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Introduction: Traumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area. Objective: The purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations. Methods: A total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months. Results: During the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ± 2.3 days (range: 3-12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane. Conclusions: Pseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations. Resumo Introdução: As perfurações traumáticas da membrana timpânica tendem a cicatrizar espontaneamente. Entretanto, neste estudo, várias perfurações exibiram cicatrização anormal, na qual a morfologia da cicatrização das membranas timpânicas diferiu da de membranas timpânicas não perfuradas. A pseudocicatrização da membrana timpânica foi caracterizada pelo acúmulo de tecido espesso na área perfurada. Objetivo: Avaliar a utilidade do fator de crescimento epidérmico em casos que apresentaram pseudocicatrização de perfurações traumáticas da membrana timpânica. Método: Um total de 26 casos de perfurações traumáticas da membrana timpânica apresentando pseudocicatrização foram incluídos neste estudo.. Em todos os casos, o tecido que se acumulou na área perfurada foi removido, o que subsequentemente causou uma nova perfuração. Uma solução de fator de crescimento epidérmico foi aplicada à membrana timpânica uma vez ao dia para manter a membrana timpânica úmida. As taxas de fechamento e os tempos foram avaliados aos 6 meses. Resultados: Dois pacientes foram perdidos no período de 6 meses de acompanhamento. Dos 24 pacientes restantes, a taxa de fechamento foi de 100% (24/24) e o tempo de fechamento foi de 6,1 ± 2,3 dias (variação: 3 a 12 dias). A morfologia da membrana timpânica cicatrizada não foi significativamente diferente daquela da membrana timpânica remanescente. Conclusões: A pseudocicatrização de perfurações traumáticas da membrana timpânica afeta a condução do som. Isso pode estar associado a vários sintomas, inclusive zumbido, plenitude aural e desconforto auditivo. A excisão do tecido epitelial excessivo e a aplicação tópica de fator de crescimento epidérmico podem corrigir a pseudocicatrização de perfurações traumáticas da membrana timpânica.

BackgroundDecades of clinical observation have led our subspecialty team to suspect that negative nasopharyngeal pressure is associated with attic retraction pocket formation. Furthermore, LaPlace's law, which states that the pressure within a sphere varies with the inverse of the radius, provides the dynamic explanation for why the attic area of the tympanic membrane tends to retract more frequently than the pars tensa.MethodsThe attic retraction pockets of 154 patients were classified into grades of severity (grades I–V). Impedance audiometry of middle-ear pressure was measured in the resting state, and after sniffing, swallowing and the Valsalva manoeuvre.ResultsNegative nasopharyngeal pressure (sniffing) caused a diminution of middle-ear pressure of −5 daPa on average in normal ears, and of −24 daPa to −45 daPa for tympanic membranes with attic retraction pockets of grade I to grade V.ConclusionAttic retraction pockets are associated with greater collapse of middle-ear volume when negative pressure is created in the nasopharynx. LaPlace's law, and the composition of the pars flaccida, suggests an explanation for why the attic region retracts more than the pars tensa.

Commercial quinolone ear drops may promote the development of perforations (TMPs) in intact tympanic membrane (TMs).Quinolone ear drops have been associated with TMPs after myringotomy +/- tube placement in a drug-specific manner and potentiation by steroids.Rats were randomized to six groups (10/group), with one ear receiving otic instillation of dexamethasone, ofloxacin, ciprofloxacin, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin + polymyxin + hydrocortisone-all commercial formulations and at standard clinical concentrations-and the contralateral ear receiving saline, twice daily for 10 days. TMs were assessed over 42 days.No TMPs were seen in ears treated with saline, dexamethasone, or neomycin. At day 10, TMPs were seen in one of 10 ofloxacin- and three of 10 ciprofloxacin + dexamethasone-treated ears (p = 0.038). At day 14, the ofloxacin TMP healed. In contrast, the three ciprofloxacin + dexamethasone TMPs remained and one new TMP developed in this group. A ciprofloxacin and an ofloxacin + dexamethasone-treated ears also had TMPs (p = 0.023). By day 21, the ofloxacin + dexamethasone TMP and two of four of the ciprofloxacin + dexamethasone TMPs healed but two new TMPs were seen in ciprofloxacin + dexamethasone ears (p = 0.0006). At day 28, 1 of 10 ciprofloxacin and 4 of 10 ciprofloxacin + dexamethasone-treated ears had TMPs (p = 0.0006). By day 35, only one ciprofloxacin + dexamethasone had TMP (p = 0.42). All TMPS were healed at day 42.Application of commercial quinolone ear drops can cause TMPs in intact TMs. This effect appears to be drug-specific and potentiated by steroids.

OBJECTIVE To determine whether an enrofloxacin–silver sulfadiazine emulsion (ESS) labeled for treatment of otitis externa in dogs has ototoxic effects in rabbits following myringotomy. ANIMALS 6 healthy adult New Zealand White rabbits. PROCEDURES Rabbits were anesthetized for brainstem auditory-evoked response (BAER) tests on day 0. Myringotomy was performed, and BAER testing was repeated. Saline (0.9% NaCl) solution and ESS were then instilled in the left and right middle ears, respectively, and BAER testing was repeated prior to recovery of rabbits from anesthesia. Application of assigned treatments was continued every 12 hours for 7 days, and rabbits were anesthetized for BAER testing on day 8. Rabbits were euthanized, and samples were collected for histologic (6 ears/treatment) and scanning electron microscopic (1 ear/treatment) examination. RESULTS Most hearing thresholds (11/12 ears) were subjectively increased after myringotomy, with BAER measurements ranging from 30 to 85 dB in both ears. All day 8 hearing thresholds exceeded baseline (premyringotomy) values; results ranged from 30 to 85 dB and 80 to > 95 dB (the upper test limit) in saline solution–treated and ESS-treated ears, respectively. All ESS-treated ears had heterophilic otitis externa, epithelial hyperplasia of the external ear canal, various degrees of mucoperiosteal edema, and periosteal new bone formation on histologic examination. Scanning electron microscopy revealed that most outer hair cells in the ESS-treated ear lacked stereocilia or were absent. CONCLUSIONS AND CLINICAL RELEVANCE Results supported that ESS has ototoxic effects in the middle ear of rabbits. Further research is needed to confirm these findings. Myringotomized laboratory rabbits may be useful to study ototoxicity of drugs used in human medicine.

