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PubMed1998

Morphometric investigation on osteocytes in human auditory ossicles.

An osteocyte lacunae differential count (1-lacunae with live osteocytes, 2-lacunae with degenerating osteocytes, 3-empty lacunae) was carried out on ear ossicles and clavicles from cadavers as well as on stapes removed by stapedotomy. The distance of the three types of lacunae from the vascular source was also determined by a computer-assisted light microscope. Results showed that the delayed fixation of bone from cadavers does not significantly interfere with osteocyte preservation, at least with the scope of this investigation. The results of osteocyte differential count show that the number of empty lacunae and lacunae with degenerating osteocytes: (a) is significantly higher in ear ossicles than in clavicles, (b) increases with age, (c) is higher in stapes than in incuses and mallei, (d) increases with the distance from the vascular sources in both ear ossicles and clavicles. Additionally it appeared that the process of osteocyte degeneration in ear ossicles is very rapid and widespread, over 40% of the cells being dead within the 2nd year of age. In the light of the recent literature and personal findings, which ascribe to osteocytes the function of mechanical detectors, and considering that bone remodeling occasionally occurs in ear ossicles, it is postulated that osteocyte death in these bones could be a programmed phenomenon (apoptosis?), due to which they lose the ability to react to strains and stresses and achieve the structural stability they need to perform their peculiar stereotyped function.

Adult↗
PubMed1981

The ENT problems following the Birmingham bombings.

The ENT problems following the Birmingham bombings of 1974 are presented. It is during the positive phase of bomb blast that the tympanic membrane ruptures. Spalling is a likely explanation for the mechanism of rupture of the tympanic membrane specially in large perforations. Tympanic membrane defects involving 80 per cent of the surface area of the drumhead or more persisted, whereas those involving less than 80 per cent healed with conservative treatment. The majority of perforations (81.4 per cent) healed spontaneously, with a three-layered membrane. A month should be allowed for the healing of every 10 per cent loss of the surface area of the drumhead. During surgical repair of persistent perforations, the malleus handle was found to be on a deeper plain than the long process of the incus. Tympanic membrane perforations did not protect the inner ear, the sensorineural deafness producing either a high tone or a flat loss. One in four of the victims seen in the hospital complained of deafness. A patient who suffered blast injuries to the lung also developed cord palsy.

Blast Injuries↗
PubMed1983

Traumatic luxation of the stapes.

A case of traumatic middle and inner ear damage due to involuntary piercing of the tympanic membrane with a knitting needle is reported. The incudo-stapedial joint was dislocated and the intact stapes was depressed into the vestibule. Exploration of the middle ear, followed by extraction of the stapes, closure of the oval window with a vein graft and interposition of a prosthesis between the incus and oval window, improved the condition but did not restore inner ear function. A second case, of unclear etiology, is also presented. The indications, timing and technique of surgical intervention in cases of traumatic luxation of the stapes are briefly discussed.

Ear Ossicles↗
PubMed1983

Stapes-replacing prosthesis (S.R.P.).

Any chronic inflammatory condition of the middle ear may bring about bone destruction. Today, in the antibiotic era, this destruction concerns mostly the ossicular chain. Any one of the ossicles or all of them together may be partially damaged or completely destroyed (Sadé et al, 1981). Hearing is usually impaired if the stapes or the incus or both of them are damaged. To overcome the resulting hearing deficit, various surgical techniques, using various materials, have been introduced, with various degrees of success. The most problematic situation encountered surgically is the one in which the stapes is missing, and it is with this situation that the present study deals. The surgical solution so far advocated has been in the form of a surgical bridge or columella between the mobile footplate and the drum. The columella (Fig. 1) is made out of bone or some non-organic biocompatible material. Often, however, this solution is not very successful, for two reasons: A. Instability of the columella (prosthesis) is often unavoidable because of its slim attachment to the footplate; B. Biologically, an incompatibility between the drum and the prosthesis is all too often present, when the latter is made of plastic materials. These columellas have been found, sooner of later, to extrude. It is the purpose of this communication to report a new technique and a new concept, which tries to overcome the above shortcomings, using a different type of stapes-replacing prosthesis.

Hearing Loss↗
PubMed1986

Cranial hyperostosis and hearing loss (a new syndrome?).

We present two patients, mother and daughter, with a skeletal disorder of the skull, hearing loss and in one of them recurrent facial paralysis. In one patient middle ear exploration was performed. The malleus and incus were found to be fixed in the epitympanum. The differential diagnosis is discussed. We reviewed all known hereditary conditions with hearing loss and musculoskeletal disease but we could not accept any of these diagnoses for our patients.

Adult↗
PubMed1990

Tympanosclerosis of the middle ear: late results of surgical treatment.

The late results of one stage operation for middle ear tymanosclerosis in 73 patients during the period January 1965 to December 1980 are presented. Mean observation time was 11.2 years (range 3-20.2 years), with a follow-up rate 86 per cent. Among 64 patients with stapes fixation, 59 had removal of tympanosclerotic masses and stapes mobilization, and five cases underwent stapedectomy. The series was divided into six groups and the results analyzed. The best and most stable results occurred in the group with stapes mobilization and an intact ossicular chain followed by the group with stapes mobilization and Type II tympanoplasty with incus interposition. The poorest late results were obtained in ears with lacking stapes crura and stapes mobilization, and in ears subjected to stapedectomy. No case of post-operative sensorineural hearing loss occurred. We recommend that care is taken to preserve an intact ossicular chain at stapes mobilization performed at the same stage as myringoplasty. Also in ears with a defective ossicular chain but intact stapes with tympanosclerotic fixation we recommend stapes mobilization in one stage. In ears with fixation of the stapes footplate and defective crura, we recommend stapedectomy or stapedotomy in two stages.

Adolescent↗
PubMed1991

Otological manifestations of a new familial polyostotic bone disorder.

Fifty members of a family with a unique autosomal dominant bone disease were investigated. Nineteen of the family members were either known to have, or were strongly suspected of having the disease. All but one of these had a hearing loss which was conductive in the younger age group and mixed in the older members. The common finding in those who had middle ear surgery was replacement of the long process of incus by a fibrous band. The histological features were similar to those found in Paget's disease. The age of onset, distribution of lesions and radiographic findings, however, were not typical of this disorder.

Adult↗
PubMed1992

Temporal bone histopathological findings in campomelic dysplasia.

Both temporal bones of a newborn (35 gestational weeks old) with campomelic syndrome were studied histopathologically. This is to our knowledge the second temporal bone report (third case) of this syndrome. The findings included: abnormal cartilagenous and osseous tissues and abnormality in the globuli interossei in the otic capsule; deformities of the vestibule and semicircular canals, probably due to compression by the abnormal cartilaginous tissue; hypoplastic cochlea and semicircular canals; aberrant course of the facial nerve; wide dehiscence of the facial canal in the tympanic portion; slight hypoplasia of the malleus and anomalies in the incus and stapes; and large epitympanic space. These findings closely resembled those of the first report, and suggest that: 1) campomelic dysplasia is a definite disease entity with consistent pathogenesis, and 2) similar otologic manifestations may be expected in the majority of patients with this syndrome.

Abnormalities, Multiple↗
PubMed1993

The use of cortical bone grafts in ossiculoplasty, II: Graft mass and hearing change at different frequencies.

The masses of preserved ossicles and cortical bone grafts have been studied in vitro using a Stanton Unimatic CL41 balance. The cortical bone grafts prepared for use in malleus-stapes assemblies had a mean mass 28 per cent greater than that for an incus, while those prepared for use in a malleus-footplate or drum-footplate assembly had a mean mass 58 per cent greater. Analysis of the hearing results for the first 20 ossiculoplasty operations performed by the author using cortical bone grafts revealed no significant differences in outcome attributable to increased mass. However, large grafts did become fixed to surrounding structures in some cases.

Audiometry, Pure-Tone↗
PubMed1995

Osteoplastic changes in attic cholesteatoma.

Eighty-nine cases of attic type cholesteatoma were operated on during a three and a half-year period. Of these, eight cases were characterized by bony tissue proliferation at the aditus ad antrum or mastoid antrum. Sex, age, and hearing levels were not significant in these cases. Bony fixation of the incus and the malleus was seen in six cases. Bony tissue blocked further expansion of attic cholesteatoma at the aditus in four cases, narrowed the epithelial tract to the antrum in two cases, and completely separated the cholesteatoma into two cholesteatomas in two cases. Infectious stimuli, at an early stage of the disease, might stimulate such osteoplastic activity at the aditus. Axial CT scans give useful information regarding structure before surgery.

Adult↗
PubMed1997

Autograft ossicle selection in cholesteatomatous ear disease: histopathological considerations.

In order to determine whether selection of autograft ossicles in cholesteatomatous ear disease should be based upon their appearance under the surgical operating microscope, we studied the histopathological features of 113 such ossicles. We attempted to correlate the extent of erosion of the ossicle, as noted under the surgical operating microscope, with their histopathological appearance. There were 60 mallei and 53 includes. Seventy-nine ossicles were eroded and 34 were intact. The commonest abnormality noted was erosion of the long process of the incus (75 per cent). Both intact and eroded ossicles had similar histological features. There was no evidence of intra-ossicular cholesteatoma. The results suggest that the extent of erosion of these ossicles as seen under the surgical operating microscope should in no way prejudice their use as autografts when required.

Bioprosthesis↗
PubMed1999

Isolated congenital stapes suprastructure fixation.

Isolated congenital anomalies of the ossicles are rare. The majority of cases of congenital conductive hearing loss secondary to middle-ear anomalies have other associated defects, such as atresia, microtia and craniofacial deformities. We present a rare case of isolated congenital stapes suprastructure fixation, where a monocrural stapes with a mobile footplate was attached to the promontory by bony synostosis. There was no stapedius muscle nor pyramidal process. The incus and malleus were of normal configuration. Mobilization of the stapes from the promontory resulted in improvement in hearing. We believe this is the first reported case of such an abnormality. A review of the world literature of isolated stapes suprastructure ankylosis and the classifications of minor congenital anomalies are discussed.

Adult↗
PubMed1996

Revision surgery in otosclerosis--an investigation of the factors which influence the hearing result.

The hearing improvement obtained by revision surgery for otosclerosis has been assessed in 163 patients with a conductive hearing loss. Several different surgical techniques had been used at the primary operation. On average at revision a hearing improvement of 11 dB was obtained. The hearing improvement was related to the surgical technique of the primary operation, the middle ear abnormalities and the surgical technique used at revision. Patients in whom a small-fenestra-technique had been used for the primary as well as the revision procedure, had a better result than patients who had total removal of the footplate. Patients with adhesions and an eccentric prosthesis only showed a small hearing improvement. Patients with necrosis of the long process of the incus were also difficult to manage. Since the complication rate was low it does not seem to be more dangerous to perform a revision than to perform a primary operation. The results obtained by revision are poorer than can be obtained by the primary procedure. This indicates that in stapes surgery the greatest chance for hearing improvement is the first operation, therefore centralization of this type of operation should be considered.

Ear, Middle↗
PubMed2000

Performance assessment of ossicular chain reconstructions in a University hospital.

It remains to be demonstrated that normal, day-to-day routine surgery is as effective as it would appear from the literature, where the results of very experienced surgeons are presented. The object of this study was to measure our performance for ossicular chain reconstructions. One hundred and thirty-eight total and partial reconstructions performed by 13 different surgeons were evaluated. The population was divided into four different groups based on the presence or absence of the canal wall and stapes suprastructure. The results varied widely. A number of patients benefited greatly, whereas others experienced deterioration in their hearing. The best improvement (median 13 dB) was achieved in the group with an intact canal wall and absent stapes suprastructure. The postoperative air bone gap was better for autologous incus rather than prosthesis in the group where the canal wall and stapes were intact. There were three minor complications. This continuous feedback reports exceptional results (good and bad). The strengths and weaknesses of the department can be determined. This feedback indicates that this procedure is safe and beneficial for the patients in our Institution.

Adolescent↗
PubMed1997

Stage-specific expression patterns of alkaline phosphatase during development of the first arch skeleton in inbred C57BL/6 mouse embryos.

Timing and pattern of expression of alkaline phosphatase was examined during early differentiation of the 1st arch skeleton in inbred C57BL/6 mice. Embryos were recovered between 10 and 18 d of gestation and staged using a detailed staging table of craniofacial development prior to histochemical examination. Expression of alkaline phosphatase is initiated at stage 20.2 in the plasma membrane of mesenchymal cells in the distal region of the first arch. Expression is strongest in osteoid (unmineralised bone matrix) and presumptive periosteum at stage 21.32. Mineralisation begins at stage E23. Expression is present in the mineralised bone matrix. Secondary cartilages form in the condylar and angular processes by stage M24. The cartilaginous cells and surrounding cells in the processes are all alkaline phosphatase-positive and surrounded by the common periosteum, suggesting that progenitor cells of the processes, dentary ramus and secondary cartilages all originate from a common pool. Nonhypertrophied chondrocytes of Meckel's cartilage express alkaline phosphatase at stage M23. Expression in these chondrocytes is preceded by the expression in their adjacent perichondrium. This is true of chondrocytes in all other cranial cartilages examined. 3-D reconstruction of expression in Meckel's cartilage also revealed that the chondrocytes of Meckel's cartilage which express alkaline phosphatase and the matrix of which undergoes mineralisation are those surrounded by the alkaline phosphatase-positive dentary ramus. By stage 25, coincident with mineralisation in the distal section of Meckel's cartilage, most chondrocytes are strongly positive. The perichondria of malleus and incus cartilages express alkaline phosphatase at stage M24. Nonhypertrophied chondrocytes along these perichondria also express alkaline phosphatase. Superficial and deep cells in the dental laminae of incisor and 1st molar teeth become alkaline phosphatase-positive at the bud stage, stages 21.16 and 21.32, respectively. Dental papillae are negative until stage M24 when alkaline phosphatase expression begins in the dental papillae and follicles of the incisor teeth and the dental follicles of the 1st molar teeth. The dental papillae of the 1st molar teeth express alkaline phosphatase at stage 25. Expression in the dental papillae and follicles appears to coincide with cellular differentiation of follicle from papilla. The presumptive squamosal, ectotympanic and gonial membrane bones, lingual oral epithelial cells connected to the dental laminae of the incisor teeth, hair follicle papillae and sheath and surrounding dermis all express alkaline phosphatase in a stage-specific manner.

