[Advances in research on treatment of tympanosclerosis]

Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.

Evaluation of aortic stiffness by echocardiography in tympanosclerosis patients

BACKGROUND AND AIMS

Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. This study aimed to determine echocardiographically whether aortic elasticity is impaired in TS-detected patients and to correlate blood inflammatory parameters with TS and aortic elasticity.

METHODS

Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were assigned to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were comparable.

RESULTS

Demographic, clinical, and laboratory parameter differences were insignificant. Hs-CRP, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in the study group than in the control group (P=0.018, P=0.003, P=0.019, respectively). The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; P<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; P=0.001) values than the control group. The AS index was significantly higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; P<0.001).

CONCLUSION

In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, may signify early cardiovascular involvement in TS-developed patients.

[Analysis of medium and long term efficacy of ossicle chain bypass technique in treatment of tympanosclerosis]

Objective:For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. Methods:From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People's Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group（OCM）, 56 cases in the ossicular chain bypass reconstruction group（OCB）, and 40 cases in the malleus-incus complex resection reconstruction group（MICR）. Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed. Results:There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group（0） was significantly lower than that in OCM group（11.76%） and MICR group（7.5%）（P<0.05）. At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group（P<0.05）. At 36 months after operation, ΔABG of OCB group was better than that in the OCM group（P<0.05）, and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis（ETS） at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis（PTS） and total tympanosclerosis（TTS）（P<0.05）. Conclusion:Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.

Myringosclerosis as a predictor of the requirement for a permanent pacemaker in patients with drug-related atrioventricular block

AIMS

Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative conduction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guidelines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation.

METHODS

This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients' demographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed.

RESULTS

There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4-7] days vs. 2 [1-5] days; P<0.001). The incidence of myringosclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194-3.058; P=0.01).

CONCLUSION

Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB.

CoCl2 -simulated hypoxia potentiates the osteogenic differentiation of fibroblasts derived from tympanosclerosis by upregulating the expression of BMP-2

Tympanosclerosis (TS) is a result of long-standing middle ear inflammation characterized by fibroblasts ossification. Fibrosis is the last revertible stage in the progress of middle ear inflammation to TS. It was hypothesized that chronic hypoxia could be modulating fibrosis, which in turn additionally further aggravated hypoxia via decreasing oxygen diffusion. However, the effects of hypoxia on osteoinductive activity of fibroblasts have not been explored. Herein, we purposed to explore the role of hypoxia in osteogenic differentiation of fibroblasts derived from TS. The expression of bone morphogenetic protein-2 (BMP-2), hypoxia-inducible factor-1α (HIF-1α), and Vimentin in the human surgical specimens of tympansclerosis was investigated by immunofluorescent staining. Furthermore, cultured fibroblasts were stratified into the following study groups: control, 25, 50, and 100 μM cobaltous chloride (CoCl₂ ) group. BMP-2, as well as HIF-1α levels of expression were detected via western blotting and immunofluorescence analysis. We found that the expression of BMP-2 and HIF-1α was significantly upregulated in TS tissues and these fibroblasts, which was vimentin positive surrounding sclerotic plaques, were also expressing HIF-1α positive. The results also demonstrated that CoCl₂ treatment increased nuclear HIF-1α protein level in the fibroblast. Furthermore, treatment with CoCl₂ significantly increased BMP-2 expression and remarkably elevated alkaline phosphatse activity and the mineralized nodules area. These data illustrate that hypoxia may play an osteogenic role in TS fibroblasts via the elevated expression of a possible osteogenic factor, BMP-2.

Reliability of high-resolution CT scan in diagnosis of ossicular tympanosclerosis

OBJECTIVES

To evaluate the reliability of high-resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post-surgical hearing outcome based on comparing radiological and surgical findings.

METHODS

A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air-bone gap (ABG) were compared. A postoperative pure-tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients.

RESULTS

The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo-malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo-malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow-up after 6 months.

