The goal of this study was to analyze whether tympanic plexus neurectomy is a successful surgical option in patients with intractable otalgia.

A retrospective single institution study from the experience of two surgeons was conducted.

Records of adult patients with intractable unilateral otalgia of likely glossopharyngeal origin were reviewed, with institutional review board approval. Patients who responded to a tympanic plexus block were considered for tympanic neurectomy. Twelve patients (13 ears) underwent the procedure. Surgical outcomes and the presence of persistent otalgia were evaluated.

Persistent otalgia was present for 16.7 months ± 8.6 standard‐error‐of‐the‐mean months prior to an intervention. Narcotic medication was used in 41.7% of patients prior to surgery. Patients received tympanic plexus blocks (median: 1, range 1–3) prior to tympanic neurectomy to evaluate candidacy for surgery. Intractable otalgia resolved in six of 13 ears (46.2%) after one surgery, with an average follow‐up of 25.5 months. A significant reduction in pain occurred in two of 13 ears (15.4%) after an initial surgery. One patient received no benefit from the initial procedure. Revision surgery occurred in four ears, resulting in pain relief in three of four cases. All together, nine of 13 ears received complete resolution of pain, and an additional two of 13 ears received partial benefit using our algorithm for treatment of intractable otalgia of tympanic plexus origin.

Intractable otalgia treated with tympanic neurectomy is a viable treatment option in cases of failed medical management. These findings provide important information that will aid clinicians in counseling chronic otalgia patients.

NA.

• Tympanic neurectomy
• glossopharyngeal neuralgia
• otalgia
• tympanic nerve
• tympanic neuralgia

• Bone conduction
• Cochlear injury
• Evoked potentials
• Guinea pigs
• Magnetostrictive transducer
• Otologic surgical procedures

Animal models of middle ear surgery help us to explore disease processes and intervention outcomes in a manner not possible in patients. This review begins with an overview of animal models of middle ear surgery which outlines the advantages and limitations of such models. Procedures of interest include myringoplasty/tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and active middle ear implants. The most important issue is how well the model reflects the human response to surgery. Primates are most similar to humans with respect to anatomy; however, such studies are uncommon now due to expense and ethical issues. Conversely, small animals are easily obtained and housed, but experimental findings may not accurately represent what happens in humans. We then present a systematic review of animal models of middle ear surgery. Particular attention is paid to any distinctive anatomical features of the middle ear, the method of accessing the middle ear and the chosen outcomes. These outcomes are classified as either physiological in live animals, (e.g., behavioural or electrophysiological responses), or anatomical in cadaveric animals, (e.g., light or electron microscopy). Evoked physiological measures are limited by the disruption of the evoking air-conducted sound across the manipulated middle ear. The eleven identified species suitable as animal models are mouse, rat, gerbil, chinchilla, guinea pig, rabbit, cat, dog, sheep, pig and primate. Advantages and disadvantages of each species as a middle ear surgical model are outlined, and a suggested framework to aid in choosing a particular model is presented.

• Otologic surgical procedures
• Middle ear
• Animal models
• Electrophysiology
• Microscopy

• Adult
• Animals
• Equipment Design
• Female
• Guinea Pigs
• Humans
• Laser Therapy/instrumentation
• Male
• Middle Aged
• Ossicular Replacement/instrumentation
• Otosclerosis/surgery
• Otoscopes
• Prospective Studies
• Stapes Surgery/instrumentation
• Treatment Outcome

• Animals
• Head/surgery
• Humans
• Laser Therapy
• Neck/surgery
• Rats

• Animals
• Carbon Dioxide
• Cats
• Ear, Middle/pathology
• History, 20th Century
• Humans
• Laser Therapy
• Lasers/adverse effects
• Lasers/history
• Stapes Surgery/adverse effects
• Stapes Surgery/history
• Stapes Surgery/methods
• Temporal Bone/surgery