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Biomedical subjects

F E Offeciers

Publications and source records attributed to F E Offeciers.

At least 37 records · Page 2Linked to original sources
PubMed1997

Tympano-ossicular allografts for cholesteatoma in children.

At the Sint Augustinus Hospital, Antwerp, Belgium, all children with cholesteatoma are operated by a canal wall up approach and immediate reconstruction with a tympano-ossicular allograft. In the majority of the cases, a second stage is performed after 1 year. This paper presents the results of a retrospective review of the charts of 103 consecutive children treated between 1979 and 1995. The mean patient age was 10 years and the mean postoperative follow-up was 4.5 years. In 28 children residual cholesteatoma was found at the second stage operation and 20 developed recurrent cholesteatoma in the course of time. So far no residual cholesteatoma surfaced after the staged procedure, but 11 children needed more than two operations to control recurrent disease. An intact, trouble-free graft was present in 79 children at the latest follow-up. The median postoperative bone-conduction thresholds were equal to the preoperative thresholds. The median postoperative air-conduction thresholds improved in 50% of the cases, remained unchanged in 25%, and deteriorated in 25% of the cases. It is concluded that the tympano-ossicular allograft technique is effective and safe and offers good anatomical and acceptable functional results.

Adolescent↗
PubMed1997

Histology of the perforated tympanic membrane and its muco-epithelial junction.

A histological study was performed on total human tympanic membranes with a central perforation. The specimens originated from 30 consecutive and unselected operations in which a total myringectomy was performed prior to reconstruction by means of a tympanic allograft. Beside excessive thickening of the tympanic membrane in 73%, all membranes showed other histological abnormalities: inflammation (97%), excessive fibrosis (97%), tympanosclerosis (80%), hyperkeratosis (83%), rete riges (43%) and epithelial inclusions (6%). Histological localisation of the muco-epithelial junction showed a medial position in 30%, with extensive middle ear invasion by squamous epithelium in 7%. The surgeon performing myringoplasty should keep these findings in mind and he should closely examine the medial side of the perforated tympanic membrane in order to remove any ingrowing epithelium that otherwise would be trapped.

Adolescent↗
PubMed1997

Aplasia and hypoplasia of the vestibulocochlear nerve: diagnosis with MR imaging.

PURPOSE: To introduce aplasia or hypoplasia of the vestibulocochlear nerve (VCN) as a possible cause of hearing loss and to identify the magnetic resonance (MR) imaging characteristics of this entity. MATERIALS AND METHODS: In seven patients with congenital deafness or unexplained sensorineural hearing loss, MR imaging enabled diagnosis of aplasia or hypoplasia of the VCN. Axial (0.7-mm) three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) images and parasagittal reconstruction images perpendicular on the course of the VCN were obtained. Twenty normal inner ears were also studied; their findings were compared with those of the patients. RESULTS: The facial nerve and inferior and superior vestibular and cochlear branches of the VCN were identified on the MR images in the 20 normal inner ears. Aplasia of the VCN was detected in two patients with normal labyrinths but with a severe stenosis of the internal auditory canal. A common VCN with absence of the cochlear branch was found bilaterally in two patients with a congenital malformation of the labyrinth. A common VCN with absence or hypoplasia of the cochlear branch was found in three patients with normal internal auditory canals and labyrinths. CONCLUSION: Submillimetric gradient-echo images (eg, 3DFT-CISS) should always be used to exclude aplasia or hypoplasia of the cochlear branch of the VCN in all cochlear implant candidates and patients with congenital deafness. This entity, which can occur with or without associated labyrinthine malformation, should be confirmed in two planes.

Adult↗
PubMed1997

A gene for autosomal dominant nonsyndromic hearing loss (DFNA12) maps to chromosome 11q22-24.

We performed linkage analysis in a Belgian family with autosomal dominant midfrequency hearing loss, which has a prelingual onset and a nonprogressive course in most patients. We found LOD scores >6 with markers on chromosome 11q. Analysis of key recombinants maps this deafness gene (DFNA12) to a 36-cM interval on chromosome 11q22-24, between markers D11S4120 and D11S912. The critical regions for the recessive deafness locus DFNB2 and the dominant locus DFNA11, which were previously localized to the long arm of chromosome 11, do not overlap with the candidate interval of DFNA12.

Audiometry, Pure-Tone↗
PubMed1996

The LAURA multichannel cochlear implant in a true Mondini dysplasia.

A congenitally deaf child with bilateral Mondini dysplasias of the inner ear was successfully implanted with a LAURA multichannel cochlear prosthesis. This is the first report of a patient with a Mondini dysplasia in whom a LAURA multichannel cochlear prosthesis was successfully implanted. The cerebrospinal fluid leakage typically occurring after cochleostomy in similar patients was readily controlled, indicating that the deformity present was not a contra-indication for cochlear surgery. The audiological results obtained are described in detail. Since the internal unit of the LAURA prosthesis is very flexible, various speech processing strategies, such as continuous interleaved and phase-locked continuous interleaved strategies, can be tried and evaluated.

Child↗
PubMed1996

Allograft tympanoplasty type 1 in the childhood population.

Seventy allograft type 1 tympanoplasties in children under 16 years of age were studied retrospectively. Only patients with a tympanic membrane perforation without cholesteatoma and a normal ossicular chain were included. Short-term and long-term anatomic and functional results were analyzed after a mean follow-up of 40 months. The overall short-term take rate was 97% and the long-term take rate was 88%. A number of variables with alleged prognostic value for surgical outcome were analyzed, but none showed statistical correlation with either anatomic or functional results. A median hearing gain of 10 dB was achieved, which was stable over time. We conclude that allograft tympanoplasty type 1 in this group of children is anatomically and functionally successful regardless of age.

Adolescent↗
PubMed1996

Numerical assessment of TOAE screening results: currently used criteria and their effect on TOAE prevalence figures.

The literature on neonatal hearing screening by means of oto-acoustic emissions (OAE's) presents various prevalence figures, and gives little quantitative information on the procedure used to score the recordings. If the OAE test is to be interpreted by users who do not have the opportunity to develop intuitive interpretation skills through extensive training, a clear numerical decision criterion is needed. The present paper discusses the scoring procedure used by 25 teams, which together screen 22,356 neonates annually. More than 60% of the groups involved in this study use visual interpretation of the recorded OAE response, together with numerical criteria. Amongst the teams, 21 different ways of numerical scoring are used. It is shown that for a given set of OAE recordings, prevalence varies from 61% to 90%, depending on the numerical decision criterion being applied. We conclude that at this moment no consensus exists regarding the numerical criterion to be used when assessing OAE screening results. In view of the strong effect of criteria on the outcome of OAE screening, such consensus is urgently needed, but should be based on sensitivity and specificity figures for each scoring technique.

Adult↗
PubMed1996

Neonatal hearing screening with otoacoustic emissions: an evaluation.

For several years now, it is possible to test the cochlear function immediately after birth in an easy way by means of click evoked otoacoustic emissions. Thanks to this early detection, hearing aid fitting and appropriate hearing rehabilitation can now be started at a very young age, which significantly enhances the possibility of integration of the congenitally hard of hearing in society. An international consensus is growing to endorse a universal neonatal hearing screening in western societies. Setting up screening programs necessitates good preparation, continuous quality control and regular analysis of procedures and results. The present paper evaluates the procedure as organised from January 1993 till December 1994 in the University ENT-Department of the Sint-Augustinus Hospital. Of the 907 included neonates who were considered not to be at risk for hearing loss, 81% passed the test immediately, and 93% passed after maximum 3 tests. Some changes in the initial procedure increased the prevalence of emissions from 69% to 84%. The practical problems of the screening program and especially the importance of a stringent follow-up procedure in case of failure, are discussed.

Algorithms↗
PubMed1994

Facial nerve neuroma. Report of two cases including histological and radiological imaging studies.

Unlike the acoustic neuroma, a facial nerve neuroma is an uncommon finding, even in referral clinical centers. Two cases of facial nerve neuromas are presented, with special focus on the importance of adequate radiological imaging techniques and histological characteristics of tumor specimens. Surgical modalities regarding tumor removal as well as facial nerve repair are discussed and the current world literature reviewed.

Aged↗
PubMed1994

Preoperatively diagnosed utricular neuroma treated by selective partial labyrinthectomy.

Unlike the acoustic neuroma that occupies the internal acoustic meatus and extends into the cerebellopontine angle, the true intralabyrinthine neuroma is an extremely uncommon finding. The majority of the published cases were found at autopsy or during destructive labyrinthectomy for uncontrollable Meniere's syndrome. To the best of our knowledge, we present the smallest exclusively intrautricular neuroma that has ever been diagnosed preoperatively. Detailed magnetic resonance imaging studies allowed the detection of this tumor, measuring only 3.5 mm in diameter. The tumor was removed via atticomastoidectomy and partial labyrinthectomy. The diagnostic workup, radiographic characteristics, and surgical treatment are discussed, together with a review of the literature.

Ear, Inner↗
PubMed1994

The bone anchored hearing aid and auricular prosthesis.

The bone anchored hearing aid (B.A.H.A.) has been fitted to 10 of our patients presenting a bilateral profound conductive hearing loss and who were unable to wear a classical hearing aid. The group of patients with bilateral inoperable aural atresia (n = 5) formed the main indication and were found to give the best results. Cases with bilateral chronic otitis media (n = 5), presenting otorrhea each time a classical hearing aid was worn, formed the second indication. Audiometric performances are dependent on the bone conduction thresholds. The auricular epithesis has been adapted in 11 cases, mainly for atretic ears. The surgery for B.A.H.A. and epithesis is now routinely performed in one stage and has been found safe and reliable. The skin reactions around the abutments (total number fixtures = 32) were found to be rare and often easy to treat. Only around one abutment further subcutaneous tissue reduction was necessary to stabilize the skin. The B.A.H.A. and auricular epithesis are valuable alternatives in those cases where the limits of reconstructive (middle or outer ear) surgery are reached.

Adolescent↗
PubMed1993

Persistent stapedial artery: does it prevent successful surgery?

Because of the important function of the embryologic stapedial artery, it is taken for granted by many surgeons that the finding of such a persistent artery in postnatal humans during middle ear surgery should urge maximal caution in order not to damage the artery. Often, discontinuation of the surgery is recommended. Yet this attitude is based on theoretic considerations rather than on any clinical evidence of complications following injury to this vessel. The present paper describes the embryology in relation to this specific aspect and reviews the literature on the persistent stapedial artery, emphasizing the papers dealing with injury to this vessel. In addition, we report 4 cases of persistent stapedial artery from the files of almost 20,000 patients in whom tympanotomy was performed. From all these data we conclude that injury to this artery or even complete section probably does not cause major, if any, postoperative sequelae, and that consequently, middle ear surgery is not necessarily hindered by the presence of this vessel.

Adolescent↗
PubMed1993

Management of labyrinthine fistulas in cholesteatoma.

Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas.

Adolescent↗
PubMed1990

The solitary schwannoma of the eighth cranial nerve. An immunohistochemical study of the cochlear nerve-tumor interface.

Given recent controversy concerning hearing preservation surgery of the acoustic neurinoma, an immunohistochemical study was undertaken to investigate the cochlear nerve-tumor interface. Ten intact medium-sized acoustic neurinomas were studied by means of classic staining procedures and an immunohistochemical technique using monoclonal mouse antibodies to human neurofilaments. Our observations indicate that the cochlear nerve is histologically involved in the tumoral process in those cases in which macroscopically visible adherences between the cochlear nerve and the tumor are present. We were not able to discern a clear cleavage plane. Six of the 10 specimens showed tumoral invasion of the cochlear nerve. Several therapeutic attitudes are discussed in view of these observations and reports from the international literature. In conclusion, the principle of hearing preservation surgery is rejected in favor of total tumor removal in every case in which surgery is indicated.

Aged↗