摘要:

AbstractTwenty‐eight patients, who underwent ossicular reconstruction one or more years after the incident trauma, were studied.The overall short‐term (one year or less) improvements were as follows:1. 66 percent were within 10 db of closure of the air bone gap, and 82 percent were within 20 db;2.85 percent had a 10 db improvement in the SRT; and3.60 percent had a 10 percent improvement in the discrimination scores.On long‐term (two years or more) follow‐up, the results demonstrated that:1.43 percent maintained a 20 db air bone gap;2.50 percent had a 10 db improvement in the SRT; and3.35 percent had a 10 percent improvement in the discrimination score.These patients are subdivided into four classes of injuries:1.incudostapedial complex;2.incus dislocation or trauma;3.epitympanic trauma; and4.middle ear fibrosis. Patients who sustained isolated incudal injuries or incudo‐stapedial injuries had the best prognosis for maintaining the hearing after reconstruction, while in the latter two classes, this was not the case.Lysis of adhesions, incus interposition and reposition methods gave un‐predictable postoperative hearing improvement. Incus replacement prosthesis and conversion to Type III tympanoplasty gave more stable audiologic results.Selected case histories are presented to demonstrate the variability of the results in each of the four classes of injury.Two concepts are stressed:1.ossicles which have been severely traumatized, interposed, repositioned or transposed behave as autogenous grafts, and2.the post traumatic ear is not in a static state and that surgery alters the ongoing process of healing only to a cer

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00001

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to analyze long‐term hearing results in 122 tympanoplasties with incus repositioning and in 64 tympanoplasties using a homograft incus. The mean postoperative follow‐up period in the autograft incus group was 56 months (range 18 to 95 months) and in the homograft incus group 54 months (range 28 to 87 months). Results were compared after incus placement between the tympanic membrane‐malleus complex and stapes head and placement between the tympanic membrane‐malleus complex and stapes footplate. In each group, hearing results tended to be better after malleus‐to‐stapes head placement. There was no statistically significant difference in the results achieved when similar incus placements in the two groups were compared. When the data on malleus‐to‐stapes head tympanoplasty (152 patients) and malleus‐to‐stapes footplate tympanoplasty (34 patients) in each group were combined, the results with malleus‐to‐stapes head placements were considerably better (P= 0.01). The best hearing results were not satisfactory, however, with only 54 percent of the malleus‐to‐stapes head placements achieving a socially adequate hearing level and the air‐bone gap being closed to within 15 db on only 32 percent.Hearing results were also analyzed for three subgroups. The autograft and homograft incus groups were combined. The first subgroup consisted of 30 patients who had no additional surgery other than ossicular chain reconstruction; the second subgroup consisted of 53 patients who in addition to ossicular chain reconstruction had closure of the tympanic membrane perforation; the third subgroup consisted of 103 patients who in addition to ossicular chain reconstruction had tympanic membrane perforation repair and mastoidectomy. There was no statistically significant difference in the hearing results among the three subgroups.Eleven percent of the autograft incus group and 13 percent of the homograft incus group initially had excellent hearing results and then, at various times after the operation, developed gradual deterioration in auditory acuity, which eventually resulted in an unsatisfactory hearing level. In revision operations, the most common cause of failure was non‐attachment of the incus to the head of the stapes. Second in frequency was fixation of the ossicular chain by fibrous tissue and impaction of the incus against the posterior bony annular rim. The most serious complication was depression in cochlear reserve, which occurred in 5 percent of the 186 tympanoplasties. This analysis of the long‐term hearing results achieved with incus grafts revealed that the r

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00002

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractLuetic deafness is an otologic tragedy, not only because it can cause a total sensori‐neural deafness, but also it is a treatable condition if recognized.The most prominent feature of luetic deafness is discrimination loss out of proportion to the pure tone threshold. It is usually caused by congenital or late lues.The FTA‐ABS test should be used as the diagnostic test because of its sensitivity and low number of false positive reactions.Treatment should be with high doses of penicillin and prednis

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00003

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractAural cholesteatoma presents a challenging management problem. The literature abounds in excellent reports concerning surgical management, but emphasis should also be placed on the pre‐operative evaluation of the patient in a systematic and complete manner.Relative to the patient's evaluation, the surgeon must decide whether or not surgery is necessary, the anticipated prognosis, and the effects of the management upon the patient in his socioeconomic environment.A series of seven questions are presented. Their answers should assist the otologist in systematically approaching the management of the patient with aural cholesteatom

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00004

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThree patients, all children, are presented with a diagnosis of eosinophilic granuloma isolated to the temporal bone. In two cases the disease was unilateral, and in the third, bilateral disease was encountered. General evaluations, audiometric studies, and laboratory findings will be discussed. X‐rays will be shown as well as photomicrographs of the gross and microscopic lesions to supplement this discussion. Our approach was surgical in all four ears involved. Radiation therapy was not utilized. A thorough review of the literature on this subject will accompany the presentations of these cases. Long term results have been satisfactory and will be correlated with those in the literature treated by other method

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00005

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThe usual clinical course of children with embryonal rhabdomyosarcoma of the head and neck has been the rapid development of distant metastases and death within one year of clinical presentation. Since 1967, seven children with the diagnosis of embryonal rhabdomyosarcoma have been treated with a specific regimen of surgery, radiation therapy and chemotherapy. All five patients who presented with tumor localized to one region of the head and neck showed objective tumor response. In four patients, the tumor disappeared completely, and there has been no sign of recurrence for five and one half, three and one half, one and one half, and one half years, respectively.

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00006

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractSix cases of hypernephroma metastatic to the head and neck are presented (larynx, tongue, temporal bone, supraclavicular region, nasopharynx, and occipital region) and the literature is reviewed. Hypernephromas that metastasize to the head and neck often simulate primary tumors, and the otolaryngologist must be aware of this diagnostic possibility, especially when dealing with paratracheal masses. Surgical removal of accessible solitary metastasis is recommended and offers the best palliation.

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00007

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThe otolaryngologist is very familiar with inflammatory lesions occurring in the head and neck. The chronic draining fistula is somewhat less common, and its origin may be obscure. A case presentation illustrates some of the typical problems of a fistula in the submandibular triangle which proved to be of dental origin. Knowledge of the spread of periapical infection helps to understand the development and location of cutaneous, dentoalveolar fistulas. Recognition of the source of the fistula is essential as treatment must be directed primarily to the underlying dental infection.

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00008

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractClinical and experimental observations suggest that vasomotor rhinitis results primarily from a relative overactivity of the parasympathetic nervous system; however, some questions remain unanswered. Does the autonomic imbalance produce vasomotor rhinitis through local neural effects on the mucosal and submucosal structures or is there activated a more systemic response involving, for instance, the immunologic system? Our study was designed to determine whether we could consistently produce unilateral vasomotor rhinitis in dogs by thorough ipsilateral sympathectomy and to evaluate the role that the immunologic system may have in the etiology of this disorder.Histologic observations were made on the nasal mucosa of control and sympathectomized dogs. In addition, serum and nasal wash specimens were collected for albumin and immunoglobulin analysis.When compared to that of control dogs, the nasal mucosa of sympathectomized dogs initially demonstrated epithelial discontinuity, submucosal fluid, and cellular infiltrates. There was no significant difference in mean albumin or immunoglobulin values of the nasal washings from control and sympathectomized dogs. Although not statistically significant, a trend was suggested in that serum IgA and IgGa,blevels were lower in the sympathectomized dogs. Although histologic changes suggestive of vasomotor rhinitis occurred in the sympathectomized dogs, biopsy specimens of nasal mucosa taken three months after operation did not reveal the prominent mucosal changes present one month after operation.The decrease in serum IgA and IgGa,blevels in the sympathectomized dogs suggests decreased production secondary to autonomic disturbance.The entity of vasomotor rhinitis may be contrived from several factors. The local effects of autonomic imbalance combined with alterations in immunologic competence may be of particular importance.

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00009

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractCommonly, 12‐18 months must elapse before the final postoperative result following rhinoplasty may be judged. Unless actively compensated for during surgery, an inconstant degree of nasal tip ptosis (“settling”) may lead to displeasing nasal profile characteristics. Supra‐tip rounding accentuates tip ptosis, creating the undesirable “pollybeak” deformity. Generally, these two complications of rhinoplasty arepredictableandpreventable, providing that their various etiologies are clearly understood.Nasal tip ptosis in the postoperative healing period occurs iffalse projectionof the tip confuses the surgeon. Operative tip swelling (infiltration anesthesia and edema) along with malpositioned columellar “bunching” sutures and “orthopedic” septocolumellar sutures create spurious tip projection. Loss of normal tip support occurs when incisions interrupt the attachment of the lower lateral cartilages to the upper lateral cartilages as well as the “wrap‐around” relationship of the feet of the medial crura to the caudal cartilaginous septum. Complete transfixion incisions should be avoided when possible. Cartilaginous or bony shoring struts increase tip support. Modeling of the lower lateral cartilage should not include over‐generous removal of the lateral crura, thus further weakening tip support.Unfavorable healing factors contributing to tip ptosis include linear contraction of the transfixion incision scar, the natural downward torque influence of the lower lateral cartilages, and detrimental synergistic activity of specific muscles of facial expression.Tip ptosis may accentuate the undesirable formation of supra‐tip prominence, thus unmasking the eventual stigma of “pollybeak” deformity. Supra‐tip prominence may develop as the result of:1.Inadequate lowering of cartilaginous dorsal hump.2.Inadequate lowering of upper lateral cartilages.3.Insufficient nasal skin undermining.4.Failure to excise adequately redundant mucous membrane projecting above the newly‐established profile line.5.Inadequate tip splinting.Preventive operative maneuvers can reduce the incidence of displeasing profile relationships, leading to a natural and harmonious

ISSN:0023-852X    

DOI:10.1288/00005537-197306000-00010

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY