ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo evaluate the usefulness of cartilage plates as tympanic membranes combined with total middle ear reconstructive surgery for radicalized ears.Study DesignRetrospective study between 1994 and 1999.SettingTertiary care referral medical center.PatientsSeven patients had seven ears with severe chronic otorrhea after radical mastoidectomy. All patients had severe to profound sensorineural hearing loss and expected a trouble-free ear rather than improved hearing after surgery. Patients were followed up for 4 years postoperatively.MethodsAfter the middle ear space was cleaned, the tympanic membrane was reconstructed using a plate prepared from the tragal cartilage. The major part of the posterior wall was reconstructed using a conchal cartilage plate. Cortical bone segments were inserted to support the cartilage plate.ResultsPreoperatively, cultures of ear discharge were positive for various bacteria. Recovery with dry eardrums was noted in six patients, and one patient showed minimal erosion. No postoperative complications were encountered, but the hearing threshold did not improve postoperatively.ConclusionsTotal middle ear reconstructive surgery is suitable for patients with chronic otorrhea complicating radical mastoidectomy. The use of cartilage plates seems to be clinically appropriate, particularly for patients with severe infection who expect a trouble-free ear rather than hearing gain after surgery.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Hypothesis and BackgroundThe Eustachian tube has three important functions with respect to the middle ear: ventilation, clearance, and protection. Surfactants are assumed to be important to maintain these functions. The administration of exogenous surfactant may therefore be effective to improve the function of the Eustachian tube. This randomized, double-blind, placebo-controlled study was designed to investigate the effect of exogenous surfactant on the function of the Eustachian tube in rats.Materials and MethodsExogenous surfactant was administered into the middle ear of 10 otologically healthy rats, and 10 other rats received placebo. The effect on the opening and closing pressure (passive ventilatory function) and the dye clearance time (clearance function) of the rat's Eustachian tube was measured.ResultsA significant decrease in the opening pressure was seen after the administration of surfactant. Both surfactant and placebo caused an increase in the closing pressure. A serious disturbance of the dye clearance time was induced in 13 rats, and the test failed in 1 rat. In the remaining 6 rats, no significant differences in the dye clearance time were observed between the two groups.ConclusionsExogenous surfactant decreased the closing forces of the Eustachian tube even in otologically healthy rats. No significant effect on the mucociliary clearance was observed, but this may have resulted from the small number of rats. Additional randomized, double-blind, placebo-controlled trials should be conducted to determine the clinical relevance of these changes and to further assess the effect of surfactant on the function of the Eustachian tube.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

HypothesisIt was hypothesized that the differences in the bioacoustic performance of ossicular replacement prosthesis designs, and insertion positions, could be quantified using finite element analysis.BackgroundMany designs of prosthesis are available for middle ear surgery. The materials used, and the shape of the implants, differ widely. Advances in computer simulation technologies offer the possibility of replicating the in vivo behavior of the different prostheses. If this can be achieved, insight into the design attributes required for improved biofunctionality may be gained.MethodsMicro-computed tomography and nuclear magnetic resonance imaging were used to obtain geometric information that was translated into a finite element model of the outer and middle ear. The forced frequency response across the hearing range of the normal middle ear was compared with the middle ear reconstructed with partial and total ossicular replacement prostheses.ResultsThe amplitude of vibration of the footplate was more similar to that of the normal ear when a Kurz total ossicular replacement prosthesis was implanted than when a Xomed total ossicular replacement prosthesis was implanted. This may be attributed to the latter's titanium link. Partial ossicular replacement prostheses were stiffest and had lower umbo vibrations and higher stapedial footplate vibrations. In all cases but one, the vibration of the prostheses had resonances that caused the vibration of the stapes footplate to be noticeably different from normal.ConclusionThe authors confirmed the hypothesis that finite element modeling can be used to predict the differences in the response of ossicular replacement prostheses. This study shows that computer simulation can potentially be used to test or optimize the vibroacoustic characteristics of middle ear implants.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo report the long-term results in a series of ossiculoplasties using Ceravital prostheses.Study DesignRetrospective case review.SettingDistrict general hospital.PatientsOssiculoplasties using Ceravital prostheses were performed in 25 patients with a mean age of 39 years. Cholesteatoma was present in 9 cases and absent in 16 cases before surgery. The reconstruction was single stage in 23 cases and second stage in 2 cases.Main Outcome MeasuresHearing gain and prosthesis-related complications. The mean length of follow-up was 6 years 6 months.ResultsIn the short term, the mean air-bone gap improved from 43 dB preoperatively to 24 dB 6 months postoperatively. In the long term, the results were as follows: good in 4 cases, absorption of the prosthesis in 9 cases, slippage of the prosthesis in 4 cases, extrusion of the prosthesis in 3 cases, atelectasis of the tympanic membrane in 2 cases, and unknown in 3 cases. The mean time for complications to become apparent was 6 years 4 months for absorption, 3 years 3 months for extrusion, 7 months for slippage, and 1 year 9 months for atelectasis. Revision surgery was performed on 11 of the 18 cases in which the results were poor.ConclusionsCeravital prostheses highlight the potential complication of absorption of ossicular prostheses. Absorption takes much longer to become apparent than other complications such as extrusion, slippage, or atelectasis. The much higher rate of absorption in this series than in previous series with shorter follow-up times suggests that the rate of absorption increases significantly over time.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

HypothesisThe osseointegrative capacity of medical-grade bone cement can be used to improve fixation and prevent displacement of an ossicular prosthesis in a guinea pig model.BackgroundSuccessful ossiculoplasty requires a firm connection between the vibrating tympanic membrane and the inner ear. In patients requiring revision ossiculoplasty, half of failures are due to prosthesis displacement. Bone cements have been used as prosthetic material in craniofacial surgery, and their adhesive and osseointegrative properties make them ideal for use in ossicular reconstruction.MethodsTwenty-four adult male guinea pigs underwent a postauricular surgical approach for access to the middle ear. Hydroxyapatite and Dahllite cements were used in an alternating fashion to fix ossicular bone. Four animals were killed immediately to demonstrate mechanical bonding of the ossicles at the time of application. Nineteen animals were killed 8 weeks postoperatively to assess bonding capacity and histologic inflammation.ResultsBoth cements mechanically bonded the ossicles at the time of application, but Dahllite cement set faster in the moist environment of the middle ear space. Histologic examination showed bonding of the ossicles with both cements, with little evidence of inflammation or foreign body reaction.ConclusionsHydroxyapatite and Dahllite bone cements showed evidence of osseointegration with ossicular bone in the guinea pig model. Further studies are under way to determine the osseointegrative capacity of Dahllite cement between the guinea pig malleus and a partial prosthesis, and any ototoxic effects with use in the middle ear.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundOssicular discontinuity may result from chronic otitis media, with or without cholesteatoma, and usually cannot be determined unless an operation is performed. If preoperative information can be used to determine whether or not the ossicular chain is intact, the patient can be better informed and the surgeon can be better prepared before surgery.ObjectiveTo examine the correlation between preoperative findings and the status of the ossicular chain at surgery.Study DesignRetrospective.SettingA tertiary referral center.PatientsData from 190 patients (212 ears) who were undergoing their first operations for chronic otitis media were reviewed.InterventionThe operations for the cholesteatoma or noncholesteatoma ears were classified into different groups and analyzed separately. Ossicular discontinuity was identified only if the discontinuity of the ossicular chain was confirmed at the time of operation.ResultsThe cholesteatoma group consisted of 59 ears, and the noncholesteatoma group contained 153 ears. In the cholesteatoma group, two statistically significant preoperative parameters were observed to be significantly correlated with ossicular discontinuity: persistently draining ears (p= 0.026) and a cholesteatoma that extended to the tympanic sinus (p= 0.006). In the noncholesteatoma group, only one parameter was observed to be predictive of ossicular discontinuity. In this group of patients, perforation of the tympanic membrane with an edge adherent to the promontory occurred significantly more frequently in patients with ossicular discontinuity (p= 0.004) than in those with intact ossicular chains. Surprisingly, an air-bone gap was not significantly correlated with ossicular discontinuity. The cholesteatoma and granulation tissue in the middle ear cavity may serve as transmission bridges of acoustic energy, resulting in narrowed air-bone gaps.ConclusionsIn the cholesteatoma group, both cholesteatoma extension into the tympanic sinus and persistently draining ears were predictive of ossicular discontinuity. In the noncholesteatoma group, perforation edges adhering to the promontory also revealed a higher incidence of ossicular discontinuity. Therefore, all these findings can be considered as potential preoperative predictors of ossicular discontinuity in chronic otitis media.