摘要:

The introduction of intact canal wall tympanoplasty (ICWT) in 1958 by Jansen1received a mixed response from otologists. Many saw in it a means of improving treatment for cholesteatomatous middle ear disease because of both avoidance of postoperative cavity problems and the possibility of better functional results. Others—often those having experience with life-threatening complications following partial mastoidectomy—while conceding the possibility of short-term advantages, predicted an unacceptable incidence of eventual failure.While these reservations appeared to be strengthened by several papers delivered at the First International Conference on Cholesteatoma in 1976, there were also reports of encouraging results with low complication rates. Since then the otologic literature has been silent with regard to the controversy between those favoring and those condemning canal wall preservation in the cholesteatomatous ear. To clarify the situation, the results of a long-term study of my cases are presented here.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Thirty-five years have passed since the basic concepts of tympanoplasty were proposed by H. L. Wullstein in 1949. The idea was based on the successful transplantation of a free skin graft across an infected middle ear. The free graft was supported medially by soaked Gelfoam—so-called formed drops—and was in vascular contact only at its margin with the surrounding bony annulus, the annulus fibrosus, and the mental skin, in order to heal and to function as a vibrating membrane. The fenestration operation, with its experience in free skin grafting, laid the groundwork For surgical procedures to improve hearing in patients with chronic otitis media.I first reported on osteoplastic epitympanotomy in 1971. Among the points I emphasized then were the necessity or complete exposure of the epitympanum—especially its foremost anterior part, the so-called recessus protympanicus—and a new method of one-stage osteoplastic exposure of the main focus of disease in the epitympanum. The cholesteatoma findings are so variable that during the operation one should always search first for its origin and its pathways of progression, starting in the epitympanum and not in the mastoid, in order to operate as exactly and conservatively as possible.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Obliteration of the mastoid is one of the techniques that may be used to promote healing and decrease the need for postoperative care in surgery of cholesteatoma. I will review the history or the various techniques used at the Otologic Medical Group (OMG). Sixty-six primary obliterative procedures will be reviewed in detail in regard to indications and results.

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Recurrent and residual cholesteatoma following tympanomastoid surgery may occur anywhere from the ear canal, the eardrum, the middle ear, the mastoid, or the petrous apex.The true recurrent cholesteatoma comes from the redevelopment of an attic retraction pocket after an intact canal wall procedure and is the result of irreversible longstanding poor eustachian tube function. As such, recurrent cholesteatomas are subject to reinfection from the ear canal and therefore may present as typical infected attic cholesteatomas and/or infected postauricular abscesses.Residual cholesteatoma is more likely to be a well-encapsulated, noninfected, destructive cyst which may linger in the mastoid for many years before it presents as a doughy, pitting postauricular mass. Residual encapsulated cholesteatoma of the middle ear will destroy the reconstructed ossicular chain. Residual cholesteatomas may develop under any type of ablation flap or material and will gradually expand to fill the cavity and ablate the external auditory canal.Each one of these residual or recurrent cholesteatomas is to be differentiated from a brain hernia, a cholesterol granuloma, or a retention cyst of the mastoid.When residual cholesteatoma of the middle ear does not become encapsulated, the exfoliated cholesterin debris may be gradually discharged down the eustachian tube, and such exfoliative cholesteatoma may linger in the middle ear for many years without producing significant destruction. We have had one patient in whom such exfoliative cholesteatoma quietly existed in the middle ear for 13 years.1

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Cholesteatoma is a skin-related otologic disorder. The histologic and electron microscopic findings in a human cholesteatoma matrix have been studied in detail.1The cellular composition of the matrix and its adjacent mucosal lining is, however, not static but undergoes permanent changes in terms of cells moving from the circulation into and out of this area. Migrant lymphoid and nonlymphoid cells (Langerhans' cells, monocytes) presumably play a key role in the natural history of the disease. This constant local cell traffic indicates that an aural cholesteatoma is a much more dynamic disease entity, on a cell biologic level, than has ever been assumed before. Our new data, obtained by analyzing human cholesteatoma biopsy specimens, external ear canal skin, and normal tympanic membranes with modern (immuno-) histochemical tools—by application of so-called monoclonal antibodies to cell-membrane receptors and tissue components—should be placed against the background of observations recently made in immunodermatology and lymphoid tissue research.2,3

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

For centuries it has been the dream of many surgeons to repair human tissue by using glue. Different techniques and types of adhesives have been proposed; unfortunately, most have had disappointing results. The original use of blood plasma and fibrinogen solutions—which were clotted by adding thrombin—to fix grafts in humans, as reported by Tidrick and Warner1and by Cronkite and associates, had a relatively high rate of failure owing to poor adhesive strength and durability of the sealings. Matras and colleagues3successfully used a highly concentrated fibrinogen solution in combination with factor XIII, thrombin, and calcium chloride to seal severed nerves in animal experiments. A few years later, Matras and Kuderna4reported on the applicaton of this new method in humans. The recent availability of such nontoxic, absorbable biologic glue led to the development of a 2-component fibrin sealant, (IMMUNO AG, Industriestrasse 72, A-1220 Vienna, Austria).

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1985

数据来源: OVID