BACKGROUND: Conductive or mixed hearing loss with an intact tympanic membrane is a group of diseases characterized by similar clinical symptoms. Definitive diagnosis depends on the findings of exploratory tympanic surgery. Cone-beam computed tomography (CBCT) has great potential for middle ear imaging. This study evaluated the diagnostic value of CBCT for conductive or mixed hearing loss with an intact tympanic membrane.
METHODS: CBCT and high-resolution computed tomography (HRCT) imaging data were collected from patients with an intact eardrum who received medical treatment in our hospital for conductive or mixed hearing loss from October 2020 to May 2023. The imaging characteristics and diagnostic values of CBCT and HRCT were analyzed.
RESULTS: A total of 137 patients who met the inclusion criteria and underwent CBCT were enrolled, including 89 with otosclerosis, 41 with ossicular chain interruption, and 7 with tympanosclerosis. CBCT clearly displayed a middle ear focus, such as low-density lesions located in the fissula ante fenestram, ossicular chain malformation or dislocation, and tympanic calcification foci. The area under the curve values for otosclerosis, ossicular chain interruption, and tympanic sclerosis were 0.934, 0.967, and 0.850, respectively. CBCT was more effective than HRCT for visualizing the lenticular process, incudostapedial joint, and stapes footplate.
CONCLUSIONS: CBCT of the middle ear demonstrated higher-quality imaging to improve the diagnosis of conductive or mixed hearing loss with an intact tympanic membrane. Therefore, CBCT is recommended for further investigation of noninflammatory diseases of the middle ear with no special findings on HRCT.

UNASSIGNED: Pathologies within the tympanic membrane (TM) and middle ear (ME) can lead to hearing loss. Imaging tools available in the hearing clinic for diagnosis and management are limited to visual inspection using the classic otoscope. The otoscopic view is limited to the surface of the TM, especially in diseased ears where the TM is opaque. An integrated optical coherence tomography (OCT) otoscope can provide images of the interior of the TM and ME space as well as an otoscope image. This enables the clinicians to correlate the standard otoscopic view with OCT and then use the new information to improve the diagnostic accuracy and management.
UNASSIGNED: We aim to develop an OCT otoscope that can easily be used in the hearing clinic and demonstrate the system in the hearing clinic, identifying relevant image features of various pathologies not apparent in the standard otoscopic view.
UNASSIGNED: We developed a portable OCT otoscope device featuring an improved field of view and form-factor that can be operated solely by the clinician using an integrated foot pedal to control image acquisition. The device was used to image patients at a hearing clinic.
UNASSIGNED: The field of view of the imaging system was improved to a 7.4 mm diameter, with lateral and axial resolutions of 38    μ m and 33.4    μ m , respectively. We developed algorithms to resample the images in Cartesian coordinates after collection in spherical polar coordinates and correct the image aberration. We imaged over 100 patients in the hearing clinic at USC Keck Hospital. Here, we identify some of the pathological features evident in the OCT images and highlight cases in which the OCT image provided clinically relevant information that was not available from traditional otoscopic imaging.
UNASSIGNED: The developed OCT otoscope can readily fit into the hearing clinic workflow and provide new relevant information for diagnosing and managing TM and ME disease.

The tympanic membrane (TM) is one of the most common routes to access the middle ear and inner ear for the treatment of hearing and balance pathologies. Since the TM is a soft thin biological tissue with small dimensions, using needles seems to be among the most practical interventional approaches. In this study, we proposed a finite-element (FE) analysis of needle-TM interactions that combines a 3D model of the TM and other main middle-ear structures in gerbil, and a 2D model of needle insertion into the TM based on the cohesive zone method (CZM). The TM was modelled using a 1st-order Ogden hyperelastic material and its properties were obtained by fitting to the experimental force-displacement plots of large deformation in the TM under needle indentation. The cohesive parameters were also acquired by calibrating the puncture force against the experimental data of needle insertion into the TM. These FE models were then used to obtain the deformation behaviour of the TM and other middle-ear structures due to the insertion force applied at different locations on the TM. Moreover, we investigated the effect of the TM thickness, the geometry of the needle (i.e., diameter and tip angle), and needle material on the insertion of needles into the TM. We also studied the penetration success of deformable needles.

Optical Coherence Tomography (OCT) is a light-based imaging modality that is used widely in the diagnosis and management of eye disease, and it is starting to become used to evaluate for ear disease. However, manual image analysis to interpret the anatomical and pathological findings in the images it provides is complicated and time-consuming. To streamline data analysis and image processing, we applied a machine learning algorithm to identify and segment the key anatomical structure of interest for medical diagnostics, the tympanic membrane. Using 3D volumes of the human tympanic membrane, we used thresholding and contour finding to locate a series of objects. We then applied TensorFlow deep learning algorithms to identify the tympanic membrane within the objects using a convolutional neural network. Finally, we reconstructed the 3D volume to selectively display the tympanic membrane. The algorithm was able to correctly identify the tympanic membrane properly with an accuracy of ~98% while removing most of the artifacts within the images, caused by reflections and signal saturations. Thus, the algorithm significantly improved visualization of the tympanic membrane, which was our primary objective. Machine learning approaches, such as this one, will be critical to allowing OCT medical imaging to become a convenient and viable diagnostic tool within the field of otolaryngology.

OBJECTIVE: To evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique.
METHODS: In our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around.
RESULTS: At 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05).
CONCLUSIONS: Compared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification.

UNASSIGNED: The assessment of the integrity of the tympanic membrane (TM) can be a diagnostic challenge in patients with otitis externa and/or otitis media (OM) under an otoscopic examination. In computed tomography (CT), the TM is not always visualized. However, a positive contrast canalography using conventional radiography has been previously described to evaluate the TM integrity.
UNASSIGNED: This single-center study aimed to describe the positive contrast canalography technique in CT and its usefulness in identifying TM integrity in 11 dogs.
UNASSIGNED: Dogs with clinical signs of ear disease underwent CT canalography following a systematic protocol.
UNASSIGNED: The presence of contrast medium and contrast homogeneity within the tympanic cavity was assessed, confirming TM rupture when contrast medium was present in the tympanic cavity. CT canalography was performed in 16 ears, and in 7 of the 16 ears (44%), there was a contrast in the tympanic cavity, confirming TM rupture (positive CT canalography result). In two of the seven cases (29%), rupture of the TM was identified in both otoscopic and CT canalography. In the remaining five of the seven (71%) positive CT canalography results, tympanic membrane rupture was identified only by CT canalography.
UNASSIGNED: In conclusion, a positive contrast CT canalography is a complementary and safe technique to assess TM integrity, with a potentially higher sensitivity than otoscopic examination for the diagnosis of TM rupture in dogs.

Various non-invasive delivery systems have recently been developed as an alternative to conventional injections. Local transdermal administration represents the most attractive method due to the low systemic side effects, excellent ease of administration, and persistent drug release. The tympanic membrane (TM), a major barrier between the outer and middle ear, has a similar structure of the stratum corneum compared to the surface of the skin. After several attempts, non-invasive trans-tympanic drug delivery has been regarded as a promising option in the treatment of middle and inner ear diseases. The round window membrane (RWM) was a possible non-invasive delivery approach from the middle to inner ear. The improved permeability of nanocarriers crossing the RWM is a current hotspot in therapeutics for inner ear diseases. In this review, we include the latest studies exploring non-invasive trans-tympanic delivery to treat middle and inner ear diseases. Both passive and active delivery systems are described. A summary of the benefits and disadvantages of various delivery systems in clinical practice and production procedures is introduced. Finally, future possible approaches for its effective application as a non-invasive middle and inner ear drug delivery system are characterised.

OBJECTIVE: Examine outcomes among a series of pediatric patients who underwent myringoplasty using human birth tissue (BT) for repair of large tympanic membrane (TM) perforations.
METHODS: Case series.
METHODS: Single-institution pediatric hospital.
METHODS: Retrospective chart review of patients treated with BT during a 4-year study period. Subjects who underwent myringoplasty for large (size 40% or greater) TM perforations were included for this study. Patients with a stable perforation of at least 1 month\'s duration preoperatively who then followed up for at least 3 months postoperatively met inclusion criteria.
RESULTS: Six subjects were included in this study. One subject underwent bilateral repair; thus, this series includes a total of 7 perforations. TM perforations ranged from 40% to 70% of the TM. At initial follow-up (median of 2 months), 5 of the 7 perforations had healed. One of these 5 had evidence of a 10% recurrent perforation at 5 months, which subsequently healed. Of the 2 patients not healed at initial follow-up, 1 had only a residual pinpoint perforation that subsequently healed; the other had a persistent 30% perforation that was possibly related to their postoperative recovery period, which was complicated by a respiratory viral illness.
CONCLUSIONS: For large TM perforations, myringoplasty with BT grafts may be a viable alternative to longer, more invasive procedures like tympanoplasty. Larger, randomized, prospective studies are needed.

The perforation characteristics and fracture-related mechanical properties of the tympanic membrane (TM) greatly affect surgical procedures like myringotomy and tympanostomy performed on the middle ear. We analyzed the most important features of the gerbil TM perforation using an experimental approach that was based on force measurement during a 2-cycle needle insertion/extraction process. Fracture energy, friction energy, strain energy, and hysteresis loss were taken into consideration for the analysis of the different stages of needle insertion and extraction. The results demonstrated that (1) although the TM shows viscoelastic behavior, the contribution of hysteresis loss was negligible compared to other irreversible dissipated energy components (i.e., fracture energy and friction energy). (2) The TM puncture force did not substantially change during the first hours after animal death, but interestingly, it increased after 1 week due to the drying effects of soft tissue. (3) The needle geometry affected the crack length and the most important features of the force-displacement plot for the needle insertion process (puncture force, puncture displacement, and jump-in force) increased with increasing needle diameter, whereas the insertion velocity only changed the puncture and jump-in forces (both increased with increasing insertion velocity) and did not have a noticeable effect on the puncture displacement. (4) The fracture toughness of the gerbil TM was almost independent of the needle geometry and was found to be around 0.33 ± 0.10 kJ/m2.

Objective:To analyze the surgical efficacy and safety of tympanoplasty with and without mastoidectomy for the treatment of active simple chronic suppurative otitis media（CSOM）, and to investigate whether mastoidectomy can be avoided in tympanoplasty for active CSOM. Methods:The clinical data of 55 patients（55 ears） with active CSOM were retrospectively analyzed. Based on the development of the mastoid process and the upper tympanic chamber, patients who met the criteria for wall-up mastoidectomy were classified as group A （30 patients）, and underwent tympanoplasty combined with wall-up mastoidectomy. Patients who did not meet the criteria for wall-up mastoidectomy were classified as group B（25 cases）, and underwent tympanoplasty with the opening of the middle and upper tympanic chambers and sinus drainage after partial removal of the shield plate bone. The survival rate of tympanic membrane grafts, hearing before and after surgery, and complications such as reperforation were compared between the two groups at 3 months postoperatively. Results:The overall postoperative tympanic membrane survival rate of patients with active CSOM was 96.4%（53/55）, including 96.7% in group A; 96.0% in group B. There was no significant difference in the tympanic membrane survival rate between the two groups（P>0.05）. The postoperative mean air-bone gap（ABG） was significantly reduced in both groups compared with the preoperative period, but there was no significant difference in ABG gain between the two groups（P>0.05）. No patients experienced serious adverse conditions such as peripheral facial paralysis, cerebrospinal fluid leakage, or sensorineural deafness after surgery. Conclusion:Microscopic tympanoplasty with patency of the middle and upper tympanic chambers and tympanic sinus drainage can be used to treat active simple chronic otitis media with satisfactory tympanic membrane viability and hearing improvement efficacy. This approach reduces patient trauma, prevents complications such as skin depressions in the mastoid area due to abrasion of the mastoid bone, and shortens the waiting time before surgery.
目的：分析鼓室成形术伴与不伴乳突切开治疗活动期单纯型慢性化脓性中耳炎（chronic suppurative otitis media，CSOM）的手术疗效及安全性，探讨在活动期CSOM鼓室成形术中是否可以避免开放乳突。 方法：回顾性分析55例（55耳）活动期CSOM患者的临床资料，根据患者乳突及上鼓室发育情况，将有条件完成完壁式乳突切开术的患者为A组（30例），行鼓室成形术联合完壁式乳突切开术。无条件完成完壁式乳突切开术的患者为B组（25例）采用去除部分盾板骨质后通畅中、上鼓室及鼓窦引流，同时完成鼓室成形术。比较2组患者术后3个月鼓膜移植成活率、手术前后的听力情况及再穿孔等并发症情况。 结果：活动期CSOM患者术后整体鼓膜成活率为96.4%（53/55），其中A组为96.7%；B组为96.0%，2组患者鼓膜成活率差异无统计学意义（P>0.05）。2组患者术后平均气骨导差值（ABG）较术前均有明显缩小，但2组患者ABG增益差异无统计学意义（P>0.05）。所有患者术后均无周围性面瘫、脑脊液漏、感音神经性聋等严重不良情况。 结论：显微镜下采用通畅中上鼓室、鼓窦引流后的鼓室成形术治疗CSOM可获得满意的鼓膜成活率和听力提高疗效。且减少患者的创伤，防止因磨除乳突骨质后发生乳突区皮肤凹陷等并发症，缩短手术前的等待时间。.