The present study aimed to develop a machine learning network to diagnose middle ear diseases with tympanic membrane images and to identify its assistive role in the diagnostic process. The medical records of subjects who underwent ear endoscopy tests were reviewed. From these records, 2272 diagnostic tympanic membranes images were appropriately labeled as normal, otitis media with effusion (OME), chronic otitis media (COM), or cholesteatoma and were used for training. We developed the “ResNet18 + Shuffle” network and validated the model performance. Seventy-one representative cases were selected to test the final accuracy of the network and resident physicians. We asked 10 resident physicians to make diagnoses from tympanic membrane images with and without the help of the machine learning network, and the change of the diagnostic performance of resident physicians with the aid of the answers from the machine learning network was assessed. The devised network showed a highest accuracy of 97.18%. A five-fold validation showed that the network successfully diagnosed ear diseases with an accuracy greater than 93%. All resident physicians were able to diagnose middle ear diseases more accurately with the help of the machine learning network. The increase in diagnostic accuracy was up to 18% (1.4% to 18.4%). The machine learning network successfully classified middle ear diseases and was assistive to clinicians in the interpretation of tympanic membrane images.

The human tympanic membrane (TM) captures sound waves from the environment and transforms them into mechanical motion. The successful transmission of these acoustic vibrations is attributed to the unique architecture of the TM. However, a limited knowledge is available on the contribution of its discrete anatomical features, which is important for fabricating functional TM replacements. This work synergizes theoretical and experimental approaches toward understanding the significance of geometry in tissue-engineered TM scaffolds. Three test designs along with a plain control are chosen to decouple some of the dominant structural elements, such as the radial and circumferential alignment of the collagen fibrils. In silico models suggest a geometrical dependency of their mechanical and acoustical responses, where the presence of radially aligned fibers is observed to have a more prominent effect compared to their circumferential counterparts. Following which, a hybrid fabrication strategy combining electrospinning and additive manufacturing has been optimized to manufacture biomimetic scaffolds within the dimensions of the native TM. The experimental characterizations conducted using macroindentation and laser Doppler vibrometry corroborate the computational findings. Finally, biological studies with human dermal fibroblasts and human mesenchymal stromal cells reveal a favorable influence of scaffold hierarchy on cellular alignment and subsequent collagen deposition.

We evaluated the graft and hearing outcomes of patients with chronic perforations treated via the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and external auditory canal (EAC) packing.Thirty-nine patients with chronic perforations and residual tympanic membranes around the perforation margins were treated using the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and EAC packing. Patients were followed-up for 6 months.For all 39 patients with unilateral perforations, the graft success rate was 100% (39/39) at 6 months after surgery. The mean air-bone gap significantly (P 0.05) improved from 13.41 ± 8.34 dB preoperatively to 7.45 ± 3.81 dB postoperatively in patients with small and medium perforations; the mean air-bone gap significantly improved from 20.57 ± 9.41 dB preoperatively to 9.84 ± 2.41 dB postoperatively in patients with large perforations. The lateral perichondrium gradually became necrotic and crust at postoperative 2-3 months and migrated into the EAC in all patients.The cartilage-perichondrium over-underlay myringoplasty without de-squamatization of the TM and EAC packing is feasible, affording a high graft success rate and good hearing improvement. The lateral perichondrium may gradually become necrotic and crusted, and migrate along the EAC over time.

Purpose Studying the effect of Mesna on middle ear otitis media and cholesteatoma induced by propylene glycol on an experimental animal model. Methods The study was designed to consist of sixteen Wistar albino rats, their right ears being the control group and left ears being the experiment group. %50 propylene glycol, gentamicinsulfate and physiologic salt water were applied to the right ear and %50 propylene glycol, gentamicinsulfate and %20 Mesna were administered to the left ear through intratympanic injections on days 1, 3, 8, 15 and 21. The rats were sacrificed 45 days after the first injection and underwent histopathological examination. Results It was seen that cholesteatoma and fibrosis were less common in the experiment group in microscopic evaluation. A statistically significant decrease was observed when the average and maximum thicknesses of the tympanic membranes and the minimum thicknesses of the tympanic bulla of the control group and the experiment group were compared. (p< 0.05) Conclusion In the experimental cholesteatoma model created in rats, no statistical significance was observed, indicating that Mesna, which was applied intratympanically, completely prevented the formation of cholesteatoma. However, it was found that the prevalence of cholesteatoma formation was microscopically less in the experimental group.

PURPOSE OF REVIEW One of the most common diseases of the tympanic membrane is a perforation, and tympanoplasty is one of the more common procedures in otolaryngology. Tympanic membrane regeneration and bioengineering aim to improve the success rate of the procedure, increase the availability of different scaffolds and provide innovative tools that will simplify the surgical technique and make it accessible for surgeons with varying expertise level. This review aims to raise awareness of current tissue engineering developments in tympanic membrane regeneration and how they may augment current clinical practices. We focus here on achievements in tympanic membrane cell cultures and on innovations in development of new scaffolds and growth factors that enhance regeneration of patient's native tympanic membranes. RECENT FINDINGS In recent years, great achievements were reached in the field of tympanic membrane regeneration in the three hallmarks of bioengineering: cells, scaffolds and bioactive molecules. New techniques for modeling normal tympanic membrane proliferation were developed, as well as for isolation and expansion of normal tympanic membrane keratinocytes from miniature samples of scarred tissue. Ongoing clinical trials aim to seal the perforation by applying different scaffolds infiltrated by growth factors on the tympanic membrane. SUMMARY Research efforts in tympanic membrane regeneration continue to seek the ideal single tissue-engineered substitute. Recent advances in tympanic membrane bioengineering include new types of scaffolds that may augment and provide a safe and effective alternative to the current gold-standard autograft. New bioactive molecules may simplify the surgical procedure and reduce surgical time by augmenting the native tympanic membrane regeneration. Several groups of bioengineering scientists and neurotologists are continuing to move forward and develop new strategies, seeking to create a fully functional tissue-engineered tympanic membrane.

Objective: The aim of this study was to investigate the preventative effect of oral curcumin (CMN) on myringosclerosis (MS) in an experimental rat model. Methods: The study included 21 female Wistar albino rats randomly separated into three groups. Group 1 was given no treatment (control group). In Group 2 and Group 3, the tympanic membrane (TM) was perforated using a sterile ear pick. The rats in Group 3 were administered oral CMN 200 mg/kg/day. All rats were sacrificed after 16 days. Otomicroscopic and histopathologic examinations were performed on the tympanic membranes. Results: Histopathologic examinations revealed that there were statistically significant differences between Group 2 and Group 3 in terms of MS degrees (p

Whereas for smaller animals the eardrums are well-characterized as excitable membranes or drums, some animals such as several archosaurs feature, as a first approximation, a rather stiff elastic shell supported by an elastic ring. Mathematically, the theory of plates and shells is applicable but its governing equations overly complicate the modeling. Here the notion of tympanic structure is introduced as a generalization of “ordinary” tympanic membranes so as to account for sound perception as it occurs in archosaurs, such as birds and crocodilians. A mathematical model for the tympanic structure in many archosaurs called two-spring model implements this notion. The model is exactly soluble and solutions are presented in closed form and as a series expansion. Special emphasis is put onto offering an easy-to-apply model for describing experiments and performing numerical studies. The analytic treatment is supplemented by a discussion of the applicability of the two-spring model in auditory research. An elasticity-theoretic perspective of the two-spring model is given in the Appendix.

In this study, our aim was to identify the possible effects of montelukast sodium (ML) on the prevention of experimentally induced myringosclerosis. Twenty-eight female Wistar albino rats were used and they were divided into four groups randomly. Tympanic membranes (TM) of all animals were perforated and then group 1 received no treatment (control group), group 2 was treated with a topical saline solution, group 3 received topically ML and group 4 received orally ML. On the 15th day, all animals were euthanized. Tympanic membranes were evaluated otomicroscopically and histopathologically. The histopathological findings, compared against a control and saline groups, showed the topically and orally ML groups had statistically significant differences of degree of myringosclerosis (p

This study aims to compare the effectiveness of three different models of chronic tympanic membrane perforations.The experimental study included 18 male chinchillas, divided into 3 equal groups. Group 1 perforations were performed with infolding technique myringotomy. Laser myringotomy was performed for perforation creation in Group 2. Group 3 perforations were performed with infolding myringotomy combined with ventilation tube insertion. At the end of the follow-up period, which lasts 8 weeks, all tympanic membranes with patent perforations were examined histologically.Although, the mean perforation patency in Group 2 was significantly higher than in Group 1 (5 vs. 2.4 weeks, p 0.01), both of them failed in creation of chronic perforation according to time parameters. Group 3 demonstrated the longest mean perforation patency among investigated models (8 weeks). In Group 3, histological examination of perforations, which were considered to be chronic, revealed, that stratified squamous epithelium continued from the lateral surface around the perforation edge to join with the medial mucosal layer of TM.Our findings demonstrated that the combination of infolding technique and ventilation tube insertion seems to be a potential candidate for an effective animal model of tympanic membrane perforation. Further large-scale studies are required to verify our promising results.

Objectives The aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration. Methods Twenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated. Results No significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups. Conclusion Diclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.

Objectives We investigated the normative data on the hearing threshold levels of Koreans with normal tympanic membranes and the prevalence of hearing loss (HL) and nonserviceable hearing using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2010-2012. Methods Data obtained from 16,673 participants ≥12-year-of-age with normal tympanic membranes who completed audiometric testing. We defined HL as the pure tone average (PTA) >25 dB hearing level at 500, 1,000, 2,000, and 3,000 Hz and non-serviceable hearing as PTA >40 dB hearing level. Results The hearing levels at some frequencies (0.5, 3, and 6 kHz) did not differ in between the 10's and 20's, but the hearing thresholds at all frequencies increased gradually from the 30's. The hearing thresholds were higher in men than in women at high frequencies (3, 4, and 6 kHz) in the 30's and older. The prevalence of HL in either ear was 16.5% (estimates of 5.9 million), from 2.4% in the 10's up to 75.4% in the 70's and older. The prevalence of nonserviceable hearing in either ear was 6.8% (estimates of 2.5 million) and that of bilateral nonserviceable hearing was 2.5% (estimates of 0.9 million). Conclusion Hearing loss aggravated from the 30's at all frequencies and men showed poorer hearing levels than women at high frequencies. Hearing loss was a common condition and the prevalence of non-serviceable hearing in either ear, which needs hearing rehabilitation to help social communication, was 6.8%. Normative pure tone thresholds at each frequency can be used as referent values when counseling patients complaining of hearing loss.

ObjectiveTo evaluate discrepancies prevalent between self-reported hearing difficulty (SHD) and audiometrically measured hearing loss (AHL) and factors associated with such discrepancies.DesignNationwide cross-sectional survey.SettingData from 2010 to 2012 Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention.ParticipantsWe included 14 345 participants aged ≥19 years who had normal tympanic membranes (mean age of 49 years).MeasuresSelf-reported hearing was assessed by asking participants whether they had difficulty in hearing. AHL was defined as >25 dB of mean hearing thresholds measured at 0.5, 1, 2 and 4 kHz in better ear. Underestimated hearing impairment (HI) was defined as having AHL without SHD. Likewise, overestimated HI was defined as having SHD without AHL. Prevalence of underestimated and overestimated HIs was determined. Univariable and multivariable analyses were performed to examine factors associated with such discrepancies compared with concordant HL.ResultsAmong 14 345 participants, 1876 (13.1%) had underestimated HI while 733 (5.1%) had overestimated HI. Multivariable models revealed that participants who had discrepancies between SHD and AHL were less likely to have older age (OR: 0.979, 95% CI: 0.967 to 0.991 for the underestimated HI, OR: 0.905, 95% CI: 0.890 to 0.921 for the overestimated HI) and tinnitus (OR: 0.425, 95% CI: 0.344 to 0.525 for the underestimated HI and OR 0.523, 95% CI: 0.391 to 0.699 for the overestimated HI) compared with those who had concordant HI. Exposure to occupational noise (OR: 0.566, 95% CI: 0.423 to 0.758) was associated with underestimated HI, and medical history of hypertension (OR: 1.501, 95% CI: 1.061 to 2.123) and depression (OR: 1.771, 95% CI: 1.041 to 3.016) was associated with overestimated HI.ConclusionAge, tinnitus, occupational noise exposure, hypertension and depression should be incorporated into evaluation of hearing loss in clinical practice.

Commercial quinolone ear drops (0.3%) delivered twice daily for 10 days cause tympanic membrane perforations (TMPs) in rats. We aimed to evaluate if a single application of 6% quinolone in poloxamer causes TMPs in rats.Rats were randomized to 5 groups (10/group), with one ear receiving a single otic instillation of 16% poloxamer 407 or 188 (as found in a commercial otic preparation and a wound dressing), or ofloxacin, ciprofloxacin, or neomycin at 6% in suspension with 16% poloxamer 407. The contralateral ear received saline. Rats were assessed over 42 days.No TMPs were seen in ears treated with saline, poloxamer 407 or 188, or in ears treated with ofloxacin-, ciprofloxacin-, or neomycin-poloxamer suspension. White precipitates were observed on the canal or tympanic membrane of ciprofloxacin and ofloxacin-treated ears. Precipitates were more common in ciprofloxacin-treated ears until day 10 (p 0.0001 to p = 0.0004). Tympanic membrane surface irregularities, were also observed mostly in the ciprofloxacin-treated ears from day 3-42 (p = 0.03 to p = 0.0033).Quinolone in poloxamer otic preparations may be a safer therapeutic alternative to conventional quinolone ear drops in ears with intact TMs, particularly those felt to be at risk for developing TMPs.

