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PubMed1994

Endoscopy in otology and neurotology.

Since the early 1980s rigid endoscopes have been used by otorhinolaryngologists in the United States primarily for sinus surgery. Recently rigid endoscopes have been used as an adjunct to standard otologic and neurotologic procedures. Diagnostic inspection of the middle ear can be performed through a myringotomy incision to rule out perilymphatic fistula, for identification of cholesteatoma, or for evaluation of the status of the ossicular chain. During chronic ear surgery endoscopes can be used to locate hidden cholesteatoma in difficult to visualize areas such as the eustachian tube, attic, sinus tympani, and beneath an intact posterior canal wall. In acoustic neuroma surgery in which hearing preservation is an objective endoscopes are used to inspect the lateral aspect of the internal auditory canal (IAC) for residual tumor. During vestibular neurectomy endoscopes are used to view the IAC and to help identify the cochleovestibular cleavage plane. The applications, techniques, and limitations of rigid endoscopy in otology and neurotology are discussed.

Cholesteatoma↗

PubMed1994

Update of computed tomography and magnetic resonance in otology.

Since my report of 4 years ago at the 8th Shambaugh-Shea Workshop in Otology, equipment and software techniques have continued to evolve with consequent further refinement of imaging studies. Three-dimensional images have greatly improved and have acquired an important role in maxillofacial reconstructive surgery. In otology their value is limited except in congenital atresia. New developments in imaging technique (3-D Fourier transformation) allow sections as thin as 1 mm in any plane. The facial nerve, endolymphatic sac and vestibular aqueduct are well demonstrated but differentiation of the components of the membranous labyrinth is limited. Applications of postcontrast imaging have become more defined for cerebellopontine angle masses, inner ear pathology, and middle ear and facial nerve lesions. Gradient echo techniques and bipolar flow encoding have enabled the development of magnetic resonance angiography. This new, noninvasive procedure is currently useful for the study of aneurysms, vessel stenosis, vascular tumors, and arteriovenous shunts and malformations.

Humans↗

PubMed1993

[Laser: otology, oto-neurosurgery].

The use of lasers in otology is rather recent and their use in otoneurosurgery is even more so, as shown by the limited number of publications dealing with this subject in the literature. After a review of the main bibliographical data on these subjects, the authors present their experience and analyze their results. Two types of lasers were used successively, an Argon laser and then a laser with a double KTP 532 and Nd: YAG 1320 nm beam. The Argon laser and the KTP 532 laser were exclusively used in otology whereas in otoneurosurgery, both KTP 532 and Nd: YAG 1320 nm beams were used depending on the indications. The KTP 532 beam appears to be preferable for treating vascular and small-sized lesions; the Nd: YAG 1320 nm beam proves to be very advantageous for vaporizing the slightly vascular, larger lesions such as stage III and IV neurinomas of the VIIth.

Chronic Disease↗

PubMed1993

Psychiatric and otologic diagnoses in patients complaining of dizziness.

BACKGROUND: Dizziness is a common and disabling symptom in primary care practice, especially among the elderly. Though there are many organic causes of dizziness, the results of medical workups are negative in the majority of patients. METHODS: A total of 75 patients with dizziness who were referred to a community otolaryngology practice received a structured psychiatric diagnostic interview (National Institute of Mental Health Diagnostic Interview Schedule) and questionnaires that assessed psychological distress as well as a complete otologic evaluation, including electronystagmogram. Patients with evidence of a peripheral vestibular disorder were compared with those without such evidence. RESULTS: While psychiatric diagnoses were present in both those with and without evidence of a peripheral vestibular disorder, those without such evidence had a greater mean number of lifetime psychiatric diagnoses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, and specifically, a greater lifetime prevalence of major depression and panic disorder. This group also more frequently met criteria for somatization disorder, had more current and lifetime unexplained medical symptoms, and had more severe current depressive, anxiety, and somatic symptoms. CONCLUSIONS: Psychiatric diagnoses are common among patients with dizziness referred for otologic evaluation who do not show evidence of a peripheral vestibular disorder. Specific psychiatric disorders should be part of the differential diagnosis of patients who present with dizziness.

Adult↗

PubMed1994

Advances in otology and neurotology.

During the last few years many advances occurred in the field of Otolaryngology. In this article we will present significant advances in the fields of otology and neurotology. The adaptation of laser energy to surgery is a significant event in the evolution of ear microsurgery. Lasers in otology reduce trauma and increase accuracy. Implantable hearing devices are used to rehabilitate patients with mild to moderately severe hearing loss. Cochlear implants have secured a permanent role in the management of selected profoundly deaf patients. Intraoperative cranial nerve monitoring is a major advance in ear surgery. Facial nerve and auditory nerve monitoring are now widely used and are the basis for facial and hearing conservation.

Cochlear Implants↗

PubMed1994

Malignant hyperthermia in the otology patient: the UCLA experience.

Malignant hyperthermia is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C is its hallmark. Malignant hyperthermia is usually triggered by potent inhalational anesthetics and/or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are at risk, otologists may be reluctant to operate on these patients. Seven such patients were referred to the Section of Otology, Neurotology, and Skull Base Surgery and the UCLA Malignant Hyperthermia Center Following first episodes of malignant hyperthermia or with a strong family history of malignant hyperthermia for anesthetic and surgical management. They were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants. The patients were not treated prophylactically with dantrolene. Cardiac monitoring, end-tidal PC02, and rectal temperatures were followed. All seven patients had a vastus lateralis muscle biopsy performed and subsequent caffeine/halothane contracture studies completed. The contracture study was positive in six of the seven patients studied. No anesthetic or surgical complications were encountered. This study demonstrates that patients at risk of developing malignant hyperthermia crisis can have otologic surgical procedures performed safely while undergoing appropriately selected general anesthesia.

Administration, Inhalation↗

PubMed1995

Biomechanical assessment of a new adhesive bone cement for otologic surgery.

The adhesion of metallic prostheses to bone is a major problem in otologic surgery. Conventional bone cements lack significant adhesive strength, which predisposes the cemented prosthesis to loosening. The advent of surgically implantable hearing devices is one example where an adhesive cement to secure metal to bone would be useful. The biomechanical properties of a new cement, 4-META/MMA-TBB opaque resin, were evaluated in an animal model. The cement is composed of 4-methacryloyloxyethyl trimellitate anhydride (4-META) and methyl methacrylate (MMA) as monomers and tri-n-butyl borane (TBB) as an initiator. Titanium disks were cemented to the tibias of rabbits, which were sacrificed at 0 and 90 days. Tensile and shear bond strengths between bone and metal were tested at both times. The mean baseline tensile and shear bond strengths were 8.92 MPa and 11.96 MPa, respectively. Adhesive failure occurred at the bone-cement interface. The decrease in bond strength at 90 days was minimal. Thus, 4-META/MMA-TBB cement is a promising new metal-to-bone adhesive that may be useful for the surgical fixation of metallic prostheses in otologic surgery.

Adhesives↗

PubMed1996

The Bari Center: an audiology and otology pilot center for Mediterranean countries.

The Audiology and Otology Center for Mediterranean Countries began activities in 1990. Until today, the Bari Center has sponsored meetings, coordinated research projects and, above all, it has been host to 5 young colleagues coming from the Mediterranean Area, to take part in 2 or 3 month clinical stages: two from Egypt, one from Syria and one from Lybia. The Center is now verifying the possibilities of setting up an Audiology and Otology Center in Tirana (Albania).

Audiology↗

PubMed1996

[Meningioma with otological etiology].

Meningiomas are tumours which first symptomatology are related to its sitting. When localized in the posterior fossa present as otological complaints and may mimic other otological conditions. The AA. report 3 meningioma cases starting with audiovestibular pictures. All were both electrophysiologically and radioimaging studied and underwent an otoneurologic procedure and the histopathological verification. The paper underlines the importance of these cases for ENT-specialist under both the clinical and surgical point of view.

Cerebellar Neoplasms↗

PubMed2004

Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the uncooperative child.

