Development and Validation of a Prognostic Model to Predict Hearing Recovery for Patients With Chronic Otitis Media

Objective To explore the factors affecting postoperative hearing recovery in chronic otitis media (COM) patients, establish a clinical prediction model for hearing recovery, and verify the accuracy of the model. Methods Data of patients with COM who were admitted to our hospital between January 1, 2012 and September 30, 2020 were retrospectively analyzed. We collected data on relevant clinicopathological characteristics of patients. The patients were randomly divided into the development cohort and validation cohorts. A postoperative air-bone gap (ABG) ≤20 dB was defined as successful hearing recovery. Univariate and multivariable logistic regression analyses were used to investigate the association of several prognostic factors with hearing recovery. These factors were then used to establish a nomogram. The model was subjected to bootstrap internal validation and performance evaluation in terms of discrimination, calibration, and clinical validity. Results This study included 2146 patients with COM: the development cohort comprised 1610 patients (mean [standard deviation; SD] age, 44.1 [14.7] years; 733 men [45.5%]) and the validation cohort included 536 patients (mean [SD] age, 42.9 [14.4] years; 234 men [43.7%]). Multivariable logistic regression analysis showed that age, duration of onset, styles of surgery (tympanoplasty, canal wall up-CWU, or canal wall down-CWD), ossicular prosthesis, granulation or calcified blocks around the ossicular chain, ossicular chain integrity, duration of drilling, eustachian tube dysfunction, mixed hearing loss, semicircular canal fistula, and second surgery were associated with hearing recovery. A nomogram based on these variables was constructed. The area under the curve was 0.797 (95% confidence interval [CI], 0.778–0.812) in the development cohort and 0.798 (95% CI, 0.7605–0.8355) in the validation cohort. Conclusions This study demonstrated the various clinical factors correlated with hearing recovery in patients with COM. The nomogram developed with these data could provide personalized risk estimates of hearing recovery to enhance preoperative counseling and help to set realistic expectations in patients.

Numerical Analysis of Stapes Prosthesis Constraining in the Case of Otosclerosis

In the case of otosclerosis, it has been noticed that even though there are a variety of different prostheses on the market, due to the anatomical characteristics, it is not always possible to restore excellent mobility to the ossicles and the prosthesis. On the one hand, this happens because the incus long process and the prosthesis create difficult angles. On the other hand, incus necrosis is among the most common causes of the loss of stability to the prosthesis and stapedectomy failure. The aim of this research is to suggest an improvement for stapes prosthesis stability and numerically evaluate the impact of the prosthesis constraining to its dynamical behavior. Numerical 3D models of a standard as well as a modified (adjustable angled) stapes prosthesis were created in order to achieve this aim. Consequently, the modal analysis has been performed to evaluate the mechanical behavior of the prosthesis, assuming that the piston (thick part) would be made of Teflon, and the thin part, fixated on the incus long process, would be made from titanium alloy. Finally, the numerical analysis has been conducted by changing the boundary conditions in respect of the prosthesis constraining, where the attached stapes prosthesis connects to the ossicular chain. Subsequently, there were two hypotheses raised for the prosthesis loop constraining. The first is that during the surgery, the prosthesis is perfectly crimped with certain looseness. The second is that the prosthesis is outgrown by the tissues over time and thus becomes over-constrained. Then, the analyzed standard stapes prosthesis does not fulfil its functions because of the over-constraining that develops over time. An improvement for the standard stapes prosthesis, i.e., a modified stapes prosthesis (adjustable angled), that has been proposed in this research allows avoidance of the negative effects of the over-constrained standard stapes prosthesis that appear over time. Moreover, the proposed modified prosthesis helps to regain hearing when the angle between the incus long process and prosthesis is unfavorable.

Round Window Stimulation of the Cochlea

Mixed hearing loss associated with a sensorineural component and an impaired conductive mechanism for sound from the external ear canal to the cochlea represents a challenge for rehabilitation using either surgery or traditional hearing amplification. Direct stimulations of the ossicular chain and the round window (RW) membrane have allowed an improved hearing in this population. The authors review the developments in basic and clinical research that have allowed the exploration of new routes for inner ear stimulation. Similar changes occur in the electrophysiological measures in response to auditory stimulation through the traditional route and direct mechanical stimulation of the RW. The latter has proven to be very effective as a means of hearing rehabilitation in a group of patients with significant difficulties with hearing and communication.

Anatomical and morphometric study of goat middle ear ossicles (Capra aegagrus hircus)

ABSTRACT The social and economic roles of goat farming in Northeastern Brazil, allied to the fact that the use of goat middle ear ossicles for research and human ear surgery training has not yet been proposed, justify the study of their applicability as an experimental model. The middle ears of 19 goats (Capra aegagrus hircus) from the bone collection of the Laboratory and Didactic Anatomy Museum of Domestic and Wild Animals of the Federal University of Vale do São Francisco (UNIVASF) were dissected. The malleus, incus, and stapes were evaluated regarding their macroscopic morphology and biometry (length, width, and height). Ossicle morphology was similar to sheep, human, and bovine morphology. The malleus was 1.3 times heavier and 2.2 times longer than the incus, and 9.0 times heavier and 3.7 times longer than the stapes. The size relationship was positive between the stapes and the malleus and negative between the stapes and the incus. It is concluded that the middle ear size and the anatomical similarities with human ossicles make goats a useful model for experimental scientific studies, reconstructive surgery practice of the ossicular chain, and human ear surgery training.

Study of ossicular chain defects in patients with chronic otitis media

<p><strong>Background:</strong> Chronic otitis media (COM) is a long-standing disease of middle ear cleft and mastoid cavity having a permanent perforation in the tympanic membrane with or without discharge. It’s a worldwide health problem and it is still predominant in the modern antibiotic era. Aim<strong> </strong>was to determine the prevalence and types of ossicular chain defect in mucosal and squamosal type of COM. Also, to evaluate the hearing loss in relation to ossicular chain defect.</p><p><strong>Methods:</strong> The study was prospective observational study conducted in Bhopal over the duration of one year (January 2019 to June 2020). Patient aged 11-70 years reporting with COM were included in the study. Details regarding sociodemographic profile and extensive examination were recorded. Data was entered into MS excel 2007, analysis was done.</p><p><strong>Results:</strong> It was more prevalent in the age groups of 21-30years (39%) with female (53%) preponderance. Right sided ear was commonly involved (58%). Majority of the patients had tubo-tympanic disease (62%) whereas 38% had attico-antral disease. Ossicular chain was found intact in 33% cases. Average hearing loss was maximum (67.6 dBHL) when all ossicles are eroded. Hearing loss was minimum (33.6 dBHL) with isolated handle of malleus involvement.</p><p><strong>Conclusions:</strong> COM is one of the commonest causes of preventable hearing impairment in our society, hence early diagnosis and timely intervention is needed. Awareness among patients and doctors regarding the need for better ear hygiene is necessary.</p>

A STUDY ON OSSICULOPLASTY

The diagnosis of chronic otitis media (COM) implies a permanent abnormality of the pars tensa or acida, most likely a result of earlier acute otitis media, negative middle ear pressure or otitis media with 1 2 effusion . Ossiculoplasty is a micro surgical operative procedure, performed to repair or reconstruct the ossicular chain . Present study was done to nd out the epidemiology and hearing result after ossiculoplasty. Materials and methods Study design –Retrospective study Study setting – Tertiary care hospitals in south India. Study period - Over a period of 3 years (from July 2017 to June 2020) Sample size – 55 Methodology - All the patient with COM and ossicular chain damage were considered for study. Data was collected from the medical record department and analyzed. Results - Study was to be done to nd out the natural behavior of the disease, COM with ossicular damage and how it can be managed effectively. In our study of 55 cases of ossiculoplasty, followings are nding1. 52.72% are male and 47.27% are female. And the male to female ratio is 1.11:1. 2. Mean age of the patient is 27.63. 3. Most common ossicle involved was incus. 4. Mean improvement in ABG is 15.49 and in 87.2% of patients ABG closure was with in 20dB.

Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children

Background To investigate the feasibility and efficacy of transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Methods Eleven children diagnosed with congenital middle ear cholesteatoma were collected at Huazhong University of Science and Technology Union Shenzhen Hospital from January 2016 to December 2020. The retrospective study of their operation process, comparison of pre- and post-operative hearing result, surgical complications through the surgical video. Results Eleven children received total ear endoscopic surgery under general anesthesia. One of them received planned second operation to reconstruct the ossicular chain. At six months after operation, 11 children underwent re-examination. The mean bone conduction hearing threshold had no significant change (P>0.05), the mean air conduction hearing threshold was significantly decreased (P<0.05), and the air-bone conduction difference was significantly reduced (P<0.05). In 11 children, the air-bone conduction difference were all reduced to less than 20 dB, and 7 cases were reduced to less than 10 dB. All the children were followed up so far without sensorineural deafness, facial paralysis and other serious complications, as well as no recurrence. Conclusion Otoendoscope can provide a wide-angle field of vision and advantages in small surgical trauma, quick healing, avoiding repeated dressing changes and high acceptance of secondary surgery. Intraoperative application of 30° and 45° otoendoscope can effectively reduce residuals. Otoendoscope is widely used as a surgical method in the treatment of congenital middle ear cholesteatoma in children.

P092 Infantile osteopetrosis: a case report Traduction en Anglais

Background Infantile osteopetrosis is a rare genetic disorder characterized by increased bone density due to defective osteoclastic resorption. Case report We report the case of a 6 years old girl, born of a consanguineous marriage, hospitalized in our department for bone deformations and visual disturbances. On clinical examination, there was conjunctival pallor, thoracic deformity, genu-valgum and dentigenesis disorder as well as nystagmus and severe loss of visual acuity. The complete blood count showed regenerative normochromic normocytic anaemia as well as thrombocytopenia. Assessment for infectious disorders was negative. The skeletal X-ray revealed diffuse osteocondensation of the skeleton. The CT scan of the rock bones of cranial bases revealed bilateral segmental stenosis of the facial canal with densification of the ossicular chain and thickening of the stapes. Cranio-orbital MRI revealed bilateral optic duct stenosis with atrophy of the optic nerves and chiasma. The diagnosis of osteopetrosis was retained according to this set of clinical and radiological arguments. Unfortunately, the genetic study could not be performed. Histocompatible bone marrow transplant may be curative but was not available for our patient. Genetic counseling was offered for the family as well as dental and orthopedic care. Conclusion Infantile osteopetrosis is a rare but serious pathology that can have severe functional repercussion and even be life-threatening, requiring early diagnosis and management.

Special Somatic Sensory Afferent Systems Overview

The special somatic sensory afferent systems include the auditory, vestibular, and visual systems. Auditory and vestibular afferent information is received by cranial nerve VIII, which projects to central pathways. Cranial nerve II carries afferent visual information to central pathways. This chapter reviews the receptors and structural components of these special somatic sensory afferent systems. The ossicular chain (malleus, incus, and stapes) within the air-filled middle ear serves as a transformer that bridges the impedance mismatch between sound vibrations in air on the large tympanic membrane and the resulting vibrations onto the small stapedial footplate.