Search Results (3)

Background/Objectives: Conductive hearing loss (CHL) recurrence or persistence after stapes surgery is often due to prosthesis displacement or malfunction, with malleus fixation being a less common cause. While persistent CHL linked to malleus fixation can be managed with appropriate diagnosis and surgical intervention, recurrent CHL cases remain poorly documented. This report describes a rare case of recurrent CHL due to malleus neck fixation, likely secondary to surgical trauma. Case Presentation: A 49-year-old woman underwent bilateral stapedectomy. CHL worsened after two years. CT showed right incus erosion and a left bony bridge. Revision surgery corrected the right side. Left tympanotomy revealed malleus fixation from a prior atticotomy. Removing the bony bridge restored ossicular mobility and hearing, stable at 6 and 12 months. Discussion: Malleus fixation after stapedectomy is rare and often related to congenital anomalies, chronic otitis media, tympanosclerosis, or surgical trauma. Bone dust or fragments from surgery may promote new bone formation, causing delayed fixation. Ossicular fixation can develop postoperatively and may be missed during primary surgery. High-resolution CT aids in diagnosis, especially in revision cases, while intraoperative palpation is key to detecting subtle abnormalities. Treatment options include ossicular mobilization, prosthesis revision, or chain reconstruction, tailored to the fixation’s location and severity. Conclusions: Surgical trauma should be considered a potential cause of recurrent CHL post-stapedectomy. Thorough removal of bone debris through aspiration and irrigation during surgery is essential to minimize this risk and optimize long-term hearing outcomes. Full article

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003–2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients. Full article

Introduction: Three tiny bones compose the human ossicular chain: malleus, incus and stapes. Also known as auditory ossicles, they are united by joints in the middle ear cavity of the petrous part of the temporal bone. Completely developed two years after birth, the ossicular chain is involved in the physiological process of hearing, by which sound waves from the environment are converted into electrochemical impulses. In the last 500 years, most studies have focused on the morphogenesis, morphological variability and clinical pathology of the ossicular chain, whilst only a few studies have added relevant knowledge to anthropology and forensic science. The auditory ossicles and the enclosing petrous bone are some of the hardest in the human skeleton. This is reflected in a relative resistance to fire and in the possibility of preservation and fossilization in millions of years. Materials and Methods: The literature and four present-day forensic cases were included in studying the postmortem loss of the auditory ossicles in skeletal or decomposing remains. Results indicate that it can be ascribed to their destruction or physical displacement, by either macro-micro-faunal action and/or any other natural or artificial disturbance. Discussion: Physical displacement is closely connected to the depositional environment of the skeletal remains, such as burial, entombment (sarcophagus, coffin, vault…), submersion or exposure to natural elements. Auditory ossicles can be recovered in situ, or very close to their anatomical location, when the skeletal material has been involved in an archaeological excavation. In the case of accessible or disturbed remains, scavengers may remove the tiny ossicles and/or they can slip out of the middle ear cavity following skull movements. Entombment offers effective protection against the displacement of the auditory ossicles, whereas aquatic submersion and aquatic movement almost invariably displace them. Conclusion: the preservation of the human auditory ossicles should be critically considered in the comprehensive context of any forensic investigation on human remains since it can assist the reconstruction of their taphonomic history. Taphonomic histories of remains can add crucial information to forensic investigations (e.g., the Post Mortem Interval, PMI). The aim of this study, limited by scarce relevant literature, is to discuss the potential role of the ossicular chain, detected by postmortem imaging techniques, as a taphonomical indicator in decomposing and/or skeletonized bodies. Full article