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[Reconstruction of the ossicular chain (author's transl)].

197 consecutive tympanoplasties involving reconstruction of the ossicular chain were analyzed. After a one-year followup, the interposition of a homologous ossicle between the mobile stapes and the long process of the malleus with intact anterior half of the drum has given a satisfactory result in 93% of the patients. Unsatisfactory results were obtained in 50% of those patients presenting with only the stapes or its footplate intact. Reasons for the failures were: graft lateralisation, fixation, atrophy or displacement of the homologous ossicle used. The twostage tympanoplasty with utilisation of John Shea's TORP prosthesis has considerably improved the hearing result achieved in the second category of patients. One has to await, however, long-term results in order to assess whether or not the TORP Plastipore prosthesis should be recommended in middle ear surgery.

Ear Ossicles↗

Ossiculoplasty using a hemi-incus interposition.

A damaged incus is one of the common reconstruction problems encountered by the otologic surgeon. Eighty-five hemi-incus interposition reconstructive procedures performed between 1976 and 1982 were reviewed. Reconstruction consisted of an autogenous or homologous incus bone graft interposed between the tympanic membrane and the mobile stapes superstructure. Air bone gap closure to within 20 dB was obtained in 77% of cases. Reconstruction using bone graft is better tolerated by the middle ear and the extrusion rate less than that of the biocompatible implants.

Audiometry↗

[On the history of ENT in Austria (author's transl)].

The history of otology in Austria begins with Adam Politzer, the founder of clinical otology. In 1873, Politzer and Gruber founded the Clinic of Otology of the University of Vienna, the first of its kind in the world. The first stapes mobilization was performed in 1875 by Kessel in Graz. Similar university clinics were founded in Graz under Habermann in 1893 and in Innsbruck under Juffinger in 1894. Urbantschitsch initiated auditory training of the hard of hearing. In 1914 Barany received the Nobel prize for his research on the vestibular apparatus. The history of laryngology in Austria begins in 1857 when the laryngeal mirror was used for diagnosis for the first time by Ludwig Türck. In 1870, the first clinic of laryngology in the world was opened in Vienna by Schrötter von Kristelli. In 1873, the surgeon, Theodore Billroth, performed the first total laryngectomy. All the investigations made at the Austrian clinics were of decisive importance for the development of our specialty.

Austria↗

Impedance transfer: acoustic impedance of the annular ligament and stapedial tendon reconstruction in otosclerosis surgery.

The resistance rebuilt around the lower tip of the piston must be the same as that created by the annular ligament of the stapes footplate. Otherwise, the threshold at which an acoustic or barotrauma is able to damage the membranes and hair cells of the inner ear will be lowered. The elasticity reestablished around the lower tip of the piston plays a part in the quality and quantity of hearing for the low frequencies up to 3 kHz. To protect the ear against acoustic traumas, an attempt to rebuild the stapedial reflex is proposed.

Acoustic Impedance Tests↗

[Otosclerosis in the elderly. The effect of stapes-plasty on hearing ability and hearing aid management].

We examined 105 patients who underwent partial stapedectomies at the age of 65 years or older as treatment for combined hearing losses due to otosclerosis. Among other things investigated was the influence of the operation on the hearing of both the operated and unoperated ears, as well as on tinnitus existing preoperatively and the use of a hearing aid. Findings showed that tinnitus decreased or vanished in 75% of the cases. Sixty-one percent of the patients needed a hearing aid continuously preoperatively, with 48% not needing it post-operatively and 13% using it only occasionally. The degree of sensorineural hearing loss had by the other patients was so severe that the use of a hearing aid was also necessary post-operatively. However, in some of these cases, a successful use of a hearing aid became possible for the first time due to the surgical improvement in hearing.

Aged↗

[Stapedectomy and micro-stapedotomy in the treatment of otospongiosis. A comparative study].

This is a comparative study of 622 patients undergoing either stapedectomy or stapedotomy for otosclerosis. 379 underwent stapedectomy, which in the majority of cases employed interposition of the posterior crus of the stapes into a venous graft placed over the newly created fenestra. The results of this technique are compared with 243 microwindow stapedotomies performed since 1976. For all patients a minimum of 5 years had elapsed between surgery and evaluation of outcome. In some instances, this time period was 20 years. One month post-surgery the closure of the air-bone gap was more frequently superior with stapedectomy, particularly in the low frequencies. The degree of an incidence of overclosure was comparable for both techniques. However, at 4,000 Hz, bone threshold levels deteriorated more usually following stapedectomy. The air-bone gap widened progressively over the proceeding years post-stapedectomy. This was in contrast to the effect seen during the same period after stapedotomy, namely a narrowing of the air and bone threshold levels. Additionally a progressive loss of bone thresholds was noted after the latter technique. The incidence of sudden total deafness, either immediate or delayed, was less than 1% for both procedures. Even after 15 years or more poststapedectomy, the air-bone gap (13 dB average) and bone thresholds remained stable. Revision surgery was necessary in 8% of stapedectomies and in 4% stapedotomies. However, the post-operative follow up period is much shorter for the latter.

Auditory Threshold↗

Lasers in surgery for chronic ear disease.

This article describes specific situations in which the laser has been found to be useful in surgery for chronic ear disease. In the opinion of the authors, the most important application is the atraumatic removal of cholesteatoma from a mobile stapes. Additional uses include precise and hemostatic removal of diseased tissue (polyps, granulations, adhesions) and manipulations upon an intact ossicular chain without induction of vibrational trauma. Potential complications such as facial nerve and inner ear injury are considered.

Cholesteatoma, Middle Ear↗

Middle ear mechanics of Type III tympanoplasty (stapes columella): II. Clinical studies.

OBJECTIVES: To determine the structural features that are responsible for the large variation in postoperative hearing results after Type III stapes columella tympanoplasty, to compare the clinical results after Type III tympanoplasty with predictions based on experimental investigations using a temporal bone model, and to investigate the effectiveness of a modification in surgical technique for Type III reconstruction. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. INCLUSION CRITERIA: The ear was healed with an intact tympanic membrane graft; the status of the stapes was known, whether mobile or fixed; and the postoperative status of aeration of the middle ear was known, whether aerated or not. MAIN OUTCOME MEASURE: Air-bone gap at frequencies 250, 500, 1,000, 2,000 and 4,000 Hz. RESULTS: In ears with temporalis fascia graft onto stapes head: mobile stapes and aerated middle ear (n = 34), mean air-bone gaps at audiometric frequencies were 15 to 30 dB, consistent with predictions of the experimental model; mobile stapes and nonaerated middle ear (n = 16), large air-bone gaps of 35 to 55 dB; fixed stapes and aerated middle ear (n = 4), large air-bone gaps of 30 to 50 dB; fixed stapes and nonaerated middle ear (n = 2), large air-bone gaps of 30 to 70 dB. In ears with a fascia-cartilage graft onto stapes head, where a thin disc of meatal cartilage, 0.3 to 0.5 mm thick and 4 to 6 mm in diameter was interposed between the fascia graft and the stapes head: mobile stapes and aerated middle ear (n = 9), mean air-bone gaps at audiometric frequencies were 10 to 25 dB, about 5 dB better at 250, 500, and 2,000 Hz than in ears with only a fascia graft ( <0.05), improvement consistent with that observed experimentally when a thin cartilage disc was used in the temporal bone model, hypothesis that the cartilage increased the effective vibrating area of the graft; mobile stapes and nonaerated middle ear (n = 2), air-bone gaps were 40 to 50 dB. CONCLUSIONS: Large air-bone gaps of 30 to 70 dB occurred as a result of stapes fixation, nonaeration of the middle ear, or both. When the stapes was mobile and the middle ear was aerated, a fascia graft resulted in air-bone gaps of 15 to 30 dB. Interposing a thin disc of cartilage between the fascia graft and stapes head to improve the effective vibrating graft area gave better hearing, with air-bone gaps of 10 to 25 dB. The clinical Type III results were consistent with predictions based on experimental investigations of mechanics of the Type III procedure in a temporal bone model.

Acoustic Impedance Tests↗