Search PubMed⌕ Search

PubMed · 10393781

Middle ear reconstructive techniques.

Abstract

Middle ear reconstructive techniques have increased to such an extent that the otolaryngologist is faced with a bewildering number of surgical options. The literature, however, has yet to demonstrate any technique to be optimal in every surgical scenario. This is because of the lack of direct comparisons between techniques and dissimilar criteria for measuring success. This article uses hearing results and the ability to resist extrusion as the principle measures of success, and provides middle ear reconstructive techniques proven to be successful for commonly faced surgical dilemmas.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

R A Chole, D J Skarada. 1999. Middle ear reconstructive techniques.. https://doi.org/10.1016/s0030-6665(05)70147-x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Immunologic aspects of otitis media.

The middle ear cleft is a modified gas pocket which functions normally when the gas contents are regulated by a normal eustachian tube, resulting in equalization of middle ear pressure to that of the environment. The most important regulator of this middle ear pressure is the eustachian tube, a critical passageway from the nasopharynx into the middle ear. Any alteration of eustachian tube mucociliary function caused by virus, allergy, pollutants, or alteration of the normal homeostasis of the nasopharynx will result in eustachian tube obstruction. This, in turn, leads to underventilation of the middle ear, and transudation of fluid. If bacteria or virus or viral-bacterial interaction leads to infectious disease of the middle ear, an immune response is produced as a result of the inflammatory response, allowing lymphocytes and antigen-presenting cells to enter into the middle-ear mucosa. This article summarizes the immunologic reactivity in the middle ear following a viral-bacterial inflammatory reaction in the middle-ear mucosa. Although secretory IgA is critical for protection of the nasopharynx, its function in the middle ear has still not been resolved. The evidence strongly suggests that IgG1 and IgG3 subclasses are responsible for eradication of middle ear pathogens. Finally, a review of alternative approaches to the prevention of otitis media is briefly discussed in this critical period of emergence of resistant bacteria to available antibiotics.

Ear, Middle↗

Middle meatal vs antral lavage cultures in intensive care unit patients.

OBJECTIVE: The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis. METHODS: Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center. RESULTS: Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, chi(2)-1.52, P = 0.218). CONCLUSION: Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.

Ear, Middle↗

Usefulness of virtual endoscopic three-dimensional reconstructions of the middle ear.

This work uses a new programme for producing 3D radiological images acquired by means of CT which enables the internal surfaces of the examined structures to be visualized. This new method, which is able to navigate inside organs in a similar way to fibreoptic endoscopy, is known as virtual endoscopy. CT examinations of the temporal bone were carried out using spiral equipment and endoscopic 3D processing was carried out on a separate workstation equipped with a volume-rendering programme. Once the technical parameters necessary for obtaining a representation of the internal surfaces had been defined, a simulation of a virtual otoscopy was conducted by moving the virtual endoscope from the external auditory canal through the annulus to the tympanic cavity. The simulation can be obtained either by moving the endoscope by hand, using the mouse, or by defining a path along which the software automatically creates an endoscopic 3D reconstruction. The images thus obtained are projected sequentially to give a "movie" effect, i.e. a continuous progression of the endoscope. The average time required to conduct the procedure ranges from 20 to 30 min. A virtual endoscopic visualization of the middle ear was obtained which, in particular, generated images of the tympanic cavity with the ossicular chain. In our experience, virtual otoscopy shows the anatomy of the structures of the tympanic cavity in excellent detail and may be considered complementary to CT, providing useful images enabling better visual representation and understanding of this complex structure. Although clinical applications of the technique remain to be defined it may have a role to play in presurgical diagnostic evaluation of the ossicular chain, epitympanum and retrotympanum.

Ear, Middle↗