OBJECTIVE: Otomicroscopic examination with suctioning of ears or other procedures is frequently uncomfortable especially for children. Anxiety and pain with lack of cooperation may result in trauma to the ear, incompletion of the examination, delayed diagnosis and treatment and need for completion of the examination under general anesthesia. The purpose of this study was to evaluate the efficacy and safety of utilizing nitrous oxide-oxygen inhalation for sedation and analgesia in otologic examination and minor surgical procedures performed on the uncooperative child at the outpatient clinic. METHODS: In a prospective pilot case series study conducted at the Pediatric Otolaryngology outpatient clinic of a tertiary medical center, nitrous oxide-oxygen inhalation was administered by the examining otolaryngologist and the assisting nurse. The study group included children over 2 years old, for which an accurate diagnosis of ear pathology could not be made or a minor surgical procedure could not be tolerated because of anxiety and lack of cooperation. RESULTS: Completion of the indicated procedure was successful in 21 of 24 patients (88%). Full cooperation, where no restraint was necessary was achieved in 20 of 24 patients (83%). The mean rank pain scores, evaluated separately by the patient, parent and staff, were in the mild pain range using a 0-10 coding for Faces Pain Rating Scale. The mean procedure time was 8.9 min. An adverse reaction, vomiting, occurred in one patient. Twenty-one of 24 parents stated that they would repeat the procedure if necessary. CONCLUSION: This pilot study shows the potential usefulness of nitrous oxide-oxygen inhalation administered by an otolaryngologist in the outpatient clinic. Alleviation of pain and anxiety and avoiding the need for physical restraint is an important goal that can be achieved with this form of sedation.

Anesthetics, Inhalation↗

PubMed2005

An international otology database.

There are many reports in the literature on the outcome of ear surgery. However, it is difficult to make comparisons from these reports because of a lack of uniformity in the way in which outcomes are reported. At the same time, the general public expects doctors to provide them with information regarding the benefits and risks of surgery. Many ear surgeons will not be able to provide this information because few have an up-to-date database. A group of otologists in Europe has attempted to establish a common otology database. The aim is to create a framework whereby surgeons in Europe can contribute to a common ear database using a web-based system. The proposed methodology involves two levels of data entry. Level 1 is a minimal database where the main outcomes are included. Level 2 is a comprehensive database where detailed information on pathologies, risk factors, and surgical procedures is also recorded. As both databases share the same core data, clinicians using database 1 can still compare their outcomes with those using database 2. Clinicians will be able to input and retrieve ear data onto or from the web-based database. There has already been an international consensus on the content of the common ear database. The website address is www.ear-audit.net. The international project has now been in operation for more than 6 months, and Ear UK has already given its endorsement. The founder members include 27 otologists from 12 European countries. The cumulative outcome from this group of surgeons will be used as the benchmark for the purpose of comparative audit. These benchmark sites will be subjected to regular external validation. The web-based system is interactive and gives instant feedback to individual surgeons who wish to compare their results to the benchmark. Therefore, it can be a good learning tool for trainees or less experienced surgeons. The common data entry system also provides an opportunity for clinicians to collaborate in clinical research.

Databases, Factual↗

PubMed2006

Alloplastic bone cements in otologic surgery: long-term follow-up and lessons learned.

OBJECTIVE: Otolaryngologists are often confronted with structural defects in the tegmen, scutum, or external auditory canal (EAC). Carbonated calcium phosphate (CCP) bone cements offer an alternative way of managing these defects. STUDY DESIGN AND SETTING: Retrospective review in an academic otology practice. The technical feasibility of these techniques described as well as the wound healing and structural integrity results. RESULTS: CCP bone cement was used to reconstruct defects of the tegmen or EAC in 22 patients. The material was used to repair the EAC in 19 of these patients, including complete EAC reconstruction in 4 patients, and tegmen defects only in 3 cases. CONCLUSION: The surgical technique is not technically difficult and the alloplastic material is hard within minutes of application. Twenty patients have been followed for over 1 year with an average follow-up period of 3.8 years. Failure, defined as infection or explantation, occurred in 4 patients followed over 3 years. There was a difference in outcomes for pediatric cases. EBM RATING: C-4.

Adolescent↗

PubMed1999

Efficacy of a eutectic mixture of local anesthetics as a topical anesthetic in minor otologic procedures.

