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Histopathology of the inner ear in unoperated acoustic neuroma

Mahmud MR, Khan AM, Nadol JB

Ann Otol Rhinol Laryngol, 2003 Nov;112(11):979-86.
PMID: 14653368

Although hearing loss is the most common presenting symptom in patients with acoustic neuroma, the pathophysiology of hearing loss associated with acoustic neuroma is unknown. Although primary dysfunction of the auditory nerve is intuitively logical, available histopathologic and clinical data suggest that although neural degeneration is common, it alone does not adequately account for hearing loss in many cases. The purpose of this study was to evaluate 11 cases of unoperated unilateral acoustic neuromas. Temporal bones were identified by means of a search mechanism provided by the National Temporal Bone, Hearing, and Balance Pathology Resource Registry and were prepared for light microscopy by standard techniques. Quantification of spiral ganglion cells, hair cells, stria vascularis, and spiral ligament was accomplished for each specimen. In addition, the maximum diameter and volume of each tumor were calculated from histopathologic sections. Increasing tumor size did predict a reduced spiral ganglion count. However, although there was a tendency for decreasing spiral ganglion cell count and for increasing tumor size to predict a higher pure tone average and lower speech discrimination score, these correlations did not reach statistical significance. In tumor ears in which the speech discrimination score was 50% or less, there was always significant degeneration of other structures of the inner ear in addition to neurons, including hair cells, the stria vascularis, and the spiral ligament. Endolymphatic hydrops and eosinophilic precipitate in the perilymphatic spaces were found in 2 of 3 such cases. It is concluded that acoustic neuromas appear to cause hearing loss, not only by causing degeneration of the auditory nerve, but also by inducing degenerative changes in the inner ear. It is hypothesized that the proteinaceous material seen histologically may represent the products of up-regulated genes in acoustic neuroma, some of which may interfere with normal cochlear function.

Matched MeSH terms: Ear, Inner/pathology*
Fulltext Aural Polyp or Temporal Bone Carcinoma: Lesson to Learn

Mahmud KA, Nasseri Z, Mohamed Mukari SA, Ismail F, Abdullah A

Cureus, 2021 Mar 01;13(3):e13629.
PMID: 33816028 DOI: 10.7759/cureus.13629

Temporal bone carcinoma is a rare malignant tumor of the head and neck region. Its clinical presentations can mimic benign ear diseases, leading to inaccurate diagnosis and substandard management. We present the case of a 53-year-old female with a three-month history of progressive right otalgia, otorrhea, and hearing loss. Otoscopic examination revealed a mass occupying the right external auditory canal. However, the lesion was presumed to be an aural polyp by several clinicians previously. Multiple courses of oral antibiotics had been prescribed before she was referred to our clinic for the non-resolving aural polyp. Imaging studies showed an external auditory canal soft tissue mass with extradural and parotid extension. The mass was biopsied, and the result was reported as squamous cell carcinoma of the temporal bone. The patient was advised for a total temporal bone resection and parotidectomy; however, she declined the surgical intervention. Within a month, the tumor had metastasized to her lung, liver, and vertebral bodies. She was referred to the Oncology team for palliative chemo-radiotherapy. Temporal bone malignancy must be considered as a differential diagnosis in a middle-aged or elderly patient with a non-resolving aural polyp without a chronic discharging ear. Imaging studies and histopathological evaluation should be prompted to ascertain the diagnosis. Repeated course of oral antibiotic will delay treatment and subsequently may lead to poor prognosis.

Matched MeSH terms: Ear Canal; Ear Neoplasms
Human otoacariasis

Indudharan R, Ahamad M, Ho TM, Salim R, Htun YN

Ann Trop Med Parasitol, 1999 Mar;93(2):163-7.
PMID: 10474641

Accidental entry of insects and other arthropods is a common aetiology of aural foreign bodies (FB) presenting to accident and emergency departments. A retrospective study revealed that the FB in almost half (148) of 348 cases of aural FB investigated at the Universiti Sains Malaysia Hospital was an arthropod. The most common arthropod encountered was the cockroach, followed by a cattle tick. The high prevalence of tick infestation of the human ear canal (i.e. human otoacariasis) currently appears to be unique to the Malaysian state of Kelantan. The presentation of patients with intra-aural ticks, the methods used to remove the ticks, the complications encountered, and recommendations for an appropriate course of action in such cases are discussed.

Matched MeSH terms: Ear Canal/parasitology*
Long-term status of middle-ear aeration post canal wall down mastoidectomy

Ezulia T, Goh BS, Saim L

J Laryngol Otol, 2019 Aug;133(8):662-667.
PMID: 31267884 DOI: 10.1017/S0022215119001385

BACKGROUND: Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.
OBJECTIVE: This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.
METHODS: All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.
RESULTS: Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.
CONCLUSION: After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

Matched MeSH terms: Cholesteatoma, Middle Ear/surgery*
An anthropological study of the Malay and the Chinese of Malaysia

Chattopadhyay PK, Ganeson D

Ann Hum Biol, 1977 Jul;4(4):379-81.
PMID: 931362

Data for the ABO blood groups and for handclasping, arm folding, handedness, ear lobe types and camptodactyly are presented for 104 Malay and 57 Chinese males in the city of Alor Star, Kedah, Malaysia. The two groups exhibit marked differences in the frequencies of most of these attributes.

Matched MeSH terms: Ear/anatomy & histology
Fulltext Bilateral microtia, canal atresia and aplasia of cochleovestibular nerve

Asma A, Roslenda AR, Fadzilah I, Mazita A, Marina MB, Ab Aziz A

Med J Malaysia, 2017 04;72(2):135-137.
PMID: 28473682 MyJurnal

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication.

Matched MeSH terms: Ear Canal/abnormalities*
Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

Ng AWA, Muller R, Orton J

Undersea Hyperb Med, 2017 8 5;44(2):101-107.
PMID: 28777900

CONTEXT: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB.
OBJECTIVE: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols.
DESIGN: Double-blinded, randomized controlled trial.
SETTING: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014.
PATIENTS: 100 participants undergoing their first hyperbaric oxygen therapy session.
INTERVENTION: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre- and post-treatment and then graded. Middle ear barotrauma was defined as an increase of at least one grade on a modified TEED scale.
RESULTS: The observed MEB incidence under the staged protocol was 48% compared to 62% using the linear protocol (P=0.12, exact one-sided binomial test), and thus the staged protocol did not show a significant improvement in MEB. However, the staged protocol resulted in significantly less severe deteriorations in MEB grades when compared to the linear protocol (P=0.028, exact one-sided Mann-Whitney type test).
CONCLUSION: The use of the assessed staged compression protocol for the first hyperbaric oxygen treatment showed no significant effect on the overall incidence of MEB when compared to the gold standard linear protocol but resulted in a significant improvement in the severity of the experienced MEBs. Further studies are needed to elucidate an optimal compression protocol to minimize middle ear barotrauma.

Matched MeSH terms: Ear, Middle/injuries*
Fulltext Craniofacial anthropometric norms of Malays

Ngeow WC, Aljunid ST

Singapore Med J, 2009 May;50(5):525-8.
PMID: 19495526

INTRODUCTION: This study was undertaken to establish the craniofacial anthropometric norms of young adult Malaysian Malays.
METHODS: The study group consisted of convenient samples of 100 healthy volunteers (aged 18-25 years), with an equal number of female and male subjects who had no history of mixed racial parentage. 22 linear measurements were taken twice from 22 landmarks over six craniofacial regions.
RESULTS: The Malays shared many similar sizes of measurements with the Singaporean Chinese. Their left eye fissure length and mouth width (ch-ch) were almost identical for both genders. However, Malay females had an upper lip height (sn-sto) (left) and ear width (pra-pa) similar to Singaporean Chinese females. Six other measurements, viz. the head width (eu-eu), head circumference (on-op), face height (n-gn), lower face height (sn-gn), (left) eye fissure height (ps-pi), cutaneous upper lip height (sn-ls) and cutaneous upper lip height (ls-sto), were 0.4-4.3 mm less in the Malays. Measurements for another four parameters, viz. the length of the head (g-op), biocular width (ex-ex), lower vermillion height (sto-li) and (left) ear length (sa-sba), were 0.5-3.6 mm higher in the Malays. Only three measurements were obviously different; the height of the head (v-n) and intercanthal width (en-en), were lower, and the protrusion of the nasal tip (sn-prn) was higher in the Malays.
CONCLUSION: These findings suggest that three features, i.e. the height of the head (v-n), intercanthal width (en-en) and protrusion of the nasal tip (sn-prn) may be useful in differentiating a Malay face from a Singaporean Chinese one.

Matched MeSH terms: Ear/anatomy & histology
Fulltext Rheumatoid pachymeningitis

Tan HJ, Raymond AA, Phadke PP, Rozman Z

Singapore Med J, 2004 Jul;45(7):337-9.
PMID: 15221051

Symptomatic rheumatoid pachymeningitis is a rare extra-articular manifestation of rheumatoid arthritis. Clinical symptoms are non-specific and diagnosis is frequently made by exclusion. We present a 61-year-old woman with a 9-year history of rheumatoid arthritis presenting with deafness and progressive disability over a two month duration. She was diagnosed as having rheumatoid pachymeningitis based on the cerebral magnetic resonance imaging findings.

