ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveFacial paralysis can occur after surgery for cholesteatoma. The risk of facial nerve injury is great when the nerve is not covered by its normal bony Fallopian canal. The objective of this study was to identify the incidence of facial nerve dehiscence in patients undergoing surgery for cholesteatoma.Study DesignRetrospective chart review.SettingTertiary referral hospital.Patient PopulationAn assessment of all cases performed by the senior author from 1991 to 1999 revealed 59 patients with adequate data available for analysis. These patients ranged in age from 3 to 92 years. In all, 67 surgical procedures.InterventionSurgery for cholesteatoma, including tympanoplasty and mastoidectomy.Main Outcome MeasureThe presence of facial nerve bony dehiscence after exenteration of disease, and postoperative facial nerve function.ResultsIn 33% of the total procedures analyzed, 30% of the initial procedures, and 35% of the revision procedures, the patients were found to have facial nerve bony dehiscence. The dehiscence was present in the tympanic portion of the facial nerve in the vast majority of patients. Of the 97% of patients with normal preoperative facial nerve function, all retained normal function postoperatively.ConclusionsFacial nerve dehiscence in our series was far greater than that reported in the literature, underscoring the fact that this is an under-appreciated condition. These findings suggest that surgeons should be highly vigilant when dissecting near the facial nerve. Intraoperative facial nerve monitoring has been shown to be of value in facial nerve preservation during acoustic neuroma resections, and may have a role during surgery for cholesteatoma.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo describe and analyze a middle ear condition in which the steady state of the middle ear pressure is elevated above the atmospheric pressure.Setting and Study DesignThis is a long-term survey of 59 patients from a private clinic who were observed on routine examination to have a ballooned out (hyperinflated) tympanic membrane.InterventionAll patients underwent hearing tests, tympanometry, and Shüllers (lateral) mastoid radiography.Main Outcome MeasuresA hyperinflated tympanic membrane indicates a middle ear pressure that is higher than atmospheric pressure. The ballooned tympanic membrane returns to its physiological level after being punctured. This pressure situation is the reverse or opposite of atelectasis and is therefore termedhyperectasis. Hyperectasis, like atelectasis, is associated with a poorly pneumatized mastoid.ResultsFifty-nine hyperectatic ears persisted in their hyperinflated state for weeks, months, or even years. The hyperectasis was preceded by atelectasis, and both conditions occasionally changed one into the other. The ballooned part of the tympanic membrane is usually thin and “scarred.” Hyperectasis is not a rare situation and, once recognized, can be readily encountered in an otologic clinic.ConclusionsLike most biologic systems (e.g., blood pressure, temperature), the middle ear's central feature, i.e., pressure, also has a dynamic character vacillating up and down. It is conceivable that middle ear pressure is also actively regulated and controlled with the aid of a feedback mechanism. Passage of gas through the eustachian tube or absorption by diffusion-perfusion is also at least partly an active process. The up and down middle ear pressure vacillations are usually clinically benign and do not lead to any pathologic features as long as they are buffered by an accompanying normal mastoid pneumatization. It is the ear with a nonpneumatized mastoid that has limited ability to buffer pressure changes and that will present as an atelectasis, a retraction pocket, or (eventually a cholesteatoma) or their reverse, a hyperectatic tympanic membrane.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed.Patients and Study DesignThis study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties.SettingThe study was carried out partly at a private practice and partly in an academic tertiary referral center.Main Outcome MeasuresThis study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology - Head and Neck Surgery (1995).ResultsWhen success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency.ConclusionCumulative data from several authors show that ∼50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe authors report the results of a survey of members of the American Otological Society (AOS) and the American Neurotology Society (ANS) regarding their use of prostheses currently available for ossiculoplasty and stapedectomy. These findings are compared with a similar study presented by one of the authors in 1989.MethodsQuestionnaires were sent to the entire membership of the AOS and ANS with questions regarding biomaterial and prosthesis usage for stapes and chronic ear surgery, as well as satisfaction with each type of prosthesis used. Of the 575 questionnaires mailed, 274 (47%) were returned. Only 248 of the respondents