Acute facial palsy
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
Due to the nature of force required, the majority of patients with temporal bone fractures will have multiple injuries, including possible intracranial and cervical spine injury. Therefore, initial assessment follows advanced trauma life support protocols with multidisciplinary involvement. Once the patient is stabilised, a complete neuro-otological examination is required, including otoscopy for haemotympanum/perforated eardrum, evidence of postauricular ecchymosis (Battle’s sign), CSF leak from the ear or nose and, in the conscious patient, assessment of facial nerve function, nystagmus and hearing loss (bedside tuning fork test and formal audiometric testing at the earliest opportunity). In the critically ill patient, rapid imaging with high-resolution CT is essential to evaluate the temporal bone but also the intracranial contents and potential cervical spine injury.
Ears
Marie Lyons, Arvind Singh in Your First ENT Job, 2018
This is an operation to repair an eardrum perforation. The approach depends on the site and size of the perforation. The first part of the operation involves preparation of the edges of the perforation (‘freshening’) (a). This involves scratching the edges of the perforation and getting back to healing eardrum tissue. Tiny perforations in ears with wide canals can be repaired using a fat patch harvested from the lobule of the ear. They are repaired permeatally. Larger or more inaccessible perforations are repaired using temporalis fascia harvested via an endaural or postaural incision. A tympanomeatal flap (eardrum plus ear canal skin) is raised (b) and the graft is placed underneath the eardrum (c).
Noise, hearing and vibration
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
Conductive: Occurs within outer and/or middle ear.May be amenable to medical or surgical correction.Sound not conducted efficiently through outer/middle ear to inner ear; reduction in sound level heard or ability to hear soft sounds.Causes may include fluid in the middle ear, eardrum perforation, impacted earwax, ear infection or auditory tube dysfunction.
Spontaneous closure of traumatic tympanic membrane perforation following long-term observation
Published in Acta Oto-Laryngologica, 2019
Tomoyasu Tachibana, Shin Kariya, Yorihisa Orita, Takuma Makino, Takenori Haruna, Yuko Matsuyama, Yasutoshi Komatsubara, Yuto Naoi, Michihiro Nakada, Yohei Noda, Yasuharu Sato, Kazunori Nishizaki
Spontaneous closure of TTMP during long-term observation has not been well described in the literature. In the present study, four patients experienced successful spontaneous closure following long-term observation ≥6 months. There have been two previous studies including TTMP cases with spontaneous closure following long-term observation: one reported two successful cases of perforation closure at 5 and 11 months [4]; and the other described two patients who successfully healed at 4 and 9 months, respectively [5]. In the present study, cases 1 and 3 exhibited large-size perforations in contact with the malleus and the annulus, and case 4 exhibited a small-size perforation near the annulus. The larger the perforation, the longer it will take epithelial migration to cover wider tissue defects [4,8]. Perforations involving the malleus or those with umbo damage could lengthen the healing time of perforation [5]. The epithelial generation center was reported to be located near the annulus and the handle of the malleus in an experimental study [2]. In the present study, case 2 exhibited outward and centrifugal migration, and outward epithelial migration may prolong the closure time of traumatic eardrum perforation [3]. Dry perforations have been reported to achieve successful closure only when the proliferating epithelium migrated centripetally, but not centrifugally [16]. In the present study, all four cases had factors that could prolong the spontaneous healing described above.
Expression of aquaporins mRNAs in patients with otitis media
Published in Acta Oto-Laryngologica, 2018
Su Young Jung, Sung Su Kim, Young Il Kim, Hyung-Sik Kim, Sang Hoon Kim, Seung Geun Yeo
Hearing loss is a symptom that frequently follows OM. Normally OM occurs in the form of CHL but, depending on OM type, severity and duration, MHL or SNHL may occur as a complication [20]. Therefore, alteration of AQP expression as a function of the presence or type of hearing loss would suggest that AQPs may play essential roles in the inner ear or auditory nerves involved in pathological mechanisms of hearing loss in OM. However, contrary to our expectations, we found that the expression of AQP mRNAs in all OM types did not vary according to types and symptoms of hearing loss. Generally, the degree of hearing loss commonly associated with OM is determined by both the size and location of the eardrum perforation, as well as the state and motility of the ossicular chain. Various components of the immune system are involved, including immune cells such as B cells, T cells, macrophages, and polymorphonuclear leukocytes, which secrete products such as cytokines, chemokines, and prostaglandins during the progression of inflammation. In contrast, our results showed that the expression of AQPs was not significantly affected by the degree and type of hearing loss, suggested that water and ion channel abnormalities caused by changes in AQP expression during the pathophysiological processes involved in hearing loss in various types of OM may have relatively minor effects.
Preliminary experience and feasibility test using a novel 3D virtual-reality microscope for otologic surgical procedures
Published in Acta Oto-Laryngologica, 2021
Merlin Schär, Christof Röösli, Alexander Huber
The novel microscope was introduced to the surgery after skin incision, flap preparation and incision of the posterior ear canal wall. Notable findings during the procedure included a severely overhanging antero-inferior and inferior canal wall, and a completely fixated but intact ossicular chain. The tympanic membrane, which was retracted in the upper quadrants, was perforated in the anterior and inferior quadrants. After separation of the incudo-stapedial joint (Figure 2(B)), the stapes was found to be mobile. The antrum was noticeably filled with sclerotic material (Figure 2(D)). No cholesteatoma was found. An epitympanectomy with removal of the malleus head and the incus (Figure 2(E)) was performed. The tympanic membrane was reconstructed with temporalis fascia inserted in underlay technique (Figure 2(F)) (Supplemental online material: Intraoperative video recording). No ossicular reconstruction was done in this first stage surgery according to in-house guidelines for eardrum perforation of more than 1/3 of the area. There were no technical difficulties during the procedure related to the use of the novel microscope, and a conversion to the conventional surgical microscope was not necessary at any given point during surgery. No perioperative complications were observed.
Related Knowledge Centers
- Conductive Hearing Loss
- Otitis Media
- Otoscope
- Tinnitus
- Infection
- Eardrum
- Vertigo
- Injury
- Ear Clearing
- Ear Pain