Matched MeSH terms: Ear, Inner/pathology
Fulltext Tympanometric values in young Malay adults: preliminary data

Wahab NA, Rashid MF

Singapore Med J, 2009 Nov;50(11):1077-9.
PMID: 19960163

INTRODUCTION: The present study aimed to obtain preliminary tympanometric data of young Malay adults and to compare the results between genders.
METHODS: 96 undergraduate students (49 males and 47 females), aged 19-25 (mean and standard deviation 21.14 +/- 1.31) years, participated in this study. Otoscopic examination, pure tone audiometry, qualitative tympanogram and ipsilateral acoustic reflex were measured to ensure a clear ear canal, normal hearing and normal middle ear function, prior to tympanometric measurement. As a result, a total of 154 ears (80 ears from males and 74 ears from females) were selected for further statistical analyses. The tympanometric parameters measured were peak compensated static acoustic admittance (Peak Y(tm)), tympanometric width (TW) and equivalent ear canal volume (V(ea)).
RESULTS: The results showed that the mean Peak Y(tm), V(ea) and TW for males were 0.81 mmhos, 1.48 cubic cm and 113.67 daPa, respectively. The mean Peak Y(tm), V(ea) and TW for females were 0.63 mmhos, 1.12 cubic cm and 98.04 daPa, respectively. Males were found to have significantly higher mean V(ea) and mean Peak Y(tm) than females. However no significant gender difference was observed in the mean TW.
CONCLUSION: The current study suggests that young Malay adults may require gender-specific Peak Y(tm) and V(ea) values when implementing a quantitative approach in tympanogram interpretation.

Matched MeSH terms: Ear Canal/pathology
Stephanofilaria kaeli Buckley 1937 as the cause of chronic dermatitis on the foot of a goat and on the ears and teats of cattle in West Malaysia

Fadzil M, Cheah TS, Subramaniam P

Vet Rec, 1973 Mar 24;49(12):316-8.
PMID: 4716635
Matched MeSH terms: Ear/pathology
Fulltext A case of auricular myiasis in Malaysia

Rohela M, Jamaiah I, Amir L, Nissapatorn V

Southeast Asian J Trop Med Public Health, 2006;37 Suppl 3:91-4.
PMID: 17547059

Many cases of myiasis have been reported in Malaysia. This is the second reported case of auricular myiasis caused by Chrysomya bezziana. The patient was a 41-year-old, mentally retarded, Orang Asli man. He was brought to the clinic by his mother with a complaint of pain and bleeding in his right ear for 3 days. On examination, blood and multiple maggots were seen packed in the external auditory canal of the right ear. A total of 39 live maggots were removed and maintained until they developed into 3rd instar larvae, which were later processed and identified as Chrysomya bezziana. The patient was discharged with amoxicillin 500 mg three times a day for 1 week.

Matched MeSH terms: Ear, External/parasitology*
Cholesteatoma in patients with congenital external auditory canal anomalies: retrospective review

Mazita A, Zabri M, Aneeza WH, Asma A, Saim L

J Laryngol Otol, 2011 Nov;125(11):1116-20.
PMID: 21846418 DOI: 10.1017/S0022215111002052

To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.

Matched MeSH terms: Ear Canal/abnormalities*; Ear Canal/radiography; Ear Canal/surgery
Epithelial migration in open mastoidectomy cavities

Ong CA, Prepageran N, Godbole S, Raman R

Asian J Surg, 2007 Jan;30(1):57-9.
PMID: 17337373

To study the rate and pattern of epithelial migration in 18 dry, open mastoidectomy cavities.

Matched MeSH terms: Cholesteatoma, Middle Ear
Fulltext Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Vasiwala R, Burud I, Lum SK, Saren RS

Med J Malaysia, 2015 Oct;70(5):314-5.
PMID: 26556123 MyJurnal

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.

Matched MeSH terms: Ear, Middle
Fulltext Managing a Complicated Acute Otomastoiditis at Day Four of Life

Lim R, Zulkifli S, Hailani I, Hashim ND

Cureus, 2021 Jan 25;13(1):e12905.
PMID: 33654590 DOI: 10.7759/cureus.12905

Acute mastoiditis in a newborn complicated by the presence of facial nerve palsy is an alarming finding requiring rapid assessment and further investigation. Such an early presentation should point the clinician towards an underlying systemic pathology or congenital anatomical abnormality. Facial nerve involvement indicates severe infection and possible dehiscence of the facial canal. Although more frequent in children, it is rare in neonates. We would like to share our experience in managing the youngest known presentation of otomastoiditis at four days of life. The patient presented with otorrhea and facial paralysis and progressed to meningitis. He was finally diagnosed with chronic granulomatous disease.

Matched MeSH terms: Ear Diseases
A Longitudinal Analysis of Pressurized Wideband Absorbance Measures in Healthy Young Infants

Wali HA, Mazlan R, Kei J

Ear Hear, 2019 2 27;40(5):1233-1241.
PMID: 30807541 DOI: 10.1097/AUD.0000000000000707

OBJECTIVES: Wideband absorbance (WBA) is an emerging technology to evaluate the conductive pathway (outer and middle ear) in young infants. While a wealth of research has been devoted to measuring WBA at ambient pressure, few studies have investigated the use of pressurized WBA with this population. The purpose of this study was to investigate the effect of age on WBA measured under pressurized conditions in healthy infants from 0 to 6 months of age.
DESIGN: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age.
RESULTS: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies (<0.4 kHz) and increased at high frequencies (2 to 5and 8 kHz) with age. Specifically, WBA measured at TPP and 0 daPa in 3- to 6-month-olds was significantly different from that of 0- to 2-month-olds at low (0.25 to 0.31 kHz) and high (2 to 5 and 8 kHz) frequencies. However, there were no significant differences between WBA measured at TPP and 0 daPa for infants from 3 to 6 months of age.
CONCLUSIONS: The present study provided clear evidence of maturation of the outer and middle ear system in healthy infants from birth to 6 months. Therefore, age-specific normative data of pressurized WBA are warranted.

Matched MeSH terms: Ear, Middle
Zygomatic root abscess: A rare entity not to be forgotten!

Hong CX, Razuan NA, Alias A, Hassan FH, Nasseri Z

Auris Nasus Larynx, 2021 Aug;48(4):788-792.
PMID: 32513602 DOI: 10.1016/j.anl.2020.05.007

Zygomatic root abscess is a rare extracranial extratemporal complication of otitis media. To the best of our knowledge, there are only a few scattered cases of zygomatic root abscesses reported in the literature. We present an unusual case of a zygomatic root abscess in a 24 years old adult. He presented with one month duration of right zygomatic swelling. Otoscopic examination revealed superior and posterior external auditory canal wall sagging with an intact tympanic membrane. High Resolution Computed Tomography (HRCT) temporal bone revealed a rim enhancing lesion lateral to the zygomatic process with fluid filled mastoid air cells. He was managed with antibiotics and staged surgical interventions. He recovered well. Our case serves to shed light on the pathways of infection, clinical manifestations and timely staged surgical intervention in this rare pathology.

Matched MeSH terms: Ear Canal
Otological outcome in cleft lip and palate children with middle ear effusion

Azman A, Manuel AM

Int J Pediatr Otorhinolaryngol, 2020 Nov;138:110274.
PMID: 32836138 DOI: 10.1016/j.ijporl.2020.110274

OBJECTIVE: To evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion.
METHOD: A prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1-18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome.
RESULTS: 68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p

Matched MeSH terms: Middle Ear Ventilation
First record of Megaselia scalaris (LOEW) (DIPTERA: PHORIDAE) infesting a spinose ear tick, Otobius megnini, colony in Sri Lanka

Diyes GCP, Karunaratne WAIP, Tomberlin JK, Rajakaruna RS

Trop Biomed, 2015 Dec 01;32(4):791-795.
PMID: 33557472

Megaselia scalaris (Loew) is a cosmopolitan polyphagous small fly with the ability of exploiting variety of ecological niches. Different life history stages act as detritivore, parasite, and parasitoid of wider spectrum of plant and animal matter under natural and laboratory conditions. Here, for the first time we present the opportunistic parasitism of M. scalaris on Otobius megnini, which act as a vector of Q fever and is capable of causing paralysis, toxic conditions, otoacariasis and otitis in humans and other animals. Tick samples from the ear canals of 14 thoroughbred horses were brought to the laboratory and several days later, larvae of M. scalaris were found feeding on immature stages of O. megnini. When the development was completed pupae were found attached to adult ticks and all nymphs were found dead. This context reveals the capability of M. scalaris surviving on O. megnini and the risk of their invading ear canals of horses.

Matched MeSH terms: Ear Canal

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