摘要:

Extensive research on enzymes led to the discovery of the innermost mechanism of the otospongiotic disease. The authors present the results of multiple correlations made from February 1976 to September 1980 on 648 samples of perilymph taken during stapedectomies performed on otosclerotic patients. We studied microdosages of three selected enzymes—trypsin, α1 antitrypsin, and α2 macroglobulin—in each of the samples and their relationship with cochlear deterioration expressed in dBs of bone conduction decrease in pure-tone audiometry testing.This study allowed us a better knowledge of the enzymatic mechanism of the otospongiotic disease, based on the previously reported trypsin-α1 antitrypsin balance, but in which α2 macroglobulin appears to play a role as essential as that of α1 antitrypsin.This enzymatic mechanism explains NaF efficiency, which is due in fact to a double action: not only direct trypsin inhibition, but also an overall reduction in enzymatic values in the perilymph of otospongiotic/otosclerotic patients.Current studies could lead to the possibility of future NaF replacement by pro-teinase inhibitors either of microbial origin, under study by Japanese researchers, or even of synthetic origin, which should be investigated. In fact, the role of NaF therapy could already be taken over by diphosphonates currently under study.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

One hundred twenty-five intact canal mastoidectomies were followed up two to eight years postoperatively. Twenty-two ears (or 18 percent) presented an essentially symptomless breakdown of their preserved posterior wall. This posterior wall atrophy (PWA) appeared either as a partial atrophy (77 percent), with or without skin retraction, or as a total atrophy (23 percent), in which the ear looks like a nature's modified radical. Some of these breakdowns were wet (27 percent), but most (73 percent) were dry. This phenomenon is easily missed because its detection is usually possible only when the ear is examined looking at the posterior wall from the anterior angle—a position the examiner usually does not take. In fact, we would have missed most, if not all, of these atrophies if we had not called our patients back for follow-up and looked for this particular phenomenon. The atrophies occurred equally frequently in cholesteatomatous and noncholesteatomatous ears. Ears after classical CAT operations with facial recess exposure develop PWA more frequently (22 percent) than ears with other intact canal mastoidectomies (8 percent). While any intact canal mastoidectomy leaves an ear prone to PWA, thinning of the posterior wall is probably conducive to this condition. Our previous report showed the same phenomenon in 16 percent of 177 ears;1thus, the combined result of 302 intact canal mastoidectomies revealed this as occurring in 16.5 percent of all the ears submitted to some kind of intact canal mastoidectomy. In CAT-operated ears the risk of PWA is 20 percent. This study confirms our previous study and shows that, based on 95 percent of 316 ears followed up after mastoidectomy with posterior wall preservation, a silent breakdown of the conserved posterior wall will eventually occur in about 17 percent.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Radiologists' mastoid and sinus film reports have often not helped the otolaryngologist clinically. The trend in radiography of the temporal bone has swung almost entirely to tomograms, further de-emphasizing the importance of plain films. A review of the literature reveals that the details for taking films of high quality were worked out prior to 1930, but the equipment available was cumbersome and difficult to use. Applying the available knowledge to today's sophisticated equipment yields films of outstanding quality and gives clinical information of considerable usefulness. The objectives of this article are:to review the literature on plain film otolaryngologic radiography and equipment used,to present previously unpublished material on the exact technique for obtaining films of high quality,to assemble for the first time all the available information on the subject in one source,to present the author's modification of the Waters view for small children, andto stress the clinical usefulness of office radiography in the author's practice.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A rational surgical approach to Meniere's disease eludes us because of the uncertainty of the pathophysiology and the variability in the natural history of the disease. The results of different surgical techniques are difficult to compare because of differences in patient selection, methods of analysis, and length of follow-up reported.This study reviews long-term results in twenty-four ELS procedures in which the test group and parameters of evaluation are carefully described. The overall rate of vertigo control is 75 percent and incidence of significant hearing improvement is 25 percent. This low rate of hearing improvement is related to the selection of patients with advanced disease and other factors. In this series, surgery limited to simple decompression of the ELS proved generally more effective than shunt procedures. It is noteworthy that the Arenberg valve implant provided impressive results in a small number of revisions. Postoperative fibrosis appears to affect results adversely, therefore, measures to prevent scar tissue proliferation seem indicated.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Twelve patients with balance problems resulting from head injury were treated by a trans labyrinthine or middle fossa vestibular neurectomy. The clinical, otoneurologic, and surgical data combined with morphologic findings on the removed operative eighth nerve specimens were evaluated with the aim of deciding the site of primary lesion in each case.In six patients a peripheral lesion was interpreted. Four of them had features of delayed endolymphatic hydrops syndrome, the fifth patient might have suffered a fracture of the stapedial footplate with associated perilymphatic fistula. The sixth patient had a deforming fracture of the internal auditory canal that had produced severe hearing loss and constant unsteadiness because of the compression of the eighth nerve, which had atrophied as a result.Half of the patients were diagnosed as having a central lesion. Only one of them benefited from the neurectomy. This patient had a large arterial loop within the internal auditory canal and the symptoms may have arisen because of friction of the vessel of the proximal portion of the vestibular nerve. The other five patients probably had a lesion at the level of eighth nerve brain-stem junction or central to it.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The purposes of this study were (1) to determine the effect of the severity of hearing loss on the most comfortable loudness level (MCL) and the loudness discomfort level (LDL), and (2) to assess the efficacy of obtaining maximum intelligibility (PB max) at MCL and/or LDL. One hundred twenty-nine ears were tested from seventy-four elderly subjects having mild to moderate sensorineural hearing losses. The results showed that mean MCLs and LDLs remained fairly constant as spondaic thresholds increased from 5 to 55 dB HTL. The data also exhibited considerable intersubject variability and indicated that MCLs and LDLs could not be closely predicted from threshold. Thus, for most clinical purposes MCL and LDL must be measured directly. This study also indicated that measuring speech intelligibility at MCL approximated PB max (± 12 percent) only about two-thirds of the time. Thus, decisions concerning auditory functioning may frequently be inaccurate if intelligibility is measured only at MCL. Neither can LDL be the single intensity at which speech intelligibility is measured, at least with elderly patients, since one in ten scores did not closely approximate PB max. Consequently, we concur with previous investigators who recommend generating an entire intelligibility function. The present findings also suggest that hearing aid users may not receive optimal benefit if their hearing aid is adjusted to MCL, and that improved intelligibility may be achieved at higher volume control settings. The hearing aid evaluation process should investigate this possibility.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This article describes a patient with documented sudden, severe, unilateral, sensorineural hearing loss occurring four days after audiometric evaluation for nonspecific complaints. He was hospitalized immediately; treatment included I.V. histamine and oral steroid therapy. He noted improvement within two days, and serial audiometry has documented recovery to the initial audiometric levels. We believe that this documentation of recovery to pre-illness levels is unique.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The background for this workshop is perhaps best summarized in the words of Kornhuber, who reminded us that the function of the vestibular system is not as obvious as that of vision, hearing, touch, or smell.1Sudden loss of vestibular function, however, becomes clearly apparent to both the patient and his examiner. These observations are among the reasons that the vestibular sense was not discovered until the nineteenth century and probably account, in large part, for the fact that clinicians have continued to play a major role in basic research through the history of investigations on the vestibular and its central nervous system projections.It is important to note that the cortex-governed auditory system is phylogenetically younger than the vestibular system. Most of the vestibular system information distribution into the central nervous system is directed to the musculature of the body for motor control. The cerebellum evolved out of the vestibular system and thus accounts for its important relationships with and control of vestibular reflexes. Both basic and clinical researchers of vestibular mechanisms recognize the importance in understanding vestibular mechanisms for body posture control and eye movements. Although body limb movements are far more complicated than the simpler organization of active eye movements, the postural control system offers the investigative advantage of simultaneous control of proprioceptive and visual manipulations in relation to vestibular input. This capability permits the design of studies regarding complex sensory interactions and their role in body posture and movement control.The Symposium was designed to study information flow in the human vestibular system and its neural connections.

ISSN:0192-9763    

出版商:OVID    

年代:1982

数据来源: OVID