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Biomedical subjects

J Sadé

Publications and source records attributed to J Sadé.

At least 19 recordsLinked to original sources
PubMed1992

The correlation of middle ear aeration with mastoid pneumatization. The mastoid as a pressure buffer.

Atelectatic ears, which by definition are poorly aerated, are also usually associated with poor mastoid pneumatization. On the other hand, otosclerotic patients, whose middle ears are usually exceptionally well aerated, also have excellent mastoid pneumatization. Three unusual cases are presented, in which partial atelectasis developed in stapedectomized patients. In each case the mastoid was later found to be nonpneumatized, and further analysis revealed that their stapes fixation had in effect most probably been of non-otosclerotic origin. Thus, although these three cases had at first appeared to represent exceptions to the general rule of otosclerotics having a well-aerated middle ear, in fact they support the association between atelectasis and poor pneumatization. The linkage of good middle ear aeration with large mastoid pneumatization and vice versa may suggest that the mastoid plays a role of a pressure buffer in the middle ear, which is a system of a gas pocket with fluctuating pressures. Also, otosclerosis may be considered to be an unlikely cause of conductive deafness in cases of poor pneumatization.

Adult↗
PubMed1991

The effect of mastoid surgery on atelectatic ears and retraction pockets.

Forty children and 53 adults with a total of 111 atelectatic ears were operated on and followed up. Eight-four ears underwent tympanoplasty, while 27 ears underwent both a tympanoplasty and a mastoid operation. There were no statistically significant differences between the two operation groups as far as their age groups and the extent of the disease present. After follow-up of over 4 years, aeration of the middle ear was found to be better in the tympanoplasty group alone when compared with ears with also had mastoid operations.

Adolescent↗
PubMed1991

The influence of ventilating tubes on the surgical treatment of atelectatic ears.

Forty children and 53 adults having 111 atelectatic ears were operated on and followed up. All patients underwent a tympanoplasty operation, while 27 patients underwent concomitant various mastoid operations. A ventilating tube was inserted in 55 out of the 111 atelectatic ears, while in 56 ears the tympanoplasty was left without a ventilating tube. After an average of 53.1 months of post-operative follow-up we found that all ears were adequately aerated as long as a ventilating tube was in place. However, at the final check, once all ventilating tubes extruded, it was found that insertion of a ventilating tube at operation did not change the natural evolution of the atelectatic condition after surgery. Our conclusion is that the only way to overcome the atelectatic prone condition is to reinsert a ventilating tube whenever atelectasis reformation occurs.

Adolescent↗
PubMed1991

The histological patterns of normal and inflamed middle ear mucosa.

Thirty temporal bones from infants up to the age of 24 months were chosen randomly. Bones were sectioned serially and studied histologically. Inflammatory cellular and mucoid elements were identified and evaluated semiquantitatively. Some inflammatory infiltration was found in all 30 ears. Seven ears from infants up to 1 month of age presented inflammatory infiltration only. Twenty-three ears presented both cellular and mucoid elements. All temporal bones exhibiting mucoid elements showed concomitant cellular inflammatory infiltration. Practically no temporal bones in this age group were free of inflammatory elements, with secretory features appearing chronologically after the cellular ones.

Child, Preschool↗
PubMed1991

Adenoidectomy in otitis media. A review.

For many years adenoids were thought to affect adversely middle ear (ME) aeration by obstructing the eustachian tube opening, leading to ME infections and effusions. Consequently, the adenoids have often been removed in children suffering from ME diseases; indeed, adenoidectomy is still performed around the globe on millions of children annually. Opinions vary, however, on the usefulness of the operation in various ME diseases. The purpose of this study is to review the available studies concerning the relationship of adenoids to the ME as well as the effect and benefit of adenoidectomy on ME effusions and ME infections.

Acute Disease↗
PubMed1991

Gas diffusion in the middle ear.

The ex vacuo theory, claiming that in cases of middle ear underaeration air enters the middle ear through the Eustachian tube in diminished amounts while oxygen continues to leave it into the blood by diffusion as in normal condition, does not provide a complete explanation for the aeration problems encountered in middle ear pathology. This study shows that when atelectatic ears are politzerized (hyperinflated) with different gases, these gases disappear with a speed that correspond to the diffusion coefficient of the different gases. This finding together with the fact that the composition of middle ear gases is very similar to that found in the venous circulation suggests that it is a diffusional process of several gases from the middle ear into the blood and in the opposite direction that mainly determines the middle ear pressure.

Adolescent↗
PubMed1990

Cartilage in the bony portion of the eustachian tube.

The distribution of cartilage in the bony section of the eustachian tube was studied by examining histological serial sections of 50 temporal bones of infants and adults. When cartilage was found to be present in the bony segments of the eustachian tube, its cross-sectional area was measured. Cartilage was seen in the isthmic region in all specimens. In the post-isthmic region it was present in all of the specimens taken from infants and in 92.3% of the adult specimens. In the pretympanic region cartilage was found in 34.6% of the infants' eustachian tubes and in 25% of the adults'. The results indicate that cartilage is also present in the bony part of the eustachian tube at all ages but diminishes in frequency the more the eustachian tube approaches the middle ear.

Adult↗
PubMed1990

Value of middle ear inflation as a diagnostic indicator of eustachian tube patency.

The value of tubal inflation as a diagnostic procedure for Eustachian tube patency and function is controversial. In an attempt to assess the diagnostic value of air douche in atelectatic ears, 49 such ears of 40 patients were politzerized. The procedure was successful in 45 ears. However, of the four unsuccessful cases, two of the patients were able to autoinflate their ears. These results show that air douches pass regularly through the Eustachian tube into the tympanic cavity even in atelectatic ears, which by definition suffer from aeration deficiency, which is often considered to be secondary to 'Eustachian tube obstruction', or alternatively 'Eustachian tube dysfunction'. Thus, the ability to force air through the Eustachian tube by politzerization is of no diagnostic value as an indicator of normal or abnormal tubal patency or functioning in atelectatic ears and most probably in allied conditions.

Adolescent↗
PubMed1990

Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients.

Twenty-three consecutive patients with malignant external otitis (MEO) were treated with oral ciprofloxacin, 1.5-2.25 g/day for 6 weeks. Treatment was combined with local surgical debridement. Patients were discharged early for ambulatory follow-up. Few minor side effects were reported, and full compliance with the study drug was observed. In 21 patients cure was achieved; in 2 the response was not adequate. Oral ciprofloxacin is an effective, convenient, nontoxic, economically justified alternative to the combination intravenous therapy previously advocated.

Administration, Oral↗
PubMed1990

Correlation between mastoid pneumatization and position of the lateral sinus.

The distance between the lateral sinus and the external ear canal was measured in 148 patients (150 ears) with completely sclerotic (nonpneumatized) mastoids and in 75 healthy random control subjects (150 ears), with pneumatized mastoids. A highly significant difference (p less than .0001) was found between the two groups, the mean distance (+/- SD) among patients being 7.8 +/- 1.7 mm, while among controls it was 13.5 +/- 2.8 mm. Moreover, a significant positive correlation (p less than .001) was found within the pneumatized control group itself, between the sinus' distance and the degree of mastoid pneumatization. The results of this study may be interpreted by those who espouse environmental theories as denoting that infantile otitis media will determine the position of the lateral sinus. However, those who favor the genetic explanation may maintain that since the position of the sinus is established prenatally and involves organogenetically the shape of the skull, the final position is unlikely to be influenced by postnatal otitis media.

Adolescent↗
PubMed1990

Middle ear as a gas pocket.

An analysis of 45 adult ears that underwent a modified radical mastoidectomy for cholesteatoma and remained with an intact unperforated pars tensa is described. 1) While in practically all these ears some air was present behind the tympanic membrane, its amount varied considerably. 2) The air present behind the tympanic membrane was always in communication with the eustachian tube. 3) The regions in the middle ear devoid of air presented a deep atelectasis that was found predominantly in the posterior-superior part of the middle ear. Topographically the regions of air and atelectasis corresponded to the distribution of ciliated and flat epithelia in the middle ear, respectively. The presence of air in the middle ears obliges us to view these ears as being aerated gas pockets. The aeration difference between such an atelectatic ear and one in a physiologic state is probably a difference of degree. This difference can result from reduction in aeration through the eustachian tube or from excessive absorption of gases into the circulation, or from deficient normal diffusion of carbon dioxide or nitrogen from the circulation into the middle ear, or from a combination of these factors. The analogy with the respiratory system is emphasized.

Absorption↗
PubMed1990

Daily fluctuations of middle ear pressure in atelectatic ears.

The position of the drum of 84 atelectatic ears, of patients 5 to 79 years old, was examined with the help of the operating microscope at different times of the day. All ears were found to be atelectatic during the daytime, yet on the patients' awakening in the morning, 37.73% of the drums of the adolescents' and adults' ears were found to be inflated, usually even hyperinflated. None of the children showed an inflated eardrum in the morning. All eardrums that were inflated in the morning returned to their original atelectatic position within an average of 54.56 minutes after awakening. This observation illustrates another fluctuating aspect of the atelectatic condition.

Adolescent↗
PubMed1989

Ciprofloxacin treatment of malignant external otitis.

The Ear, Nose, and Throat department of the Meir Hospital treated 91 patients with malignant external otitis during the past 16 years. The last 23 patients with malignant external otitis were treated with ciprofloxacin 750 mg twice daily, combined with local excision of the aural lesion. The records of 61 of our previous 68 patients who underwent surgery and were hospitalized and treated with an intravenous extended-spectrum penicillin and gentamicin for six to eight weeks, were analyzed. Twenty-one of 23 patients treated with ciprofloxacin were cured; therapy failed in two patients. Treatment averaged 16.8 days of hospitalization, and bacteriologic eradication was achieved after an average of 7.04 days, as compared with 49 and 15.3 days, respectively, in the group of patients with the intravenous treatment. The mean peak concentrations of ciprofloxacin in serum varied between 2.5 and 3.7 micrograms/ml, and the drug concentrations in different ear tissues were 0.2 to 13 micrograms/g. The treatment with ciprofloxacin was well tolerated with no significant side effects, whereas serious side effects were noted in 45.9 percent of the previous intravenously treated group. The concentrations of the drug in serum and ear tissues were higher than the average minimal inhibitory concentration for Pseudomonas aeruginosa. Use of ciprofloxacin treatment, combined with local excision of the aural lesion, will bring about healing of malignant external otitis in the majority of cases. Ciprofloxacin can be given on an ambulatory basis after a relatively short period of hospitalization.

Aged↗
PubMed1989

'Tripod' ossiculoplasty in incudal lesions.

A method of ossiculoplasty, in cases where the long process of the incus is eroded, is described. The defect created by the erosion of the incus is bridged by an autogenic or allogenic bone graft that leans on the stapes, the remaining part of the incus, and the side of the malleus. These three contact points allow for stability of the bony graft and account for the name tripod. The method was applied in 30 ears and was successful in all but three cases. All the rest (ie, 27 ears) achieved an average gain of 24.8 dB, leaving an average air-bone gap of 11.1 dB. The postoperative air-bone gap was 20 dB or less in all 27 ears that were successfully operated on; and in 21 of them (77.8%), it was no more than 10 dB. The average period of follow-up was 23.8 months. Operative success depended on both the technique chosen and the favorable selection of cases.

Bone Conduction↗
PubMed1989

Gaseous pathways in atelectatic ears.

Thirteen atelectatic ears were politzerized with CO2, O2, air, and N2. In consequence, the atelectasis in these ears disappeared, only to reappear again slowly. The reappearance of retraction corresponded in speed to the diffusion coefficient of the gases, indicating a regular diffusion process. At the same time, four of these politzerized patients were able to collapse the tympanic membrane of their air-filled middle ears abruptly through sniffing or swallowing. At least three patients could introduce air actively and voluntarily into their ears. These observations indicate that in atelectatic ears, as in normal ears, air can enter and leave the middle ear through one of two routes. One is the eustachian tube, through which air can pass both ways as a bolus. The second route is through the bloodstream, which gases enter and leave according to the rules of biologic diffusion. While the origin of negative pressure in atelectatic ears is unknown, this study shows that it may be a complex process stemming from a quantitative imbalance of loss versus gain of gas entry through either of the two routes.

Adult↗
PubMed1989

Mastoid pneumatization in otosclerosis.

The extent of mastoid pneumatization in 150 otosclerotic ears was compared with that of 150 healthy control ears. The size of mastoid pneumatization was measured by use of the Schüller lateral x-ray projection with the help of computed planimetry. The measurements showed the average pneumatized area in otosclerotic ears to be 17.4 +/- 5 cm2, in contrast to 12.9 +/- 4 cm2 for the healthy control ears. The difference between the two groups was highly significant (p less than .0001). While both groups showed a bell-shaped distribution of the measured pneumatized area, the curve of the otosclerotic ears was shifted significantly to the right. Our findings indicate a link between otosclerosis on the one hand and highly pneumatized mastoids on the other. This link between a hereditary disease and a specific type of pneumatization points to the likelihood that heredity also plays some role in determining the final type of pneumatization.

Adult↗