Irina Arechvo

New total ossicular replacement prostheses with a resilient joint: experimental data from human temporal bones.

Hypothesis New flexible total ossicular prostheses with an integrated microjoint can compensate for large static displacements in the reconstructed ossicular chain. When properly designed, they can mimic the function of the joints of the intact chain and ensure good vibration transfer in both straight and bent conditions. Background Prosthesis dislocations and extrusions are frequently observed after middle ear surgery. They are mainly related to the altered distance between the coupling points because of large static eardrum displacements. Methods The new prostheses consist of 2 titanium shafts, which are incorporated into a silicone body. The sound transfer function and stapes footplate displacement at static loads were evaluated in human temporal bones after ossicular reconstruction using prostheses with 2 different silicones with different hardness values. The stiffness and bending characteristics of the prostheses were investigated with a quasi-static load. Results The sound transfer properties of the middle ears with the prostheses inserted under uncompressed conditions were comparable with those of ears with intact ossicular chains. The implant with the soft silicone had improved acoustic transfer characteristics over the implant with the hard silicone in a compressed state. In the quasi-static experiments, the minimum medial footplate displacement was found with the same implant. The bending characteristics depended on the silicone stiffness and correlated closely with the point and angle of the load incidence. Conclusion The titanium prostheses with a resilient joint that were investigated in this study had good sound transfer characteristics under optimal conditions as well as in a compressed state. As a result of joint bending, the implants compensate for the small changes in length of the ossicular chain that occur under varying middle ear pressure. The implants require a stable support at the stapes footplate to function properly.

Syringocystadenoma Papilliferum of the Bony External Auditory Canal: A Rare Tumor in a Rare Location

Tumors originating from ceruminous glands are rare lesions of the external auditory canal. The lack of specific clinical and radiological signs makes their diagnosis challenging. We report the case of an exceptionally rare benign tumor, a syringocystadenoma papilliferum (SCAP), in an atypical location in the bony segment of the external auditory canal with uncommon clinical signs. The special traits of the case included the following: the most lateral component of the tumor was macroscopically cystic and a granular myringitis with an obstructing keratin mass plug was observed behind the mass. The clinical, audiological, radiological, and histological characteristics of the neoplasm are consequently presented. Intraoperative diagnosis of the epidermal cyst was proposed. The final diagnosis of SCAP was determined only by histological analysis after the surgical excision. The educational aspects of the case are critically discussed.

Reliability and validity of the Lithuanian Tinnitus Handicap Inventory

OBJECTIVE The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap. MATERIALS AND METHODS A cross-sectional psychometric validation study was performed in the University Hospital. A total of 248 subjects reporting chronic tinnitus as their primary complaint or secondary to hearing loss were encluded in the study and filled in the Lithuanian version of THI. For assessment of construct validity a subgroup of 55 participants completed the Lithuanian version of the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. Test-retest and internal consistency reliability as well as construct validity were calculated. RESULTS The Lithuanian version of the THI and its subscales showed a robust internal consistency reliability (Cronbachs alpha=0.93) comparable to the original version. Statistically significant correlations were observed between the Lithuanian translation of the THI and the measures of self-perceived levels of anxiety and depression using HADS. Confirmatory factor analysis demonstrated that the three subscales of the THI Lithuanian version corresponded to three different factors, which strongly correlated between themselves. CONCLUSIONS The results suggest that the Lithuanian version of THI maintains its original validity and may serve as reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living.

Bilateral fracture of the styloid process with parapharyngeal emphysema.

