Intensity modulated conformal radiotherapy of a jugulo-tympanic paraganglioma

Jugulo-tympanic paragangliomas are rare benign tumors arising from the neuroectodermal cells of the tympanic cavity and the dome of the jugular vein. Surgical resection has long been the first-line treatment. However, when this is not possible, radiotherapy remains a therapeutic alternative allowing local control with less morbidity. We report the case of a patient with an unresectable tympano-jugular paraganglioma, the symptomalagy was dominted by chronic headaches and right sided hypoacousie, and the treatment consisted of external radiation therapy with a total dose of 50 Gy in 25 fractions, one fraction per day, 2 Gy per fraction using the IMRT technique. The evolution was good with disappearance of clinical symptomatology, significant local control with less toxicity.

A Case Report of a Middle Ear Mass Originated From Cartilage-like Tissue Treated With Transcanal Endoscopic Ear Surgery

Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal endoscopic ear surgery (TEES) has increased in recent years because of its advantages, such as clear visual field and minimally invasive procedure. Here, we report a middle ear mass originating from cartilage-like tissue treated with TEES. A 62-year-old woman presented with progressive right-sided hearing loss. A white mass was revealed through the tympanic membrane, and pure-tone audiometry detected a mean 50.0 dB conductive hearing loss. Computed tomography showed a mass in the tympanic cavity. TEES was performed for diagnosis and treatment. A white translucent tumor was observed intraoperatively, and it was completely resected. Histopathological examination confirmed the diagnosis of a mass originating from degenerated cartilage-like tissue. To the best of our knowledge, this is the first study of a middle ear mass originating from cartilage-like tissue treated with TEES. TEES with its clear visual field and precise techniques was beneficial in treating the middle ear lesions circumscribed in the tympanic cavity.

Postoperative results of ventilation tube insertion: a retrospective multicenter study for suggestion of grading system of otitis media with effusion

Background In otitis media with effusion (OME), it is important to know when to surgically intervene and when careful monitoring is more appropriate. This study aimed to visualize and classify the clinical manifestations of OME and the correlation between the new grading system and postoperative results after ventilation tube insertion (VTI). Methods We classified the collective 1,012 ears from 506 patients into six groups: grade 0 (no effusion), grade I (scant effusion, but abnormal), grade II (effusion less than half of the tympanic cavity), grade III (effusion over half of the tympanic cavity, with air bubbles), grade IV (complete effusion), and grade V (retracted tympanic membrane or hemotympanum without air bubbles). Results The mean age at VTI was 5.2 (±2.9) years and mean duration between diagnosis and operation was 4.1 (±1.8) months. Between the grades, the nature of the middle ear effusion was also significantly different (p < 0.001). The duration of ventilation tube retention after VTI was significantly different when compared between two groups: grade I-IV and grade V (p = 0.019). Our results showed that the recurrence rate, as well as rate of revision VTI, increased as the grade increased (p < 0.001). Conclusions The new grading system of OME using endoscopic otoscope evaluation had a significant correlation with the age at VTI, the nature of middle ear effusion, the recurrence rate of OME, and the rate of revision VTI.

Risk factors for the formation of effusion in tympanic cavity and its clinical features in adults

Objectives to analyse the risk factors for developing effusion in the tympanic cavity in adults. Material and methods. We examined patients who were treated for otitis media with effusion (n=51) aged 18-70 years in the ENT department of the 11 Minsk City Clinical Hospital and the Gomel Regional Clinical Hospital during the 2018-2020 years. Results. The acute otitis media with effusion was significantly prevailing in patients of the age group 31-40 years, the chronic form predominated in people of 51-60 years old, and in all analyzed groups women dominated. In 81% of chronic inflammation of the paranasal sinuses the chronic form of otitis media with effusion prevails. Conclusion. The most frequent risk factors for the formation of the tympanic exudate were inflammatory diseases of the paranasal sinuses, pathology of the nasal cavity, predominantly female sex of working age. According to the research, it was reliably proved that smoking and rural or urban residence were not a risk factor for the formation of tympanic effusion.

