ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:The purpose of this study was to determine the factors that are important for the early diagnosis of intracranial and intratemporal complications of otitis media.Study design:The study design was a retrospective follow-up study.Setting:The study took place at a tertiary referral center.Patients:The medical history of 23 patients with intracranial and intratemporal complications of otitis media was analyzed.Interventions:Diagnostic and therapeutic procedures were performed.Main Outcome Measures:Age, initial diagnosis, final diagnosis, early presenting symptoms, otoscopic findings, time interval between the first manifestation of symptoms and the start of therapy, and follow-up status were measured.Results:In almost all patients, early symptoms included persisting fever and headache. High morbidity and mortality were correlated to a prolonged time interval between the early symptomatology and start of treatment. Doctor's delay was regarded as the most significant delaying factor.Conclusion:Early diagnosis of otogenic complications of otitis media based on the early symptoms persisting fever and headache can reduce morbidity and mortality associated with these complications.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hypothesis:Aural cholesteatoma has different morphologic and biologic characteristics from the normal epithelial cells.Background:The exact pathophysiology of aural cholesteatoma has not been proved. There are certain factors that can be involved in the development of the aural cholesteatoma, which makes it necessary to find the morphologic and biologic changes in aural cholesteatoma.Methods:The animal model of aural cholesteatoma was induced in gerbils with the external auditory canal (EAC) ligation method. Using immunohistochemical method, the distribution of cytokeratin and the binding patterns of lectin were observed to show the biologic and morphologic changes that take place in aural cholesteatomas.Results:The successful induction rate was 86.7%. The cytokeratin distribution of aural cholesteatoma was similar to that of EAC but different from that of the middle ear mucosa. The cytokeratin distribution in the cholesteatoma did not change with the different duration of EAC ligation. The results of the lectinbinding study indicate that the mucin-type cells are mainly distributed in the suprabasal cells of aural cholesteatoma and that the basal cells of cholesteatoma lack a D-galactosyl sugar residue.Conclusion:This study suggests that the origin of aural cholesteatoma may be the external auditory canal epidermal cells, and the characteristics of these cells do not change once the cholesteatoma develops. This study also suggests that cholesteatoma has different biologic nature from that of the normal epithelial cell, especially in the basal cells.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases.Study Design:Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture.Setting:The study was performed partly at a private practice and partly in an academic tertiary referral center.Patients:At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied.Results:The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal.Conclusions:This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives:The purpose of this report is to provide data on the incidence of delayed facial palsy (DFP) after tympanomastoid surgery, compare incidence among various otologic and neurotologic procedures, and discuss the possible etiology.Study Design:The study design was a retrospective case review.Setting:The study was conducted at a tertiary referral center.Patients:The records of 486 patients with normal facial function before tympanomastoid surgery were reviewed.Intervention:Patients underwent tympanomastoid surgery.Outcome Measures:Delayed facial palsy was defined as facial palsy occurring more than 72 hours after surgery.Results:Seven of 486 (1.4%) patients had DFP after tympanomastoid surgery. In two patients, the DFP was caused by a postoperative wound infection. Facial palsy in the other five patients likely was caused by viral reactivation.Conclusions:Published data for otologic surgery suggest a rising incidence of DFP with increased manipulation of the sensory branches of the facial nerve. Viral reactivation is postulated to be an important contributing mechanism in the development of DFP. A number of viruses could potentially cause this phenomenon, but observations in this study implicate the varicella zoster virus. Patients with a history of viral reactivation may be at greater risk for development of this complication.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To test whether the posterior external auditory canal (EAC) wall reconstructed only by soft tissues retracts after surgery in the noninflamed ear.Study Design:The condition of the posterior EAC wall was observed for more than 1 year after surgery in 20 noninflamed ears in which only the posterior EAC wall skin was preserved or in which the wall was reconstructed only by soft tissue during surgery.Patients:Eighteen patients (20 ears) underwent ear surgery for conditions other than otitis media, including ossiculoplasty in 12 ears, cochlear implant in 3, resection of congenital cholesteatoma in 4, and resection of glomus tympanicum tumor in I.Results:Retraction of the soft posterior EAC wall was observed in only 1 of the 20 ears. In this ear, the posterior EAC wall showed only a slight retraction without any serious problems. Computed tomography revealed that mastoid aeration recovered in all 20 ears.Conclusions:In noninflamed ears, surgeons can remove the bony posterior EAC wall if necessary, and may not need to reinforce or reconstruct the wall with hard tissue. This enables surgeons to spare time and energy and obtain the same advantages as in the intact-canal-wall technique or canal wall reconstruction by a hard material.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To assess the effect of stapedectomy on high frequency hearing.Study Design:A retrospective, one-group, pretest-posttest case review was performed of the audiometric data of patients who underwent stapedectomy at a tertiary referral center.Patients:Thirty-eight patients (40 ears) with primary uncomplicated surgery were selected. Twenty-two of the patients were older than 40 years. Preoperative and postoperative audiograms were analyzed.Results:Preoperative and postoperative audiograms exhibited a down-sloping configuration toward the high frequencies. Surgery resulted in a significant improvement (p <0.05) from 500 to 4000 Hz in air conduction and 500 to 2000 Hz in bone conduction. Analysis of variance showed that age had no bearing on preoperative audiometric results (p <0.05) for air conduction, bone conduction, and the air bone gap. Postoperatively, younger patients' 4000 to 8000 Hz (air conduction) and 4000 Hz (bone conduction) were better than those of the older patients (p <0.05), but the high frequency range was still poorer than age-matched controls in the younger patients.Conclusion:Stapedectomy resulted in significant closure of the air bone gap between 500 to 4000 Hz, but failed to influence hearing above 4000 Hz. Age appears to be an important variable; poorer results in the high frequency range were seen in the older patients who underwent stapes surgery. These findings, together with the residual postoperative hearing loss in the high frequency range in young patients, may reflect disease-specific injury resulting from cochlear otosclerosis.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:This study aimed to investigate the differential effect of the loop diuretic furosemide on the auditory and vestibular (otolith) end organs in the same animals simultaneously.Design and Methods:Auditory nerve-brain stem-evoked responses (ABR-generated in the cochlea) and short latency vestibular-evoked responses to linear acceleration impulses (L-VsEP-generated in the otolith organs) were recorded from albino Sabra rats both before and at minute intervals after intravenous injections of the loop diuretic furosemide. In some animals, an equal volume of saline was injected to control for the effect of the injection itself. In most animals, more than one injection of saline or furosemide was possible (furosemide, N=17 injections in 10 rats; saline, N=18 injections in 9 rats). Peak-to-peak amplitude and peak latency changes in the first wave in each recording (representing endorgan activity) as a function of postinjection time were compared between the two evoked potentials using analysis of variance and repeated /-tests.Results:Saline injections caused only minor changes in the amplitude of the ABR and the L-VsEP. After administration of furosemide, the amplitude of the L-VsEP hardly changed. However, there was a noticeable decrease in the amplitude of the ABR.Conclusions:Although furosemide has a major depressant effect on cochlear function, vestibular end-organ activity is hardly altered.

ISSN:0192-9763    

出版商:OVID    

年代:1999

数据来源: OVID