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At least 73 records · Page 4Linked to original sources
PubMed2004

Submillimetric target-registration error using a novel, non-invasive fiducial system for image-guided otologic surgery.

OBJECTIVE: Otologic surgery is undertaken to treat ailments of the ear, including persistent infections, hearing loss, vertigo, and cancer. Typically performed on otherwise-healthy patients in outpatient facilities, the application of image-guided surgery (IGS) has been limited because accurate (<1 mm), non-invasive fiducial systems for otologic surgery have not been available. We now present such a fiducial system. METHODS: A dental bite-block was fitted with a custom-designed rigid frame with 7 fiducial markers surrounding each external ear. The bones containing the ear (i.e., the temporal bones) of 3 cadaveric skulls were removed and replaced with discs containing 13 surgical targets arranged in a cross-hair pattern about the centroid of each ear. The surgical targets (26/skull) and fiducial markers (14/skull) were identified both within CT scans using a published algorithm and in physical space using an infrared optical tracking system. Fiducial registration error (FRE), fiducial localization error (FLE), and target registration error (TRE) were calculated. RESULTS: For all trials, root mean square FRE = 0.66, FLE = 0.72, and TRE = 0.77 mm. The mean TRE for n = 234 independent targets was 0.73 with a standard deviation of 0.25 mm. CONCLUSIONS: Using a novel, non-invasive fiducial system (the EarMark), submillimetric accuracy was repeatably achieved. This system will facilitate image-guided otologic surgery.

Artifacts↗
PubMed2004

Otologic manifestations of ectodermal dysplasia.

OBJECTIVES: To determine the range and prevalence of otologic disorders in patients with ectodermal dysplasia (ED) and provide a general review of its multiple otolaryngological manifestations. DESIGN: Case series. SETTING: Ectodermal dysplasia family conference. PATIENTS: Sixty-nine individuals with ED were evaluated. The average age was 11 years (range, 1-56 years). Most were male patients (44 [64%]), and most had Christ-Siemens-Touraine syndrome/hypohidrotic ED (42 [61%]), with the remaining having Hay-Wells, Clouston, and ectrodactyly ED clefting syndromes and unclassified types of ED. INTERVENTIONS: Questionnaire including a quality-of-life assessment modeled after the Otitis Media 6 instrument, physical examination, screening audiogram, and tympanometry. RESULTS: Of the 69 patients, 15 (22%) had a known history of hearing loss, and over half reported some level of difficulty processing verbal information (30 patients [43%] reported speech problems and 4 patients [6%] required hearing aids). A history of otitis media was common, with 15 patients (21%) presenting with tympanostomy tubes in place. The mean +/- SD quality-of-life rating was 2.0 +/- 1.1 (range 1-7), with lower scores suggesting less of a problem. On physical examination, 18 patients (26%) had pinna anomalies. One case of advanced cholesteatoma and 2 cases of external auditory canal stenosis were identified. Of the 24 patients who received 4-tone screening audiogram, 2 (8%) had a highest pure-tone average threshold of 50 to 65 dB, whereas 5 patients (21%) had a 30- to 45-dB threshold, with the remaining having a 0- to 25-dB threshold. CONCLUSION: In our study, which is, to our knowledge, the largest reported collection of ED patients evaluated for otologic disease, most patients were found to have 1 or more otologic abnormalities, ranging from auricular anomaly to complications of otitis media to profound hearing loss.

Adolescent↗
PubMed1989

Otologic manifestations of Langerhans' cell histiocytosis.

Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.

Child↗
PubMed1990

A survey of otologic training in US residency programs.

Otologic cases are dwindling in numbers, jeopardizing the clinical training of our residents. A survey was performed to determine the magnitude of the problem facing our training programs. Seventy-three of 79 questionnaires distributed were returned. Results of the survey indicate that facial nerve decompression, exostosis repair, and stapedectomy were, on the average, infrequently performed by residents. Training for these seldom-performed procedures consists of temporal bone laboratory experience, close operative supervision, and the use of private patients for resident training. The majority (84%) of respondents did not feel that fellowship training was required to perform otologic surgery on graduation or that it should be required for obtaining hospital privileges in seldom-performed cases. Approximately three quarters (76%) of the program directors consider the training of seldom-performed procedures to be a moderate-to-serious problem facing otologic training today.

Exostoses↗
PubMed1996

Neuro-otological findings after radiosurgery for acoustic neurinomas.

OBJECTIVE: To evaluate the neuro-otological complications in patients after radiosurgery for acoustic neurinomas. DESIGN: Inception cohort, retrospective study. SETTING: University hospital. PATIENTS: A consecutive sample of 46 patients with acoustic neurinomas who underwent unilateral gamma knife radiosurgery at the University of Tokyo, Japan, between June 1990 and June 1994 were followed up by otolaryngologists for more than 3 months. INTERVENTION: Gamma knife stereotactic radiosurgery. MAIN OUTCOME MEASURES: Neuro-otological examinations including pure tone audiometry, auditory brain stem response, and caloric test. RESULTS: Tumor growth occurred in 2 patients (4.3%). Seven (18%) of the 38 patients with preserved hearing of any extent became deaf within 1 year. In cases of gradual hearing loss, the average deterioration rate was approximately 8 dB per year. Abnormalities of auditory brain stem response preceded deafness in 2 patients. Caloric response, preserved before treatment in 13 patients, disappeared 4 to 13 months after treatment (median, 8 months) in 9 (69%) of them, whereas their hearing was preserved. Delayed facial palsy and persistent trigeminal neuropathy occurred in 10 (22%) and 7 (15%) of the 46 patients, respectively. Severe facial palsy tended to persist. CONCLUSIONS: The rates of neuro-otological complications of radiosurgery are almost comparable with those previously reported from other institutions. The deafness within 1 year after treatment might be attributed to a lesion in the cochlear nerve. Hearing loss did not parallel vestibular function loss. The persistent severe facial palsy contrasts with previously reported findings. Considering the serious facial nerve complications that occurred in some of our patients, further study to disclose the risk factors for neurological dysfunction would be needed for radiosurgery to become a true, safe alternative to microsurgery.

Adolescent↗
PubMed1984

Neuro-otological findings in patients with small acoustic neuromas.

The method of choice for the diagnosis of even the smallest acoustic neuromas is CT gas cisternography. Lumbar puncture and gas insufflation, however, is an intervention demanding strict indication. Neuro-otological examinations should lead to this indication. The aim of this paper is to demonstrate neuro-otological findings on 19 patients presenting small acoustic neuromas. These neuro-otological findings are not necessarily comparable to earlier reports in the literature dealing with mainly larger tumours at a time when early diagnosis was not so advanced.

Adult↗
PubMed1995

Dizziness following head injury: a neuro-otological study.

Dizziness is a frequent and debilitating complications of head injury and accounts for increasing numbers of medico-legal claims. A detailed neuro-otological study was carried out from the records of 100 patients with post-traumatic dizziness to explore the neuro-otological basis of their symptoms: 50 patients presenting for medico-legal purposes (group I) and 50 presenting for management of their vestibular symptoms (group II). The two groups showed a similar sex distribution, a similar range of causes of head injury and similar severity of head injury (72 minor, 24 moderate and 4 severe). Of the 100, 88 showed at least one audio-vestibular abnormality on testing. Vertigo of the benign positional paroxysmal type was the commonest vestibular diagnosis in both groups (61/100), and only 8 patients showed central vestibular abnormalities. Fifty-three patients had audiometric abnormalities attributable to the head injury, the commonest of which was a high-tone sensorineural hearing loss. There was no significant difference in the incidence of any of the abnormalities in the medico-legal group (group I) when compared with the symptom management group (group II). The results provide strong evidence for an organic basis to recurring dizziness after head injury, whether or not a claim for compensation is pending, and emphasize the need for specialist neuro-otological investigation if abnormalities are to be identified and managed correctly.

Adult↗
PubMed1994

Symptoms as a clue to otologic and psychiatric diagnosis in patients with dizziness.

Dizziness is a common symptom that often remains unexplained despite extensive medical evaluation. Psychiatric disorders are usually considered only after all medical causes of dizziness have been ruled out. Sixty-five patients referred to an otolaryngology practice received a structured psychiatric interview, an otologic evaluation, and a dizziness questionnaire modified to assess psychiatric symptoms. They were divided into four diagnostic groups: psychiatric diagnosis only, otologic diagnosis only, both diagnoses, or neither diagnosis. Eleven questionnaire items were significantly associated with diagnostic groupings. Stepwise discriminant function analysis utilizing age, gender, rapid/irregular heartbeat, extremity weakness, nausea/vomiting, and difficulty with speech resulted in correct group classification for 70% of subjects. The presence of dizziness symptoms like vertigo or lightheadedness was not significantly different between groups. This study suggests that assessment of psychiatric and autonomic symptoms should accompany, not follow, otologic evaluation of dizziness. These symptoms may be more important diagnostically than dizziness quality.

Adult↗
PubMed2005

Validation of tele-otology to diagnose ear disease in children.

OBJECTIVE: To determine if digitised still eardrum images, with a clinical history, and audiometry and tympanometry data provide sufficient information to an ear specialist to make an assessment of a patient. METHODS: 66 children (9 months to 16 years) from remote communities were assessed by an ear specialist by standard otoscopy, using a clinical history, audiometry and tympanometry. Up to five images of each ear were digitised. At a later date, the ear specialist made observations, diagnoses and recommendations for management from the images and clinical data. RESULTS: There was a significant correlation (p<0.01) between image quality and age of the subject. There were significant agreements for the clinically important observations of otorrhea, perforation, retracted tympanic membrane and atrophy of the tympanic membrane (p<0.05). There were significant agreements for the diagnoses of acute otitis media, chronic suppurative otitis media, otitis media with effusion and Eustachian tube dysfunction. The rate of recommendations for review or referral after a tele-otology assessment were between 4 and 16% higher than those in made in the field. The agreements between the various forms of advice or recommendations made in the field to those made by tele-otology were statistically significant (p<0.01). CONCLUSIONS: A tele-otology system that incorporates good quality digitised images of the tympanic membrane, audiological and tympanometric data, and a comprehensive clinical history provides the ear specialist with sufficient information to make a confident diagnose of existing middle ear disease, and provide management advice to the patients' primary care provider.

Acoustic Impedance Tests↗
PubMed2004

Long-term otological outcome of hamular fracture during palatoplasty.

OBJECTIVE: It has been suggested that fracture of the hamulus during palatoplasty in children with cleft palate may lead to adverse otological sequelae, however, there is little evidence to support this. STUDY DESIGN AND SETTING: The otological records of 42 children with repaired cleft palate (excluding submucous cleft palate) aged 8 years old or older were examined. A questionnaire regarding the incidence, treatment, and outcome of middle ear problems was completed by the parents of 68 children with repaired cleft palate, aged 9 years old or older. RESULTS: There was no significant difference between children who did and did not undergo hamular fracture with regard to tympanic membrane appearance, audiometry, history of ear problems (P = 1.000), ear infections (P = 0.622), ventilation tube insertion (P = 0.532), or surgery for chronic otitis media (P = 1.000). Parents of children not undergoing hamular fracture reported a higher incidence of below normal hearing (P = 0.023).Conclusion and significance There is no evidence that hamular fracture during palatoplasty affects long-term otological outcome in cleft palate.

Adolescent↗
PubMed2005

In vitro assessment of image-guided otologic surgery: submillimeter accuracy within the region of the temporal bone.

OBJECTIVES: Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily usable (noninvasive and nonobstructive). METHODS: A dental bite-block was fitted with a rigid frame with 7 fiducial markers surrounding each external ear. The temporal bones of 3 cadaveric skulls were removed and replaced with surgical targets arranged in a bull's-eye pattern about the centroid of each temporal bone. The surgical targets were identified both within CT scans and in physical space using an infrared optical tracking system. The difference between positions in CT space versus physical space was calculated as target registration error. RESULTS: A total of 234 independent target registration errors were calculated. Mean +/- standard deviation = 0.73 mm +/- 0.25 mm. CONCLUSIONS: These findings show that image-guided otologic surgery with submillimeter accuracy is achievable with a minimally invasive fiducial frame. Significance In vivo validation of the system is ongoing. With such validation, this system may facilitate clinically applicable image-guided otologic surgery. EBM RATING: A.

Humans↗
PubMed1997

Use of a screening RAST in a large neuro-otologic practice.

Evidence in the literature emphasizes the role of the immune system in disorders of the inner ear and eustachian tube. We initially investigated the presence of inhalant allergy in selected patients seen for otologic problems by means of a screening radioallergosorbent test (RAST), using either a microscreen or a limited antigen panel. This study analyzed the results of tests performed over a 2-year period on 186 patients seen by one of us (WLM) for treatment of vertigo (66%), tinnitus (63%), hearing loss (49%), aural fullness (48%), Meniere's quadrad (27%), balance disturbance other than true vertigo (21%), and eustachian tube dysfunction (4%). We found an incidence of immunoglobulin E-mediated hypersensitivity of nearly 40% in a patient population selected solely for neuro-otologic symptoms and not for sinonasal symptoms. This figure is more than double that quoted for the general population. We also found a surprisingly high incidence of mold antigen atopy in this selected population. Allergy can contribute to a number of otologic symptoms, including eustachian tube dysfunction, vertigo, tinnitus, hearing loss, aural fullness, and nonspecific balance disturbance. Allergy also has been emphasized as an etiologic factor in a portion of patients diagnosed with Meniere's syndrome. A screening RAST, combined with clinical evaluation, appears to be an excellent tool for evaluating these patients for inhalant allergy as part of a comprehensive workup.

