Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.
Humans ; Tympanoplasty ; Ear, Middle ; Ear Ossicles/surgery* ; Tympanic Membrane/surgery* ; Tympanosclerosis

Objective: To analyze the clinical characteristics and treatment of middle ear myoclonus. Methods: Fifty-six cases of middle ear myoclonus were enrolled in Shandong Provincial ENT Hospital, Shandong University from September 2019 to August 2021, including 23 males and 33 females. The age ranged from 6 to 75 years, with a median age of 35 years; Forty-seven cases were unilateral tinnitus, nine cases were bilateral tinnitus. The time of tinnitus ranged from 20 days to 8 years. The voice characteristics, inducing factors, nature (frequency) of tinnitus, tympanic membrane conditions during tinnitus, audiological related tests, including long-term acoustic tympanogram, stapedius acoustic reflex, pure tone auditory threshold, short increment sensitivity test, alternate binaural loudness balance test, loudness discomfort threshold, vestibular function examination, facial electromyography, and imaging examination were recorded. Oral carbamazepine and/or surgical treatment were used. The patients were followed up for 6-24 months and the tinnitus changes were observed. Results: Tinnitus was diverse, including stepping on snow liking sound, rhythmic drumming, white noise, and so on. The inducing factors included external sound, body position change, touching the skin around the face and ears, speaking, chewing and blinking, etc. Forty-four cases were induced by single factor and 9 cases were induced by two or more factors. There was no definite inducing factor in 1 case. One patient had tinnitus with epilepsy. One case of traumatic facial paralysis after facial nerve decompression could induce tinnitus on the affected side when the auricle moved. Tympanic membrane flutter with the same frequency as tinnitus was found in 12 cases by otoscopy, and the waveform with the same frequency as tinnitus was found by long-term tympanogram examination. There were 7 patients with no tympanic membrane activity by otoscopy, the 7 cases also with the same frequency of tinnitus by long-term tympanogram examination, but the change rate of the waveform was faster than that of the patients with tympanic membrane flutter. All patients with tinnitus had no change in hearing. One case of tinnitus complicated with epilepsy (a 6-year-old child) was treated with antiepileptic drug (topiramate) and tinnitus subsided. One case suffered from tinnitus after facial nerve decompression for traumatic facial paralysis was not given special treatment. Fifty-four cases were treated with oral drug (carbamazepine), of which 10 cases were completely controlled and 23 cases were relieved; 21 cases were invalid. Among the 21 patients with no effect of carbamazepine treatment, 8 patients were treated by surgery, 7 patients had no tinnitus after surgery, 1 patient received three times of operation, and the third operation was followed up for 6 months, no tinnitus occurred again. The other 13 cases refused the surgical treatment due to personal reasons. Conclusions: Middle ear myoclonus tinnitus and the inducing factors manifestate diversity. Oral carbamazepine and other sedative drugs are effective for some patients, and surgical treatment is feasible for those who are ineffective for medication.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Ear, Middle/surgery* ; Hearing Tests ; Myoclonus/complications* ; Tinnitus/etiology* ; Tympanic Membrane

Patients with patulous Eustachian tubes(PET) usually suffer from annoying symptoms, such as tinnitus, autophony and aural fullness, due to the excessive opening of the Eustachian tube. There is no uniform standard of treatment, and conservative therapy combined with"Stepup"surgical intervention strategy is the main treatment. In this article, we reviewed various surgical treatments of patulous Eustachian tube in recent years, including key points of surgical operation, effectiveness, safety and complications. Full communication and evaluation are needed to establish appropriate patients' expectations preoperatively. A "Stepup" treatment strategy will be carried out, including conservative treatment, tympanic membrane surgery, Eustachian tube pharyngeal orifice constriction surgery, Eustachian tube tympanic orifice plug surgery and Eustachian tube muscle surgery, which aims to maintain normal Eustachian tube function and good middle ear ventilation.
Humans ; Eustachian Tube/surgery* ; Ear Diseases/diagnosis* ; Ear, Middle ; Tympanic Membrane/surgery* ; Tinnitus ; Otitis Media

Objective: To compare the effect of topical epidermal growth factor (EGF) instillation versus observation alone on healing of acute tympanic membrane perforations in terms of closure and hearing test results. Methods: Design: Randomized, Open label, Clinical Trial. Setting: Tertiary Government Training Hospital. Participants: Seventeen (17) ENT-HNS OPD patients aged between 18 to 65 years old diagnosed with acute tympanic membrane perforation were included in the study. Group A underwent observation while group B was treated with recombinant human EGF solution. Follow- up was on a weekly basis (7th, 14th, 21st and 28th days) where video otoscopy for documentation and measurement of perforation using ImageJTM software was done. Pure tone audiometry was used to compare hearing improvement pre and post study in both observation and treatment groups. Results: At baseline, there was no significant difference in the sizes of perforations: 24.20 ± 9.95 (treatment) vs. 32.64 ± 11.62 (observation) with a p-value of .131. Following treatment, mean changes in perforation size were significantly greater in the treatment group compared to the observation group from baseline to day 7 (M = -9.08, n = 15.11 vs. M = -1.06, n = 31.58); p = .009; day 7 to 14 (M = -6.37, n = 13.78 vs. M = -0.79, n = 30.79); p = .003; and from day 14 to 21 (M = -5.65, n = 10.89 vs. M = -0.72, n = 30.07); p = .004 but not from day 21 to 28 (M = -4.16, n = 13.99 vs. M = -0.36, n = 29.71; p = .021. From baseline pure tone averages, four participants with mild hearing loss and two with moderate hearing loss achieved normal hearing in the treatment group (while one each with moderate and severe hearing loss did not improve). None of the observation group participants had improved hearing. Conclusion Based on our limited experience, topical EGF can be used for traumatic tympanic membrane perforation and otitis media with dry ear perforation during the acute phase or within 3 months of perforation.
Tympanic Membrane Perforation ; Otitis Media ; Hearing Loss ; Tympanic Membrane Perforation ; Wound Healing

Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(
Child ; Chronic Disease ; Humans ; Otitis Media, Suppurative/complications* ; Procalcitonin ; Risk Factors ; Tympanic Membrane Perforation/etiology*

Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.
Adult ; Ear Ossicles/surgery* ; Ear, Middle/surgery* ; Hearing Loss, Conductive/surgery* ; Humans ; Osteoma/surgery* ; Tympanic Membrane

Objective: To evaluate the preliminary surgical results of Endoscopic Type I Tympanoplasty among patients with inactive chronic otitis media without ossicular pathology. Methods: Design: Prospective Series. Setting: Tertiary Government Hospital. Participants: Seventy patients with inactive mucosal chronic otitis media (COM) with air bone gap (ABG) of ≤ 40 dB on the preoperative audiogram scheduled to undergo Type I Tympanoplasty between July 2018 and December 2020 were enrolled. Results: Seventy-three (73) ears were evaluated. The overall rate of graft uptake was 95.9% at 12 weeks. There was a statistically significant (p<.001) improvement in hearing on comparison of pre-operative (25.74 ± 7.34 dB) and post-operative (14.82 ± 6.55 dB) air bone gap. The duration of surgery was less than one hour in 76.7% and 77.2 % patients experienced only mild post[1]operative pain. Conclusion Endoscopic tympanoplasty can provide good results with respect to graft uptake and hearing gain with short surgical duration and minimum postoperative morbidity. Longer follow up of at least 6 months (for graft uptake) and preferably not less than 12 months (for hearing results) may confirm our preliminary findings.
Pain, Postoperative ; Tympanic Membrane Perforation ; Hearing ; Morbidity

BACKGROUND AND OBJECTIVES: Inlay butterfly cartilage tympanoplasty makes the graft easy, and reduces operating time. The present study aimed to investigate the outcomes of microscopic versus endoscopic inlay butterfly cartilage tympanoplasty. SUBJECTS AND METHODS: In this retrospective study, the outcomes of 63 patients who underwent inlay butterfly cartilage tympanoplasty with small to medium chronic tympanic membrane perforation were evaluated. Twenty-four patients underwent conventional microscopic tympanoplasty and 39 underwent endoscopic tympanoplasty. The outcomes were analyzed in terms of the hearing gain and graft success rate. RESULTS: The surgical success rate was 95.8% in the patients who underwent conventional microscopic tympanoplasty and 92.3% in those who underwent endoscopic tympanoplasty. In both groups of patients, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values in either group. CONCLUSIONS: Endoscopic inlay tympanoplasty using the butterfly cartilage technique appears to be an effective alternative to microscopic tympanoplasty and results in excellent hearing.
Butterflies ; Cartilage ; Endoscopy ; Hearing ; Humans ; Inlays ; Microscopy ; Retrospective Studies ; Transplants ; Tympanic Membrane Perforation ; Tympanoplasty

BACKGROUND: In the Philippines, screening for ear problems especially in children at entry to school is usually undertaken by school nurses and teachers who typically do not have specialized instrumentation. The penlight has recently been employed as screening method in determing the possibilities of ear problems in public school communities. This study attempts to determine the accuracy of the penlight as an alternative method for screening to assess the common external ear abnormalities among Grade 1 students in an elementary school. OBJECTIVES: 1. To compare the result of otologic examination using the penlight versus otoscopy in determining of common pediatric ear problems. 2. To determine the sensitivity, specificity and predictive values of penlight examination in the screening of ear canal and tympanic membrane for abnormal conditions among Grade 1 students. METHODS: Otologic examination with the use of a penlight was carried out by the tranined nurse in ears of Grade 1 students and the results compared with those obtained from otoscopy done by an otolaryngologist. Presence of ear conditions such as cerumen, discharge, foreign body, tympanic membrane visualization, and an overall assessment were recorded in an Excel file. The examiners were both blinded with the findings. RESULTS: Ninety-four students (188 test ears) with a median age of 6 years, ranging from 5 to 10 years, and a 1:1 sex distribution were included in the study. The result showed an excellent agreement (P<.001) between the penlight and otoscopic examination. The sensitivity and specificity were of 98.6% and 100%, respectively. The PPV is nearly 100% and NPV of 95.2% and and overall accuracy of 98.94%. CONCLUSIONS There is an excellent agreement between the nurse‘s findings and otolaryngologist‘s findings in examining the ear canal and tympanic membrane. The penlight has on overall accuracy of 98.94%, in identifying cerumen, discharge, foreign body and visualizing the tympanic membrane. Thus, this study shows that with trained nurse in otologic examination, the penlight is an effective screening in identifying common ear problem among children.
Tympanic Membrane

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