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Wang Z, Hu HT, Bakheet N, Yoon SH, Park JH, Kim KY, Jeon JY, Kang WS, Kim YR, Lopera JE, Park HJ, Song HY. The rat eustachian tube: Anatomical, histological, and radiological features. J Interv Med 2023; 6:14-19. [PMID: 37180372 PMCID: PMC10167518 DOI: 10.1016/j.jimed.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose This study investigated the anatomical and histological characteristics of the rat Eustachian tube (E-tube) and the feasibility of Eustachian tubography in a rat model. Materials and methods Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate E-tube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the trans-tympanic approach. Results The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes' mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices' mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat. The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks. Conclusion In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.
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Affiliation(s)
- Zhe Wang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, CN, 300052, China
| | - Hong-Tao Hu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Minimal-Invasive Intervention, Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou City, Henan Province, 450003, China
| | - Nader Bakheet
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Gastrointestinal Endoscopy and Liver Unit, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sung Hwan Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
- Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Ree Kim
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jorge E. Lopera
- Department of Radiology, UT Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Hong Ju Park
- Department of Otorhinolaryngology Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 05505, Republic of Korea
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Kanotra S, Purbi S, Bashir S, Sharma P. Endoscopic Treatment of Otitis Media with Effusion. Indian J Otolaryngol Head Neck Surg 2022; 74:4356-4359. [PMID: 36742874 PMCID: PMC9895635 DOI: 10.1007/s12070-021-03012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Myringotomy with grommet insertion is considered the standard of care for patients with unresolved otitis media with effusion and is traditionally performed under the operating microscope. The introduction of endoscopic ear surgery has provided otologists a tool for minimally invasive ear surgery with a panoramic view. We have described the use of endoscope for myringotomy and grommet insertion. The technique was found to be safe and effective and has the added advantage of being an excellent tool for teaching. The advantages and disadvantages of this technique vis a vis the traditional otomicroscopic technique have been discussed.
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Affiliation(s)
- Sonika Kanotra
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Shweta Purbi
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Seerat Bashir
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Preeti Sharma
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
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A three-dimensional printed myringotomy, tympanostomy and ventilation tube placement simulator. The Journal of Laryngology & Otology 2021; 135:420-425. [PMID: 33952362 DOI: 10.1017/s0022215121001146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement. METHODS An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed. RESULTS The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education. CONCLUSION The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.
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Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion. The Journal of Laryngology & Otology 2020; 134:497-500. [PMID: 32618522 DOI: 10.1017/s0022215120001188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope. METHODS A prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained. RESULTS There was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group. CONCLUSION The absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing 'steep learning curve' in arguments against the use of endoscopes in middle-ear surgery.
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Malic M, Milicic B, Gjuric M. Endoscopic Removal of Medially Migrated Tympanostomy Tube. EAR, NOSE & THROAT JOURNAL 2019; 100:NP191-NP192. [PMID: 31565990 DOI: 10.1177/0145561319869606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mislav Malic
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Borna Milicic
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Gjuric
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
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Erbek S. Oto-endoscopic Versus Microscopic Ventilation Tube Placement In Children. ENT UPDATES 2018. [DOI: 10.32448/entupdates.458859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Park JH, Kang WS, Kim KY, Kang BC, Park JW, Kim MT, Bekheet NG, Hwang SJ, Choi J, Cho KJ, Park HJ, Song HY. Transnasal Placement of a Balloon-Expandable Metallic Stent: Human Cadaver Study of the Eustachian Tube. J Vasc Interv Radiol 2018; 29:1187-1193. [PMID: 30056936 DOI: 10.1016/j.jvir.2018.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To investigate the technical feasibility of stent placement in the cartilaginous portion of the Eustachian tube (ET). MATERIALS AND METHODS Twelve ETs of 6 cadavers were used. Two different-sized stents were placed on either the right (2.5 mm in diameter) or left (3.5 mm in diameter) side of the ET. The procedural feasibility was assessed by subtraction Eustachian tubography, computed tomography before and after the procedure, and fluoroscopic and endoscopic images. The stent location, inner luminal diameter of the stented ET, radiation dose, procedural time, and fluoroscopy time were analyzed. RESULTS Stent placement was successful in 11 of 12 cadaveric specimens without procedure-related complications. In the 1 specimen, the balloon catheter with crimped stent was passed into the bony canal of the ET without any resistance. The distal end of the stent was located in the middle ear cavity. Stents were located within the cartilaginous portion of the ET (n = 1), the proximal tip bridging the nasopharyngeal orifice of the ET (n = 5), or the proximal end of the stent protruded from the tubal orifice (n = 5). The mean luminal diameter in the outer segment was significantly smaller than in the middle (P < .001) and inner (P < .001) segments. The mean procedure time was 128 ± 37 seconds. The mean radiation dose and fluoroscopy time of each cadaver were 3235.4 ± 864.8 cGy/cm2 and 139 ± 49 seconds, respectively. CONCLUSIONS Stent placement of the ET under endoscopic and fluoroscopic guidance is technically feasible in a human cadaver model.
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Affiliation(s)
- Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung-Chul Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jun Woo Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min Tae Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Nadar G Bekheet
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Jun Hwang
- Department of Anatomy and Cell Biology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joonmyeong Choi
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, 05505, Republic of Korea
| | - Kyu-Jin Cho
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, 05505, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Kuo CH, Wu HM. Comparison of endoscopic and microscopic tympanoplasty. Eur Arch Otorhinolaryngol 2017; 274:2727-2732. [PMID: 28439691 DOI: 10.1007/s00405-017-4570-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
Tympanoplasty was conventionally performed using a microscope for decades. However, since the endoscope began to be used in middle ear surgery in the 1970s, endoscopic tympanoplasty has gained increasing attention. The main objective of this study was to compare endoscopic and microscopic tympanoplasty with and without ossiculoplasty, demonstrating the potential advantages, disadvantages, and outcomes of each. This retrospective study included 126 patients with chronic otitis media who received tympanoplasty from 2013 to 2015 in our hospital. The clinical follow-up continued for at least 3 months postoperatively. Otoscopy and audiometry were conducted before and after the procedure. The different variables affecting surgical outcomes were thoroughly documented in each case. A total of 126 patients (131 ears) were included in this retrospective study. Moreover, 74 and 57 ears underwent endoscopic and microscopic tympanoplasty, respectively. The overall endoscopic tympanoplasty graft uptake rate was 97.7% (128/131). The operation time was significantly shorter in the endoscopic group statistically. A paired t test was used to compare pre- and postoperative audiometry results and showed significant differences between the endoscopic and microscopic groups. However, no statistically significant difference was observed in audiometry improvement between the two groups. No major complications were observed in any of the patients. Our study demonstrated that endoscopic tympanoplasty can be feasibly applied in middle ear surgery. The success rate, audiometry improvement, and complication rate are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. Moreover, the endoscopic group had smaller operation wounds and lower medical expenditures.
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Affiliation(s)
- Che-Hung Kuo
- Otolaryngology Department, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan
| | - Hsing-Mei Wu
- Otolaryngology Department, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan. .,Medical School, Fu-Jen Catholic University, Taipei, Taiwan.
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Bakshi SS. Letter to the Editor on "Myringotomy and Ventilation Tube Insertion with Endoscopic or Microscopic Technique in Adults: A Pilot Study". Otolaryngol Head Neck Surg 2015; 153:1076. [PMID: 26621925 DOI: 10.1177/0194599815603056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Martellucci S, Gallo A. Re: "Myringotomy and Ventilation Tube Insertion with Endoscopic or Microscopic Technique in Adults". Otolaryngol Head Neck Surg 2015; 153:1076-7. [PMID: 26621926 DOI: 10.1177/0194599815603057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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