Data and Picture Interpretation Stations: Cases 1–45
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar in ENT OSCEs, 2023
Stapes surgery, commonly known as ‘stapedectomy’ is a treatment for otosclerosis and any other cause of stapes fixation. The middle ear is entered by lifting the tympanic membrane. The bony scutum may then be widened for greater access, aiming to preserve the chorda tympani which lie in the same plane. After confirmation of stapes fixation by testing ossicular chain mobility, then incudostapedial joint is divided. The stapedius tendon is then divided, followed by the posterior crus of the stapes suprastructure. The stapes suprastructure is then downfractured and removed. A hole is then made in the stapes footplate. Typically this might measure 0.4–0.6mm. Prosthesis is placed onto the long process of incus and passes through the footplate fenestration. This then restores the conduction of sound from the tympanic membrane all the way through to the inner ear. Risks to explain in the consent process include: dead ear, worsening or failure to improve hearing, infection, bleeding, dizziness, tinnitus, altered taste, facial palsy, perilymph leak, prosthesis failure and tympanic membrane perforation.
Ear, Nose, and Paranasal Sinus
Swati Goyal in Neuroradiology, 2020
The external auditory canal (EAC), with lateral one-third cartilaginous and medial two-thirds bony composition, extends from the auricle to the tympanic membrane. The middle ear cavity is within the petrous portion of the temporal bone and consists of the tympanic cavity (containing the ossicles, namely the malleus, incus, and stapes) and the antrum. The mastoid antrum communicates with the epitympanum via aditus ad antrum. The middle ear also contains muscles (tensor tympani and stapedius), the round and oval windows, and the chorda tympani nerve. The inner ear consists of the osseous labyrinth (cochlea, vestibule, and the three semicircular canals, namely the superior, posterior, and lateral canals) and the membranous labyrinth (the cochlear duct, utricle, saccule, semicircular ducts, endolymphatic duct, and endolymphatic sac). The membranous labyrinth contains endolymph, surrounded by perilymph, and is enclosed within the bony labyrinth. The internal auditory canal (IAC) is located in the petrous bone and transmits facial and vestibulocochlear nerves along with the labyrinthine artery. The pars flaccida is the upper delicate part that is associated with Eustachian tube dysfunction and cholesteatoma. The pars tensa is larger and more robust, and associated with perforations.
Special Senses
Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard in Toxicologic Pathology, 2018
The middle ear contains a chain of three small bones called the ossicles. These are most often termed the malleus, incus, and stapes but also termed the hammer, anvil, and stirrup respectively. The malleus (hammer) is attached to the tympanic membrane and articulates with the incus (anvil) (Figure 23.5a). The incus articulates with the stapes (stirrup) and the footplate of the stapes is attached to the membranous oval window of the cochlea. There are two muscles associated with ossicles; the tensor tympani muscle (innervated by the trigeminal nerve) is attached to the malleus and the stapedius muscle (innervated by the facial nerve) is attached to the stapes. Contraction of these muscles is associated with a reflex induced by loud sounds and contraction of the muscles restricts movement of the ossicles and reduces transmission of sound.
On the battery life of a totally implantable active middle ear device: a retrospective study in a single implanting center
Published in Acta Oto-Laryngologica, 2023
Maurizio Barbara, Valerio Margani, Luigi Volpini, Chiara Filippi, Edoardo Covelli, Simonetta Monini, Haitham H. Elfarargy
When comparing the post-implantation BC thresholds with the pre-implantation ones, hearing deterioration prevailed in the group with three battery changes. These data follow the observation by Shohet et al. who found an increase in the BC thresholds by 3.7 dB [14]. Also, Barbara et al. found a delayed deterioration of bone conduction in the operated ear and the contralateral one to a minor degree [15]. At present, it is difficult to explain this finding. However, it is possible to rule out the role of the etiology of deafness since, in bilateral symmetric cases, the implanted ear displayed a much worse deterioration than the contralateral one [11]. The other factor to be taken into account is the role of direct vibratory stimulation on the stapes with eventual inner ear effects. In this regard, it is known that, contrary to electromagnetic devices, piezoelectric systems may deliver powerful energy with minimal consumption, the main reason for selecting them for fully-implantable devices [16].
Conservative management of post-traumatic pneumolabyrinth: case report
Published in Hearing, Balance and Communication, 2022
Cristina Aguiar, Leandro Ribeiro, João Larangeiro, Artur Condé
Due to paucity of reports of pneumolabyrinth, no algorithm management has been proposed [3]. There is a place for conservative management, as there is a possibility of spontaneous repair [4]. Conservative management consists on corticosteroids and prophylaxis of inner ear infection with antibiotics, bed rest, head elevation, avoidance of Valsalva Manoeuvre and serial CT scans [1]. If the patient has a persistent or worsening vertigo/sensorineural hearing loss, we can consider an exploratory tympanotomy to close the defect with fat, fascia or muscle [1,3]. It is important to assess the stapes’ status, and the decision to manipulate it needs to be carefully pondered. If it is deeply depressed into the vestibule, mobilisation of the stapes itself can be harmful to the inner ear. In contrast, if the stapes is left in the vestibule, fibrosis around it will obstruct vestibular spaces, causing inner ear dysfunction afterwards [2].
Mycobacterium tuberculosis of the temporal bone
Published in Acta Oto-Laryngologica Case Reports, 2021
Yael Friedland, Timothy Whitmore, Eric Chu, Jafri Kuthubutheen
Given the profound SNHL and the possibility of complicated cholesteatoma, the patient underwent an urgent left intact canal wall mastoidectomy and tympanoplasty. Intraoperatively there was extensive granulation tissue in the left mastoid cavity extending into the antrum and middle ear, with a well-pneumatised mastoid cavity. Anterosuperior and anteroinferior tympanic membrane perforations were present together with dehiscence of the tympanic segment of the facial nerve which was stimulating normally. The long and short processes of the incus were eroded and the stapes superstructure was intact but surrounded by granulation tissue. Intraoperative tissue samples, including granulation tissue of middle ear and mastoid, were sent for histopathology, cytology, immunophenotyping and microbiological testing. The patient’s postoperative course was uncomplicated.
Related Knowledge Centers
- Bone
- Incus
- Inner Ear
- Middle Ear
- Ossicles
- Oval Window
- Pharyngeal Arch
- Annular Ligament of Stapes
- Body
- Incudostapedial Joint