Adolescent↗
PubMed1997

Analyses of neuro-otological complications after radiosurgery for acoustic neurinomas.

PURPOSE: To find out the optimum treatment parameters and the proper indications for treatment of acoustic neurinomas, univariate and multivariate actuarial analyses of neuro-otological complications after stereotactic radiosurgery for acoustic neurinomas were performed. METHODS AND MATERIALS: The subjects were 46 patients with acoustic neurinomas who underwent unilateral radiosurgery between June 1990 and June 1994 and were followed up at the University of Tokyo. Age ranged from 13 to 77 years (median, 54 years). Tumor diameter ranged from 0 to 25 mm (mean, 12 mm) at the cerebellopontine angle and from 2 to 15 mm (mean, 8.3 mm) in the internal auditory meatus. Maximum tumor doses ranged from 20 to 40 Gy (mean, 31.4 Gy), and peripheral doses from 12 to 25 Gy (mean, 16.8 Gy). One to eight isocenters were used (mean, 3.2). Median follow-up was 39 months. Eight events concerning neuro-otological complications were chosen, and the potential risk factors for them were analyzed by the actuarial analyses (univariate and multivariate). The events examined include hearing loss, vestibular function loss, facial palsy, and trigeminal nerve dysfunction. In order to point out potential risk factors for neuro-otological complications, univariate analyses were performed using both the Wilcoxon test and the log rank test, and multivariate analyses were performed with the Cox proportional hazards model. Variables nominated as potential risk factors were 1) demographic variables such as patient age and sex, 2) tumor dimensions, 3) treatment variables such as tumor doses and number of isocenters, and 4) pretreatment hearing levels. A variable with significant p-values (p < 0.05) in two or more of the three actuarial analyses (two univariate and one multivariate) was considered a possible risk factor. RESULTS: The possible variables that increase the risk for each event analyzed were: neurofibromatosis type II (NF2) and the number of isocenters for total hearing loss; experience of prior operation, the tumor diameter in the internal auditory meatus, and NF2 for hearing threshold elevation; peripheral tumor dose for vestibular function loss; patient age or midporus transverse tumor diameter (the two variables were correlated), and the number of isocenters for facial palsy; and the number of isocenters for trigeminal neuropathy. CONCLUSION: NF2 and the tumor diameter were the common risk factors for hearing loss in previous studies and ours. For the 5th/7th nerve dysfunction, the tumor diameter was the common risk factor. The risk of using more isocenters remains controversial. The difference in risk factors for hearing impairment and vestibular function loss suggests different mechanisms for the two. Further studies with larger populations and longer follow-up periods are required in order to draw conclusions on the risk factors in radiosurgery.

Adolescent↗
PubMed1993

Neuro-otological findings in patients with spinocerebellar degeneration: with special regard to the duration of illness.

Neuro-otological findings in 150 patients with spinocerebellar degeneration were analyzed based on the duration of illness since onset. The results of each kind of neuro-otological examination varied in close relation to the duration of illness. Also, the results of each kind of examination correlated closely. In particular, the optokinetic nystagmus test and the visual suppression test correlated most closely. Neuro-otological examinations were confirmed to be of great value in gauging progression in spinocerebellar degeneration.

Adolescent↗
PubMed1992

Ionomeric bone cement in neuro-otological surgery.

The use of a polymaleinate glass ionomer cement in 80 neuro-otology cases is described. It has proved of great value in translabyrinthine acoustic neuroma surgery, reducing the incidence of CSF fistula to nil. It is the method of choice for fixation of the Nucleus cochlear implant, and has many other applications in the field of otology and neuro-otology. It is easy to use and appears to have no side effects.

Cerebrospinal Fluid Otorrhea↗
PubMedDate not supplied

Nasal and otologic effects of experimental respiratory syncytial virus infection in adults.

PURPOSE: Upper respiratory tract viral infections continue to cause substantial patient morbidity and complications including sinusitis, otitis media, and pneumonia. This study was conducted to more clearly define the extent and frequency of nasal and otologic effects of respiratory syncytial virus infection in healthy adult volunteers. MATERIALS AND METHODS: Thirty-two healthy, susceptible adult volunteers were cloistered for a 9-day period. During this time, subjects underwent nasal inoculation with respiratory syncytial virus. Monitoring included daily self-assessment of general health, as well as nasal and otologic symptoms. Objective measurements of nasal and otologic function included expelled nasal secretion weight, saccharin-dye mucociliary clearance, sonotubometry, tympanometry, and physical examination. A nasal lavage was done each morning, and fluids were submitted for viral detection. Twenty-one days after viral inoculation, all subjects had convalescent blood samples drawn for assay of virus-specific antibody titres. RESULTS: Eighteen subjects (56%) became infected with the challenge as determined by either viral shedding (47%) or antigen detection (41%) from the nose or a 4-fold rise in virus-specific antibody titer (34%). Infected subjects more frequently reported adverse nasal (congestion, rhinorrhea) and general symptoms (fever, malaise, illness). By day 6, only 46% of infected subjects had normal middle ear pressure (> -100 mm H2O). Nasal secretion also increased substantially after infection. No patterned changes in mucociliary clearance or sonotubometry occurred, and no subjects developed otitis media. CONCLUSIONS: Nasal inoculation of healthy, susceptible adult volunteers with respiratory syncytial virus results in detectable infection in only about half of the subjects challenged. Infected subjects experience substantial symptoms and signs of a viral upper respiratory tract illness. As in our previous studies using rhinovirus and influenza A virus, respiratory syncytial virus disrupted the maintenance of normal middle ear pressures. These findings provide further support for the relationship between viral upper respiratory tract infections and otitis media.

Adolescent↗
PubMed1995

Neuro-otologic findings in the lightning-injured patient.

Although lightning injuries are common, neuro-otologic sequelae are infrequently reported. The most common otologic injury encountered in the lightning strike victim is tympanic membrane rupture; the most common vestibular disturbance documented is transient vertigo. A variety of other clinical findings have been described in this population of patients. They include sensorineural hearing loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the mastoid bone, burns to the external auditory canal, and peripheral facial nerve palsy. The initial treatment of the lightning strike victim consists of basic life support measures. Once stabilized, the patient should undergo a complete otologic and vestibular evaluation. The majority of otolaryngologic problems encountered can be managed expectantly, with periodic re-evaluation. Tympanoplasty should be delayed for 6 to 12 months because of the frequent delay in spontaneous healing.

Ear Canal↗
PubMed2004

Otologic consequences of blast exposure: a Finnish case study of a shopping mall bomb explosion.

OBJECTIVE: On 11 October, 2002, in the Myyrmanni shopping mall, Vantaa city, Finland, an explosion by a suicide bomber killed 7 people and injured at least 160,44 of whom had ear trauma. We investigated the acute and subacute otologic consequences of the explosion. MATERIAL AND METHODS: Otologic examination of the 29 patients treated for ear trauma at the ENT clinic of the University Hospital of Helsinki was performed during the first month after the explosion, and a questionnaire was completed regarding subjective aural symptoms. Symptoms occurring directly after the explosion and for up to 1 month afterwards were assessed. RESULTS: Of the 29 patients, 66% had tinnitus as the initial symptom, 55% hearing loss, 41% pain in the ears and 28% sound distortion. Tinnitus and hearing loss in combination were experienced by 12 patients (41%). Eight patients who had been situated<10 m from the center of the explosion had a rupture of the tympanic membrane. This supported the initial evaluation by the authorities that the bomb had consisted of approximately 3 kg ammonium nitrate, equivalent to approximately 0.5 kg of trinitrotoluene. It was estimated that some kind of ear injury was likely for individuals situated<70 m from the center of the explosion. CONCLUSIONS: People often think that tinnitus and hearing impairment are naturally occurring phenomena after blast exposure, and if their symptoms resolve they do not seek medical advice. However, some of them may have substantial hearing impairment, particularly at high frequencies. Otologic consultation, or at least an audiometric screening test to exclude hearing impairment, should be performed regardless of symptoms, on the basis of exposure data only. Some symptoms, such as tinnitus and hearing loss, may be permanent consequences of a blast injury and their effect on quality of life may be substantial.

Adolescent↗