performed middle ear surgery (43%), and their responses constitute the database for this study.ResultsFor those respondents performing stapes surgery in both 1989 and 1999, the mean number of cases per year has increased from 32 to 37 (p ≤ 0.004). The mean number of chronic ear cases has also increased from 95 in 1989 to 110 in 1999 (p ≤ 0.001). As a biomaterial, hydroxyapatite prostheses are used by most surgeons (82%), followed by autograft and homograft bone (72%), autograft and homograft cartilage (62%), and Plastipore (59%). (Although 62% of respondents use cartilage, only 4.4% ranked it first in preference.) In 1989, bone was used most (93%), followed by cartilage (78%) and Plastipore (81%). Hydroxyapatite, which had just been introduced as a biomaterial, was used by only 9% of respondents. For stapes prostheses in 1999, the majority of respondents used stainless steel/platinum (71%), bucket handle (69%), or partial fluoroplastic (56%) prostheses. There was a high overall satisfaction rate in the use of most of these prostheses (> 85%), with several exceptions. The lowest satisfaction rate was 71% for Plastipore partial ossicular replacement prosthesis and total ossicular replacement prosthesis. Usage and satisfaction rates are presented for specific types of implants and compared with the earlier survey findings.ConclusionThe current use of implants in middle ear surgery demonstrates a specific pattern with a high degree of user satisfaction. The preference for implants by respondents has remained stable over the past 10 years; there has been a decrease in the percentage of use of bone, cartilage, and Plastipore with a corresponding increase in the use of hydroxyapatite.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo investigate the outcome of tympanoplasty in the elderly (patients older than 60 years) compared with younger patients.Patients and Study DesignRetrospective review of 87 (28.3%) older patients among a total of 307 patients with chronic otitis media with or without cholesteatoma who were surgically treated at a university hospital by the senior author. Follow-up was systematically provided at the same institution.InterventionsSurgery included tympanoplasty with mastoidectomy performed as the primary procedure in 358 ears. Tympanoplasty was performed with canal-wall-up or canal-wall-down with canal wall reconstruction, ossiculoplasty with autologous or homologous ossicle interposition or columella. Mean follow-up was 30 months (range, 12–70 months).Main Outcome MeasuresPre-and postoperative air-and bone-conduction thresholds were calculated as an average of three speech frequencies (0.5, 1, and 2 kHz). Analysis was subsequently carried out on the postoperative air-bone gap, hearing gain, and postoperative problems such as elevation of the bone-conduction threshold, delayed epithelialization, and reperforation of the eardrum. Statistical analysis was performed by chi-square or Student'st-test. A p value less than 0.05 was considered significant.ResultsCompared with results from younger patients, there was no particular disadvantage in postoperative hearing results and complications in the elderly, although preoperative bone-conduction thresholds were gradually worsened with age.ConclusionsThere is no contraindication for tympanoplasty in older patients if their physical status is the same or better than what is normal for their chronological age.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisMiddle ear prostheses made from nonmagnetic, magnetic resonance (MR)-compatible metals reportedly displace ex vivo in the presence of high magnetic fields used in MR imaging (MRI). The authors postulate that the prosthesis displacement seen with “nonmagnetic” MR-compatible prostheses ex vivo may not be clinically significant in vivo.MethodsMiddle ear prostheses made from ferromagnetic (420F stainless steel) and nonmagnetic MR-compatible metals (316L stainless steel and platinum) were examined for magnetic field interactions at 4.7 Tesla (T). Ex vivo testing consisted of measurements of the translational and rotational motion of the prosthesis induced by the static magnetic field. In vivo testing was assessed by implanting prostheses in cadaveric temporal bones and performing clinical MRI sequences. Prosthesis displacement was measured semiquantitatively.ResultsAngular deflection was observed in all samples made from nonmagnetic stainless steel. The negative control (platinum) demonstrated no deflection, and the positive controls (ferromagnetic stainless steel) deflected >90°. Torque analysis showed movement in five of five nonmagnetic stainless steel prostheses. Prostheses made from nonmagnetic stainless steel remained in place without appreciable loosening in vivo after MRI. Prostheses made with known ferromagnetic properties were displaced at 4.7 T but not at 1.5 T.ConclusionMiddle ear prostheses made from low-magnetic stainless steel do move in the presence of high magnetic fields ex vivo; however, this does not appear to be clinically or statistically significant in vivo at 4.7 T. Magnetic resonance imaging should be undertaken with caution in individuals with prostheses made from stainless steel with strong ferromagnetic properties.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisHistopathologic examination of temporal bones from patients who had undergone stapedectomy may provide information concerning the causes of both residual and recurrent conductive hearing loss (CHL).BackgroundAlthough closure of the air-bone gap to within 10 dB occurs in approximately 90% of primary stapedectomies, a residual CHL occurs in approximately 10% and recurrent CHL may occur in up to 35% of cases. Putative causes of failure of surgery as determined during revision include erosion of the incus, bony regrowth at the oval window, and displacement of the prosthesis. Most reports on the histopathologic findings of temporal bones from such patients have focused on complications of surgery, with little attempt to correlate postoperative air-bone gap with the observed histopathology.MethodsA retrospective review of the author's collection of temporal bones ascertained 22 cases with postoperative CHL of 10 dB or greater (air-bone gap averaged at 500, 1000, 2000, 3000, and 4000 Hz, using postoperative air-and bone-conduction levels) after stapedectomy. These temporal bones were prepared by standard methodology for light microscopy.ResultsOf the 22 cases with postoperative CHL equal to or greater than 10 dB, there were 19 with residual CHL, 2 with recurrent CHL, and 1 with both residual and recurrent CHL. The most common histopathologic correlates of residual and recurrent hearing loss included resorptive osteitis of the incus (64%); obliteration of the round window by otosclerosis (23%); the prosthesis lying on a residual footplate fragment (23%); the prosthesis abutting the bony margin of the oval window (18%); adhesions in the middle ear (14%); and new bone formation in the oval window (14%).ConclusionsHistopathologic examination of temporal bones from patients who in life had undergone stapedectomy provides useful information concerning causes of both residual and recurrent CHL. These data provide a basis for improving both surgical technique and prosthesis design.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundCerebro-oculo-facio-skeletal (COFS) syndrome is a rare autosomal-recessive disorder that includes microcephaly, severe mental retardation, and multiple congenital anomalies. Otologic findings are usually limited to descriptions of the auricles.Patient and MethodsThe authors report inner ear histopathologic findings of a deceased 13-year-old patient with COFS. A histologic study of the inner ear in COFS syndrome has not yet been described. This patient was documented as having a profound bilateral sensorineural hearing loss at the age of 2 years.ResultsHistologic evaluation revealed accelerated neural and neuronal degeneration at the cochlear and retrocochlear levels. Remaining myelinated nerve fibers, counted in the spiral lamina, had degenerated by up to 97% when compared with normal innervation densities. Afferent nerve fibers innervating inner hair cells were completely absent, whereas medial efferent fibers to outer hair cells were found. Vestibular nerve fibers were less affected.ConclusionThe authors report inner ear findings that differ from animal models of primary cochlear neural degeneration and that resemble the pattern of hereditary cochlear nerve degeneration reported in Friedreich's ataxia.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisComputer-enhanced three-dimensional (3D) computed tomography (CT) provides accurate spatial representation of the complex surgical anatomy of congenitally atretic ears, and is superior to conventional CT for surgical planning.BackgroundThe surgical repair of congenital aural atresia is challenging. Conventional CT, routinely used for surgical planning, is limited in its ability to represent spatial relationships between important structures. Because of the lack of density differences between bony structures in the ear, 3D CT has thus far been useful for representing surface contour but not internal anatomy.MethodsA two-level segmentation scheme was developed to distinguish structures in the temporal bone. 3D CT reconstructions of congenital ears were produced with a high-resolution helical scanner. An interactive tool was used to mark the ossicles and facial nerve. The segmentation scheme was used to color-enhance the ossicles and otic capsule, and render the surrounding bone translucent. “Virtual surgery” was then performed by subtracting a cylindrical volume of bone lateral to the atresia plate. The enhanced 3D CT reconstructions were correlated with intraoperative video recordings.ResultsIn four congenital ears, computer-enhanced 3D CT was highly predictive of the actual anatomy. Surgery was avoided in two anatomically unfavorable cases.ConclusionComputer-enhanced 3D CT is a major advance over conventional CT for demonstrating the complex spatial relationships in congenitally atretic ears.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID