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Purpose: The aims of the present study were to identify detailed positional relationship between the auditory ossicles and to provide theoretic navigational guidelines for optimal prosthesis adaptation and effective malleostapedotomy., Methods: Fifty sides of the temporal bone from donated cadavers were scanned by MicroCT and the malleus, incus, stapes and tympanic membrane were materialized three dimensionally using computer software. Dimensions between the auditory ossicles closely related to malleostapedotomy were measured twice., Results: The grip site of malleus handle was mean 1.8 mm superior and mean 1.3 mm anterior, and linear distance between the grip site of malleus handle and the footplate of the stapes was mean 6.5 mm. The stapes was not parallel to the tympanic membrane and rotated mean 10.7° posteriorly relative to the tympanic membrane., Conclusion: Surgeons should start with at least 8.75 mm prosthesis to cover the upper limits of potential anatomy and then trim down to the individualization to the case. The ideal loop morphology has to be oval shape more than 1.4 mm in the long diameter and 1.0 mm in the short diameter. The wire of the prosthesis has to be bended at the two points: about 10° anteriorly at the most proximal point of the wire and about 50° superiorly at the stapes head point.

A detailed anatomy of the braincase and stapes of the subadult specimen of Diadectes absitus from early Permian sediments of Germany are described for the first time based on the high-resolution X-ray microcomputed tomography. In contrast to previous studies of Diadectes, the bones of the braincase (opisthotic, prootic, supraoccipital, basioccipital, exoccipital, basisphenoid, and sphenethmoid), and parasphenoid of D. absitus are not co-ossified, but suturally defined. This has allowed for a reconstruction of a complete braincase with all sutures between the individual bones. The opisthotic, prootic, and supraocciptal contain a well-preserved endosseous labyrinth. The three-dimensional-reconstruction of its cavities shows a well-preserved vestibule, three semicircular canals, and well-developed cochlear recess. In addition, a shallow subarcuate fossa is present on the ventral surface of the supraoccipital, which lies medial to the anterior semicircular canal. A typical feature of the diadectid braincase is the presence of the otic tube leading from the fenestra vestibuli to the vestibule. A revision of the topology of this structure is presented here. Here, we describe new structures of the stapes, especially in its proximal portion, as well as its position to the fenestra vestibuli. These structures are described for the first time not only in D. absitus, but for the genus., (© 2020 American Association for Anatomy.)

Background: Ultra-high-resolution computed tomography (U-HRCT) utilizes a 1024 × 1024 matrix with 0.25-mm section thickness, offering better spatial resolution than conventional multi-detector row CT to detect anatomic data for otologic surgery., Aims: We examined stapes footplate thickness using U-HRCT in relation to stapedotomy to predict the difficulty of the surgical procedure., Materials and Methods: Subjects were 12 otosclerosis patients and 25 controls who underwent diagnostic U-HRCT. A profile curve (Hounsfield units) was used to measure stapes footplate thickness along a perpendicular line across the stapes footplate in a plane parallel to the lateral semicircular canal., Results: Footplate thickness was smaller at the midpoint than just before the anterior crus and just after the posterior crus. Interobserver variability was lowest at the midpoint, where foot plate thickness was significantly greater in the affected ear in otosclerosis patients compared with controls (0.60 ± 0.09 mm vs 0.46 ± 0.04 mm; p  < .001). Otosclerosis patients were detected using U-HRCT with a high area under the curve. Difficulty in the stapes opening procedure correlated with stapes footplate thickness., Conclusions: Footplate thickness on U-HRCT correlated with temporal bone anatomy and corresponded to surgical difficulty. Significance: U-HRCT-derived anatomic data is useful for evaluating the stapes.

Objectives: To compare the results of ossiculoplasty with two different partial ossicular replacement prostheses (PORP) to ossiculoplasty with a total ossicular replacement prosthesis (TORP) in patients with an intact stapes suprastructure., Methods: All patients required primary or revision surgery for chronic middle ear disease and ossicular reconstruction with either a PORP or a TORP, as well as a with an intact stapes suprastructure. In total, 141 patients receiving classic tympanoplasty with PORP (N = 92), ossiculoplasty with PORP with ball joint (N = 22), or TORP (N = 27) between January 2011 and March 2017 were included in this study. The inclusion criterion was an intact stapes suprastructure. The underlying indication for surgery was either middle ear disease, such as cholesteatoma, or revision surgery for audiological improvement. The main outcome measures were four-frequency pure tone average (0.5, 1, 2, 3 kHz) at early and late follow-up after ossiculoplasty, the effects of clinical factors including the underlying middle ear disease, and primary or revision surgery., Results: All patients showed a significantly reduced air-bone gap (ABG 0.5, 1, 2, 3 kHz) at late follow-up (mean: 18 dB) compared to preoperative measurements (mean: 25.5 dB). A significantly better outcome in ABG closure was shown among patients with a preoperatively intact tympanic membrane, with an intact stapes suprastructure or without preexisting cholesteatoma. Outcome was not significantly influenced by the prosthesis-type, the creation of an open mastoid cavity, the status of the mucosa, or the indication for surgery., Conclusion: TORP with an intact stapes suprastructure is a safe procedure and provides audiological outcomes similar to PORP., Level of Evidence: 2C Laryngoscope, 130:768-775, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Research using rat as an in-vivo model has played an important role in otological research. The rat ear anatomy has been described; however, detailed surgical procedures to access the temporal bone are limited. The authors present a technique to approach the inner ear of rat that was standardized by cadaveric dissections and later replicated in living animals., Methods: Adult Wistar albino rats were dissected via the post-auricular approach. The emphasis was on early identification of the facial nerve that formed a reliable landmark for the tympanic bulla, which in turn houses the round window and stapedial artery. The point of identification of facial nerve was postero-inferior to the external auditory meatus. The procedure was then repeated in living animals., Results: Seventeen cadaveric rats were dissected. Initially, the investigators attempted to identify the facial nerve at its crossing over the external auditory meatus. However, that method was found to be unsatisfactory. The facial nerve was then attempted to be identified in its course postero-inferior to the external auditory meatus. The technique improved drastically, and the facial nerve was identified promptly and reliably. The procedure was then repeated in seven living rats under general anaesthesia. The major issues encountered were bleeding from the stapedial artery, hematoma of the pinna in one rat., Conclusion: This study suggests that the post-auricular approach is a feasible and less time consuming route for round window drug delivery experiments in Wistar albino rats. Recognition of anatomical landmarks, particularly the facial nerve is the key to surgery., (Copyright © 2019 Elsevier B.V. All rights reserved.)

BACKGROUND Otosclerosis is a primary disease of the bony labyrinth. In the course of otosclerosis, abnormal resorption and recalcification of the endochondral layer of the temporal bone is observed. The otosclerotic process most commonly develops in the anterior part of the oval window. MATERIAL AND METHODS We analyzed stapes superstructures from 4 patients undergoing surgery for otosclerosis. The first step involved tissue assessment under a scanning electron microscope. The resulting images were analyzed in terms of morphological changes. The stapes superstructure was then divided into small "ossicles", including fragments from the closest vicinity of the stapes footplate and a fragment of the head of the stapes. This material was examined using a scanning electron microscope with a unit for chemical analysis in microareas. RESULTS Chemical analysis confirms the appearance of considerable quantities of the following elements: carbon, oxygen, potassium, and calcium, and the appearance of small quantities of sodium and magnesium. Based on a detailed analysis of the chemical composition, these fragments could represent a calcium phosphate compound from the following system: CaO-P₂O₅-H₂O. Fragments of the superstructure from the region closest to the base of the stapes demonstrated a considerably larger presence of carbon, oxygen, and nitrogen, which most likely suggests an increased metabolic process in this region. CONCLUSIONS Our analysis revealed an increased metabolic activity in the closest vicinity of the otosclerotic focus, the fissula ante fenestram. The increased metabolism correlated with the bone tissue changes seen on scanning electron microscopy.

Background: The anatomy of the membranous labyrinth within the vestibule has direct implications for surgical intervention. The anatomy of the otoliths has been studied, but there is limited information regarding their supporting connective tissue structures such as the membrana limitans in humans., Methods: One guinea pig and 17 cadaveric human temporal bones were scanned using micro computed tomography, after staining with 2 per cent osmium tetroxide and preservation with Karnovsky's solution, with a resolution from 1 µm to 55 µm. The data were analysed using VGStudio Max software, rendered in three-dimensions and published in augmented reality., Results: In 50 per cent of ears, the membrana limitans attached directly to the postero-superior part of the stapes footplate. If attachments were present in one ear, they were present bilaterally in 100 per cent of cases., Conclusion: Micro computed tomography imaging allowed three-dimensional assessment of the inner ear. Such assessments are important as they influence the surgical intervention and the evolution of future innovations.

Background: The aim of the study was to determine morphometric and macroanatomic features of auditory ossicles and the tympanic bulla in wolf., Materials and Methods: For this purpose, 7 skulls of adult male wolf were used in the study. Auditory ossicles was photographed on a dissection microscope after it was removed from the skull. A total of 14 morphometric measurements were taken among the different points of malleus, incus and stapes in Image J programme. Mean values of the measurements were obtained and statistically compared in terms of sides (right-left)., Results: In male wolves, the lengths of the right and left malleus were determined as mean 9.35 ± 0.14 and 9.57 ± 0.25 mm, the lengths of the incus as mean 3.01 ± 0.32 and 2.94 ± 0.16 mm, and the lengths of the stapes as mean 2.57 ± 0.12 and 2.59 ± 0.14 mm, respectively. The differences were not statistically significant when all the morphometric parameters were compared in terms of sides (p > 0.05)., Conclusions: It is considered that this study will contribute to the anatomical studies to be conducted in the Canidae family regarding auditory ossicles.

The middle ear bones of Mesozoic mammals are rarely preserved as fossils and the morphology of these ossicles in the earliest mammals remains poorly known. Here, we report the stapes and incus of the euharamiyidan Arboroharamiya from the lower Upper Jurassic (∼160 Ma) of northern China, which represent the earliest known mammalian middle ear ossicles. Both bones are miniscule in relation to those in non-mammalian cynodonts. The skull length/stapedial footplate diameter ratio is estimated as 51.74 and the stapes length as the percentage of the skull length is 4%; both numbers fall into the stapes size ranges of mammals. The stapes is "rod-like" and has a large stapedial foramen. It is unique among mammaliaforms in having a distinct posterior process that is interpreted as for insertion of the stapedius muscle and homologized to the ossified proximal (stapedial) end of the interhyal, on which the stapedius muscle attached. The incus differs from the quadrate of non-mammalian cynodonts such as morganucodontids in having small size and a slim short process. Along with lack of the postdentary trough and Meckelian groove on the medial surface of the dentary, the ossicles suggest development of the definitive mammalian middle ear (DMME) in Arboroharamiya. Among various higher-level phylogenetic hypotheses of mammals, the one we preferred places "haramiyidans" within Mammalia. Given this phylogeny, development of the DMME took place once in the allotherian clade containing euharamiyidans and multituberculates, probably independent to those of monotremes and therians. Thus, the DMME has evolved at least three times independently in mammals. Alternative hypothesis that placed "haramiyidans" outside of Mammalia would require independent acquisition of the DMME in multituberculates and euharamiyidans as well as parallel evolution of numerous derived similarities in the dentition, occlusion pattern, mandibles, cranium, and postcranium between the two groups and between "haramiyidans" and other mammals. J. Morphol. 279:441-457, 2018. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Although human stapes are known to have varied dimensions and the footplate is considered to be oval (fitting as it does into the oval window), few studies of high-resolution imaging of these structures have been performed. No study appears to have addressed the bilateral symmetry of stapes dimensions or to have determined if an association exists between the size of the stapes and the size of mastoid pneumatization; a small mastoid pneumatization is an indicator of childhood otitis media. We obtained 41 ear-normal cadaver crania specimens for study in our temporal bone laboratory and isolated 10 for further analysis: the 5 with the largest areas of mastoid pneumatization and the 5 with the smallest. Microcomputed tomography of tissue blocks was performed on the in situ stapes. Using ImageJ software, we created a three-dimensional model of each stapes. The mean height of these stapes was 3.43 mm (range: 3.20 to 3.80), the mean length of the footplates was 2.71 mm (range: 2.52 to 2.97), and the mean width of the footplates was 1.23 mm (range: 1.12 to 1.46). Qualitatively, the footplate was shaped like a human footprint in moist sand, as Eysell described in 1870. The dimensions of the stapes were found to be bilaterally symmetrical in general, but there was no correlation between these dimensions and the size of mastoid pneumatization. The distribution of footplate widths may be bimodal, which is consistent with the observation of Sim et al that men have wider footplates than do women.

Middle ear ossicles (malleus, incus, stapes) are known for few multituberculate taxa, and three different stapedial morphotypes have been suggested: (i) slender, columelliform and microperforate, (ii) robust and rod-like, and (iii) bicrural. Reinvestigation of Upper Jurassic (Kimmeridgian) mammalian petrosals from the Guimarota coal mine in central Portugal (Western Europe) revealed an asymmetric bicrural stapes (ABS) in the paulchoffatiid Pseudobolodon oreas The middle ear ossicles displaced inside the osseous vestibule were detected by a µCT analysis. The Kimmeridgian age of the Guimarota stapes exceeds the stapes from the Early Cretaceous (Barremian) of Asia (about 122-124 Ma) by approximately 30 Myr, and is only slightly younger than the stapes of the recently described Oxfordian euharamiyidan Arboroharamiya allinhopsoni The Guimarota stapes indicates that the stapes of Lambdopsalis , described as columelliform and microperforate (small stapedial foramen), does not represent a general condition for multituberculates. The stapes of Pseudobolodon is bicrural, the anterior crus sits centrally on the oval footplate, and the stapedial head is simple and smaller than the footplate. We hypothesize that the ABS evolved from the symmetric bicrural stapes (SBS) of non-mammaliaform cynodonts. The ABS appears to be the ancestral morphotype of the mammalian SBS, and the mammalian columelliform imperforate stapes., (© 2018 The Author(s).)

Functional outcomes and complications in otosclerosis surgery are governed by the surgeon's experience. Thus, teaching the procedure to residents to guide them through the learning process as quickly as possible is challenging. Artificial 3D-printed temporal bones are replacing cadaver specimens in many institutions to learn mastoidectomy, but these are not suitable for middle ear surgery training. The goal of this work was to adapt such an artificial temporal bone to aid the teaching of otosclerosis surgery and to evaluate this tool. We have modified a commercially available 3D-printed temporal bone by replacing the incus and stapes of the model with in-house 3D-printed ossicles. The incus could be attached to a 6-axis force sensor. The stapes footplate was fenestrated and attached to a 1-axis force sensor. Six junior surgeons (residents) and seven senior surgeons (fellows or consultants) were enrolled to perform piston prosthesis placement and crimping as performed during otosclerosis surgery. The time required to perform the tasks and the forces applied to the incus and stapes were collected and analyzed. No statistically significant differences were observed between the junior and senior groups for time taken to perform the tasks and the forces applied to the incus during crimping and placement of the prosthesis. However, significantly lower forces were applied to the stapes by the senior surgeons in comparison with the junior surgeons during prosthesis placement (junior vs senior group, 328 ± 202.9 vs 80 ± 99.6 mN, p = 0.008) and during prosthesis crimping (junior vs senior group, 565 ± 233 vs 66 ± 48.6 mN, p = 0.02). We have described a new teaching tool for otosclerosis surgery based on the modification of a 3D-printed temporal bone to implement force sensors on the incus and stapes. This tool could be used as a training tool to help the residents to self-evaluate their progress with recording of objective measurements.

The stapes is held in the oval window by the stapedial annular ligament (SAL), which restricts total peak-to-peak displacement of the stapes. Previous studies have suggested that for moderate (<130 dB SPL) sound levels intracochlear pressure (P IC ), measured at the base of the cochlea far from the basilar membrane, increases directly proportionally with stapes displacement (D Stap ), thus a current model of impulse noise exposure (the Auditory Hazard Assessment Algorithm for Humans, or AHAAH) predicts that peak P IC will vary linearly with D Stap up to some saturation point. However, no direct tests of D Stap , or of the relationship with P IC during such motion, have been performed during acoustic stimulation of the human ear. In order to examine the relationship between D Stap and P IC to very high level sounds, measurements of D Stap and P IC were made in cadaveric human temporal bones. Specimens were prepared by mastoidectomy and extended facial recess to expose the ossicular chain. Measurements of P IC were made in scala vestibuli (P SV ) and scala tympani (P ST ), along with the SPL in the external auditory canal (P EAC ), concurrently with laser Doppler vibrometry (LDV) measurements of stapes velocity (V Stap ). Stimuli were moderate (∼100 dB SPL) to very high level (up to ∼170 dB SPL), low frequency tones (20-2560 Hz). Both D Stap and P SV increased proportionally with sound pressure level in the ear canal up to approximately ∼150 dB SPL, above which both D Stap and P SV showed a distinct deviation from proportionality with P EAC . Both D Stap and P SV approached saturation: D Stap at a value exceeding 150 μm, which is substantially higher than has been reported for small mammals, while P SV showed substantial frequency dependence in the saturation point. The relationship between P SV and D Stap remained constant, and cochlear input impedance did not vary across the levels tested, consistent with prior measurements at lower sound levels. These results suggest that P SV sound pressure holds constant relationship with D Stap , described by the cochlear input impedance, at these, but perhaps not higher, stimulation levels. Additionally, these results indicate that the AHAAH model, which was developed using results from small animals, underestimates the sound pressure levels in the cochlea in response to high level sound stimulation, and must be revised., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Determining the degree of ossicular fixation is a difficult task, with the final assessment often being made with manual palpation during exploratory tympanotomy. A more objective method to evaluate ossicular fixation would be valuable. In this paper we describe a new method which makes use of a magnet and coil to measure ossicular motion through the ear canal with an elevated tympanic membrane. We report measurements of the vibration response at the umbo, the tip of the incus long process and the lateral posterior crus of the stapes before and after artificially fixing the stapes footplate and anterior mallear ligament with luting cement. Results were obtained on temporal bones, but the practicality of the method allows easy clinical implementation. Velocity ratios between different measurement points along the ossicular chain may provide a quantitative indication of the degree of stapes fixation. Isolated anterior mallear ligament fixation was not distinguishable from the unfixed condition., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The Mongolian gerbil (Meriones unguiculatus) is commonly used in hearing research because the hearing frequency spectrum of the gerbil is rather similar to that of the human being. However, a precise description of the surgical post-auricular route has not been reported. The aim of this technical note is to provide details on the procedure and the surgical anatomy of the post-auricular route in the Mongolian gerbil. Surgery was performed under general anesthesia on eight (2 males and 6 females) adult Mongolian gerbils. All steps of the post-auricular route were detailed. This surgery provided an access to the following structures: the semi-circular posterior and lateral canals, the external auditory meatus, the tympanic membrane, the round window, the stapes, the stapedial artery and the reliefs of the cochlea. No anatomic variation was noticed among the 8 animals. This post-auricular route in the Mongolian gerbil defines a brief and simple surgery, overall standardized as a consequence of the absence of common anatomic variation, with painless and uncomplicated post-operative stage., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The stapes is known in several non-mammaliaform cynodonts, although it has only been cursorily studied. Here we thoroughly analyze the stapedial anatomy of several basal cynodonts in a phylogenetic framework. Our study shows that the stapedial anatomy is more variable than previously thought. The morphological variation of the stapes led to the recognition of 11 phylogenetic characters that were included in a total evidence data matrix centered in the analysis of gomphodont cynodonts. Stapes morphology does not provide evidence to suggest a direct connection between the stapes and a postquadrate tympanic membrane (if present) and the hypothesis of a dorsal process as the site of attachment of a small ligament or the stapedial muscle is supported. The re-evaluation of the theories concerning the position of the tympanic membrane in non-mammaliaform cynodonts allowed us to conclude that the hypothetical postquadrate tympanic membrane associated with the squamosal sulcus is at best relictual and most likely non-functional (not connected with the stapes). The sound waves were most likely transmitted to the stapes from a postdentary tympanic membrane through the quadrate. Our analysis results in a better understanding of the auditory system in basal cynodonts and its evolution, highlighting the variability of the stapedial anatomy.

The morphology of the vertebrate head skeleton is highly plastic, with the number, size, shape, and position of its components varying dramatically between groups. While this evolutionary flexibility has been key to vertebrate success, its developmental and genetic bases are poorly understood. The larval head skeleton of the frog Xenopus laevis possesses a unique combination of ancestral tetrapod features and anuran-specific novelties. We built a detailed gene expression map of the head mesenchyme in X. laevis during early larval development, focusing on transcription factor families with known functions in vertebrate head skeleton development. This map was then compared to homologous gene expression in zebrafish, mouse, and shark embryos to identify conserved and evolutionarily flexible aspects of vertebrate head skeleton development. While we observed broad conservation of gene expression between X. laevis and other gnathostomes, we also identified several divergent features that correlate to lineage-specific novelties. We noted a conspicuous change in dlx1/2 and emx2 expression in the second pharyngeal arch, presaging the differentiation of the reduced dorsal hyoid arch skeletal element typical of modern anamniote tetrapods. In the first pharyngeal arch we observed a shift in the expression of the joint inhibitor barx1, and new expression of the joint marker gdf5, shortly before skeletal differentiation. This suggests that the anuran-specific infrarostral cartilage evolved by partitioning of Meckel's cartilage with a new paired joint. Taken together, these comparisons support a model in which early patterning mechanisms divide the vertebrate head mesenchyme into a highly conserved set of skeletal precursor populations. While subtle changes in this early patterning system can affect skeletal element size, they do not appear to underlie the evolution of new joints or cartilages. In contrast, later expression of the genes that regulate skeletal element differentiation can be clearly linked to the evolution of novel skeletal elements. We posit that changes in the expression of downstream regulators of skeletal differentiation, like barx1 and gdf5, is one mechanism by which head skeletal element number and articulation are altered during evolution., (Copyright © 2014 Elsevier Inc. All rights reserved.)