{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:47:39Z","timestamp":1790160459891,"version":"4.1.0"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T00:00:00Z","timestamp":1569283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To study optimal head position after intratympanic steroid injections to enhance drug bioavailability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Application of virtual and in vitro models of the intratympanic anatomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The surgical 3\u2010dimensional printing laboratory of a tertiary academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>A high\u2010resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3\u2010dimensional model. The tympanic membrane was perforated in the posterior\u2010inferior quadrant. Methylene blue\u2013stained 10\u2010mg\/mL dexamethasone was administered to the middle ear cleft, after which a 3\u2010dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The virtual model yielded the following position of the head as optimal: 53\u00ba rotation away from the injected ear in the vertical axis (yaw), 27\u00ba rotation toward the noninjected ear in the longitudinal axis (roll), and 10\u00ba neck extension in the transverse axis (pitch).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Virtual imaging determined that 53\u00ba and 27\u00ba yaw and roll, respectively, away and 10\u00ba pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599819878699","type":"journal-article","created":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T04:45:30Z","timestamp":1569300330000},"page":"1012-1017","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Optimal Head Position Following Intratympanic Injections of Steroids, As Determined by Virtual Reality"],"prefix":"10.1002","volume":"161","author":[{"given":"Omer J.","family":"Ungar","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Maxillofacial Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ophir","family":"Handzel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Maxillofacial Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limor","family":"Haviv","sequence":"additional","affiliation":[{"name":"Surgical 3D Printing Lab Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Dadia","sequence":"additional","affiliation":[{"name":"Surgical 3D Printing Lab Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Cavel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Maxillofacial Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan M.","family":"Fliss","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Maxillofacial Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahav","family":"Oron","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Maxillofacial Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel"},{"name":"affiliated to the Sackler School of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199907001-00001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31821fbdd1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016480701558906"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1967.00760050130002"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1981.tb01785.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2017.04.004"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016480601126952"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000322504"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24482"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31815aee21"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24872"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-5117-y"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.03.004"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/17452759.2017.1310050"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819878699","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599819878699","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599819878699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:00:09Z","timestamp":1760958009000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599819878699"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,24]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1177\/0194599819878699"],"URL":"https:\/\/doi.org\/10.1177\/0194599819878699","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,24]]},"assertion":[{"value":"2019-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}