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A persistent stapedial artery (PSA) is a rare embryologic remnant that typically involutes at week 10 of embryogenesis. However, if it is persistent, it may lead to conductive hearing loss and pulsatile tinnitus. It is of utmost importance to identify such an anomaly, as it leads to serious complications intraoperatively if overlooked. Proper clinical and radiological assessment helps an otologist recognize the PSA. We describe the case of a 24-year-old female presenting with a chronically discharging ear in addition to pulsatile tinnitus and conductive hearing loss with an incidental finding of a PSA upon otoscopy.

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PURPOSE: Progressive adherent pars tensa occasionally induces ossicular erosion. Specifically, stapes discontinuity adversely affects postoperative hearing. However, this irretrievable sequela is challenging to prove preoperatively, partly because perimatrix inflammation on the pars tensa can obscure the visibility of the ossicles or the partial volume effect of computed tomography (CT) imaging can hamper detailed ossicular visualization. Therefore, there is no consensus regarding the ideal timing for switching from a wait-and-see approach to a surgical one. Herein, we aimed to explore the potential predictors of stapes superstructure destruction in adherent pars tensa. METHODS: This retrospective cohort study enrolled consecutive patients who underwent primary tympanoplasty for adherent pars tensa categorized as grade IV on Sadé's grading scale between April 2016 and September 2021. The impact of features on otoscopy and CT and air-bone gap (ABG) on stapes superstructure destruction was assessed using uni- and multivariable logistic regression analyses. RESULTS: Sixty-four ears were included. Multivariate analysis revealed the presence of debris on the adherent pars tensa (odds ratio [OR] [95% confidence interval {CI}]): 4.799 [1.063-21.668], p = 0.0415), presence of soft-tissue density occupying the oval window (OR [95% CI]: 13.876 [3.084-62.437], p = 0.0006), and a ≥ 20-dB preoperative ABG at 3 kHz (OR [95% CI]: 7.595 [1.596-36.132], p = 0.0108) as independent predictors for stapes superstructure destruction. CONCLUSION: High preoperative awareness of the possibility of destruction of the stapes superstructure would enable the surgeon to make a timely decision to provide surgical intervention before progression to severe stapes destruction, thereby maintaining long-term satisfactory hearing.

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Background: Currently, the optimum surgical approach for treating adherent otitis media is debatable. The traditional treatment is usually performed by microscopic tympanoplasty combined with temporal myofascial tympanic tube placement. In recent years, the application of whole ear endoscopic surgery in the treatment of middle ear diseases has gradually increased, otoendoscopy has been used in the operation of adhesive otitis media, but its safety and effectiveness are still controversial. Methods: This study retrospectively analyzed 17 patients with adhesive otitis media treated by endoscopic ear surgery (EES) in our hospital from January 2018 to July 2021 over a 6-month period post-surgery. Of the 17 patients, 8 were males and 9 were females (mean age, 53 years; age range, 24-70 years). There were 12 and 5 cases of adhesive otitis media involving the left and right ear, respectively. The patients had follow-up evaluations 1 week, 2 weeks, 1 month, 3 months, and 6 months after surgery. Results: A total of 17 patients with adhesive otitis were enrolled, including 1 patient with Dornhoffer stage II; 6 patients with stage III; and 10 patients with stage IV. Adhesive otitis media was combined with middle ear cholesteatoma in 4 patients (24%). Fourteen patients (82%) had disruption or interruption of the ossicular chain (8 malleus, 14 incus, and 4 stapes lesions), 11 of whom had artificial ossicular chain reconstruction [8 with partial ossicular reconstruction prosthesis (PORP) and 3 with total ossicular reconstruction prosthesis (TORP) implantation]. All patients had good tympanic membrane and graft morphology, no invaginations, and no perforations. The mean postoperative air-conduction hearing threshold [49.06±22.15 dB hearing level (dB HL)] and mean air-bone gap (19.94±10.00 dB HL) were significantly improved compared with the preoperative values (65.29±21.53 and 32.53±8.21 dB HL, respectively; P<0.05). No recurrences, secondary cholesteatomas, or secondary surgeries were reported. Conclusions: EES seems to be a safe and effective surgical method for the management of adhesive otitis media. The study has limitations due to its small sample size and lack of controlled studies. It still needs to be proven in clinical randomized controlled trials.

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Purpose: To compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15). Methods: 50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up. Results: There was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group. Conclusion: ETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.

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OBJECTIVES: Atelectatic eardrum and adhesive otitis media in children are related to persistent otitis media with effusion (OME) and eustachian tube dysfunction in infancy. However, the pathogenesis of these diseases is not fully understood, and some cases even progress to pars tensa cholesteatoma. This study analyzed the clinical characteristics of children with atelectatic eardrum and adhesive otitis media to clarify associated causes of and risk factors for progression of these middle ear pathologies in children. PATIENTS AND METHODS: This retroactive study included 38 ears of 31 children with atelectatic eardrums (atelectasis group), and 19 ears of 17 children with adhesive otitis media (adhesive OM group). Thirty-two contralateral non-cholesteatoma ears of 32 children with congenital cholesteatoma were also examined as a control group. Participants were aged 15 or younger. Life history (obtained via questionnaire), associated diseases, hearing acuity, aeration and development of the temporal bone were investigated. RESULTS: All children in the atelectasis and adhesive OM groups had a history of recurrent acute otitis media (rAOM) and/or OME. The prevalence of perennial allergic rhinitis was 18 cases (58%) in the atelectasis group and 16 cases (94%) in the adhesive OM group. The prevalence of perennial allergic rhinitis was significantly higher in the adhesive OM group compared to the control group (P < 0.01). The development of mastoid air cells, categorized by MC classification, showed MC0 + MC1 (poor pneumatization) in 19 ears (50.0%) with atelectatic eardrums and 12 ears (63.2%) with adhesive OM. Poor pneumatized mastoid was more frequently observed in the ears of the atelectasis and adhesive OM groups compared to the control group (P < 0.01). No significant difference was found in regards to aeration of the middle ear between the two groups; however, aeration was significantly poorer in both groups compared to the control group (P < 0.01). Three characteristics were analyzed using multivariate logistic regression: perennial allergic rhinitis (odds ratio [OR] 4.319, P = 0.013), poor mastoid pneumatization (OR 8.457, P = 0.012), and pars flaccida retraction pocket (OR 20.897, P = 0.006). These characteristics were shown to be significant risk factors for atelectatic eardrums and adhesive OM. In addition, the predisposition to perennial allergic rhinitis was shown to be the most important factor in the progression from atelectatic eardrum to adhesive otitis media (OR 16.615, P = 0.012). CONCLUSION: Children with perennial allergic rhinitis, poor development of mastoid air cells, poor aeration of the temporal bone, and with pars flaccida retraction pocket were at an increased risk of developing an atelectatic eardrum and adhesive OM. In particular, perennial allergic rhinitis was shown to be a significant risk factor in the progression from atelectatic eardrum to adhesive otitis media. Allergic inflammation may affect not only the nasal passages but also the eustachian tube, resulting in persistent middle ear dysfunction. Therefore, children with rAOM/OME who have these risk factors should be carefully monitored and treat over time in effort to prevent progression of pathology.

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OBJECTIVE: Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma. METHODS: Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography. RESULTS: Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834-264.184), total adhesion (OR, 28.550; 95% CI, 0.962-847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022-366.589) were related to pars tensa cholesteatoma. CONCLUSION: Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.

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INTRODUCTION: We developed a new treatment method that combines tympanoplasty with transplantation of autologous cultured nasal mucosal epithelial cell sheets to regenerate the mucosa of patients with adhesive otitis media, which has been difficult to treat effectively. We verified whether this procedure could be performed safely and measured its therapeutic efficacy. METHODS: Autologous nasal mucosal epithelial cell sheets were manufactured at a good manufacturing practice-compliant cell processing facility using autologous nasal mucosal tissue. We performed tympanoplasty and transplanted the cell sheets into the middle ear cavity in six patients with adhesive otitis media. RESULTS: The manufactured autologous cultured epithelial cell sheets met the predetermined quality standards and were successfully transplanted safely in all cases. Computed tomography findings after cell sheet transplantation showed that aeration in the tympanic cavity was maintained or restored in five of the six patients (83.3%). Four of the six (66.7%) patients had postoperative air-bone gap within 20 dB, which is considered a postoperative success in tympanoplasty for chronic middle ear disease. CONCLUSIONS: The results of this clinical study suggest that tympanoplasty with cell sheet transplantation can be used to treat adhesive otitis media by reliably preventing re-adhesion of the tympanic membrane.

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PURPOSE: The best surgical method for the management of adhesive otitis media is controversial. The aim of the study was to explore the feasibility and effectiveness of tympanoplasty combined with fascia grafting catheterization in the treatment of adhesive otitis media. METHODS: This was a retrospective study of patients with adhesive otitis media and who underwent tympanoplasty combined with fascia grafting and catheterization between April 2015 and December 2016 at the Eye-Ear-Nose-Throat Hospital Affiliated to Fudan University. All injured ears were examined by pure tone audiometry at 0.5, 1 and 2 kHz before and at 3 months after operation. RESULTS: Thirty-five patients (35 ears) were followed for 12-44 months. The air-conduction pure tone average was 31.7 ± 12.3 dBnHL. Hearing of 28 patients (80%) was improved to a practical level within 40 dBnHL, but 2 patients (6%) had no change in postoperative hearing. Numbers of patients with spontaneous prolapse, artificial removal of tympanic membrane ventilation tube, and unobstructed in place were 15, 12, and 8, respectively. Twenty-seven patients had perforations left after the prolapse and removal of tympanic membrane ventilation tubes, of which 22 (81%) had perforations healing by themselves. All patients had dry ears after operation, without recurrence. Thirty-three patients (94%) had dry ears within 3 months and only 2 patients (6%) for more than 6 months. CONCLUSION: Tympanoplasty combined with fascia grafting catheterization is effective in the treatment of adhesive otitis media.