Alkaline Phosphatase↗
PubMed2000

["Vibrant Soundbridge" middle ear implant for auditory rehabilitation in sensory hearing loss. I. Clinical aspects, indications and initial results].

BACKGROUND: The adequate therapy for patients suffering from a sensory hearing loss consists of fitting electronic hearing devices. Conventional hearing aids, however, present with significant inherent drawbacks such as insufficient amplification in the high frequency range, problems with the ear mold (feed back, occlusion, external otitis), or distortion of sound with an "unnatural" hearing impression. METHODS: The partially implantable middle ear device Vibrant Soundbridge provides a sound wave conversion into mechanical vibrations at the middle ear ossicles using the Floating Mass Transducer (FMT). The audiological advantages are due to a direct moving force to the perilymph via incus and stapes. The Vibrant Soundbridge system is indicated in patients with a medium to severe symmetrical sensory hearing loss and a normal middle ear. Candidates need previous experience with conventional hearing aids without satisfactory results. RESULTS: The eight operated patients report a "natural" quality of sound and speech, a better hearing perception at high frequencies and the absence of feed back phenomena. Audiological evaluation and questionnair results support the patients subjective hearing impression. CONCLUSIONS: The Vibrant Soundbridge improves hearing quality in patients with sensory hearing loss. The hearing implant is indicated in particular in patients that are unable to wear conventional hearing aids.

Adult↗
PubMed2000

[Local antibiotic administration decreases risk of inner ear damage in effodation].

BACKGROUND: Mobilising the stapes via the removal of the tympanosclerotic plaques from the oval window niche (effodation) and stapedectomy or malleovestibulopexy are the different procedures generally available for the surgical therapy of stapes fixation due to tympanosclerosis. These techniques bear a significant risk of sensory hearing loss. Here we analyse our results using the mobilisation technique together with locally applied antibiotics. PATIENTS: Nineteen ears in seventeen patients with tympanosclerosis involving the stapes and its footplate which underwent stapes mobilisation between 1991 and 1999 have been investigated retrospectively. According to the literature this operation has a high risk of cochlear hearing loss. To reduce this risk, azlocillin was instilled locally during removal of tympanosclerotic plaques. RESULTS: Different operation techniques have been used: classic type III with placement of a cartilage disc on the head of the stapes (4), interposition of the incus (3), interposition of the head of malleus (1), interposition of a ceramic-PORP (6) and cartilage columella in cases of significant stapes footplate erosion (3). In two operations the chain was intact and no reconstruction was necessary. Pure-tone-audiometry showed no significant decrease of bone-conduction thresholds. Preoperatively 4 (21.1%) ears had an average air-bone-gap < or = 30 dB, while postoperatively 15 (78.9%) ears had this level of hearing. CONCLUSIONS: Until the exact causes of the loss of hearing after mobilisation or stapedectomy in cases of tympanosclerosis are known, the local administration of antibiotics is certainly recommended, bearing in mind the initial hypothesis that infection may be jointly responsible for cochlear hearing loss on mobilisation or stapedectomy in cases of tympanosclerosis.

Adult↗
PubMed2001

[Posterior crus stapedectomy: an obsolete method in otosclerosis surgery?].

BACKGROUND: Stapedectomy and stapedotomy with interposition of prostheses are the methods of choice for surgical treatment of otosclerosis. For the present study we resumed and reevaluated the posterior crus stapedectomy, a method based on the principal of renouncing a prosthesis by cutting the posterior crus of the stapes close to the footplate and the anterior crus close to the stapes head. METHODS: The posterior crus is temporarily transposed with the incudostapedial joint remaining intact. After performance of platinectomy and sealing of the oval window with fascia it is repositioned onto the center of the window. RESULTS: 19 of 20 ears operated on applying this technique showed good results (closure of air bone gap) after a mean follow up of 24.6 months. One patient showed persistence of air bone gap of 32.5 dB. Revision surgery revealed that the posterior crus had migrated to the posterior rim of the oval window. No inner ear affection, perilymph fistula or sensorineural hearing loss were observed. CONCLUSIONS: The major advantage of this technique is the avoidance of incus necrosis and foreign body reactions related to the material of the prosthesis. Disadvantages are technical plus the longer duration of the procedure.

Adult↗