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Biomedical subjects

M Luntz

Publications and source records attributed to M Luntz.

At least 55 records · Page 3Linked to original sources
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

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

'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

Eustachian tube lumen: comparison between normal and inflamed specimens.

This study presents measurements of the cross-sectional luminal area of the eustachian tube. Comparisons are made between the lumens of eustachian tubes obtained from temporal bones presenting acute or secretory otitis media and those from noninflamed temporal bones. The material consisted of 71 temporal bones obtained postmortem from individuals up to 2 years of age. Forty-six of these showed no middle ear inflammation, while 25 presented either acute or secretory otitis media. In both groups the lumens of all the eustachian tubes were patent, presenting no obstruction. The mean cross-sectional area of the lumens of inflamed temporal bones was smaller than that of the noninflamed ones. This difference was not found to be statistically significant in the cartilaginous regions and was found to be statistically significant or borderline significant in the bony parts of the eustachian tube.

Acute Disease↗
PubMed1989

Diagnosis and treatment of secretory otitis media.

The majority of patients with secretory otitis media present with signs and symptoms characteristic of an inflammatory condition. The authors describe the use of various techniques to detect secretory otitis media. They then present options for treatment.

Humans↗
PubMed1988

The value of politzerization in the treatment of atelectatic ears.

The value of Politzerization as a method of treatment in atelectatic ears and secretory otitis media is controversial. In some places it has been used routinely for decades, in others it has been almost forgotten. A quantitative study of its therapeutic value has been difficult to find. The present study is an attempt to evaluate the therapeutic value of such an 'air douche' in atelectatic ears. Thirteen middle ears with atelectasis were Politzerized daily with air or N2 for up to five consecutive days. Once Politzerized, the atelectasis and retraction pockets disappeared in all the ears examined. However, continuous observation of the Politzerized ears with the surgical microscope revealed that all the ear drums returned swiftly to their retracted position. The time it took for a drum to return to its original place varied from 15 minutes up to a maximum of 335 minutes. Our observations show that even an increased number of Politzerizations did not alter the speed of reappearance of the atelectasis. It would therefore seem that the therapeutic value of Politzerization in atelectatic ears is doubtful.

Ear Diseases↗
PubMed1988

Fluctuations of middle ear aeration in atelectatic ears.

This is a prospective study of 27 eardrums which were found to be in an atelectatic condition before night sleep. On awakening in the morning, 10 (37.0%) of these ears were found to be inflated. The atelectasis as well as the presentation of spontaneous disappearance of the atelectasis were observed with the operating microscope. After awakening, the original atelectatic state reappeared within 65.7 min (on average). Spontaneous autoinflation of atelectatic ears cannot be explained by nocturnal CO2 diffusion into the middle ear, as CO2 would rediffuse within one order of time quicker than found-i.e. 6 min. The phenomenon emphasizes the fluctuating nature of atelectatic conditions.

Adult↗
PubMed1987

The biochemical composition of tympanosclerotic deposits.

We have studied the quantitative analysis of calcium, phosphate and cholesterol in the tympanosclerotic plaques removed from 25 patients. Our findings confirm that tympanosclerosis has a partly calcified organic matrix, in which the calcification process is probably similar in its qualitative chemical structure to that occurring in other calcified pathological tissues. The degree of calcification varies from one case to another and is even different in various locations of the same sampling. However, calcium levels are usually lower than in other pathological tissues which are calcified. The average quantity of calcium in our studies was 2 mg in 100 mg tissue or 12 mg in 100 mg protein. The average molar ratio between calcium and phosphate was 3, corresponding to the hydroxyapatite ratio. The average total quantity of cholesterol present was only 15 micrograms in 100 mg protein.

Calcinosis↗
PubMed1986

Large perilymph fistulas.

Perilymph fistulas may manifest themselves either by otologic symptoms, as in cases of small fistulas, or primarily through neurologic symptoms, as with large fistulas. A case history is presented of a 3-year-old girl with recurrent bouts of meningitis who was found to have a large perilymph fistula. She had a right undeveloped cochlea and labyrinth, as well as multiple defects of the medial wall of her middle ear. The only way of preventing the recurrent bouts of bacterial meningitis in cases of large perilymph fistulas is surgical repair. Our conclusion is that, considering the problems involved in cases of large congenital perilymph fistulas, a simple closure of the fistula is not sufficient and the method of choice is obliteration of a deeper structure--such as the vestibule itself.

Child, Preschool↗
PubMed1986

The infant's "post-isthmus" region of the eustachian tube in health and disease.

The size of the eustachian tube post-isthmic lumen in infants and children less than 2 years old is discussed. The material in our study consisted of serially sectioned eustachian tubes of twenty-six normal temporal bones and fourteen temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: There is no increase in the lumen size of the post-isthmic region of the eustachian tube from birth to 2 years of age. Each age group presents a considerable range in luminal area, compatible with the natural biologic distribution. No obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens. There is no significant statistical difference between the lumen size of the post-isthmic region coming from normal temporal bones as compared with those from temporal bones with acute or secretory otitis media.

Acute Disease↗