Figure 4 - available via license: Creative Commons Attribution 2.5 Generic
Content may be subject to copyright.
![Changes in middle ear pressure after administration of N2O gas. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]](profile/Masaru-Yamashita-2/publication/232533826/figure/fig5/AS:282659411513387@1444402663453/Changes-in-middle-ear-pressure-after-administration-of-N2O-gas-Color-figure-can-be.png)
Changes in middle ear pressure after administration of N2O gas. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Source publication
Most cases of chronic otitis media (OMC) are associated with poor development of the mastoid air cells (MACs) and poor Eustachian tube (ET) function. We have previously reported that MAC regeneration can effectively eliminate intractable OMC. In this study, we assessed the ability of regenerated MACs to restore normal gas exchange function and cont...
Similar publications
Vertical nystagmus without a torsional component is generally considered a finding indicative of central nervous system pathology. We report two cases of purely upbeat nystagmus elicited with mastoid vibration after bilateral superior canal plugging, to highlight the vestibular pathophysiology involved in this unusual peripheral cause for upbeat ny...
Citations
... The authors postulate that in applying this method, cases of chronic otitis might be treated that otherwise could not be optimally treated. In another trial from 2013, Kanemaru et al. published a positive effect of this therapy on the function of the Eustachian tube [117]. In 26 patients, again 3D-HA was applied for regeneration of mastoid air cells in addition to conventional cholesteatoma treatment and tympanoplasty. ...
Zusammenfassung
Die Regeneration als therapeutisches Prinzip und damit die Regenerative Medizin ist ein vielversprechender Ansatz künftig die therapeutischen Optionen der Hals-Nasen-Ohrenheilkunde um eine weitere Dimension zu erweitern. Während heute rekonstruktive chirurgische Verfahren, Medikamente und Prothesen wie bspw. das Cochlea Implantat die Funktionen defekter Gewebe im Kopf-Hals-Bereich ersetzen, sollen durch die Regenerative Medizin die defekten Gewebe und deren Funktion selbst wiederhergestellt werden. In dieser Übersichtsarbeit werden neue Entwicklungen wie das 3D-Bioprinting und dezellularisierte, natürliche Biomaterialien für regenerative Ansätze vorgestellt und durch eine Zusammenstellung aktueller präklinischer und klinischer Studien im Bereich der Regenerativen Medizin in der Hals-Nasen-Ohrenheilkunde ergänzt.
... Kanemaru et al examined the ability of regenerated MACS to restore normal gas exchange and improve ETF in patients with COM. 210 Although an ideal material for mastoid air cell regeneration has not yet been identified, several materials have been investigated, including ceramic-based biphasic calcium phosphate granules [211][212][213] mixed with fibrin sealant, 214 polycaprolactone-tricalcium phosphate 215 composites, artificial or biologic hydroxyapatite, 216,217 autogenous bone cement, 218 and bioactive glass. 219 Biodegradable materials 220 and biomaterials coated with growth factors 221,222 have been investigated and/or encapsulated with cultured ME mucosal epithelial cells 223 and supplemented with collagen nanofibers. ...
Objective
In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear–mastoid–eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research.
Data Sources
PubMed, Web of Science, Medline.
Review Methods
The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed.
Conclusions
Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction.
Implications for Practice
In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
... Trans-nasal videoendoscopic observation of the ET component movements (medial wall, lateral wall, cartilage) at the level of the nasopharynx (NP) is becoming a common assessment procedure in the clinical setting. [1][2][3][4][5][6][7][8][9][10][11][12] The technique has evolved from qualitative to semiquantitative 6 to quantitative. 5,7 This technique allows real-time visualization and recording of the ET component rotations and displacements caused by the synchronized activities of the levator (mLVP) and tensor veli palatini (mLVP) muscles effecting luminal opening during swallowing. ...
Objectives/hypothesis:
Describe the relationship between the magnitude of eustachian tube (ET) dilation during swallowing observed on transnasal videoendoscopy and quantified by sonotubometry.
Study design:
Descriptive observational study.
Methods:
Simultaneous transnasal videoendoscopic and sonotubometric recordings were done on 33 adults with no middle ear disease. Briefly, microphones were placed in the ear canals, a 45° telescope introduced through one side of the nose to visualize and record ipsilateral ET movements, and the probe from a sound generator placed in the opposite nostril. At a generated nasopharyngeal sound level, ET movements and ipsilateral microphone signals were continuously recorded while the subject performed a series of three swallows. For each swallow, relational movements among ET structures observed on video recordings and characteristics of the sonotubometry signal envelope at the ear canal were quantified at three times: swallow onset (T1), maximum soft-palate elevation (T2), and maximum ET luminal dilation (T3).
Results:
A total of 99 swallows were analyzed. The average medial rotation of the ET cartilage and lateral wall over the T1-T2 interval were -32.7 ± 14.9° and 7.2 ± 25.1°, and over the T2-T3 interval were 4.6 ± 7.7° and 6.2 ± 14.6°, respectively. The transtubal sound transmission during a swallow peaked at an amplitude of 30.5 ± 35.7 mV during the 572.5 ± 292.6 ms of elevated sound-pressure time. Correlational analysis documented significant linear associations between the relational measures of ET component movements from videoendoscopy and the signal envelope measures from sonotubometry.
