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PubMed1986

A simple autologous fibrinogen glue for otologic surgery.

A simple method of concentrating a patient's own fibrinogen for use with a thrombin/calcium solution--to produce a coagulum-type tissue glue for otologic surgery--is presented. The principal advantages of this system include a simple modification of the cryoprecipitate technique, which can be easily performed in any hospital laboratory using a minimal amount of the patient's blood, and the use of autologous fibrinogen, which completely rules out the possibility of transmission of hepatitis or AIDS viruses. Useful tips on preparation and use of this autologous tissue glue, based on experience over the past 2 years, will be presented.

Aprotinin↗

PubMed1990

In situ hybridization for the study of gene expression in neuro-otologic research.

In situ hybridization histochemistry technology was developed for future application to neuro-otologic research. This method allowed the detection of cellular mRNA in tissue sections from the temporal bone or brainstem after cRNA/mRNA hybridization. To produce specific cRNA, single-stranded 35S-labeled cRNA (complimentary to target mRNA) is transcribed from commercially available plasmid vectors. These vectors contain promotor sequences for specific synthesis of RNA, and polylinker regions that will accept cloned DNA inserts for virtually any target nucleic acid sequence of interest. The protocol used in this research was optimized for studies that included concomitant immunohistochemical evaluation. The combination of in situ hybridization and immunohistochemistry provides the only method to correlate molecular information (gene expression) with biochemical or molecular markers, such as peptides or proteins (mRNA translation products) on individual cells in the temporal bone or brainstem. Using these techniques, we examined the distribution of the neuropeptide calcitonin gene-related peptide in rat temporal bone and brainstem sections using calcitonin gene-related peptide (CGRP) antisera and CGRP cRNA probes. We used in situ hybridization histochemistry with a cRNA probe complementary to the 3'-end noncoding sequence of the alpha CGRP mRNA and immunohistochemistry with a polyclonal antibody to the (TYR)CGRP23-37 to study the distribution of CGRP mRNA and CGRP-like immunoreactivity in the central and peripheral facial nerve. Numerous motoneuron cell bodies in the facial nucleus and accessory seventh nucleus and cell bodies in the gustatory geniculate ganglion were found to contain CGRP mRNA and the CGRP peptide.(ABSTRACT TRUNCATED AT 250 WORDS)

Academies and Institutes↗

PubMed1995

Otologic and systemic manifestations of experimental influenza A virus infection in the ferret.

In an effort to further validate an animal model and to better define the mechanisms relating viral upper respiratory tract infections and acute otitis media, we infected 10 ferrets intranasally with influenza A virus. Infection was monitored by cultures and antibody titers, illness was monitored by signs and temperatures, and otologic complications were monitored by otoscopy, tympanometry, and eustachian tube function testing. All animals became infected. Forced-response test results showed progressive increases in the passive function variables after inoculation. Inflation-deflation test results documented progressive impairment of active tubal function, which was accompanied by the development of middle ear underpressures. No otitis media was seen. The results suggest that influenza A virus infection results in progressive, subtotal occlusion of the eustachian tube lumen, which compromises the ventilatory function of the tube, thereby promoting the development of middle ear underpressures. These findings support the hypothesized pathophysiologic relationship between viral upper respiratory tract infections, eustachian tube dysfunction, middle ear underpressures, and acute otitis media. Given these pathophysiologic changes and previously documented physiologic similarities to the eustachian tube-middle ear system of human beings, we conclude that the ferret represents an appropriate animal model for studying the pathogenic processes related to viral upper respiratory tract infections, eustachian tube dysfunction, and otitis media and for testing of potential prophylactic and therapeutic regimens.

Animals↗

PubMed1975

Adam Politzer, otology and the Centennial Exhibition of 1876.

The Centennial Exhibition of 1876 was held in Philadelphia. Among the exhibits was a collection of temporal bone dissections produced by Adam Politzer of Vienna. This exhibit included both normal and pathological temporal bones, and emphasized the relationship of the tympanic membrane to the middle ear, external canal and bony labyrinth. At the close of the Centennial Exhibition the collection was purchased by the College of Physicians of Philadelphia. This collection and the congress associated with the Centennial had a tangible effect on the otology in this country.

Ear Canal↗

PubMed1976

DMSO in otology.

The most controversial therapeutic agent in the past decade has been dimethylsulphoxide (DMSO), an industrial solvent to which great healing powers have been attributed. After initial laboratory testing, DMSO was rapidly introduced into veterinarian medicine and clinical medicine as an experimental agent with the ability to relieve pain, reduce swelling and edema in trauma, to show anesthetic, antibacterial and anti-inflammatory properties when applied topically to the skin. Ninety percent DMSO was used alone and in conjunction with alkaloids and antibiotics to test the clinical properties attributed to this drug. Although DMSO was found not to be ototoxic, laboratory and clinical testing which included double blind studies on patients with otological infections demonstrated that DMSO had no antibacterial, anesthetic or anti-inflammatory properties when applied within the external auditory canal. There was no indication that 90% DMSO, when combined with these various preparations, potentiated or acted synergistically to enhance their penetration through the dermal barrier.

Administration, Topical↗

PubMed1976

Zinc therapy in otology.

At a recent panel on Otology, I asked the audience for a show of hands of those using Zinc for delayed healing and granulations. It was surprising to note that not more than 4 physicians out of 100 had tried Zinc. The need to report our encouraging results was apparent. From 1971 to 1975, 544 tympanoplasties and 122 mastoidectomies were studied for delayed healing due to granulations. Forty-six patients were found to have resistant granulations. Thirty-three of these healed within two weeks of therapy, 10 more required a total of four weeks for healing, and three did not respond well. Sixteen patients had recurrence when the medication was terminated as soon as healing had occurred but responded well when the medication was continued for four weeks after healing was complete. Five patients had nausea, which subsided when the dosage was reduced from the usual 200 mg. of Zinc Sulfate, three times daily with meals to 100 mg., t.i.d. or b.i.d. One patient developed mild urticaria. Zinc therapy is apparently indicated in granulomata of the ear when healing does not occur with conventional therapy, especially in the post-operative patient; however, it will not suffice when there is massive involvement of the mastoid or middle ear, where surgical removal is indicated.

Adult↗

PubMed1989

Otologic manifestations of AIDS: the otosyphilis connection.

Five cases of otosyphilis presenting in patients with HIV infection are discussed. The group is representative of the known stages of the disease, from asymptomatic carrier to the fully expressed immunodeficiency syndrome, and it is of relevance because otosyphilis appears to have developed at an accelerated rate from the primary infection. Four patients had been treated with penicillin 2 to 5 years previously and had a positive fluorescent treponemal antibody absorption (FTA-ABS) test. The fifth had concurrent neurosyphilis and was VDRL-test (Venereal Disease Research Laboratory) negative 2 years prior to the onset of symptoms. In all five patients, syphilis was in the latent stage. It is proposed that it is during this phase of the disease that HIV may alter its course and hasten the development of otosyphilis. It is also suggested that otosyphilis can present at any stage of HIV infection and should be considered in seropositive patients presenting with otologic complaints.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Otologic disease in AIDS patients: CT correlation.

The contrast-enhanced computed tomographic (CT) scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome (AIDS) were retrospectively reviewed. Seven scans revealed middle ear and mastoid disease; three scans were consistent with central nervous system (CNS) pathology; and eight scans demonstrated no abnormalities. CT scanning was found useful in localizing otopathology and diagnosing CNS toxoplasmosis, aural polyps, osteomyelitis, mastoiditis, and middle ear effusion due to hypertrophic lymphoid tissue. The authors conclude that AIDS patients with sensorineural hearing loss should undergo contrast-enhanced brain CT scans to rule out CNS pathology; AIDS status does not alter criteria for CT scanning in patients with conductive hearing loss; and that images of the nasopharynx should be included on temporal bone CT scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Otologic sequelae after pneumococcal meningitis: a survey of 164 consecutive cases with a follow-up of 94 survivors.

As part of a comprehensive study on sequelae after pneumococcal meningitis, 94 of 111 consecutive survivors were re-examined 4 to 16 years after discharge. Twenty-three patients had otological sequelae after pneumococcal meningitis. In these patients, 17 had hearing losses, 7 had tinnitus, 9 had vertigo, 13 had vestibular areflexia, 4 had loss of smell, and 3 had loss of taste. Among the patients with hearing loss, 4 were bilaterally deaf, 6 were unilaterally deaf, and 2 had mild and 5 had slight hearing losses. From correlations with extensive data from the medical records, preadmission antibiotic treatment appeared to protect from acousticovestibular damage. Purulent otitis media and otosurgical intervention did not correlate to the fatality rate or the development of sequelae. Acute purulent otitis media appeared as a concomitant manifestation, rather than the focus of pneumococcal meningitis.

Adolescent↗

PubMed1994

Otologic manifestations of experimental rhinovirus infection.

Episodes of acute otitis media are commonly associated with viral upper respiratory tract infections. Rhinoviruses account for approximately 40% of these infections, and were previously shown to alter eustachian tube function and middle ear pressures. However, progression to otitis media has not been prospectively documented. In the present study, changes in tympanometric pressures and otoscopic findings resulting from experimental intranasal rhinovirus type-39 inoculation were documented in 60 adult volunteers. Fifty-seven (95%) subjects became infected and 34 (60%) of these had a clinical cold. Prior to viral inoculation, 3 (5%) subjects had middle ear pressures of less than -100 mm H2O and two of these subjects developed middle ear effusions following infection. In all, 22 (39%) subjects developed middle ear pressures of less than -100 mm H2O. No subject with normal middle ear pressures prior to infection developed evidence of effusion. This study extends the otologic manifestations of rhinovirus infection to include otitis media. Furthermore, these results support the hypothesized relationship between upper respiratory tract infections, eustachian tube dysfunction, and otitis media.

Acoustic Impedance Tests↗

PubMed1991

Multivariate analysis of family risk factors in predicting appointment attendance in a pediatric otology and communication clinic.

Parents of pediatric patients attending regional otologic medical clinics were given a questionnaire to document family risk factors predictive of poor appointment attendance, and to determine barriers which caused non-attendance of medical appointments. Family risk factors which affected clinic attendance were studied using univariate and multivariate analyses. Univariate analyses revealed all factors except patients' sex and family size to be correlated with attendance. However, multivariate analysis revealed that parental age (p less than 0.0153), ownership of car (p less than 0.0012), parental education (p less than 0.0048), and age of patient (p less than 0.0023) were major predictors of clinic attendance. Although ownership of a car was a major independent factor, it was highly correlated with parental age and parental education and only shown to be significant in the subset of patients not having access to public transportation. The identified parental factors which affect pediatric health care delivery underscores the importance of family centered case management in promoting the health care of children and casts doubt on the effectiveness of interventions which are solely centered on the patient or are designed to mitigate only one of these factors.

Adult↗

PubMed1999

Otological evaluation of newborns who failed otoacoustic emission screening.

Early identification of congenital hearing loss and early rehabilitation is extremely important. Otoacoustic emissions (OAE) are an efficient tool for hearing screening. Previous studies using click evoked otoacoustic emissions (CEOAEs) for newborn hearing screening resulted in approximately 70% pass rate, reflecting intact hearing. The aim of our study was to perform a detailed otological evaluation of newborns who failed OAE screening, using otoscopy, tympanometry and ABR. CEOAEs were recorded from 257 newborns prior to their release from the hospital. Those babies who did not pass the CEOAE were examined by DPOAE, otoscopy, tympanometry and ABR, if needed. 73% of all the newborns had CEOAE in both ears. 20% had CEOAE in only one ear. When the test was administered again three days postpartum, the CEOAE pass rate increased; 98% passed in at least one ear. Most of the newborns (84%) who failed had an obstruction of the external ear canal (collapsed ear canal or debris). There was a good correlation between the otoscopy and the tympanometry. Based on the above results, a newborn hearing screening protocol was introduced.

Deafness↗

PubMed1990

The otologic significance of cleft palate in a Sri Lankan population.

The otologic findings from 197 subjects with repaired and unrepaired clefts and 121 noncleft controls are presented. All data were collected in Sri Lanka during a 3-week period attached to the Sri Lanka Project in 1986. Subjects were examined otoscopically and also tested audiometrically if they were able to perform a pure-tone audiogram, a performance test, or a distraction test. Subjects with clefts of the palate were found to have fewer otoscopically normal ears than the controls. A comparison between subjects with unrepaired and repaired palates revealed a similar rate of otoscopically normal ears in subjects older than 10 years of age. Comparisons for younger ages could not be performed because of a lack of subjects less than 10 years of age who had repaired palates. The impedance data were used to verify the accuracy of otoscopy in detecting effusion.

Acoustic Impedance Tests↗

PubMedDate not supplied

Otologic manifestations of the immotile-cilia syndrome.

The immotile-cilia syndrome is caused by a hereditary, inborn, ultrastructural defect of the cilia, rendering them immotile or poorly motile and thereby abolishing mucociliary clearance. Five cases are presented and the otologic manifestations are described in some detail. The syndrome should be suspected in children who have a persistent secretory otitis media with recurring bouts of acute otitis media, and a perpetual cough with repeated episodes of bronchitis. A lobar atelectasis is a frequent finding. Half the cases also have situs inversus. The immotile-cilia syndrome is of special interest to the otologist, as it seems to throw some light on the pathogenesis of secretory otitis media.

Adolescent↗

PubMed1991

Neuro-otological manifestations in different stages of HIV infection.

A systematic investigation of the incidence and type of peripheral and central auditory and vestibular disorders occurring in different stages of HIV infection was performed: 43 HIV-seropositive patients (14 were symptomatic with manifestation of AIDS or related complex and 29 were clinically asymptomatic) were compared with a matched control group of 33 HIV-seronegative homosexual volunteers. Among the symptomatic patients 8 (57%) out of 14 and among the asymptomatic HIV-positive patients, 13 (45%) out of 29 had abnormal results in various audiological, vestibular and electrophysiological tests. Only minor anomalies were found in 4 (12%) of the 33 seronegative homosexuals. Our results indicate a high incidence of neuro-otological disorders among patients suffering from AIDS. The numerous electrophysiological abnormalities found in asymptomatic HIV-seropositive persons suggest furthermore an early subclinical involvement of the auditory and vestibular systems.

AIDS-Related Complex↗

PubMed1991

Classification of peripheral and central (pontine infarction) vestibular deficits. Selection of a neuro-otological test battery using discriminant analysis.

The results obtained from a complete neuro-otological test battery were examined statistically in order to select measurement variables which would optimally indicate significant differences between four groups: normal patients, patients with partially compensated unilateral peripheral vestibular deficit, patients with an acoustic neurinoma and patients with central (brainstem) vestibular deficit. A stepwise-discriminant analysis was performed on measurements of slow-phase velocity obtained from each test. The primary measurements selected to assign a subject optimally to one population were the canal paresis (CP) of the caloric test, the eye-tracking gain contralateral to the deficit for a 15 deg/s stimulus, the gain asymmetry for optokinetic nystagmus with a 30 deg/s stimulus, and the level of spontaneous nystagmus. The resulting classifications were 100% correct for normal and central deficit patients. However, the division between peripheral deficit and acoustic neurinoma patients overlapped causing about 30% false classifications of neurinoma patients: some 20% of the peripheral deficit patients were classified as normal. If the CP was not available the discriminant analysis substituted the rotating chair response for 5 deg/s2, in place of CP. This substitution caused a 10 to 20% decrease in classification accuracy.

Diagnosis, Differential↗

PubMed1995

Neuro-otological and neuropathological findings in two cases with Machado-Joseph disease.

We report chronological changes of neuro-otological findings and associated neuropathological findings in 2 patients. Concerning gaze limitation, upward gaze was primarily disturbed, followed by downward gaze and abduction. Adduction tended to be preserved although convergence was disturbed at the early stage. And, upward gaze limitation was followed by loss of oculocephalic responses (OCRs). Bell's phenomenon was preserved until the late stage of the disease. Caloric nystagmus was absent at the early stage. One patient showed dissociation between nystagmus and vestibulo-collic reflex in the caloric test at the early stage of the disease. Neuropathological examination revealed gliosis in the interstitial nucleus of Cajal and the MLF as well as neuronal loss and gliosis in the oculomotor nuclei. The vestibular nuclei also showed gliosis and atrophy of nerve cells.

Brain Stem↗

PubMed1988

The value of combining auditory brainstem responses and acoustic reflex threshold measurements in neuro-otological diagnosis.

Acoustic reflex thresholds (ART) and auditory brainstem responses (ABR) were measured in 69 patients referred to the Neuro-otological clinic on the suspicion of a retrocochlear lesion. The pure-tone selection criterion was an average hearing loss of less than 60 dB at 0.5, 1, 2, and 4 kHz, with no thresholds exceeding 70 dB and only one threshold exceeding 60 dB. Both tests proved independently to be most effective in the diagnosis of cerebello-pontine angle (CPA) tumours and to a lesser extent for brainstem lesions. The ABR was positive in 100% of CPA group and 90% in the brainstem group compared with 93% and 70% respectively for the ART. The combination of the two tests provides patterns of abnormality which are more disease specific. In the CPA cases the most common and consistent patterns of abnormality were the unilateral delay of Wave V or III and V of the ABR associated with a vertical ART pattern indicative of an abnormality of the ipsi and contralateral reflexes on stimulating the affected side. Intrinsic brainstem lesions most commonly resulted in bilateral ABR abnormalities combined with the full-house ART pattern indicative of bilateral abnormalities of both ipsi and contralateral reflexes.

Adolescent↗