ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo review the outcome in consecutive patients who have undergone complete epitympanic and mastoid obliteration and concurrent tympanic membrane reconstruction over a 53-month period.Study DesignRetrospective review.SettingTertiary referral center.PatientsSixty-two ears in 56 sequential patients undergoing mastoid obliteration with major indications including recurrent infection, debris trapping in the canal wall-down cavity, intolerance of water exposure, calorically induced vertigo in an existing cavity, a semicircular canal fistula, and inability to wear a hearing device. Thirty-six ears in 33 patients who underwent second-stage surgery for ossicular reconstruction during the same time period are also reviewed.InterventionTransplanted autogenous cranial bone is used to induce osteoneogenesis resulting in complete obliteration of the epitympanic and mastoid spaces while maintaining a mesotympanic space.Main Outcome MeasuresSuccess of obliteration, incidence of symptoms prompting intervention, hearing outcome, incidence of recurrent cholesteatoma, and incidence of eustachian tube dysfunction necessitating treatment and need for revision surgical procedures.ResultsComplete take of the bony obliteration occurs in over 95% of cases; 90% of treated patients enjoy complete absence of original symptoms, whereas symptoms improved in the remainder. For over 95% of patients, existing eustachian tube function has been adequate after obliteration. To date, no patient has required revision surgical intervention.ConclusionMastoid obliteration with autogenous cranial bone is a safe and extremely effective option for treatment of problematic canal wall-down mastoid cavities. Surgical techniques that include sterile harvest of the cranial bone graft mixed with antibiotic, revision of the cavity to expose viable native bone, inclusion of the epitympanic spaces in the obliteration, and complete coverage of the pÂte with autogenous fascia have proven critical to successful outcome.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine whether chronic suppurative otitis media may cause sensorineural hearing loss.MethodsThe files of 121 patients with unilateral chronic suppurative otitis media were reviewed in a retrospective study. Air conduction and bone conduction threshold averages were calculated over the speech frequencies (500 Hz, 1,000 Hz, and 2,000 Hz). Thresholds at 4 kHz were examined separately but in a similar way. Multiple linear regression models were used to clarify the relationships between sensorineural hearing loss and chronic otitis media.ResultsChronic suppurative otitis media was seen to be associated with sensorineural hearing loss. When age and normal side were corrected for, pure-tone threshold and bone conduction threshold at either the speech frequencies or at 4 kHz increased gradually according to the duration of the chronic suppurative otitis media. The threshold shift was more accentuated as age increased. The sensorineural hearing loss at 4 kHz seemed to be higher than that at the speech frequencies.ConclusionsThe inner ear is vulnerable against chronic suppurative otitis media. Older age increases this vulnerability. The proximity of the sensory cells to the potential source of harm (inflamed middle ear) may mean higher exposure, as reflected by the fact that sensory cells processing higher frequencies are more seriously damaged.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe the pathophysiology and treatment of the lateralized tympanic membrane that occurs after canal wall down tympanoplasty.Study DesignRetrospective case review.SettingTertiary referral hospital.PatientsFour patients in whom lateralization of the tympanic membrane developed as a complication of canal wall down tympanoplasty.ResultsThe patients had undergone middle ear surgery 20 to 34 years before their first visit to the authors. A Bondy operation with soft-wall reconstruction of the ear canal had been performed in three patients and a modified radical mastoidectomy in one patient. They all had severe conductive hearing loss. Common findings were anterior canal sulcus blunting, good tubal function, normal middle ear mucosa, and mobile stapes. At revision surgery, the lateralized tympanic membrane was removed, and the temporalis fascia was grafted medial to the malleus manubrium. The exposed bony surface in the ear canal was covered with a split-thickness skin graft, and the ear canal and the mastoid cavity were tightly packed to secure the graft. All the patients regained good hearing after the revision. Although deterioration of the anterior tympanic ring was presumed to be the primary cause of the graft lateralization, the lack of a posterior bony ear canal might have facilitated this condition.ConclusionLateralization of the tympanic membrane can occur even in an ear with a radicalized mastoid cavity, especially when the anterior tympanic ring is torn and the posterior ear canal is reconstructed with soft tissue.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo report the efficacy of titanium middle ear prosthesis for ossicular reconstruction.Study DesignRetrospective chart reviews were performed for 25 patients who had undergone titanium ossicular implants between January 1, 1999, and June 1, 20001.SettingTertiary otology referral center.PatientsAll patients had a minimum of 6 months of postoperative follow-up and no evidence of recurrent otologic disease.InterventionAll patients had undergone ossiculoplasty using titanium middle ear implants.Main Outcome MeasuresComparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap closures and implant extrusion rates were measured.ResultsOverall mean pure tone averages improved 22.2 dB with air-bone gap improvement at 20.9 dB. Fifty-six percent of patients achieved air-bone gap less than 20 dB postoperatively. The overall extrusion rate was 4%. However, with the placement of cartilage graft interposed between the prosthesis and the tympanic membrane, no extrusion was observed.ConclusionTitanium implants provide comparable hearing improvement compared with other materials. The extrusion rate seems quite low if cartilage interposition graft is inserted. Its ease of handling, biocompatible properties, and sound conducting properties improve its efficacy as an ossicular implant.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn 1994, the favorable experience with composite cartilage shield tympanoplasty was reported to the American Otological Society. On that occasion, the technical question regarding the concomitant placement of a ventilating tube was posed. In response, the authors proposed that the tympanostomy tube be incorporated in the cartilage graft. Moreover, they proposed that this marriage, when used to reverse atelectasis and to repneumatize the middle ear, should offer the advantage of both procedures while reducing the incidence of tube extrusion and other complications of prolonged intubation. Although attractive in theory, this supposition could be validated only after prolonged follow-up, reported here.ObjectiveTo describe an effective means to secure prolonged middle ear ventilation in a patient population prone to atelectasis and chronic middle ear effusion and to establish the incidence of favorable and unfavorable outcomes after 6 years of observation.Study DesignRetrospective case series.SettingTertiary referral center.PatientsForty patients (28 adults and 12 children) who underwent tympanic membrane reconstruction with a composite cartilage shield T-tube “unit.”ResultsThe overall retention rate was 62.5% over 6 years. Sixty-five percent of retained tubes were maintained for a minimum of 4 years in adult patients. Extrusion and permanent perforation rates were 0%.ConclusionThe cartilage shield T-tube tympanoplasty can effectively reverse atelectasis and provide prolonged middle-ear ventilation. The technique can be used safely and minimizes the risk of tympanic membrane perforation and other complications associated with prolonged middle ear intubation.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe the fat graft as a reconstructive material in myringoplasty.MethodIn a review of 45 patients conducted between 1993 and 1999, the authors analyzed their patients' outcomes after having myringoplasties with fat graft. Median follow-up was 2.5 years (range, 6 mo–6 yr).ResultsWe achieved a success rate of 91.1%. Different features of the patient and the tympanic perforation were studied to demonstrate their role in the quality of the surgical closing. A review of the literature was done to compare our results with the results of other series using this type of graft as well as with studies of the temporalis fascia as a graft material.ConclusionThe high reliability of the fat graft and the technical simplicity of this procedure in anterior perforations, especially with the use of intraoperative endoscopy, make it an attractive technique.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

HypothesisIt was hypothesized that laser-Doppler vibrometry measurements of umbo velocity in aerated middle ears with conductive loss can differentiate ossicular interruptions, stapes fixations, and mallear fixations. More generally, we hypothesize that laser-Doppler vibrometry measurements of umbo velocity can give information about how differences in the impedance that the ossicles work against affect middle-ear function.BackgroundLaser-Doppler vibrometry is a well-established research tool for exploring middle-ear function. The authors wished to investigate its potential as a clinical tool for differential diagnosis of the cause of conductive hearing loss.MethodsLaser-Doppler vibrometry was used to investigate the relationship between the sound-induced velocity of the tympanic membrane at the umbo and the cause of conductive hearing loss when the tympanic membrane was normal and the middle ear was aerated. The results of measurements in 17 adult ears before exploratory tympanotomy were compared with the surgically determined cause of the hearing loss. The authors also measured the motion of the umbo in 10 patients who had undergone successful small-fenestra stapedectomy procedures. In all the studied ears, pure-tone audiograms were measured at the time of laser-Doppler vibrometry testing.ResultsThere were clear statistical differences between the umbo velocity in normal ears and in ears with different ossicular pathologic conditions. There was also a clear separation of the results between ears with ossicular interruptions and ossicular fixation. The pattern of laser-Doppler vibrometry measurements in poststapedectomy ears approximated the pattern in ears with ossicular interruptions.ConclusionComparison of laser-Doppler vibrometry results and audiometry may be a sensitive and selective indicator of ossicular pathologic conditions as well as a useful tool for investigating middle ear function.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo investigate the mechanics of Type III tympanoplasty by developing a cadaveric temporal bone model.BackgroundType III stapes columella tympanoplasty involves the placement of a tympanic membrane graft, usually made of temporalis fascia, directly onto the stapes head. The procedure is usually done in conjunction with a canal wall down mastoidectomy. Postoperative hearing results vary widely, with air-bone gaps of 10 to 60 dB. The structural features responsible for the wide range in hearing results have not been systematically investigated.MethodsCanal wall down Type III procedures were performed in eight cadaveric temporal bones. Acoustic stimuli were presented in the ear canal, and round window velocity VRW(used as an index of hearing) was measured, while systematically varying stapes mobility, mechanical properties of tympanic membrane graft, and tightness of connection between tympanic membrane graft and stapes. The effect of interposing a thin cartilage disc between the tympanic membrane graft and stapes head was also assessed.ResultsWhen the middle ear was aerated and the stapes was mobile, VRWwas 15 to 30 dB lower than in an intact, normal ear. Stapes fixation led to a significant reduction in VRW; reduction was greatest at low frequencies. There was little effect of varying the tightness of connection between the tympanic membrane graft and stapes head. Sound energy was transmitted from the graft to the stapes as long as the graft was in physical contact with the stapes head. Different tympanic membrane graft materials with a range of mechanical properties (stiffness and mass) resulted in little variation in VRW. Interposing a thin cartilage disc between the tympanic membrane graft and stapes improved VRWin the lower frequencies by 5 to 10 dB. The authors hypothesize that the disc acted to increase the effective vibrating area of the graft.ConclusionsThe feasibility of using a cadaveric temporal bone model to study the mechanics of Type III tympanoplasty was demonstrated. A mobile stapes and aerated middle ear were essential for a successful Type III tympanoplasty. There was little effect of varying the mechanical properties of the tympanic membrane graft or changing the tightness of connection between the graft and stapes head. Improved results were achieved by interposing a thin cartilage disc between the graft and stapes head to increase the effective vibrating area of the graft.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo determine the structural features that are responsible for the large variation in postoperative hearing results after Type III stapes columella tympanoplasty, to compare the clinical results after Type III tympanoplasty with predictions based on experimental investigations using a temporal bone model, and to investigate the effectiveness of a modification in surgical technique for Type III reconstruction.Study DesignRetrospective case review.SettingTertiary referral center.Inclusion CriteriaThe ear was healed with an intact tympanic membrane graft; the status of the stapes was known, whether mobile or fixed; and the postoperative status of aeration of the middle ear was known, whether aerated or not.Main Outcome MeasureAir-bone gap at frequencies 250, 500, 1,000, 2,000 and 4,000 Hz.ResultsIn ears with temporalis fascia graft onto stapes head: mobile stapes and aerated middle ear (n = 34), mean air-bone gaps at audiometric frequencies were 15 to 30 dB, consistent with predictions of the experimental model; mobile stapes and nonaerated middle ear (n = 16), large air-bone gaps of 35 to 55 dB; fixed stapes and aerated middle ear (n = 4), large air-bone gaps of 30 to 50 dB; fixed stapes and nonaerated middle ear (n = 2), large air-bone gaps of 30 to 70 dB. In ears with a fascia-cartilage graft onto stapes head, where a thin disc of meatal cartilage, 0.3 to 0.5 mm thick and 4 to 6 mm in diameter was interposed between the fascia graft and the stapes head: mobile stapes and aerated middle ear (n = 9), mean air-bone gaps at audiometric frequencies were 10 to 25 dB, about 5 dB better at 250, 500, and 2,000 Hz than in ears with only a fascia graft (p<0.05), improvement consistent with that observed experimentally when a thin cartilage disc was used in the temporal bone model, hypothesis that the cartilage increased the effective vibrating area of the graft; mobile stapes and nonaerated middle ear (n = 2), air-bone gaps were 40 to 50 dB.ConclusionsLarge air-bone gaps of 30 to 70 dB occurred as a result of stapes fixation, nonaeration of the middle ear, or both. When the stapes was mobile and the middle ear was aerated, a fascia graft resulted in air-bone gaps of 15 to 30 dB. Interposing a thin disc of cartilage between the fascia graft and stapes head to improve the effective vibrating graft area gave better hearing, with air-bone gaps of 10 to 25 dB. The clinical Type III results were consistent with predictions based on experimental investigations of mechanics of the Type III procedure in a temporal bone model.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID