Changes in external ear resonance after 3 types of surgery in the patients with chronic otitis media

Hair regrowth in cicatricial alopecia: A literature review

Cicatricial alopecias (CA) describes multiple subtypes of hair loss in which the hair follicle is destroyed by an unknown inflammatory mechanism. The main goal of treatment is to stop this inflammatory process and prevent further hair loss; however, there have been occasional reports of hair regrowth following treatment in some subtypes of CA. This review aims to highlight these reports. A total of 71 cases of hair regrowth were found documented in the literature. The treatments used varied widely both between and within each subtype of alopecia. This review highlights that regrowth is possible in at least a subset of patients with cicatricial alopecia; however, the mechanism by which this occurs has yet to be elucidated.

Effect of mouth-opening levels on sound field gain in the ear canal

The human external auditory canal can become deformed when the mandible moves, and this changes the sound field in the external auditory canal. This study measured the sound field gain in the external auditory canal while varying mouth-opening in three levels. The mandible was fixed at the 1/3, the 2/3, and the maximal mouth-opening levels. Seven 65-dB tones of 200, 500, 1000, 2000, 4000, 6000, and 8000 Hz, which are the sound pressure level and frequency range when people are talking at a normal level, were adopted as the sound stimulus to measure sound field gains at 5, 10, 15, and 20 mm to the interior of the external auditory canal. The results show that, with the exception of the 1.25 dB decrease from 12.96 to 11.71 dB at a depth of 5 mm with a stimulus at 8000 Hz, the differences in the sound field gain at the other depths and stimulus frequencies were within 1 dB and were not statistically significant. These results suggest that mouth-opening level has no effect on the measurement of the sound field in the external auditory canal.

Canal wall reconstruction and preservation in the surgical management of cholesteatoma in children with Down's syndrome

INTRODUCTION

Down's syndrome is associated with poor Eustachian tube function, and an increased incidence of cholesteatoma. The only previously published case series suggests that 'canal wall preserving' procedures are only rarely suitable for the management of cholesteatoma in this population.

METHODS

We conducted a retrospective review of the hospital's clinical records database to identify patients with Down's syndrome and cholesteatoma. These patients' notes were then reviewed.

RESULTS

We identified nine patients with Down's syndrome who had undergone surgical management of cholesteatoma over a twelve year period. Three patients had bilateral disease, meaning twelve ears were treated. Seven ears were initially treated with 'canal wall down' procedures. Four out of five of the remaining ears were successfully treated using 'canal wall preservation' or 'canal wall reconstruction', with one ear requiring subsequent conversion to a 'canal wall down' approach.

CONCLUSION

Canal wall preservation/reconstruction is feasible in patients with Down's syndrome, even when cholesteatoma extends into the mastoid.

Gain affected by the interior shape of the ear canal

OBJECTIVE

This study investigated the correlation of gain distribution and the interior shape of the human external ear canal.

STUDY DESIGN

Cross-sectional study of gain measurement at the first bend and second bend.

SETTING

Chang Gung Memorial Hospital and Chang Gung University.

SUBJECTS AND METHODS

There were 15 ears in patients aged between 20 and 30 years (8 men/7 women) with normal hearing and middle ears. Stimulus frequencies of 500, 1000, 2000, 3000, and 4000 Hz were based on the standard clinical hearing test. Measurements closer to the tympanic membrane and the positions at the first and second bends were confirmed by using otoscope. Real ear measurement to analyze the canal resonance in human external ears was adopted.

RESULTS

This study found that gain at stimulus frequencies of 4000 Hz was affected by the interior shape of the ear canal (P < .005), particularly at the first and second bends, whereas gain was only affected by the length of the ear canal for stimulus frequencies of 2000 Hz (P < .005).

CONCLUSION

This study found that gain was affected not only by the length of the external auditory canal (EAC) but also by the interior shape of the EAC significantly. The findings of this study may have potential clinical applications in canalplasty and congenital aural atresia surgery and may be used to guide surgeries that attempt to reshape the ear canal to achieve more desirable hearing outcomes.

Hearing Outcomes According to the Types of Mastoidectomy: A Comparison between Canal Wall Up and Canal Wall Down Mastoidectomy

Objectives

The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM) and canal wall down mastoidectmy (CWDM).

Methods

One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty.

Results

The preoperative ABG in both groups (CWUM and CWDM) were 28.4±15.6 dB and 31.8±14.5 dB, respectively (P=0.18). Both groups didn't show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25).

Conclusion

The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.

Epitympanoplasty with mastoid obliteration technique: A long-term study of results

Objective: To report the long-term results of epitympanoplasty with mastoid obliteration technique.

Subjects and Methods: Two hundred adult cases had undergone epitympanoplasty with mastoid obliteration from December 1994 to May 2003. The mean postoperative observation period was 91 months, with a minimum of five years. Epitympanoplasty with mastoid obliteration technique has four major procedures: the widening of the external auditory canal and removal of the scutum; preservation of the posterior canal wall; epitympanoplasty; and mastoid obliteration. We examined postoperative complications and hearing outcomes.

Results: There was no retraction pocket formation and recurrence of cholesteatoma. Residual cholesteatoma in the tympanic cavity was seen in 10 cases (5%) and three cases were seen in the mastoid cavity (1.5%). Other complications were otorrhea (15 cases), perforation (8 cases), material extrusion (6 cases), and posterior auricular infection (4 cases). The average preoperative pure tone air-bone gap, postoperative pure tone air-bone gap, and air-bone gap closure were 31.5 ± 12.4 dB, 25.3 ± 12.2 dB, and 6.2 ± 12.6 dB, respectively. There were significant differences between the preoperative and postoperative values ( P < 0.01).

Conclusions: The authors believe that epitympanoplasty with mastoid obliteration technique can combine the advantages of canal wall down and canal wall up techniques while improving their shortcomings.