ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisIn view of the proven effectiveness of vitamin A for the treatment of hyperkeratosis, it was hypothesized that vitamin A may also be a feasible therapeutic option for cholesteatoma, which has similar histologic features.BackgroundCholesteatoma is a major cause of chronic ear disease, often requiring surgery. The recurrence rate may exceed 20%. Hyperkeratosis is a major sequela of tympanomastoid surgery, causing chronic ear hygiene problems.MethodsThe external auditory canals of 40 Mongolian gerbils were ligated to induce cholesteatomas. The ears were divided into three groups by type of treatment: group I, vitamin A drops (n = 40); group II, Cortisporin drops (n = 20); group III, no treatment (control subjects) (n = 20). Examination for the development and grade of cholesteatomas was performed after 9 months.ResultsCholesteatomas developed in 26 ears (65%) of group I, 12 ears (60%) of group II, and 20 ears (100%) of group III. The differences were significant between groups I and III and groups II and III for both rate of cholesteatomas and severity of grade. There were no significant differences between groups I and II.ConclusionLocal treatment reduces the risk of cholesteatomas in ligated gerbilline ears. Cortisporin and vitamin A are equally effective as local treatments.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisMatrix metalloproteinase 1 (MMP-1) is overexpressed in cholesteatoma.BackgroundCholesteatoma destroys bone, whereas deep meatal skin does not. MMP-1 is a type I collagenase that may be responsible for this destruction. This prospective study was designed to identify overexpression of MMP-1 by cholesteatoma in comparison with deep meatal skin.MethodsTen cholesteatoma specimens and nine deep meatal skin specimens were removed during otologic surgery and then fixed in formalin and embedded in paraffin. Immunocytochemistry studies were performed using a monoclonal antibody to MMP-1. A pathologist assessed the slides in a blinded fashion. Expression of MMP-1 protein in epidermis and in stroma was scored from 0 to 10.Five further cholesteatoma specimens and three deep meatal skin specimens underwent reverse transcriptase polymerase chain reactions to assess messenger ribonucleic acid production. Paired and unpaired Student'sttests were used to assess the difference in expression levels.ResultsCholesteatoma stroma expressed significantly more MMP-1 protein than did deep meatal skin stroma (p = 0.04). MMP-1 was localized to stromal fibroblasts. There was no difference in the epidermal expression levels of the two tissue types (p = 0.42). The reverse transcriptase polymerase chain reaction showed expression at the messenger ribonucleic acid size of MMP-1 (262 base pair) in all cholesteatoma specimens examined. One deep meatal skin specimen showed a weak signal; no signal was seen in the other specimens.ConclusionsMMP-1 is overexpressed by the stromal fibroblasts present in cholesteatoma as compared with deep meatal skin. It is possible that these cells rather than the keratinocytes are responsible for bone destruction in this disease.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe overall purpose of the study was the evaluation of the efficacy of Tübingen titanium prostheses (TTPs) for ossiculoplasty.Study DesignA two-part clinical study of 216 patients undergoing ossiculoplasty was performed. The first part was a prospective study using TTPs (n = 114). The second part involved study of historical control patients (n = 102) with gold and ceramic prostheses.InterventionsAll patients underwent ossiculoplasty.Main Outcome MeasuresMeasures included median air conduction thresholds and air-bone gaps.ResultsAll patients were per-protocol patients. When the air-bone gap “gold standard” (i.e., ≤10 dB) was investigated in the main speech spectrum, partial TTPs reached this level at 2 kHz in 44% (n = 22) and at 3 kHz in 38% (n = 19). Gold and ceramics revealed significantly lower values. Similar results were obtained for total prostheses. Differences for TTPs and ceramics were statistically significant (Mann-WhitneyUtest, &agr; = 5%).ConclusionThe use of TTPs for ossiculoplasty is an efficient treatment method.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveHuman eustachian tubes with known pathologic conditions of the ear were inspected endoscopically, and video recordings were made for slow-motion analysis of the pathophysiologic changes.SettingAmbulatory office in a tertiary referral center.SubjectsForty-four adults with 64 ears having pathologic conditions.InterventionsTransnasal endoscopic examination of the nasopharyngeal opening of the eustachian tube during rest, swallowing, and yawning to study the dilatory movements of the eustachian tube.Main Outcome MeasuresSlow-motion video analysis of the dilatory movements of the eustachian tube.ResultsSixty-four ears and eustachian tubes with pathologic changes were studied. Tubal function was graded on (1) the extent of lateral excursion and progression of dilatory wave as estimates of tensor veli palatini and dilator tubae muscle function, reduced function being observed in 43 tubes; (2) the degree of mucosal disease, which was significant in 48 tubes; (3) obstructive mucosal changes, which were present in 15 tubes; (4) ease and frequency of tubal dilation with maneuvers—26 tubes opened moderately, 21 opened minimally, and 11 were unable to open; and (5) patulous tubes—all 6 clinically patulous tubes showed concavities in the superior third of the tube, which is convex in normal subjects. All tubes with active pathologic conditions of the ear (otitis media with effusion, tympanic membrane retraction, draining ear, cholesteatoma) had significant abnormalities. A correlation could not be made between the severity of middle ear disease and the severity of observed eustachian tube dysfunction.ConclusionsSlow-motion endoscopic video analysis is a potentially useful technique in classifying types of pathologic changes in the eustachian tube. Additional studies of dysfunctional tubes are needed to predict outcomes in operative ear cases and to design intratubal therapy for chronically dysfunctional tubes.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundHistologic otosclerosis is a disease process without clinical symptoms or manifestations that can be discovered only by sectioning of the temporal bone at autopsy. Clinical otosclerosis is otosclerosis at a site where it causes conductive hearing loss by interfering with the motion of the stapes or of the round window membrane. Various authors have studied the prevalence of histologic otosclerosis on laboratory collections of temporal bones. Some 12% to 15% of temporal bones with histologic otosclerosis have demonstrated stapedial fixation. Using these figures for calculating the prevalence of clinical otosclerosis gives an extrapolated clinical prevalence of 0.99% to 1.2%. This does not correlate well with the clinical data on otosclerotic families, from which a clinical prevalence of 0.3% has been estimated.ObjectiveTo study the prevalence of histologic otosclerosis in an unselected series of temporal bones.Study DesignDuring a 1-year period, 118 consecutive pairs of temporal bones of deceased patients at a tertiary care center were collected to determine the prevalence of otosclerosis. Although histology remains the gold standard for evaluation of otosclerosis, the gross observation of temporal bone slices combined with microradiography was used to screen for otosclerotic lesions more rapidly and with a lower cost/benefit ratio. The temporal bones, which were suspected of having otosclerosis with these techniques, were further analyzed by conventional histology.Results2.5% of the 236 temporal bones (or 3.4% of patients) studied demonstrated histologic otosclerosis.ConclusionsAlthough the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30% to 0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by hearing loss or other otologic diseases.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesTo determine the incidence of middle ear abnormalities in patients with bilateral otosclerosis, which could potentially affect successful stapedectomy, and the rates of success in these patients, including the chance of overclosure in the second ear.Study DesignRetrospective case review of operative and audiologic records.SettingPrivate otology practice.PatientsOne thousand eight hundred patients underwent 3,600 primary stapedectomies for bilateral otosclerosis.InterventionAnalysis of perioperative and follow-up audiograms with associated operative findings, including obliterative otosclerosis and solid footplates, dehiscent or overhanging facial nerve, narrow oval window niche, promontory overhang, and ossicular fixation or malformation.Main Outcome MeasuresAudiologic stapedectomy success was determined as overclosure or closure of preoperative air-bone gap to less than 10 dB at 1 year or more of follow-up.ResultsThe rate of finding any abnormality was 25%. Abnormalities present bilaterally were found in 135 patients (7%), with otosclerosis requiring an oval window drillout as the most common finding (41%), followed by dehiscent or overhanging facial nerves (25%). Success in patients with abnormalities was 78% overall, with bilateral overclosure in 40%.ConclusionsAbnormal middle ear findings during stapedectomy occur in a significant percentage of patients. Reasonable rates of success and overclosure can still be expected, but this is somewhat finding-specific. The predictive value of these findings, the associated rates of success with potential impact on surgical counseling, and planning for the “other ear” are discussed.