Feasibility of endoscopic treatment of middle ear myoclonus: a cadaveric study

COVID-19-Associated Middle Ear Myoclonus in a 10-Year-Old Male

Middle ear myoclonus is a rare condition attributed to abnormal, repetitive contractions of the middle ear muscles including the tensor tympani and/or stapedius muscles. This condition generates objective tinnitus that is characterized by a “clicking” noise that is audible to both the patient and an outside observer. No specific pathophysiologic process has been identified as the cause of middle ear myoclonus, making its diagnosis and treatment challenging. In this report, we present a presumptive case of COVID-19-associated middle ear myoclonus in a 10-year-old male.

[Basis of endoscopic dissection of the ear with analysis of endoscopic anatomy. Part 2.]

Nowadays, endoscopic transcanal otosurgery with confident steps is becoming a practice. Obviously, any new method of intervention needs to be repeatedly tested by the surgeon before it is used on the patient. This is why dissection work is so important and popular. Working on biomaterial sets itself several tasks: training manual skills of working with an endoscope and an instrument in the middle ear cavities, stage-by-stage training for performing specific interventions, detailed analysis and repetition of anatomy and topography of structures. This article presents a step-by-step dissection algorithm with an analysis of the anatomical landmarks of each area, such as the prototype. The proposed training protocol allows practicing such interventions as endaural atticotomy, types of ossiculoplasty, stapedoplasty, decompression of the facial nerve to the geniculate ganglion area, infracochlear and transpromontorial approaches to the internal auditory canal. Keywords: endoscopic otosurgery, transcanal otosurgery, chronic otitis media, otitis media, otitis media in children, otodissection, endoscopic otodissection.

[Basis of endoscopic dissection of the ear with analysis of endoscopic anatomy. Part 1]

Today, endoscopic transcanal ear surgery with confident steps is becoming a practice. It will be used by the patient in repeated practice by the surgeon before being used in the patient. It is so important and popular in connection with this dissection work. Working on biomaterial sets itself several tasks: training manual skills to work with an endoscope and an instrument in the middle ear, stage-by-stage training for performing specific interventions, detailed analysis and understanding of structures anatomy and topography. This article presents a step-by-step dissection algorithm with an analysis of the each area anatomical landmarks, like a prototype. Moreover, the course of dissection allows you to work out the performance of type I tympanoplasty.

Pain After Ear Surgery: A Prospective Evaluation of Endoscopic and Microscopic Approaches

Objectives/Hypothesis

Assumed advantages of a minimally invasive endoscopic transmeatal approach in ear surgery are less postoperative pain, faster healing, and preservation of functional anatomy. We evaluated pain after ear surgery and compared endoscopic transmeatal, microscopic endaural, and retroauricular approaches.

Study Design

Prospective cohort study.

Methods

A prospective evaluation of pain during 3 weeks after ear surgery was performed. Three groups were defined: endoscopic transmeatal, microscopic endaural, and retroauricular. Data from 20 fully completed questionnaires (Brief Pain Inventory–Short Form) per group were analyzed with Bayesian and frequentist statistics.

Results

For all approaches, low pain scores were found, not exceeding 4 on a scale of 0 to 10. Analysis of the worst, least, and average pain scores documented per 24 hours showed no statistically significant difference nor equality between groups. With Bayesian statistics, a Bayes factor of 1.07, 0.25, and 0.51 was found, respectively. With frequentist statistics a p value of .092, .783, and 0.291 was found, respectively. Small, but statistically significant, differences were found for sleep, natural sleeping position, normal work, and pain medication taken. The location of pain correlates with the incision site.

Conclusions

The results of this study show that the surgical approach has no clinically relevant influence on postoperative pain after ear surgery. The statistically significant differences on natural sleeping position, sleep, normal work, and amount of pain medication taken are small and should be interpreted with caution. Therefore, these should not be decisive factors in the choice of surgical approach in ear surgery.

Level of Evidence

3 Laryngoscope, 131:1127–1131, 2021

A Novel Technique for the Diagnosis and Management of Middle Ear Myoclonus

A novel technique for the diagnosis and management of middle ear myoclonus is described. A patient with middle ear myoclonus underwent a trans-canal microscopic middle ear exploration with injection of botulinum toxin into the stapedius and tensor tympani muscles. Postoperatively, the patient noted complete resolution of symptoms. This is the first report of the use of botulinum toxin directly applied to the middle ear musculature via a trans-canal approach for the management of middle ear myoclonus. This approach is both a useful diagnostic and therapeutic tool that allows for temporary muscle paralysis prior to offering definitive surgical management. Laryngoscope, 131:E248-E249, 2021.

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

[Myoclonus of the middle ear]

The objective of the present study was to overview the foreign literature concerning middle ear myoclonus (MEM) known to be the most common cause of the manifestations of objective tinnitus. The authors reports two typical clinical cases of myoclonus of the middle ear. The present article is aimed at the enhancement of the awareness of the otorhinolaryngologists, audiologists, and neurologists of the condition of interest as a way to promote the further progress in its treatment.

Endoscopic and minimally-invasive ear surgery: A path to better outcomes

The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.