Objectives
The post‐traumatic ear deformity, known today as cauliflower ear, has been described since antiquity. It has long been associated with pugilistic sports (wrestling, boxing) as well as ...among the mentally ill. The aim of this study is to present the various terms used since antiquity to describe these traumatic deformations of the auricle and to trace the origin of the modern moniker “cauliflower ear.”
Methods
Historical study, only based on original documentation accessed through personal libraries and universities repositories, completed with online sources and etymological dictionaries.
Results
We were able to identify no fewer than 39 names for the deformity. The term cauliflower ear is of relatively recent origin. It was coined in the first decade of the 20th century, initially in the popular press and subsequently adopted by the medical profession.
Conclusion
Ironically, the deformity has only superficial resemblance to a cauliflower. The vegetable, which is part of the cabbage family, has a symmetrical and highly ordered fractal geometry with well‐circumscribed excrescences. Cauliflower ear, by contrast, notably lacks symmetry and its rounded protuberances flow into one another. Although somewhat a misnomer, the term is deeply rooted in both popular and medical culture.
Level of Evidence
N/A Laryngoscope, 131:E1315–E1321, 2021
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Transcanal endoscopic ear surgery (TEES) is an increasingly used surgical approach for otologic surgeries, but no en face preoperative imaging format currently exists. We aim to assess the utility of ...a transcanal high resolution computed tomography (HRCT) reformat suitable for TEES preoperative planning.
Preoperative HRCTs of patients with middle ear pathologies (cholesteatoma, otosclerosis, and glomus tympanicum) who underwent TEES were obtained. Axial image series were rotated and reformatted −90 or +90 degrees for left and right ear surgeries, respectively, where additional rotation along the left-right axis was performed to align the transcanal series with the plane of the external auditory canal. Quantitative measurements of middle ear structures were recorded. Consecutive transcanal reformatted sections were then reviewed to identify critical middle ear anatomy and pathology with corresponding TEES cases.
The aforementioned methodology was used to create three transcanal view HRCTs. The mean left-right axis degree of rotation was 4.0 ± 2.2 degrees. In the cholesteatoma transcanal HRCT, areas of cholesteatoma involvement in middle ear compartments (e.g. epitympanum) and eroded ossicles were successfully identified in the corresponding case. In the otosclerosis transcanal HRCT, areas for potential otosclerotic involvement were visualized such as the round window as well as a low-hanging facial nerve. In the glomus tympanicum transcanal HRCT, the span of the glomus tympanicum was successfully visualized in addition to a high riding jugular bulb.
A transcanal HRCT reformat may aid preoperative planning for middle ear pathologies. This novel reformat may help highlight patient-specific anatomy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Following middle ear ventilation tube (tympanostomy tube or grommet) insertion, most surgeons advise that a child's ears should be kept dry during the immediate postoperative period. ...Following the initial period some surgeons will permit swimming or bathing, whereas other surgeons will recommend ongoing water precautions. A large number of studies have been conducted to explore the association between water exposure and ear infections in children with ventilation tubes, however a range of differing conclusions exist regarding the need for water precautions and there is wide variation in clinical practice.
Objectives
To assess the effectiveness of water precautions for the prevention of ear infections in children with ventilation tubes (grommets), at any time while the tubes are in place.
Search methods
The Cochrane ENT Trials Search Co‐ordinator searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 September 2015.
Selection criteria
Randomised controlled trials recruiting children (0 to 17 years) with ventilation tubes and assessing the effect of water precautions while the tubes are in place. We considered all forms of water precautions, including behavioural (i.e. avoidance or swimming/bathing restrictions) and mechanical (ear plugs/moulds or hats/bands).
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. Our primary outcome measures were episodes of otorrhoea and adverse effects; secondary outcomes were antimicrobial prescriptions for ear infections, ventilation tube extrusion, surgical intervention to remove ventilation tubes and hearing outcomes.
Main results
Two randomised controlled trials recruiting a total of 413 patients met the criteria for inclusion in our review; one study had a low risk of bias and the other study had a high risk of bias.
