Carla Branco

The posterosuperior quadrant of the tympanic membrane.

Objective: To document the anatomic relationship of the posterosuperior segment of the tympanic membrane. Study Design: Point-prevalence study of postmortem material. Subjects and Materials: One hundred seventy temporal bones from adults without history of otologic pathology were studied. The anatomic details of the tympanic membrane were observed, histology was documented on 30 sectioned bones, and, with the use of the scanning electron microscope, lamina propria was studied in 40 bones. Results: We established that the posterosuperior quadrant was the largest, representing 28.7 percent of the total area of the eardrum. This feature implies that this quadrant is more likely than are the other quadrants to exhibit changes prompted by pressure challenges. We also verified that the posterosuperior part of tympanic sulcus, above the chorda tympanic nerve, lost its depth in an unexpected way in 60 percent of the cases. In association, we established that at this level there was a decrease in annulus caliber. In 25 percent of cases, by the absence of the circular fibers of lamina propria, the posterosuperior quadrant had only the radial fiber layer. Conclusions: Anatomic and morphologic details in posterosuperior quadrant were newly described and may explain the greater incidence of retraction pockets and marginal perforations that provide origin for the cholesteatoma.

Endonasal endoscopic repair of the orbital floor defect in the silent sinus syndrome

The “silent sinus syndrome” defines a rare condition in which eyeball retraction, or enophthalmos, with or without diplopia, spontaneously occurs in a patient who displays some form of asymptomatic chronic maxillary atelectasis. Persistent ostial blockage, hypoventilation with longstanding negative intrasinus pressure, along with retention of secretions, antral walls bone remodeling, and inferior displacement of the orbital floor, ultimately risking herniation of the orbital contents in the sinus cavity, seem to hallmark this entity. Authors agree that management includes a prompt surgical drainage of the occluded sinus; the current trends favor an endoscopic approach to the maxillary antrum with the creation of an intranasal antrostomy. The specific management of the orbital floor anatomic abnormality is, however, still subject to debate. Some contend that the antral drainage is frequently sufficient, as the ensuring sinus healing will naturally retract the sinus cavity and thus correct the enophthalmos. Others maintain that some sort of orbital floor augmentation procedure may also, at times, be needed, and favor sameor second-stage orbital floor reconstruction, with the use of some type of implant material. We present a silent sinus syndrome case on which, at the same-stage a wide middle meatal antrostomy was created for maxillary sinus drainage, an endoscopic transnasal/ transantral technique successfully addressed the repair of a large orbital floor defect using autogenous materials. A 35-year-old man was referred to ENT care after having been seen by an ophthalmologist because of a 3 mm left eye enophthalmos of five months duration, normal visual acuity, and unaffected intraocular pressure and

Does calcemia influence the onset of myringosclerosis after myringotomy with the insertion of ventilation tubes

INTRODUCTION Myringosclerosis is one of the most frequent late complications of the insertion of ventilation tubes, and its aetiopathogenesis remains unknown. The calcification that occurs in the formation of myringosclerosis plaque raises the hypothesis of the presence of a calcium metabolism disorder. The objective is to determine whether calcemia contributes to the development of myringoscelerosis after insertion of ventilation tubes. MATERIAL AND METHODS A longitudinal, prospective, analytical cohort study was conducted in patients undergoing myringotomy with the insertion of ventilation tubes due to otitis media with effusion. Calcemia was evaluated pre-operatively and in the follow-up the appearance of myringosclerosis and the percentage of the tympanum involved were evaluated. RESULTS The study included 156 patients (297 ears), with calcemia values ranging from 7.6 to 10.2mg/dl. Myringosclerosis was identified in 35.4% of the operated ears. No relationship was found between the appearance of myringosclerosis and calcemia (p=.596). It was found, however, that the greater the percentage of the tympanum affected by myringosclerosis, the lower the calcemia values (p=.014). CONCLUSION The population studied had calcemia values within the normal range, which allows us to infer that no changes in calcium metabolism are required for the development of myringosclerosis. Moreover, unlike in previous studies, higher calcium levels are not associated with more myringosclerosis. Calcemia did not influence the appearance of myringosclerosis after myringotomy with the insertion of ventilation tubes.

S221 – The Postero-superior Quadrant of the Tympanic Membrane

Objectives The purpose of this study was to document the anatomic relationship of the postero-superior segment of the tympanic membrane and its clinical implications. Methods 100 temporal bones from adults without history of otologic pathology were studied. The morphological and anatomical details of the tympanic membrane were observed in 70 bones, which implied the use of macroscopic sections of the bones. The histological results were documented in 30 serially sectioned bones, stained previously with hematoxylin-eosin. Results We established that the postero-superior quadrant was the largest in size, with a mean dimension of 21.05 mm2, which represents 28.7% of the total area of the tympanic membrane. This feature implies that this quadrant is more exposed to pressure changes. We also verified that the posterosuperior part of the tympanic sulcus, above the chorda tympanic nerve, lost its depth in an unexpected way (60%) or that it gradually diminished from 0.9 to 0.5 mm until it disappeared near the posterior tympanic spine. In association, we established that at this level there was a decrease in the annulus caliber. Additionally, in 25% of cases, given the absence of the circular fibers of lamina propria, the postero-superior quadrant had only the radial fiber layer. Conclusions Anatomic and morphologic details in the postero-superior quadrant were newly described and may explain the greater incidence of retraction pockets and marginal perforations that provide the origin of cholestheatoma.