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OBJECTIVES/HYPOTHESIS: To investigate the simultaneous application of cartilage tympanoplasty combined with eustachian tube (ET) balloon dilatation in the treatment of adhesive otitis media (AdOM). STUDY DESIGN: Multicenter, prospective, double-blind, randomized, controlled clinical trial. METHODS: Patients with AdOM were randomly divided into four groups: control group (conservative treatment), ET balloon dilatation (ETBD) group, cartilage tympanoplasty (CT) group, and cartilage tympanoplasty combined with ET balloon dilatation (ETBD+CT) group. Patients were followed up at 3 months, 6 months, 1 year, and 2 years after treatment, receiving otoendoscopy and pure-tone audiometry, and were evaluated using the Tinnitus Handicap Inventory (THI), visual analogue scale (VAS) for the symptom of ear stuffiness, Chronic Otitis Media Outcome Test (COMOT-15), and eustachian tube scores (ETS). RESULTS: There was no improvement in tympanic membrane (TM) morphology and mean pure-tone air-bone gap (ABG) after treatment in the control and ETBD groups. The postoperative TM morphology was improved in the CT group and ETBD+CT group, although retraction pockets reoccurred in two cases of CT group. Reduced ABG and improvements in ETS, THI, VAS, and COMOT-15 were all achieved in these two groups, but the difference was not statistically significant. CONCLUSIONS: Cartilage tympanoplasty combined with ET balloon dilatation could be used as an appropriate surgical technique for AdOM, which could relieve the symptoms of tinnitus and ear stuffiness, and improve postoperative TM morphology, hearing level, ET functions, and quality of life, with low incidence of complications. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:1462-1467, 2019.

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Patulous Eustachian Tube (PET) is of increasing importance in otology. However, despite the abundance of diseases requiring a differential diagnosis from PET, such as superior semicircular canal dehiscence syndrome, perilymphatic fistula, acute low-tone sensorineural hearing loss, etc., there are currently no established diagnostic criteria for PET. In view of these circumstances, the Japan Otological Society (JOS) Eustachian Tube Committee proposed the diagnostic criteria for Patulous Eustachian Tube in 2012, in order to promote clinical research on PET. A revision was made in 2016, maintaining the original concept that the criteria should be very simple, avoid any contamination of "Definite PET" with uncertain cases. Moreover, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings ("Possible PET"). The criteria can be used by all otolaryngologists even without using the Eustachian tube function test apparatus. However, the use of such an apparatus may increase the chances of detecting "Definite PET". The algorithm for the diagnosis of PET using the criteria has also been described. The JOS diagnostic criteria for Patulous Eustachian Tube will further promote international scientific communication on PET.

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OBJECTIVES: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM). MATERIALS AND METHODS: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient. RESULTS: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05). CONCLUSIONS: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

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The likelihood of recurrent retraction and adhesion of newly formed tympanic membrane is high when middle ear mucosa is extensively lost during cholesteatoma and adhesive otitis media surgery. If rapid postoperative regeneration of the mucosa on the exposed bone surface can be achieved, prevention of recurrent eardrum adhesion and cholesteatoma formation, for which there has been no definitive treatment, can be expected. Suture-less transplantation of tissue-engineered mucosal cell sheets was examined immediately after the operation of otitis media surgery in order to quickly regenerate middle ear mucosa lost during surgery in a rabbit model. Transplantable middle ear mucosal cell sheets with a three-dimensional tissue architecture very similar to native middle ear mucosa were fabricated from middle ear mucosal tissue fragments obtained in an autologous manner from middle ear bulla on temperature-responsive culture surfaces. Immediately after the mucosa was resected from middle ear bone bulla inner cavity, mucosal cell sheets were grafted at the resected site. Both bone hyperplasia and granulation tissue formation were inhibited and early mucosal regeneration was observed in the cell sheet-grafted group, compared with the control group in which only mucosal removal was carried out and the bone surface exposed. This result indicates that tissue engineered mucosal cell sheets would be useful to minimize complications after the surgical operation on otitis media and future clinical application is expected.

