Objective: To describe an improvised optical myringotomy knife essential in creation of an incision in a myringotomy simulator.

Methods:

Study Design: Instrumental Innovation

Setting:          Tertiary Private Hospital

Subject:          None

Results: The optical myringotomy knife was able to create incisions on mock membranes made up of polyethylene film (Cling Wrap) in a myringotomy simulator. The incisions measured approximately 2 mm with sharp edges indicating that the myringotomy knife was able to penetrate the mock membrane with ease. It provided good control in performing myringotomy incisions under endoscopic visualization of the tympanic membrane.  

Conclusion: Our initial experience with this optical myringotomy knife for tympanostomy tube insertion suggests that it may greatly improve the performance of myringotomy especially among less experienced surgeons. Further studies may establish its accuracy and replicability in vitro, after which formal in vivo trials can be attempted.

The use of electro-acoustic impedance instrument to obtain a tympanogram is an excellent way for determining the status of tube function. The presence of a middle-ear effusion of high negative middle-ear press can be determined by this method. Unfortunately, assessment of the tympanograms is not simple. They always change.
diagnosis ; Middle Ear Ventilation ; physiology ; ear

BACKGROUND AND OBJECTIVES: The mastoid air cell system has been recognized as an important contributor to the function of middle ear ventilation. And, mastoid pneumatization is thought to be correlated with the petrous apex pneumatization. We attempted a comparative analysis of petrous apex pneumatization and the mastoid portion by using target imaging CT. MATERIALS AND MEDTHOD: Pneumatization of the petrous apex v as investigated in 100 subjects without middle ear disease by computer-assisted digital processing of CT images of' the hone. RESULTS: The rate of pneumatization of the petrous apex in all subjects was 22% (44/200 ears), and there was no difference in the degree of pneumatization between the left and the right ears or between sexes. In 44 ears that showed pneumatization of the petrous apex, a higher degree of pneumatization was found in larger mastoid cavities, suggesting a correlation between pneumatization of the petrous apex and the pneumatized air cells in other parts of the temporal bone. Pneumatization in all parts of the petrous apex was found in about 5% (2/44 ears), and pneumatization in some parts of the petrous apex eas about 95% (42/44 ears). In the latter cases, there was no difference in the degree of pneumatization between the lower portions of the CT slices and the higher ones. SUMMARY: These results indicate that the effects of pneumatization of the petrous apex must be taken into consideration in studies measuring the gas composition and volume of the middle ear, and in temporal bone peumatization which acts as a pressure buffer in middle ear diseases.
Ear ; Ear, Middle ; Mastoid ; Middle Ear Ventilation ; Temporal Bone

We studied three patients in whom otorrhea occurred without bacterial infection following ventilation tube (VT) insertion. These patients took oral steroids since the conventional therapy was not effective; however, the oral steroids produced temporal effect since sticky otorrhea occurred when the oral steroids were stopped. We collected ear discharge from each patient and consulted the pathologist about histopathologic findings of it. We identified the predominant eosinophilic infiltration at specimen. We tried to relate this type of otitis media with eosinophilic otitis media (EOM) and treated the patients with intratympanic steroid injection.
Bacterial Infections ; Dexamethasone ; Ear ; Eosinophils ; Humans ; Middle Ear Ventilation ; Otitis ; Otitis Media ; Polymethacrylic Acids ; Steroids ; Ventilation

It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.
Cleft Palate* ; Ear, Middle* ; Eustachian Tube ; Hearing Loss ; Humans ; Infant ; Middle Ear Ventilation ; Otitis Media ; Prevalence ; Recurrence ; Ventilation

BACKGROUND AND OBJECTIVES: Middle ear effusion (MEE) is common in children, so the effects of the ventilation tube (VT) should be taken into account in prescribing hearing aids. With the ventilation tube, the external auditory canal communicates with the middle ear space, hence changing the impedance in the middle ear. This change, in turn, will have an effect on the external ear resonance (EER, real ear unaided response (REUR)). The aim of this study is to observe the effects of the tympanic membrane perforations caused by the ventilation tube on EER. MATERIAL AND METHODS:We selected 30 ears with MEE and measured EER before and after the ventilation tube insertion. We compared the EERs of the control group with the MEE group and two types of VT groups. RESULTS: In the subjects who had middle ear effusion, the average gain of the peak resonance was larger than that of the control group. After the VT insertion, the amplitude of the gain decreased to the level of control groups, although negative gain appeared in some cases characteristically around 1000 Hz. This negative gain was observed more frequently in the VT with larger diameter. CONCLUSION: The external ear resonance gain can be changed according to disease status or by VT insertion in patients with MEE. These changes should be considered especially in the low frequencies around 1000 Hz when prescribing the hearing aids for patients.
Child ; Ear ; Ear Canal ; Ear, External* ; Ear, Middle* ; Electric Impedance ; Hearing Aids ; Humans ; Otitis Media with Effusion* ; Tympanic Membrane ; Ventilation*

OBJECTIVETo explore evaluation strategies for middle ear dysfunction in cleft palate patients, to optimize the diagnosis and treatment of this dysfunction, and ultimately to improve the comprehensive treatment of cleft palate.

METHODSThe relationship among abnormal tympanic types (B, C, and Anomaly), effusion rate, tympanic pressure, and hearing loss were analyzed. We collected relevant information on 469 ears of cleft palate patients and traced one-year longitudinal changes in the tympana of 124 ears from 62 patients with both cleft lip and cleft palate.

RESULTSThe effusion rates of cleft palate patients with type B, type C, and type Anomaly were 50.3% (97/193), 34.8% (8/23), and 20.9% (53/253), respectively. The tympanic pressure of the ears with and without effusion showed no significant difference (P>0.05). The hearing loss in type B cleft palate patients with middle ear effusion was worse than that in patients without effusion (P=0.001). However, the hearing loss in type Anomaly showed no difference (P>0.05). The constituent ratio of each tympanic type remained constant during the period between cheiloplasty and palatoplasty for cleft lip and palate patients (P>0.05).

CONCLUSIONCleft palate patients of all tympanic types may all suffer from middle ear effusion at different rates. Examination by centesis is suggested for ears with abnormal tympanic types. Early aggressive therapy is essential for type B cleft palate patients with middle ear effusion to avoid hearing loss. However, catheterization may be not necessary for type Anomaly patients, and conservative observation should be performed instead. Myringotomy with grommet insertion during palatoplasty does not delay treatment timing for patients with both cleft lip and cleft palateg.

Objective: To establish a three-dimensional model of middle ear-eustachian tube based on Chinese digital visual human dataset, and the deformation and pressure changes of the middle ear-eustachian tube system after eustachian tube opening are simulated by computer numerical simulation. Methods: The first female Chinese Digital Visual Human data was adopted. The images were imported by Amira image processing software, and the images were segmented by Geomagic software to form a three-dimensional model of middle ear-eustachian tube system, including eustachian tube, tympanum, tympanic membrane, auditory ossicles, and mastoid air cells system. The 3D model was imported into Hypermesh software for meshing and analysis. The structural mechanics calculation was carried out by Abaqus, and gas flow was simulated by Xflow. The tissue deformation and middle ear pressure changes during eustachian tube opening were numerically simulated by fluid-solid coupling algorithm. Several pressure monitoring points including tympanum, mastoid, tympanic isthmus, and external auditory canal were set up in the model, and the pressure changes of each monitoring point were recorded and compared. Results: In this study, a three-dimensional model of middle ear-eustachian tube and a numerical simulation model of middle ear ventilation were established, including eustachian tube, tympanum, mastoid air cells, tympanic membrane, and auditory ossicles. The dynamic changes of the model after ventilation could be divided into five stages according to the pressure. In addition, the pressure changes of tympanum and tympanic isthmus were basically synchronous, and the pressure changes of mastoid air cells system were later than that of tympanum and tympanic isthmus, which verified the pressure buffering effect of mastoid. The extracted pressure curve of the external auditory canal was basically consistent with that of tympanometry in terms of value and trend, which verified the effectiveness of the model. Conclusions: The numerical simulation model of middle ear-eustachian tube ventilation established in this paper can simulate the tissue deformation and middle ear pressure changes after eustachian tube opening, and its accuracy and effectiveness are also verified. This not only lays a foundation for further research, but also provides a new research method for the study of middle ear ventilation.
China ; Ear, Middle ; Eustachian Tube ; Female ; Human Body ; Humans ; Middle Ear Ventilation

