ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe aim of this study was to examine the clinical presentation and natural history of chronic myringitis (CM).Study DesignRetrospective case review.SettingTertiary referral center.PatientsChronic myringitis is defined as a loss of tympanic membrane epithelium for >1 month without disease within the tympanic cavity. Seven hundred fifty patient records were reviewed to determine the prevalence of CM in an academic otology practice. The records of 40 patients (45 ears) with CM seen between 1995 and 1999 inclusive were reviewed.Main Outcome MeasuresThe series was reviewed with attention to previous medical and otologic history, the nature and duration of symptoms, the physical findings, and management.ResultsThe prevalence of CM was found to be ∼1% (approximately one fourth as common as cholesteatoma). Symptoms were often present for many years before the diagnosis of CM, with CM often mistaken for chronic otitis media. Sixty percent of patients had undergone previous otologic procedures. There did not appear to be an association between CM and systemic disease. Physical findings were varied, with granulation tissue and tympanic membrane perforations often occurring transiently. The clinical course of CM is typified by recurrent episodes of symptoms, often interspersed with long asymptomatic periods. A subset of CM can result in an acquired atresia. The most effective treatment appeared to be prolonged topical medications, surgery being reserved for only the most refractory cases.ConclusionsChronic myringitis is often mistaken for chronic otitis media. Such confusion prolongs the initiation of appropriate management and sometimes leads to needless tympanomastoid surgery. The otologist should be aware of this clinical entity and its varied presentation.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Hypothesis and BackgroundSecretory otitis media is associated with a highly increased goblet cell density, confirming the secretory pathogenesis of this disease. Previous studies have shown that the middle ear goblet cell density, and thus the secretory capacity, are massively increased during experimental acute otitis media and at least 6 months thereafter, conceivably predisposing to the subsequent development of secretory otitis media. These studies used middle ear inoculation of eitherStreptococcus pneumoniae, nontypeableHaemophilus influenzae, orH. influenzaetype b. The present study aimed at determining the goblet cell density during and after acute otitis media caused byMoraxella catarrhalisto clarify whether this bacterium induces an equivalently enhanced secretory capacity.MethodsTwenty-five 25 rat middle ears were inoculated withM. catarrhalis. Five rats were killed on days 4, 8, 16, 60, and 180 after inoculation, followed by staining, dissection, and whole-mount embedding of the middle ear mucosae. The goblet cell density was determined by counting in 24 fields, covering the entire middle ear.ResultsIn comparison with 25 normal middle ears, the goblet cell density was significantly increased in almost all counting localities, from day 4 and ≤2 months after inoculation. The goblet cell density peaked on day 16, subsided thereafter, and in some areas reached a normal level 6 months after the acute incident. Mucosal areas containing goblet cells were consistently enlarged, thus leaving the middle ear with an increased secretory capacity during and 6 months after inoculation.ConclusionThe goblet cell density of the middle ear mucosa is increased during acute otitis media caused byM. catarrhalisand up to several months thereafter. This may predispose to the subsequent development of secretory otitis media. However, in comparison with acute otitis media caused by other bacteria,M. catarrhalisinduced only modest changes in goblet cell density.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisCultured fibroblasts derived from experimental gerbil cholesteatoma tissue exhibit an invasive phenotype in comparison with normal fibroblasts.BackgroundAural cholesteatomas are enlarging accumulations of keratin debris caused by keratinizing squamous epithelium in the middle ear. They characteristically result in the destruction of adjacent tissues, specifically bone erosion. The mechanisms by which cholesteatomas relentlessly invade the structures of the temporal bone are varied, but it has been suggested that one factor contributing to the aggressive nature of cholesteatomas is the transformation of resident fibroblasts into an invasive phenotype.MethodsThe ability of cultured normal and cholesteatoma fibroblasts to invade a basement membrane matrix in a Boyden chamber assay was examined.ResultsLess than 1% of gerbil fibroblasts invaded the matrix, compared with almost 10% of the invasive HT-1080 fibrosarcoma cells. Normal and cholesteatoma fibroblasts did not differ from each other in their invasive potential.ConclusionNormal fibroblasts and fibroblasts from induced cholesteatomas do not exhibit the invasive phenotype characteristic of true neoplastic cells.