ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The status and hearing function of the contralateral ears in 493 patients undergoing surgery for chronic otitis media were studied at the final follow-up examination of the patients (on average, 6.5 years after the surgical treatment). In only 37% of the patients was the contralateral ear found to be normal, with atrophy of the pars tensa and tympanosclerosis being the most common abnormal findings, followed by pars tensa and attic retractions. In 18% of the patients, the contralateral ear had also undergone surgery. In only 64% of the patients, the contralateral ears had normal (≤20 dB) hearing levels, and in 21%, the hearing levels were >30 dB, the hearing function of patients with cholesteatoma being worse than that of other patients with chronic otitis media. In 14 (3%) of the patients, even the better hearing ear had a hearing level of >60 dB, including one patient with both ears totally deaf. To improve the functional outcome of patients with chronic otitis media, earlier and more effective treatment of middle ear infections is needed.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:A clear understanding of the surgical anatomy of the epitympanic space is crucial in modern otologic surgery. The tortuous facial nerve within the tight confines of this region presents important surgical challenges, especially when normal anatomy is obscured by disease. Microdissections of 20 human temporal bones were carried out with particular emphasis on the spatial relations of the facial nerve with various temporal bone landmarks. Measurements were made through a standard transmastoid approach to ensure clinical relevance. A high margin of safety can be achieved by observing consistent landmarks and relations in dealing with the facial nerve. We demonstrated the limitations of the transmastoid approach, particularly in accessing the labyrinthine segment of the facial nerve.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The present study deals with morphological observations of temporal dorsal bullae obliterated by implantation of hydroxyapatite granules. The specimens were obtained from guinea pigs 1 year after implantation, and undecalcified tissue sections were examined under a light microscope. The temporal dorsal bullae were found to be completely filled with bone tissue including the hydroxyapatite granules in all animals examined. The bone and hydroxyapatite granules interdigitated tightly without any intervening connective tissue or dead space. The newly formed bone displayed incomplete osteon structures with lamellae surrounding a haversian canal. There was no evidence of inflammation, such as lymphocyte infiltration, in the temporal bullae. The bone formation induced by hydroxyapatite implantation appeared to be a physiological reaction. It was concluded that the hydroxyapatite granules are safe and useful for mastoid obliteration during tympanoplasty.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded. The residual air-bone gap was <20 dB in 86.1% of cases 2 months after surgery, in 77.0% 1 year later, and then remained stable over time, even in patients seen 5 to 15 years after the operation. Complications were rare. A total sensorineural hearing loss occurred in two cases (0.4%), the cause of which remained unexplained. Other complications included a high-frequency hearing loss in 10 (2.3%) cases, tinnitus in 12 (2.7%), and transitory vertigo in two (0.4%). We conclude that this type of ossiculoplasty is a simple but adequate procedure for primary restoration of hearing in chronic otitis media if the stapes is intact and mobile.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Previous studies have shown an altered epithelial cell proliferation in middle ear cholesteatoma, reporting an aberrant expression of epidermal growth factor receptor (EGFR) glycoprotein by immunohistochemistry. In this study, we quantified the presence of EGF-R using enzyme-linked immunosorbent assays (ELISAs) on tissue extracts, as well as the EGF-R gene expression by in situ hybridization on frozen sections. Human skin obtained from the external ear canal was used as control. The amounts of EGF-R glycoprotein in cholesteatoma were very similar to those in human skin. Human skin showed EGF-R messenger RNA (mRNA) only in the basal layer. A higher percentage of cells hybridized for the anti-sense probes EGF-R was found in cholesteatoma epithelium. Furthermore, we could find suprabasal cells with EGF-R mRNA. Our results confirm that the abnormal growth of cholesteatoma epithelium is reflected in an aberrant expression of EGF receptor.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The choice of antimicrobial agents used to treatPseudomonas aeruginosainfections of the ear is quite empiric. Yet in spite of this, very little has been published examining susceptibility patterns of aural isolates ofP. aeruginosa. Recently, increasing concern has emerged over the development of resistance to many of the commonly used ototopical preparations with activity againstP. aeruginosa. This concern stems from the fact that these preparations have been in use for a long time, andP. aeruginosais known to develop resistance fairly readily. We prospectively studied the susceptibilities of aural isolates ofP. aeruginosain 231 consecutive children who were seen in the outpatient Pediatric Otolaryngology Department at Children's Hospital of Pittsburgh during the years 1992 and 1993. The agents tested included neomycin, polymyxin B, colistin, and norfloxacin. We found that only 17.8% of the isolates were sensitive to neomycin, as opposed to >95% for each of the other agents tested (polymyxin B, 99.6%; colistin, 97.4%; and norfloxacin, 98.3%). This difference proved to be statistically significant (p<0.05). Given the concern of aminoglycoside-induced ototoxicity and the high rate of neomycin resistance, we believe that further investigation of other alternative ototopic agents with activity againstP. aeruginosais warranted.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Because fewer stapedectomies are performed today, concern has focused on whether or not residents are adequately trained in stapedectomy techniques. A retrospective study was done of patients undergoing stapedectomy over the last 11 years. This series represents primary resident-assisted cases performed under direct supervision of the attending surgeon. For 102 consecutive stapedectomies, the air—bone gap was closed to within 10 dB in 91 (89%), and no serious complications occurred. These results are compared with other published results, and our philosophy of teaching stapedectomy in residency is discussed.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:In a prior study, findings indicated that when reporting results of chronic ear surgery, neither choice of preversus postoperative bone-conduction scores nor choice of frequencies to include in averaging makes a substantial difference in reported outcome. In this study, audiologic data from 240 stapes-surgery patients at three different institutions were used to generate a variety of outcome measures. Use of preoperative rather than postoperative bone-conduction values in computing postoperative air—bone gap resulted in an ˜5-dB smaller mean gap and a 2% higher success rate. Frequencies included in averaging made little difference in mean computed air—bone gap, although success rate (gap <10 dB) was lower by 6% when 4 kHz was used in a four-frequency average rather than 3 kHz. Results for air conduction were similar to those for air—bone gap regarding choice of frequencies to include in averaging. When using air-conduction pure-tone average (PTA) as the outcome measure, those with normal preoperative sensorineural hearing had a >20% higher success rate than the general population of stapes-surgery patients. The greatest differences in success rate were based on definition of and criteria for success. Success rate was higher when based on air—bone gap than when based on airconduction PTA. As in the prior chronic ear study, differences in outcome were more drastically affected by criteria for “success” than by frequencies included. Unlike similar data from chronic ear surgery, however, success rate differed depending on choice of air—bone gap or air-conduction PTA as the definition for success. Further, air and bone scores from the same test interval must be used to accurately reflect air—bone gap in stapes surgery.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Over the last 10 years, lasers have evolved to become an integral part of stapes surgery. Argon, KTP, and CO2lasers have all been tested for their improved accuracy and safety in the middle ear. Because of the difference in optical properties between visible light (argon, KTP) and infrared (CO2) lasers, discussions have evolved around which laser is better and safer. In an effort to clarify the issues, a prospective comparison was made of 100 consecutive primary stapedotomies by using either the CO2or KTP laser.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID