We report the application of optical coherence tomography (OCT) to the diagnosis and evaluation of otitis media (OM). Whereas conventional diagnostic modalities for OM, including standard and pneumatic otoscopy, are limited to visualizing the surface of the tympanic membrane (TM), OCT effectively reveals the depth-resolved microstructure below the TM with very high spatial resolution, with the potential advantage of its use for diagnosing different types of OM. We examined the use of 840-nm spectral domain-OCT (SD-OCT) clinically, using normal ears and ears with the adhesive and effusion types of OM. Specific features were identified in two-dimensional OCT images of abnormal TMs, compared to images of healthy TMs. Analysis of the A-scan (axial depth scan) identified unique patterns of constituents within the effusions. The OCT images could not only be used to construct a database for the diagnosis and classification of OM but OCT might also represent an upgrade over current otoscopy techniques.
Adult ; Ear Canal/anatomy & histology ; Eustachian Tube/physiology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/classification/*diagnosis ; Tomography, Optical Coherence/instrumentation/*methods ; Tympanic Membrane/*physiology

We report the application of optical coherence tomography (OCT) to the diagnosis and evaluation of otitis media (OM). Whereas conventional diagnostic modalities for OM, including standard and pneumatic otoscopy, are limited to visualizing the surface of the tympanic membrane (TM), OCT effectively reveals the depth-resolved microstructure below the TM with very high spatial resolution, with the potential advantage of its use for diagnosing different types of OM. We examined the use of 840-nm spectral domain-OCT (SD-OCT) clinically, using normal ears and ears with the adhesive and effusion types of OM. Specific features were identified in two-dimensional OCT images of abnormal TMs, compared to images of healthy TMs. Analysis of the A-scan (axial depth scan) identified unique patterns of constituents within the effusions. The OCT images could not only be used to construct a database for the diagnosis and classification of OM but OCT might also represent an upgrade over current otoscopy techniques.
Adult ; Ear Canal/anatomy & histology ; Eustachian Tube/physiology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/classification/*diagnosis ; Tomography, Optical Coherence/instrumentation/*methods ; Tympanic Membrane/*physiology

Acupuncture Points ; Adult ; Drugs, Chinese Herbal ; administration & dosage ; Ear ; anatomy & histology ; Female ; Humans ; Melanosis ; drug therapy ; Middle Aged ; Young Adult

OBJECTIVE: To provide the anatomic data for the correlated otologic microsurgery by the microdissection of temporal bone through facial recess approach. METHOD: Sixteen human temporal bones of eight adult cadaveric heads were dissected under surgical microscope through facial recess approach, and the relative anatomic structures were observed and measured, such as the bony entrance of facial recess approach, facial nerve, stapes, round window, round window niche, pyramidal eminence, cochleariform process, etc. The data were analyzed statistically. RESULT: The width of the bony entrance of facial recess approach was (2.94 +/- 0.32) mm, the height was (8.83 +/- 0.84) mm, the depth was (3.51 +/- 0.17) mm. The distances from stapes to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, cochleariform process and anterior ligament of malleus were (1.38 +/- 0.21) mm, (6.94 +/- 0.47) mm, (3.60 +/- 0.55)mm, (2.23 +/- 0.33)mm, (4.93 +/- 0.61) mm, respectively. The distances from pyramidal eminence to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, round window niche and cochleariform process were (1.05 +/- 0.09) mm, (5.63 +/- 0.41) mm, (3.01 +/- 0.34) mm, (3.29 +/- 0.44) mm, (4.13 +/- 0.51) mm, respectively. The distances from round window to cochleariform process and tympanic segment of facial nerve were (5.11 +/- 0.61) mm and (3.97 +/- 0.61) mm. The distances from round window niche to tympanic segment of facial nerve and mastoid segment of facial nerve were (4.13 +/- 0.38) mm and (7.28 +/- 0.29) mm. CONCLUSION The facial recess approach played an important role in modern otologic microsurgery. The position of anatomical structure was constant relatively, including short crus of incus, stapes, pyramidal eminence and cochleariform process, etc. These could be used as reference marks for otologic microsurgery.
Adult ; Ear, Middle ; anatomy & histology ; surgery ; Facial Nerve ; anatomy & histology ; surgery ; Humans ; Microsurgery ; Round Window, Ear ; anatomy & histology ; surgery ; Stapes ; anatomy & histology ; Temporal Bone ; anatomy & histology ; surgery

OBJECTIVETo investigate the related parameters of the temporal bone structure for determining the position of implanting electrode into the scala tympani in cochlear implantation surgery through the facial recess and epitympanum approach.

METHODSIn a surgical simulation experiment, 20 human temporal bones were studied and measured to determine the related parameters of the temporal bone structure.

RESULTSThe distance 5.91∓0.29 mm between the short process of the incus and the round window niche, 2.11∓0.18 mm between the stapes and the round window niche, 6.70∓0.19 mm between the facial nerve in the perpendicular paragraph and the round window niche, 2.22∓0.21 mm from the pyramidal eminence to the round window, and 2.16∓0.14 mm between the stapes and the round window. The minimal distance between the implanting electrode and the vestibular window was 2.12∓0.19 mm. The distance between the cochleariform process and the round window niche was 3.79∓0.17 mm. The position of the cochlear electrode array insertion into the second cochlear turn was 2.25∓0.13 mm under the stapes. The location of the cochlear electrode array insertion into the second cochlear turn was 2.28∓0.20 mm inferior to the pyramidal eminence.

CONCLUSIONThese parameters provide a reference value to determine the different positions of cochlear electrode array insertion into the scale tympani in different patients.

Adult ; Cochlea ; anatomy & histology ; surgery ; Cochlear Implantation ; Cochlear Implants ; Ear, Middle ; anatomy & histology ; surgery ; Female ; Humans ; Male ; Round Window, Ear ; anatomy & histology ; surgery ; Scala Tympani ; anatomy & histology ; surgery

OBJECTIVE: To investigate the related parameters of temporal bone structure in the surgery of cochlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization. METHOD: In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope. RESULT: Distance between suprameatal spine and short process of incus was (12.44 +/- 0.51) mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was (2.67 +/- 0.51) mm. Distance between short process of incus and crotch of chorda tympani nerve was (15.22 +/- 0.83) mm. The location of maximal width of the facial recess into short process of incus, crotch of chorda tympani nerve were (6.28 +/- 0.41) mm, (9.81 +/- 0.71) mm, respectively. The maximal width of the facial recess was (2.73 +/- 0.20) mm. The value at level of stapes and round window were (2.48 +/- 0.20 mm) and (2.24 +/- 0.18) mm, respectively. Distance between pyramidalis eminence and anterior round window was (2.22 +/- 0.21) mm. Width from stapes to underneath round window was (2.16 +/- 0.14) mm. CONCLUSION These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.
Anatomic Landmarks ; anatomy & histology ; Chorda Tympani Nerve ; anatomy & histology ; Cochlea ; anatomy & histology ; Cochlear Implantation ; methods ; Ear, Middle ; Facial Nerve Injuries ; prevention & control ; Humans ; Incus ; anatomy & histology ; Organ Sparing Treatments ; methods ; Round Window, Ear ; anatomy & histology ; Stapes ; anatomy & histology ; Temporal Bone ; anatomy & histology ; Tympanic Membrane ; anatomy & histology

OBJECTIVE: To study the normal anatomy of aditus of antrum and antrum on the high-resolution CT (HRCT) and the three-dimensional reconstruction, testing the normal range. And comparison was carried out according to the age, sex and side. METHOD: Ninety cases were randomly selected without ear lesions. Scanning were taken in sagittal, transverse and coronal planes on HRCT respectively. The structure of aditus and antrum was displayed by three-dimensional reconstruction. The left-right distances and up-down distances, antero-posterior distances were measured and analyzed. RESULT: The image of antrum varied with age, while aditus remained constant on the HRCT and the three-dimensional reconstruction. The average of left-right distance of aditus was (5.19 +/- 1.39) mm, and the average of up-down distance of aditus was (5.74 +/- 1.16) mm. The average of left-right distance of antrum was (8.27 +/- 1.41) mm (<6 years old) and (5.41 +/- 1.32) mm (> or = 6 years old). The average of up-down distance of antrum was (11.78 +/- 1.65) mm (<6 years old) and (9.91 +/- 2.04) mm (> or = 6 years old). The average of antero-posterior distance of antrum was (12.25 +/- 1.23) mm (<6 years old) and (10.05 +/- 1.69) mm (> or = 6 years old). No statistically significant differences were seen in left-right distance of aditus by age, sex and side (P > 0.05). Significant differences in up-down distance of aditus was found between male and female, and the distance in male was greater than that in female (P < 0.05). Statistically significant differences were seen in left-right distance and up-down distance, antero-posterior distance of antrum by age (P < 0.05), but no statistically significant differences by sex or side (P > 0.05). CONCLUSION Imaging of aditus ad antrum is relatively constant in the normal persons, while the aditus is more diverse. Significant gender differences were seen in up-down distance. There were significant differences in left-right distance, up-down distance, and antero-posterior distance of aditus among all age groups.
Adolescent ; Child ; Child, Preschool ; Ear, Middle ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Image Processing, Computer-Assisted ; Infant ; Male ; Tomography, X-Ray Computed

OBJECTIVETo analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery.

METHODSFrom Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured.

RESULTSThe patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group.

CONCLUSIONSAccording to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.

Adolescent ; Adult ; Anatomy, Cross-Sectional ; Child ; Child, Preschool ; Ear ; abnormalities ; diagnostic imaging ; Ear, External ; abnormalities ; diagnostic imaging ; Ear, Middle ; abnormalities ; diagnostic imaging ; Female ; Humans ; Male ; Tomography, Spiral Computed ; Young Adult

OBJECTIVE: To study the location of facial nerve and prevent facial nerve injury in middle ear surgery according to dissection of temporal bone and experience of middle ear surgery. METHOD: Thirty sides of temporal bones were exposed tympanic and mastoid segment of facial nerve with facial nerve decompression. The course of facial nerve was located by the markers of middle ear. RESULT: Tympanic segment of facial nerve passed between horizontal semicircular canal and stapes,then superior and anterior to the cochleariform process. Mastoid segment of facial nerve located in posterior wall of tympanic cavity. The mastoid segment of facial nerve travelled below the level of horizontal semicircular canal and annulus membrane tympani, and the extension line of its posterior margin and posterior-one-third of horizontal semicircular canal intersected to form an included angle (117.04 +/- 2.42) degrees. External genu of facial nerve located anterior and inferior to the horizontal semicircular canal. The shortest distance was (1.97 +/- 0.53) mm between middle point of horizontal semicircular canal and facial nerve, (1.03 +/- 0.29) mm between incus short process and facial nerve, (0.93 +/- 0.25) mm between cochleariform process and facial nerve, (1.18 +/- 0.42) mm between head of stapes and facial nerve, (3.08 +/- 0.28) mm between tympani sulcus and facial nerve at the vestibule window level, and (2.13 +/- 0.34) mm between tympani sulcus and facial nerve at round window level, respectively. CONCLUSION Horizontal semicircular canal carina, incus short process, stapes, annulus membrane tympani and cochleariform process are ideal landmarks of tympanic and mastoid segment of facial nerve, which are helpful in middle ear surgery.
Ear, Middle ; surgery ; Facial Nerve ; surgery ; Facial Paralysis ; prevention & control ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Mastoid ; anatomy & histology ; surgery ; Microsurgery ; methods

OBJECTIVE: To study the management of basic parameters related to individual piston shaping on malleostapedotomy by MDST 3D reconstruction and microanatomy and to assess the accuracy of MDST method. METHOD: Ten Chinese temporal bones without ear diseases were numbered randomly and scanned by GE Light Speed Ultra 64 rows of spiral CT. 3D structure of ossicular chain were reconstructed by MPR and VR methods in AW4. 1 workstation. Then measurements of distances between stapes head to stapes footplate (A line), and manubrium to stapes head (B line), and manubrium to stapes footplate (C line), angle between line A and line B (angle AB) are completed. After that, all samples of temporal bone were undergone canal wall down mastoidectomy under microscope and the relevant measurements were completed. RESULT: The MPR and VR technique of MDCT reconstructed ossicular chain clearly, and revealed the spatial relationship between every structure stereoscopically. Respectively, lengths of A, B, C line by MDST and microanatomy are (3.42 +/- 0.86) mm and (3.60 +/- 0.94) mm, (3.42 +/- 0.80) mm and (2.96 +/- 0.42) mm, (5.86 +/- 0.60) mm and (6.22 +/- 1.10) mm, while angle AB (141.05 +/- 30.07) degrees and (144.57 +/- 41.86) degrees. There are no statistically significant differences between two groups (P>0.05). CONCLUSION The MPR and VR technique of MDCT can clearly reconstructed the 3D shapes of the temporal bone and finish the exactly managements on A, B, C lines and AB angel which is crucial for shaping a individual piston on malleus-to-oval window surgery.
Adult ; Ear, Middle ; anatomy & histology ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Malleus ; anatomy & histology ; surgery ; Stapes ; anatomy & histology ; diagnostic imaging ; Temporal Bone ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed