Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy

Objectives The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized. Methods Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other’s surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon. Results The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P<0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered. Conclusions and relevance Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.

Teaching Middle Ear Anatomy and Basic Ear Surgery Skills: A Qualitative Study Comparing Endoscopic and Microscopic Techniques

Objective Endoscopic ear surgery is gaining popularity as a minimally invasive surgical technique for middle ear diseases. Its ongoing implementation into clinical routine has consequences regarding teaching of middle ear anatomy and surgery. To improve undergraduate and postgraduate training, we investigated the perception of and preference for endoscopy as compared with microscopy at different educational levels. Study Design Qualitative study based on a thematic analysis approach. Setting Tertiary academic medical center. Methods After a standardized curriculum was run on endoscopic and microscopic anatomy and surgical skills education, 5 focus groups were held. The interviews were conducted, video recorded, transcribed, and analyzed. Analysis of the data gave rise to 11 themes showing the participants’ perceptions and preferences. Results Five medical students, 11 otorhinolaryngology residents, and 3 staff members participated in this qualitative study. For anatomy teaching, there was a clear preference for the endoscopic technique. The main advantages were the enhanced overview and perception of the anatomic details provided through endoscopy. For skills acquisition, the perceived advantages of the techniques were the same view of the surgical field for endoscopy and the 2-handed surgical technique for microscopy. However, there was no clear preference between the techniques for skills acquisition. Conclusion The endoscopic technique was generally judged more beneficial for teaching anatomy, especially due to the greater visualization of the complex middle ear anatomy. Given that both techniques will remain important to future surgeons, the relative unique benefits of each must be considered when designing and optimizing curricula for otologic education.

Teaching middle ear anatomy using a novel three-dimensional papercraft model

Background The middle ear is a complex anatomical space which is difficult to interpret from two-dimensional imagery. Appropriate surgical knowledge of the area is required to operate, yet current anatomical teaching methods are costly and hard to access for the trainee. Methods A papercraft 3D design involving anatomical elements added separately to a model was designed, and then peer-validated by medical students and junior doctors. Preliminary quantitative assessment was performed using an anatomical labelling questionnaire, with six students given a lecture to act as a control. Qualitative feedback was also gathered. Results 18 participants were recruited for the study. A total of 12 models were constructed by 6 medical students and 6 junior doctors. 6 medical students received a lecture only. Qualitative feedback was positive and suggested the model improved knowledge and was useful, yet timing and complexity were issues. Students scored, on average, 37% higher after completing the model, with junior doctors also improving anatomical knowledge, though these differences were not significant (p > 0.05). Conclusions In this initial investigation, the model was shown to be an engaging way to learn anatomy, with the tactile and active nature of the process cited as benefits. Construction of the model improved anatomical knowledge to a greater extent than a classical lecture in this study, though this difference was not significant. Further design iterations are required to improve practical utility in the teaching environment, as well as a larger study.

Correlation between microscopic and endoscopic approach to tympanoplasty: a comparative study

<p><strong>Background:</strong> The objective of the study was to evaluate the role of endoscopes in the management of dry central perforations of the tympanic membrane, compare the visualization of middle ear anatomy, time taken for the procedure and each step of the surgery and preoperative and postoperative hearing results/improvement.</p><p><strong>Methods: </strong>Fifty patients of chronic suppurative otitis media without cholesteatoma who came to ENT OPD at MGM medical college and hospital Aurangabad were included. They were divided into 2 groups with 25 patients each. Group A underwent microscopic approach to tympanoplasty and group b underwent endoscopic approach to tympanoplasty. Patients were assessed pre and postoperatively after 7 days, 14 days, 1 month, 3 months and 6 months with postoperative audiometry in the third month. <strong></strong></p><p><strong>Results: </strong>There was an improvement in the post-operative audiometry air bone gap (ABG) in both the groups. The operative time for group A was comparatively lesser than group B. Residual perforation were detected in one patient in group A at postoperative months 3 and 6, and for group B at postoperative month 3 and in two patients at postoperative month 6.<strong></strong></p><p><strong>Conclusions: </strong>A shorter operative duration is an advantage of microscopic tympanoplasty technique. One handed technique is one of the disadvantages of endoscope. The endoscopic approach gave better results in terms of easy visualization of the entire tympanic membrane and ossicular system. Tympanoplasty using endoscope was found to be an effective method for management of dry central perforations of the tympanic membrane.<strong></strong></p>

The Role of Multi-slice CT in Preoperative Assessment of Temporal bone in patients prepared to cochlear implantation

Background MDCT plays a critical role in evaluation and management of different causes of hearing loss which require many therapeutic techniques including cochlear implantation. In general, most causes of hearing impairment are best diagnosed using computed tomography scan of the temporal bone using bone algorithm and windowing techniques. Patients and Methods The study included a total of 20 patients referred to the Radiodiagnosis department from the E.N.T department in EL-Galaa Military Hospital. CT was done for assessment of the cochlear state prior to the cochlear implantation operation. The CT was used to delineate the different cochlear and middle ear anatomy and to orient and modify the surgical strategy. Results Only 18 patients from 20 patients underwent cochlear implantation, the other two cases were diagnosed as Otosclerosis & Bilateral longitudinal fractures. Patients with multiple other congenital anomalies in the external or internal ear had the cochlear implantation in the other ear (To raise the % of success). Conclusion MDCT is the technique of choice in preoperative assessment of patient of SNHL.

Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas

Background High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades. Results In HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (28%), type B in 142 ears (71%), and type C in 2 ears (1%). The STR grading was grade 1 in 12 ears (6%), grade 2 in 160 ears (80%), and grade 3 in 28 ears (14%) without significant relationship between ST types and STR grading (P = 0.3). Conclusion The current study provided reliable and applicable methods of CT assessment of STR and ST that can help to predict the degree of surgical visibility of the ST and STR during ear surgery.

Endoscopic exploratory tympanotomy in cases of conductive hearing loss with intact tympanic membrane: our experience

<p class="abstract"><strong>Background:</strong> Determining the cause of conductive hearing loss with an intact tympanic membrane has been a challenge for the otologists for over decades<strong>. </strong>The aim of this study is to ascertain the usefulness of endoscopes to study the various middle ear pathologies on performing endoscopic exploratory tympanotomy.</p><p class="abstract"><strong>Methods:</strong> A retrospective analysis of various pathologies encountered in the middle ear in 88 patients who underwent endoscopic exploratory tympanotomy done over a study period of 3.5 years (January 2015 to June 2018). </p><p class="abstract"><strong>Results:</strong> In our study, age of the patients ranged from 14 to 50 years with a mean age of 32 years. Most common finding on exploration was otosclerosis in 59 patients followed by revision stapedotomy in 12 patients. 5 patients had normal middle ear findings with all ossicles intact and mobile while other pathologies encountered were tympanosclerosis (4.6%), biscuit foot plate (2.3%), mucosal bands (3.4%) and middle ear developmental anomalies (3.4%).</p><p class="abstract"><strong>Conclusions:</strong> On exploring the middle ear<strong> </strong>knowing the various aetiologies helps in better preoperative counseling of the patients for the outcome of surgery. Endoscopic approach for exploratory tympanotomy has the benefit of excellent resolution with higher magnification and wider panoramic view of middle ear anatomy.</p><p> </p>