Objective:To investigate the occurrence and managements of poor recovery after total endoscopic middle ear surgery. Methods:A total of 302 cases（315 ears） who underwent endoscopic middle ear surgery in our hospital from June 2020 to June 2021 were collected. Follow up by means of endoscopy, pure tone hearing threshold, tympanogram was conducted at 1 month, 3 months, 6 months and 1 year after surgery to analyze the incidence, possible causes, treatment strategies and effects of poor results tympanic membrane healing and hearing recovery. Results:Among 302 patients（315 ears） followed up, there were 28 cases with poor recovery. There were fourteen cases of poor eardrum healing, of which 10 cases achieved healing of eardrum after tympanic membrane patching in the outpatient department, with a success rate of about 71.4%. TM recurrence adhesion occurred in 4 cases after surgeries of cholesteatoma and adhesive otitis media. One case completely recovered after self eustachian tube insufflation, while 2 cases maintained the degree of eardrum subsidence, and one ineffective patient chose resurgical treatment, with an effective rate was 75.0%. Failure in hearing improvement occurred in 8 cases, all of which underwent second surgical exploration, and seven cases were improved after the second surgery, with an effective rate of 87.5%. Among the 8 patients with no improvement or aggravation of hearing loss after surgery, four cases had postoperative B-type or C-type of tympanogram, and the hearing could not improve after self eustachian tube insufflation for secondary surgical exploration. and the hearing improved after the secondary surgery. Incorrect orientation of ossicular prosthesis was accounted for another 2 cases, the hearing was improved after the ossicular orientation adjustment. One patient with lateral healing of TM and failed hearing recovery was corrected by a second operation. One case of tympanosclerosis underwent stapes release surgery, but hearing recovery still failed. One patient had recurrent postoperative cicatricial atresia of external auditory canal, and the patient was reluctant to undergo reoperation. Postoperative delayed facial paralysis occurred in 1 case, and the facial paralysis recovered recovered after conservative treatments. Conclusion:Eardrum patch and eustachian tube autoflation are simple and effective early outpatient treatment for patient with poor recovery. For those who failed with conservative treatments such as eardrum patch or eustachian tube and poor hearing recovery, the second surgical exploration is safe and effective. Regular follow up after endoscopic middle ear surgery is necessary for the managements of poor recovery.
Humans ; Ear, Middle/surgery* ; Female ; Male ; Endoscopy/methods* ; Adult ; Middle Aged ; Tympanic Membrane/surgery* ; Treatment Outcome ; Hearing Loss/surgery* ; Otologic Surgical Procedures/methods* ; Otitis Media/surgery* ; Eustachian Tube/surgery*

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

A malignant tumor of the external auditory canal (EAC) is a rare tumor, with a prevalence of between 1 and 6 people per 1 million population. Common symptoms of the EAC cancer include otorrhea, hearing loss, otalgia, or tinnitus, which are similar to symptoms of otitis media or otitis externa. Therefore, diagnosis may be delayed due to lack of EAC cancer-specific symptoms and the prognosis is also relatively poor despite intensive treatment. The most malignant tumor of the EAC is squamous cell carcinoma (SCC), which usully invades the ear unilaterally. SCC of bilateral EAC is extremely rare. We report here a rare case of bilateral EAC SCC. In this case, unilateral EAC SCC was treated via stereotactic radiosurgery and contralateral EAC SCC developed subsequently. This case implicates that radiosurgery can be a treatment option for EAC SCC but it may have carcinogenic effect. This case also shows that the ear should be examined bilaterally even when unilateral EAC cancer is encountered.
Carcinoma, Squamous Cell* ; Diagnosis ; Ear ; Ear Canal* ; Earache ; Epithelial Cells* ; Hearing Loss ; Otitis Externa ; Otitis Media ; Prevalence ; Prognosis ; Radiosurgery ; Tinnitus

BACKGROUND AND OBJECTIVES: This study aims to evaluate that usefulness of the endoscopic ear surgery (EES) through the systematic review. SUBJECTS AND METHOD: We searched literatures in literature databases (MEDLINE, EMBASE, Cochrane Library, etc.). Inclusion criteria is 1) studies of patients with chronic otitis media, otitis media with effusion, cholesteatoma, conductive hearing loss, mixed hearing loss etc. 2) studies in which a transcanal endoscopic surgery was performed; and 3) studies in which one or more of the appropriate medical outcomes have been reported. We excluded that 1) non-human studies and pre-clinical studies; 2) non-original articles, for example, non-systematic reviews; editorial, letter and opinion pieces; 3) research not published in Korean and English; and 4) grey literature. Finally, 65 articles were selected and those results were analyzed. RESULTS: The safety of the EES was reported in 61 articles. Some studies reported damaged facial nerve or perilymph gusher but these are the complications that can arise due to the characteristics of the disease and not due to the EES and other reported complications were of similar or lower level in the intervention group rather than the microscopy group. The effectiveness of the EES was reported in 23 articles. The EES tended to show improved effects in terms of graft uptake status, cholesteatoma removal, and hearing improvement although effective outcomes of most studies reported no significant difference between EES and microscopic ear surgery. CONCLUSION: EES is a safe and effective technique and as it is less invasive than the microscopic ear surgery.
Cholesteatoma ; Ear ; Endoscopes ; Facial Nerve ; Hearing ; Hearing Loss, Conductive ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Methods ; Microscopy ; Otitis Media ; Otitis Media with Effusion ; Otologic Surgical Procedures ; Perilymph ; Transplants

OBJECTIVES: Aquaporins (AQPs) are integral membrane proteins engaged in the modulation of water homeostasis, but the roles they play in chronic otitis media (COM) have not been well investigated. Accordingly, we undertook document relations between the mRNA expressions of AQPs and COM, and explored the relation between these expressions and otorrhea, which is one of the most common symptoms of COM. METHODS: Levels of the mRNAs of AQP 1, 2, 3, 4, 5, 6, 8, and 10 were assayed by real-time polymerase chain reaction in inflammatory tissue samples from 81 patients with COM with or without otorrhea. Relationships between AQP mRNA levels and the presence or absence of otorrhea, the presence or absence of bacteria, hearing threshold levels, types of hearing loss, and clinical manifestations were also evaluated. RESULTS: AQP 1, 2, 3, 4, 5, 6, 8, and 10 mRNAs were expressed in inflammatory tissues obtained from all 81 patients with COM with or without otorrhea. AQP 5 mRNA was most expressed in, followed in descending order by AQP 3, 1, 10, 6, 8, 2, and 4. There were no significant intergroup differences in terms of age, sex, duration of illness, levels of hearing loss in both ears, or incidences of conductive or sensorineural hearing loss. However, AQP 4 (P=0.035) and 6 (P=0.085) mRNA levels were significantly lower in the otorrhea group. In addition, bacteria culture positivity (P=0.014) and the incidence of sensorineural hearing loss (P=0.020) were higher in the otorrhea group. CONCLUSION: AQP 1, 2, 3, 4, 5, 6, 8, and 10 are involved in the development of COM. Specifically, it shows reductions in AQP 4 and 6 mRNA levels, as observed in the otorrhea group, have an effect on the clinical manifestations of COM.
Aquaporin 4 ; Aquaporins ; Bacteria ; Ear ; Ear, Middle ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Homeostasis ; Humans ; Incidence ; Membrane Proteins ; Otitis Media ; Otitis ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Water

BACKGROUND AND OBJECTIVES: To investigate the relationship between hearing impairment and alcohol drinking patterns in South Korean adults. SUBJECTS AND METHODS: Data collection was performed by Korean National Health and Nutrition Survey from January 1 to December 31, 2012. Data analyses were performed from February 20 to March 3, 2018. Data from 3,860 adults 20 years of age or older without a history of malignancy or chronic otitis media in the Korean National Health and Nutrition Survey 2012 database who participated in the health questionnaires, and who had available results from otologic examinations that included pure tone audiogram, were included. Pure-tone average hearing thresholds were calculated at 500, 1,000, 2,000, and 4,000 Hz. Hearing loss was defined as a pure-tone average >40 dB in one or both ears. The Alcohol Use Disorder Identification Test was used to evaluate drinking statuses of subjects. Data were analyzed using the complex-sample χ²-test of independence and a complex-sample logistic regression analysis. RESULTS: Of the 29,954,319 individuals in the weighted cross-sectional study population, 15,106,040 (50.4%) were men and 14,848,098 (49.6%) were women. A total of 8.1% of men and 7% of women had hearing impairment. The degrees of drinking with appropriate, risky, and hazardous drinking habits were 58.2, 32.1, and 9.7% among men; and 76.4, 12.5, and 11.1% among women, respectively. Among men, the odds ratio of hearing loss increased by 2.506 times when comparing hazardous and appropriate drinking (confidence interval, 1.083 to 5.800, p=0.002). Moderate alcohol consumption (≤2 drinks per day) was not protective for hearing in either group. CONCLUSIONS: As hazardous drinking tends to coexist with hearing impairment in men, appropriate prevention and intervention strategies should be emphasized. A longitudinal study to investigate harmful drinking and the mechanism of hearing loss should be performed.
Adult ; Alcohol Drinking ; Alcoholism ; Cross-Sectional Studies ; Data Collection ; Deafness ; Drinking ; Ear ; Female ; Hearing Loss ; Hearing ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Nutrition Surveys ; Odds Ratio ; Otitis Media ; Prevalence ; Retrospective Studies ; Risk Factors ; Statistics as Topic

It is challenging to achieve sufficient hearing gain in patients with mixed hearing loss. In chronic middle ear diseases, conventional passive reconstructive surgeries often result in suboptimal hearing gain and additional hearing aids may have limitations due to insufficient sound amplification, occlusion effect, acoustic feedback, and skin irritation. Middle ear implantation (MEI) using Vibrant Soundbridge (VSB) is another option for auditory rehabilitation in mixed hearing loss as well as sensorineural hearing loss. The floating mass transducer of VSB can be placed on various middle ear structures either directly or using different types of couplers in order to deliver vibratory mechanical energy to the cochlea. We report a patient who presented with bilateral mixed hearing loss due to chronic otitis media and had limitations using conventional hearing aids in the worse hearing ear. The patient was successfully treated with MEI using the Bell coupler together with middle ear surgery in a single step.
Acoustics ; Cochlea ; Ear ; Ear, Middle* ; Hearing ; Hearing Aids ; Hearing Loss, Mixed Conductive-Sensorineural* ; Hearing Loss, Sensorineural ; Humans ; Ossicular Prosthesis* ; Otitis Media ; Rehabilitation ; Skin ; Transducers

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) otorrhea with impression material of hearing aid in the middle ear. The patient had chronic otitis media in the right ear with sensorineural hearing loss in both ears. The silicone flowed into the middle ear through a tympanic membrane perforation during the process of making an ear mold. Several days after hearing aid fitting, the patient had severe otalgia, intractable otorrhea, aggravated hearing loss, and dizziness. The pus culture and sensitivity test revealed MRSA. After topical treatment using diluted vinegar irrigation and ototopical vancomycin solution, intractable otorrhea was controlled. The infected silicone impression was removed by canal wall-up mastoidectomy, and hearing was saved. We present here a review of the literature regarding silicone impression in the middle ear after hearing aid mold fitting.
Acetic Acid ; Dizziness ; Ear ; Ear, Middle* ; Earache ; Fungi ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Otitis Media ; Silicon* ; Silicones* ; Suppuration ; Tympanic Membrane Perforation ; Vancomycin

OBJECTIVES: Temporomandibular joint disorders (TMD) are often associated with aural manifestations. However, it is not clear whether aural fullness could be induced by TMD. The purpose was to investigate the TMD and effectiveness of TMD treatments in patients with mainly or exclusively aural fullness complaint. METHODS: One hundred and twelve patients, who had aural fullness as the main or sole complaint, presented to the Otolaryngology Department, PLA Army General Hospital, Beijing, China, between January 2010 and January 2015. Patients’ medical history indicated that they had previously been diagnosed and treated for otitis media or sensorineural hearing loss but without positive results. Patients were subjected to pure tone audiometry and acoustic immittance screening using GSI-61 clinical audiometer and GSI TympStar middle ear analyzer respectively. Patients were examined by questionnaire, X-ray and/or computed tomography scan of temporomandibular joint. TMD was categorized according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were then treated for TMD. RESULTS: All the patients showed normal eardrum and type A tympanogram. The patients of 60.7% (68/112) were classified as group I TMD disorders (muscle disorders), 34.8% (39/112) were group II (disc displacements), and 4.5% (5/112) were group III (arthralgia, osteoarthritis, and osteoarthrosis). Aural fullness was completely resolved or significantly improved in 67 and 34 patients respectively following treatments aimed at improving TMD, with a combined effectiveness of 90.2% (101/112). TMD treatments are especially effective (94.1%) in group I TMD. CONCLUSION: TMD as a potential cause of aural fullness should be considered in otolaryngology practice.
Acoustics ; Audiometry ; Beijing ; China ; Ear, Middle ; Hearing Loss, Sensorineural ; Hospitals, General ; Humans ; Mass Screening ; Osteoarthritis ; Otitis Media ; Otolaryngology ; Temporomandibular Joint Disorders* ; Temporomandibular Joint* ; Tympanic Membrane

Labyrinthitis ossificans (LO) is a pathologic formation of fibrosis and new bone within the lumen of the otic capsule. The LO is a challenging issue in cochlear implantation since obliteration and obstruction of the cochlea make electrode insertion through scala tympani (classic route) difficult. Moreover, tympanomastoidectomy for resolution of chronic otitis media is also simultaneously considered for tympanogenic LO with severe to profound hearing loss because ossification could progress in case of staged or delayed implantation after initial tympanomastoidectomy. We report a patient with tympanogenic LO, who received subtotal petrosectomy with simultaneous cochlear implantation via scala vestibuli instead of the scala tympani for hearing rehabilitation.
Cochlea ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner* ; Electrodes ; Fibrosis ; Hearing ; Hearing Loss ; Humans ; Labyrinthitis* ; Otitis Media ; Rehabilitation ; Scala Tympani ; Scala Vestibuli*