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate if laser tympanostomy (LT) flexibly combined with ventilation tube insertion(VT) would result in the decreased rate of general anesthesia. This approach (LT+VT) would be an initial surgical approach for children with otitis media with effusion (OME). SUBJECTS AND METHOD: We made a prospective study that enrolled all the children with bilateral otitis media with effusion (OME) eligible for surgical intervention from January 2003 to December 2003, and 12 months postoperative follow-up. Laser tympanostomy under topical anesthesia was followed by VT insertion in the cooperative children. The success of treatment was defined as VT insertion under topical anesthesia or management of MEE without general anesthesia for 12 months. RESULTS: 79 children with bilateral OME were included. Overall cooperation to bilateral laser tympanostomy was 87%. Further cooperation to 1st VT was possible in 73% and 2nd VT in 45%. Overall efficacy of LT+VT was 91%. VT insertion on the cooperative children was presumed to increase the efficacy of laser tympanostomy by 24%. LT with VT might eliminate 80% of general anesthesia and the rate of G/A was 20% in our hospital. The rate of general anesthesia decreased to 9% when the child tolerated LT on both ears and to only 3% when the child tolerated at least one VT. CONCLUSION: LT with VT insertion might help to maintain high cooperation rate (87%), improved efficacy (91%), and therefore could reduce the rate of general anesthesia. LT+VT used under topical anesthesia might be an initial surgical approach for all OME children if the surgeon is willing to.
Anesthesia ; Anesthesia, General* ; Child ; Ear ; Follow-Up Studies ; Humans ; Middle Ear Ventilation* ; Otitis Media ; Otitis Media with Effusion ; Prospective Studies* ; Ventilation*

OBJECTIVETo explore the effect of myringotomy with insertion of tube and tympanocentesis on alleviating secretory otitis media (SOM) and hearing loss in cleft palate infants.

METHODSNineteen cleft lip and palate infants with SOM and hearing loss (38 ears) were treated with myringotomy with insertion of ventilation tube at the same time of repair of the cleft lip, who were performed averagely at 6.9 months of age. Fifteen cleft lip and palate infants with SOM (30 ears) were treated with tympanocentesis at the same time of repair of the cleft lip averagely at 6.6 months of age. All cases were followed up from 1 week to 12 months and estimated by auditory brainstem response (ABR) and acoustic immitance audiometry.

RESULTSThe average wave V reacting thresholds of ABR were separately 55.41 dBnHL and 28.48 dBnHL, and 79.17% tympanogram B changed to tympanogram A in cleft palate infants with insertion of tube before and after operation. The average wave V reacting thresholds of ABR were separately 40.63 dBnHL and 26.50 dBnHL, and 40.91% tympanogram B changed to tympanogram A in cleft palate infants with tympanocentesis preoperatively and in 1 week postoperatively, in whom the average hearing thresholds and tympanograms had no significant difference preoperatively and in 1 or 3 months postoperatively (P>0.05).

CONCLUSIONThe early myringotomy with insertion of tube is effective to restore the function of the middle ear in cleft palate infants with SOM, so to suggest to be performed at the same time of the repair of cleft lip within the first 1-year of life. The tympanocentesis should not be used as a regular management in the cleft palate infants with SOM.