ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo determine whether a patient with a serious defect of the tympanic membrane (TM) will be able to dive after surgery.Patients and MethodsThe authors describe three patients who were divers with serious defects of the TM (more than 75% of TM). In all three cases, cartilage palisade tympanoplasty was used to reconstruct the TM.ResultsSix months after surgery, the patients passed clinical examinations, audiograms (hearing restored to normal), tympanometry (increased stiffness of the TM), and pressure tolerance tests in hyperbaric chamber (30-m immersion was simulated for 4 minutes), and they began to dive again. Approximately 2 years after the surgery, all three patients are able to dive without any difficulties.ConclusionThe authors conclude that patients can dive after cartilage palisade tympanoplasty.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisAn influx of amniotic fluid cellular content (AFCC) into the middle ears during birth may lead to the development of a chronic inflammatory process in the form of varying amounts of granulation tissue even if signs of otitis media are absent. This foreign body neonatal otitis media may predispose the child to recurrent otitis media.BackgroundForeign body neonatal otitis media caused by AFCC was described by Aschoff and elaborated by Wittmaack 100 years ago. Recent studies have shown how AFCC spreads to various middle ear compartments and causes histologic changes, the severity of which is related to the amount of AFCC. Specific elements become phagocytized after the first months of life but have caused the formation of inflammatory polyps and granulation tissue with round cell secretions in the meantime.MethodsTen temporal bones from the Temporal Bone Foundation, derived from infants aged 5 months to 1 year 11 months, were serially sectioned at 20 &mgr;m, saved at 0.2-mm intervals, numbered, and stained with hematoxylin and eosin. Every slide was studied for the presence, nature, and stage of pathologic tissue changes of the middle ear and the mastoid antrum.ResultsPseudocystic granulation tissue was massive in the temporal bone of the 8-month-old child born through thick meconium. Severe changes were present in the temporal bones of two infants aged 5 months, one of which showed traces of AFCC. In the temporal bones of two older children, long-standing changes were minor, one of them still showed traces of AFCC. Fresh acute changes and long-standing histologic changes occurred side by side.ConclusionsNeonatal otitis media caused by AFCC can give rise to extensive granulation tissue and round cell secretion, which is likely to make the ear susceptible to infectious otitis media. Cumulative development of granulation tissue as a result of infection may lead to blockage of attic aeration and drainage pathways, causing irreversible adhesive otitis media. A data base should be formed of all neonates born through meconium-stained amniotic fluid to allow a comparison with those born through clear fluids. Surgery with the creation of auxiliary aeration pathways becomes advisable in the treatment of ears with massive development of granulation tissue.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundSeveral theories have been proposed with respect to the origin and pathogenesis of cholesteatoma behind an intact tympanic membrane.Case ReportThe authors describe a case of cholesteatoma behind an intact tympanic membrane in a 71-year-old man with a history of tympanic membrane retraction fixed to the incus without evidence of a perforation. The membrane eventually became detached, and remnants of keratinizing squamous epithelium were found on the incus.DiscussionMechanisms such as metaplasia, ectopic epidermis rests, or ingrowth of meatal epidermis have been proposed to explain the pathogenesis of cholesteatoma behind an intact tympanic membrane. These findings, based on temporal bone histopathology, support the role of an acquired epidermal rest.ConclusionsThis case report provides evidence that cholesteatoma behind an intact tympanic membrane can be established from a resolved retraction of the pars tensa of the tympanic membrane.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo describe one patient with a puzzling therapy-resistant unilateral chronic otitis media, analyze his diagnosis, and describe three similar patients with the same symptoms and signs, i.e., a chronic ear problem together with gastroesophageal reflux disease (GERD).Study DesignThorough analysis of one patient with a chronic ear problem and GERD, both of which responded favorably after antireflux therapy consisting of omeprazole and conservative antireflux measures (raising the head of the bed by 20 to 25 cm, avoiding meals and drinks 3 hours before retiring, and other dietary and lifestyle modifications), and a search for more patients with similar coexisting conditions.SettingTertiary referral center.MethodsPatients with chronic ear problems and GERD were thoroughly analyzed by the otorhinolaryngologist and the gastroenterologist. The latter used endoscopy and Savary-Miller's classification of esophagitis, a 24-hour ambulatory dual esophageal pH monitoring, and esophageal manometry.ResultsFour patients were identified who had a chronic ear problem and simultaneous GERD. It is reasoned that the GERD leads to nasopharyngitis and this to a chronic ear problem. All the patients responded favorably to anti-GERD therapy.ConclusionsGERD may manifest itself as an extraesophageal manifestation, such as nasopharyngitis, leading to ear disease. Therapy-resistant chronic middle ear disease may be caused by GERD.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesTo identify the common presentation(s) and the clinical and operative finding(s) in patients with cholesteatomatous and long-term noncholesteatomatous chronic suppurative otitis media and to adapt a surgical management best suited to ensure long-term safety in these Papua New Guinean patients for whom postoperative follow-up is minimal.DesignRetrospective case series.SettingPort Moresby General Hospital, the tertiary referral center for otolaryngologic services.PatientsEighty-one patients in all age groups who received a clinical diagnosis of chronic suppurative otitis media, with or without cholesteatoma, with or without its associated complications.InterventionCanal-down (modified radical) mastoidectomy with wide meatoplasty.Main Outcome Measure and ResultsAdults were more commonly affected than adolescent or pediatric cases, and there was a male preponderance. The median age was 24 years (range, 13 months to 73 years). Otorrhea remained the most common presentation in all age groups. Postauricular abscesses and fistulae were seen frequently. Cholesteatoma and granulation with polypoidal mucosa were frequent operative findings; a high incidence involved both the attic space and the antrum. Five (6%) patients had preoperative facial paralysis; in addition, postoperative facial paralysis developed in three (4%) patients. The incidence of postoperative “wet ear” was high in all age groups. Meningitis was the most common intracranial complication, followed by lateral sinus thrombosis. There were seven (9%) deaths altogether, and all the deaths occurred as a direct result of otogenic intracranial complication.ConclusionLack of health consciousness, poor socioeconomic status, and lack of health care delivery system resulted in late presentations and poor postoperative follow-up. Hence, the canal-wall-down technique with wide meatoplasty is recommended to ensure a best possible one-time treatment in Papua New Guinean patients with cholesteatomatous or long-term “dangerous” chronic suppurative otitis media with or without complications.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveIs M-meatoplasty the solution for chronic otitis externa caused by wax retention? This study discusses acceptance of this operation and whether sedation is necessary.Study DesignBetween October 1994 and October 1997, 199 successive M-meatoplasties (125 patients) were studied, and 79% of the patients completed a questionnaire in which patient satisfaction with the procedure and outcome was assessed.SettingLocal hospital, functioning as a secondary referral center.PatientsAll patients had narrowing of the lateral part of the outer ear canal resulting from anterior displacement of the cavum conchae cartilage.InterventionThe aim of M-meatoplasty is to increase the lumen of the entrance to the external ear canal by reducing the conchal cartilage on the posterior wallMain Outcome MeasuresReduction of visits to the outpatient clinic, patient satisfaction on a scale from 1 (very bad) to 10 (excellent).ResultsThe number of preoperative visits was 7 (range 1–153). The median number of postoperative visits for the same problems more than 3 months after surgery was 1 (range 0–14). The patient score for the surgery and the final result was a median of 9 (very good).ConclusionsWax obstruction and related external otitis can be cured by M-meatoplasty if the conchal cartilage is too prominent on the posterior wall. It is a simple outpatient operation and is very well tolerated. After the operation, there is an enormous reduction in outpatient visits.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundOtosclerosis is a heritable disease affecting the otic capsule. Its genetics have been studied since the 19th century, but several issues remain controversial.ObjectiveThe goals of this study were to assess the prevalence of sporadic and familial forms of otosclerosis in a population of otosclerotic patients and to compare the radiologic findings between both groups.Study Design and SettingThis retrospective study was conducted in a single institution.PatientsThis study included 211 patients operated on for otosclerosis.Main Outcome MeasuresClinical data, including pure tone audiograms, were available from patients' charts. A questionnaire assessing family history of otosclerosis and deafness was mailed to the otosclerotic patients. A relative was considered otosclerotic if surgery confirmed the disease. The family history was correlated with the computed tomography results. This examination was performed before surgery in all patients.ResultsA family history of otosclerosis was found in 24.2% of the patients. The radiologic findings differed between patients with a sporadic form of otosclerosis and those with a familial form. The lesions were more often detectable, bilateral, and severe in the familial forms (p < 0.05).ConclusionThese findings lead to the assumption that fenestral radiologic otosclerosis occurs more in sporadic forms, whereas more extensive lesions on computed tomography seem to indicate the familial forms. Hereditary forms demonstrated to be familial seem to lead to more severe disease. The search for a genome locus of otosclerosis may be enlightened by these findings.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo study the incidence, pathogenesis, and prevention of delayed facial palsy after stapedectomy.Study DesignRetrospective case review.SettingOtology/neurotology referral center.PatientsA series of 2152 stapedectomy procedures in 2106 patients over 12 years.InterventionDelayed facial palsy after stapedectomy was studied.Main Outcome MeasureHouse-Brackmann facial nerve grading system and serum antibody titer tests for herpes simplex virus type I and type II, and varicella zoster virus.ResultsDelayed facial palsy occurred in 11 of 2152 procedures. Delayed facial palsy occurred from 5 to 16 days (mean 8) after stapedectomy. Predisposing factors were bony facial canal dehiscence with bare or bulging facial nerve herniation in 5 patients; chorda tympani nerve stretched, manipulated, or cut in 2 patients; granulomatous reaction to Gelfoam in 1 patient; fever blisters on the upper lip in 1 patient; and sinusitis in 2 patients. Elevated anti–varicella antibody titers were found in all 6 patients studied. Anti–herpes simplex type I and II antibody titers were elevated in 5 of 6 patients. Acyclovir was effective in preventing delayed facial palsy in 1 patient who had undergone revision stapedectomy and experienced delayed facial palsy after previous stapedectomy in the same ear with elevated anti–herpes antibody titer.ConclusionsDelayed facial palsy occurred in 0.51% of patients after stapedectomy. Serologic investigation suggests activation of latent herpesvirus. Mechanical irritation of the facial or chorda nerve during operation may trigger the activation. The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo evaluate issues pertaining to cochlear implantation in patients with far advanced cochlear otosclerosis.Study DesignProspective cohort.SettingTertiary care referral center.PatientsEight adult patients (18 years of age or older) referred for management of profound hearing loss, the cause of which was determined to be otosclerosis.InterventionCochlear implantation with multichannel cochlear implant device.Main Outcome MeasuresBenefit from cochlear implant as measured by CID sentence scores, incidence and management of facial nerve stimulation, and technical issues pertaining to cochlear implantation in this patient population.ResultsAll patients demonstrated significant improvement in auditory function as measured by performance on CID sentence scores and ability to engage in telephone conversation. Facial nerve stimulation was present in two of eight patients and was managed with deactivation of the stimulating electrodes. Ossification in the basal turn of the cochlea, detected on preoperative computed tomography, necessitated placement of the electrode into the scala vestibuli in two patients and use of a thinner electrode (Nucleus 24) in a third patient.ConclusionPatients with profound hearing loss secondary to otosclerosis derive excellent benefits from cochlear implantation. Surgical implantation may be complicated by ossification of the cochlea, which can be detected on preoperative computed tomography. Electrode activation may be complicated by facial nerve stimulation, which can be addressed with programming strategies.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID