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Background: Mastoid pneumatisation is subject to numerous influencing factors including race, sex, and surrounding structures of the middle ear. This study aims to determine the mastoid air cell system (MACS) volume and its relationship with middle ear structures, and the influence of sex., Materials and Methods: A cross-sectional study was performed analysing computed tomography (CT) scans in which MACS volume and the Eustachian tube length (ETL) were visible. MACS volume, ETL, and width and height of the aditus ad antrum were obtained., Results: A total of 100 CT were included with a mean age of 38.5 ± 15.3 years, of which 56 were women and 44 were men. The mean right and left MACS volume were 5.43 ± 3.15 cm³ and 5.54 ± 3.43 cm³, respectively, with an ETL of 24.55 ± 3.07 mm in the right side and 24.24 ± 2.60 mm on the left side, and an aditus ad antrum width of 2.98 ± 0.65 on the right and 2.98 ± 0.58 on the left, and height of 4.51 ± 1.05 and 4.32 ± 0.85, on right and left side, respectively. There were statistical differences between sexes in left ETL, and in MACS volume bilaterally. A low positive correlation between aditus ad antrum height and MACS volume was identified., Conclusions: Mastoid pneumatisation was greater in men than in women. There was a low positive correlation between mastoid volume and ETL on both sides, and a significant correlation between right mastoid volume and aditus ad antrum height. This could lead us to believe that the length of ETL does not affect the pneumatisation of MACS.

Objective: Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear., Patients: Three cadaveric temporal bone specimens were used in this work., Intervention: Diagnostic transeustachian endoscopy of the middle ear was performed., Main Outcome Measure: Diagnostic image quality., Results: A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity., Conclusions: A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Background: Constructing a three-dimensional (3D) model through non-invasive techniques will greatly benefit the diagnosis and treatment of otitis media. However, such a model should reflect the physiological characteristics of the middle ear; in particular, the pressure-flow responses determine the validity of the model. Objectives: A 3D model of the middle ear was constructed by digital scanning and simulation. The pressure-flow properties in the model were measured to evaluate whether the model could reflect the real middle ear under physiological and pathological conditions. Materials and methods: Computed tomography (CT) scanning data from a healthy woman were input into Mimics 20.0 to construct 3D images of the middle ear. The 3D images were treated with Ansys 15.0 for finite element mesh generation. Msc Nastran 2014 were used for the fluid-solid coupling calculations. Results: The pressure-flow rate in the model resembled a Venturi tube, namely, the pressure decreased with increasing flow velocity, especially in the Eustachian tube. In the absence of the right mastoid process, the differences in air pressure and the maximal velocity in the model were reduced. Conclusions: This numerical model based on CT images of the middle ear recapitulates the biomechanical characteristics of the real middle ear. Significance: This study provides an easy and rapid approach to constructing a middle ear model for diagnosis and treatment of otitis media.

Objective: To summarize the clinical characteristics and therapeutic experiences of the middle ear teratoma in infants. Methods: Three cases of middle ear teratoma, from 2012-2015 in Beijing Friendship Hospital were analyzed. Results: The three cases all developed slowly and presented unilateral otorrhea and hearing loss. Otoscopy showed the granulation tissue in the external ear canal. Audiological changes varied according to the degree of severity. Imaging features showed the pocket-like occupancy lesions in the Eustachian tube area. The temporal bone CT showed mass with soft tissue density usually involved in the mastoid and tympanic cavity. MRI showed mixed signal intense on both T1 and T2 weighted imaging. All the three cases received neoplasm resection of the middle ear. Only one case received tympanoplasty surgery at the same time. And all the pathology results displayed mature teratoma. The follow-up time was 17 to 54 months. MRI showed complete removal of the tumor. Conclusions: Teratoma are rare in the head and neck neoplasm. When the infants suffer from the unilateral otorrhea, hearing loss, and granulation tissue formed in the external ear canal, it should be vigilant for teratoma. The differential diagnosis is middle ear cholesteatoma, congenital first branchial cyst or fistula, and middle ear carcinoma. Temporal bone CT combined with MRI could improve the accuracy of diagnosis. It should be totally resection as soon as possible if there is no contraindication. Postoperative follow-up and imaging examination are necessary to eliminate tumor recurrence.

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objective: To observe the anatomic characteristics of supratubal recess and the morphological change of it in the sick ear. To investigate the relation between the morphological changes of supratubal recess and otitis media., Method: Using high resolution CT to observe and measure the supratubal recess of the normal ears and the ailing ones., Result: For the normal adults, the anteroposterior diameter of the supratubal recess is (3.83 +/- 1.28) mm, the vertical diameter (3.67 +/- 1.14) mm, the height (3.76 +/- 0.36) mm; and the length of the cog is (2.84 +/- 0.38) mm. The size of the supratubal recess showed no significant difference between left and right (P>0.05). There was no relationship between the size of the supratubal recess and pneumatization of mastoid cells (P>0.05). There was significant differences in size of the supratubal recess between normal ears and the ears with cholesteatoma (P<0.05), but there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells (P>0.05) in the ears with cholesteatoma. There was no significant differences in size of the supratubal recess between normal ears and the ears with chronic otitis media (P>0.05). In the ears with cholesteatoma, 40% had osseous destruction in supratubal recess., Conclusion: For the normal adults, the size of the supratubal recess showed no significant difference between left and right, and there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells. Anterior tympanic isthmus , posterior tympanic isthmus and supratubal recess which is the supplement of the formers constitute the air way between attic and mesotympanum. The supratubal recess of the cholesteatoma is smaller than the normal, when the eustachian tube dysfunction occurs, the air way in the middle ear would herein be affected, and cholesteatoma forms eventually. There was no significant differences in size of the supratubal recess between normal ears and ears with chronic otitis media, as in the clinic. The effect of the supratubal recess should be taken into account when we consider the pathogeny and treatment of the middle ear cholesteatoma.

Virtual otoscopy enables noninvasive 3D endoluminal imaging of the middle ear through postprocessing of computed tompgraphy (CT) data. A standardized imaging approach for the middle ear was established in six normal dogs in an attempt to optimize the clinical application and student education. High-resolution CT data were obtained. Virtual otoscopic images of the middle ear cavity and ossicles were generated using commercially available software. The views of the four different directions (the ear canal, tympanic bulla, eustachian tube, and ossicular chain) were made for virtual otoscopy. The promontory, cochlea window, tympanic bulla, septum bulla, and auditory tube were distinguished easily and clearly. One of the ossicles, the malleus, was visualized accurately. However, small structures such as the incus and stapes always could not be seen. The main advantage of virtual otoscopy is not only to provide diagnostic information but also to enhance the quality and efficiency of student education, because it contributes to an understanding of the anatomy of the middle ear. We describe the normal topographical 3Dimages of the middle ear of the dog using virtual otoscopy.

Objective: To evaluate the 3D anatomy of the ET and its surrounding tissues in cases with or without patulous Eustachian tube (ET) using CT with the multiplanar reconstruction (MPR) technique., Material and Methods: Twenty patients with a patulous ET and 25 without middle ear problems were investigated. After performing a temporal bone CT examination, MPR images of the ET were reconstructed and measurements were made., Results: The ET lumen and its surrounding tissues were clearly identified. In the patulous ET group, the ET lumen was open throughout the cartilaginous portion and the volume of the low-density area was smaller in size than in the controls. In unilateral patulous ET patients, the anatomical features were found to be similar on both sides, in spite of the fact that the non-involved side did not show symptoms associated with a patulous ET., Conclusion: For the first time, we were able to obtain clear reconstructed images of the patulous ET and its surrounding structure and to study its anatomical features. This method is useful for obtaining a better understanding of the ET and ET-related diseases such as patulous ET.

Ten cadaver temporal bone blocks were studied with high-resolution computed tomography (HRCT) in order to produce topographic images, which are more informative than ordinary CT slices. Virtual endoscopic images were produced with separate, commercially available software, paying attention to the middle ear cavity and ossicles. Four major viewing locations for virtual endoscopy (the ear canal, hypotympanum, attic and eustachian tube) developed images acceptably. The malleus and incus were visualized properly. Small structures such as the lenticular process and the stapes sometimes failed to have good imaging. The eustachian tube and attic virtual views, which are usually not receptive to ordinary endoscopy, gave proper visualization of middle ear structures. Even the smallest structure, the stapes, can produce a virtual image.Virtual endoscopic images, or topographic images, of the middle ear and ossicles contribute to the understanding of the anatomy of the middle ear, thus enhancing the chances for successful surgery.

Twenty-six ears (of 25 patients) with congenital dysplasia of the external and middle ear were studied with two different types of imaging technologies in order to find out if it is possible to improve the anatomical overview of the dysplastic middle ears by combining the imaging methods. All the 26 ears were studied with computed tomography (CT), which gave cross-sectional images of the tympanic cavity. A fiberoptic video-endoscope (FVE) was introduced through the nose and via the Eustachian tube into the middle ear so that the topographic view of the anatomical structures of the middle ear could be visualized. Some structures were visualized better with FVE than with CT and vice versa. We concluded that the combined information obtained from these two imaging technologies provided a better understanding of the structural anatomy of a congenital dysplastic middle ear.

Secretory otitis media (SOM) is a disease of childhood, and this period is characterized by active growing of the craniofacial skeleton (CFS). In this study, we purposed to answer the question 'how deviations in CFS play a role in ethiopathogenesis of SOM'? Therefore, we evaluated the 'mastoid-middle ear-Eustachian tube (M-ME-ET) system' in 30 SOM cases and 30 healthy children by using lateral cephalographies on which reference points and one line related to CFS and 'M-ME-ET system' were pointed. The results disclosed that the bony Eustachian tube, the vertical portion of the tensor veli palatini (TVP) muscle and the mastoid air cell system were smaller in SOM cases. In the view of the statements of Enlow (1990) on craniofacial growth, we suggest that the deviations in the growth process of the nasomaxillary complex lead to corresponding imbalances in the bony tube and vertical portion of the TVP. However, since regional imbalances often tend to compensate for one another to provide functional equilibrium (Enlow, 1990), improvement of the tubal function occurs with age.

The ventilation mechanism of the middle ear is very important as regards the pathogenesis of middle ear disease, but its mode of function is still obscure. Therefore, we tried to measure the ventilation and clearance of the middle ear using radio-isotope imaging techniques and 133Xe in order to gain a clearer picture of the ventilation mechanism. In normal Eustachian tube cases, approximately 10% of the initially insufflated gas immediately entered into the middle ear cavity and mastoid air cells. The gas introduced into the middle ear diminished at a rate of 8% of volume per hour in the normal resting state. Two hours after the first procedure, air was insufflated, and gas volume in the middle ear cavity immediately diminished by 30%. In stenotic tube cases, it proved difficult to insufflate the gas into the middle ear, however, its diminishing rate with the passage of time was slightly faster than in normal tube cases. From this data, it was evident that air could easily and quickly enter into even the periphery of the mastoid air cells by insufflation via the Eustachian tube, despite the fact that the middle ear and mastoid air cells form a closed cavity. In the resting state, moreover, the air in the middle ear was thought to be absorbed mainly into the middle ear mucosa at a regular rate. It was confirmed that the insufflation procedure as a therapy for tubal stenosis and OME is very useful for the ventilation of the middle ear.