Clinical Examination of the Ear and Hearing
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in Scott-Brown's Essential Otorhinolaryngology, 2022
If a structured approach to otoscopy is taught, diagnostic skills improve and disease patterns are more easily recognised and appropriately dealt with.1 In most ears, the most recognisable feature is the handle of malleus (Figure 3.2). The umbo and lateral process should be identified and the adjacent tympanic membrane visualised. The pars tensa and pars flaccida should be inspected (see Figure 3.1B). The examiner should decide if the pars tensa is intact and if so whether it is in its normal position. Clues as to its normal position should be sought in identifying the angle of the handle of the malleus. Foreshortening indicates retraction of the tympanic membrane medially as does lipping around the annulus creating a ‘neo-annulus’ (Figure 3.2.1). Mobility of the pars tensa can be assessed by getting the patient to perform a Valsalva manoeuvre or use of a pneumatic Siegel closed speculum. Immobility would suggest middle ear fluid.
Ears
Marie Lyons, Arvind Singh in Your First ENT Job, 2018
The external ear consists of the pinna and the outer ear canal (seeFigure 1.1). The outer third of the ear canal is cartilaginous, hair-bearing and wax-producing. It is also not particularly sensitive, which makes it relatively easy to inspect with an auroscope. The inner third is bony and exquisitely sensitive. Push too deep into the bony ear canal and the patient will certainly protest! The outer ear canal ends at the eardrum, which in a healthy ear is a pale grey structure (seeFigure 1.2). The most obvious features are the handle of the malleus and antero-inferiorly the cone of light (see below). When you are shown a picture of the eardrum you can always identify which side it is on by the direction in which the malleus is pointing. If the eardrum is on the right side, the malleus will point upwards and superiorly to the right from the middle of the eardrum. If it is on the left side, the malleus will point to the left (amaze your boss at quizzes!).
Ear Trauma
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Fractures of the ossicles are much less frequent,86 being mostly of the incus long process.93 Studies of cadavers following severe head injuries have noted a variety of damage that includes disconnection of the malleoincudal or incudostapedial joints and fractures of the malleus or stapes.94 The malleus handle may be fractured, particularly in cases of middle ear barotrauma.95,96 Complete malleus dislocation has also been described.88 Isolated fracture dislocation of the stapes footplate is very rare97 and almost always the result of penetrating injuries, with associated pneumolabyrinth and perilymphatic fistula.98 Trauma to the stapes may result in fracture of the arch,88,91,93 or dislocation of the whole stapes.99 In some cases, a combination of these lesions may be found and there may also be fractures of the bony external auditory meatus or fixation of the incus and/or malleus.93,100 Ossicular disruption following trauma may occur without perforation of the tympanic membrane.101
Transcanal endoscopic management of isolated congenital middle ear malformations
Published in Acta Oto-Laryngologica, 2023
Licai Shi, Shuainan Chen, Rujie Li, Yideng Huang
When it comes to the situation that the stapes suprastructure was intact with MIC fixed with the lateral wall of the superior tympanum, there were two ways to choose. One way was removing the incus and head of the malleus to reconstruct the connection between the handle of the malleus and the head of the stapes. The other was to preserve of intact ossicular chain by mobilizing the MIC. At present, it was reported in the literature that there was still controversy in these two surgical methods [8,11]. When the stapes footplate is active but the stapes suprastructure is missing or deformed, with intact MIC, TORP or Piston can be used for hearing reconstruction in theory, but the former may need to bypass the MIC for type III tympanoplasty, while the latter may need to open the vestibular window. Both of them have advantages and disadvantages, but there is no research on which of the two surgical methods benefits more.
Effect of ossicular chain deformity on reverse stimulation considering the overflow characteristics of third windows
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Houguang Liu, Lin Xue, Jianhua Yang, Gang Cheng, Lei Zhou, Xinsheng Huang
To simulate the structural abnormalities of the ossicular chain, we used our previously reported FE model including the ear canal and middle ear (Zhou et al. 2016). In brief, the geometric model of the ear canal and middle ear are based on a series of histological section images collected from a human temporal bone (male, 60 years old, right ear). The volume of the air in the ear canal is 952.18 mm3, and the average length is about 26.32 mm. The volume of the malleus, incus, and stapes are 13.53, 15.54, and 2.95 mm3, respectively. The corresponding mass can be calculated from the measured dimensions. The definition of fluid-structure interaction surface, boundary conditions, and material properties of components in the model are consistent with those reported by Zhou et al. (2016). Figure 2 indicates the FE model of the ear canal and the middle ear. Coupled structural–acoustic analysis of the FE model was conducted using Abaqus (Dassault Systèmes, Johnston, RI, USA).
Transcanal endoscopic ear surgery for management of ossicular malformation: clinical outcomes of 17 cases
Published in Acta Oto-Laryngologica, 2022
Alyssa Yoshida, Makoto Hosoya, Sho Kanzaki, Masato Fujioka, Hiroyuki Ozawa
Seventeen cases (seven women and ten men) of ossicular malformation performed using TEES were included in this study. The mean age of the patients was 34.4 years. Of these 17 cases, 13 were performed only by TEES, but 4 cases were supported by a surgical microscope (1 case in 2015, 1 case in 2016, and 2 cases in 2017). After 2018, all the cases were performed using TEES. According to the Teunissen and Cremers classification system, six ears were type I, two ears were typeII, and nine ears were type III. Endoscopic exploratory tympanotomy revealed that cases showing malformations of the stapes superstructure tended to be more common in terms of percentage. Most cases showed normal malleus, except for five ears (29.4%), including the fixation of the incudomalleolar joint or a malleus bar. The malformation of incus was observed in five ears (29.4%). The most common malformation was the missing of the long process. Stapes malformation was observed in 12 ears (70.5%), which often involved the stapes superstructure malformations with a mobile footplate (4 in 12 ears). Oval window aplasia or dysplasia, which was classified as type IV, was not observed.
Related Knowledge Centers
- Ossicles
- Middle Ear
- Incus
- Eardrum
- Pharyngeal Arch
- Meckel'S Cartilage
- Inner Ear
- Palpation
- Surgeon
- Otorhinolaryngology