ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hypothesis: The aim of this study was to find suitable methods for basic anatomic evaluation of the supratubal recess and the anterior surface of the tensor fold.Background: The current method of superior microdissection via the middle fossa floor provides a good picture of the anatomy and pathology of the epitympanum, but the supratubal recess can be evaluated only after excision of the tensor fold. Postinflammation changes cannot be examined accurately because destruction of the tensor fold necessarily alters the anatomic details.Methods: Eight temporal bones were studied via a lateral and 14 via an anterior approach, both complemented by the superior microdissection. Data on 51 earlier superior dissections were re-evaluated as to the state of the supratubal recess. Histology was documented from eight biopsy specimens and of four serially sectioned temporal bones, two normal and two infected.Results: The lateral route offered a good view to the tensor tendon and lower portion of the tensor fold, but the anterior malleal ligament obstructed the view to the fold's upper portion. The anterior route offered excellent visibility to the anterior pouch, mesotympanum, tensor fold, and the whole supratubal recess. The tensor fold was mostly fixed superiorly to the bony roof with a narrow or broad soft band of composite tissue, infrequently to the transverse crest directly. Inflammatory changes spread from the tympanic isthmus region to the supratubal space over the fold and, if extensive, formed broad inflammatory and scar tissue bands between the fold and the anterior bony wall.Conclusions: The supratubal recess and the mesotympanum can best be evaluated via the anterior approach, which should be added to the temporal bone microdissection program. It serves well as the starting route, followed by the conventional superior dissection of the epitympanum. The knowledge gained is indispensable in surgery for chronic otitis media for creation of a large common middle ear air space and functioning aeration pathways.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: To avoid the limitations of canal wall down surgery yet maintain the exposure provided by canal wall down mastoidectomy, the authors have developed a completely “reversible” canal wall down mastoidectomy technique. The purpose of this case report is to determine the feasibility of the “reversible” canal wall down mastoidectomy technique in the treatment of a patient with an aural cholesteatoma.Study Design: Having refined the surgical technique using cadaver temporal bones, the “reversible” canal wall down mastoidectomy was performed in a patient with a recurrent aural cholesteatoma.Setting: The surgical technique was refined in the Carolina Ear Research Institute's temporal bone dissection lab. The patient underwent the surgical procedure by JTM in a standard operating room setting at a private hospital in Raleigh, North Carolina.Patients: The patient was a private patient, referred to the Carolina Ear & Hearing Clinic for treatment of recurrent cholesteatoma.Intervention: A “reversible” canal wall down mastoidectomy was performed in this patient.Main Outcome Measures: The surgeon determined the adequacy of cholesteatoma exposure following temporary removal of the posterior bony canal wall. Intra-operatively, the surgeon assessed the repositioned posterior bony canal segment, looking specifically at its stability and the absence of gaps along the canal cuts.Results: Temporary removal of the posterior bony canal wall improved exposure of the cholesteatoma and facilitated cholesteatoma removal. The repositioned bony canal segment was well stabilized by the bone cement (Oto-cem) and no gaps were noted along the canal cuts.Conclusion: Although it is premature to compare the effectiveness of the “reversible” canal wall down technique to other mastoidectomy procedures, this case confirms the feasibility of this approach.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: This study aimed to evaluate improved surgical outcomes from middle and external ear surgery using local vascular flaps to enhance tissue healing.Study Design: The study design was a review of the design and clinical trials of three soft tissue flaps: the middle temporal flap (MTF), the middle temporal canal flap (MTCF), and the wing flap. All derive axial vascular supply from the middle temporal vessels.Setting: The study was performed at a single surgeon's private otologic practice.Patients: A total of 319 patients were treated from 1991–1996: MTF in 223, MTCF in 38, and wing flap in 58. The average case maturity was 2.25 years. Most cases were mastoidectomy reconstruction or intact canal wall mastoidectomy.Intervention: The flaps are used to introduce an improved blood supply to key repair sites in the middle and external ear.Main Outcome Measures: Canal skin breakdown, chronic myringitis, and chronic otitis externa were measured.Results: Dehiscence rates fell from 15–5% and myringitis rates fell from 15–4%. Thicker, vascular canal skin was the usual result.Conclusions: The flaps provide the optimal method of revascularizing the external canal during mastoidectomy reconstructions and possibly canal defect repairs during intact canal wall mastoidectomy. Further studies are required to evaluate the efficacy of the wing flap and the MTCF.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: Little is known about the arrested healing of chronic central tympanic membrane perforations and the mechanism involved in this process. Some authors have traced the failure to a growth factor deficiency at the perforation margin. In addition, recently, several growth factors have been tried out to improve tympanic membrane (TM) closure in animals. The authors sought to determine the expression of some well-known growth factor peptides in normal human TM and in TMs with a chronic central perforation.Materials and Methods: Total TM specimens were obtained from patients with a normal TM (N = 10) soon after death and from patients with a chronic perforation (N = 20) undergoing myringoplasty with use of an allograft TM. Formaldehyde solution-fixed TMs were analyzed after immunohistochemical staining using highly purified monoclonal antibodies to determine whether epidermal growth factor receptor (EGF-r), transforming growth factor-alpha (TGF-α), basic fibroblast growth factor (b-FGF), or transforming growth factor-beta 1 (TGF-β1) was expressed in the TMs.Results: The distribution pattern for EGF-r, TGF-α, and b-FGF was similar in perforated and nonperforated TMs. In contrast to this, TGF-β1 staining was markedly different in perforated and nonperforated TMs. No or minimal TGF-β1 was observed in normal TMs, whereas TGF-β1 staining was prominent in perforated membranes, mostly at the perforation border.Conclusions: The authors experimental findings imply that EGF-r, b-FGF, and TGF-α expression are not significantly different in TMs with and without a central chronic perforation. However, for TGF-β1, the authors found an increased staining pattern in perforated TMs when compared with that of normal TMs, and staining at the fibrotic and scarred perforation margin was pronounced. Based on these findings, the authors speculate on the possible role of TGF-β1 in the development of the fibrotic scar at the perforation margin explaining the deficient healing pattern of tympanic membranes in chronic otitis media. Possible clinical implications for the future, including growth factor therapy, are discussed.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: This study aimed to examine the effectiveness of intratympanic injection of gentamicin as a nonsurgical treatment option in the treatment of patients with unilateral Meniere's disease who are refractory to medical treatment.Study Design: The study design was a prospective case series.Setting: The study was conducted at a physician's office setting in a tertiary care hospital.Patients: The results of 37 patients who became eligible for reporting according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for reporting treatment results of Meniere's disease were reviewed.Intervention: Intratympanic injections of a prepared gentamicin concentration of approximately 30 mg/ml were given weekly until the patient reported cessation of vertigo attacks. Patients reclined for 45 minutes after each injection.Main Outcome Measures: The 1995 AAO-HNS guidelines were used in this report, and measures included pure-tone hearing results, word recognition scores, vertigo control scores, and ice-water calories after a minimum of 24 months of follow-up.Results: Vertigo control was achieved in 32 patients (87%). Fifteen patients (41%) had complete recovery from vertigo spells, 17 patients (46%) had substantial recovery, and 5 patients (14%) had treatment failure requiring additional surgery to control vertigo. Hearing results showed that 21 patients (72%) had unchanged or better hearing, 10 patients (28%) had an average threshold shift of 10–25 dB, 4 patients (11%) had a threshold shift between 16 and 25 dB, 1 patient (3%) had a threshold shift between 26 and 40 dB, and 1 patient (3%) had a threshold shift of>40 dB.Conclusions: The authors found intratympanic gentamicin to be a useful alternative to surgery. The flexible treatment protocol allowed for better hearing monitoring compared to the more frequent injection schedules of other studies and yielded a lower rate of severe hearing loss. It had a higher failure rate for vertigo control and a greater amount of hearing loss than the authors' experience with vestibular nerve section.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: Auditory testing is not routinely performed within 4–6 weeks after stapedotomy, because hearing acuity is thought to be transiently depressed. In rare circumstances, postsurgical auditory and vestibular complaints may lead one to test hearing soon after stapedotomy. The early postoperative effects of carbon dioxide (CO2) and potassium titanyl phosphate (KTP) lasers, which now are routinely used to perform stapedotomies, have not been reported. The purpose of this report is to present normative data for auditory thresholds measured within 2 weeks of laser stapedotomy.Study Design: The study design was a prospective, unblinded study.Setting: The study was conducted at three academic medical centers.Patients: Thirty-six subjects undergoing 38 stapedotomies for otosclerosis by 5 surgeons participated.Main Outcome Measures: Behavioral audiometry was performed using standard techniques beginning before surgery and continuing through>1 year after surgery.Results: The CO2laser was used in 26 stapedotomies and the KTP laser was used in 12. Nine cases were revision procedures. Bone conduction pure-tone averages and speech discrimination scores did not worsen during the early postoperative period. Bone conduction at 250 and 4,000 Hz dropped slightly within the first 2 weeks (-4.3 and −6.7 dB) but recovered thereafter. Bone conduction at 1,000 Hz actually improved within the first week after surgery (+6.2 dB, p = 0.021). Significant improvements in air conduction thresholds (and air-bone gap) were seen at the second week and late audiometry. The results for CO2and KTP laser-treated groups were not significantly different.Conclusions: Cochlear function is not significantly depressed in the early postoperative period after laser (CO2or KTP) stapedotomy.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hypothesis: Experimentally induced herpes simplex virus type 1 (HSV-1) labyrinthitis provides a suitable model for idiopathic sudden sensorineural hearing loss (ISSHL).Background: Viral labyrinthitis has been postulated to play a role in the pathophysiology of ISSHL. Circumstantial evidence is pointing at members of the herpes virus family. Experimental viral labyrinthitis elicited by various virus families leaves a virus-specific pattern of cochlear damage. Herpes viruses provide the best matching pattern in the distribution of cochlear damage when compared with ISSHL postmortem cochlear histopathology.Methods: Herpetic viral labyrinthitis was induced in guinea pigs using perilymphatic inoculation with HSV-1. A control group was inoculated with the culture medium only. Infection was confirmed by the measurement of HSV antibodies. Hearing was monitored. Cochlear damage was evaluated by light and electron microscopy.Results: In all HSV-1 inoculated animals, rapid loss of hearing occurred. Seroconversion took place, but no systemic manifestations of herpetic infection were observed. The control group showed no cochlear or systemic symptoms. When comparing cochlear histopathology in ISSHL to experimental viral HSV-1 labyrinthitis, strong similarities were found: degeneration of the stria vascularis, destruction of the organ of Corti, loosening of the tectorial membrane, and inflammatory changes in neural structures.Conclusions: Based on clinical and histopathologic characteristics, experimental HSV-1 labyrinthitis provides a suitable model of ISSHL.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: This study aimed to document the communicative outcomes of early implantation.Hypothesis: It is hypothesized that by implanting children between the ages of 2 and 5 years, it would be possible to capitalize on the critical period of language learning that occurs in the preschool years and thus positively effect communicative outcomes.Study Design: Thirty-three children who were between 2 and 5 years at the time of implantation were followed longitudinally. They were administered a battery of speech perception (closed and open set), speech production, and oral language (vocabulary and syntax) tests at five test intervals across a 3-year span.Results: Open-set speech perception was attained by 24 months with mean scores of 70% correct phonemes by the end of year 3. Speech production improved to mean scores of 90% for suprasegmental features and 88% and 69% for vowels and consonants, respectively, by 3 years postimplant. These children made 33 months' gain in receptive vocabulary and 48 months' gain in expressive vocabulary in 36 months' time. Syntactically, they progressed from simple vocalization to simple sentences with some grammatical elements present. Repeated measures analysis of variance showed no significant differences between the subjects implanted between 2 and 3 years of age and those implanted between 3 and 5 years of age at any period. Within groups, the scores obtained for each test period were significantly different from each other.Conclusions: Rapid improvement was noted in speech production and language acquisition after improved speech perception for these children implanted before 5 years of age, at levels that exceed those reported in the literature for children implanted at older ages.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective: This study aimed to compare open-set speech perception of single-channel with multichannel cochlear implants in the same ear of postlingually deafened adults.Study Design: The study design was a retrospective case and literature review.Setting: The study was conducted at a tertiary referral center with an associated veterans administration hospital.Patients: Postlingually deafened adults with at least 6 months of experience with a single-channel cochlear implant were studied.Intervention: Replacement of a single-channel with a multi-channel cochlear implant in the same ear was performed.Main Outcome Measures: Open-set word and sentence perception scores at least 6 months after single-channel implantation and multichannel reimplantation were measured.Results: Six of six patients had substantial improvement in open-set speech recognition after reimplantation of the same ear.Conclusions: Removal of a functioning single-channel implant and replacement with a multichannel device are appropriate in postlingually deafened adults who desire better speech recognition.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID