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Soft tissue conduction is an additional mode of auditory stimulation which can be initiated either by applying an external vibrator to skin sites not overlying skull bone such as the neck (so it is not bone conduction) or by intrinsic body vibrations resulting, for example, from the heartbeat and vocalization. The soft tissue vibrations thereby induced are conducted by the soft tissues to all parts of the body, including the walls of the external auditory canal. In order for soft tissue conduction to elicit hearing, the soft tissue vibrations which are induced must penetrate into the cochlea in order to excite the inner ear hair cells and auditory nerve fibers. This final stage can be achieved either by an osseous bone conduction mechanism, or, more likely, by the occlusion effect: the vibrations of the walls of the occluded canal induce air pressures in the canal which drive the tympanic membrane and middle ear ossicles and activate the inner ear, acting by means of a more air conduction-like mechanism. In fact, when the clinician applies his stethoscope to the body surface of his patient in order to detect heart sounds or pulmonary air flow, he is detecting soft tissue vibrations.

Treacher Collins syndrome (TCS) is a heterogenous malformation syndrome characterized by a distinct facial appearance including downslanting palpebral fissures, malar hypoplasia, conductive hearing loss, and mandibular hypoplasia. Recently, a new causative gene, POLR1B, encoding DNA-directed RNA polymerase I subunit RPA2, was identified as a fourth type of TCS (TCS4). We describe another patient with TCS4 caused by a recurrent POLR1B variant, c.3007C>T; p.Arg1003Cys. Including our patient, all 4 patients with p.(Arg1003Cys) had atresia of the external auditory canal and microtia. All of the reported pathogenic variants in POLR1B were clustered at only 2 residues. Our patient highlights the genotype-phenotype correlation in TCS4 associated with POLR1B.

Background This case series study is to evaluate the results of our technique for correction of congenital aural atresia. Seventeen patients were done from 2015 till 2018, 4 cases bilateral and 13 unilateral. Surgical canalization of congenital aural atresia with the same session reconstruction of the meatus and TM by split thickness graft (Autograft) was done. Follow-up is done weekly for 3 months then every 2 weeks for another 3 months, till we establish the formation of EAC. All cases were followed up for at least 1 year. Results All patients have now established skin limned external canal. There is no facial nerve or dural or sigmoid injuries. Only one case TMJ was exposed during the surgical procedure. One case had postauricular wound gapping and another one was complicated after 1 year by stenosis. All patients improved subjectively in speech and language postoperatively except one case who has autism and still undertreatment. Conclusion Congenital aural atresia is a challenging surgery. Surgical canalization with the same session grafting of the drum and the formed cavity by split thickness skin graft is effective with minimal minute rate of complications and recurrence.

Mucosal melanoma arising in the middle ear or eustachian tube is uncommon. We present a patient with hearing loss and otalgia found to have mucosal melanoma which occurred in the eustachian tube with extension into the middle ear cavity and external ear canal. Otologic clinics was consulted and biopsy of the mass located at the external canal was performed to ascertain the pathological diagnosis. The patient refused immunotherapy and surgery instead of undergoing radiotherapy and died from hepatic metastasis 8 months later. The mucosal melanoma originated from the eustachian tube with extension into the external ear canal is exceedingly rare, and the differential diagnosis should be considered for tumors in external ear canal.

A 6-year old neutered male chinchilla (Chinchilla laniger) presented for surgical consultation for chronic left-sided otitis externa. A computed tomography scan showed diffuse soft tissue opacity of the left external canal and tympanic bulla consistent with otitis media associated with concurrent otitis externa. A modified total ear canal ablation and temporary fenestration of the caudodorsal and rostroventral chambers of the bulla was performed. The patient required a temporary tarsorrhaphy due to post-operative facial nerve palsy, but otherwise recovered without any complications. The temporary fenestration windows remained open for approximately 5 weeks which allowed for routine flushing and medicating with topical antibiotics (based on culture and susceptibility results). Recheck computed tomography scan showed reoccurrence of soft tissue opacity within the bulla. Despite diagnostic imaging results, the patient has shown no return of clinical signs to date. Therefore, this procedure is considered a success and the first published report of this technique being used for this disease in a chinchilla. Chinchillas present a unique surgical challenge due in part to the anatomy of their tympanic bulla.

Congenital external canal atresia is one of the congenital ear anomalies that can occur in patients. Similarly, congenital cholesteatoma is also another congenital disease that is often diagnosed in early adulthood. Both the above-mentioned diseases can occur independently but the presence of both these entities is a rare occurrence and needs a high degree of suspicion aided by a computed tomography scan to make the diagnosis. We are presenting a case of a sixteen-year-old patient who presented with unilateral ear anomaly, earache, facial palsy, and postaural swelling and was diagnosed as a right sided congenital aural atresia with congenital cholesteatoma. He was surgically managed with right-sided modified radical mastoidectomy with canaloplasty and closure of mastoid fistula under general anesthesia.

Middle ear ailments include a broad range of pathological conditions. Otitis media is the leading middle ear disease of childhood, which incurs significant health care resources in developed countries and, in developing countries, causes significant mortality and morbidity. Recurrent and chronic infections of the middle ear lead to the prolonged presence of inflammatory factors and cellular infiltrates resulting in temporary hearing loss. However, long-term alteration of the middle ear space can pose the risk of permanent damage to the delicate ear structures and cause tissue remodeling. While the etiopathogenesis of middle ear diseases is multifactorial, targeting the biological mechanisms and molecular networks that drive disease development is critical. Yet, a pivotal step in realizing the potential of molecular therapies is the development of methods for local drug delivery, since systemic application risks side effects. Utilizing bacteriophage display in the rat, we discovered rare peptides that are able to transit the intact tympanic membrane from the external canal to the middle ear cavity by an active process. An in vitro assay demonstrated that transport occurs across the tympanic membranes of humans and that the peptides cross the membrane independent of phage. Transport of phage, which is ~900 nm in length, suggests that these peptides could non-invasively deliver drug packages or gene therapy vectors into the middle ear.

ObjectiveSafe cochlear implantation is challenging in patients with canal wall down mastoid cavities, and the presence of large meatoplasties increases the risk of external canal overclosure. This paper describes our results of obliteration of the mastoid cavity with conchal cartilage as an alternative procedure in cases of canal wall down mastoidectomy with very large meatoplasty.MethodsThe cases of seven patients with a canal wall down mastoidectomy cavity who underwent cochlear implantation were retrospectively reviewed. Post-operative complications were analysed. The mean follow-up duration was 4.5 years.ResultsThere was no hint of cholesteatoma recurrence and all patients have been free of symptoms during follow up. Only one patient showed cable extrusion six months after surgery, and implantation of the contralateral ear was needed.ConclusionPseudo-obliteration of the mastoid cavity with a cartilage multi-layered palisade reconstruction covering the electrode may be a safe alternative in selected patients with a large meatoplasty.

A 4-year-old boy presented with the left ear discharge and polyp of the external canal. The patient was treated as a case of chronic ear infection with mastoidectomy done twice and polypectomy done three times and histopathology came as non-specific inflammation, then as botryoid rhabdomyosarcoma. The patient underwent bone marrow biopsy and confirmation of the diagnosis done. The patient received chemotherapy and doing well. The case discussed because it is rare and because rhabdomyosarcoma rarely presented as external canal polyp and to highlight the presentation of serious malignant problems may mimic the benign diseases.

Exposure of the cochlear implant electrode array as a late complication has been reported rarely in the literature. A retrospective analysis revealed 4 patients presenting with exposure of their cochlear implant electrode arrays from 2 to 17 years after implantation. Data collected from these 4 patients were surgical implantation approach, type of implant, age at implant, interval between implant and complication, surgical correction of the problem, pathology at the time of correction, and length of follow-up after intervention. All 4 patients presented with otitis or mastoiditis. Each had undergone a transmastoid approach with facial recess and cochleostomy and full implant insertion. In 3 cases, the tympanic membrane had retracted to expose the electrode array. In 1 patient, the electrode array had eroded through the external canal, lateral to the facial recess. The exposed arrays were addressed surgically, including explantation/reimplantation for 1 patient. Cochlear implant electrode arrays can become exposed by relative migration of the array and the tympanic membrane. Implant surgeons and audiologists need to be aware of the possibility of this complication. Closure of the ear canal appears to be the most effective surgical intervention.

External auditory canal cholesteatoma is a rare disease. Main symptoms of this entity are ear discharge and dull chronic ear pain and significant findings are bony erosion of the external canal with keratin debris accumulation. Inadequate diagnosis and delay in the treatment of this condition can leads to serious complications. We are presenting our experience of eight patients of spontaneous EACC treated by surgical management. As the spontaneous EACC is a rare condition, the aim of the study is to share the experience of diagnosis and management of spontaneous EACC.

Vertigo control in cases of Ménière disease and deafness can be achieved by labyrinthectomy before or as a single-stage procedure during cochlear implantation. The aim was to describe a case in which a labyrinthectomy was performed after cochlear implantation. The scar tissue was removed from the electrode cable, and the receiver was removed from the periostal pocket and placed out without electrode dislocation. Labyrinthectomy was performed after securing the electrode at the external canal. The patient disclaimed after three months no disabling vertigo. Intraoperatively, the electrode was not dislocated. A labyrinthectomy can be performed even after cochlear implantation to treat vertigo.

Objective To retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma. Methods We retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed. Results There were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period. Conclusion Overall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.

This chapter describes the sensitivity of the human ear to sound signals as corresponding to the A-weighting network, which is formed primarily by the total transfer function of the external canal, eardrum, bone chain, and the oval window.

Background: A single drilled tunnel from the lateral mastoid cortex to the cochlea via the facial recess is essential for minimally invasive cochlear implant surgery. This study aimed to explore the safety profile of this kind of new image-guided and bi-planar device-assisted surgery procedure in vitro. Methods: Image-guided minimally invasive cochlear implantations were performed on eight cadaveric temporal bone specimens. The main procedures were: (1) temporal bone specimens were prepared for surgery and fiducial markers were registered. (2) computed tomography (CT) scans were performed for future reference. (3) CT scan images were processed and drill path was planned to minimize cochlear damage. (4) bi-planar device-assisted drilling was performed on the specimens using the registration. (5) surgical safety was evaluated by calculating the deviation between the drill and the planned paths, and by measuring the closest distance between the drilled path and critical anatomic structures. Results: Eight cases were operated successfully to the basal turn of the cochlear with intact facial nerves (FNs). The deviations from target points and entrance points were 0.86 mm (0.68-1.00 mm) and 0.44 mm (0.30-0.96 mm), respectively. The angular error between the planned and the drilled trajectory was 1.74° (1.26-2.41°). The mean distance from the edge of the drilled path to the FN and to the external canal was 0.60 mm (0.35-0.83 mm) and 1.60 mm (1.30-2.05 mm), respectively. In five specimens, the chorda tympani nerves were well preserved. In all cases, no injury happened to auditory ossicles. Conclusions: This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures. Further, more in vitro experiments are needed to improve the system operation and its safety.

In patients with unilateral microtia and atresia after reconstruction of the auricle and external canal and fitting of a canal-type hearing aid for the operated ear, the ability to discriminate the inter-aural intensity difference (IID) was acquired in all of the patients, whereas that to discriminate inter-aural time difference (ITD) was acquired in one-half of the patients.To study the post-operative sound lateralization ability in patients with unilateral microtia and atresia after reconstruction surgery of the auricle and external canal and fitting of a canal-type hearing aid of the operated ear.Eighteen patients with unilateral microtia and atresia ranging from 13-24 years of age were recruited in this study. All of them underwent reconstruction of the auricle and external canal and were fitted a canal-type hearing aid for the operated ear. The sound lateralization test was conducted to determine IID and ITD using a self-recording apparatus. The test stimulus was a continuous narrow-band noise at 500 Hz and 50 dBHL presented to the right and left ears through the air conduction receivers.IID could be measured in all of the patients, whereas ITD could be measured in only nine out of the 18 patients. Post-operative binaural hearing could be acquired in all the patients.

Background Patients who undergo radiotherapy (RT) for nasopharyngeal carcinoma (NPC) may develop external auditory canal cholesteatoma (EACC). Methods The records of patients with newly diagnosed NPC who had received concomitant chemotherapy and RT in a tertiary referral center from 1997 January to 2012 July were retrospectively reviewed. Results RT-related external auditory canal cholesteatoma (RT-related EACC) was identified in 15 of 833 patients given RT for NPC. Three patients had EACC in both ears. The interval from completion of RT to the diagnosis of EACC ranged from 0.5 to 15.4 years (mean, 5.6 years). RT-related EACC commonly (75%) invaded the anterior and inferior parts of the external canal wall. Canaloplasty was used in 12 patients to surgically remove cholesteatoma. There was no recurrence of RT-related EACC during the study period. Conclusion Patients with NPC might contract RT-related EACC a few years after RT. We hypothesize that a fraction dose of 200 cGy or more induces RT-related EACC. © 2014 Wiley Periodicals, Inc. Head Neck, 2014

OBJECTIVE Current bone-anchored hearing aid (BAHA) guidelines recommend placement of the titanium implant 5 to 7 cm posterior to the ear canal. Previous studies show that bone conducted hearing is maximized the closer the transducer is to the cochlea. We aim to investigate the position of the sigmoid sinus with respect to BAHA implants to determine whether they may be safely placed closer to the ear canal in patients with chronic ear disease, enhancing the amplification available to the patient. STUDY DESIGN We performed a retrospective review of high-resolution temporal bone computed tomographies (CTs), comparing multiple measurements between ears with chronic ear disease and normal controls. SETTING Images were obtained at a single academic medical center. PATIENTS Eighty patients (160 ears) with temporal bone CTs performed between 2006 and 2009 were measured. Patients with chronic ear disease were identified by international statistical classification of diseases and related health problems, revision 9 code and confirmation by review of the imaging. MAIN OUTCOME MEASURES Measurements were made on axial CT slices from a point 1 cm posterior to the sigmoid sinus to the posterior margin of the external canal. The squamous temporal bone thickness was also measured at this point. RESULTS Forty-seven patients (55 ears) had chronic ear disease. Distance from the posterior canal was significantly different between normal and diseased ears (36.3 mm versus 33.5 mm, p