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisThe goal of this study was to compare stapes prostheses of different materials with respect to their surface structures and to discuss their suitability for their use in stapes surgery.BackgroundThe surface condition of a stapes prosthesis plays an important role in relation to the type of membrane that forms between the stapes piston and the bony edge of the stapedotomy opening. The quality of this membrane in thickness and mobility is one of the determinants for postoperative hearing improvement.MethodsThe surface conditions of gold, Teflon/steel, Teflon/platinum, and titanium stapes prostheses were examined with a scanning electron microscope. The loop, shaft, and end of each prosthesis were studied.ResultsThe gold piston was the smoothest of the four pistons examined. When it was cut with a scalpel, a very smooth surface was achieved at the end area. The Teflon piston had the roughest surface. However, when it was cut, a smooth surface with a parallel arrangement of fibers resulted. Its steel loop was the smoothest, followed by gold and platinum. The titanium shaft had a scaly surface, which remained when the end of the shaft was shortened.ConclusionBecause a certain roughness of the piston surface is necessary for the development of a stable membrane between the piston and the edge of the stapedotomy opening, the titanium prosthesis is considered to be the most suitable for stapes surgery of the three pistons examined.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThis study was designed to identify the 58-kDa inner ear protein against which the sera of some patients with idiopathic, progressive sensorineural hearing loss or Ménière's disease strongly react.BackgroundWe and other groups have previously demonstrated that a 58-kDa protein extracted from guinea pig or bovine inner ear tissue is a target of antibodies in serum samples from some patients with autoimmune inner ear diseases.MethodsAfter separation of inner ear proteins by 10% sodium dodecyl sulfate polyacrylamide gel electrophoresis, the bands corresponding to 58 kDa were localized and excised from the gel. The concentrated protein was then digested with trypsin, and the peptide fragments were separated by high-pressure liquid chromatography. Three fractions were subjected to amino acid sequencing by the classic Edman degradation.ResultsThe sequence of a stretch of 14 amino acids of the first fragment was identical to that of amino acids 526 to 539 of the COCH5B2 protein. The sequences of 11 and 10 amino acids of the second and third fragments, respectively, also were identical to residues 417 to 427 and 396 to 405 of the COCH5B2 protein. These data, together with two-dimensional gel electrophoresis followed by Western blot experiments, confirmed that the 58-kDa inner ear protein is the COCH5B2 protein.DiscussionThese findings indicate that the 58-kDa target protein of antibodies in serum samples of patients with autoimmune inner ear diseases is the COCH5B2 protein, a molecule that is highly and specifically expressed in the cochlea and vestibule.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveImmune-mediated cochleovestibular disorders (IMCVDs) continue to present a management challenge to the otolaryngologist. Antirheumatic agents, commonly used for IMCVDs, are associated with variable efficacy and sometimes with serious side effects. The authors describe the preliminary result of their experience in patients with IMCVDs who have been treated with etanercept, a tumor necrosis factor &agr; receptor blocker, recently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis.Study DesignRetrospective case series.SettingTertiary care hospital.PatientsTwelve patients suspected of having IMCVD who did not respond to conventional therapies or experienced side effects of the conventional therapies.InterventionEtanercept 25 mg by subcutaneous injection twice per week.Main Outcome MeasuresThe main outcome measurement was assessment of hearing change by air conduction pure tone audiograms and/or word discrimination. When present, vertigo, tinnitus, and aural fullness were assessed as well.ResultsFollow-up of more than 5 months was available for all patients (range, 5–12 months). Eleven (92%) of 12 patients had improvement or stabilization of hearing and tinnitus, seven (88%) of eight patients who had vertigo and eight (89%) of nine patients who had aural fullness had resolution or significant improvement of their symptoms. The benefit persisted until the last visit (5–12 months after etanercept was begun). The condition of one patient improved dramatically at first but deteriorated after 5 months. The patient's hearing was rescued and stabilized with the addition of leflunomide to etanercept. Similarly, three other patients required a second antirheumatic agent to stabilize their hearing. There were no significant side effects from the etanercept therapy.ConclusionsOur limited data suggest that etanercept therapy is safe and may be efficacious in carefully selected patients with IMCVDs, at least on a short-term basis. These preliminary efficacy and safety results appear encouraging enough to warrant further follow-up and studies for better determination of the potential clinical utility of etanercept for IMCVDs.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID