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At least 793 records · Page 44Linked to original sources
PubMed2005

Current multiplanar imaging of the stapes.

PURPOSE: CT analysis of the stapes is difficult in the axial plane (AP), because of its oblique orientation. Oblique axial reformations could provide a more precise analysis of the stapes in normal and pathologic conditions. MATERIALS AND METHODS: CT of the temporal bone was performed in 31 patients. Only the normal side was examined in the AP and oblique axial plane (OAP), in the plane of the stapes superstructure. Conspicuousness of each stapes component was evaluated in both planes by 2 independent readers. Reproducibility between the 2 readers (R1 and R2) and comparison of conspicuousness between the AP and the OAP in the analysis of the stapes crura were evaluated. The normal position of the stapes arch in relationship to the footplate was determined in the OAP by using biometric landmarks. RESULTS: Conspicuousness of the stapes crura was increased by using OAP. The conspicuousness of the anterior crus was enhanced in 38% with the OAP according to R1 (P < .05) and 32% according to R2 (P < .05). The conspicuousness of the posterior crus was enhanced in 35% with the OAP according to R1 (P < .05), but not significantly enhanced in 22% with the OAP according to R2 (P = .095). Analysis of conspicuousness of the stapes crura was reproducible according to the kappa test. A perpendicular line to the footplate intersecting its midportion crosses the stapes head and the long process of the incus in the OAP in normal patients. CONCLUSION: OAP could enhance the CT analysis of the stapes and provide useful biometric landmarks in pathologic conditions.

Adult↗
PubMed2005

[Clinical classification and treatment of localized attic cholesteatoma].

OBJECTIVE: To investigate the clinical classification and treatment of localized attic cholesteatoma through surgical management. METHOD: Twenty-one patients (21 ears) of localized attic cholesteatoma accepted atticotomy. Then different surgical managements were carried out according to the extent of cholesteatoma and whether the malleo-incudal joint was destroyed or not. If the cholesteatoma has only reached the surface of the malleo-incudal joint, it was regarded as type I (5 patients). To this type, the cholesteatoma was removed and the ossicular chain was preserved. If the cholesteatoma has entered the anterior attic space and destroyed the malleo-incudal joint, it was regarded as type II (16 patients). Besides the removing of cholesteatoma, the head of malleus and incus should be removed also in this condition. Then reconstruction of the ossicular chain was performed by putting PORP artificial auditory ossicles between the manubrium mallei and staple. In all these 21 patients, the lateral wall of attic was reconstructed with the cartilage of tragus. The perichondrium of the cartilage was used to repair the perforation in the non-vibrant membrane. Healing of the lateral wall of attic and the tympanic membrane and recovery of hearing level were investigated after the operation. RESULT: The follow-up period lasted 1 year to 5 years. Healing of the lateral wall of attic and the tympanic membrane were satisfying in all 21 patients. According to the pure tone audiometry after the operation, A-B gap was less than 10 decibel in 10 patients,less than 20 decibel in 7 patients, less than 30 decibel in 3 patients, and over 30 decibel in only 1 patient. Acoustic transmission function was preserved or reconstructed. No vertigo or tinnitus happened after operation. CONCLUSION: Diagnosis of localized attic cholesteatoma should be made early. If it can be treated by clinical classification properly, not only the removing of cholesteatoma, but also the reservation and recovery of acoustic transmission function can be obtained. It is worthy of further discussion.

Adolescent↗
PubMedDate not supplied

[Complications of stapedectomy involving the middle ear structures].

On the basis of personal experience and data from literature, the authors enumerate possible complications of the middle-ear structures during stapedectomy: perforation of the eardrum, disturbed function of the chorda tympani, peripheric paralysis of the facial nerve, incus luxation, haematotympanon, inflammatory complications, late improvement of the hearing, reoperative granuloma, cholesteatoma and sudden damage of the hearing.

Ear, Middle↗
PubMed1991

Stapedectomy modified by the application of fibrin tissue adhesive.

Certain failures of the stapes operation are caused by loosening of the crimped metal loop on the long process of the incus, atrophy or necrosis of the lenticular process, erosion of the long process with the prosthesis causing injury to the labyrinth, erosion of the incudostapedial joint with upward rotation of the long process, and dislocation of the prosthesis. To reduce the occurrences of these failures following stapes removal, we close the oval window by gluing a fascia graft into place with fibrin tissue adhesive. A ceramic strut with a cup on its upper end that fits the lenticular process is glued between the fascia graft and the lenticular process. This method does not cause bone necrosis or blood circulation disturbances. The hearing results are the same or better than those reported for other stapes procedures.

Animals↗
PubMed1990

[Severe injury of the middle ear].