A 40-year-old man presented to our tertiary care facility less than 24 hours after acute violent blunt head trauma. He was hit with brass knuckles in the right preauricular region. He did not lose consciousness after the trauma. At arrival, the patient complained of moderate headache, dizziness, hearing loss, and high-pitched tinnitus on the right side as well as mild bleeding from the mouth and painful swallowing. He also reported problems with occlusion on the right side. He denied shortness of breath, trismus, and dysphagia. On physical examination, the patient had a Glasgow Coma score of 15, a right lower lid subcutaneous hematoma and subconjunctival hemorrhage. Microscopically, there were several small tympanic membrane hematomas along the handle of the malleus with a reduced range of eardrum movements on pneumotoscopy of the right side. A skin laceration was detected on the anterior wall of the bony part of the external auditory canal on that side. The Weber lateralized to the left ear and the Rinne was positive bilaterally. Audiometry revealed moderate-to-severe mixed hearing loss with an air-bone gap of 15 dB on the right side. The hearing in the left ear was normal. A type B tympanogramwas foundon the right side.Nasopharyngoscopy with a 30-degree 4 mm-diameter rigid endoscope revealed multiple mucosal membrane lacerations on the posterior and lateral walls of the nasopharynx. High-resolution spiral nonenhanced computed tomographic (CT) scans of the temporal bones revealed air above the left mastoid tegmen and bilateral fractures of styloid processes (SP) with caudal dislocation of the inferior fragments (Figs. 1, A, B, and D, and 2, A and B). There was massive emphysema of both parapharyngeal spaces, both temporomandibular joints (TMJ) and both infratemporal fossae (Figs. 1, BYD). The patient was observed and treated conservatively. Follow-up CT imaging demonstrated no evidence of pneumocephalus with a marked reduction in parapharyngeal emphysema. The nasopharyngeal laceration healed uneventfully. Traumatic fractures of the SP can appear after motor vehicle accidents or can be complications of dental treatment and tonsillectomy (1,2). Spontaneous fracture of the SP may occur because of sudden laughter, swallowing, yawning, or coughing (3). The fractured SP should be differentiated from the ossified stylohyoid ligament and from the segmented or pseudosegmented SP (4). Before the trauma, our patient did not have complaints related to Eagle’s syndrome. He denied cervicofacial pain, a foreign body sensation in the throat, dysphagia, tinnitus, and otalgia. We report a unique case of a bilateral SP fracture with caudal dislocations of both lower fragments of the latter in conjunction with massive emphysema of both parapharyngeal spaces associated with trauma. Despite significant findings on CT scans, the patient presented with minimal signs and symptoms. Large amounts of air in deep neck spaces may sometimes cause serious complications, such as respiratory failure, because of airway compromise. An SP longer than 25 mm is defined as elongated and is related to the symptoms of Eagle’s syndrome. In our case, the total length (from the base to the dislocated apex) of the SP was 40.30 mm on the right side and 41.81 mm on the left side. Therefore, future posttraumatic Eagle’s syndrome, because of the fractured and dislocated SP, may occur. In our case, the temporal bone fracture was Address correspondence and reprint requests to Irina Arechvo, M.D., Department of Ear, Nose and Throat Diseases, Republican Vilnius University Hospital, Siltnamiu 29, 04130 Vilnius, Lithuania; E-mail: arechvo@gmail.com The authors disclose no conflicts of interest. Otology & Neurotology 35:e155Ye156 2014, Otology & Neurotology, Inc.

A Rare Case of Large Schwannoma of the Parapharyngeal Space

Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. The special traits of the presented case included the following: the patient presented with slowly progressing dysphagia, speech difficulties, jaw numbness, and taste dysfunction. A dislocated lateral pharyngeal wall with mild inflammatory changes of the oropharyngeal mucosa was observed during pharyngoscopy. The radiological and histological characteristics of the neoplasm are consequently presented. Special emphasis is placed on the surgical treatment of the tumor.

Clinical Challenges in the Diagnosis and Treatment of Temporal Bone Osteomyelitis

Temporal bone osteomyelitis is a serious life-threatening condition—a quick and proper diagnosis is needed to start treatment and reduce morbidity and mortality. Changing trends of the disease make a differential diagnosis difficult. To emphasize the importance of a clinical suspicion of this dangerous condition, our experience with three difficult cases is presented. The diagnosis was based on clinical symptoms, otoscopic findings, and findings on computed tomography or magnetic resonance imaging. Neoplasm and granulomatous inflammation were excluded by multiple biopsies. The disease can develop in nondiabetic patients. The disorder might be related to the initial inflammatory process in the middle ear with further direct spreading of infection through defects in the bony walls to deep temporal bone structures. Imaging should be performed early to detect osteolytic lesions of the skull base. Surgery was used for the presence of bone sequestra and infratemporal abscess.