Conclusions:
There is a direct linear relationship between the degree of ET luminal dilation visualized on videoendoscopy and represented in the sonotubometry signal envelope.
Level of evidence:
NA Laryngoscope, 2016.
... The normal mastoid as well as the eustachian tube is capable of passive and active counterregulation of the middle ear pressure (23). Recently, Kanemaru et al. reported that improvement of Eustachian tube function by tissue engineered regeneration of mastoid air cells in clinical trial (24). ...
OBJECTIVES/HYPOTHESIS:: We identified the efficacy and appropriate target group for intratympanic steroid injections (ITS) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN:: Retrospective case-control study. METHODS:: Fifty-five ears treated with concomitant ITS and systemic steroids and 165 ears without ITS treatment were identified. Each case had three controls matched according to the age, sex, and the presence of vertigo. Patients were divided into subgroups according to pure tone audiometric configuration and the levels of initial hearing loss. Hearing results and frequency-related hearing gain were investigated. RESULTS:: Additional ITS was effective for patients with an ascending type audiogram or patients with Grade 3 (60–90?dB) initial hearing loss. Concomitant ITS, however, resulted in a negative effect on hearing in patients with Grades 1 and 2 (<60?dB). ITS resulted in significant (p?<?0.05) hearing improvement at 250?Hz in the Grade 3 (60–90?dB) and Grade 4 (>90?dB) ITS subgroups. CONCLUSIONS:: The efficacy of additional ITS for ISSNHL was different among subgroups with various levels of initial hearing loss or audiogram configuration.
... Kanemaru et al. reported that regeneration of mastoid air cells (MACs) can effectively eliminate intractable COM [12][13][14]. In another study, Kanemaru et al. investigated the ability of regenerated MACs to restore gas exchange function and contribute to the improvement of eustachian tube function and indicated that tissue-engineered regeneration of MACs improves eustachian tube function and gas exchange in the middle ear [15]. In our study all the patients had undergone only antrostomy without mastoidectomy and relationship between preoperative mastoid volume and tympanoplasty success is evaluated. ...
Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05).
... The authors suggested a mutualistic relationship between the mastoid air system and the ET. 27 International Archives of Otorhinolaryngology Middle Ear Barotrauma after Hyperbaric Oxygen Therapy Lima et al. ...
Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention.
Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear.
Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma.
Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation.
Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.
Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).
Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.
Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air–bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p < .05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.
Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.
Objective:
In this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC.
Methods:
A total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund-Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control.
Results:
The AMEC group showed a significantly shorter sphenoid length (P < 0.01) and lower Vidic classification score (P < 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group.
Conclusion:
Our results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.
Introduction:
Middle ear (ME) pressure-regulation (MEPR) is a homeostatic mechanism that maintains the ME-environment pressure-gradient (MEEPG) within a range optimized for "normal" hearing.
Objective:
Describe MEPR using equations applicable to passive, inter-compartmental gas-exchange and determine if the predictions of that description include the increasing ME pressure observed under certain conditions and interpreted by some as evidencing gas-production by the ME mucosa.
Methods:
MEPR was modeled as the combined effect of passive gas-exchanges between the ME and: perilymph via the round window membrane, the ambient environment via the tympanic membrane, and the local blood via the ME mucosa and of gas flow between the ME and nasopharynx during Eustachian tube openings. The first 3 of these exchanges are described at the species level using the Fick's diffusion equation and the last as a bulk gas transfer governed by Poiseuille's equation. The model structure is a time-iteration of the equation: P(ME)g(t=(i+1)Δt) = ∑(s)(P(ME)s(t=iΔt)+(1/(β(ME)sV(ME))∑(P)(Қ(P)s(P(C)s(t=(iΔt)-P(ME)s(t=(iΔt))). There, P(ME)g(t=iΔt) and P(ME)s(t=iΔt) are the ME total and species-pressures at the indexed times, P(C)s(t=iΔt) is the species-pressure for each exchange-compartment, β(ME)sV(ME) is the product of the ME species-capacitance and volume, Қ(P)s is the pathway species-conductance, and ∑(S) and ∑(P) are operators for summing the expression over all species or exchange pathways.
Results:
When calibrated to known values, the model predicts the empirically measured ME species-pressures and the observed time-trajectories for total ME pressure and the MEEPG under a wide variety of physiologic, pathologic and non-physiologic conditions.
Conclusions:
Passive inter-compartmental gas exchange is sole and sufficient to describe MEPR.
Presented here is an overview of a 3D bioprinting approach that generates complex 3D geometry tissue constructs using extrudable materials and encapsulated cells based on native aortic valve tissue heterogeneity. As a fabrication strategy 3D printing overcomes the geometric limitations associated with classical heart valve tissue engineering scaffold assembly strategies. Experiments were conducted to establish photoencapsulation and fabrication parameter ranges tolerated by valve and mesenchymal stem cells, thereby enabling direct cell-hydrogel printing with optimal capacity for geometric control. Additionally, a dynamic conditioning system was designed specifically for the culture of 3D bioprinted valves. These studies indicate that bioprinted valves with encapsulated mesenchymal stem cells can be produced with high viability for the purposes of a tissue-engineered heart valve or with primary aortic valve cells for the purpose of in vitro testing and mechanistic studies.