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OBJECTIVES: To evaluate the efficiency of mastoid antral ventilation tube (MAVT) treatment in recurrent/chronic otitis media with effusion (OME). METHODS: 20 OME patients who were unsuccessfully treated with ventilation tube (VT) at least twice, who consented to MAVT and who were followed up at least three years were included in the study group. Control group comprised 10 patients who had the same characteristics and refused to undergo MAVT and underwent VT placement again. Pre-operative and post-operative otomicroscopic, hearing tests, and CT findings were compared between the groups statistically. RESULTS: MAVT was placed into 24 ears of 20 patients. In the control group, VT was placed in 13 ears of 10 patients. Postoperatively, in the study group, one tympanic membrane with adhesion and nine membranes with retraction returned to their anatomic positions after MAVT. In the control group, 2 retracted tympanic membranes returned to normal position. There was significant difference between groups in terms of mastoid aeration (P = 0.006). Post-operative pure tone threshold values and mastoid aeration findings were statistically different from preoperative conditions. CONCLUSION: This preliminary study demonstrates that MAVT may be effective in the surgical treatment of recurrent/chronic OME. However, further studies with larger patient series should be carried out.

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Introducción: Desde la introducción de esta técnica quirúrgica en la segunda mitad del siglo XIX ha habido múltiples publicaciones sobre diversas experiencias y nuevas técnicas a nivel nacional e internacional. En nuestro hospital esta cirugía es parte de la práctica clínica habitual. Objetivo: El objetivo general es revisar la experiencia en timpanoplastías en el Hospital Clínico de la Universidad Católica de Chile en los últimos 4 años. Los objetivos específicos son revisar la epidemiología de los pacientes intervenidos, las técnicas quirúrgicas utilizadas y los resultados anatómicos y audiológicos conseguidos. Material y método: Estudio retrospectivo y descriptivo. Se revisó la totalidad de las fichas y audiometrías de los pacientes sometidos a timpanoplastías que cumplieron criterios de inclusión y exclusión bien definidos. Se incluyeron sólo pacientes cuya cirugía fue realizada entre enero de 2007 y diciembre de 2010. Resultados: Se obtuvo éxito anatómico en 82,4 por ciento de nuestros pacientes, con una tasa de complicaciones de 17,57 por ciento. Con respecto a los resultados auditivos, se observó un éxito auditivo total de 87,08 por ciento, y sólo en 13 por ciento de los pacientes empeoró su audición. Conclusiones: Los resultados anatómicos y auditivos obtenidos son comparables a lo publicado en la literatura nacional en la última década. Nuestra experiencia muestra un buen rendimiento con las técnicas e injertos utilizados, así como un buen resultado en las cirugías realizadas por médicos residentes, similares a los obtenidos por médicos staff.

Introduction: Since the introduction of this surgical technique in the second half of the nineteenth century, there have been many national and international publications on various experiences and new techniques. In our hospital this surgery is part of the routine clinical practice, so we decided to conduct this study to review our experience over the last 4 years. Aim: The general objective is to review the experience of tympanoplasty in the Hospital Clínico de la Universidad Católica de Chile in the last 4 years. The specific objectives are to review the epidemiology of patients undergoing this surgery, the surgical techniques used and the anatomical and audiological results achieved. Material and method: Descriptive and retrospective study. We reviewed all the clinical records and hearing tests in patients undergoing tympanplasty who met inclusion and exclusion criteria clearly defined. We only included patients whose surgery was performed between January 2007 and December 2010. Results: Anatomical success was archieved in 82.4 percent of our patients, with a complication rate of 17.57 percent. With regard to hearing results, there was a total audiological success of 87.08 percent and only 13 percent of our patients experienced worsening of their audition. Conclusions: The anatomical and audiological results obtained are comparable to those published in the national literature in the last decade. Our experience shows a good performance with the techniques and grafts used, and good results in surgeries performed by residents, similar to those obtained by staffs.

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To investigate the role of fibrinolysis in adhesion formation in the middle ear,40 patients(45 ears) with otitis media with exudation (OME) were randomly divided into 3 groups:Dexamethasone(G1),Batroxobin1BU/ml(G2),and Batroxobin 2BU/ml(G3).The results were assessed by tympanotomy and irigation to compare the efficacy of treatment of batroxobin and dexamethasone.31 patients (33 ears) were analyzed for statistical significance.The efficacy of the treatment was evaluated by qualitative analysis of symptom and the Hearing Threshold of Air conduction of pure tone audiometry (AHT) at frequencies 0 25～2kHz,and by quantitative analysis of AHT.Cure rates of G1,G2,G3 were 41 7%(5/12),54 5%(6/11),70%(7/10) respectively;G3 was higher than G1 and G2( P 0 05). After treatment AHT of G3 was lower than G2 and G1( P