Objectives Microscopic tympanoplasty has been the standard surgery for repairing perforated tympanic membranes since the 1950s, but endoscopic tympanoplasty has been increasingly practiced since the late 1990s. In this study, we compared the efficacies of endoscopic and microscopic tympanoplasty. Data Sources PubMed, Embase, MEDLINE, and the Clinical Trial Register. Review Methods We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We included clinical studies that compared the efficacies of endoscopic and microscopic tympanoplasty. We assessed the risk of bias and calculated the pooled relative risk (RR) estimates with 95% confidence interval (CI). Results We identified four studies (involving 266 patients in total) that met the inclusion criteria. The pooled tympanic membrane closure rates and hearing results of endoscopic and microscopic tympanoplasty were comparable (85.1% vs. 86.4%, respectively; RR: 0.98; 95% CI: 0.85 to 1.11; I2 = 0) (mean difference of improvements of air-bone gaps: −2.73; 95% CI: −6.73 to 1.28; I2 = 80%). The pooled canalplasty rate of endoscopic tympanoplasty was significantly lower than that of microscopic tympanoplasty. Patients receiving endoscopic tympanoplasty had a more desirable cosmetic result than did those receiving microscopic tympanoplasty. Conclusions Our up-to-date review evidences the comparable tympanic membrane closure rates and hearing results for endoscopic and microscopic tympanoplasty. Patients receiving endoscopic tympanoplasty have a lower canalplasty rate and more desirable cosmetic result than do those receiving microscopic tympanoplasty. Laryngoscope, 127:1890–1896, 2017

Frogs and toads are capable of producing calls at potentially damaging levels that exceed 110 dB SPL at 50 cm. Most frog species have internally coupled ears (ICE) in which the tympanic membranes (TyMs) communicate directly via the large, permanently open Eustachian tubes, resulting in an inherently directional asymmetrical pressure-difference receiver. One active mechanism for auditory sensitivity reduction involves the pressure increase during vocalization that distends the TyM, reducing its low-frequency airborne sound sensitivity. Moreover, if sounds generated by the vocal folds arrive at both surfaces of the TyM with nearly equal amplitudes and phases, the net motion of the eardrum would be greatly attenuated. Both of these processes appear to reduce the motion of the frog's TyM during vocalizations. The implications of ICE in amphibians with respect to sound localizations are discussed, and the particularly interesting case of frogs that use ultrasound for communication yet exhibit exquisitely small localization jump errors is brought to light.

Many reptiles, and other vertebrates, have internally coupled ears in which a patent anatomical connection allows pressure waves generated by the displacement of one tympanic membrane to propagate (internally) through the head and, ultimately, influence the displacement of the contralateral tympanic membrane. The pattern of tympanic displacement caused by this internal coupling can give rise to novel sensory cues. The auditory mechanics of reptiles exhibit more anatomical variation than in any other vertebrate group. This variation includes structural features such as diverticula and septa, as well as coverings of the tympanic membrane. Many of these anatomical features would likely influence the functional significance of the internal coupling between the tympanic membranes. Several of the anatomical components of the reptilian internally coupled ear are under active motor control, suggesting that in some reptiles the auditory system may be more dynamic than previously recognized.

To determine the feasibility and tolerability of a steroid-eluting middle ear device on an animal model.Prospective experimental.Experimental animal study.Mometasone furoate (MF)-eluting miniature sticks were implanted through a myringotomy incision into the middle ear of 10 guinea pigs. Two additional ears of 2 animals served as controls. Fourteen days after implantation, perilymphatic fluid was collected through an endaural cochleostomy. MF concentrations were measured with high-performance liquid chromatography, and the middle ear mucosal inflammation was graded with hematoxylin and eosin colorations.Fourteen days after implantation, all tympanic membranes had fully healed. An average of 165 ng/mL of MF was detected in the perilymphatic fluid of the experimental ears, and none was measured in control ears. Microscopic residues of the ministicks were found in 90% of the samples, confirming the bioabsorbable properties of this device. Histologic analysis of the middle ear mucosa found similar inflammation profiles in both groups, thereby suggesting middle ear tolerability.MF-coated bioabsorbable miniature stick allows for prolonged delivery over 14 days without injuring the middle ear mucosa. Middle ear-sustained steroid delivery may prove to be beneficial in numerous neurotologic conditions.

To determine how collagen production by tympanic membrane fibroblasts is affected by ciprofloxacin at levels found in eardrops.Prospective, controlled, and blinded cell culture study.Academic tertiary medical center.Cell culture of mouse fibroblasts.A primary fibroblast culture was established from mouse tympanic membranes. Fibroblasts were cultured until they were 75% confluent, then treated with dilute hydrochloric acid (control) or ciprofloxacin (0.01% or 0.3%) for 24 or 72 hours for Western blotting and for 24 or 48 hours for cytotoxicity assay. Cells were observed with phase-contrast microscope. Western blotting was performed for collagen type 1 α1 (collagen 1A1) and α-tubulin.Fibroblasts treated with 0.01% and 0.3% ciprofloxacin for 24 hours had lower levels of collagen 1A1 (P = .0005 and P.0001, respectively) and α-tubulin (both P.0001) than control fibroblasts. Collagen 1A1 and α-tubulin levels were lower in fibroblasts treated with 0.3% than with 0.01% ciprofloxacin (P = .02 and P = .014). After 72 hours, 0.3% ciprofloxacin completely eliminated collagen 1A1 and α-tubulin (P.001). Cells treated with 0.01% ciprofloxacin for 72 hours also had lower collagen 1A1 (P.0001) and α-tubulin (P = .005) as compared with the control. Seventy-two-hour incubation in 0.01% or 0.3% ciprofloxacin resulted in lower levels of collagen 1A1 (P = .009 and P.0001, respectively) and α-tubulin (P = .007 and P.0001, respectively) than 24-hour incubation. Cytotoxicity assay and phase-contrast microscopy mirrored these findings.Treatment of tympanic membrane fibroblasts with 0.3% ciprofloxacin, as found in eardrops, reduces fibroblast viability and collagen and α-tubulin protein levels. These findings could explain tympanic membrane healing problems associated with quinolone eardrops.

Objective Otologists face many disadvantages after extensive mastoid drilling and canal wall down technique in cholesteatoma surgery. Mastoid and epitympanic cavity obliterations or reconstructions after canal wall down procedure using bioactive glass seem to be an interesting solution to overcome some of these disadvantages. Bioactive glass offers many benefits including the availability when there are no sufficient autologous materials for obliteration, its antibacterial activity in chronic infected ear and decreasing the recidivism of cholesteatoma. The objective of this study is to evaluate the tolerance and safety of 45S5 bioactive glass as a filing bone-synthetic material by clinical, audiological and radiological examinations. Methodology A retrospective study of 42 patients who had undergone obliteration of mastoid or/and epitympanic cavity with 45S5 bioactive glass between, November 2017 to January 2019. Data from clinical follow-ups, audiological assessment, CT-scan and MRI were analyzed. Result The patients' mean age was 49.8 years old. Microscopic examinations showed dry well-healed tympanic membranes and external auditory canals for 95.2% of the patients after 1 year. Inner ear injuries after obliteration were not observed by comparing pre and post-operative bone conduction audiometry (p value 0.457). No facial palsy was reported post-operatively. One-year postoperative radiological assessments did not reveal any silent implantation of cholesteatoma or residual disease. Conclusion Mastoid and epitympanic obliterations with 45S5 bioactive glass seem to be a tolerable and safe option in cholesteatoma surgery with favorable outcomes similar to other member of bioactive glass especially the S53P4.

Objective: To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children. Design: A prospective 3‐year cohort study of children in 10 remote Aboriginal communities in South Australia with (n = 4) or without (n = 6) swimming pools. Setting: Outback Australia. Participants: Eight hundred and thirteen school‐age children residing in remote South Australia. Main outcome measures: Prevalence of open and closed middle ear disease and prevalence of hearing loss. Results: About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non‐pool communities (P = 0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non‐pool communities in the frequency of either inactive (19.4% pool vs 22.6% non‐pool; P = 0.232) or active (19.8% pool vs 17.8% non‐pool; P = 0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non‐pool communities in the frequency of type B tympanometry (P = 0.465). Conclusions: Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.

AIM To better elucidate the cellular dynamics by which perforations in the tympanic membrane (TM) are healed. BACKGROUND Under normal conditions, epidermal cells are born and then migrate radially outward from the malleus in the TM. It is unknown what the relative contribution of newly proliferated cells from different lineages is in the healing of TM perforations. METHODS Thirty-six female mice were used in this study. Ethynyl deoxyuridine, a thymidine analogue that labels newly proliferated cells, was injected intraperitoneally into each mouse and then subsequently supplied in the drinking water. Acute perforations were performed on the right TM and the left TM served as the control and remained intact. The animals were sacrificed at six time points between 2 hours and 6 days. We stained for proliferative, epithelial, mesenchymal markers, and ethynyl deoxyuridine and analyzed the distribution of cells. RESULTS In control TMs, newly proliferated cells were detected around the malleus handle and then migrated radially outward. Perforated TMs had a significantly higher number of newly proliferated cells throughout the tympanic membrane with a marked proliferative response of epithelial, mesenchymal, and mucosal cells in the region of the malleus and perforation. The majority of cells in the healed perforation were newly proliferated. In the anterior TM opposite the perforation, an increased turnover of keratinocytes was noted, but not mesenchymal cells. CONCLUSIONS Perforation of the TM alters the cellular dynamics throughout the entire TM, rather than simply adjacent to the perforation. This argues for long distance signaling occurring in the perforated TM.

Background Otitis media is one of the most common childhood diseases worldwide, but because of lack of doctors and health personnel in developing countries it is often misdiagnosed or not diagnosed at all. This may lead to serious, and life-threatening complications. There is, thus a need for an automated computer based image-analyzing system that could assist in making accurate otitis media diagnoses anywhere. Methods A method for automated diagnosis of otitis media is proposed. The method uses image-processing techniques to classify otitis media. The system is trained using high quality pre-assessed images of tympanic membranes, captured by digital video-otoscopes, and classifies undiagnosed images into five otitis media categories based on predefined signs. Several verification tests analyzed the classification capability of the method. Findings An accuracy of 80.6% was achieved for images taken with commercial video-otoscopes, while an accuracy of 78.7% was achieved for images captured on-site with a low cost custom-made video-otoscope. Interpretation The high accuracy of the proposed otitis media classification system compares well with the classification accuracy of general practitioners and pediatricians (~ 64% to 80%) using traditional otoscopes, and therefore holds promise for the future in making automated diagnosis of otitis media in medically underserved populations., Highlights • Computer-based otitis media classification can provide access to diagnosis in developing countries. • Diagnostic accuracy of the image-analysis classification system was comparable to general practitioners' and pediatricians'. Most people globally do not have access to health care specialists who can diagnose one of the most common childhood illnesses, otitis media (middle ear infection). Affecting more than half a billion people annually, early and accurate diagnosis can ensure appropriate treatment to minimize the widespread impact of ear infections. We developed an image-analysis classification system that can diagnose otitis media with an accuracy comparable to that of general practitioners and pediatricians. The software system, which can be cloud-based for remote image uploading, could provide rapid access to accurate diagnoses in developing countries.

BACKGROUND Everolimus is an immunosuppressant agent that has antiproliferative properties and negative effects on wound healing. The effect of everolimus use to delay the closure time of myringotomy is not known. OBJECTIVES The aim of the study was to evaluate the impact of topical everolimus on myringotomy patency and to investigate its histopathologic effects on the tympanic membrane. MATERIAL AND METHODS Twenty Sprague-Dawley rats were bilaterally myringotomized with a myringotomy knife. Gelfoam soaked in 0.05% everolimus in a microemulsion formulation was applied to the right myringotomy site of the rats for 10 min (the everolimus group). The myringotomy sites of the left ears were treated with sterile saline topically (the control group). The tympanic membranes were routinely examined otomicroscopically every other day for 31 days. The membranes were then harvested and evaluated histologically after 31 days. RESULTS All tympanic membranes were closed by the 15(th) day in the control group, while in the everolimus group the myringotomy remained open in five rats (25%) on day 31. The mean durations of myringotomy patency in the everolimus group and control group were 20.90 ± 7.85 and 10.10 ± 3.14 days, respectively. The difference was found to be statistically significant (p < 0.01). In the histopathological examination of the tympanic membranes, there was less fibrosis and less inflammation in the everolimus group than in the control group (p < 0.01). CONCLUSIONS Topical everolimus application is effective in extending myringotomy patency in rat tympanic membranes. Inflammatory reactions and fibrosis in the lamina propria were observed to be significantly less when topical everolimus was used.

OBJECTIVE. This article presents an approach to imaging conductive hearing loss in patients with normal tympanic membranes and discusses entities that should be checked as the radiologist evaluates this potentially complicated issue. CONCLUSION. Conductive hearing loss in a patient with a normal tympanic membrane is a complicated condition that requires a careful imaging approach. Imaging should focus on otosclerosis, and possible mimics and potential surgical considerations should be evaluated. The radiologist should examine the ossicular chain and the round window and keep in mind that a defect in the superior semicircular canal can disturb the hydraulic integrity of the labyrinth.

The authors administered a written survey consisting of colour images of 28 tympanic membranes (TM) to four groups of examiners: 86 medical students, 68 paediatric residents, 62 paediatricians and seven expert otoscopists. For each image, examiners were asked to indicate whether redness or bulging of the TM was present and to assign a diagnosis. The odds of diagnosing acute otitis media (AOM) was examined according to perceived redness or bulging of the TM. Medical students and paediatricians attributed approximately equal importance to isolated redness and isolated bulging of the TM. In contrast, experts placed significantly greater importance on isolated bulging of the TM compared with isolated redness of the TM. The authors suggest that training curricula emphasize the strong association between a bulging TM and a diagnosis of AOM, while de-emphasizing the association between TM redness and AOM.Les auteurs ont demandé à quatre groupes d’examinateurs de remplir un sondage écrit composé d’images couleur de 28 tympans. Ces groupes se composaient de 86 étudiants en médecine, 68 résidents en pédiatrie, 62 pédiatres et sept spécialistes de l’otoscopie. Pour chaque image, ils étaient invités à indiquer s’ils observaient une rougeur ou un bombement du tympan et à poser un diagnostic. Les auteurs ont examiné la possibilité de diagnostiquer une otite moyenne aiguë (OMA) selon la rougeur ou le bombement perçu du tympan. Les étudiants en médecine et les pédiatres attribuaient environ autant d’importance à une douleur isolée qu’à un bombement isolé. En revanche, les spécialistes accordaient beaucoup plus d’importance à un bombement isolé du tympan qu’à une rougeur du tympan. Les auteurs proposent que, dans le cursus d’enseignement, les professeurs soulignent l’association importante entre le bombement du tympan et un diagnostic d’OMA, mais atténuent l’association entre la rougeur du tympan et l’OMA.

Objective To compare the accuracy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) in identifying people with eustachian tube (ET) dysfunction based on symptoms and an objective ET function test. Study Design Cross-sectional study. ObjSettingective Tertiary referral center. Subjects and Methods Fifty-five subjects with and without symptoms suggestive of ET dysfunction completed the ETDQ-7 and had their ET function evaluated by the percentage of middle ear pressure equilibrated after 5 swallows (PEq5) either during a pressure chamber test (intact tympanic membranes) or by the inflation-deflation test (nonintact tympanic membranes). ETDQ-7 score ≥14.5 and PEq5

To prove the concept that a dissolvable "on-command" tympanostomy tube placed into the tympanic membrane of a chinchilla can dissolve when a benign solution is applied and result in a well healed tympanic membrane without histologic evidence of injury.Prospective Randomized Single-Subject Controlled Trial.Prototype tympanostomy tubes were fabricated from poly(butyl methacrylate-co-(2-dimethylaminoethyl) methacrylate-co- methyl methacrylate) (PBM). "In vitro" dissolution studies were performed with applications of the benign chemical, hydrogen peroxide (HP). PBM tubes were placed into ten chinchilla tympanic membranes matched with standard plastic tubes placed into the contralateral side. All 20 tubes were exposed to HP for 21 days with serial endoscopic examinations. In vitro PBM tubes were weighed before and after interventions and compared to control tubes. In vivo photo documentation was used to show progression of dissolution and histologic slides were obtained to show the effect of the PBM on surrounding tissues.Compared to control tubes, all those exposed to hydrogen peroxide had a statistically significant reduction in weight (p 0.01). After placement into the tympanic membrane of chinchillas, all PBM tubes dissolved within 21 days of hydrogen peroxide treatment leaving behind histologically normal, intact tympanic membranes.Our PBM tubes dissolve "on-command" in a chinchilla model when exposed to treatment with a benign chemical. Dissolvable "on-command" tympanostomy tubes may reduce significant complications related to pediatric tympanostomy tube use.

Objective We aimed to examine the effect of topical dexamethasone by otomicroscopic and histologic examinations for preventing myringosclerosis induced by myringotomy in rat tympanic membranes. Methods Twenty-one Sprague Dawley rats (42 ears) were randomly divided into the following three groups after otomicroscopic examinations: experimental surgical group (5 rats), control group (8 rats), and study group (8 rats). The rats of all the groups underwent myringotomy in both tympanic membranes. Other than myringotomy, no additional procedure was performed for the rats in the experimental surgical group. In the control group, 0.9% NaCl was applied to the ears, whereas in the study groups, topical dexamethasone was applied to the ears. These applications in the control and study groups were repeated for nine days. On the 10th day of the study, the rat ears of all groups underwent otomicroscopic and histologic examinations. The prevalence and process of myringosclerosis were evaluated by otomicroscopic examination, whereas inflammation, membrane thickness, and myringosclerosis intensity were evaluated by histologic examination. Results The growth of myringosclerosis with otomicroscopic examination was lesser in the study group in which topical dexamethasone was applied than the control and the experimental surgical groups. Moreover, it was observed that myringosclerosis effected fewer quadrants in the study group.Histologic examinations revealed that inflammation was significantly lesser in the study group than in the experimental surgical and control groups. The average membrane thickness values were significantly lesser in the study group than in the experimental surgical group. With respect to myringosclerosis growth, no statistically significant difference was observed among all groups, whereas with respect to myringosclerosis intensity, the rat ears in the study group were less severely affected. Conclusion Thus, our study results suggest that applying topical dexamethasone after myringotomy has positive effects on limiting the intensity and prevalence of myringosclerosis.

A wide-field optical coherence tomography (OCT) probe was developed that adapts a diagonal-scanning scheme for three-dimensional (3D) in vivo imaging of the human tympanic membrane. The probe consists of a relay lens to enhance the lateral scanning range up to 7 mm. Motion artifacts that occur with the use of handheld probes were found to be decreased owing to the diagonal-scanning pattern, which crosses the center of the sample to facilitate entire 3D scans. 3D images could be constructed from a small number of two-dimensional OCT images acquired using the diagonal-scanning technique. To demonstrate the usefulness and performance of the developed system with the handheld probe, in vivo tympanic membranes of humans and animals were imaged in real time.

The aim of our study was an experimental evaluation of tissue engineering approach to chronic tympanic membrane perforation closure.Chronic tympanic membrane perforation models were created both sides in 12 chinchillas. Right sided perforations were divided into two equal groups (A and B) according to treatment; left sided perforations were used as a control group. Group A perforations were treated with collagen scaffold and fibroblast growth factor, group B perforations were treated with collagen scaffold only. During follow-up, we provided otovideoendoscopy for closure rates assessement every 2 weeks. In case of perforation closure, a morphological investigation of the regenerate was performed.Group A perforations were totally closed 2 weeks after treatment in all animals. In group B, complete closure of perforation was achieved after the third treatment procedure in one case. There were no spontaneous perforation closure in the control group. According to morphological investigation, the restoration of trilaminar structure was observed only in tissue engineering group tympanic membranes.Экспериментальное обоснование эффективности тканеинженерного подхода для закрытия стойкого дефекта барабанной перепонки.Первым этапом нами были созданы стойкие перфорации барабанной перепонки у 12 лабораторных шиншилл. Далее правосторонние перфорации были разделены на две равные группы в зависимости от проводимого лечения, а левосторонние перфорации составили группу контрольного наблюдения. В 1-й группе закрытие перфорации проводилось с использованием коллагенового скаффолда и фактора роста фибробластов, во 2-й группе использовался только коллагеновый скаффолд. В течение периода наблюдения во всех трех группах мы проводили отовидеоэндоскопию каждые 2 нед. В случае закрытия дефекта проводилось гистологическое исследование регенерата.В 1-й группе мы наблюдали закрытие дефекта у всех животных через 2 нед. Во 2-й группе полного закрытия перфорации удалось достичь после трехкратного повторения процедуры у одного животного. Спонтанного закрытия перфорации у животных в группе наблюдения отмечено не было. По данным гистологического исследования, восстановление трехслойной структуры барабанной перепонки наблюдалось только в барабанных перепонках, восстановленных тканеинженерным способом.