Objectives/hypothesis Compare surgical and audiometric outcomes following canal wall reconstruction (CWR) tympanomastoidectomy used as a primary versus secondary approach for treating cholesteatoma. Study design Retrospective. Methods Patients treated for primary/secondary cholesteatoma from 2006 to 2017 via CWR were included if they had preoperative/postoperative audiograms, detailed operative note(s), and >12 months' follow-up. Patients were stratified by previous surgical history into two groups: primary CWR group (PG) and secondary CWR group (SG). Surgical outcomes measured were prevalence of recidivistic cholesteatoma, canal cholesteatoma, revision rate, and canal wall down (CWD) conversion rates. Secondary outcomes were prevalence of infection, external canal adhesions/stenoses, and retractions. Audiometric outcomes included change in pure-tone average and air-bone gap. Results We stratified 45 patients/ears into the PG and 26 into the SG. The groups did not significantly differ in age, sex, or smoking status. Overall, median follow-up was 35 months. SG patients had higher rates of cholesteatoma detected at staged surgery than did PG patients (P = .04). However, these patients exhibited lower rates of open revision surgery (4% vs.13%) and a significant improvement in air-bone gap (P = .004). Three PG patients (7%) required conversion to CWD versus zero SG patients. Secondary outcomes were similar. Patients who underwent delayed staging >12 months from CWR had increased rates of recidivism and canal adhesion/stenosis. Conclusions CWR was effective for treating cholesteatoma as both a primary and secondary surgical approach. SG patients experienced higher rates of recidivism and secondary canal cholesteatoma. PG patients had higher rates of revision surgery. Staging of ears undergoing CWR is important regardless of prior surgical history. Level of evidence 4 Laryngoscope, 129:2580-2587, 2019.

Acquired atresia of the external acoustic meatus is a rare pathological condition characterized by obliteration of the medial part of the external acoustic canal by a soft fibrous plug. The present article presents an overview of a series of cases of acquired atresia and stenosis of the external acoustic meatus with the description of etiology, pathogenesis, and methods for the treatment of this condition. In the majority of the cases, atresia develops at the final stage of granulation external otitis with or without an accompanying dermatological pathology. Another common cause of the acquired atresia of the external acoustic meatus is the fracture of the temporal bone as well as extensive ear surgery, radiation therapy and a neoplasm in the auditory passage. The surgical strategy for the management of the acquired atresia and stenosis of the external acoustic meatus consists, besides the excision of the fibrous plug, of the application of the cutaneous flaps and/or transplants to cover the bare parts of the bone portion of the affected external canal. In spite of such treatment, the state of the external acoustic canal remains unstable, and a relapse of its atresia and stenosis can not be wholly excluded.Приобретенная атрезия наружного слухового прохода - это редкое состояние, при котором медиальная часть наружного слухового прохода облитерируется соединительнотканным конгломератом. Представлен обзор серии случаев, описана этиология, патогенез и методы лечения этого состояния. В большинстве случаев атрезия формируется на конечной стадии грануляционного наружного отита, иногда вкупе с сопутствующей дерматологической патологией или без нее. Другой частой причиной этого состояния являются травмы височной кости, ушные операции, лучевая терапия или новообразования слухового прохода. Хирургическая тактика при приобретенной атрезии заключается, помимо иссечения атретической ткани, в применении кожных лоскутов и/или трансплантатов для покрытия оголенных участков костного отдела слухового прохода. Тем не менее наружный слуховой проход остается нестабильным и может произойти рецидив атрезии.

Objective The aim of this study was to compare the outcomes of lateral temporal bone resection and pedicled temporalis muscle flap stuffing with external auditory canal closure with those of canal wall down mastoidectomy for the treatment of mastoid osteoradionecrosis. Study Design Prospective nonrandomized case-control clinical study. Setting Department of Otolaryngology of the First People's Hospital of Foshan. Subjects and Methods Seventy-seven postirradiation nasopharyngeal carcinoma patients with mastoid osteoradionecrosis were included. Forty patients (40 ears) underwent lateral temporal bone resection in the temporalis muscle flap group. Their pedicled temporalis muscle flaps were laid on the surgical cavity, and the external canal opening was simultaneously closed. Thirty-seven patients (37 ears) underwent a canal wall down mastoidectomy in the mastoidectomy group. The surgical wounds and complications following surgery were retrospectively analyzed. Results The patients were followed for 2 years. The percentage of patients with purulent otorrhea and persistent osteoradionecrosis in the temporalis muscle flap group was lower than that in the mastoidectomy group. Conclusion Our preliminary results suggest that lateral temporal bone resection with the pedicled temporalis muscle flap filled into the surgical cavity, followed by closure of the external auditory canal, represents a valuable approach for treating mastoid osteoradionecrosis.

Background Patulous Eustachian tube (pET) is a rare dysfunction of the Eustachian tube described in humans. It is characterized by failure of the ET to close, resulting in unrestricted passage of air, sound and material between the nasopharynx and the middle ear. Objective To report a case of pET associated with otitis in a dog. Animal A 6-year old-female spayed Dachshund dog. Methods and materials Otoscopic examination, cytological evaluation, culture and susceptibility, computerized tomography (CT), video-otoscopic flushing and surgery. Results Left ear otoscopic examination revealed erythema, purulent frothy discharge, ceruminous gland hyperplasia, stenosis and a partial tear of the tympanum. Cytological evaluation from the left external canal showed neutrophils, macrophages, rods and cocci. Aerobic culture showed predominantly multidrug-resistant Pseudomonas aeruginosa. The CT findings of the left ear included chronic changes in the external canal, marked lysis of the tympanic bulla and marked dilation of the ET. During video-otoscope flushing, saline drained through the mouth. Bilateral incomplete hypoplasia of the soft palate was noted. Total ear canal ablation and bulla osteotomy with ET dissection were curative. Histopathological findings were compatible with chronic otitis externa (OE) and media. Conclusion and clinical importance To the best of the authors' knowledge, this is the first case of pET described in animals. The ET dysfunction and palatine defect were likely the cause of the otitis in this dog. Clinicians should investigate pET in animals with signs of OE characterized by frothy liquid and food fragments in the ear canal in addition to sneezing after drinking water.

Objectives The study evaluates the hearing result, complication rate and parental satisfaction following two different approaches in the management of external auditory canal atresia. Methods A retrospective chart review of 30 patients with external auditory canal atresia was conducted. Twenty of them underwent external canal atresia surgery and 10 had Bone Anchored Hearing Aid ( BAHA ). Hearing results, pre- and post-intervention, complications, parental satisfaction rate and speech improvement were measured. Results Closure of the air-bone gap (ABG) to 30 dB was seen in less than 50% in the surgery group. The BAHA group had closure of the ABG to less than 15 dB. Parental satisfaction was higher in BAHA group. The most common complications in the surgical and BAHA groups were group was soft tissue stenosis and adverse skin reactions for the BAHA group. Conclusion In the treatment of auditory canal atresia, BAHA provides superior hearing results, greater parental satisfaction and fewer complications as compared to surgery.

SUMMARY: A subset of patients presents with unilateral conductive hearing loss, a normal pinna or grade I microtia, and mild external auditory canal stenosis. The physical findings of microtia and a small external canal are commonly absent or subtle in this group of patients, who are being commonly referred for imaging to evaluate isolated conductive hearing loss. We present a case series of patients with unilateral conductive hearing loss and characteristic ossicular abnormalities, commonly anterior fixation of the malleus. All patients had a significantly increased distance from the cochlear promontory to the handle of the malleus and an abnormal incudostapedial angle, indicative of an abnormal ossicular position and/or morphology. Successful surgical reconstruction of the ossicular chain was attempted and accomplished in 3 patients.

Previous reports describing the prevalence of ear diseases in dogs have primarily been based on dogs presenting with clinical signs of disease. The prevalence of subclinical ear disease remains unknown. The purpose of this cross-sectional retrospective study was to describe the prevalence of lesions consistent with middle and external ear disease in dogs presented for multidetector computed tomography (CT) of the head and/or cranial cervical spine at our hospital during the period of July 2011 and August 2013. For each included dog, data recorded were signalment, CT findings, diagnosis, and treatment. A total of 199 dogs met inclusion criteria. Nineteen dogs (9.5%) were referred for evaluation of suspected ear disease and 27 dogs (13.5%) had histories or physical examination findings consistent with otitis externa. A total of 163 dogs (81.9%) had CT lesions consistent with external ear disease (i.e. ear canal mineralization, external canal thickening, and/or narrowing of the external canal). Thirty-nine dogs (19.5%) had CT lesions consistent with middle ear disease (i.e. soft tissue attenuating/fluid material in the tympanic bullae, bulla wall thickening or lysis, and/or periosteal proliferation of the temporal bone). Findings from this study indicated that the prevalence of external and middle ear disease in dogs could be higher than that previously reported.

Acute diffuse otitis externa (OEAD) is a common condition especially in summer months. It is defined as generalized inflammation of the external canal skin, most often caused by bacterial infection (P. aeruginosa, S. aureus). OEAD is characterized by pain, itching and fullness in the ear with tenderness of the tragus, erythema and swelling of the external ear canal skin and purulent discharge. Several conditions (diabetes, immunocompromised states, eczema, psoriasis) and factors (excessive water exposure, scratching, trauma, devices that occlude ear canal) predispose to OEAD. Topical preparations are recommended as initial therapy because of safety and efficacy. Although meta-analysis of randomized trials did not show substantial differences between various topical interventions, patient symptoms lasted two days less with an antibiotic-steroid combination treatment than with formulations of antiseptics. Recent studies showed superiority of treatment with topical fluoroquinolones/steroid versus neomycin/polymyxinB/steroid. Taking into account high efficacy, suitability to the spectrum of pathogens causing OEAD, good tolerance when applied locally, low frequency of hypersensitivity reactions and lack of ototoxicity preparations of fluoroquinolones with steroid are considered the best choice for local treatment. Systemic antimicrobial therapy should be used only in patients with extension of inflammation outside the ear canal or with other diseases that can modify the course of OEAD (diabetes, immunocompromised state, prior radiotherapy).

33 males and 12 female patients were selected for tymponoplasty either righter left harvesting of the tragalcartilage graft with a thickness between 0.2 to 0.4 mm and techniques used were underlay techniques and lateral to the hand of malleus supported by gel foam on both sides. During the study mean value of diameters of external canal in 21 males (63.6%) was 1.2 mm, and 12 males (36.3%) it was 1-4mm. In females 7 females (58.3%) the diameters of external canal was 1.2mm and in 5 females (41.6%) it was 1.3mm. The size of perforating gap in tympanic membrane Air borne gap range and average range study. 20 males had 1–2 mm perforations, air borne range was 10–31 dB and average range was 22dB. In 10 males the perforation size was upto 1mm, air borne range was-0.25mm, the average range was 11dB. In 3 males air borne range 17-31dB and average range was 23 dB. In females study 7 females had 2-3mm perforation, air borne range was 14–36 and average was 24 dB, In 3 females perforation was upto 1mm, air borne range was 0–25 dB and average was 9 dB, In 2 females had 3-4mm perforation, air borne range was 17–31 dB and average range was 23 dB. This study of tympanoplasty by tragal cartilage will be certainly helpful to junior ENT surgeons and biotechnologist to invent such similar technique in future.

An ectopic thyroid is a rare occurrence with a majority of ectopic thyroid tissue located in the lingual region or in the midline. The abnormal sites represent developmental defects in migration from the floor of the primitive foregut at the foramen caecum of the tongue to the final pre-tracheal position of the gland. A few cases of ectopic thyroid tissue have also been reported from sites seemingly unrelated to the normal development of the thyroid gland. We report a case of ectopic thyroid in the external ear canal, which presented as a small reddish mass in the external ear canal. To the best of our knowledge, this is the first such reported case in literature and adds to the body of knowledge in such cases. Although such a finding is exceedingly rare, the authors recommend routine histopathology in all cases of polyps in the external canal and standard investigation for the status of the residual thyroid gland via isotope scans, ultrasonography or thyroid function tests.

PURPOSE: Initial study of the pig`s temporal bone anatomy in order to enable a new experimental model in ear surgery. METHODS: Dissection of five temporal bones of Sus scrofa pigs obtained from UNIFESP - Surgical Skills Laboratory, removed with hole saw to avoid any injury and stored in formaldehyde 10% for better conservation. The microdissection in all five temporal bone had the following steps: inspection of the outer part, external canal and tympanic membrane microscopy, mastoidectomy, removal of external ear canal and tympanic membrane, inspection of ossicular chain and middle ear. RESULTS: Anatomically it is located at the same position than in humans. Some landmarks usually found in humans are missing. The tympanic membrane of the pig showed to be very similar to the human, separating the external and the middle ear. The middle ear`s appearance is very similar than in humans. The ossicular chain is almost exactly the same, as well as the facial nerve, showing the same relationship with the lateral semicircular canal. CONCLUSION: The temporal bone of the pigs can be used as an alternative for training in ear surgery, especially due the facility to find it and its similarity with temporal bone of the humans.

Fibrous dysplasia is a slowly progressive benign fibro-osseous disease, rarely occurring in temporal bones. In these cases, most bony lesions developed from the bony part of the external auditory canals, causing otalgia, hearing impairment, otorrhea, and ear hygiene blockade and probably leading to secondary cholesteatoma. We presented the medical history of a 24-year-old woman with temporal monostotic fibrous dysplasia with secondary cholesteatoma. The initial presentation was unilateral conductive hearing loss. A hard external canal tumor contributing to canal stenosis and a near-absent tympanic membrane were found. Canaloplasty and type I tympanoplasty were performed, but the symptoms recurred after 5 years. She received canal wall down tympanomastoidectomy with ossciculoplasty at the second time, and secondary cholesteatoma in the middle ear was diagnosed. Fifteen years later, left otorrhea recurred again and transcanal endoscopic surgery was performed for middle ear clearance. Currently, revision surgeries provide a stable auditory condition, but her monostotic temporal fibrous dysplasia is still in place.

This article reports a case of piloleiomyoma of external auditory canal, which is the 7th case of leiomyoma of the external auditory canal being reported and the 2nd case of leiomyoma arising from arrectores pilorum muscles, all the other five cases were angioleiomyomas, arising from blood vessels. A 52 years old male presented with a mass in the right external auditory canal and decreased hearing of 6 months duration. Tumor excision done by end aural approach. Histopathological examination report was leiomyoma. It is extremely rare for leiomyoma to occur in the external auditory canal because of the non-availability of smooth muscles in the external canal. So it should be considered as a very rare differential diagnosis for any tumor or polyp in the ear canal.

We sought to determine the efficacy of commonly used earplugs using an anatomically correct ear model.The total volume and rate of water that leaked past the earplug and subsequent defect in the tympanic membrane over separately measured 30, 60, 120, and 180-second intervals were recorded. Scenarios tested included a control with no earplug, custom molded earplug (Precision Laboratories, Orlando, FL), Mack's plug (Warren, MI), Doc's plug (Santa Cruz, CA), and cotton balls coated with petroleum jelly.All plugs tested resulted in less leakage at all time points when compared with no plug (P.05). At 30 seconds, the custom molded, Mack's and Doc's plugs all showed significantly less leakage when compared with the cotton ball coated with petroleum jelly (P.05). At 60, 120, and 180 seconds, Mack's, Doc's, and the cotton plugs all showed significantly less leakage compared with the customized plug (P.05). At 120 and 180 seconds, Mack's plugs had significant less leakage than the cotton plug (P.05). Among the types of plugs, the molded variety (Mack's) showed the least volume and lowest leakage rate (f(4,45) = 94 [P.001]). In addition, Doc's and cotton balls coated with petroleum jelly were more effective than the customized earplugs.If the clinician feels that middle ear and external canal water exposure should be minimized, then use of earplugs, particularly the moldable variety, merits further consideration.

Non-accidental caustic injury is a rare form of child abuse usually secondary to forced ingestion. Caustic injury to the ear most commonly arises from battery lodgement in the external canal. This case series represents the first report of non-accidental caustic injury to previously normal ears resulting in profound sensorineural hearing loss, vertigo with horizontal canal hypofunction and in one patient a severe facial nerve paralysis. Both patients required blind-end sac closure of the injured ear and one required sural nerve interposition combined with transfer of the masseteric branch of the trigeminal nerve to the ipsilateral facial nerve.

Objectives/Hypothesis: The aim of this study is to indicate anatomic and immunologic peculiarities of the temporal bone which leave it vulnerable to traumatic, infectious and neoplastic insult. Study Design: Seven patients' cases are described in which the clinical pathology of the temporal bone was bilateral. The bilaterality of these cases serves to illustrate the anatomic points which are the focus of this study. Methods: This is a case series. Results: The seven paradigmatic cases are described and the relevant anatomy is explored. These are bilateral tuberculosis of the middle ear and mastoid, bilateral histiocytosis X, bilateral external canal amyloidosis, bilateral middle ear polyposis in Samter's triad, bilateral temporal bone fractures, bilateral middle cranial fossa encephaloceles, and bilateral congenital enlarged superior vestibular nerve canals. The thinness of the skull base, the many fluid-filled and tissue-filled canals which enter the temporal bone and the thinness of the tissues investing all the surfaces contribute to the temporal bone's vulnerability to trauma, infection and neoplasm. Conclusion: Cases of bilateral temporal bone pathology demonstrate the temporal bone's structural and immunologic weaknesses.

Objective Conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the risk of postoperative complications. Inlay butterfly cartilage myringoplasty (IBCM) has been shown effective for same-day closure of bilateral tympanic membrane perforations and is a quicker and more comfortable procedure for the patient. Immediate postoperative hearing is not compromised by packing materials because no external canal packing or middle ear support is required. We assessed the efficacy and safety of bilateral same day IBCM. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Of the 81 patients (age range, 9-64 years) who underwent conventional tympanoplasty/mastoidectomy for bilateral perforated chronic otitis media between June 2005 and September 2009, 17 with small-to-medium perforations and no history of otorrhea underwent same-day cartilage IBCM on the contralateral ear. Median follow-up duration was 13.0 months. Results The graft take rate was 100 percent, with no retraction pockets or displaced grafts observed during follow-up. Mean air−bone gap was improved from 15.8 to 8.4 dB. Twelve patients had an average air−bone gap between 0 and 10 dB, three between 11 and 20 dB, and two between 21 and 30 dB. Two patients had myringitis postoperatively, but it improved with antibiotic treatment. Conclusion Bilateral same-day IBCM offers favorable outcomes in selected patients.

In treating congenital microtia and atresia, we conduct simultaneous external canal plasty, tympanoplasty, and auricle elevation with plastic surgeons about 6 months after auricleplasty by only plastic surgeons. The results are good both cosmetically and functionally. We report 13 cases in which hearing did not improve satisfactorily after surgery using postoperative high-resolution computed tomography (HRCT) of the temporal bone. Lateral healing was seen in 9 (69%), new bone proliferation in 3 (23%), malpositioning of a cartilage block in 2 (15%), and both lateral healing and malpositioning of a cartilage block in 1 (7.6%).

Summary Objective Nodular fasciitis of external auditory canal may mimic a malignant tumor due to its progressive course, so it was the aim of this study to focus on a new etiology for aural masses to avoid unnecessary aggressive treatment. Study design Retrospective study on six children presented with aural masses that were diagnosed pathologically to have nodular fasciitis. Methods Presentation of the cases clinically, radiologically and pathologically was carried out. Surgical excision of the lesions was done through the external canal with follow up of the cases for 1 year. Results Recurrence was detected in two cases, one after 2 months and the other after 4 months. Re-excision was carried out without recurrence till the end of the follow up period. Conclusions Proper diagnosis of this lesion is mandatory to avoid aggressive treatment (radical surgery and/or radiotherapy) as the disease has favorable prognosis with local excision.

Fungal infections of the ear are recognised quite rarely, but they make sometimes, for many reasons, very important diagnostic-therapy issue. Cantagion may developes in every elements of the ear, ranging from external ear (external canal ear, sometimes auricle), middle ear (every pneumatic structure) to iner ear (extra ordinary rarely). Every states, which weaken general and punctual immunity (like immunosupression, chemo-sterydotherapy, blood disease, pregnancy and HIV) are circles, which give facilities to invansion. After penetrated organism, course of infections, in case of type of patogens, trim of the patient and localization, can have without symptoms, sharp, chronic or fulminant shape. For the sake of morphological differentiation fungal, in their developing cycle, treatment mycosis recommends serious difficulty, extra factor, which impeds therapy, is a must of prolongely antifungal treatment and repeated (to total elimination) remove hyphae from ear, which stay sometimes even for week. Progress of the mycotic infections ear, remain bacterial infections and is often reason of bad diagnosis and incorrect treatment.

This report describes a case with the re-growth of a residual recurrence of cholesteatoma in a patient who had previously undergone mastoid obliteration using bone putty. At the first visit to the clinic, his external canal resembled one that had undergone canal wall down surgery and his symptoms resembled a cavity problem. Because this recurrent cholesteatoma showed an unusual development, it was not possible to distinguish the cholesteatoma recurrence and a neoplasm using CT and MRI. Surgical removal of the cholesteatoma was extremely difficult because the obliteration covered most of the surgical landmarks. No continuity was identified between the matrix of the cholesteatoma and the eardrum /external ear canal epithelium. The follow-up CT 2 weeks after the initial surgery revealed a residual mass in the mastoid cavity, which required a second surgery for complete removal. This experience indicated that confirmation of the complete removal of a cholesteatoma matrix is critical before deciding to obliterate the mastoid cavity, and that, it is never easy to determine if the procedure is complete. The goal is pneumatization at the mastoid cavity, thereby making it possible to both confirm the recurrence of the cholesteatoma and allowing surgeons to remove it safely.

Cavernous hemangioma involving the external canal, tympanic membrane, and middle ear cavity is extremely rare. We present a case of a 45-year-old woman who had progressive right sided decreased hearing, pulsatile tinnitus, and aural fullness of 7 months duration. Microscopic examination, imaging studies, surgical treatment, and histological evaluation are reported. To the best of our knowledge, this is the first case of cavernous hemangioma with simultaneous involvement of the external ear, tympanic membrane, middle ear, and attic reported in English literature.

In two stages of total ear reconstruction surgery for children with microtia and atresia, plastic surgeons and otologists have cooperated to reduce the number of surgeries and to achieve both esthetically and functionally better results. Ear elevation, external canal plasty and tympanoplasty are performed cooperatively in the second stage of surgery.In the past 5 years we have experienced 70 cases of combined surgery as the second stage of microtia reconstruction: 59 boys and 11 girls, 12 cases of bilateral microtia and atresia and 58 cases of unilateral microtia and atresia. Analysis of the 3D CT scan was useful to plan total reconstruction surgery for microtia and atresia, and was important for education and design of surgery. Esthetically and functionally combined surgery at the second stage is convenient to make a natural orifice of the external canal, elevate the external ear and reconstruct the ossicular chain.After bilateral reconstructive surgery, patients with bilateral microtia and atresia can localize sounds in the right and left auditory spaces.