ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Osteoradionecrosis of the temporal bone is an unusual sequela of radiation therapy to the head and neck. Symptoms occur many years after the radiation is administered, and progression of the disease is insidious. Hearing loss (sensorineural, conductive, or mixed), otalgia, otorrhea, and even gross tissue extrusion herald this condition. Later, intracranial complications such as meningitis, temporal lobe or cerebellar abscess, and cranial neuropathies may occur.Reported here are five cases of this rare malady representing varying degrees of the disease process. They include a case of radiation-induced necrosis of the tympanic ring with persistent squamous debris in the external auditory canal and middle ear. Another case demonstrates the progression of radiation otitis media to mastoiditis with bony sequestration. Further progression of the disease process is seen in a third case that evolved into multiple cranial neuropathies from skull base destruction.Treatment includes systemic antibiotics, local wound care, and debridement in cases of localized tissue involvement. More extensive debridement with removal of sequestrations, abscess drainage, reconstruction with vascularized tissue from regional flaps, and mastoid obliteration may be warranted for severe cases. Hyperbaric oxygen therapy has provided limited benefit.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform diagnostic work-up of all patients, which enables us to make a nonselected comparison of the diagnostic efficiency of the various tests. In patients with hearing better than 80 dB, a normal auditory brainstem response, the presence of recruitment, and normal caloric reaction, the presence of a tumor can be excluded. In patients with poor hearing, tomography is necessary if one does not prefer to perform CT directly. If CT, even with contrast enhancement, is negative, we continue to perform air CT. Only then do we know whether or not the patient has a tumor. Magnetic resonance imaging has not been available to us, but with this diagnostic modality even intrameatal tumors are visualized. However, with the present economy involved with magnetic resonance imaging it is not realistic at the present time to use this way of imaging as a screening procedure.In spite of an intensive campaign for making early diagnosis of acoustic neuromas, our attempts have not been successful, since we have even more tumors measuring over 40 mm in diameter among the latest 100 patients than among the first one hundred. Both patients and physicians (otologists) to some extent are still ignoring the possible significance of a unilateral, progressive, sensorineural hearing impairment. Guidelines for improving this situation are given.Twenty-one patients were followed for an average of 4 years, repeated CT scans were performed, and the tumor appeared to be progressing to a size requiring surgical intervention in only three of these patients. Because of our complete lack of knowledge regarding the causes of tumor growth in some patients and the absence of growth in others, a more differentiated attitude toward indications for surgery is needed, and in some, mostly elderly, patients a period of “watchful waiting” is appropriate.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate.The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens.Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facia! nerve.On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions:1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology.2. There is a high rate of local recurrence.3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary.4. Primary surgical treatment is required.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Guinea pigs systematically challenged with type II collagen were examined electrophysiologically, histologically, and immunologically for inner ear lesions. Some functional, morphologic, and immunologic changes could be demonstrated. Evidence of possible immunoglobulin deposition in the basilar membrane, the perivascular region, as well as in other inner ear tissue were present.Immunologic and histopathologic simulations to inner ear diseases in humans and to the inner ear antigen-induced animal model were found.The results are discussed in light of the original model introduced by Yoo et al and the reexamination findings reported by Harris et al. The discrepancies in the results are argued, and the impact of this experimental model on human autoimmune inner ear disease is analysed.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A possible role for type II collagen autoimmunity in the pathogenesis of Meniere's disease and otosclerosis was recently suggested by studies demonstrating anti-type II collagen antibody in the serum of humans with these disorders and by the induction of similar lesions in animals immunized with type II collagen. In light of these findings, we studied the anatomic distribution of type II collagen in the nonhuman primate ear by immunohistochemical techniques using defined monoclonal antibodies to type II collagen.Type II collagen was observed in the cartilage plate of the auricle and external auditory meatus, tympanic annulus, lamina propria of tympanic membrane (pars tensa), interossicular joints, stapes footplate, eustachian tube cartilage, enchondral layer and globuli interossei of the otic capsule, Rosenthal canal, cribriform base, osseous spiral lamina, spiral ligament, limbus, tectorial membrane, semicircular canal membrane and subepithelial layer of the ampullary crista, utricular and saccular maculae, and the endolymphatic duct and proximal part of the sac.Thus, type II collagen should be considered an important component of ear tissue.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Bone destruction is one of the clinical features of chronic otitis media with cholesteatoma. Bone resorption may be due to the epithelial debris accumulated in the cholesteatoma epidermal sac that acts as foreign body material inducing a destructive granulation tissue and creates pressure on the bony middle ear. This compressive force then induces bone resorption. The present study was designed to replicate certain conditions similar to those in cholesteatoma leading to bone resorption. Four types of materials were implanted into the middle ear cavity of rats: (1) laminaria, an expandable seaweed material, (2) preswollen laminaria, (3) keratin powder suspension, and (4) surgical grade silicone, which when bent exerts pressure on the bulla wall. The placement of laminaria segments in the middle ear cavity of rats was followed by swelling of the implanted materials within 7 days. The bulla bone response was by neo- osteogenesis as well as active bone resorption. The new bone was observed on the external and/or internal surface of the tympanic bone. The cochiear bone also showed extensive bone resorption in the animals. Osteogenesis was rarely observed on the capsule of the cochlea. We also observed no bone resorption at sites without presence of inflammatory connective tissue between laminaria and bone. The typical multinucleated osteoclasts were often seen at the resorption area but the majority of bone resorption sites were characterized by the presence of mononuclear cells and other inflammatory cells. Preswollen laminaria, keratin powder, and silicone strips induced minimal bone resorption. No resorption was observed in the bony cochleas of these experimental groups. The morphometric quantitative analysis of bone resorption in each group was analyzed through 10-μ. serial sections of bone using a computerized digitizer system with an IBM microcomputer PS/2 and a Sigma scan program. The volumes of bone resorption were measured by the sum of areas for each section and multiplied by the thickness of sections. We found that (1) bone resorption in the group with laminaria was significantly greater than the group implanted with preswollen laminaria, keratin, and silicone strips; (2) bone resorption in the bulla was not statistically different for the groups even though they underwent tests for varying time periods; and (3) the extent of bone resorption was not significantly different between rats implanted with preswollen laminaria, keratin, and silicone strips. These findings further suggest that pressure as well as foreign body material can cause bone resorption, and pressure associated with a foreign body produces greater bone resorption than either condition on its own.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

There has recently been a dramatic increase in the demand for custom canal hearing aids. One of the significant limitations sometimes created by these instruments is the increased sensitivity to bone-conducted stimuli known as the occlusion effect. A large occlusion effect is often cited as the reason for rejection of these devices. This investigation tested a method of measuring the occlusion effect through bone- conducted speech reception thresholds (SRTs). The results indicated that the bone conducted SRT procedure is sensitive enough to differentiate between the occlusion effect created by shell earmolds versus canal hearing aids.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This section is a regular feature of The American Journal of Otology. Readers are invited to submit letters pertaining to specific patient problems to: Mark May, M.D., Facial Paralysis Center, Shadyside Hospital, Suite 210, 510 S. Aiken Ave., Pittsburgh, PA 15232. Dr. May is affiliated with the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, as Clinical Professor.

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1990

数据来源: OVID