The authors describe the anatomic and functional results obtained with a sandwich myringoplasty technique (MPL) employing an endaural approach. The suggested technique is a modified sandwich MPL by endaural approach with a reduced Shambaugh incision, a systematic profiling of the canal wall bulge and separation of the meatal and tympano-meatal flaps that are maintained pedunculated. The temporal fascia is inserted between the fibrous layer of the tympanic remnant and a single pedunculated tympano-meatal cutaneous flap replaced in the original location. The authors present 72 cases operated between January 1987 and December 1989 for perforations involving up to three quadrants. In 93.1% of the cases a complete and lasting resolution of the perforation was obtained. Of the 5 failures, 4 presented a perforation smaller than the original one. An average (250, 500, 1000 Hz) functional recovery of 14.1 dB was observed compared to an average pre-operatory gap of 21.6 dB. In 25% of the cases, average recovery was greater than 25 dB and in 5 patients a slight worsening with an average difference of -3.3 dB was observed. On the whole, in 41 patients a residual post-operatory gap of only 10 dB was achieved. The anatomical results obtained with the MPL presented are similar to those found in the literature describing the classical overlay technique. However, the cases reported do not present those inconveniences associated to the latter technique (lateralization of the graft and blunting). The anatomic and functional results obtained with the technique discussed are on the whole superior to those described with the underlay and the classical overlay techniques. The Authors believe that this is mainly due to the absence of the gelfoam in the middle ear and to the double contention and vascularization of the temporal fascia graft. By means of the profiling of the canal wall the endaural approach permits a good view of the operating field. Furthermore, it is less traumatic and more acceptable to the patient than the postauricular one that has to be limited to the MPL where there are clinical indications for the exploration of antrum. The personal technique here presented implies, however, a certain presence of epithelial pearls. Their localization is nevertheless facilitated by the absence of blunting, thickening and lateralization of the graft. This allows for an early and easy removal on an out-patient basis. Other inconveniences of the technique are the length of the procedure and a more difficult control of the ossicular chain.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMedDate not supplied

[Bidirectional horizontal and tridimensional apogeotropic nystagmus: 2 semeiological realities].

The authors take into account two different types of stationary, persistent and direction-changing nystagmus (ny): 1) the horizontal bidirectional ny (nyOB), apogeotropic (nyOBA) and geotropic (nyOBG); 2) the tridirectional apogeotropic ny (nyAT). The nyOBA was identified in experimental studies in 1973 but no other studies on the subject have been published since then. In existing literature the nyOBG has been reported in only one paper, whereas the nyAT has not yet been studied at all. The nyOBA is the combination of a 2nd degree left ny with the head turned right and a 2nd degree right ny with the head turned left. The nyOBG is the combination of a 2nd degree right ny with the head turned right and a 2nd degree left ny with the head turned left. The nyAT is a 2nd degree apogeotropic ny noticeable with the head turned left, right and in the position of Rose (head hanging down). From among a total of 5,960 consecutive vestibular examinations performed from 1986 to 1990, the authors chose those presenting nyOBA, nyOBG and nyAT and discuss them in the light of other vestibular findings and clinical diagnosis. A routine vestibular examination aims at verifying an eventual, spontaneous/evoked ny with the head turned right and left, in the position of Rose and in the two rapid Hallpike positionings. Frenzel glasses are used for detecting the gaze and rebound ny and these, in turn, are checked for visual fixation. During the caloric stimulation, according to the Fitzgerald-Hallpike method, the ny visual suppression test is performed at the culmination period. When electronystagmography is performed, visual oculomotor reflexes are often tested as well. The nyOB and/or nyAT were observed in 3.9% of the patients (234 subjects). The nyOB was present in 177 patients as follows: apogeotropic ny in 128 and geotropic in 49. This was the only vestibular finding in 46.9% of the nyOB cases (83 out of 177 patients). The nyAT was observed in 57 patients and in 17.6% of them was the only pathological finding of the otoneurological examination. When nyOB or nyAT were observed, clinical diagnosis evidenced their central origin in 138 of the 234 patients, most frequently present in cranial trauma, vertebral-basilar vasculopathy and multiple sclerosis. In a limited number of cases some sign of peripheral vestibulopathy were also observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Caloric Tests↗

PubMedDate not supplied