ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo present the symptoms, signs, and findings on diagnostic tests of patients with the superior canal dehiscence syndrome and to describe the surgical procedures used to treat the dehiscence in five patients.Design and SettingProspective study of a series of patients identified as having this syndrome at a tertiary care referral center.Patients and ResultsSeventeen patients with vertigo, oscillopsia, or both evoked by intense sounds or stimuli that caused changes in middle ear and/or intracranial pressure were identified over a 4-year period. The evoked eye movements had vertical and torsional components, with the direction corresponding to the effect of the stimuli in causing excitation (Valsalva against pinched nostrils, tragal compression, sounds) or inhibition (Valsalva against a closed glottis or jugular venous compression) of the affected superior semicircular canal. Thirteen (76%) of these patients also experienced chronic dysequilibrium that was often the most debilitating symptom. Dehiscence of bone overlying the superior semicircular canal on the affected side was confirmed with computed tomographic scans in each case.Surgical procedures through the middle fossa approach to plug or resurface the superior canal were performed in five patients (canal plugging in three cases and resurfacing of the dehiscence without plugging in two). The debilitating symptoms resolved or improved after the procedures. Signs of vestibular hypofunction, without loss of hearing, were noted in one patient after plugging of the superior canal and in one other patient after resurfacing of the canal.ConclusionsThe superior canal dehiscence syndrome is identified based on characteristic symptoms, signs, and computed tomographic findings. The clinical presentation and findings can be understood in terms of the effect of the dehiscence on the physiology of the labyrinth. The syndrome is a treatable cause of vestibular disturbance.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo measure the middle ear (ME) volume displaced when the pars tensa (PT) retracts during conditions of atelectasis (AT).Study DesignMeasurements were carried out on AT tympanic membrane (TM).SettingMeasurements were carried out on ambulatory patients in a private clinic.PatientsThirty-nine patients treated for otologic disorders who came for a routine follow-up.InterventionsQuantitative assessment of ME volume displaced by retraction of the PT was achieved by measuring the amount of fluid needed to fill up the retracted part of a TM. The fluid–3% aqueous boric acid solution was colored with gentian violet.Main Outcome MeasuresRetraction of the PT may prevent formation of high ME negative pressure by reducing the ME volume. Retraction of the PT acts as a pressure buffer according to Boyls law, in which volume × pressure = constant.ResultsDirect correlation was found between the degree of AT and the ME volume displaced by the AT. Measurements of 12 AT ears grade I showed them to have a volume of 5 &mgr;L to 31 &mgr;L (average, 19.5 &mgr;L) and ten AT ears grade II had a volume of 15 &mgr;L to 87 &mgr;L (average, 39.5 &mgr;L). Eight AT ears grade III had a volume of 26 &mgr;L to 67 &mgr;L (average, 54.3 &mgr;L), and nine AT ears grade IV had 80 &mgr;L to 200 &mgr;L (average, 130.6 &mgr;L).ConclusionsRetraction of the PT may counteract an important potential negative ME pressure (up to several hundred millimeters of water) depending on the degree of retraction and the extent of mastoid pneumatization.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the efficacy and safety of intravenous ondansetron (4 mg) for the prevention of nausea and vomiting after middle ear surgery under local anesthesia.SettingThe study was conducted by Division of Otorhinolaryngology in Prince of Wales Hospital, which is a tertiary referral center and teaching hospital for The Chinese University of Hong Kong.Study DesignA double-blind randomized controlled trial.PatientsFifty-eight Chinese patients undergoing tympanoplasty under local anesthesia from July 1995 to June 1997 were recruited. The mean age of patients was 42.8 years (range 18–71 years).InterventionPatients were randomly allocated to receive a single dose of intravenous ondansetron (4 mg) (n= 29) or placebo (n= 29) immediately before surgery.Main Outcome MeasuresPatients were assessed for severity and frequency of postoperative nausea and vomiting at the 1st, 2nd, 4th, 8th, and 24th hours after middle ear surgery.ResultsFemale patients showed a higher prevalence of postoperative nausea and vomiting. Twenty-eight percent of the patients experienced postoperative nausea, of whom 14% also experienced vomiting. Although the ondansetron group demonstrated a lower prevalence of postoperative nausea and vomiting (PONV) (24% nausea and 10% vomiting) than the placebo group (31% nausea and 17% vomiting), significant reduction in postoperative vomiting only occurred in the first postoperative hour (p= 0.038). No complications or adverse side effects were found to be associated with the use of ondansetron.ConclusionsSingle-dose ondansetron (4 mg) given intravenously preoperatively significantly reduces postoperative vomiting in patients after tympanoplasty under local anesthesia and causes no adverse effects.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo reevaluate the validity of the soft-wall reconstruction method of the posterior meatal wall in surgeries for cholesteatomas.Study DesignRetrospective case review.PatientsSubjects consisted of 52 patients (54 ears) with fresh cholesteatoma (excluding residual or recurrent cholesteatomas) who were operated by the soft-wall reconstruction method in our clinic and observed for more than 2 years after surgery, and 29 patients (29 ears) who were operated by canal-wall-down and open method.Main Outcome MeasuresPostoperative period required for complete epithelization (dry ear), hearing, and incidence of the residual and recurrent cholesteatomas were compared with those operated by canal-wall-down and open method. The postoperative conditions of the soft posterior meatal wall was also investigated.ResultsPostoperative period to be a dry ear was significantly shorter in the soft-wall reconstruction group than in the canal-wall-down and open group (Student'st-test,t= 2.99,p< 0.01). There was no significant difference in the postoperative hearing or incidence of residual and recurrent cholesteatomas between the two groups.ConclusionsThese results indicate that the soft-wall reconstruction method seems more versatile than the canal-wall-down and open method for cholesteatoma surgery.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectivesTo report on cases of labyrinthine fistula diagnosed in an ear, nose, and throat department and to study the incidence, location, pre-and postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy), preoperative diagnostic imaging, and surgical treatment of two types of cholesteatomatous labyrinthine fistulae—the extensive fistula that erodes both the bony and membranous labyrinths and the bone fistula that affects only the bony abyrinth.Study DesignRetrospective case review.PatientsFifty-four patients with cholesteatomatous chronic otitis media with labyrinthine fistulae.SettingTertiary referral center.InterventionsDiagnosis and treatment.Main Outcome MeasuresClinical, imaging, and surgical correlation of extensive fistulae and bone fistulae.ResultsThe incidence of labyrinthine fistulae was 7% in all patients who underwent surgery for chronic otitis media. The bone type (66%) is more common than the extensive type (33%). Compared with bone fistulae, the outcome for extensive fistulae is more severe in terms of hearing loss, vertigo, and facial palsy. In terms of preoperative diagnosis, computed tomography imaging ensured early diagnosis in 89% of extensive cases and in 28% of bone cases. For extensive fistulae, the surgical technique was more radical, requiring an open technique in 66% of cases versus 22% of the bone fistulae cases. The most common location is the lateral semicircular canal (61%).ConclusionsThe breach in the membranous labyrinth is consistent with a more aggressive pathology, causing more severe pre-and postoperative symptoms. Preoperative computed tomography is more sensitive for diagnosing extensive fistulae, which also require a more radical treatment.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

HypothesisGlucocorticoid hormones exert an influence on the inflammatory response of the middle ear during acute otitis media. Rats with experimentally induced purulent otitis media were given either glucocorticoid hormones in excess or a glucocorticoid hormone blocker that deprived the animals of the hormone.BackgroundAcute otitis media is a common inflammatory disease among children.Streptococcus pneumoniaeis the most usual causative agent. The standard treatment today is phenoxymethylpenicillin. The role of glucocorticoid hormones in inflammatory reactions in the middle ear has been widely debated.MethodsIn an otitis media model, a suspension of pneumococci was inoculated into the bulla of the rat, after the animals were pretreated with either a dose of corticosteroid hormones or the glucocorticoid receptor blocking agent RU 486. Rats with induction of otitis media only, but no pretreatment, were used as control subjects, as were the left control-operated ears of all rats. The inflammatory response in the inner ear and in the middle ear was evaluated. The presence of glucocorticoid receptors and the enzyme Na,K-ATPase was investigated with immunohistochemistry.ResultsThe inflammatory response in the animals with untreated otitis media and in the group with otitis media in rats pretreated with the receptor blocker was much more extensive than in the group of animals pretreated with corticosteroids. In the corticosteroid-treated group, the tympanic membrane and the mucous membrane of the middle ear were less edematous, but the middle ear cavity contained more pus. Only a few lymphocytes were found in the inner ears of these rats. When the inner ear was labeled with antibodies against glucocorticoid receptors, there seemed to be no difference between the labeling patterns in the three groups. This was also the case for antibody labeling against Na,K-ATPase.ConclusionThe present results indicate that the reaction in the middle ear mucous membrane is more pronounced in rats that had been pretreated with the hormone receptor blocking drug. An increase of corticosteroid hormone levels during the inflammatory process seem to diminish the reaction in the tympanic membrane and the middle ear mucosa. Neither the hormone receptor blocking drug nor the steroid hormones change the content of glucorticoid receptors and Na,K-ATPase in the inner ear in the otitis media rat model.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveThe Vibrant soundbridge is a semi-implantable hearing device; the transducer is implanted, coupled directly to the incus. The influence of the implant surgery and the presence of the transducer on hearing sensitivity was studied in six implanted subjects.Study DesignLongitudinal case reports.SettingTertiary referral center.Subjects.The subjects had bilateral sensorineural hearing loss with an average hearing loss of 40 to 70 dB HL.ResultsIn five of the six subjects, no long-term effect of the surgery or the presence of the transducer on hearing thresholds was found. In the remaining subject, a deterioration in hearing thresholds was found of 20 dB, with a high and low frequency component. In the 2-kHz region, hearing sensitivity was not deteriorated. In addition, chronic negative middle ear pressure occurred after surgery.ConclusionHearing thresholds did not change significantly in five of the six patients after placement of the “floating mass transducer.” It was speculated that the high frequency component of the hearing deterioration in the remaining patient was caused by cochlear damage caused by the surgery and that the low frequency component was caused by the chronic aeration problems indirectly related to the surgery.

ISSN:0192-9763    

出版商:OVID    

年代:2000

数据来源: OVID