A 29-year-old Marine was treated after he was injured by an IED in Afghanistan. The explosion caused traumatic amputations of the right leg and hand, as well as blast and fragmentation injuries of the left arm, left hand, left thigh, abdomen, corneas, and tympanic membranes.

Children undergoing anaesthesia are prone to hypothermia. Perioperative monitoring of patient temperature is, therefore, standard practice. Postoperative temperature is regarded as a key anaesthetic performance indicator in Australian hospitals. Many different methods and sites of temperature measurement are used perioperatively. It is unclear to what degree these methods might be interchangeable. The aim of this study was to determine the relationships between temperatures measured at different sites in anaesthetised children. Two hundred children, 0 to 17 years, undergoing general anaesthesia for elective non-cardiac surgery, were prospectively recruited. Temperature measurements were taken in the operating theatre concurrently at the nasopharynx, tympanic membranes, temporal artery, axilla and skin (chest). Patient age and weight were documented. Temperatures varied according to site of measurement. The mean difference from nasopharyngeal temperature to temperatures at left and right tympanic, temporal, axillary and cutaneous sites were +0.24°C, +0.24°C, +0.35°C, -0.38°C and -1.70°C, respectively. Levels of agreement to nasopharyngeal temperature were similar at tympanic, temporal and axillary sites. Tympanic and temporal temperatures were superior to axillary temperatures for detection of mild hypothermia (

Ambient noise is “the new secondhand smoke.” Like secondhand smoke, excessive ambient noise is not just a nuisance but is a health and public health problem for millions of Americans. Excessive ambient noise causes hearing loss; disrupts sleep, function, and communication; and causes non-auditory health effects including cardiovascular disease and death. The sounds that matter to people are the ones reaching their tympanic membranes, or perhaps the cochlear hair cells or auditory processing cortex. Specific evidence-based noise exposure levels affect human health. 30 dBA (LAeq(8)) disrupts sleep. 45 dB (Ldn) disturbs concentration. 55 dB daily average (Lden) has non-auditory heath effects, including cardiovascular disease and death, due to stress responses including activation of the autonomic nervous system and neuroendocrine axis. Approximately 60 dBA (LAmax) interferes with speech comprehension for the hearing impaired. 70 dBA daily average (LAeq(24)) causes hearing loss, and 70 dBA (LAmax) interferes with speech comprehension for those with normal hearing. 85 dBA (LAeq(8)) is the occupational recommended exposure level in the United States, and 85 dBA (LAeq(1)) is the recommended exposure limit to prevent hearing loss. Acoustic scientists and engineers must be aware of these specific, evidence-based noise exposure levels and must work to reduce excessive ambient noise.

BACKGROUND On April 15, 2013, at approximately 2:49 p.m. EDT, two improvised explosive devices detonated near the finish line of the 117th Boston Marathon. Patients were transported from the scene to several trauma centers, including the authors' institution. METHODS Plastic surgical assessment of patients began in the Emergency Department and then rapidly expanded as the scope of the incident became clear. Daily interdisciplinary meetings involving the acute care surgery, orthopedic surgery, plastic surgery, and nursing services were convened in order to coordinate operating room schedules and treatment plans. An interdisciplinary weekly clinic continued until all patient goals had been reached. RESULTS Twenty-four patients were treated at Beth Israel Deaconess Medical Center within the first 24 hours of the Boston Marathon bombing. Seven were triaged directly to the operating room from the Emergency Department. The Division of Plastic Surgery was directly involved with the care of 11 patients, all of whom were treated surgically within 24 hours of the bombing. Patients were aged 23 to 50 years old. All 11 patients sustained lower extremity injuries with gross contamination. Four patients also sustained significant upper extremity trauma. Injuries included extremity amputations and fractures, soft-tissue loss, impaction of nails and other debris, burns, ocular injury, and ruptured tympanic membranes. CONCLUSIONS Twenty-four patients received acute care at Beth Israel Deaconess Medical Center following the Boston Marathon bombing. Institution of dedicated interdisciplinary daily rounds, protected operating room block time, and joint follow-up clinic allowed for efficient early diagnosis and treatment of patients' injuries.

Objective To investigate the ototoxic effect of boric acid solution prepared with different degree of alcohol. Methods This study was performed on 28 young albino guinea pigs. After the animals divided four groups prior to the application of the solution an auditory brainstem response (ABR) test was applied to the each animal under general anesthesia. Their tympanic membranes perforated and test solutions were administrated to the middle ear through the perforation. On 15th day, ABR measurements were carried out and comparison was made with preadministration values. Results The degrees of hearing loss occurring as a result of the administration of 4% boric alcohol solutions prepared with 60° and 40° alcohol differed significantly ( p Conclusion It was established that 4% boric acid solution prepared with 60 alcohol affected hearing in guinea pigs more negatively and an increase in degree of alcohol also increased the ototoxicity of the boric acid solution.

Type II collagen is synthesized in the tympanic membrane during healing of a perforation. The time course and appearance of Type II collagen regrowth in the newly healed tympanic membrane is the subject of the present study.The arrangement of Type II collagen fibers in the tympanic membrane gives it a unique tensile strength important for sound conduction. Healing after tympanic membrane perforation can cause the tympanic membrane to lose its characteristic. At what phase Type II collagen in tympanic membrane is replaced during healing of a perforation has previously not been studied.Rat tympanic membranes were perforated, and the animals were sacrificed 9 to 16 days after perforation. Tympanic membranes were stained with a Type II collagen antibody.At Day 9, a majority of the tympanic membranes had healed. Keratinizing epithelium and connective tissue had formed, but there was no Type II collagen. At Day 10, all tympanic membranes had healed, and staining for Type II collagen appeared. After Day 10, staining was more intense. Newly formed collagen did not show the parallel bundle arrangement seen in normal tympanic membranes but was more scattered in the tissue.Type II collagen was seen in tympanic membranes only after closure of the perforation. The fiber arrangement after healing was disturbed, which presumably has an impact on the function of the tympanic membrane. Understanding the formation of Type II collagen in the healing of tympanic membrane perforations could enable further research toward treating tympanic membrane perforations.

A close relationship between reactive oxygen species (ROS) and myringosclerosis, which is a common complication of myringotomy, was recently reported. The objective of this study was to measure ROS levels directly in rat tympanic membranes using luminol-aided chemiluminescence (CL) in order to compare the levels of ROS after incisional and radiofrequency (RF) myringotomy.Fifteen Sprague-Dawley rats were separated into three groups of five animals each. Bilateral myringotomies were made using an appropriate myringotomy lancet in Group 1 and RF in Group 2. Group 3 served as the control group with no myringotomy. Twenty-four hours after the procedure, all tympanic membranes were inspected with an otomicroscope and then excised for the measurement of ROS using luminol-aided CL.The mean ROS level in Group 1 was significantly higher than that in Groups 2 and 3 (p0.05 for both). The difference in mean ROS level between Groups 2 and 3 was not significant (p0.05). Otomicroscopy revealed increased vascularity and vessel dilation in all tympanic membranes that underwent myringotomy. Vascular dilation was observed in the annular region in the vessels that passed along the long arm of the malleus, in addition to the vessels feeding the anterior and posterior tympanomalleolar folds.Although the relationship between ROS and the development of myringosclerosis after myringotomy has been demonstrated, the present study is the first to compare incisional and RF myringotomy based on the measurement of ROS levels. Our results indicate that the increase in ROS due to myringotomy was greater following incisional myringotomy than RF myringotomy.

Objectives:This study aimed to investigate the effect of local and intraperitoneal administration of l-carnitine on the prevention of experimentally induced myringosclerosis, and to compare treatment efficiency.Methods:Twenty-four Albino-Wistar rats (48 ears) were bilaterally myringotomised and divided randomly into four groups: group one received no treatment, group two received intraperitoneal l-carnitine, group three received local l-carnitine, and group four received both intraperitoneal and local l-carnitine. On the 15th day after treatment, tympanic membranes were harvested and evaluated histopathologically for myringosclerotic plaque formation, fibroblastic proliferation, tympanic membrane thickness and new vessel formation.Results:The group one tympanic membranes showed extensive thickness, and the incidence of myringosclerosis and fibroblast proliferation were greater than in groups two and four. There were statistically significant differences in tympanic membrane thickness between groups three and four, and in myringosclerosis incidence and fibroblast proliferation, comparing groups two, three and four.Conclusion:Myringosclerosis development was significantly reduced in rats receiving myringotomy plus intraperitoneal l-carnitine. Intraperitoneal l-carnitine administration prevented fibroblastic proliferation and tympanic membrane thickening (both of which cause further tympanic membrane destruction), thus reducing myringotomy-associated morbidity. Local l-carnitine administration had limited effectiveness in this experimental setting.

Natural passive mechanical systems such as ear tympanic membranes may show active responses by incorporating feedback mechanisms which then affect their mechanical structure. In this paper, the moth's auditory system is used as a biological model of inspiration. A smart acoustic system which alters its natural resonance frequency was developed. Experimental results, given by a proposed-built real-time embedded system, show time and amplitude dependency towards dynamic frequency adaptation according to the intensity of acoustic input signals.

1. Lisa Mitchell, DO* 2. William Adams, MD* 3. Francois Aspesberro, MD† 1. *Madigan Army Medical Center, Tacoma WA. 2. †Seattle Children's Hospital, Seattle, WA. A previously healthy 30-month-old girl presents a third time to the emergency department (ED) with a 3-day history of cough, increased fussiness, neck stiffness, clumsiness, and unwillingness to open her mouth. She continues to drink well but refuses to eat. She has had several brief episodes of screaming followed by paroxysmal stiffness, during which she has difficulty drawing breath and has roving eye movements, but she seems awake and alert. A normal breathing pattern resumes quickly after the episodes resolve. Episodes have been worsening in frequency, duration, and apparent intensity of pain, and today she had an episode at home that lasted 60 seconds and was accompanied by perioral cyanosis. She takes no medications, has had no immunizations, and has no travel history or sick contacts, and her parents deny known ingestions or trauma. Two days ago, the patient developed a cough, listlessness, and vocal raspiness. Her parents noticed that she was drinking liquids well but had difficulty chewing and opening her mouth, and her neck seemed stiff. On the second day of illness, she presented to another ED after 2 brief episodes of stiffening during which she had noisy, shallow breathing, followed by a gasp, and then resumption of a normal breathing pattern. Apart from erythematous tympanic membranes, her examination results were normal, and she was diagnosed with acute otitis media and sent home with ibuprofen and azithromycin. Early the next morning, she had a more prolonged episode in which she cried out in pain, stiffened, and then tried to breathe but seemed unable to do so. This lasted longer than before and was accompanied by cyanosis but …

In the context of Middle and Late Pleistocene eastern Eurasian human crania, the external auditory exostoses (EAE) of the late archaic Xuchang 1 and 2 and the Xujiayao 15 early Late Pleistocene human temporal bones are described. Xujiayao 15 has small EAE (Grade 1), Xuchang 1 presents bilateral medium EAE (Grade 2), and Xuchang 2 exhibits bilaterally large EAE (Grade 3), especially on the right side. These cranial remains join the other eastern Eurasian later Pleistocene humans in providing frequencies of 61% (N = 18) and 58% (N = 12) respectively for archaic and early modern human samples. These values are near the upper limits of recent human frequencies, and they imply frequent aquatic exposure among these Pleistocene humans. In addition, the medial extents of the Xuchang 1 and 2 EAE would have impinged on their tympanic membranes, and the large EAE of Xuchang 2 would have resulted in cerumen impaction. Both effects would have produced conductive hearing loss, a serious impairment in a Pleistocene foraging context.

Objective:In this study, we evaluated the effect of low-level lasers on the healing of tympanic membrane perforation, one of the most common otological pathologies.Methods and materials:Twenty-four guinea pigs were randomly assigned to either the experimental or control group. One day after the induction of a 2 mm diameter, centred myringotomy in all animals, the tympanic membranes in the experimental group were irradiated with 630 and 860 nm lasers for 10 days. Two weeks later, histological changes in the membranes were evaluated.Results:Tympanic membrane thickening and inflammatory cell infiltration in the tympanic membranes and surrounding tissues were significantly less in the experimental group (p p = 0.42).Conclusion:The results show that the combined application of 630 and 860 nm lasers had a significant effect on the healing of tympanic membrane perforation, and on the prevention of thick fibrotic or atelectatic neomembrane formation.

Objective A pressure equalization tube placed within the tympanic membrane is the only clinically available method for inhibiting tympanic membrane regeneration. Problems associated with this include associated otorrhea, biofilm formation, medial migration of the tube, tube retention, induction of granulation tissue, and a small but significant rate of cholesteatoma. We aimed to demonstrate that a single administration of a sustained-release polymer formulation of KB-R7785 maintains tympanic membrane perforation for at least 6 months. Materials and methods Sustained-release KB-R7785 was delivered within a novel polymer hydrogel to 20 mice with bilateral acute tympanic membrane perforations (a total of 40 perforations). The perforations were monitored at 3-month intervals until 9 months. Results At 3 months, 90% of perforations were open (n=36/40). At 6 months, 75% of perforations were open (total n=30/40). At 9 months, 22.5% of perforations were open (total n=6/40). The majority of tympanic membrane perforations (75%) were open (not healed) beyond 6 months and close (fully healed) prior to 9 months (77.5%). Once healed, tympanic membranes resembled their normal histological appearance. Conclusion This study demonstrates that a single administration of a sustained-release polymer formulation of KB-R7785 inhibits tympanic membrane regeneration for 6-9 months.