A eutectic mixture of local anesthetics (EMLA), prepared as a cream, is an oil-in-water emulsion of 2 anesthetic agents lidocaine and prilocaine. Several clinical applications of EMLA cream, its effectiveness as a topical anesthetic, and its safety profile have been previously reported. We report our experience with EMLA cream in 17 adult and 24 pediatric patients. We find EMLA to be the preferred anesthetic for performing minor outpatient otologic procedures in adults. We also find EMLA to be a safe, well-tolerated alternative to general anesthesia in some pediatric patients. Potential cost savings of EMLA cream during pediatric myringotomies in the clinic are also discussed.

Adolescent↗

PubMed2001

Ventral approach to the rat middle ear for otologic research.

OBJECTIVE: To describe a simple approach to the rat middle ear because there are few clear descriptions of this technique with minimal morbidity and mortality. STUDY DESIGN AND SETTING: Six male Long-Evans rats were used in this study. We designed a cervical approach to the middle ear with the purpose of creating an experimental model of ossiculoplasty that permits the postoperative survival of the animal. RESULTS: It was possible in all cases to visualize the majority of structures of the tympanic cavity: promontory, round window, stapedial artery, stapes, incus, and tympanic membrane. There were no cases of postoperative infection or facial paralysis. CONCLUSIONS AND SIGNIFICANCE: The ventral approach to the rat middle ear is a rapid and simple technique that makes the rat the animal of choice for many otologic investigations.

Animals↗

PubMed2003

Effects of partial neuromuscular blockade on facial nerve monitorization in otologic surgery.

OBJECTIVE: Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery. MATERIAL AND METHODS: Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action. RESULTS: All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10 +/- 0.08 and 0.11 +/- 0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%. CONCLUSION: This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.

Adolescent↗

PubMed2007

References in the history of otology: the importance of being earnest.

BACKGROUND: Historical vignettes are often included in scientific otological articles. However, they may contain inaccuracies and errors when authors use secondary or compiled texts rather than primary source material. METHODS: Examples of errors arising from the use of secondary sources are obtained from compiled works in comparison with original publications, with a particular focus on Hildanus' speculum. RESULTS: Different types of inaccuracies may be found in historical vignettes. In Hildanus' works, two different specula are depicted: one was described by himself during his lifetime, and the other after his death, probably by his publisher. Only the posthumous description of Hildanus' speculum has been retained historically, but it is uncertain that it was really developed by Hildanus himself. Other such inaccuracies exist because of confusion with the original terminology of referring to an instrument, such as the otoscopes of Toynbee and Brunton, inaccuracies in dates, misinterpretation of the original text, such as the attribution to Charcot as the first to propose the intracranial division of the eighth nerve in Menière's disease, and problems of translation (e.g., the different translations of the book titled Diseases of the Ear by Wilhelm Kramer). CONCLUSION: These different examples of inaccuracies show the common problems encountered in writing a historical report. Authors must be aware of such errors and work almost exclusively with original references. Secondary and compiled references should be reserved for a background of discussion and not as a source of direct support.

Germany↗

PubMed2001

The otologic T-tube: a cost effective dacryocystorhinostomy stent.

Endoscopic endonasal dacryocystorhinostomy (EDCR) has established itself as a popular means of relieving post-saccal obstruction of the naso-lacrimal ducts. Soft tissue stenosis of the rhinostomy is a significant cause of long-term failure. We describe the technique of using a standard otological T-tube as a cheap and easy self-retaining stent to ensure a patent rhinostomy following EDCR.

Cost-Benefit Analysis↗

PubMed1997

Cerebellopontine angle meningiomas with primary otologic symptoms.

The majority of cerebellopontine angle (CPA) tumors are acoustic neuromas (AN). However, an intracranial meningioma may occur at this site and will produce symptoms similar to an AN. The most common presenting symptoms of CPA meningiomas are hearing loss, tinnitus, dizziness and dysequilibrium. It cannot be easily distinquished from an AN only on the history and physical examination. Even with an audiogram, evoked response audiometry (ERA) and vestibular function tests, it still cannot be distinquished. CT scan and MRI are helpful in differentiating these two tumors radiographically. In this article, we report two cases of CPA meningiomas which presented with otologic symptoms. The diagnosis and treatment of CPA meningioma is discussed.

Adult↗