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How your ears work
Explains how the parts of the ear work to translate sound from the outside world into signals that the brain can understand.
Book
Treatment outcomes and prognostic factors in external auditory canal squamous cell carcinoma
External auditory canal carcinoma (EACC) is a rare and aggressive malignancy with substantial variability in prognosis depending on tumor stage and adjacent structure involvement. We retrospectively reviewed 56 patients with histologically confirmed squamous cell carcinoma of the external auditory canal treated at a tertiary referral center between 2000 and 2022. Clinical data including demographics, tumor stage, treatment modalities, surgical approach, and survival outcomes were analyzed. Kaplan–Meier survival curves and Cox proportional hazards regression were used to identify prognostic factors for overall survival (OS) and disease-specific survival (DSS). Of the 56 patients (mean age 61.6 years; 46.4% female), 30 had early-stage (T1–T2) and 26 had advanced-stage (T3–T4) tumors. The 5-year OS rates were 100.0% for early-stage, 60.0% for T3, and 42.0% for T4 disease. Advanced T-stage, nodal metastasis, and abutment to vascular structures such as the carotid artery or jugular bulb were significantly associated with worse outcomes. In multivariate analysis, younger age, vascular abutment, and nodal metastasis were independent negative prognostic factors. En bloc resection with clear margins was associated with improved survival. These findings emphasize the importance of early diagnosis and meticulous surgical planning to achieve complete resection and optimize outcomes in patients with EACC.
Journal Article
Whose ears?
\"Round ears, pointy ears, big ears, little ears, ears that hear well, and ears that don't! How many can you guess?\"--Book jacket.
Book
Emerging Paradigms in Cholesteatoma: From a Traditional Approach to Personalized Therapy
Cholesteatoma is a prevalent disease affecting both children and adults. In this review, we present the recent findings related to the molecular mechanisms involved in cholesteatoma and discuss how researchers can target new molecules to treat this disease. These new approaches illustrate the paradigm shift from a primarily surgical solution to a biological “control and prevent” strategy.
Journal Article
Middle ear congenital cholesteatoma: systematic review, meta-analysis and insights on its pathogenesis
Purpose
Congenital cholesteatoma (CC) presents as a white pearl-like lesion behind a normal tympanic membrane (TM), without a history of otorrhea, infection, perforation or previous otologic surgery. Several recent studies provided new data improving this pathology characterization. The aim of this paper is to expand the knowledge about CC and to provide new insights on its pathogenesis.
Methods
The study consisted of two main research parts: (1) systematic review and meta-analysis; (2) medical literature review englobing anatomy, histology, embryology and congenital pathology of the ear.
Results
The search strategy identified a total of 636 papers. Seventy retrospective studies were included. A total of 1497 cases were studied and the mean age was 6.58 years, with a male–female ratio of 3:1, 34% were asymptomatic, 26% had hearing loss and 2% had facial dysfunction/paralysis. The overall estimate for antero-superior quadrant involvement was 0.70 [95% confident interval (CI) 0.64–0.76], in the postero-superior quadrant was 0.60 (95% CI 0.52–0.69), in the antero-inferior quadrant was 0.32 (95% CI 0.23–0.41), in the postero-inferior quadrant was 0.38 (95% CI 0.29–0.47), in the attic was 0.53 (95% CI 0.43–0.63) and in the mastoid was 0.33 (95% CI 0.26–0.41). More advanced Potsic stages were present in older patients. The most likely inclusion place seems to be between the pars flaccida and the upper quadrants of the pars tensa.
Conclusions
During the last decades, a substantial improvement in CC diagnosis and management had been achieved. The presented mechanism seems to explain most of middle ear CC.
Journal Article
Middle ear lymphoepithelioma-like carcinoma with cerebellopontine angle invasion misdiagnosed as meningioma: A case report and literature review
Lymphoepithelioma-like carcinoma typically arises in the nasopharynx. Primary occurrence in the middle ear with subsequent intracranial extension remains exceedingly rare, and its diagnosis is often challenging owing to the paucity of detailed clinicoradiological data. Herein, we describe a case of an 82-year-old male presenting with a 2-year history of left-sided hearing loss, a 3-year history of left facial asymmetry (including mouth deviation and eyelid insufficiency), and a 10-day history of nausea/vomiting. His medical history included chronic otitis media. Imaging studies revealed a left cerebellopontine angle mass and chronic left otomastoiditis. Subtotal tumor resection was performed, and pathological analysis confirmed the diagnosis of lymphoepithelioma-like carcinoma. The patient received only supportive care and survived for 23 months. This case report aimed to emphasize the need for clinicians consider atypical cerebellopontine angle tumors in patients with chronic otitis media from Epstein-Barr virus–endemic regions and highlight the importance of a comprehensive diagnostic and therapeutic approach.
Journal Article
Updates and Knowledge Gaps in Cholesteatoma Research
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
Journal Article