OTO MASTOIDITIS AND SEPTIC CEREBRAL VENOUS THROMBOSIS

11 yr old female child, admitted with history of fever, left ear pain, swelling behind the left ear of 5 days duration, for which she was treated by a nearby doctor. After 1 week the child had left ear discharge, headache, neck pain, recurrent episodes of vomiting. On general examination she is thin built, febrile, toxic and dehydrated. On local examination she had ear discharge, swelling behind the left ear. On neurological examination, she had neck stifness. Routine blood investigations including, CBC, LFT, RFT were normal. On CSF examination Protein-188 mg%,Sugar- 16 mg%,Cell count-165 cells/cumm,85% were Neutrophils. Aural swab C/S showed growth of Klebsiella sensitive to Amikacin, Ciprooxacin, Piperacillin / Tazobactum and Cotrimoxazole. ENT opinion was in favour of doing Mastoidectomy. HRCT Temporal bone showed complete opacication of external auditory canal, tympanic cavity and mastoid air cells with a possibility of lling up with pus. MRI BRAIN showed Left mastoid and postauricular abscess, mastoiditis, ventriculitis, venulitis with thrombosis of left transverse and sigmoid sinuses. Patient was treated with parenteral piperacillin tazobactum, Ciprooxacin, Amikacin, Metronidazole, Mannitol, Dexamethasone and Low molecular weight heparin.Patient improved in 3 weeks.Ear discharge dried up, mastoid abscess subsided, and the child became active and ambulant

Measurement of the Intracochlear Hypothermia Distribution Utilizing Tympanic Cavity Hypothermic Rinsing Technique in a Cochlea Hypothermia Model

Introduction: Cochlea implants can cause severe trauma leading to intracochlear apoptosis, fibrosis, and eventually to loss of residual hearing. Mild hypothermia has been shown to reduce toxic or mechanical noxious effects, which can result in inflammation and subsequent hearing loss. This paper evaluates the usability of standard surgical otologic rinsing as cooling medium during cochlea implantation as a potential hearing preservation technique.Material and Methods: Three human temporal bones were prepared following standard mastoidectomy and posterior tympanotomy. Applying a retrocochlear approach leaving the mastoidectomy side intact, temperature probes were placed into the basal turn (n = 4), the middle turn (n = 2), the helicotrema, and the modiolus. Temperature probe positions were visualized by microcomputed tomography (μCT) imaging and manually segmented using Amira® 7.6. Through the posterior tympanotomy, the tympanic cavity was rinsed at 37°C in the control group, at room temperature (in the range between 22 and 24°C), and at iced water conditions. Temperature changes were measured in the preheated temporal bone. In each temperature model, rinsing was done for 20 min at the pre-specified temperatures measured in 0.5-s intervals. At least five repetitions were performed. Data were statistically analyzed using pairwise t-tests with Bonferroni correction.Results: Steady-state conditions achieved in all three different temperature ranges were compared in periods between 150 and 300 s. Temperature in the inner ear started dropping within the initial 150 s. Temperature probes placed at basal turn, the helicotrema, and middle turn detected statistically significant fall in temperature levels following body temperature rinses. Irrigation at iced conditions lead to the most significant temperature drops. The curves during all measurements remained stable with 37°C rinses.Conclusion: Therapeutic hypothermia is achieved with standard surgical irrigation fluid, and temperature gradients are seen along the cochlea. Rinsing of 120 s duration results in a therapeutic local hypothermia throughout the cochlea. This otoprotective procedure can be easily realized in clinical practice.

Features of external auditory canal anatomy

The external auditory canal is not only a part of the external ear, but also an integral part of the human auditory system, which conducts and amplifies the sound wave. In the field of otosurgery, it is often the priority access to the tympanic cavity, and therefore it is necessary to clearly understand the features of its anatomy. The dimensions and anatomy of the external auditory canal are extremely variable: the length is 2–3,5 cm, the diameter ranges from 5-9 mm, it is somewhat curved in the horizontal and frontal planes and consists of a membranous cartilaginous part and a bony part, between which there is the most the bottleneck – the isthmus. The ear canal is covered with skin, the thickness and structure of which depends on the section of the ear canal. The membranous cartilaginous section contains sebaceous and sulfur glands. Studies identify several forms of the bony part of the ear canal: conical, hourglass-shaped, ovoid, reverse conical, and cylindrical. The endoscopic scale (CES) for the visibility of the tympanic membrane was also proposed for the convenience of assessment. It has been suggested that the shape of the external auditory canal is an etiological factor in chronic otitis externa. Unambiguous interpretations of the relationship between ear diseases and the shape of the external auditory canal have not yet been obtained, but modern developments tend to consider its importance in the development of ear diseases. Clinical observations show that certain anatomical forms of it may be involved in the pathogenesis of chronic inflammation, since they interfere with proper self-cleaning.