Ear plugs versus control
One study recruited 201 children (aged six months to six years) who underwent myringotomy and ventilation tube insertion. The study compared an intervention group who were instructed to swim and bathe with ear plugs with a control group; the participants were followed up at one‐month intervals for one year. This study, with low risk of bias, showed that the use of ear plugs results in a small but statistically significant reduction in the rate of otorrhoea from 1.2 episodes to 0.84 episodes in the year of follow‐up (mean difference (MD) ‐0.36 episodes per year, 95% confidence interval (CI) ‐0.45 to ‐0.27). There was no significant difference in ventilation tube extrusion or hearing outcomes between the two study arms. No child required surgical intervention to remove ventilation tubes and no adverse events were reported.
Water avoidance versus control
Another study recruited 212 children (aged three months to 12 years) who underwent myringotomy and ventilation tube insertion. The study compared an intervention group who were instructed not to swim or submerge their heads while bathing with a control group; the participants were followed up at three‐month intervals for one year. This study, with high risk of bias, did not show any evidence of a reduction or increase in the rate of otorrhoea (1.17 episodes per year in both groups; MD 0 episodes, 95% CI ‐0.14 to 0.14). No other outcomes were reported for this study and no adverse events were reported.
Quality of evidence
The overall quality (GRADE) of the body of evidence for the effect of ear plugs on the rate of otorrhoea and the effect of water avoidance on the rate of otorrhoea are low and very low respectively.
Authors' conclusions
The baseline rate of ventilation tube otorrhoea and the morbidity associated with it is usually low and therefore careful prior consideration must be given to the efficacy, costs and burdens of any intervention aimed at reducing this rate.
While there is some evidence to suggest that wearing ear plugs reduces the rate of otorrhoea in children with ventilation tubes, clinicians and parents should understand that the absolute reduction in the number of episodes of otorrhoea appears to be very small and is unlikely to be clinically significant. Based on the data available, an average child would have to wear ear plugs for 2.8 years to prevent one episode of otorrhoea.
Some evidence suggests that advising children to avoid swimming or head immersion during bathing does not affect rates of otorrhoea, although good quality data are lacking in this area. Currently, consensus guidelines therefore recommend against the routine use of water precautions on the basis that the limited clinical benefit is outweighed by the associated cost, inconvenience and anxiety.
Future high‐quality studies could be undertaken but may not be thought necessary. It is uncertain whether further trials in this area would change the findings of this review or have an impact on practice. Any future high‐quality research should focus on determining whether particular groups of children benefit more from water precautions than others, as well as on developing clinical guidelines and their implementation.
The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to ...exudative inflammation of middle ear and mastoid process, is still uncertain.
To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation.
A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups.
The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (
< 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15-36 dBHL in Group 1 and by 7-22 dBHL in Group 2 (
< 0.05).
The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation.
Purpose
Congenital cholesteatoma (CC) presents as a white pearl-like lesion behind a normal tympanic membrane (TM), without a history of otorrhea, infection, perforation or previous otologic surgery. ...Several recent studies provided new data improving this pathology characterization. The aim of this paper is to expand the knowledge about CC and to provide new insights on its pathogenesis.
Methods
The study consisted of two main research parts: (1) systematic review and meta-analysis; (2) medical literature review englobing anatomy, histology, embryology and congenital pathology of the ear.
Results
The search strategy identified a total of 636 papers. Seventy retrospective studies were included. A total of 1497 cases were studied and the mean age was 6.58 years, with a male–female ratio of 3:1, 34% were asymptomatic, 26% had hearing loss and 2% had facial dysfunction/paralysis. The overall estimate for antero-superior quadrant involvement was 0.70 95% confident interval (CI) 0.64–0.76, in the postero-superior quadrant was 0.60 (95% CI 0.52–0.69), in the antero-inferior quadrant was 0.32 (95% CI 0.23–0.41), in the postero-inferior quadrant was 0.38 (95% CI 0.29–0.47), in the attic was 0.53 (95% CI 0.43–0.63) and in the mastoid was 0.33 (95% CI 0.26–0.41). More advanced Potsic stages were present in older patients. The most likely inclusion place seems to be between the pars flaccida and the upper quadrants of the pars tensa.
Conclusions
During the last decades, a substantial improvement in CC diagnosis and management had been achieved. The presented mechanism seems to explain most of middle ear CC.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Today's audiometric methods for the diagnosis of middle ear disease are often based on a comparison of measurements with standard curves, that represent the statistical range of normal hearing ...responses. Because of large inter-individual variances in the middle ear, especially in wideband tympanometry (WBT), specificity and quantitative evaluation are greatly restricted. A new model-based approach could transform today's predominantly qualitative hearing diagnostics into a quantitative and tailored, patient-specific diagnosis, by evaluating WBT measurements with the aid of a middle-ear model. For this particular investigation, a finite element model of a human ear was used. It consisted of an acoustic ear canal and a tympanic cavity model, a middle-ear with detailed nonlinear models of the tympanic membrane and annular ligament, and a simplified inner-ear model. This model has made it possible for us to simulate pathologies like the stiffening of ligaments or joints, because we can simply change the corresponding mechanical parameters of the model. On the other hand, it is also possible to identify pathologies from measurements, by analyzing the parameters obtained by a system identification procedure. This reduces the number of required model parameters through sensitivity studies and parameter clustering. Uncertainties due to the lack of knowledge, subjectivity in numerical implementation and model simplification are taken into account by the application of fuzzy arithmetic. The most confident parameter set can be determined by applying an inverse fuzzy method on the measurement data. The principle and the benefits of this model-based approach are illustrated by the example of a two-mass oscillator, and also by the simulation of the energy absorbance of an ear with malleus fixation, where the parameter changes that are introduced can be determined quantitatively through the system identification.
•Model-based approach enables an objective, patient-specific quantitative diagnosis.•It maximizes the gain of information from objective diagnostic measurement data.•Primary investigations show high potential especially in wideband tympanometry.•Clinical knowledge on certain pathologies can be mathematically described.•Inverse fuzzy arithmetic enables an effective model-based evaluation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
At present, there are not international unified standards and reports on Congenital Ear Malformation (CEM) in the world, which makes it difficult to transfer information and compare the literature.
...Through the statistical analysis of a large sample of CEM, a unified standard of all aspects of CEM is proposed and the data are provided for reference, which is convenient for the international work and literature comparison in this field.
Based on the author's 30 years of clinical and scientific research work on CEM and the relevant cases of 3231 (4714 ears) in our hospital, and combined with literature, statistical analysis was made.
This paper summarizes the classification, definition, epidemiology, embryonic development, pathogenic factors of CEM and elaborates on the clinical manifestations, examination and sequence therapy of representative Congenital Malformation of the Middle and Outer Ear (CMMOE). We also introduce malformation of the auricle and inner ear, so as to cover the outer, middle and inner ear. At the same time, we introduce our achievements and contributions in this field.
This study provides reference to the international unified standard and treatment principle of the CEM.
Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or ...improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis‐unrelated factors work against this intent. Surgery is always individualized to the case and there is no one‐fits‐all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life‐threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him‐ or herself intensively on temporal bones before performing surgery on a patient.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Primary Inverted Papilloma of the Middle Ear Blioskas, Sarantis; Konstantinidis, Iordanis; Antoniadis, Ioannis ...
Ear, nose, & throat journal,
06/2024, Volume:
103, Issue:
6
Journal Article
Peer reviewed
Open access
Significance Statement: Primary middle ear inverted papilloma is an exceedingly rare finding posing a diagnostic challenge, as symptomatology often mimics common clinical entities like serous otitis ...media. Clinical and radiological findings are not specific, whilst high recurrence rates, local destruction, and potential malignant transformation constitute an overall demanding surgical challenge, requiring aggressive procedures. We report the case of a primary inverted papilloma of the middle ear, discussing diagnostic and therapeutic issues.
Despite a number of surgical procedures for the reconstruction of moderate to severe constricted ears described in the literature, a most cost-effective method remains to be explored. It is still a ...challenge to maximize the full use of the ear cartilage and surrounding skin while achieving the best results.
From 2011 to 2016, seven constricted ear patients were enrolled in this study. Five of them were moderate (type IIB Tanzer classification) deformities, and two were severe (type III Tanzer classification). All constricted ear patients were treated with bilateral cartilage flaps bridging and the V-Y advancement flap from preauricular skin, with the option of inserting a conchal cartilage graft if additional stability was required. Mean follow-up period was 4.0 ± 3.5years.
All patients were satisfied with significant increase in the height of the constricted ears, also with the reconstruction of scapha and antihelix. The surgical scar was not obvious. No complications were observed. Long-term follow-up period revealed that the reconstructive procedure produced the long-lasting cosmetic results.
Combination of bilateral cartilage flaps bridging with V-Y advancement of preauricular flap can make full use of its deformed tissue and surrounding skin. The method is effective and reliable in the reconstruction of moderate and some severe constricted ears.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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