摘要:

ABSTRACTWe have used intraoperative monitoring and stimulation of facial nerve function routinely in 301 consecutive otologic and neurotologic cases. The device has been safe, simple to use, and practical. Facial contraction is detected by a strain-gauge sensor in the corner of the mouth and is signalled audibly to the surgeon. Electrical stimulation of the facial nerve can be delivered through a sterile probe, which produces a constant-current-square-wave impulse. The device has several advantages: it signals unintentional mechanical stimulation of the facial nerve during surgery; it allows mapping of the nerve through soft tissue, tumor, and bone; it predicts dehiscences in the bony covering of the nerve; and it allows confirmation of the electrical integrity of the nerve before and after surgery. In this paper we present a technical description of the device, relevant intraoperative electrical measurements, and illustrative case examples. Although the device does not replace anatomic knowledge and surgical ability, it provides a margin of security during ear surgery. This system for intraoperative facial monitoring is practical, and the authors encourage its routine use.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTHigh-resolution computed tomography (CT) of isolated temporal bones was performed in the transaxial, coronal, and sagittal planes at 1.5-mm intervals. The temporal bones were then sectioned at 2.0-mm intervals in planes parallel to the CT scans. The structures making up the vestibular apparatus were identified, and the planes in which each is best visualized were selected for the illustrations. The vestibule, oval window, tympanic cavity, and tympanic portion of the facial nerve are best seen in the transaxial and coronal planes; the arch of the superior semicircular canal in the transaxial plane and its limbs in the coronal plane; the arch of the posterior semicircular canal in the coronal and sagittal planes and its limbs in the transaxial plane; and the common crus in the sagittal plane. The horseshoe-shaped lateral semicircular canal is displayed in the transaxial plane, and the relationship of its lateral limb to the tympanic segment of the facial nerve is best demonstrated in the sagittal plane. The ampullae of all three canals can be appreciated equally well in all three planes.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTThis study reports otoneurologic findings in 18 senior army officers with noise-induced hearing loss, balance disturbance, and history of long exposure to impulse noise from firearms. Most of the patients had symptoms resembling those of Meniere's disease. The risk of Meniere-type symptoms appears to be significantly higher among impulse-noise-exposed professional soldiers than in the normal population. The possibility of endolymphatic hydrops as the underlying pathophysiologic mechanism is discussed in light of recent observations.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTIn 533 surgical procedures for cholesteatoma, a closed technique was used in 60%, an obliteration technique with Palva flap was used in 35%, and an open technique was used in 5%. The closed technique has been done in stages in the authors' institution since 1973. The obliteration technique was only staged if the mesotympanum was dissected. In some cases, the Palva flap was partially lifted from the bone to check posterior cavities.A closed technique in one stage provided intact tympanic membrane in 97% of cases, but retraction pocket occurred in 25%; ABG was within 20 dB in 68% of ears if the stapes was intact and in 40% if crura were missing.Obliteration technique in one stage (if the mesotympanum was normal) provided intact tympanic membrane in 100% of cases, but one late residual cholesteatoma under the flap eroded the semicircular canal after 5 years. ABG within 20 dB was achieved in 68% of the ears if the stapes was intact and in 40% if crura were missing.Closed technique in two stages with Silastic sheeting achieved intact tympanic membrane in 97% of the ears. Residual cholesteatoma was removed at the second stage in 24% of the ears. ABG within 20 dB was achieved in 57% of the ears if stapes was intact and in 52% if crura were missing. Ten percent of the ears underwent an obliteration transformation at the second stage because of large mesotympanum cholesteatoma or retraction pocket. Late retraction pockets were observed in 10% of cases.Obliteration technique in two stages provided an intact tympanic membrane in 96.8% of the ears. ABG was within 20 dB in 61 % of the ears if stapes was intact and 46% if crura were missing.The choice between closed and obliteration techniques depends on the size of the mastoid and the cholesteatoma: closed technique in two stages is safer in patients with large mastoid and large cholesteatoma.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTThe natural history of individuals with acute acoustic trauma who ceased to be exposed to impact noise was examined. Retrospective follow-up was carried out for 4 years on patients who were qualified as disabled following acoustic trauma with permanent threshold shift. Eight hundred forty-one individuals (1682 ears) were examined, of which 1514 ears with acoustic trauma were included in the study group; 150 individuals (300 ears) who continued to be exposed to impact noise even after discovery of acoustic trauma comprised the control group. In the latter, as long as exposure to gunfire continued, the severity of acoustic trauma increased. In the study group, during the first year after injury, changes were observed in hearing, whether improvement or deterioration; after this period, hearing loss appeared to be final. We suggest that, after 1 year following acute acoustic trauma, the associated hearing loss be considered as final, provided there is no further exposure to noise. This finding holds great importance from the medicolegal standpoint, an aspect that is unclear in the literature. It clarifies that beyond the period of 1 year after initial exposure, the pathologic process ceases (as long as there is no additional exposure to noise or gunfire). Further hearing deterioration beyond this period is not related to the initial acoustic trauma but rather to other factors.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTOn the basis of data obtained from different sources, the incidence of clinical otosclerosis in Sweden in the year 1981 was estimated to be 6.1 cases per 100,000 population. This figure is lower than others reported previously. The annual incidence of stapedectomies is 8.3 per 100,000 population.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTPostoperative cerebrospinal fluid (CSF) leakage continues to be one of the most common and potentially serious complications following translabyrinthine surgery despite numerous strategies aimed at its prevention. Fibrinogen-based tissue adhesives may be helpful in decreasing this complication rate. Although commercial glues have been used widely in Europe (especially for dural repairs), they are not approved for use in the United States. Recent investigation has provided a relatively simple technique for producing a comparable autologous glue that obviates the risks of the commercial product. Since this glue will bind fascia, fat, and dura in the watertight fashion, it is potentially ideal for preventing CSF leaks. Experimental studies in rabbits reveal that autologous tissue adhesive can be used safely around intact nerves, suggesting it can be used safely to supplement fat, fascia, or muscle plugs for closing translabyrinthine defects. Clinical trials to test the efficacy of tissue adhesives in this application are currently under way.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTThe state of anxiety experienced by menieric patients indicates the importance of the psychologic component in this disease. Uncertainties as to the type of treatment that is actually curative for this disease have put doubts on the favorable outcome for patients referred for endolymphatic shunt procedures; some clinicians claim that in such cases surgery simply had a psychologic support function. To evaluate the effectiveness of such a statement, the authors have studied three groups of patients: patients who underwent surgery; patients who underwent medical treatment; and nonmenieric, otosclerotic subjects prior to surgery as a control group. The first group was further divided into subjects with and without improvement after surgery. The following personality tests were used: Minnesota Multiphase Personality Inventory, reduced version; Adjective Check List; State-Trait Anxiety Inventory; and Symptom Check List. The results relative to the whole menieric group show a tendency toward a state of dysphoria and more striking somatizations than in the otosclerotic group. In regard to the distinction between operated and nonoperated patients, the former group showed a personality with a strong neurotic trait associated with dysphoria and a state of free anxiety tending toward hypochondria. The outcome of the operation (improvement of the vertigo) does not seem to influence the personality of the subjects, even though there are signs of higher anxiety levels than in subjects without improvement.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTIn this study a disposable ear canal electrode and stimulus delivery system (the Enhancer I) was evaluated for its clinical utility and the observed enhancement of the auditory brainstem response Wave I with its use. Data were collected from normally and abnormally hearing subjects, with both the conventional forehead-to-mastoid electrode array and the forehead-to-ear canal electrode arrangement provided by the Enhancer I ear canal electrode setup. For the normally hearing group, simultaneous acquisition of forehead-to-ipsilateral ear canal and forehead-to-ipsilateral mastoid electrode linkages was obtained. For the abnormally hearing subjects, a comparison was made between the Enhancer I system and the conventional forehead-to-mastoid electrode configuration used with a TDH-49 transducer for click delivery. Our findings indicate that Wave I was enhanced substantially when using the disposable ear canal electrode compared with the more conventional forehead-to-mastoid electrode configuration for both normally and abnormally hearing subjects. The Enhancer I electrode evaluated in this study proved to be painless for the subjects and extremely easy to use, requiring no more time in subject preparation than the more common surface recording electrode application.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

ABSTRACTThe authors followed 1685 transtympanal ventilation tubes during at least 6 months. In 10.4% of the cases, otorrhea was noticed; it formed a serious problem in 3.1 % of the ears. It was more frequent in younger children: 20.8% under 2 years vs 7% above 6 years. It was more frequent (25%) in patients with a history of recurrent acute otitis media, especially if they had associated otorrhea.

ISSN:0192-9763    

出版商:OVID    

年代:1988

数据来源: OVID