Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus

Objective Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus. Design Cadaveric specimens were stained with iodine–potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model. Results Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus. Conclusions Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.

Feasibility of an Innovative Absorbable Ventilation Tube Designed to Provide Intermediate-Term Middle Ear Ventilation

Myringotomy with ventilation tube placement is a common surgical procedure performed in children and adults to remove fluid buildup behind the tympanic membrane. However, retention of tubes beyond achievement of therapeutic response increases risk for complications and additional intervention. This small feasibility study was conducted to demonstrate proof of concept of a novel bioabsorbable ventilation tube that provides the necessary duration of ventilation with absorption shortly thereafter. Tubes were placed in 15 ears of 14 patients meeting indications for short or intermediate duration of middle ear ventilation. Two independent examiners documented tube patency and tube absorption status at 3, 6, and 12 weeks or until absorption was complete. Results indicate that average ventilation time was 12 weeks (range, 3 weeks to 18 months). There was no observation of blockage. These findings support the feasibility of a novel bioabsorbable ventilation tube.

Clinical Factors Associated With the Outcomes of Long-Term Middle Ear Ventilation Tube Insertion in Pediatric Patients

Background: Ventilation tube (VT) insertion is the most common treatment for otitis media with effusion (OME). However, OME recurrence and persistent tympanic membrane (TM) perforation after VT removal are encountered in a certain percentage of such children. Methods: This study was performed to determine the outcomes of children who underwent long-term VT insertion. A total of 326 ears from 192 patients were analyzed. The associations among the patient age, sex, history of OME, history of repeated acute otitis media, placement duration, whether the VT had been removed intentionally or spontaneously, and the outcome (persistent TM perforation or OME recurrence) were analyzed. The outcomes of multiple VT tube insertions were also reviewed. We also analyzed whether or not local or general anesthesia was associated with the early spontaneous extrusion of the VT. Result: The OME recurrence and TM perforation rates were 29% (96/326 sides) and 17% (57/326 sides), respectively, for first insertions. In addition, 96 (29%) sides underwent ≥2 insertions. The shorter the duration for which the VT was retained in the middle ear, the more significant the rate of increase in OME recurrence. The OME recurrence was observed more often when VT was spontaneously removed than when intentionally removed. The rate of persistent TM perforation was significantly associated with male sex. Persistent TM perforation was not observed in patients who underwent 4 or 5 insertions. The anesthesia method did not significantly influence the timing of spontaneous extrusion of VT. Conclusion: The retention period of VT should be at least 2 years, and VT removal at the age of 7 might be a viable strategy. Multiple VT insertions are recommended for patients with recurrent OME. Ventilation tube under local anesthesia is an effective option for tolerable children.

Feasibility of an Innovative Absorbable Ventilation Tube Designed to Provide Intermediate-Term Middle Ear Ventilation: Clinical Human Proof-of-Concept

Myringotomy with ventilation tube placement is a common surgical procedure performed in children and adults to remove fluid build-up behind the tympanic membrane. However, retention of tubes beyond achievement of therapeutic response increases risk for complications and additional intervention. This small feasibility study was conducted to demonstrate proof-of-concept of a novel bioabsorbable ventilation tube (BVT) that provides the necessary duration of ventilation with absorption shortly thereafter in human adult patients. BVTs were placed in 15 ears of 14 patients meeting indications for short or intermediate-duration of middle ear ventilation. Two independent examiners documented eardrum status. BVT patency and BVT absorption status at 3, 6, and 12 week intervals until absorption was complete. Results indicate that average ventilation time was 12 weeks (range 3 weeks to 18 months). There was no observation of blockage. These findings support the safety and utility of a novel bioabsorbable ventilation tube.

Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation

Introduction: To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME). Aim: The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients. Methods: Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months. Results: Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value ( P = .0015). Conclusions: Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation.

Multiple Osteomas of Eustachian Tube Causing Ipsilateral Otitis Media

Background: Middle ear ventilation and the drainage of secretions are the basic functions of the eustachian tube. Eustachian tube (ET) dysfunction can lead to otitis media. Multiple causes of ET dysfunction exist; ET obstruction is one of them. Osseous obliteration of ET is quite rare. In the literature, there are two cases of solitary osteoma and a case of hamartoma with an osseous content in the ET. Herein, this report describes the case of a patient with multiple osseous lesions consistent with osteomas in the ET, causing ipsilateral otitis media with CT findings. Case Report: A 53-year-old woman presented with left-sided intermittent otalgia and otorrhea. Temporal bone computed tomography showed opacification of middle ear consistent with otitis media and nearly complete blockage of the left ET lumen with multiple osseous lesions wall probably consistent with osteomas on the left side. Conclusion: There are limited data about the radiological features of ET osteoma due to its rare occurrence. Radiographically, external ear osteoma generally appears as a single pedunculated hyperdense mass on CT scan originating from the tympanosquamous or tympanomastoid suture line and extending into the auditory canal with otherwise preserved canal dimensions. Considering this information, osseous lesions arising from ET bone wall and extending into the lumen in the present case were considered as osteomas. Especially in the case of unilateral chronic otitis media, ET should not remain a neglected anatomical area.

Effect of nasal obstruction surgery on eustachian tube function and middle ear ventilation

<p class="abstract"><strong>Background:</strong> The purpose of this study was to assess the effect of surgery for nasal obstruction in improving Eustachian tube function and middle ear ventilation.</p><p class="abstract"><strong>Methods:</strong> This prospective study involved 60 patients with different nasal pathologies causing nasal obstruction along with complaints of ear fullness. In required cases the nasal pathologies were surgically managed. Pre and postoperative impedance audiometric evaluation and nasal endoscopy were done to assess the eustachian tube function, changes the value of middle ear pressure and ear fullness sensation at 1 month and at 3 months after surgery. </p><p class="abstract"><strong>Results:</strong> Preoperatively, 56 (93.3%) patients had sensation of ear fullness, postoperatively at 1 month and at 3 months after nasal surgery only 20 (33.3%) patient and 18 (30%) respectively, has sensation of ear fullness, with significant improvement (p&lt;0.05). Preoperatively, 74 (61.6%) ears were type A tympanogram, 50 ears of them had poor eustachian tube function and 24 ears had good Eustachian tube function. 42 (35%) ears were type C, 4 (3.3%) ear were type B tympanogram, all of them had poor eustachian tube function. The postoperative results of eustachian tube function test and tympanometric value were significantly better than preoperative results (p&lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> We find out that nasal obstruction has a definite relationship with eustachian tube function. Surgery for nasal obstruction has a favourable effect on the middle ear pressure and eustachian tube function. Corrective surgery for nasal obstruction should be considered at least 1 month before undertaking the middle ear surgery to improve middle ear ventilation.</p>

Middle ear functional state in case of pathological changes of nose and throat

Objectives -to compare the functional state of middle ear in adults in case of various pathology of nasal cavity, paranasal sinuses and throat. Material and methods. In 2018-2019 period, 151 patient, aged from 16 to 70 years, was examined by acoustic impedancemetry. The patients reported the subjective satisfactory state of the acoustic organ, but had a pathology of the upper respiratory tract. Results. In the groups, there were no significant differences associated with gender. Most of the patients were of working age. In all study groups, the impaired function of the auditory tube, with various intensity, was registered, although the patients had no hearing complaints. At the same time, the acumetry and tonal threshold audiometry data indicated the normal acuity of hearing. Conclusion. Acute and chronic sinusitis was the most frequent risk factor for middle ear ventilation disorder. A quarter of patients with acute sinusitis, without otological complaints, had type B and C tympanograms. 93.7% of patients, who had undergone the surgical correction of the deviated nasal septum, did not have a middle ear ventilation disorder. Surgical intervention in the nasal cavity and oropharynx leads to a transient dysfunction of the auditory tube, but does not require special treatment due to self-recovery.

Adenoidectomy and adenotonsillotomy in patients treated in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018 – a retrospective analysis

Introduction. Adenoidectomy and adenotonsillotomy are among the most common surgical procedures worldwide. Sleep-related breathing disorders and recurrent upper respiratory tract infections are two primary categories of indications for adenoidectomy and adenotonsillotomy. Aim. The aim of this study was to analyse selected adenoidectomy and adenotonsillotomy procedures performed in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018. Material and methods. A total of 474 patients aged between 11 months and 18 years, who underwent adenoidectomy and adenotonsillotomy in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw in 2018, were included in the study. Data on age, gender, length of hospital stay, as well as additional diagnoses in adenoid hypertrophy or adenoid and palatine tonsil hypertrophy were collected. Minor surgeries performed in addition to tonsillectomy were also evaluated. Results. A total of 472 patients underwent adenoidectomy and adenotonsillotomy in 2018. Adenotonsillotomy was almost twice more common. Tonsillar hypertrophy was accompanied by exudative otitis media in almost 1/3 of children, and ear ventilation tubes were needed in almost 1/5 of children. Mean hospital stay equaled 4.19 ± 1.44 days. Conclusions. We have shown that adenotonsillotomy was the most common procedure in the Department of Paediatric Otorhinolaryngology. Exudative otitis media was the most common concomitant diagnosis, and middle ear ventilation was the most common additional procedure. Hospital stay usually lasted 3 days.