Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 5, pp 2141–2148 | Cite as

The variants of the retro- and hypotympanum: an endoscopic anatomical study

  • Marco Bonali
  • Lukas AnschuetzEmail author
  • Matteo Fermi
  • Domenico Villari
  • Giulia Adalgisa Mariani
  • Lucia Manzoli
  • Marco Caversaccio
  • Livio Presutti
Otology

Abstract

The retro- and hypotympanum are hidden areas of the middle ear, only poorly recognized. Nevertheless, this region is of relevant clinical significance, since it is regularly affected by disease such as cholesteatoma. The aim of this study is to explore and describe the anatomical variants of the hypo- and retrotympanum by the means of transcanal endoscopy. We hypothesize a significant variability of this hidden region of the middle ear. Moreover, we believe that the minimal invasive, endoscopic access is suitable since angled scopes may be used to explore the region. To this end a total of 125 middle ears (83 cadaveric dissections, 42 surgical cases) were explored by the means of 3 mm straight and angled scopes. The variants were documented photographically and tabularized. The bony crests ponticulus, subiculum and finiculus were most frequently represented as ridges. The ponticulus showed the highest variability with 38% ridge, 35% bridge and 27% incomplete presentation. The subiculum was bridge-shaped only in 8% of the cases, the finiculus in 17%. The sinus tympani had a normal configuration in 66%. A subcochlear canaliculus was detectable in 50%. The retro- and hypotympanum were classified, respectively, to the present bony crests and sinus in a novel classification type I–IV. In conclusion, we found abundant variability of the bony structures in the retro- and hypotympanum. The endoscopic access is suitable and offers thorough understanding and panoramic views of these hidden areas.

Keywords

Middle ear anatomy Sinus tympani Retrotympanum Hypotympanum Endoscopic ear surgery Ponticulus Subiculum Finiculus 

Notes

Compliance with ethical standards

Conflict of interest

LA holds a research fellowship by the Bangerter-Rhyner Foundation, Bern, Switzerland and by Karl Storz GmbH, Tuttlingen, Germany. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Therefore, the authors declare no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional, regional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

References

  1. 1.
    Marchioni D, Mattioli F, Alicandri-Ciufelli M, Presutti L (2009) Transcanal endoscopic approach to the sinus tympani: a clinical report. Otol Neurotol 30:758–765CrossRefPubMedGoogle Scholar
  2. 2.
    Weiss MH, Parisier SC, Han JC et al (1992) Surgery for recurrent and residual cholesteatoma. Laryngoscope 102:145Y51Google Scholar
  3. 3.
    Jeng FC, Tsai MH, Brown CJ (2003) Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol 24:29–32CrossRefPubMedGoogle Scholar
  4. 4.
    Pickett BP, Cail WS, Lambert PR (1995) Sinus tympani: anatomic considerations, computed tomography, and a discussion of the retrofacial approach for removal of disease. Am J Otol 16:541–550Google Scholar
  5. 5.
    Pulec JL (1996) Sinus tympani: retrofacial approach for the removal of cholesteatomas. Ear Nose Throat J 75:77–88PubMedGoogle Scholar
  6. 6.
    Pratt LL (1984) Complications associated with the surgical treatment of cholesteatoma. Laryngoscope 93:289–291Google Scholar
  7. 7.
    Presutti L, Marchioni D, Mattioli F, Villari D, Alicandri Ciufelli M (2008) Endoscopic management of acquired cholesteatoma: our experience. J Otolaryngol 4:1–7Google Scholar
  8. 8.
    Thomassin JM, Korchia D, Doris JM (1993) Endoscopic guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope 103:939–943CrossRefPubMedGoogle Scholar
  9. 9.
    Badr-El-Dine M (2002) Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol 23:631–635CrossRefPubMedGoogle Scholar
  10. 10.
    Marchioni D, Alicandri-Ciufelli M, Pothier DD, Rubini A, Presutti L (2015) The round window region and contiguous areas: endoscopic anatomy and surgical implications. Eur Arch Otorhinolaryngol 272(5):1103–1112CrossRefPubMedGoogle Scholar
  11. 11.
    Marchioni D, Alicandri-Ciufelli M, Piccinini A, Genovese E, Presutti L (2010) Inferior retrotympanum revisited: an endoscopic anatomic study. Laryngoscope 120(9):1880–1886CrossRefPubMedGoogle Scholar
  12. 12.
    Baki FA, El Dine MB, El Said L et al (2002) Sinus tympani endoscopic anatomy. Otolaryngol Head Neck Surg 127:158–162CrossRefPubMedGoogle Scholar
  13. 13.
    Proctor B (1969) Surgical anatomy of the posterior tympanum. Ann Otol Rhinol Laryngol 78:1026–1040CrossRefPubMedGoogle Scholar
  14. 14.
    Holt JJ (2005) The ponticulus: an anatomic study. Otol Neurotol 26:1122Y4CrossRefGoogle Scholar
  15. 15.
    Marchioni D, Alicandri-Ciufelli M, Grammatica A, Mattioli F, Presutti L (2010) Pyramidal eminence and subpyramidal space: an endoscopic anatomical study. Laryngoscope 120(3):557–564CrossRefPubMedGoogle Scholar
  16. 16.
    Marchioni D, Alicandri-Ciufelli M, Rubini A, Presutti L (2015) Endoscopic transcanal corridors to the lateral skull base: initial experiences. Laryngoscope 125(Suppl 5):S1–S13CrossRefPubMedGoogle Scholar
  17. 17.
    Bennett ML, Zhang D, Labadie RF, Noble JH (2016) Comparison of middle ear visualization with endoscopy and microscopy. Otol Neurotol 37(4):362–366PubMedGoogle Scholar
  18. 18.
    Yong M, Mijovic T, Lea J (2016) Endoscopic ear surgery in Canada: a cross-sectional study. J Otolaryngol Head Neck Surg 19:45 (1:4)Google Scholar
  19. 19.
    Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F, Presutti L (2015) Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience. Int J Pediatr Otorhinolaryngol 79(3):316–322CrossRefPubMedGoogle Scholar
  20. 20.
    James AL, Cushing S, Papsin BC (2016) Residual cholesteatoma after endoscope-guided surgery in children. Otol Neurotol 37(2):196–201CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of ModenaModenaItaly
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryInselspital, University Hospital and University of BernBernSwitzerland
  3. 3.Department of Biomedical Sciences, Medical SchoolUniversity of BolognaBolognaItaly

Personalised recommendations