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Biomedical subjects

M Tos

Publications and source records attributed to M Tos.

At least 163 records · Page 9Linked to original sources
PubMed1989

Stability of tympanoplasty in children.

The results of tympanoplasty performed for noncholesteatomatous chronic otitis in children aged 2 to 14 years are described. The authors report that the stability of hearing was excellent; they found hearing to be equally good in young children and in older children. Tympanic membrane perforation can be closed at any age. There is no age limit below which perforation should not be closed.

Adolescent↗
PubMed1988

Treatment of sinus cholesteatoma. Long-term results and recurrence rate.

We classified cholesteatomas as attic cholesteatoma, developing from Shrapnell's membrane; tensa cholesteatoma, originating in pars tensa, which is subdivided into tensa retraction cholesteatoma involving the entire pars tensa, and sinus cholesteatomas, developing from a posterosuperior retraction (perforation). From 1964 to 1980, one-stage operations were carried out on 271 ears with sinus cholesteatomas. Follow-up included 90% of the patients, and the median observation time was 9.75 years. The recurrence rate was 10%. The recurrence rate was found to be independent of the mastoidectomy type employed. The best hearing results were obtained in ears with intact ossicular chain. We conclude that, wherever possible, sinus cholesteatoma should be removed through the auditory canal without mastoidectomy just as an intact ossicular chain should be preserved. "Canal wall up" and "canal wall down" appear to be equally valuable mastoidectomy types, and both methods must be employed to obtain optimum results.

Acoustic Impedance Tests↗
PubMed1988

Diagnostic strategies in search for acoustic neuromas. Findings in 300 acoustic neuroma patients.

The diagnostic findings in 300 patients with acoustic neuromas are reported. Because of a centralized treatment of acoustic neuromas, we have a uniform work-up of all the patients, which enables us to make a non-selected comparison of the diagnostic efficiency of the various tests. Diagnostic dilemmas in patients with normal hearing, anakusis, normal auditory brainstem recordings, normal vestibular function and normal tomography of the internal acoustic meatus are discussed. In patients with hearing better than 80 dB, a normal ABR, the presence of recruitment and a normal caloric reaction can exclude the presence of a tumour, making tomography superfluous. In patients with poor hearing, the need for tomography is imperative. We perform CT if two procedures among the following produce tumour-positive results: ABR, recruitment tests, caloric test, and tomography. Those who have only one tumour-positive finding at the screening are re-examined after one year. If, even with contrast enhancement, CT proves negative, we continue to perform air CT. Only then do we know for sure whether the patient has a tumour or not. An advantage with using many tests for the same physiological function is that they complement each other, though, on the other hand this often adds to the confusion. With fewer tests, the confusion is reduced, but the requirements regarding technical quality must be very stringent. ABR, the Metz recruitment test and tomography are purely objective, while the caloric test is subjective on the part of the investigator. The Hallpike procedure, however, has stood the test of time in separating pathologic from normal.

Adolescent↗
PubMed1988

Acoustic neuromas. Diagnostic delay, growth rate and possible non-surgical treatment.

In spite of an intensive campaign to achieve early diagnosis of acoustic neuromas, our attempts have not been successful, since we have even more tumours measuring more than 40 mm in diameter among our latest 100 patients than among the first one hundred. It is demonstrated that both patients and physicians (otologists) are to some extent still ignoring the possible significance of a unilateral, progressive, sensorineural hearing impairment. Guidelines for improving this condition are given. We have been able to follow 21 patients for an average of 4 years, with repeated CT scans, and only in 3 of these patients did the tumour appear to be progressing to a size requiring surgical intervention. In the remaining 18 patients the tumour has not increased in size, as judged by the CT. Because of our complete lack of knowledge about the causes of tumour growth in some patients and absence of growth in others, a more differentiated attitude towards indications for surgery is needed, and in some, mostly elderly, patients a period of 'watchful waiting' is appropriate.

Adult↗
PubMed1988

Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size.

The results from the Danish model of acoustic neuroma surgery are presented. In the period from 1976 to 1985, 300 patients with acoustic neuromas were operated upon using the translabyrinthine procedure. There were one small intrameatal tumour; 96 medium-sized tumours with an extrameatal diameter up to 25 mm; 85 large tumours, measuring 26-40 mm, and 118 very large tumours with a diameter exceeding 40 mm. The mortality rate was 2%, and CSF leak occurred in 11%, persisting for more than 2 weeks in 5% of the patients in whom the fistula had to be closed operatively. Facial nerve function was completely normal in 66%, slightly reduced in 17%, moderately reduced in 8% and abolished in 9%. The facial nerve was anatomically preserved in 95% of the patients. Reconstruction of the facial nerve, most often an XII-VII anastomosis, was performed in only 6% of the patients. Cerebellar symptoms, occurring in 45% preoperatively, were demonstrated in only 7% postoperatively. We find that a standardization of the measurement of tumor size and of the assessment of sequelae changes is urgently needed.

Adolescent↗
PubMed1988

Is preservation of hearing in acoustic neuroma worthwhile?

In a series of 300 translabyrinthine removals of acoustic neuromas, comprising almost all tumours operated on in Denmark during a period of 10 years, the preoperative hearing in the tumour ear and in the contralateral ear was analysed in 72 patients with tumours smaller than 2 cm in extrameatal diameter. These patients constitute likely candidates for a hearing preserving operation via the suboccipital approach. In the tumour ear in 4 patients there was a pure-tone average (PTA) of 0-20 dB and a discrimination score (DS) of 81-100%. Applying this criterion to the whole series, 1% of the patients would be candidates for a hearing preserving procedure. Changing the criterion to a PTA of 0-40 dB and a DS of 61-100%, the number of candidates would increase to 8 patients (3%), and with a PTA of 0-50 dB and a DS of 51-100% 14 candidates (5%) would have been found. In all of these patients, contralateral hearing was normal (SRT 0-20 dB, DS 95-100%). Since preservation of hearing would be achieved in only half of those subjected to suboccipital removal and since the hearing retained in patients with successful operations is generally poorer than the preoperative level, the number of patients obtaining serviceable hearing is so modest that preservation of hearing cannot be considered an argument in favour of suboccipital tumour removal. It should be borne in mind that contralateral hearing is normal in these patients and that, according to most reports, the mortality rate is higher and paralysis of the facial nerve more frequent with the suboccipital approach than with the translabyrinthine procedure.

Adolescent↗