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo discuss the value of intratympanic dexamethasone (IT-DEX) perfusion for sudden sensorineural hearing loss (SSNHL), clinically and in an animal model.Study DesignRetrospective case review of 10 patients with SSNHL treated with IT-DEX. The findings are correlated with this institution's previous findings from a study of IT-DEX in guinea pigs.SettingAmbulatory tertiary otologic referral center.PatientsSequential patients with SSNHL who chose IT-DEX treatment.InterventionsDexamethasone 0.5 mg was injected transtympanically and bathed the round window for 20 minutes. Animal study: 79 ears were randomized into five groups: control, IT-DEX versus intravenous (IV)-DEX, IT-DEX with histamine, IT-DEX with hyaluronic acid, and IT-DEX with dimethylsulfoxide.Main Outcome MeasuresClinical study: postprocedure audiometry. Animal study: perilymph steroid concentration.ResultsIT-DEX results in significant hearing improvement and in significantly higher perilymph concentration of steroid than IV-DEX.ConclusionsIT-DEX is an appropriate treatment option for the treatment of SSNHL. Further study of dosages and frequency of administration is warranted.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo increase the number of intracochlear electrodes that may be inserted into a totally obliterated cochlea, a special implant has been developed in collaboration with Cochlear Limited. This implant features two separate electrode carriers containing 11 and 10 active electrodes, respectively, as well as a reference electrode located on the receiver-stimulator package. The potential stimulation modes available with this device therefore include monopolar and bipolar stimulation, and stimulation between both arrays.Surgical TechniqueA cochleostomy anterior to the round window provides access to the basal turn (both the scala tympani and the scala vestibuli), and new built connective tissue and bone can be removed until the anterior wall of the basal turn is approached. A second cochleostomy is performed at the second turn caudal of the cochleariform process and 2 mm anterior of the oval window after removal of the incus. New tissue should also be removed if necessary. The two electrode carriers are then placed into the scala tympani of the basal and the scala vestibuli of the second turn, respectively. The remaining surgical procedure is identical with that used for cochlear implantation in patients without obliterated cochleas.PatientsIn this clinical study, 10 patients aged 32 to 66 years with an obliterated cochlea each received a double array cochlear implant. All patients had total obliteration of the basal turn either on preoperative imaging or during surgery. Intraoperatively, the second turn was not obliterated in only 4 of 10 patients. Postoperatively, a standard audiologic test battery was used to determine auditory improvement over time.Postoperative ResultsAll patients achieved significantly improved speech understanding when the additional apical electrode array was used, compared with the use of each electrode array independently. No complications occurred.ConclusionIn patients with a totally obliterated cochlea, the number of intracochlear electrodes can be increased by use of the Nucleus double array implant. As a result, patients achieve significantly better auditory results.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe aim of these studies was to investigate the insertion properties and safety of a new intracochlear perimodiolar electrode array design (Contour).BackgroundAn electrode array positioned close to the neural elements could be expected to reduce stimulation thresholds and might potentially reduce channel interaction.MethodsTwo sequential studies were conducted. In study 1, the Contour electrode array was inserted in 12 human temporal bones. After cochlear surface preparation, the position of the array was noted and the basilar membrane was examined for insertion damage. On the basis of the outcome of this temporal bone study, study 2 investigated the Contour array, mounted on a Nucleus CI-24 M device and implanted in three adult patients.ResultsStudy 1 showed that in 10 temporal bones, the Contour array was positioned close to the modiolus, and the basilar membrane was intact. In the two remaining bones, the arrays had pierced the basilar membrane and were positioned in the scala vestibuli apical to the penetration. Statistical analysis showed an equivalent probability of insertion-induced damage of the two array designs. In study 2, image analysis indicated that the Contour electrodes were positioned closer to the modiolus than the standard Nucleus straight array. Lower T and C levels, but higher impedance values, were recorded from electrodes close to the modiolus. Initial speech perception data showed that all patients gained useful open-set speech perception, two patients achieving scores of 100% on sentence material 3 months postoperatively.ConclusionsThe temporal bone studies showed the Contour electrode array to be generally positioned closer to the modiolus than the standard Nucleus straight array, and to have an equivalent probability of causing insertion-induced damage.