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine the morphologic and hearing results of the combined application of the palisade cartilage technique and titanium ossicular replacement prostheses in Type III tympanoplasty.Study DesignRetrospective review of 61 tympanoplasties.SettingTertiary referral center.Patients59 patients (39 women and 20 men, mean age 36 years, range 7–81 years) consecutively operated on because of cholesteatoma, adhesive otitis, chronic otitis media, subtotal tympanic membrane defects, and tympanofibrosis requiring tympanoplasty with ossiculoplasty.InterventionsTympanoplasty Type III, with application of the palisade cartilage technique and total or partial titanium ossicular replacement prosthesis.Main Outcome MeasuresOtoscopic findings and hearing results using a four-frequency pure tone average air-bone gap.ResultsA recurrent defect was seen in 1 ear (1.6%). The graft take rate was 100%. There were no extrusions of prostheses. Preoperatively, a pure tone average air-bone gap of 0 to 10 dB was seen in 1 ear, 11 to 30 dB in 30, and 31 to 50 dB in another 30 ears. Postoperatively, the corresponding numbers were 11, 41, and 9 ears, respectively. Hearing results were better in the total ossicular replacement prosthesis group.ConclusionsThe palisade cartilage technique is suitable to manage difficult pathologic conditions in middle ear surgery. It was demonstrated that the palisade cartilage technique can be combined safely with titanium ossicular replacement prostheses. Regarding postoperative hearing results, the negative preselection of pathologic conditions must be considered.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo evaluate the long-term anatomic and functional results after partial and total autologous cartilage palisade type III tympanoplasties to assess the efficacy of cartilage palisades in preventing recurrent cholesteatoma.Study DesignRetrospective data bank and patient review.SettingTertiary referral center.PatientsThe study population included all patients with more than 36 months follow-up who underwent tympanoplasty or tympanomastoidectomy for previously untreated cholesteatoma using partial or total autologous cartilage palisade graft associated with a reconstruction of the ossicular chain from October 1, 1992, to October 31, 1998.InterventionTympanoplasty or tympanomastoidectomy using autologous cartilage palisade graft for partial or total reconstruction of the tympanic membrane and the ossicular chain.Main Outcome MeasuresAnatomic results, i.e., closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and reperforation rate related to the use of autologous cartilage were clinically evaluated. Postoperative speech reception thresholds, speech discrimination scores, and postoperative air-bone gap were compared with preoperative levels. The outcomes of canal wall up and canal wall down procedures were compared.ResultsClosure of the tympanic membrane was achieved in 98.3% of patients. Speech reception thresholds did not change significantly. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was less than 10 dB in 29.8% of patients and between 11 and 20 dB in 32.3%. The complication rate of the tympanoplasty in general was 0.67%. The rate of recurrences of cholesteatoma was 2.2%. No complications could be related to the use of cartilage.ConclusionsThe cartilage palisade technique is effective for the reconstruction of the tympanic membrane and also prevents new retractions and recurrences of cholesteatoma. The functional results show that autologous cartilage grafts are able to transmit sound.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo quantify the relationship between the stage of histologic changes of the stapedial footplate in otosclerosis and the magnitude of preoperative hearing loss, tinnitus, vestibular disorder, and postoperative improvement of hearing.Study DesignRetrospective case review.SettingTertiary referral center.PatientsThe study included 97 patients (ears) (69 female and 28 male patients), with conductive or mixed hearing loss who were operated on for otosclerosis. The criterion for including a patient in the study was otosclerosis established by tympanoscopy and confirmed by histologic examination of a piece of the stapedial footplate.Main Outcome MeasuresBy the histologic features of the stapedial footplate fragments, the stage of the otosclerotic lesion was classified as spongiotic, fibrotic, or sclerotic. The patients were carefully matched for sex, age, duration of hearing impairment, presence of tinnitus, and vestibular symptoms. Preoperative and postoperative air-conduction and bone-conduction thresholds were calculated as an average of four frequencies (0.5, 1, 2, and 4 kHz). Analysis was subsequently carried out on the preoperative and postoperative air-bone gap and bone-conduction threshold improvement.ResultsWith regard to the histologic stage of otosclerotic lesions, tinnitus and vestibular disorders were present more frequently in patients with the sclerotic type of lesion. The type of otosclerotic lesion had no significant influence on the mean preoperative air-conduction threshold, bone-conduction threshold, and air-bone gap or on postoperative air-conduction threshold and bone-conduction threshold, but the postoperative air-bone gap was higher in patients with the fibrotic type of otosclerotic lesion and was highest in patients with the spongiotic type of otosclerotic lesion (p< 0.01).ConclusionsTinnitus, vestibular disorders, and better postoperative closure of the air-bone gap are present more frequently in patients with a sclerotic type of otosclerotic lesion on the stapedial footplate.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID