Structural changes in the middle ear tissues of the rat after fractionated irradiation

Magnuson, Karin; Franzén, Lars; Henriksson, Roger; Gustafsson, H.; Hellström, Sten

doi:10.1007/bf00179305

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Others etiologies include chronic suppurative otitis media, tympanic membrane perforation (TMP), fibrotic changes of the middle ear mucosa, and/or ossicular necrosis ( 11 ). While OME is most frequent during radiation therapy, the mucosal damages to the middle ear ( 12 , 13 ) associated with persistent ET dysfunction can lead to persistent OME after RT completion ( 11 ). Although ventilation tube placement will help with symptoms, the underlying cause may persist and compromise the outcomes of local procedures.…”

Section: Introductionmentioning

confidence: 99%

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study

2022

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IntroductionAlthough cutting-edges antineoplastic therapies increase survival in children with malignancies, the optimal surgical strategy to address associated comorbidities such as chronic tympanic membrane perforation is still poorly documented. The aim of this study is to evaluate the outcomes of type I tympanoplasty in pediatric cancer survivors who received chemo and/or radiotherapy to the skull and to identify potential associated risk factors.MethodsThis case-control study included medical records review of oncologic patients (age <21) treated at the same Academic medical oncologic center between March 2015 and July 2021 and referred for conductive hearing loss and chronic tympanic membrane perforation. Patients and middle ear status-related variables were analyzed, and outcomes were compared with matched peers without any history of malignancies.ResultsA total of seven pediatric cancer survivors and seven paired children without any history of malignancies were included in this report. The mean age at tympanoplasty type I surgery was 10.2 years (range = 4.3–19.9; median = 7.9 years) for the pediatric cancer survivors' group and 10.1 years (range = 5.5–19.2; median = 7.9 years) in the control group. Three pediatric cancer patients had received chemotherapy alone, one patient had radiotherapy to the skull base, and three patients had received chemoradiotherapy. On average, surgery was performed 3.9 years after chemo and/or radiotherapy termination, except for 1 patient for whom the tympanoplasty was performed during chemotherapy treatment. A retroauricular approach was used for one of the pediatric cancer patients, a transcanal approach was performed in one other and five patients benefited from an otoendoscopic approach. Tragal perichondrium with cartilage was used in most of the pediatric cancer survivor cases (four out seven cases) while xenograft (Biodesign) and Temporalis fascia without cartilage graft were used in five out of the seven control cases. Rate of tympanic membrane perforation recurrence was similar between groups (28.6%). Mean functional gain for air conduction Pure Tone Average (AC PTA) was 2.6 and 7.7 dB HL for the oncologic and control group, respectively. Mean postoperative air-bone gap (ABG) was 10.7 dB HL [median = 8.7; inter-quartile range (IQR) = 13.8] for the oncologic cohort and 10.1 dB HL (median = 10.7; IQR = 9.6) for the control group.DiscussionChemo- and chemoradiotherapy to the skull are associated with damages to the inner and middle ear structures with secondary eustachian tube dysfunction and chronic middle ear effusion. Although healing abilities and immunological defenses are compromised as part of the expected effects of antineoplastic therapies, type I tympanoplasty can be safe and effective in this population. While different approaches may be considered, otoendoscopy showed excellent results with less morbidity in this vulnerable population.

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Section: Introductionmentioning

confidence: 99%

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study

2022

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“…Histological examination of experimental animal models after high-dose radiation has demonstrated pathological changes to the middle ear, inner ear, and skull base structures. [1][2][3] Patients receiving radiation therapy for skull base tumors have been also shown to develop accelerated atherosclerosis and cranial nerve palsies such as facial paresthesias and weakness, as well as hearing loss, tinnitus, and imbalance, partly due to radiation exposure of healthy neurovascular structures of the skull base. 4 Although better than microsurgery, the long-term quality of life in patients with vestibular schwannoma treated with SRS has been shown to be reduced due to ongoing headaches, dizziness, hearing loss, facial nerve weakness, and tinnitus.…”

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confidence: 99%

“…Histological examination of experimental animal models after high‐dose radiation has demonstrated pathological changes to the middle ear, inner ear, and skull base structures 1‐3 . Patients receiving radiation therapy for skull base tumors have been also shown to develop accelerated atherosclerosis and cranial nerve palsies such as facial paresthesias and weakness, as well as hearing loss, tinnitus, and imbalance, partly due to radiation exposure of healthy neurovascular structures of the skull base 4 .…”

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Dosimetric Analysis of Neural and Vascular Structures in Skull Base Tumors Treated with Stereotactic Radiosurgery

Haidar¹,

Bhatt²,

Ghavami³

et al. 2017

Otolaryngol.--head neck surg.

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Objective To examine the relationship between the prescribed target dose and the dose to healthy neurovascular structures in patients with vestibular schwannomas treated with stereotactic radiosurgery (SRS). Study Design Case series with chart review. Setting SRS center from 2011 to 2013. Subjects Twenty patients with vestibular schwannomas treated at the center from 2011 to 2013. Methods Twenty patients with vestibular schwannomas were included. The average radiation dose delivered to healthy neurovascular structures (eg, carotid artery, basilar artery, facial nerve, trigeminal nerve, and cochlea) was analyzed. Results Twenty patients with vestibular schwannomas who were treated with fused computed tomography/magnetic resonance imaging-guided SRS were included in the study. The prescribed dose ranged from 10.58 to 17.40 Gy over 1 to 3 hypofractions to cover 95% of the target tumor volume. The mean dose to the carotid artery was 5.66 Gy (95% confidence interval [CI], 4.53-6.80 Gy), anterior inferior cerebellar artery was 8.70 Gy (95% CI, 4.54-12.86 Gy), intratemporal facial nerve was 3.76 Gy (95% CI, 3.04-4.08 Gy), trigeminal nerve was 5.21 Gy (95% CI, 3.31-7.11 Gy), and the cochlea was 8.70 Gy (95% CI, 7.81-9.59 Gy). Conclusions SRS for certain vestibular schwannomas can expose the anterior inferior cerebellar artery (AICA) and carotid artery to radiation doses that can potentially initiate atherosclerotic processes. The higher doses to the AICA and carotid artery correlated with increasing tumor volume. The dose delivered to other structures such as the cochlea and intratemporal facial nerve appears to be lower and much less likely to cause immediate complications when shielded.

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Structural changes in the rat tympanic membrane following repeated pressure loads

Magnuson

Hellström

Magnuson

1995

Eur Arch Otorhinolaryngol

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Healthy adult laboratory rats were exposed to alternating negative pressure and atmospheric pressure to replicate the clinical situation found in patients with chronic sniffing habits and chronic middle ear disease. The rats were placed in a box in which the pressure changed at intervals of 30 s between atmospheric pressure and a negative pressure of -3 kPa. This was repeated continuously for periods of 3 and 7 days. At completion of the experimental period, all rats had a normal otomicroscopic status. However, histological studies demonstrated that the pars flaccida was wrinkled and the loose connective tissue contained large fibroblasts with their long axes lying in a disorganized manner. The cells of the keratinizing epithelium were thicker than normal and mitoses were seen. Epithelial crypts filled with keratin were numerous along the epithelium. In the pars tensa, all layers were thicker than normal. These findings demonstrate that repeated pressure loading can create structural changes in the tympanic membrane.

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Structural changes in the middle ear tissues of the rat after fractionated irradiation

Cited by 5 publications

References 18 publications

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study

Dosimetric Analysis of Neural and Vascular Structures in Skull Base Tumors Treated with Stereotactic Radiosurgery

Structural changes in the rat tympanic membrane following repeated pressure loads

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