Biomedical subjects
Publications and source records attributed to J Helms.
Follow-up of 38 patients with facial nerve paralysis in fractures of the petrous bone. Transmastoidal approach was performed in 23 cases. 15 patients underwent either translabyrinthine or transtemporal approach. The clinical and intraoperative findings and procedures are demonstrated. The need for surgical treatment in facial paralysis caused by petrous bone fractures is stressed.
Facial diplegia is a rare disease. 18 patients suffering from bilateral facial palsy were examined. The clinical findings and therapeutic possibilities of ENT-surgeons are demonstrated. Common and rare causes of the lesions are discussed.
Explore the source record for details and available documents.
We report about 3 patients with a Arachnoidal Cyst in the internal acoustic meatus. The first patient had a cyst deriving from the Falloppian Canal fundus into the cochlea reaching the internal carotic artery. The second cyst we found followed the widened Falloppian canal from the internal acoustic meatus to the region of the oval window with disturbance of the ossicular chain function. The third patient had a Arachnoidal Cyst in the borders of a enlarged internal acoustic meatus. We describe the history and the anatomic situation of the three patients.
Explore the source record for details and available documents.
Since 1979, various ceramics have been recommended as valuable implant materials in tympanoplasties. Such implants are used for the reconstruction of the ossicular chain or the posterior canal wall. Animal studies on bioinert and bioactive ceramics in the middle ear have been carried out to confirm their biocompatibility. Histologic and clinical findings have made it obvious that aluminum- or borum-aluminum oxide ceramics are well tolerated in the middle ear and may produce functional results, provided they are separated from the tympanic membrane or the footplate of the stapes by an interposition of cartilage. Porous tricalcium phosphate ceramics cannot be recommended for the reconstruction of the ossicular chain because they are degradable, but they may be useful for the obliteration of small mastoid cavities. Our five-year histologic and clinical experience with the bioactive glass ceramic Ceravital revealed in 1983 that this material is suitable for the reconstruction of the ossicular chain as well as of the posterior canal wall, without the need for protection by cartilage. Ceravital implants in fact behave like homologous ossicles.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
39 patients who suffered from therapy-resistant cochlear-vestibular disturbance, underwent neurectomy procedures for the control of their disease; half a year after surgery a follow-up inquiry ascertained their present condition. 29 patients had a history of Ménière's disease; in 9 patients the patients' condition after stapedectomy, injury of the skull or vascular malformation in the internal auditory canal were the reason for surgery. In the first group the disabling attacks of vertigo had disappeared. The effects of symptoms such as tinnitus, pressure, hearing loss and an occasional unsteadiness were felt to be less severe. Strikingly divergent opinions were expressed on the results of surgery in the second group; on the whole, these patients did not feel as positively about their operation as those who had been suffering from Ménière's disease.
Explore the source record for details and available documents.
Vestibular ganglia of 17 patients with Menière's disease, obtained by transtemporal or translabyrinthine neurectomy, were studied by electron microscopy. Three ganglia removed because of other disease and four ganglia of normal ears taken post mortem served as controls. The neuronal fibrous tissue of Menière cases showed without exception pathologic changes of various extent. The amount of collagen was increased, whereby different fiber diameters were observed as well as changes in the periodicity of cross banding. Signs of continuing collagen formation were found: active fibroblasts and an increased number of isolated Schwann cells without axons, showing deerhorn-like ramifications which enveloped collagen bundles. The blood vessels were frequently surrounded by multiple basal membranes and broad bands of homogenous matrix. The pericytes were either necrotic or nonexistent. The endothelial cell cytoplasma was usually not in an active state. Sometimes it seemed to be autolytic. The pinocytotic activity was strikingly diminished. These qualitative changes of the interstitial tissue might point to a local pathologic event in the region of the vestibular nerve and ganglion.
Surgical labyrinthectomy in patients with Menière's disease produces unsatisfactory results in 10-70% of the cases. A pathological process in the vestibular nerve comprising an increase in connective tissue formation and the development of bony material within the nerve is possibly the reason for the pathological function of the vestibular system. This process may arise after a mechanical trauma to the labyrinth. Labyrinthectomy should be performed only for the treatment of Menière's disease if other therapeutical regimens or neurectomy under general anaesthesia cannot be tolerated by the patients.
Conservative treatment of zoster oticus seems to be possible by promoting increased activity of the immunological system. The techniques to be applied were described by Mayr, Stickl and coworkers. These researchers used a special preparation of an attenuated virus. A transtemporal decompression of the facial nerve should be performed after Fisch and Esslen when more than 90% of the neurons of the facial nerve are lost. Signs of vestibular and cochlear damage are additional arguments for decompression surgery. A case is described in which one year after the onset of the disease necrosis of the facial nerve at the fundus of the internal auditory meatus and the beginning of the Fallopian canal (canalis facialis Fallopii) was seen and histologically proven. This was repaired by inserting a nerve graft. Motility of the face returned. An earlier decompression operation would most probably have prevented this course of the disease.
One third out of 181 patients who had been operated for chronic otitis, had tinnitus. In one third of these patients with tinnitus the ear noise disappeared after the tympanoplasty, in one third it remained unchanges and in one third the tinnitus appeared after the tympanoplasty.
Fractures of the pyramid, longitudinal fractures in the majority of cases, lead to a damage of the facial nerve in the surrounding of the geniculate ganglion. This area has to be controlled surgically when a facial nerve paralysis occurs after a head injury.
Serous otitis media is sometimes treated by Eustacian tube catheterization or by insufflation of the middle ear via a myringotomy. Both techniques can cause death as has been described in the literature. Two patients, in whom following middle ear insufflation via a myringotomy air was found intracranially are presented. In one the finding on skull X-ray was coincidental and no symptoms occurred, whereas in the other a paresis of the right foot that lasted for 30 min occurred from the time of the middle ear insufflation for his serous otitis media.
Explore the source record for details and available documents.
Pathophysiology and tomography of the blood vessels of the posterior cranial fossa gain clinical interest in treatment of diseases of the inner ear, complications of middle ear inflammations, tumors of the pyramid and cerebello-pontine angle. Numerous variations in the arterial venous system restrict neuroradiological procedures. Techniques to treat a thrombosis of the sinuses were developed 50 years ago. Surgical procedures to remove glomus tumors of the pyramid could be improved by new anatomical and surgical experiences. Unilateral neck dissection occasionally alters the blood flow in the sinuses of the posterior cranial fossa causing serious complications.