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At least 433 records · Page 24Linked to original sources
PubMed1993

Revision stapedectomy.

The need for revision stapedectomy surgery still exists despite the many changes that have occurred in the surgical technique for the treatment of stapedial otosclerosis over the past 30 years. Sixty-six revision stapes operations were analyzed to determine the causes of failure of previously operated cases of stapedial otosclerosis, and to evaluate the hearing results following a revision stapedectomy. Failure was most often due to erosion of the incus (41%), displacement of the prosthesis from the incus (24%), or migration of the prosthesis from the center portion of the oval window (24%). Postoperative improvement of hearing was observed in 81% of ears operated on for a conductive hearing loss. Closure to within 10 dB, however, occurred in 61%. Two ears suffered a deterioration in the sensorineural hearing level following the revision surgery. Speech discrimination scores following revision surgery were improved in 5% of ears and unchanged in the remainder. Although the overall hearing results are less favorable than those seen in primary stapedectomy, revision stapedectomy surgery should continue to be offered to patients whose primary stapes surgery failed or whose initial good result declined over time.

Adult↗
PubMedDate not supplied

Measurement of the ossicular vibration ratio in human temporal bones by use of a video measuring system.

Vibration modes of the ossicles and the lever function were studied in human cadaver temporal bones with an intact cochlea. After placing tiny steel spheres on the ossicles, ossicular vibration to a sound stimulus was measured by observing the displacements of the spheres under a microscope with strobe illumination by means of a video measuring system. The lever ratio varied from 1.9 at 0.6 kHz (minimum) to a peak of 6 near 2 kHz. This relatively high lever ratio at higher frequencies was considered to be caused by a shift of the malleus-incus rotation axis secondary to the loading of the cochlear fluid on the ossicular system. Dependence of the lever ratio on frequency indicated that the rotation axis of the ossicles was not fixed, but variable according to frequency due to a relative increase in the translational movements of the rotation axis of the malleus and incus with frequency.

Aged↗
PubMed1988

Temporal bone histopathology over 15 years post-stapedectomy.

Twenty-three temporal bones from 14 patients who had undergone stapedectomy more than 15 years (the longest, 28 years) preceding death were studied microscopically. Although a foreign body reaction was still found in the ears with a polyethylene prosthesis, it was seldom found in the ears with a wire or Teflon prosthesis. As the resorption of the incus was not severe, it was suggested that it occurred in the early stage of post-stapedectomy and the structural condition of the incus and prosthesis was stable for a long time (even over 15 years) after stapedectomy. In all ears, the grafts on the oval window continued to be the adequate barrier between the middle ear and inner ear. Even though cupping of the graft membrane was frequently found, it seemed not to disturb the sound conduction. The depth of the cupping was correlated somewhat with the thickness of the graft.

Aged↗
PubMed1998

[72 cases of the auditory ossicle malformations but with normal findings in the tympanic membrane].

We evaluated 66 patients (72 ears) with auditory ossicle malformations, but with normal findings in the tympanic membrane, who underwent ossicular reconstruction and stapes surgery at our department between 1984 and 1997. There were 27 men (30 ears) and 39 women (42 ears). Classification of pathologic condition based on surgical findings showed separation of the incus-stapes joint in 43%, fixation of the malleus or incus in 16%, fixation of the stapes footplate in 26%, in incidence of fixation of the auditory oosicles that is higher than that previously reported. In 33% of the patients, conductive hearing loss or mixed hearing loss similar to that observed on the affected side was also present on the contralateral side. Abnormalities in the arrangement of the facial nerves were noted in 4%, inner ear malformation in 1%, and congenital cholesteatoma in 3%. Auditory ossicle reconstruction was performed by the modified type III method in 57% and by the modified type IV method in 37% of the cases. During stapes surgery, 86% underwent small-fenestra stapedectomy. Improvement in hearing after the operation was observed in 90% of the cases and the improvement was relatively high compared with tympanoplasty for chronic otitis media.

Adolescent↗
PubMed1992

[Diagnosis of ossicular chain in the middle ear by high-resolution CT].

This study was conducted to assess the usefulness and limitation of high-resolution CT for evaluating the condition of ossicular chain in the middle ear. Preoperative CT findings of the ossicular chain were compared with the operative findings of ossicles in 26 patients with chronic otitis media or congenital ossicular anomaly who underwent tympanoplasty. Total defect of head of the malleus, body of the incus and long process of the incus were completely detected by high-resolution CT. But the reliability in detecting the defect of handle of the malleus and superstructure of the stapes were 33.3% and 60%, respectively. Defect of the I-S joint (1 case) and partial defect of stapes crus (2 cases) could not be diagnosed correctly in the preoperative estimation. Although these findings demonstrate the limitations of high-resolution CT in the diagnosis of ossicular chain, it will be diminished by the advanced space resolution of CT in the future.

Ear Diseases↗
PubMed1994

[3D-CT of the temporal bone area with high-speed processing].

Three-dimentional (3D)-CT was introduced to represent abnormal findings in the temporal bone area utilizing a SOMATOM DRH CT scanner with accessory 3D reconstruction software and an exclusive high-speed 3D processing system, VOXEL FLINGER. In a patient with eosinophilic granuloma, a defect in the squamous part of the temporal bone was demonstrated suggesting exposure of the dura mater during surgery. In a patient with a normal ear, well-developed mastoid cavity, a part of the handle and the head of the malleus, the incudomalleal joint, the short limb, body and a part of the long limb of the incus and the round window niche were demonstrated. In a case of chronic otitis media, poorly developed mastoid cavity and a possible defect of the tip of the long limb of the incus were demonstrated, in contrast to the patient with the normal ear. 3D-CT yields objective and solid images which are useful for diagnosis, treatment planning and explanation of the pathology to patients and their family. To obtain convincing 3D images, physicians themselves have to choose exact rotation angles. It is not adequate to reconstruct original CT data using a CT computer with accessory 3D software whose processing capability is not good enough for this purpose. The conclusion is as follows: 1) it is necessary and effective to transfer original CT data into the memory of the exclusive high-speed 3D processing system and 2) process the data by the voxel memory method to establish a clinically valuable 3D-CT imaging system.

Adult↗
PubMed1999

The middle ear bioelectronic microphone for a totally implantable cochlear hearing device for profound and total hearing loss.

BACKGROUND: A bioelectronic middle ear microphone (BMEM) has been developed in a laboratory bench model and successfully tested in fresh human temporal bones. A transducer actually has been bench-tested in our laboratory; it was implanted in chronic animal experiments (cats) as well as in humans for a period of 1 year as a driver of a semi-implantable electromagnetic middle ear hearing device (IDE, FDA approved). This BMEM is the result of the use of this same electromagnetic transducer used in a reverse mode. The applicability of the BMEM is for the development of a totally implantable cochlear implant using the eardrum as a diaphragm that transmits vibrations to a magnet cemented to the ossicles. This BMEM is to be powered by a lithium-ion implantable, rechargeable battery. MATERIALS AND METHODS: To test the efficacy of this BMEM, the experiment was divided into two parts: (1) bench model, and (2) fresh human temporal bones, using an air-core electromagnetic (EM) coil and a ferrite core EM coil for comparison. RESULTS: In the bench model, the average displacement at 3 kHz was 0.95 microns (peak) for 4 V p-p and 1.65 microns (peak) for 10 V p-p. At 5 kHz, the measurements were somewhat higher. In fresh human temporal bones, with sound source in the ear canal (60 dB HL and 90 dB HL), the result was better with the magnet implanted on the head of the malleus with the incus removed. The ferrite core EM coil with the magnet implanted on the malleus with the incus removed was compared with the air-core EM coil. At 60 dB HL, the ferrite core EM coil yielded more than four times the amplitude of the EM coil. At 90 dB HL, the ferrite core EM coil produced more than five times the amplitude compared with the air-core coil. CONCLUSION: This BMEM using an EM ferrite coil and a permanent magnet on the head of the malleus is more efficient when compared with an EM air-core coil. This BMEM may be applicable to the construction of a totally implantable cochlear implant. Further research is necessary to integrate this BMEM with the other components of the design concept of the totally implantable cochlear implant.

Animals↗
PubMed2000

Can homograft ossicles still be used in ossiculoplasty?

The use of ossicular homografts has been legally forbidden in many countries for the last five years. In Turkey, imported ossicular biomaterials are very expensive. Malleus and incus homografts were mostly obtained during non-functional ear microsurgery on selected patients using a detailed history and special preoperative tests to avoid the risk of virus contamination. In order to determine the method for the procedure, the ossicles were first investigated histologically. The histological studies have shown, that there are no differences in the organic osseus matrix, the collagen fibres and the lamellar structure formed by these fibres in all groups of ossicles. According to the classical method, we preferred autoclaving at 135 degrees C temperature for 20 minutes after immersing the ossicles in 4% formol solution at pH 5.6 for 3 days. These ossicles were kept in 0.5% formol solution at pH 7 refrigerated at 4 degrees C. Until 1995, allograft ossicles, treated with formaldehyde solution without sterilization in the autoclave were our choice. For the last 4 years, we have been using sterilization with the autoclave especially to inactivate the prions. If the ossicles of the patient are over-eroded, ossicular allografts, which can be obtained without any cost are still a choice of treatment in our country. In the surgery of cholesteatomacous chronic otitis media, the malleus and incus which were in contact with the cholesteatoma, could be used like an autograft in ossiculoplasties, after autoclaving.

Ear Ossicles↗
PubMed2002

An important procedure in ossiculoplasty: autoclaving the ossicles.

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the reuse of the ossicles removed from patients with cholesteatomatous chronic otitis media as an autograft. It also allows utilization of the malleus, incus and stapes taken from cadavers or of the uneroded malleus and incus removed from patients undergoing non-functional middle ear surgery chosen carefully with detailed history and laboratory analysis. The powerful disinfecting effect of the sterilising procedures of the homografts inactivates prion proteins which cause degenerative encephalopathies. In various studies, it has been concluded that autoclaving does not alter the matrix of the bone which is responsiable for its biophysical properties, whereas it removes all viable cells within the bone and dentures the soft tissue attached to the surface of the ossicle. We have also found confirming histological results in our two previous studies published in 1999 and 2001. It is usually recommended that soft tissue on the surface of the ossicles is removed before autoclaving. It is also sufficient to autoclave the ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a flash autoclave. The autoclaving time of the homograft ossicles must be longer, for 20 minutes. Following the autoclaving, these homograft ossicles should be kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4 degrees C for 21 days and it should be washed with physiologic saline solution three times for 7 minutes before use. Depending on the results obtained from our planned comparative experimental study, there will be no need for additional formaldehyde fixation procedure after autoclaving and the autoclaved ossicles will be used immediately without preservation in formaldehyde solution for 24 days.

Cadaver↗
PubMed1992

Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction.

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.

Cholesteatoma↗
PubMed1992

[Revision stapedectomy].

Early and delayed complications in the inner or middle ear may follow stapedectomy and require revision surgery. The records of 72 patients who had undergone revision stapedectomy were analyzed to determine: 1. the causes of failure. 2. how to revise the conditions due to the failure following previous operation. 3. hearing results. These 72 revision operations consisted of 66 case of conductive deafness and 6 sensorineural loss. The commonest cause of failure was dysfunction of prosthesis (23.6 per cent), followed by otosclerotic regrowth (22.2 per cent), incus dislocation (13.9 per cent), reparative granuloma (12.5 per cent), incus necrosis (11.1 per cent), and fibrous adhesions (9.7 per cent). A review of these cases demonstrates that the results of revision stapedectomy are different from those for primary stapedectomy. The revision operations resulted in post-operative air-born gaps of 15 dB or less in 39.4 per cent of cases. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB or less in 97.2 per cent of cases. 'Dead ears' were encountered in 9.1 per cent as against 2.1 per cent in the primary cases. Thus the surgeon should be aware of the problems and risks involved in revision stapedectomy.

Female↗
PubMed1992

CT evaluation of malformed external and middle ear and its surgical correlation.

This study evaluated the diagnostic value of high resolution CT (HRCT) for atresia of the external auditory meatus (EAM) and isolated middle ear malformation. CT scan of the temporal bone was done in 33 patients with such disorders and 5 patients with otosclerosis etc. were studied in the same way for comparison. Coronal HRCT clearly showed conditions of the atresia plate and malformation of the malleus, incus, abnormal course of facial canal and changes in the vestibular window. The axial HRCT is useful to demonstrate the articulations in between the malleus, incus, stapes and the cochlear window. All the HRCT findings were confirmed during operation. Axial and coronal HRCT for external and middle ear deformation is highly valuable for decision making and surgical planning.

Adolescent↗
PubMed2004

[Movements of the ossicular chain during changes in static pressure].

The effects of static pressure on the movements of the ossicles have been a neglected aspect of reconstruction of the ossicular chain. The pattern and the magnitude of the movement of the intact ossicular chain during changes in static pressure described. Displacement of the handle of the malleus was also measured in three points after removing of the incus. Experiments were carried out on 7 fresh human temporal bones. Digital photographs were taken during incremental changes of static pressure from -500 to +500 daPa. Digital videos were recorded to analyse the pattern of the movement. Minimal displacement of the handle of the malleus for negative pressure was 108 microm for -100 daPa and 200 microm for -500 daPa. Maximal displacement for negative pressure was 209 microm for -100 daPa and 439 microm for -500 daPa. Minimal displacement for positive pressure was 82 microm for 100 daPa and 150 microm for 500 daPa. Maximal displacement for positive pressure was 126 microm for 100 daPa and 237 microm for 500 daPa. Malleus displacements were greater for negative pressure changes than positive pressure (p<0.01). When 500 daPa was applied medial displacement of the middle of the handle of the malleus was smaller for 30 microm and the displacement of the region of lateral process of the malleus was smaller for 94 microm than the displacement of the umbo of the drum. The lateral to medial movement of the malleus during changes in static pressure is converted into a predominantly superior to inferior movement of the incus.

Atmospheric Pressure↗
PubMed2005

[Surgical experience by 95 malformed stampedes and otosclerosis].

OBJECTIVE: To investigate the effect of stapes surgery for conductive hearing loss with intact tympanic membrane and eustachian tube. METHOD: Stapes surgery data of 95 conductive hearing loss patients, which with intact tympanic membrane and eustachian tube, was retrospective analyzed,and the surgical effect of otosclerosis, middle ear deformities and external canal stenosis was summarized. RESULT: Postoperative (4 weeks after the surgery) pure tone threshold test demonstrated that the effect of Vestibulotomy was better than incus-footplate connection (incus and footplate is connected by a cortical bone ) ( P <0.05). The surgery to the patients with external canal stenosis was better than those with otosclerosis or middle ear deformities ( P <0.05). There was no statistic significance between physiological stapedectomy and Vestibulotomy. The follow-up of 1-3 years showed that the pure tone threshold of 8 out of 14 cases reverted to the preoperative level, while the hearing improvement in the other cases still remained. CONCLUSION: Stapes surgery to the patients with stapes-oval window deformities is of significance compared with those with otosclerosis.

Adolescent↗
PubMed2005

[Abnormalities in the tympanic cavity in otosclerotic patients].

UNLABELLED: The aim of the thesis is the analysis of the anatomical abnormalities and atypical conditions in the middle ear encountered during the surgery for otosclerosis and their influence for the course of the operation. These atypical conditions could result either from the congenital anomalies or from the disease itself. MATERIAL AND METHODS: The material comprises 572 stapedectomies performed in ENT Department of the Pomeranian Academy of Medicine in Szczecin (Poland) between 1969 and 2004. Partial stapedectomy was performed with removal of the stapes crura and usually posterior part of the footplate. RESULTS: Among 572 ears which underwent the operation different abnormalities in the tympanic cavity were found in 134 cases (23,4%). These included: narrowed oval window niche in 71 cases, stapes anomalies in 46 cases, obliterative otosclerosis in 20 cases, red otospongiosis of the stapes in 9 cases, increased perilymph pressure in 7 cases, malleus and incus bony fixation in 3 cases. The presented abnormalities were the reasons of many failures at the time of the operation. While in the 438 ears with normal anatomical status in the tympanic cavity failures during the operation occurred in only 6 cases (1,4%), in the 134 ears with such abnormalities failures happened in 33 cases (24,6%). The most frequent failure - 20 cases - was premature mobilization of the stapes followed by other consequences. In the other 9 cases the operation was discontinued for different reasons. Another failure was the floating footplate in 2 ears, facial nerve paresis in 1 ear and incus subluxation also in 1 ear. In a few cases in which the operation was stopped the successful stapedectomy was performed at the 2nd stage. Only in 3 ears the stapedectomy was totally given up what makes 0,5% out of the 572 ears operated on.

Adolescent↗
PubMed1991

Morphometry of cytoplasmic components of mammalian articular chondrocytes and corneal keratocytes: species and zonal variations of mitochondria in relation to nutrition.

A morphometric analysis was made of nuclei and cytoplasmic structures in electron micrographs of chondrocytes in the non-calcified layer of articular cartilage of the femoral condyles in adult mouse and dog and of the human incus. Mitochondrial volume density (% cytoplasm) was lower in dog than in mouse cells or cells of the incus. It was also lower in the cells of deep zone cartilage than in superficial cells. Analysis of keratocytes of the corneal stroma in mouse and sheep gave similar findings to that in cartilage. Mitochondrial volume density was higher in mouse than in sheep keratocytes and, in sheep, higher in subepithelial (anterior) cells than in cells of the intermediate and subendothelial strata. Values in human stromal cells were similar to those in the sheep. Endoplasmic reticulum volume density was higher in mouse than in sheep keratocytes. Lipid and filaments were more abundant in dog than in mouse chondrocytes but keratocytes contained little or none. Mitochondrial volume densities correlate with diffusion distances (tissue thickness) from the sources of nutrition, for example, for oxygen, in the two tissues. The relationship to certain aspects of chondroitin sulphate and keratansulphate synthesis and topographical distribution in cartilage and cornea is discussed.

Animals↗
PubMed1991

Bilateral congenital cholesteatomas associated with ossicular anomalies: a case report.

A case of bilateral congenital cholesteatomas, which occurred in a 15-year-old male was reported. His family had been aware of his hearing impairment since he was 3 years old. He had experienced neither otalgia nor otorrhea. Tympanograms were A type bilaterally, and an audiogram showed conductive hearing loss of about 60 dB on both sides. High resolution CT of a horizontal section revealed soft tissue density occupying the space medial to the body of the incus in the right ear, while the middle ear space appeared to be completely clear on the left side. The membranous cholesteatomas on both sides were accompanied by ossicular anomalies with hypoplasia of the long process of incus and the superstructure of the stapes. This case constitutes the seventh case report of bilateral congenital cholesteatomas in the literature. The literature is reviewed and the pathogenesis of congenital cholesteatomas associated with ossicular anomalies is discussed.

Adolescent↗
PubMed1990

Hyogo ear bank experience with allograft tympanoplasty--review of tympanoplasties on 68 ears.

Allograft tympanoplasties on 68 ears done between October, 1980 and December, 1986 were analyzed from the viewpoint of graft take rate and hearing improvement, and also the results were compared between draining and nondraining ears as well as among three stabilizing methods of the transplanted tympanic membrane (Type I: allograft tympanic membrane (ATM) covered with reflected epithelium; Type II: entirely covered ATM with fascia; and Type III: ATM reinforced with thin crescent fascia) and four groups of allograft materials (Group I: ATM with attached malleus and incus en bloc; Group II: ATM with attached malleus; Group III: ATM attached malleus and incus columella; and Group IV: two stage surgery with Group III material). Among the three types of stabilization in draining ears, the anatomic success rate of the tympanic membrane transplant was 27% in Type I, 56% in Type II and 90% in Type III, while in nondraining ears it was 81%, 88%, and 100%, respectively. The success rate for hearing improvement in draining ears was 40% in Group A, 44% in Group B, 33% in Group C, and in nondraining ears, it was 82%, 100%, and 82%, respectively. Our results show that allograft tympanoplasty can be successful for a well-controlled middle ear with good utility of the areolar fascia in stabilization.

Graft Survival↗