title: A 3-D analysis of the protympanum in human temporal bones with chronic ear disease.
abstract: Eustachian tube dysfunction is believed to be an important factor to cholesteatoma development and recurrence of disease after surgical treatment. Although many studies have described prognostic factors, evaluation methods, or surgical techniques for Eustachian tube dysfunction, they relied on the soft tissues of its structure; little is known about its bony structure-the protympanum-which connects the Eustachian tube to the tympanic cavity, and can also be affected by several inflammatory conditions, both from the middle ear or from the nasopharynx. We studied temporal bones from patients with cholesteatoma, chronic otitis media (with and without retraction pockets), purulent otitis media, and non-diseased ears, looking for differences between the volume of the protympanum, the diameter of the Eustachian tube isthmus, and the distance between the anterior tympanic annulus and the promontory. Light microscopy and 3-D reconstruction software were used for the measurements. We observed a decrease of volume in the lumen of the four middle ear diseased ears compared to the control group. We observed a significant decrease in the volume of the protympanic space in the cholesteatoma group compared to the chronic otitis media group. We also observed a decrease in the bony space (protympanum space) in cholesteatoma, chronic otitis media with retraction pockets, and purulent otitis media compared to the control group. We found a correlation in middle ear diseases and a decrease in the middle ear space. Our findings may suggest that a smaller bony volume in the protympanic area may trigger middle ear dysventilation problems.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 2001 6th Street SE, Lions Research Building Room 210, Minneapolis, MN, 55455, USA.|Department of Otolaryngology, Head and Neck Surgery, University of Campinas-UNICAMP, Campinas, São Paulo, Brazil.
authors.forename: Henrique F
authors.initials: HF
authors.lastname: Pauna
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 2001 6th Street SE, Lions Research Building Room 210, Minneapolis, MN, 55455, USA.|Department of Otolaryngology and Head and Neck Surgery, Banco de Olhos de Sorocaba Hospital (BOS), Sorocaba, São Paulo, Brazil.
authors.forename: Rafael C
authors.initials: RC
authors.lastname: Monsanto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 2001 6th Street SE, Lions Research Building Room 210, Minneapolis, MN, 55455, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schachern
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 2001 6th Street SE, Lions Research Building Room 210, Minneapolis, MN, 55455, USA.|Paparella Ear, Head and Neck Institute, Minneapolis, MN, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Paparella
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 2001 6th Street SE, Lions Research Building Room 210, Minneapolis, MN, 55455, USA. cureo003@umn.edu.
authors.forename: Sebahattin
authors.initials: S
authors.lastname: Cureoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000473:pathology*; D005064:Eustachian Tube / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008853:Microscopy; D008875:Middle Aged; D010033:Otitis Media / Q000473:pathology*; D055815:Young Adult
keywords: Cholesteatoma; Eustachian tube; Middle ear disease; Otitis media; Protympanum; Retraction pockets