OBJECTIVES: To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations. METHODS: Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated. RESULTS: For the traumatic tympanic membrane perforations, the study showed that the small size of perforation （<1/2 quadrant） with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%. CONCLUSIONS In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification.
Humans ; Retrospective Studies ; Tympanic Membrane/injuries* ; Tympanic Membrane Perforation/physiopathology* ; Wound Healing/physiology*

OBJECTIVETo explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP).

METHODSThe hearing thresholds of the guinea pigs were assessed with auditory brainstem responses (ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection.

RESULTSAn important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa ( P<0.01). The rate of perforation of tympanic membrane reached 87.5% and that of total OHCs loss was 19.46% +/- 5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01).

CONCLUSIONSThe earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.

Animals ; Auditory Threshold ; Blast Injuries ; prevention & control ; Ear Protective Devices ; Guinea Pigs ; Hair Cells, Auditory, Outer ; metabolism ; Pressure ; Tympanic Membrane ; injuries ; Tympanic Membrane Perforation ; etiology ; physiopathology ; prevention & control

OBJECTIVETo conduct audiological assessment in patients with tympanosclerosis.

METHODSA retrospective review was conducted in 79 patients with tympanosclerosis (involving 79 ears) with complete records, including 30 patients (30 ears) with fixed Malleus-incus complex, 29 (29 ears) with fixed stapes, and 20 (20 ears) with fixations of both the stapes footplate and the Malleus-incus complex. Audiometry was performed for all the patients one or two days before operation, and the audiological features of the patients were compared between the 3 groups.

RESULTSMost of the patients (65.8%) suffered conductive hearing loss, 32.9% had mixed deafness, and one patient had sensorineural hearing loss. No statistically significant differences was noted in the speech frequency (0.5, 1, and 2 kHz) air conduction pure tone average (PTA) or the air-bone gap (ABG) in the 3 groups (P<0.05).

CONCLUSIONMost of the patients with tympanosclerosis suffer conductive hearing loss, and the severity of hearing loss is not associated with the site of tympanosclerosis.

Adolescent ; Adult ; Audiometry ; methods ; Deafness ; physiopathology ; Ear Diseases ; pathology ; physiopathology ; Female ; Hearing Loss, Conductive ; physiopathology ; Hearing Loss, Sensorineural ; physiopathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sclerosis ; Tympanic Membrane ; pathology ; physiopathology ; Young Adult

OBJECTIVE: To investigate the effects of tympanic membrane perforation on real-ear to coupler difference (RECD) in adults. METHOD: RECD was measured in 34 ears with dry tympanic membrane perforation, 34 normal subjects served as controls. RESULT: There was significant difference (P<0.05) below 1 kHz (including 1 kHz) and in 4 kHz between experimental group and control group. For perforated ears, RECD was 3.5-15 dB less from 250 Hz to 1 kHz while the values of RECD was negative from 250 Hz to 750 Hz. A larger standard deviation was found in experimental group. The mean intra-subject standard deviation was 4.4 dB in experimental group as contrasted with 1.4 dB in control group. The equivalent ear canal volume appeared to be negatively correlated with the RECD reduction below 0.75 kHz and no correlation above 1 kHz. The more the equivalent ear canal volume, the smaller the RECD. It was found that the size of tympanic membrane perforation had no effect on RECD. CONCLUSION It is recommended to perform real-ear measurement individually instead of using the age-appropriate average values, and to increase low frequency gain appropriately when fitting hearing aids for patients with dry tympanic membrane perforation.
Adolescent ; Adult ; Aged ; Case-Control Studies ; Female ; Hearing Aids ; Hearing Tests ; Humans ; Male ; Middle Aged ; Tympanic Membrane Perforation ; physiopathology ; Young Adult

OBJECTIVE: To analyze the role and significance of pepsin and pepsinogen in the pathogenesis of OME in children. METHOD: Pediatric patients with otitis media aged 2-8 years who enrolled in our department of the hospital from May of 2012 to December of 2012 were set as experimental group (38 cases, 48 ears) which should be underwent tympanic membrane puncture/tube insertion. Meanwhile, pediatric patients waiting for cochlear implant without otitis media (10 ears), were set as control group. Middle ear lavage fluid and plasma samples from the two groups were collected and detected using enzyme-linked immune method for pepsin and pepsinogen. RESULT: The concentrations of pepsin and pepsinogen in the middle ear lavage fluid of OME group [(48.8 ± 415.99) ng/ml and 676.32 ± 336.71)ng/ml] were significantly higher than those in the control group [(8.20 ± 4.59)ng/ml and (77.27 ± 50.33) ng/ml] (P < 0.01). Meanwhile, the concentration of pepsinogen in the middle ear lavage of OME patients was significantly higher than that of plasma (P < 0.01). The concentration of pepsin in the middle ear lavage fluid from the dry ear subgroup was lower than those in the serum ear and mucous ear subgroups (P < 0.01), but there was no significant difference about concentrations of pepsinogen among the dry ear, serum ear and mucous ear subgroups (P > 0.05). CONCLUSION Pepsin and pepsinogen in the middle ear cavity of OME patients maybe originated from laryngopharyngeal reflux (LPR), indicating that LPR is associated with the pathogenesis of OME in children.
Child ; Child, Preschool ; Ear, Middle ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Humans ; Laryngopharyngeal Reflux ; physiopathology ; Otitis Media with Effusion ; metabolism ; Pepsin A ; metabolism ; Pepsinogen A ; metabolism ; Tympanic Membrane ; surgery

In order to study the influence of tympanic membrane lesion and ossicular erosion caused by otitis media on the hearing compensation performance of round-window stimulation, a human ear finite element model including cochlear asymmetric structure was established by computed tomography (CT) technique and reverse engineering technique. The reliability of the model was verified by comparing with the published experimental data. Based on this model, the tympanic membrane lesion and ossicular erosion caused by otitis media were simulated by changing the corresponding tissue structure. Besides, these simulated diseases' effects on the round-window stimulation were studied by comparing the corresponding basilar-membrane's displacement at the frequency-dependent characteristic position. The results show that the thickening and the hardening of the tympanic membrane mainly deteriorated the hearing compensation performance of round-window stimulation in the low frequency; tympanic membrane perforation and the minor erosion of ossicle with ossicular chain connected slightly effected the hearing compensation performance of round-window stimulation. Whereas, different from the influence of the aforementioned lesions, the ossicular erosion involving the ossicular chain detachment increased its influence on performance of round-window stimulation at the low frequency. Therefore, the effect of otitis media on the hearing compensation performance of round-window stimulation should be considered comprehensively when designing its actuator, especially the low-frequency deterioration caused by the thickening and the hardening of the tympanic membrane; the actuator's low-frequency output should be enhanced accordingly to ensure its postoperative hearing compensation performance.
Acoustic Stimulation ; Ear Ossicles ; pathology ; Finite Element Analysis ; Hearing ; Humans ; Otitis Media ; physiopathology ; Reproducibility of Results ; Round Window, Ear ; physiology ; Tomography, X-Ray Computed ; Tympanic Membrane Perforation

lmpedance audiometry requires physical modifications during the test, which might influence retest data. Therefore, in Order to interprete retest data meaningfully, the range of variation should be identified in each measure of impedence audiometry. The present study obtained data on the retest variation of peak pressure, acoustic reflex threshold, static compliance and earcanal volume in impedance audiometry. ln addition, the authors wanted to know whether or not impedance data would assist otolaryngologists in the detection of conductive hearing impairment. The variation of the retest data was not clinically nor statistically significant in the measurement except for those of ear canal volume. The data on ear canal volume also suggested that the ear canal increases in size during the teenage period and that male ear canals are larger than those of females in ears over 20 years of age. The impedance data assisted the otolaryngologist in the detection of conductive hearing impairment
Acoustic Impedance Tests ; Adolescent ; Adult ; Age Factors ; Aged ; Auditory Threshold/*physiology ; Child ; Child, Preschool ; Comparative Study ; Diagnostic Errors ; Hearing Loss/*diagnosis ; Hearing Loss, Conductive/*diagnosis/physiopathology ; Human ; Middle Age ; *Reflex, Acoustic ; Sex Factors ; Support, Non-U.S. Gov't ; Tympanic Membrane/*physiopathology

OBJECTIVETo study the incidence of tympanosclerosis (TS) and the major risk factors of hearing loss.

METHODSA total of 118 TS patients (137 ears) were compared with 265 patients with chronic otitis media (COM) (311 ears) for gender, age and course of disease. The disease regions and hearing loss of the TS patients were analyzed.

RESULTSTS showed higher prevalence in women of older ages. Sclerosis was seen most frequently in the tympanic membrane, followed by the malleus, incus, incudomalleolar joint, other regions, ariticulus incudostapedius and stapes. The patients with sclerosis or deterioration in the ossicular chain had worse hearing loss than the other patients. Carhart notch occurred in 45 ears (32.85%), an incidence similar to that of inverted "V"-shaped curve of air-conduction audiometry near 2 kHz (47 ears, 34.31%). The factors contributing to the hearing loss, listed in the order of their importance, included pathologies in the incus, malleus, incudomalleolar joint, ariticulus incudostapedius, stapes, other regions, tympanic membrane, and gender.

CONCLUSIONSFemale patients may had increased risk of TS. The presence of Carhart notch and inverted "V"-shaped curve in air-conduction audiograph may indicate myringosclerosis or ossicular chain sclerosis. Abnormal ossicular chain is the leading factor contributing to hearing loss.

Adolescent ; Adult ; Aged ; Child ; Ear Ossicles ; pathology ; Female ; Hearing Loss, Conductive ; etiology ; physiopathology ; Humans ; Male ; Middle Aged ; Otitis Media, Suppurative ; complications ; Otosclerosis ; etiology ; pathology ; physiopathology ; Retrospective Studies ; Risk Factors ; Tympanic Membrane ; pathology ; Young Adult