ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate the results of myringoplasty operations using homograft dehydrated fascia temporalis (Tutoplast) and compare these with those performed with autograft fascia temporalis.Study DesignProspective cohort.SettingUniversity hospital.PatientsForty-three adult patients (≥18 years of age) with central, dry perforations of pars tensa with intact ossicular chains.InterventionTympanoplasty with an endaural approach and underlay technique was performed. Homograft dehydrated temporal fascia was used in 22 patients, and autograft was used in the remaining 21 patients.Main Outcome MeasuresPreoperative and postoperative air-bone gap and speech reception threshold levels and postoperative compliance values of the homograft and autograft groups were compared.ResultsPostoperative perforations were encountered in two patients (9.1%) from the homograft group and three patients (14.2%) from the allograft group. Significant postoperative improvements in air-bone gap and speech reception threshold values were detected for both groups (p< 0.05). Although the mean compliance of the tympanic membranes was significantly lower in the homograft group, no statistically significant difference was observed between groups when the postoperative air-bone gap and speech reception threshold values were compared.ConclusionHomograft temporal fascia can be used in tympanoplasty with the same success rate of autograft temporal fascia without impeding hearing. Its main advantages are the reduction in the duration of surgery and the length of preauricular and postauricular incisions. However, the advantages of the dehydrated homograft temporal fascia should be weighed against its cost and risk of transmission of viral and prion-mediated diseases.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo describe the surgical technique of mastoid cortex plasty using bone pate and its clinical significance.Study DesignRetrospective.SettingTertiary medical center.MethodsBone pate collected while drilling the mastoid cortex was mixed with fibrin glue to make a pate plate. The mastoid cortex defect was closed with a pate plate cut to the desired shape and size.Patients and Main Outcome MeasuresMastoid cortex plasty was included in the first-stage operation in 49 patients who underwent staged tympanoplasty. The second-stage operation was an inspection to see whether the mastoid cortex was reconstructed and the ingrowth of fibrous soft tissue was prevented.ResultsIn 35 patients, the mastoid cortex was reconstructed completely, and soft tissue ingrowth into the mastoid cavity was blocked completely. In the remaining 14 patients, a defect of varying size occurred at the site of drainage-tube insertion. This defect was small enough to prevent soft tissue ingrowth into the mastoid cavity.ConclusionMastoid cortex plasty is a simple and rapid procedure for preventing postoperative deformity of the mastoid process and is valuable for restoring mastoid cavity function.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the effect of closing the bone defect of the mastoid cortex using bone pate after mastoidectomy (mastoid cortex plasty) during the first-stage operation for the restoration of the mastoid cavity aeration.Study DesignThis was a prospective study.SettingTertiary medical center.PatientsThirty-five patients with cholesteatoma invading the mastoid cavity.InterventionSeventeen patients received mastoid cortex plasty with scutum plasty and insertion of a Silastic sheet after removal of the cholesteatoma using a combined approach during the first-stage operation. The 18 control patients received only scutum plasty with the insertion of a Silastic sheet without mastoid cortex plasty during the first-stage operation.Main Outcome MeasuresThe restoration of the middle ear aeration was assessed with high-resolution computed tomography before both the first-stage operation and the second-stage operation.ResultsThe range of middle ear aeration ameliorated significantly whether or not mastoid cortex plasty was performed. Scutum plasty with the insertion of a Silastic sheet without mastoid cortex plasty was significantly effective only for the amelioration of the epitympanum aeration. Mastoid cortex plasty with scutum plasty with the insertion of a Silastic sheet was significantly effective for the amelioration of the epitympanum and also the mastoid cavity aeration. In both groups, before the first-stage operation, approximately 70% of the patients had good mesotympanum aeration, and the mesotympanum aeration ameliorated further after the first-stage operation, although this amelioration was not significant.ConclusionsMastoid cortex plasty is statistically effective for the amelioration of mastoid cavity aeration after the first-stage operation.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo evaluate the accuracy of single photon emission computed tomography (SPECT) in detecting otospongiotic foci of the labyrinthine capsule in otosclerotic patients and to correlate the metabolic patterns detected by SPECT with age, sex, and sensorineural hearing loss.Patients and MethodsThirty-six patients with surgically confirmed otosclerosis and a control group of 12 subjects with normal hearing; each subject underwent SPECT study of the skull with99mtechnetium-diphosphonate (99mTc-medronate). Statistical analysis of the results was performed by use of the Mann-WhitneyUtest.ResultsSPECT seemed to be very sensitive in differentiating otospongiotic bone from normal bone; in the affected group, only 2 of 72 ears yielded false-negative results (sensitivity 97.2%). Moreover, in the otosclerotic patients, the mean petrosa uptake value was higher than in the control group, a difference that was statistically significant (p< 0.0001).Main Outcome MeasuresRegarding uptake in relation to patient age, an inverse relationship was observed between increased metabolic activity and age: the mean uptake index in the younger patients was significantly higher than that in the older patients (p< 0.0001). By contrast, no statistically significant differences were found between men and women (p= 0.1519). Comparison of SPECT alterations with bone conduction thresholds revealed a statistically significant correlation (p= 0.0002 andp= 0.0010) between increased metabolic bone activity and sensorineural involvement only in the younger group of otosclerotic patients.ConclusionsDiphosphonate bone SPECT is the only functional method that allows in vivo evaluation of disease activity, and it was highly sensitive in detecting otosclerosis. SPECT can be considered useful in the diagnosis of otosclerosis that is difficult to recognize, such as cochlear otosclerosis and far-advanced otosclerosis, and it could also find a place in evaluating the efficacy of medical therapy for otosclerosis.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveEvaluate in stapedectomy the clinical outcome and audiometric results (particularly bone conduction) of drilling the promontory because of a narrow oval window niche.Study DesignRetrospective.SettingTertiary referral center, private otology practice.PatientsTwenty-five stapedectomy patients requiring promontory drilling who had surgery between 1995 and 2000.MethodA total of 25 patients were evaluated with a minimum 6-month follow-up. Only patients who required promontory drilling and who had complete preoperative and postoperative audiometric testing including bone conduction were included. Promontory drilling was performed with a skeeter drill to thin the promontory. Twenty-five stapedectomy patients who did not undergo promontory drilling were randomly selected from this same period as a comparison group.ResultsIn addition to the narrow oval window niche, associated anatomical findings were facial nerve overhang in five patients and an obliterated footplate in three patients. Ninety-six percent of cases were successful (<10 dB postoperative air-bone gap). The one unsuccessful case was a strut over the mobile footplate that was later successfully revised. No patients suffered from intraoperative or postoperative tinnitus or vertigo. The mean 4-frequency (500–4,000 Hz) pure-tone average revealed slight improvement in bone conduction postoperatively.ConclusionDrilling of the promontory in stapedectomy is required in only a small percentage of cases. Although audiometric results indicated the possibility of a slight amount of acoustic trauma from the drilling, the effect on hearing was minimal and not considered a contraindication to this procedure.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

HypothesisTo understand cochlear dysfunction and the recovery pattern of the cochlea after acute electrical injury.BackgroundThe cochlea is believed to be more vulnerable to direct current than to alternating current. However, the damage-and frequency-specific recovery characteristics of the cochlea have not been well described.MethodsBaseline distortion product otoacoustic emission measurements were taken via transtympanic electrodes from 19 guinea pigs. A 20-Hz alternating current and a positive direct current, both at a 1,000-&mgr;A intensity, were applied to 9 and 10 animals, respectively. The measurements were repeated immediately after the application of current and after 10 days. Comparisons were made for both groups individually in signalto-noise ratios obtained before and immediately after, immediately and 10 days after, and before and 10 days after the application of electrical current.ResultsAlternating and direct currents caused a significant depression in signal-to-noise ratio immediately after the application. However, 10 days later, the mean signal-to-noise ratio in the animals subjected to alternating current came significantly close to the baseline value, particularly between the frequencies of 2,211 and 3,717 Hz. By contrast, the mean signal-to-noise ratio in the animals subjected to direct current remained significantly depressed throughout all frequencies except for 2,211 Hz.ConclusionBaseline distortion product otoacoustic emission measurements enabled cochlear function to be monitored in a frequency-specific manner after electrical injury. The functional damages were quantitatively close to each other for both types of currents at a given intensity. Nevertheless, recovery was more apparent in the animals exposed to alternating current than in those exposed to direct current. Recovery was also better in the midfrequency region than in higher frequencies. It is hypothesized that the reason for the difference in recovery in both groups was the net charge left by direct current.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine whether treatment with Mg2+improves the outcome of idiopathic sudden hearing loss and to investigate which variables influence its prognosis.Study DesignProspective randomized study.SettingDepartment of Otolaryngology–Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.PatientsThe study group included 133 patients. Sixty patients were treated with carbogen inhalation, and 73 were treated with a combination of carbogen inhalation and intravenous MgSO4.ResultsThe mean improvement rate was 66.4% in the Mg2+group and 49.9% in the carbogen group (p< 0.01). Recovery was achieved in 35 patients (48%) in the Mg2+group and only in 19 patients (31.6%) in the carbogen group (p< 0.01). Significant improvement was seen in 20 patients (27.4%) in the Mg2+group and in 14 patients (23.3%) in the carbogen group. Partial improvement was seen in eight patients (10.9%) in the Mg2+group and in 12 patients (20%) in the carbogen group. No improvement was achieved in 10 patients (13.6%) in the Mg2+group and in 15 patients (25%) in the carbogen group. Patients with vestibular symptoms had a poorer hearing outcome compared to those without vertigo (p< 0.04). Patients who commenced the treatment 8 days or more after onset had poorer recovery as compared with those who started treatment earlier (p< 0.03), regardless of the treatment regimen. Age, sex, and tinnitus had no significant impact on hearing recovery.ConclusionWe found that Mg2+improved hearing recovery in cases of idiopathic sudden hearing loss. Vertigo and treatment delay beyond 8 days were poor prognostic factors for recovery.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe evaluation process of patients with sensorineural hearing loss (SNHL) as candidates for an implantable hearing device is a complex matter. Different criteria have to be considered, such as audiologic, psychological, and socioeconomic issues, presently fitted hearing aids, and the patient's satisfaction with hearing aids. The objective of this study was to describe the evaluation process to select candidates for implantation of the Vibrant Soundbridge system (Symphonix Devices, Inc., San Jose, CA, U.S.A.) in a capital area such as Berlin, where approximately 4 million people live.Study DesignRetrospective chart review with additional clinical and audiologic testing and extensive interview of the patients.SettingThe study was conducted at two referral centers.PatientsA total of 45,350 pure-tone audiograms (PTAs) and speech audiograms (samples from 1987 to 1999) of patients with different extents and types of SNHL were screened.Main Outcome MeasuresThe PTA, speech audiograms, Abbreviated Profile of Hearing Aid Benefit questionnaire, and a telephone interview served as major criteria. However, several additional criteria in the evaluation and in the decision-making process were included and are described in detail.ResultsOf 45,350 patients' charts with their PTA, 346 patients appeared to be possible implant candidates (0.76%) because of their hearing loss. At the time of the hearing screening, 255 patients (0.56%) were possible candidates for the P-type Soundbridge audio processor, and 91 patients (0.2%) were possible candidates for the HF-type processor. Out of the initial 346 patients, 84 (24.3%) were not interested in being further tested or interviewed and declared their lack of interest in the implant technology for several reasons (e.g., satisfaction with their present hearing aid fitting, anxiety to be operated on). A total of 126 patients (36.4%) could be contacted neither by mail nor by telephone. A total of 61 patients (0.13%) declared that they were basically interested, but wanted to wait for further technological refinements (e.g., fully implantable devices). The remaining 75 patients (i.e., 0.16% of the total population screened) could be clinically reevaluated with regard to our standardized protocol. Because of clinical and other reasons, another 33 patients (0.07%) had to be excluded from this study. The resulting 42 patients (0.09%) were undergoing the final ABHAB interview and were ready to be implanted.ConclusionThe number of patients in a stochastic population who are realistic implant candidates for an implantable hearing device is limited. Although there are many more patients suffering from SNHL who meet the requirements of the implant system because of their audiograms, the complexity of a careful evaluation process extremely limits the number of implant candidates. Moreover, reimbursement restrictions in the present health economy worldwide have to be considered.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the importance of fundamental hearing aid attributes and to elicit measures of satisfaction and dissatisfaction.Study DesignA prospective study based on a survey using a decompositional approach of preference measurement (conjoint analysis).SettingEar, nose, and throat university hospitals in Cologne and Giessen; various branches of hearing aid dispensers.PatientsA random sample of 175 experienced hearing aid users aged 20 to 91 years (mean age, 61 yr) recruited at two different sites.Main Outcome MeasureRelative importance of different hearing aid attributes, satisfaction and dissatisfaction with hearing aid attributes.ResultsOf the six fundamental hearing aid attributes assessed by the hearing aid users, the two features concerning speech perception attained the highest relative importance (25% speech in quiet, 27% speech in noise). The remaining four attributes (sound quality, handling, feedback, localization) had significantly lower values in a narrow range of 10 to 12%. Comparison of different subgroups of hearing aid wearers based on sociodemographic and user-specific data revealed a large interindividual scatter of the preferences for the attributes. A similar examination with 25 clinicians revealed overestimation of the importance of the attributes commonly associated with problems. Moreover, examination of satisfaction showed that speech in noise was the most frequent source of dissatisfaction (30% of all statements), whereas the subjects were satisfied with speech in quiet.ConclusionsThe results emphasize the high importance of attributes related to speech perception. Speech discrimination in noise was the most important but also the most frequent source of negative statements. This attribute will be the outstanding parameter of future developments. Appropriate handling becomes an important factor for elderly subjects. However, because of the large interindividual scatter of data, the preferences of different hearing aid users were hardly predictable, giving evidence of multifactorial influences.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID