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MarcosV.Goycoolea·
SadySelaimendaCosta·
ChristopherdeSouza·
MichaelM.PaparellaEditors
Textbook
ofOtitis Media
TheBasics and Beyond
123
Textbook of Otitis Media
Marcos V. Goycoolea • Sady SelaimendaCosta
Christopher deSouza • Michael M. Paparella
Editors
Textbook of Otitis Media
The Basics andBeyond
Editors
Marcos V. Goycoolea
Department of Otolaryngology
Clínica Universidad de Los Andes
Santiago, Chile, USA
Sady SelaimendaCosta
Otolaryngology
Federal University of Rio Grande do Sul
Porto Alegre, Rio Grande do Sul, Brazil
Chris de Souza
Department of Otolaryngology
Tata Memorial Hospital
Mumbai, Maharashtra, India
Michael M. Paparella
Paparella Ear Head & Neck Institute
University of Minnesota
Minneapolis, MN, USA
ISBN 978-3-031-40948-6 ISBN 978-3-031-40949-3 (eBook)
https://doi.org/10.1007/978-3-031-40949-3
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
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expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable.
Preface
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The First International Symposium on Recent Advances in Otitis Media was held in May 1975
in Columbus, Ohio. At the time I was a rst-year resident—26 years old—in Otolaryngology
at the University of Minnesota, with two previous years in General Surgery. I was doing
research in otitis media in cats and “my cats made it to the meeting.” As a coauthor of Michael
Paparella and Steve Juhn, that was my rst paper ever. At that symposium I was one of the
youngest if not the youngest participant. The meeting in Columbus was organized by Doctors
Ben Senturia, Charles Bluestone, David Lim, Michael Paparella, and Steve Juhn, among others. From then on, every 4 years and for many years I participated as a member of the Minnesota
team and eventually as a member of the Chilean team. There were many groups at the time.
Our group was led by Michael Paparella and Steve Juhn and all of us residents including Tim
Jung and myself. Other groups were the Pittsburgh group of Charles Bluestone and Sylvan
Stool, the Swedish group of Dr Inglested that included, among others, Sten Hellstrom, Karin
Prellner, Margaretha Casselbrandt, and Ann Hermannsonn, the Danish group of Mirko Tos and
Jans Thomsen, the Finish group of Tauno Palva and Pekka Karma, the Japanese groups with
Drs Mogi, Honjo, Ogra, and many others, including the group in Israel led by Jacob Sadé. All
these groups kept participating every 4 years and bonds of friendship developed over time. In
between the Swedish group organized the middle inner ear interactions meeting in Umea with
unforgettable pre- and post-congress meetings with the leadership of Sten Hellstrom, Jan
Wersall, Matti Anniko, Claude Laurent, and others. Over time we became staff, and our fellows became incorporated to the group. That was the case of Marcelo Hueb, Sady Selaimen da
Costa, Carlos Ruah, and Chris de Souza, who became prominent otolaryngologists, many of
them presidents of their national societies and members of the Collegium.
At the rst Symposium in 1975, we were the young members and Doctor Senturia—a wise,
kind, and encouraging man—was gradually fading (as heroes often do over time). I will never
forget unique moments at these multiple reunions such as the Swedish group dancing and singing “the frog” at a farewell party, Goro Mogi shing in Tromso, Norway, presenting himself
as: “Goro Mogi a great sherman from Japan,” Dr Lars Eric Stenfors talking about the ying
penguins of Norway and trying to convince us that the meat we were eating was whale, David
Lim in Jukasjarvi (the town of the midnight sun in summer and the Ice Hotel in winter) telling
me: “Marcos look how far otitis media has taken you,” Ann Hermannson in northern Sweden
teaching us about the Hundras and the beliefs of the northern people (I still keep the bone box
with the magic power of northern Sweden), Sten Hellstrom organizing a pre-meeting competition of picking berries and mushrooms in the Umea forest, etc.
During these unforgettable meetings we learned a lot about otitis media but more importantly we learned about life and friendship, and my wife and I are thankful and feel privileged
to have participated and to have met all of them and consider them our friends. We were scientists but at the same time human beings and friends who enjoyed not only science but, more
importantly, friendship. These were meetings that taught us to help and treat people, persons,
far beyond the important use of statistical signicance, xi square, and computerized evidence.
The last International Symposium on Recent Advances in Otitis Media was held in June
2021, and there I was, presenting, 46 years later. Only that, this time, the difference was that I
was one of the oldest if not the oldest participant, and one of the very few originals of 1975.
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However, the difference was that at this last meeting the one that was gradually fading was me,
just like Dr Senturia at the rst meeting. Many of our mentors and pioneers like Michael
Paparella—our honored co-editor and co-author in this book—Steve Juhn and others, just like
the old heroes, are fading away. However, although they physically fade away, those that
remain and had the privilege to have lived, worked, and learned from them will keep them alive
in their hearts and in their concepts because they have become an integral part of the “otitis
media family” forever.
At this stage in my professional career, I was not about to edit another book on otitis media;
however, I accepted as an exception only to lead this book in honor of our pioneers who so
generously encouraged us, taught us, and introduced us to the subject of otitis media. In this
spirit, and before fading away myself, I accepted to lead a book in honor of their memory and
to give the torch to the young ones on my team and in other teams, who are in the same position
that I was in 1975.
God and life have been good to me and my family (it has not been free), and I feel that I
should make this last otitis media effort and personally contribute with concepts in structure,
function, and pathogenesis which are current and essential for the understanding of this multifactorial disease. At the same time, I wanted to contribute by transmitting the energy that was
given to us in 1975 and transmit it modied and improved to the new generations, which will
in turn modify and improve it in a constant enrichment that will contain the concepts and the
spirits of the “otitis media family” for eternity.
Santiago, MN, USA MarcosV.Goycoolea
Porto Alegre, Rio Grande do Sul, Brazil SadySelaimenda Costa
Mumbai, Maharashtra, India Chrisde Souza
Minneapolis, MN, USA MichaelM.Paparella
Preface
Contents
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1 Definitions, Terminology, and Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Marcos V. Goycoolea, Sady Selaimen da Costa, Chris de Souza,
and Michael M. Paparella
2 Otitis Media: Basic Concepts and Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Sady Selaimen da Costa and Rafael da Costa Monsanto
3 Otitis Media and Human Efforts to Deal with It Through Time . . . . . . . . . . . . . . 21
Marcos V. Goycoolea and Mario Castro
4 Development and Anatomy of the Human Middle Ear . . . . . . . . . . . . . . . . . . . . . . 29
Charlotte M. Burford, Hannah L. Cornwall, Matthew R. B. Farr,
Claudia M. Santoni, and Matthew J. Mason
5 Normal Histology of the Eustachian Tube, Middle Ear, and Mastoid
Complex: The Mucoperiosteum Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Marcos V. Goycoolea, Raimundo José García-Matte, and Catalina Gutiérrez
6 Understanding the Aeration Avenues of the Middle Ear with the Aid
of the Endoscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Alessia Rubini, Margherita Basso, Nicola Bisi, Pierfrancesco Bettini,
and Daniele Marchioni
7 Regulated Balance of Pressure Variations in the Temporal
Pneumatic Spaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Bernard Ars and Dominique Estève
8 The Role of Immunity in the Development of Otitis Media . . . . . . . . . . . . . . . . . . 75
Sara Concha and Rodrigo Hoyos-Bachiloglu
9 When to Suspect and How to Evaluate Immune Deficiencies
in Otitis Media
Sara Concha and Rodrigo Hoyos-Bachiloglu
10 Genetics and Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Nam K. Lee and Regie Lyn P. Santos-Cortez
11 Predictive Medicine in Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Raimundo José García-Matte, María José Herrera J, and Marcos V. Goycoolea
12 Importance of Animal Studies in the Understanding of Otitis Media . . . . . . . . . . 119
Marcelo Miguel Hueb, Fernanda Rocha Hueb, Marcela Rocha Hueb,
and Michael M. Paparella
13 Critical Appraisal of Published Research in Otitis Media or How
to Sort the Wheat from the Chaff!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Joel Lavinsky, Vagner Antonio Rodrigues da Silva, and Luiz Lavinsky
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
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14 Translational Histopathology in Otitis Media: The Real Evidence-Based
Medicine! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Suanur M. Kayaalp, Sebahattin Cureoglu, and Michael M. Paparella
15 Patulous Eustachian Tube and the Differential Diagnosis of Autophony . . . . . . . 143
Bryan K. Ward, Carrie L. Nieman, and Dennis S. Poe
16 Office Examination in Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
Fábio André Selaimen, Alice Lang Silva, Wiquinylson França de Oliveira, and
Sady Selaimen da Costa
17 Non-surgical Strategies to Restore Middle Ear Aeration . . . . . . . . . . . . . . . . . . . . 163
Bernard Ars and Dominique Estève
18 Drug Delivery Across the Intact Tympanic Membrane: Methods,
Mechanisms and Potential Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Arwa Kurabi, Molly Cooper, Emily Sereno, and Allen F. Ryan
19 Viral Otitis Media and Acute Otitis Media and Recurrent Acute
Otitis Media. An Evidence-Based Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
José Faibes Lubianca Neto, João Pedro Neves Lubianca,
and Marcelo Neves Lubianca
20 The Microbiology of Otitis Media, Biofilms and Its Implication
in the Clinical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Maria Beatriz Rotta Pereira, Manuel Ruttkay Pereira,
Denise Rotta Ruttkay Pereira, and Vlademir Cantarelli
Contents
21 Otitis Media with Effusion: Pathophysiology, Clinical Picture
and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
María José Herrera J and José Alzerreca
22 Inflammatory Mediators in the Pathogenesis of Otitis Media:
A Brief Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Timothy T. K. Jung
23 Retraction Pockets and Adhesive Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
María José Herrera J and Javiera Pardo
24 Ventilation Tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Ann Hermansson
25 Post-Tympanostomy Tube Otorrhea and Other Complications . . . . . . . . . . . . . . . 223
Henrique Furlan Pauna, Rafael C. Monsanto, Letícia A. Oyama,
Ana Paula Chornobay, Karina Salvi, Livia Tamie T. Sassaki,
and Michael M. Paparella
26 Vaccination Policies in Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Ann Hermansson
27 Managing Risk Factors in Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Joshua A. Stramielo and Daniela Carvalho
28 Otitis Media in Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
Stephanie J. Wong and Daniela Carvalho
29 Early in Life Otitis Media and Its Impact in Hearing, Speech Development,
and Central Auditory Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Berenice Dias Ramos
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30 Balance and Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Rafael da Costa Monsanto, José Carlos Convento Júnior,
José Vicente Boleli Scardini Alves, and Norma de Oliveira Penido
31 The Use of Topical Treatment and Middle–Inner Ear Interaction . . . . . . . . . . . . 275
Marcos V. Goycoolea, Leandro Rodríguez, and Pilar Epprecht
32 Silent Otitis Media and Subtle Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
Rafael da Costa Monsanto and Michael M. Paparella
33 Complications of Otitis Media Limited to Within the Temporal Bone . . . . . . . . . 287
Diane Biju, Aishan Patil, Shaila Sidam, Aditi Govil, Kanchan Gupta,
Vishal Tyagi, Rosemarie de Souza, and Chris de Souza
34 Intracranial Complications of Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Diane Biju, Aishan Patil, Shaila Sidam, Aditi Govil, Kanchan Gupta,
Vishal Tyagi, Rosemarie de Souza, and Chris de Souza
35 Basic Imaging and Normal Temporal Bone Sections . . . . . . . . . . . . . . . . . . . . . . . . 307
Marcos V. Goycoolea, Catalina Gutiérrez, and Francisco Chiang
36 Evaluation and Auditory Rehabilitation in Chronic Otitis Media (COM) . . . . . . 327
Byanka Cagnacci Buzo, S. Catherine Catenacci, and G. Raquel Levy
37 Pathogenesis of Chronic Otitis Media and the Continuum: The Basics,
Further and Beyond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Sady Selaimen da Costa and Michael M. Paparella
38 Chronic Otitis Media Without Cholesteatoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Fábio André Selaimen, Mauricio Noschang Lopes da Silva,
and Sady Selaimen da Costa
39 Tympanic Membrane Perforations and Tympanoplasty: New Profiles,
New Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Fábio André Selaimen, Mauricio Noschang Lopes da Silva,
Tiago Isamu Saiguchi Murakami, and Sady Selaimen da Costa
40 Ossicular Pathology in Chronic Otitis Media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Cemil Kayaalp, Henrique Furlan Pauna, Rafael C. Monsanto, Hamed Sajjadi,
Michael M. Paparella, and Sebahattin Cureoglu
41 Tympanic Membrane Retractions: Pathophysiology, Classification,
and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Inesangela Canali, Letícia Petersen Schmidt Rosito, and Caroline Catherine
Lacerda Elias
42 Temporal Bone Cholesteatoma: The Full Picture . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Sady Selaimen da Costa, Leticia Petersen Schimdt Rosito,
Mauricio Noschang Lopes da Silva, and Fábio André Selaimen
43 Progresses in Cholesteatoma Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
H. Sudhoff and M. Schürmann
44 Advanced Hearing and Balance Evaluation in Otitis Media . . . . . . . . . . . . . . . . . 465
Rafael da Costa Monsanto, Leandro Guena de Castro, Matheus Saito,
José Carlos Convento Junior, and Norma de Oliveira Penido
45 Radiological Evaluation of the Temporal Bone in Chronic Otitis Media . . . . . . . 481
Mauricio Noschang Lopes da Silva, Marcela Lehmkuhl Damiani,
and Sady Selaimen da Costa
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46 Surgical Anatomy of the Middle Ear Cleft and Mastoid . . . . . . . . . . . . . . . . . . . .505
Sady Selaimen da Costa, Douglas K. Reinhardt,
and Marcela Lehmkuhl Damiani
47 The Endoscopic Anatomy of Temporal Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Muaaz Tarabichi, Aneesa Ansar, Mustafa Kapadia, and Daniele Marchioni
48 Surgical Treatment of Chronic Otitis Media: Menu of Solutions . . . . . . . . . . . . . 527
Sady Selaimen da Costa, Fabio Andre Selaimen,
Mauricio Noschang Lopes da Silva, and Douglas K. Reinhardt
49 Tympanoplasty: Underlay Technique Step by Step and the Complex
Tympanoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Fábio André Selaimen, Mauricio Noschang Lopes da Silva,
and Sady Selaimen da Costa
50 Tympanoplasty: The Overlay Technique Step by Step . . . . . . . . . . . . . . . . . . . . . . 559
Fábio André Selaimen, Mauricio Noschang Lopes da Silva,
and Sady Selaimen da Costa
51 Tympanoplasty: The Inlay Technique Step by Step . . . . . . . . . . . . . . . . . . . . . . . . 567
José Faibes Lubianca Neto, João Pedro Neves Lubianca,
Marcelo Neves Lubianca, and Roland Douglas Eavey
52 Medio-Lateral Graft Tympanoplasty for Anterior or Subtotal Tympanic
Membrane Perforation: An Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .585
Timothy T. K. Jung
Contents
53 Flexible Approach Tympanoplasty/Mastoidectomy: A Pathology-Guided,
Pathogenesis—Oriented Surgery for the Middle Ear . . . . . . . . . . . . . . . . . . . . . . .589
Sady Selaimen da Costa, Michael M. Paparella, and Rochane Figini Maciel
54 Principles of Surgical Management of Cholesteatoma . . . . . . . . . . . . . . . . . . . . . . 605
Adam C. Kaufman and Peter L. Santa Maria
55 Canal Wall Down v/s Canal Wall Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615
Jorge Caro, Jai-sen F. Leung, and Phoebe H. Ramos
56 Simple Mastoidectomy: Indications and Techniques . . . . . . . . . . . . . . . . . . . . . . . . 625
Jefferson André Bauer and Felipe da Costa Huve
57 Canal Wall Up Tympanomastoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 631
Alex Joseph Fejta Tampio and Douglas Backous
58 Canal Wall-Down Tympanomastoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
Sady Selaimen da Costa, Mauricio Noschang Lopes da Silva,
Jefferson André Bauer, Fábio André Selaimen,
and Letícia Petersen Schmidt Rosito
59 Endoscopic Assisted Canal Wall Up Tmpanomastoidectomy: The Combined
Approach Redefined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 665
Mauricio Noschang Lopes da Silva, Sady Selaimen da Costa,
and Fábio André Selaimen
60 Intact-Bridge Mastoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
Rafael da Costa Monsanto, Henrique Furlan Pauna, and Michael M. Paparella
61 Radical Mastoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
Francisco Tocornal J.
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