Expression of tumor necrosis factor Alpha, interleukin-1 and matrix metalloproteinase-9 and pathomorphological changes in acquired middle ear cholesteatoma

Introduction. The inflammatory mediators play a central role in the pathogenesis of the inflammatory process of the middle ear and cholesteatoma from the aspect of initiating and maintaining the inflammatory response to infection and lesion. The aim of the study was to examine if the presence of acquired cholesteatoma could predict pathomorphological changes of the tympanic cavity mucosa in relation to the control tissue of the inflamed middle ear mucosa and to examine and compare the expression levels of tumor necrosis factor-alpha (TNF-a), interleukin-1 (IL-1) and matrix metalloproteinase 9 (MMP-9) with pathomorphological changes in the middle ear mucosa in chronic otitis media (COM), with and without acquired cholesteatoma (AC). Methods. The immunohistochemical study included 178 patients of both sexes, aged 5 to 75, who underwent microsurgical treatment of COM from 2015 to 2018. Patients were divided into two groups based on the presence or absence of AC of the middle ear: 97 with cholesteatoma (CCOM) and 81 without cholesteatoma (COM). Samples of the perimatrix of AC and inflamed middle ear mucosa were taken intraoperatively. The condition of the tympanic cavity mucosa was examined by otomicroscopy exploration intraoperatively. The expression levels of TNF-a, IL-1 and MMP-9 were determined by immunohistochemical analysis. Results. The difference in the percentage distribution of patients according to the condition of the tympanic cavity mucosa between both groups was statistically significant (p <0.01) where in the COM group the highest frequency was 43.2% of patients with mucosal hypertrophy, and in the CCOM 56.7% with granulations. With highly positive expression of TNF-R2 and IL-1, a higher probability of the presence of mucosal hypertrophy and granulations can be expected, and with highly positive expression of MMP-9 the presence of granulations. Conclusion. Acquired middle ear cholesteatoma is a statistically significant predictor of the occurence of mucosal hypertrophy and granulations in the tympanic cavity in relation to the control tissue of the inflamed middle ear mucosa. The high expression of TNF-R2, IL-1 and MMP-9 shows a statistically significant association with the presence of granulations and mucosal hypertrophy in acquired middle ear cholesteatoma which may have clinical significance in the evaluation and prognosis of the disease.

Tympanic cavity ultraphonophoresis in cases of preserving integrity of tympanic membrane

One of the most common treatments for the middle ear disorders is the injection of medications into the tympanic cavity through the acoustic meatus. This method has proven itself in treatment of the perforated forms of otitis. In cases of preserving the integrity of the tympanic membrane, its efficacy is arguable due to the impossibility of drug direct penetration via the membrane and contact with the mucous membrane. To increase the permeability of the tympanum, the authors used endaural phonophoresis of drugs. The drug penetration into the tympanum was confirmed by multispiral computed tomography (MSCT) of the temporal bones before and after contrasted ultraphonophoresis with tissue contrast. A 5% solution of potassium iodide was used as a contrast substance, as well as a solution of dexamethasone, which served as an intermediate medium in patients with external otitis and a chronic secretory otitis media. The mechanism of penetration was associated with the primary accumulation of the drug in the layers of the tympanic and adjacent mucous membranes with further dissemination into the deeper parts of the tympanic cavity. An additional confirmation of this is the reaction of the mucous membrane of the tympanic cavity, the mastoid process and the airiness restoration during endaural phonophoresis with dexamethasone. Ultraphonophoresis of drugs through the imperforated eardrum can be used in the conservative treatment of protracted forms of secretory otitis media.