摘要:

Advances in technology and otomicrosurgery have dramatically changed the management of temporal bone fractures. Based upon our experiences and a review of the literature, the following recommendations are made:1. The complete temporal bone surgeon should have access to a late-generation CT scanner and have a good working relationship with a neuroradiologist.2. The surgeon should be capable of repairing the facial nerve within the internal acoustic meatus, by both middle fossa and translabyrinthine approaches.3. It is advantageous to follow the progress of cochlear implantation.4. One should be knowledgeable about the electrophysiologic diagnosis of facial paralysis and know when to be conservative in facial palsy secondary to head trauma.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Our experiences with thirty-six cases of intratemporal facial nerve palsies using the transmastoid extralabyrinthine (TMEL) approach are reported. Palsies were mostly traumatic in origin. The technique, first developed by us and reported in May 1980, spares the labyrinth and has the same indications for use as the middle cranial fossa approach to the seventh nerve. It avoids craniotomy and overcomes the limitations of the classic transmastoid approach, allowing exploration of the nerve from the descending portion to the geniculate ganglion and surrounding regions. When the ossicular chain is already damaged by trauma, surgery is made easier by removal of the head of the malleus and of the incus, which are then transposed at the end of surgery to reconstruct the chain. In particular cases the technique can also leave the chain intact. The TMEL approach has been used in 89% of patients with traumatic palsies due to longitudinal temporal bone fractures, with either an intact or, more often, a disconnected chain. Results of facial nerve and hearing function tests at twelve months are reported i n detail.Our approach and similar techniques used by other authors represent an alternative to House's middle cranial fossa and Pulec's combined operations. Morbidity rate is lower and the operation can be performed by the majority of otologic surgeons.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The intact eustachian tube is essential for a successful tympanoplasty. Since clinical function tests do not provide satisfactory results in every case, radiologic examination of the tube becomes very significant. The technique, which we have employed since 1966 in sixty-seven cases of transtympanic radiography of the eustachian tube, is described. The most important indications for this examination are discussed (cases of chronic middle ear suppuration, post-traumatic tube stenosis, and early diagnosis and clarification of tumors of the nasopharynx and middle ear). The transtympanic method is physiologic, simple to perform, and essential for hearing improvement.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Short-term results or post-operative check-ups after tympanoplasties in children and adults are compared. There is no higher incidence of recurrent perforations in children. The distribution of air cells in adults and children does not vary, indicating that anatomic variations, rather than disease, are responsible for the sclerosis in the mastoid. Anatomic variations of the epipharynx might influence ventilation. Correlations between the width of the epipharynx and the distance between molars and premolars are shown, as is an inverse relation between the height of the palate and the height of the septum. These observations might be important for a prognosis in patients with ear disease.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Mechanical, neural, and immunologic factors controlling eustachian tube function are discussed in detail. Relationships of normal tubal function to the development of otitis media with effusion and its pathologic sequelae are reviewed.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Endoscopy of the eustachian tube provides a new diagnostic potential for many problems of middle ear disease. The flexible fiberoptic system works from the nasopharynx as well as from the tympanic orifice, depending on the indications. It must be realized, however, that this is just the beginning of a new technique. Eustachian tube surgery plays a special role in connection with the new fiberoptic system. Preservation of the posterior bony canal wall and of the mucosal lining of the eustachian tube are the essentials of this modern approach.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Clinical features of temporal bone cholesteatoma are miscellaneous, and sometimes misleading: signs of middle ear cholesteatoma, progressive or sudden facial palsy, sensorineural deafness as in acoustic neuroma, conductive deafness as in otosclerosis, secretory otitis media, or intracranial complications. Polytomography is the only way to pinpoint topography and extension. CT scanning is very useful in determining extension.Topography and severity of deafness are the guidelines for surgical approach. Among sixteen cases, total deafness was produced by the lesion itself in ten cases, and six had an intact inner ear; preservation of hearing was possible in only three.Supralabyrinthine cholesteatomas (five cases) are best managed by the middle fossa approach. Infralabyrinthine cholesteatomas (six cases) must be removed via the infratemporal approach with anterior displacement of the tympanic and mastoid segments of the facial nerve and permanent obliteration of the middle ear. Posterior perilabyrinthine cholesteatoma (five cases) may be removed by the otologic approach combined with the middle ear fossa approach if the inner ear is to be preserved. If hearing loss is total, the translabyrinthine approach can be used.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Surgical management of major congenital malformations of the ear is a difficult and complex procedure. The risk of damaging middle and inner ear structures because of their frequently aberrant location, the failure to keep a patent ear canal over the long term, and the difficulty in achieving a good hearing result all challenge the otologic surgeon. The purpose of this study was to analyze the results obtained with a surgical technique developed to prevent postoperative stenosis or total closure of the newly formed auditory meatus and to achieve at least serviceable hearing in the majority of cases. Emphasis is placed on the selection of surgical cases based on a classification that evaluates, through x-ray tomograms, the anatomic relation of the glenoid fossa of the temporomandibular joint to the middle ear space. Anatomic and functional results are presented. Comments are made in regard to different possibilities of reconstruction of the sound conducting mechanism.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Stapes gusher sometimes occurs at the moment the vestibule is opened. A flood of perilymph can be expected as a complication of stapes surgery in all males affected with the X-linked progressive mixed deafness syndrome. Audiologic features, such as a mixed hearing loss and elicitability of stapedial reflexes, are reported for eight affected males in a large Dutch family.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The divergent views concerning indications, ideal age for surgery, and surgical approach to achieve better hearing illustrate the complexity of cases of congenital aural atresia. Whether the anomaly is unilateral or bilateral also influences the criteria on which the surgical decision is based.In the thirty-six ears operated on between 1972 and 1983 using the canal plasty technique, the average hearing gain was 20 dB, with 18 ears having an air conduction threshold of 35 dB or better after a long follow-up.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID