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At least 523 records · Page 29Linked to original sources
PubMed2001

Vibrant semi-implantable hearing device with digital sound processing: effective gain and speech perception.

BACKGROUND: The Vibrant Soundbridge (Symphonix Devices, San Jose, Calif) is a semi-implantable hearing device. The transducer is attached directly to the incus and is linked by telemetry to the externally worn audioprocessor. A major advantage of this semi-implantable setup, especially during its experimental phase, is that the audioprocessor can be updated. Recently, we replaced the previous 2-channel analog audioprocessor in 14 patients with a 3-channel digital device. DESIGN: Prospective clinical study. Basic functions were measured, including gain as a function of input level and speech perception in quiet. PATIENTS: Patients (n = 14) had moderate to severe sensorineural hearing impairment (average hearing threshold at 0.5, 1.0, 2.0, and 4.0 kHz of 40- to 76-dB hearing level [HL]) and chronic external otitis, which contraindicated use of an ear mold. RESULTS: Gain of the 3-channel audioprocessor for comfortable listening levels and for conversational levels varied from approximately 15- to 30-dB HL, suggesting that the device is suitable for patients with hearing loss of up to 60- to 70-dB HL. In 5 patients, identical measurements were performed using their conventional hearing aids. The other 9 patients did not use a conventional hearing device because of severe external otitis. On average, results obtained with the Vibrant Soundbridge were not as good as those obtained with the conventional device. Nevertheless, patients were satisfied with the Vibrant Soundbridge because they could use it all day without pain or itching. CONCLUSIONS: The Vibrant Soundbridge is suitable for patients with hearing loss of up to 70-dB HL. Compared with conventional devices, in audiometric terms, a surplus value of the Vibrant Soundbridge was not found.

Adult↗
PubMed2002

Congenital cholesteatoma: classification, management, and outcome.

OBJECTIVES: To assess whether a classification system for congenital cholesteatoma (CC) can be derived from analysis of a large clinical sample of cases and to assess whether such a classification system is a reliable guide for surgical intervention, reexploration, and hearing outcome. DESIGN: A retrospective review of clinical and surgical records of 119 patients with CC. SETTING: Four tertiary care children's hospitals. PATIENTS: One hundred nineteen children with CC (age range, 2-14 years). RESULTS: Congenital cholesteatomas in the anterior mesotympanum were treated successfully with exploratory tympanotomy. Congenital cholesteatomas involving the posterior superior quadrant and the attic usually had concurrent involvement of the incus and stapes and often required a canal wall up tympanomastoidectomy and a second look for its control. Congenital cholesteatoma involving the mastoid usually involved all of the ossicles, was inconsistently controlled with canal wall up tympanomastoidectomy, and had a poor prognosis for restoration of conductive hearing loss. The mean +/- SD age of children with CC was 5.6 +/- 2.8 years, while that of children with acquired cholesteatoma was 9.7 +/- 3.3 years. CONCLUSIONS: The sequence of spread of CC, involving 3 sites, suggests a natural classification system. The CC usually originates in the anterior superior quadrant, but does not consistently remain there, and may variably occupy the middle ear and mastoid and result in ossicular destruction and conductive hearing loss. The location of CC and the involvement of the ossicles is an accurate predictor of the type of surgery necessary for its control and for the success of hearing restoration.

Child↗
PubMed1978

Ossicular replacement prostheses.

To find a way of improving the results of ossicular reconstruction in ears that were rendered hard of hearing by chronic otitis media, the suitability of two biocompatible materials has been investigated. After three years' experience with Proplast and two years with Plastipore, it is concluded that for ears which lack an incus and stapes arch, these materials provide results at least as good as those previously reported with homologous materials and have the advantage of easy manipulation, timesaving, and ready availability. As with all foreign material in the chronically infected middle ear, the risks of extrusion cannot be ignored. The results so far indicate that this problem can be overcome with the use of cartilage film to separate the prosthesis from the tympanic membrane.

Auditory Threshold↗
PubMed1978

Stapedectomy for otosclerosis with malleus fixation.

Malleus fixation, in addition to stapes fixation, presents a perplexing surgical problem. Should the incus replacement prosthesis procedure be performed or only a stapedectomy? The hearing results of a stapedectomy alone in 45 cases with both stapes and malleus fixation are 70% within 10 dB and 84% within 20 dB of the preoperative bone conduction hearing level.

Bone Conduction↗
PubMed1983

Cholesteatoma induced by stapedectomy.

A case of cholesteatoma induced by stapedectomy is reported. A year after a successful stapedectomy, the wire prosthesis extruded in part through the eardrum. Exploration revealed a cholesteatoma around the prosthesis down to the oval window. The cholesteatoma was removed and the prosthesis replaced. The patient returned for further exploratory surgery 15 months later when the prosthesis extruded again, this time due to necrosis of the distal part of the long process of the incus. There was no return of cholesteatoma. A new prosthesis was crimped on the incudal stump and covered with tragal cartilage and perichondrium. A two-year follow-up was uneventful.

Aged↗
PubMed1984

Tympanoplasty with calcium phosphate.

In 35 patients, with an average follow-up period of 2 1/2 years, the middle ear was reconstructed with prostheses of hydroxyapatite, which is the main substance of living bone tissue. In case of a missing incus, an interposition prosthesis of dense hydroxyapatite was used. Defects in the bony posterior canal wall were reconstructed with a canal wall prosthesis of porous hydroxyapatite and cavities with a barefoot plate were reconstructed with a total alloplastic middle-ear implant, consisting of a canal wall of porous hydroxyapatite and a chain of wire and dense hydroxyapatite. With these prostheses, radical surgery of the middle ear can be combined with a physiological reconstruction.

Audiometry↗
PubMed1985

Proximal symphalangia and stapes ankylosis.

A father and his two sons had an autosomal-dominant syndrome of proximal symphalangia and conductive hearing loss. Exploratory tympanotomy revealed a congenitally fixed stapes and incus in the oldest boy. Surgical intervention resulted in normal hearing. To our knowledge, this is the first such histologic report of a stapes in this syndrome.

Adolescent↗
PubMed1987

Bony ossicular fixation using 2-cyano-butyl-acrylate adhesive.

We investigated the effects of 2-cyano-butyl-acrylate (Histoacryl) on the ossicles of 11 of 12 adult guinea pigs. A small amount of the adhesive, placed precisely between the incus and its bony fossa in each middle ear, fixed the ossicles. Light microscopic investigation of the ears of animals killed at 3, 6, 9, and 12 months after surgery showed a bony union of the ossicle to its surrounding niche in 11 of 12 operated-on ears. Negligible inflammatory reaction was seen in areas of the middle ear not in contact with the adhesive. These observations suggest that 2-cyano-butyl-acrylate may be used to achieve a durable bony union in ossiculoplastic surgery with minimal side effects in the middle ear.

Animals↗
PubMed1990

Use of the argon laser in the treatment of malleus fixation.

This case demonstrates the use of the argon laser for ossicular mobilization. A preoperative audiologic evaluation revealed a severe conductive hearing loss, with a maximum air-bone gap. Since normal drilling procedures would result in a sensorineural hearing loss, the argon laser was chosen to remove a bony spur connecting the malleus to the posterior canal wall. When using the argon laser, no disarticulation of the incus and stapes is required. Postoperative audiologic evaluation revealed normal hearing sensitivity bilaterally.

Argon↗
PubMed1993

Ear-nose-throat abnormalities in the CHARGE association.

A comprehensive evaluation of the otolaryngological abnormalities in 50 patients with colobomata, heart defect, atresia of the choanae, retarded growth or development, genital hypoplasia, and ear anomalies or deafness (CHARGE) was performed. All the patients had ear abnormalities; 96% (48/50) had malformed pinnae, and 54% (27/50) had facial nerve palsies. Only 8% (4/50) had normal hearing, the commonest hearing defect being severe conductive or mixed loss. Eighty-four percent (42/50) of computed tomographic scans of the temporal bone were abnormal, the characteristic abnormality being the combination of a hypoplastic incus and absent semicircular canals. Eighty-six percent (43/50) of patients had upper airway abnormalities. Posterior choanal abnormalities occurred in 56% (28/50), and 42% (21/50) had retrognathia leading to intubation difficulties. Laryngotracheal abnormalities occurred in 38% (19/50), and 14% (7/50) required tracheostomies. Careful upper airway assessment is essential to avoid potentially lethal complications such as aspiration.

Abnormalities, Multiple↗
PubMed1995

Delayed diagnosis and fate of congenital cholesteatoma (keratoma).

OBJECTIVE: To analyze clinical presentation, modes of detection, growth pattern, operative findings, and results of surgery in children 3 years old or older who had extensive congenital cholesteatoma (keratoma). DESIGN: Survey, case series. SETTING: Two academically affiliated medical centers: a children's hospital and an eye, ear, and throat hospital, both located in major metropolitan cities. PATIENTS: Twenty-five children selected according to specified criteria. INTERVENTION: Tympanomastoid surgery, ie, canal wall up and canal wall down, some with ossicular reconstructive surgery. MAIN OUTCOME MEASURE: Audiologic assessment (speech reception threshold) and recurrence (recidivism) of cholesteatoma. RESULTS: Incidence of recidivism, 52%. Hearing maintained within the range of normal to mild hearing impairment postoperatively in 91% of the patients for whom complete data are available. CONCLUSIONS: Congenital cholesteatoma may grow for years without causing signs or symptoms and, having grown without early detection, can extend to involve the epitympanum and mastoid antrum, cause ossicular erosion, and even extend to the middle cranial fossa. To adequately remove a congenital cholesteatoma that has gone undetected for many years, exposure of the anterior epitympanum is often necessary and removal of both the body of the incus and the head of the malleus often is required. Since congenital cholesteatoma usually develops in a child with a well-pneumatized mastoid that would create a large mastoid bowl if exteriorized, the otologic surgeon is likely to hesitate in using the canal wall down mastoidectomy technique. Alternatives to the canal wall down mastoidectomy technique, which can achieve reasonably good hearing results and avoid creation of a large mastoid bowl, include planned two-stage canal wall up surgery or canal preservation with primary reconstruction and close follow-up with otomicroscopy and serial computed tomographic scans.

Adolescent↗
PubMed1996

Conductive hearing loss following retrolabyrinthine surgery.

BACKGROUND: Conductive hearing loss can occur following neuro-otological procedures due to bony ossicular fixation resulting from viable bone dust remains. OBJECTIVE: To highlight the frequency and features of the complication of conductive hearing loss following retrolabyrinthine surgery. DESIGN: In a review of 77 retrolabyrinthine neuro-otological procedures, 3 cases (3.9%) of postoperative conductive hearing loss were encountered. RESULTS: Bone dust can cause a postoperative conductive hearing deficit that becomes apparent 6 months following surgery, and progressive deterioration can occur up to 18 months. The anatomical areas of ossicular fixation are the incudomalleal joint in the attic and around the stapes in the oval window niche. Excision of these bony accumulation particles does not revert the conductive hearing loss. CONCLUSIONS: We advocate the use of occlusive material in the aditus during temporal bone surgery to prevent bone dust accumulation in the attic and middle ear. In the event of such a complication, an incus transposition ossiculoplasty is recommended.

Adult↗
PubMed1997

Shrapnell membrane and mastoid pneumatization.

OBJECTIVE: To assess whether a correlation exists between the degree of pars flaccida (PF) retraction and the degree of mastoid pneumatization. DESIGN: The degree of PF retraction was defined by means of an operating microscope and a pneumatic otoscope. Degree of mastoid pneumatization was assessed planimetrically, using mastoid x-rays. SETTING: Private otologic clinic. PARTICIPANTS: A total of 595 ears, with intact pars tensa, of 332 adult patients. RESULTS: The degree of PF retraction was found to be inversely correlated to the level of mastoid pneumatization. Poorly pneumatized mastoids were associated with PF retractions. The poorer the pneumatization, the deeper the retraction. Well-pneumatized mastoids were associated with normal position of the PF. CONCLUSIONS: This study lends further support to the possibility that the mastoid pneumatic system functions as a middle ear pressure buffer. This possibility gives further explanation as to why ears with poorly pneumatized mastoids tend to develop tympanic membrane retractions and perforations, incus necrosis, or retraction pocket cholesteatoma, while ears with a large pneumatic system are rarely at such risk.

Adult↗
PubMed2000

What is evolutionary developmental biology?

All changes in animal form and function during evolution are due to changes in their DNA. Such changes determine which proteins are made, and where and when, during embryonic development. These proteins thus control the behaviour of the cells of the embryo. In evolution, changes in organs usually involve modification of the development of existing structures--tinkering with what is already there. Good examples are the evolution of the jaws from the pharyngeal arches of jawless ancestors, and the incus and stapes of the middle ear from bones originally at the joint between upper and lower jaws. However, it is possible that new structures could develop, as has been suggested for the digits of the vertebrate limb, but the developmental mechanisms would still be similar. It is striking how conserved developmental mechanisms are in pattern formation, both with respect to the genes involved and the intercellular signals. For example, many systems use the same positional information but interpret it differently. One of the ways the developmental programmes have been changed is by gene duplication, which allows one of the two genes to diverge and take on new functions--Hox genes are an example. Another mechanism for change involves the relative growth rates of parts of a structure.

Animals↗
PubMed1987

Familial ossicular malformations: case report and review of literature.

Familial middle ear ossicular anomalies are rare. We report on a daughter and her mother with congenital conductive hearing loss. Tympanotomy disclosed hypoplasia of long crus of incus whose tip had been replaced with a fibrous strand. A review suggests that middle ear ossicular anomalies may be inherited as autosomal dominant traits. Most individuals were bilaterally affected. Most isolated cases were affected unilaterally.

Adult↗
PubMed1988

A new acro-cranio-facial dysostosis syndrome in sisters.

Two sisters born to consanguineous parents had a syndrome of short stature, acrocephaly, hypertelorism, proptosis, ptosis, down-slanting palpebral fissures, high nose bridge and anteverted nares, short philtrum, cleft palate, micrognathia, abnormal external ears, preauricular pits, sensorineural and conductive deafness, proximally placed first toes and digitalized thumbs, bulbous digits, metatarsus adductus, and pectus excavatum. Radiological abnormalities included craniosynostosis, increased mandibular angle and antegonial notching of mandible; hypoplastic first metacarpals and metatarsals; hypoplastic distal phalanges; partial duplication of the distal phalanx of the thumb; malformed malleus and incus; tall lumbar vertebrae, increased interpedicular distance, and posterior scalloping; flared iliac wings, narrow supraacetabular regions, acetabular "dysplasia," and coxa valga. Autosomal recessive inheritance is suggested.

Child, Preschool↗
PubMed2006

Multidetector row CT demonstration of inner and middle ear structures.

The aim of this study is to evaluate the anatomical details of the inner ear and middle ear, using multidetector row CT. Temporal bone CT scans were obtained using 16-detector row CT scanner (Lightspeed 16, General Electric Medical Systems, Milwaukee, WI) in 30 patients with dizziness, vertigo, or hearing loss. The three-dimensional (3D) images were reconstructed with volume rendering techniques. The 3D images were reviewed by two radiologists and scored by using a three-point quality rating for qualitative assessment of the 23 representative structures of the middle and inner ear. The malleus, incus, and facial nerve canal were identified in all patients. The incudomalleolar joint appeared fused in all patients. The stapes were seen clearly in 27 (90%) of 30 patients except in three patients. Among the three remaining patients, there was one who had effusions in the middle ear cavity. Another patient had left cholesteatoma. The third patient had normal middle ear cavity. The cochlea and the three semicircular canals (anterior, posterior, and lateral) were well demonstrated in 29 (97%) of 30 patients except for one old woman with osteoporosis. Sixteen-detector row CT imaging of temporal bone with advanced 3D reformation yields state-of-the-art anatomical details of the temporal region useful to address anatomical localization issues and ease conceptual structural learning.

Adult↗
PubMed1988

Neonatal deafening alters nonpyramidal dendrite orientation in auditory cortex: a computer microscope study in the rabbit.

In order to examine the influence of afferent input on nonpyramidal dendrite development in the auditory cortex, unilateral deafening was carried out in neonatal rabbits at birth, approximately 6 days prior to the onset of hearing. Deafening was produced by surgical removal of the incus and stapes ossicles, aspiration of the cochlear perilymph, and kanamycin injection into the oval window. At 60 days of age, acoustic stimulation of the deafened ear was unable to evoke auditory brainstem responses. The brains of experimental and littermate control rabbits were processed according to the Golgi-Cox Nissl method. The dendritic systems of lamina III/IV spine-free nonpyramidal cells in the auditory cortex contralateral to the deafened ear were digitized from 340-micron-thick coronal sections with the aid of a computer microscope. Three-dimensional spatial and statistical analyses revealed that nonpyramidal dendrite length in neonatally deafened rabbits increased 27% relative to littermate controls. A fan-in projection analysis revealed that the increased dendrite length in the deafened animals was maximum in the tangential direction and toward the white matter. Computer rotation of digitized neurons from neonatally deafened rabbits also revealed evidence of abnormal dendritic growth in the form of recurved dendrites. We interpret our results to indicate that unilateral cochlear destruction early in development causes a reorganization of the ascending auditory pathway which extends to the contralateral cerebral cortex. Because the auditory cortex contralateral to the deafened ear still receives acoustic input from the undamaged ipsilateral ear, normal nonpyramidal dendritic growth in the auditory cortex is, in part, dependent upon afferent activity arising from both ears.

Animals↗