CONCLUSIONS

Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

[An observation of long term effect of one-stage hearing reconstruction on tympanosclerosis]

Objective:To observe the long-term hearing stability of patients with tympanosclerosis after one-stage hearing reconstruction. Method:Forty-one patients with tympanosclerosis were included in the study. Their puretone thresholds before operation and those at 3 months, 6 months, 1 year, 2 to 5 years after operation were retrospectively analyzed. Differences between pre-and postoperative air-bone gaps（ABG） for speech frequencies（0.5, 1, 2, 4 kHz） as well as those of averaged ABG were calculated. Result:Preoperative averaged ABG of 44 ears was （36.0±10.4） dB. Averaged ABG at 3 months, 6 months, 1 year, 2 to 5 years after operation were （24.1±8.8） dB, （24.5±9.8） dB, （22.4±11.3） dB and （22.5±4.1） dB respectively. Averaged ABG at different time after operation were all significantly less than preoperative results but didn't differ between each other. Postoperative ABG for different frequencies varied between 9.3 and 33.7 dB. They were significantly less than preoperative results, but didn't differ between the four frequencies. At different time after operation, averaged ABG of type Ⅰ were always significantly less than those of type Ⅱ, while the latter were always significantly less than those of type Ⅳ. Differences between preoperative ABG and ABG at different postoperative time were not significantly different. Neither were differences between pre-and postoperative ABG for different frequencies. Conclusion:Hearing reconstruction has the same effect on hearing improvement of patients with tympanosclerosis at different frequencies. Type Ⅰ patients has the best hearing results while type Ⅳ patients has the worst. There is no significant difference between the long-term（1 year and more than 2 years after operation） and the short-term（3 months and 6 months after operation） hearing level. Hearing level of patients with tympanosclerosis remain stable in a long time after operation.

Role of TGF-β1-mediated epithelial-mesenchymal transition in the pathogenesis of tympanosclerosis

The present study aimed to explore the role of TGF-β1-mediated epithelial-mesenchymal transition (EMT) in the pathogenesis of tympanosclerosis. Sprague Dawley rats were injected with inactivated Streptococcus pneumoniae suspension to establish a rat model of tympanosclerosis. The rats were sacrificed 8 weeks after the model was established. H&E and von Kossa staining was used to observe the morphological changes of middle ear mucosa. Western blotting was used to detect the expression of TGF-β1 and EMT-associated proteins in the mucosa samples. Middle ear mucosal epithelial cells of rats were collected to establish a primary culture. The cultured cells were stimulated with TGF-β1 and the expression of EMT-associated proteins was detected by western blotting and immunofluorescence. In addition, the cells were treated with TGF-β receptor type I/II inhibitor and the expression level of EMT-associated proteins was detected by western blotting. Sclerotic lesions appeared on 72.4% of tympanic membranes, and marked inflammation, inflammatory cell infiltration and fibrosis were found in the middle ear mucosa of rat models of tympanosclerosis. In middle ear mucosa of rats with tympanosclerosis, the expression of mesenchymal cell markers increased and that of epithelial cell markers decreased compared with the control group. TGF-β1 stimulated the activation of the EMT pathway in middle ear mucosal epithelial cells, resulting in an increased expression of fibronectin and N-cadherin. In addition, a decreased expression level of EMT-associated proteins was observed when TGF-β1 was inhibited. In conclusion, the present study indicated that TGF-β1-mediated EMT may play an important role in the pathogenesis of tympanosclerosis.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals

BACKGROUND

The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media.

OBJECTIVE

To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis).

METHODS

The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears.

RESULTS

In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases.

CONCLUSION

The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

[Short-term effect of endoscopic one-stage tympanoplasty on tympanosclerosis]

Objective:To explore the feasibility of transcanal endoscopic ear surgery for tympanosclerosis as well as the surgical method and short-term effect. Method:Forty-one patients with type Ⅱ-Ⅳ tympanosclerosis who underwent transcanal endoscopic ear surgery were retrospectively analysed. All the tympanosclerotic lesions were removed with endoscope, then tympanoplasty was performed according to the ossicular involvement. Postoperative examination and audiometry were performed at 1, 3 and 6 months after the operation. Pre-and post-operative（6 months as the final result） pure tone air-bone gap were compared between different types of tympanosclerosis to evaluate the short-term effect, the difference of hearing improvement between different type of tympanoplasties was also compared. SPSS 22.0 was used for statistical analysis. Result:Forty-three ears recovered without complications, except one with marginal performation, the graft take rate was 97.7%. The preoperative and 6 months postoperative air-bone gap was （36.73±11.68） dB and （20.55±10.27） dB respectively, with significant difference（t=20.476, P<0.05）. There were no significant differences in hearing improvement among the three types, though the hearing improvement of Type Ⅲ typanosclerosis was worse than that of type Ⅱ and Ⅳ. There was no significant difference in the hearing improvement between type Ⅱ and Ⅲ tympanoplasty（P>0.05）. Conclusion:Transcanal endoscopic surgery is safe and effective for tympanosclerosis with satisfying short-term effect, though long-term result still needs further investigation.

Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

OBJECTIVE

To develop and validate a clinical score to predict the risk of tympanosclerosis before surgery.

METHODS

A sample of 404 patients who underwent middle ear microsurgery for otitis media was enrolled. These patients were randomly divided into 2 cohorts: the training cohort (n = 243, 60%) and the validation cohort (n = 161, 40%). The preoperative predictors of tympanosclerosis were determined by multivariate logistic regression analysis and implemented using a clinical score tool. The predictive accuracy and discriminative ability of the clinical score were determined by the area under the curve (AUC) and the calibration curve.

RESULTS

The multivariate analysis in the training cohort (n = 243, 60%) identified independent factors for tympanosclerosis as the female sex (odds ratio [OR]: 3.83; 95% CI: 1.66-9.37), the frequency-specific air-bone gap at 250 Hz ≥ 45 dB HL (OR: 3.68; 95% CI: 1.68-8.57), aditus ad antrum blockage (OR: 3.29; 95% CI: 1.38-8.43), type I eardrum calcification (OR: 25.37; 95% CI: 8.41-88.91) or type II eardrum calcification (OR: 18.86; 95% CI: 6.89-58.77), and a history of otitis media ≥ 10 years (OR: 4.10; 95% CI: 1.58-11.83), which were all included in the clinical score tool. The AUC of the clinical score for predicting tympanosclerosis was 0.89 (95% CI: 0.85-0.93) in the training cohort and 0.89 (95% CI: 0.84-0.95) in the validation cohort. The calibration curve also showed good agreement between the predicted and observed probability.

CONCLUSIONS

The clinical score achieved an optimal prediction of tympanosclerosis before surgery. The presence of calcification pearls on the promontorium tympani is a strong predictor of tympanosclerosis with stapes fixation.

[The effect of one-stage tympanoplasty for stapes fixation with tympanosclerosis]

Objective:To evaluate hearing outcome and complications of one-stage tympanoplasty in patients with stapes fixation due to tympanosclerosis. Method:59 patients（sixty-one ears） underwent one-stage tympanoplasty for stapes fixation due to tympanosclerosis were retrospectively analyzed. Stapes fixation due to tympanosclerosis were proved during the surgery in these patients diagnosed with chronic otitis media. For all the patients, tympanosclerotic plaques around stapes were removed for stapes mobilization. Then the ossicular chain was rebuilt by autogenous incus or PORP. The pre-and post-operative audiometric results（500 Hz, 1 kHz, 2 kHz and 4 kHz） were evaluated for each patient. Improvement of pure-tone average more than 10 dB postoperatively were accepted as success criteria. Result:Complications included temporary facial paralysis（1/61）, temporary vertigo（2/61）, mild elevation in bone conduction thresholds（2/61） and delayed healing of tympanic membrane（1/61）. Postoperative（1 and 3 months） bone conduction thresholds improved at frequencies of 1 and 2 kHz（P<0.01）. Postoperative（1 and 2 years） air conduction thresholds improved at all frequencies（P<0.01 or P<0.05）. A gain ≥10 dB in pure-tone average was found in 44（72.13%） patients at 1 year after surgery. The air conduction levels were significantly improved in both autogenous incus and PORP groups（P<0.01）. There was no difference about success rate between these two groups（P>0.05）. Conclusion:For patients with stapes fixation due to tympanosclerosis, one-stage tympanoplasty can improve hearing threshold though ossicular chain reconstruction and stapes release. The major complications such as facial paralysis and sensorineural hearing loss should be avoided by delicate surgical operation.

The Effect of Nasal Septal Deviation on the Postoperative Hearing Results of Patients With Tympanosclerosis

OBJECTIVE

The main aim is to discuss the effect of nasal septal deviation on the postoperative hearing results of patients with tympanosclerosis.

MATERIAL AND METHODS

We analyzed the hearing results of patients with tympanosclerosis who were operated on in a tertiary center. Pure tone audiometric results were compared according to the existence of nasal septal deviation.

RESULTS

This study included 48 patients with unilateral tympanosclerosis disease. Moderate or severe septal deviation had no significant effect on postoperative hearing results.

CONCLUSION

The nasal septal deviation as the only pathologic factor in patients with tympanosclerosis did not have a deteriorating effect after surgery.

[Single-stage open tympanoplasty in the form of tympanosclerosis with fixation of the stapes]

We used several variants of one-stage tympanoplasty, including our own method, according to which, in the absence of an anvil and malleus after mobilisation of the stapes, ossiculoplasty with partial or complete ossicular prosthesis and myringoplasty simultaneously preventively created a support (neo-malleus) in the thickness of the neotympanic membrane. To assess the effectiveness of different variants of single-stage tympanoplasty, the long-term functional results were compared in terms of 6 to 12 months after the intervention with preoperative indicators. Standard methods of statistical estimation with calculation of descriptive statistics and methods of statistical hypothesis testing based on nonparametric Wilcoxon criterion for related samples were used. All the variants of one-stage tympanoplasty used in the fixation of the stapes are effective and, in general, make it possible to achieve an improvement in auditory function. In the present study, this result was achieved in 61 of 86 patients with tympanosclerosis (71% (65%; 74%) of 95% CI). The functional results of tympanoplasty according to the developed method do not differ from the results of traditional variants with the use of prostheses, but the implementation of this variant of tympanoplasty in the absence of an anvil and hammer allows for the fixation of the stapes during the reoperative stapedotomy using a prosthesis of the piston type without additional surgical stage of the formation of the neomaleus.

[The role of stapedoplasty in the treatment of hearing impairment in the patients presenting with tympanosclerosis]

The present study included the examination and surgical treatment of 50 adult patients presenting with tympanosclerotic fixation of the stirrup. The patients comprising the first subgroup (n=25) underwent the two-stage treatment during the period from 1990 to 2009. The final phase of the treatment consisted of the implantation of different kinds of stirrup prostheses placed on the venous autograft that closed the oval window of the vestibule following partial or total instrumental stapedectomy. The second subgruop was composed of the patients (n=25) who were given the two- or three-stage surgical treatment during the period from 2009 till 2014 the final phase of which was performed following the same procedures as in the first subgroup but with the use of the surgical CO₂-laser instead of the conventional instrumental methods. The pathomorphological studies carried out at different stages of the surgical treatment have demonstrated the necessity of isolation of the vestibular fluid for the purpose of implantation of the stirrup prostheses with a view to preventing cochlear complications. The results of the present study give evidence of the efficiency of stapedoplasty with the application of the autocartilaginous prostheses of the stirrup implanted on the venous autografts to close the oval window of the vestibule with the reduction of the bone-air interval down to less than 20 dB. The performance of this procedure with the use of the instrumental technique produced a favourable outcome of the treatment in 71.4% of the patients presenting with tympanosclerosis. The use of the laser-assisted approach further increased the efficiency of the treatment up to 76%. Moreover, the latter method allows to avoid the reaction of the inner ear to the surgical intervention during the early postoperative period and results in the faster averaged reduction of the bone-air interval in comparison with the patients treated with the application of the instrumental technique.

[Transcanal endoscopic ear surgery for tympanosclerosis]

Objective:To report surgical techniques, outcomes, clinical experience and application key point of transcanal endoscopic ear surgery for tympanosclerosis. Method: Data from 25 patients (13 males and 12 females; aged 27-61 years, mean=48.8 years) who underwent transcanal endoscopic ear surgery for tympanosclerosis in our department from January 2016 to June 2017 were retrospectively analyzed. Removal of tympanosclerosis and tympanoplasty were individualized. Patients were followed up at postoperative 1, 3 and 6 month. Result: There were no failure of tympanal reconstruction by sandwich. The mean preoperative air conduction threshold was higher than that of postoperation ［(51.12±16.03）dB HL and （31.64±12.76)dB HL, respectively］(P<0.01). The mean preoperative air-bone gap was significantly increased compared to that of postoperation ［(30.33±10.12）dB and （14.19±8.97）dB,respectively］ (P<0.01). There were no complication, recurrence, residual tympanosclerosis or secondary surgery needed. Conclusion: Stand alone transcanal endoscopic ear surgery was a safe and effective method for tympanosclerosis.

Metagenomics Analysis of Bacterial Population of Tympanosclerotic Plaques and Cholesteatomas

Objective Chronic otitis media can cause cholesteatomas or tympanosclerosis; however, the pathophysiology of such conditions is not completely known. The aim was to identify a bacterial genome that might be present in tympanosclerotic plaques and cholesteatomas using sequence analysis of the gene responsible for the transcription of 16 ribosomal RNA (rRNA). Study Design Metagenomics analysis of the samples. Setting Samples were collected and evaluated at tertiary care centers. Subjects and Methods Sixty-five tympanosclerotic plaques and 37 cholesteatomas were evaluated. The polymerase chain reaction (PCR) was performed using primers designed for the amplification of the gene responsible for the transcription of bacterial 16 rRNA. The PCR-positive samples were sequenced via Sanger method, and 46 selected samples were analyzed with next-generation sequencing (NGS). Results Sanger sequencing revealed the presence of bacterial genomes in a total of 18 of the 102 samples tested. Sequencing of these genomes indicated the presence of Alloiococcus otitis, Staphylococcus aureus, Achromobacter xylosoxidans, Escherichia coli, Staphylococcus sciuri, Staphylococcus caprae, Parvimonas spp., and Bacillus sp. in the tested samples. The NGS showed 1 or more different bacterial genomes in 44 (95.7%) of the 46 samples tested. Predominately, genome of Clostridiales (27 samples), Staphylococcaceae (24 samples), Peptoniphilaceae (12 samples), and Turicella otitidis (9 samples) were identified. Conclusion The middle ear is inhabited by a diverse microbial community than that previously known. With the use of molecular biology, it has become easier to identify the bacterial genomes and improve our understanding of the role of middle ear microbiota in the pathogenesis of chronic inflammatory ear diseases.

Gene expression profile of collagen types, osteopontin in the tympanic membrane of patients with tympanosclerosis

BACKGROUND

Tympanosclerosis is a pathological process involving the middle ear. The hallmark of this disease is the formation of calcium deposits. In the submucosal layer, as well as in the right layer of the tympanic membrane, the calcium deposits result in a significant increase in the activity of fibroblasts and deposition of collagen fibers.

OBJECTIVES

The aim of our study was to examine the expression level of genes encoding collagen type I, II, III and IV (COL1A1, COL2A1, COL3A1, COL4A1) and osteopontin (SPP1) in the tympanic membrane of patients with tympanosclerosis.

MATERIAL AND METHODS

The total RNA was isolated from middle ear tissues with tympanosclerosis, received from 25 patients and from 19 normal tympanic membranes. The gene expression level was determined by real-time RT-PCR. The gene expression levels were correlated with clinical Tos classification of tympanosclerosis.

RESULTS

We observed that in the tympanic membrane of patients with tympanosclerosis, the expression of type I collagen is decreased, while the expression of type II and IV collagen and osteopontin is increased. Moreover, mRNA levels of the investigated genes strongly correlated with the clinical stages of tympanosclerosis.

CONCLUSIONS

The strong correlations between the expression of type I, II, IV collagen and osteopontin and the clinical stage of tympanosclerosis indicate the involvement of these proteins in excessive fibrosis and pathological remodeling of the tympanic membrane. In the future, a treatment aiming to modulate these gene expressions and/or regulation of the degradation of their protein products could be used as a new medical approach for patients with tympanosclerosis.

[Bone conduction in tympanosclerosis patients and its changes after surgery for tympanosclerosis]

Objective:To investigate the bone conduction (BC) in tympanosclerosis patients and its changes after surgery for tympanosclerosis, as well as its possible causes.Method:Retrospectively analyzed 30 cases of tympanosclerosis patients.Result:Before surgery, the average BC of the operated ear was (21.06±8.88) dBHL, the average BC of the healthy side was (16.78±8.97) dBHL, the difference had a statistical significance (t= 3.072, P< 0.01). The BC threshold, air conduction (AC) and ABG were significantly lower after operation. Preoperative BC at 2 000 Hz was the highest threshold (25.17±10.95) dBHL, and the postoperative decrease of BC thresholds at 500 Hz, 1 000 Hz and 2 000 Hz were statistically significant (P< 0.05 or P< 0.01). Tympanoplasty with mastoidectomy for BC threshold improvement was better than only tympanoplasty (P< 0.05)Conclusion:Tympanosclerosis leads to elevated BC threshold. Removal of tympanosclerosis lesions together with the removal of the lesions in antrum and mastoid and the reconstruction of sound conduction structures not only improve AC hearing and shorten ABG, but also improve postoperative BC hearing significantly.

[Small doses of gentamicin drum indoor injection treatment of intractableMénière disease clinical observation of the impact of the hearing]

Objective:To investigate the history,audiology,imaging,and operative characteristics of tympanosclerosis patients with intact tympanic membranes,and to provide theoretical reference for preoperative diagnosis and treatment.Method:A retrospective study was carried out among 9 tympanosclerosis patients (16 ears) with intact tympanic membranes who underwent exploratory tympanotomy.For different patients,the different reconstruction of ossicular chain are in selection.We compared the pre-operative outcomes of pure tone audiometry and otoscope with the post-operative outcomes,and calculated their air-bone gap and improvement value.Result:At 3 month after operation,otoscope showed that the tympanic membrane of all patiens were integrity.Tinnitus disappeared or improved in 5 cases.The mean thresholds of air conduction,bone conduction and air-bone gap were(40.33±11.48)dB,(27.34±8.46)dB,(13.16±9.85)dB respectively.The air-bone gap in 3 months after the operation was significantly smaller than that before operation(P<0.05).Conclusion:Most of the patients with tympanosclerosis suffer mixed hearing loss.In addition to chronic inflammatory stimulation,tympanic membrane incision catheter may be one of the important pathogenic factors.Morphology and imaging are more useful in differentiation of otosclerosis.Early and active surgery interference would attain good effect.

Long-term outcome of round window Vibrant SoundBridge implantation in extensive ossicular chain defects

OBJECTIVE

To evaluate retrospectively the long-term safety and efficacy of the first 50 patients, all suffering from severe ossicular chain defects and with moderate to severe mixed hearing loss, who received the Vibrant SoundBridge with the floating mass transducer located on the round window membrane. To evaluate differences in outcome versus etiology and age of the patient population.

STUDY DESIGN

Case series with planned data collection.

SETTING

Tertiary referral medical center.

SUBJECTS AND METHODS

Patients eligible for implantation of the floating mass transducer on the round window membrane ranged in age from 2 months to 74 years with a moderate to severe conductive or mixed hearing loss from different etiologies. For each adult patient, preoperative versus postoperative bone and air conduction thresholds, air-bone gaps, and speech understanding scores were evaluated at 24-month follow-up. At 60-month follow-up, data were available from 33 patients. Preoperative and postoperative free-field auditory brainstem responses were studied in infants and children. Intraoperative and short- and long-term postoperative complications are presented.

RESULTS

There were significant improvements in speech perception and pure-tone audiometry in adults and auditory brainstem response thresholds in infants immediately after surgery and at follow-up examinations (12 to 71 months). No significant complications or device extrusions were observed in the present series.

CONCLUSIONS

Infants, children, and adults with moderate to severe conductive or mixed hearing loss obtained substantial benefit from implantation of the floating mass transducer on the round window membrane regardless of the etiology of hearing loss and previous surgery.