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThis study involved the assessment of speech recognition abilities as a function of age at implantation and length of cochlear implant use in children who received the Nucleus CI22M cochlear implant.Study DesignTwo separate analyses were performed. The first analysis involved the assessment of speech recognition performance as a function of length of time with a cochlear implant in 48 patients evaluated at 7 years of age. The second analysis involved the assessment of speech recognition performance as a function of age at implantation in 53 patients evaluated 36 months after implantation. Patients were divided into four groups based on length of implant use or age at implantation, and the results were analyzed by a repeated-measures analysis of variance.SettingThis study was carried out at a tertiary academic medical center.PatientsPatients consisted of children implanted with a Nucleus Multi Channel cochlear implant programmed with the SPEAK encoding strategy. Their ages at the time of evaluation ranged from 5.5 to 7.8 years. Their ages at implantation ranged from 2.4 to 14.5 years.InterventionsAll patients received a Nucleus Multi Channel cochlear implant programmed with the SPEAK encoding strategy. Word and sentence recognition tests were administered at various ages and at several postimplantation intervals.Main Outcome MeasuresPerformance as a function of length of cochlear implant use and as a function of age at implantation.ResultsPatients performed significantly better as length of cochlear implant use increased and age at implantation decreased. When patients were tested at a fixed postimplantation time interval (36 months), there was an overall trend for patients who received the implant at a younger age to perform better in spite of being younger at the time of evaluation. However, these effects were not statistically significant for all speech recognition tests that were administered.ConclusionsThese results confirm previous findings indicating continued improvement of speech recognition with time in implanted children. Furthermore, the results support the concept of the advantage of a younger age at implantation.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess progress in the use of the telephone in a group of prelingually deaf children after cochlear implantation.SettingTertiary referral pediatric cochlear implant center in the U. K.Study DesignA prospective study was undertaken on a consecutive group of 150 congenital and prelingually deaf children up to 5 years after implantation. The study group was confined to prelingually deaf children aged less than 7 years at the time of implantation. No child was lost to follow-up, and there were no exclusions from the study. At the time of the study, 129 children had reached the 1-year stage, and 91, 68, 40, and 23 had reached the 2-, 3-, 4-, and 5-year intervals, respectively.MethodsA specifically designed profile was used to assess the telephone use of the implanted children. Regression analysis was used to assess the correlation between the results of the telephone profile with the outcomes of the Iowa sentence test and connected discourse tracking.ResultsAfter implantation, prelingually deaf children showed significant progress in telephone use over time, not reaching a plateau at the 5-year interval (median score 27 with maximum score available 34). The results of the telephone profile showed significant correlations with the other tests of speech perception (correlation coefficients from 0.47 to 0.79, all statistically significant p < 0.0001).ConclusionThe telephone profile provided a useful method of monitoring children's telephone use. The profile was easily administered, and it was sensitive in assessing the progress of prelingually deaf children with cochlear implants. Outcomes from the profile were highly correlated with results from other widely used closed-and open-set tests.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo evaluate the outcome of cochlear implantation in patients with severe to profound hearing loss and visual impairment.Study DesignRetrospective case review.SettingTertiary referral center with a large cochlear implant program.PatientsSix adults and two children with severe or profound hearing loss and significant visual impairment underwent multichannel cochlear implantation. Follow-up period ranged from 6 months to 9 years. Case history, etiology of visual and hearing loss, and benefit from cochlear implant were evaluated.InterventionsCochlear implantation and subsequent rehabilitation.Main Outcome MeasuresSpeech perception measures were selected based on the patient age and cognitive abilities. Identical measures were used in each patient before and after implantation.ResultsAs a group, patients did well after cochlear implantation. There was significant improvement in speech perception when compared with the score before implantation.ConclusionsCochlear implants can play a significant rehabilitative role in patients with severe visual and auditory impairment. Additional skills are required by the implant team for rehabilitation of patients with multiple sensory deficits.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID