalies of OAV dysplasia. The aim of this study was to determine the influence of genetic transmission on OAV dysplasia in comparison to FS. A striking family history was found in 66.6% of the patients with FS. In 26.1%, family members of patients with OAV dysplasia had external ear dysplasias or other striking symptoms of OAV dysplasia. In this complex of anomalies we also found a higher frequency of skeletal deformities and congenital heart defects than in the normal population. On the basis of our results we suggest that there is a genetic transmission in patients with FS as well as in some cases with OAV dysplasia. Our findings show that it is absolutely necessary to analyze family history very carefully when discussing the recurrence risk or risk of genetic transmission.

Adolescent↗
PubMed1981

Total obliteration of the mastoid, middle ear, and external auditory canal. A review of 27 cases.

In the past 22 years, 27 patients had undergone total obliteration of the mastoid, middle ear, and external auditory canal. Most of the patients had severely diseased ears, many with multiple previous operations. When performed for chronic otorrhea, the operation resulted in a dry ear in all but two cases, though healing was prolonged in some. Secondary revisions for hearing were unsuccessful. We review the indications for this procedure and the experience of others who had used similar techniques. Though seldom indicated, the mastoid obliteration operation results in a dry ear in almost all patients.

Adolescent↗
PubMed1987

Malignant tumors of the middle ear and external auditory canal: a 20-year review.

Twenty-four patients with malignant tumors of the external auditory canal and middle ear, originally seen between 1960 and 1980, were reviewed retrospectively. Seventeen patients had epidermoid carcinoma, one had adenocarcinoma, three had rhabdomyosarcoma, and one had osteosarcoma. At presentation, four had disease confined to the external auditory canal, three had superficial invasion of the bony canal, four had deeply invasive disease, and thirteen had disease that extended beyond the temporal bone. Treatment consisted of radiation, surgery, and combination therapy. Four patients with osteosarcoma or rhabdomyosarcoma received adjuvant chemotherapy. Five years after therapy, one of four patients with external auditory canal tumor died of disease, and two died of intercurrent disorders. One of three patients with superficial temporal bone invasion and two of four patients with deeply invasive tumor died of their disease; another died of intercurrent disorder. Twelve of 13 patients with tumor beyond the temporal bone died.

Adenocarcinoma↗
PubMed1978

Primary tumors of the external and middle ear. II. A clinicopathologic study of 14 paragangliomas and three meningiomas.

Paragangliomas (chemodectomas, glomus jugulare tumors) represented 15% of all neoplasms of the ear in the period from 1964 to 1975 at the University of Minnesota, Minneapolis. Women in the fifth to sixthe decades of life were mainly affected, and hearing loss and tinnitus were the principal symptoms. Although most tumors had the typical histopathologic appearance, two neoplasms that were initially diagnosed as paragangliomas illustrated the problems in differential diagnosis. One of these latter two tumors had metastasized and was thought to represent a malignant paraganglioma. Retrospectively, both neoplasms were adenomatous tumors of the middle ear. For the remaining patients with typical jugular paragangliomas, surgery and/or irradiation therapy controlled the local tumor in 12 cases. Two of the three meningiomas occurring in the middle ear were preceded by or associated with an intracranial component. There were only four prior examples in the literature, excluding our one case, of primary meningiomas of the ear-mastoid region. Histologically, the features were virtually identical to the usual intracranial meningioma.

Adult↗
PubMed1978

Primary tumors of the external and middle ear. III. A clinicopathologic study of embryonal rhabdomyosarcoma.

Embryonal rhabdomyosarcoma of the middle ear-mastoid is a highly lethal neoplasm of childhood in most cases, which clinically simulates a chronic infection. Extensive hemorrhage and necrosis in the biopsy specimen may obscure and often delay the diagnosis. Two of the six embryonal rhabdomyosarcomas in this study showed histologic evidence of differentiation. These same two patients were the only long-term survivors. Similar examples of "differentiated" embryonal rhabdomyosarcomas of the middle ear-mastoid with prolonged survival have been recorded individually in the literature. Therapeutic implications of this finding have been discussed.

Child↗
PubMed2006

Morphometric study of the external and middle ear anatomy in sheep: a possible model for ear experiments.

Sheep are a potentially useful model for otologic surgical training and experimentation, currently limited by the scarcity of morphological comparisons between the structure of the ear in sheep and in humans. A detailed morphometric study of the ear in sheep was carried out using computed tomography. Measurements made with AutoCAD Release 14 were compared with measurements for the human ear reported in the literature. In general, ear structures in sheep are two-thirds the size of those in humans. The important anatomical similarities found in this study between the ear in sheep and in humans suggest that sheep may be a useful model for surgical training and experimentation in some middle ear procedures.

Animals↗
PubMed2003

Tissue engineering by cocultivating human elastic chondrocytes and keratinocytes.

To date, there is no optimal way to reconstruct an external ear in cases of microtia or after trauma or burns damaging the external ear. However, success in the area of tissue engineering has indicated that autologous elastic cartilage produced in vitro might be of great importance in the future treatment of these patients. In the present study we have engineered human, elastic cartilage in vitro by culturing chondrocytes in fibrin glue. Furthermore, the engineered elastic cartilage was seeded with human keratinocytes to investigate the possibility of combining these two tissues into one integrated structure. Histological analysis and immunohistochemistry were done every second week for 10 weeks. The elastic chondrocytes were shown to grow well in the matrix and proliferated in a dense pattern. After 10 weeks a matrix containing elastin was shown by staining with orcein, indicating that an elastic cartilage had been formed. The seeded keratinocytes adhered to the cartilage, proliferated, and formed a stratified epidermal layer, which was shown by routine histological staining and immunohistochemistry. This study shows that human elastic chondrocytes can be cultured in fibrin glue and that human keratinocytes can be cocultured with this engineered cartilage, which might be of great importance in future reconstruction of ears.

Biomarkers↗