The author reports on a rare case of direct injury of the middle ear with elective luxation of the stapes in vestibulum, where the rest of the ossicular chain was intact. The patient had a paroxysmal vertigo and combined hearing loss. The stapes was extracted from the vestibulum the same day and was fixed to the incus with fibrin sealant in an anatomical position. The oval window was sealed with connective tissue. The inner ear function recovered immediately. After one year, the audiogram was normal and the stapedial reflex was present.

Adult↗
PubMed1990

Non-ossicle homograft bone prostheses in the middle ear.

This thesis proposes the use of human cadaver non-ossicle temporal homograft bone as middle ear reconstructive material. Bone obtained from the otic capsule histologically resembles that of the ossicles more so than any other bone in the body. The otic capsule, due to its proximity to the middle ear, can be harvested with the middle ear structures when bone cores are obtained, making it easily accessible. These prostheses are cost effective because multiple prostheses can be sculptured from one temporal bone core. This paper further proposes the use and introduction of non-ossicle homografts in primary stapedectomy, as well as in selected cases to bypass the incus and the superstructure of the stapes. Audiological data is provided. Some of the grafts have been in the middle ear for up to 5 years. There have been no extrusions and no complications. The method of harvesting, preservation, and sterilization is presented, as well as a pictorial illustration of the finished product and its relation to the natural ossicles. One histological specimen is presented. On the basis of the audiologic results, as well as the fact that no ossicles have extruded and none have been resorbed, it is proposed that non-ossicle temporal bone homografts have a place in transplantation surgery.

Animals↗
PubMed1990

[Malherbe's calcifying cyst. Apropos of an unusual case in the middle ear. Histopathogenic value].

We report the case of a 54 years old man suffering with chronic otorrhea. The surgical procedure let us be surprised at a non specific cyst located in the "additus ad antrum", close to the incus but no damaging it. The result of the histologic examination was: Malherbe's calcifying cyst. After a background study of the publications concerning this type of tumor specially located in the skin, we can affirm this localisation in the middle ear cavity as exceptional. The cutaneous origin of this tumor and its vestigial type let us think about the possible persistence of amniotic fluid cellular content (AFCC) in the middle ear and its tumoral development in adult, explaining maybe partly the chronic otorrhea syndrome of this case.

Calcinosis↗
PubMed1990

High resolution computed tomography of auditory ossicles.

Auditory ossicular sections were scanned at section thicknesses (mm)/section interspaces (mm) of 1.5/1.5 (61 patients), 1.0/1.0 (13 patients) or 1.5/1.0 (33 patients). At any type of section thickness/interspace, the malleal and incudal structures were observed with almost equal frequency. The region of the incudostapedial joint and each component part of the stapes were shown more frequently at a section interspace of 1.0 mm than at 1.5 mm. The visualization frequency of each auditory ossicular component on two or more serial sections was investigated. At a section thickness/section interspace of 1.5/1.5, the visualization rates were low except for large components such as the head of the malleus and the body of the incus, but at a slice interspace of 1.0 mm, they were high for most components of the auditory ossicles.

Adolescent↗
PubMed1989

CO2 laser stapedotomy.

This clinical study was preceded by two laboratory experiments. The first experiment compared temperature changes in the vestibule while vaporizing a 0.6-mm stapedotomy with Argon, KTP-532, and CO2 lasers. Data demonstrated that the CO2 laser possesses superior tissue characteristics for stapedotomy. In the second experiment safe energy parameters were established for various Sharplan CO2 laser models. Using these safe power settings, 153 consecutive CO2 laser stapedotomies were performed under local anesthesia. No patient experienced intraoperative dizziness during or immediately following the application of the CO2 laser to the stapes footplate. Long-term postoperative hearing results demonstrated that 87% of the patients maintained an air/bone gap to within 10 dB and 94% maintained an air/bone gap to within 15 dB (mean follow-up 32 months). No patient incurred a significant sensorineural hearing loss (greater than 10 dB) in the speech range. Four patients developed a perilymph fistula (three immediate and one delayed) and fluctuating sensorineural hearing loss, but all were successfully repaired without significant permanent nerve deafness. At 4,000 Hz, five patients lost 20 dB and two patients dropped 40 dB compared with preoperative levels. Postoperative complications included four perilymph fistulas, two prostheses displaced from the stapedotomy opening, one fixed prosthesis, and one fixed incus. Seven of eight of these complications were successfully revised. At the time of this writing, 6/153 patients have a persistent conductive hearing loss greater than 20 dB and have not been revised. Using appropriate energy parameters, the CO2 laser provides a safe, efficient microsurgical tool for performing stapedotomy simply and with minimum inner ear trauma.

Carbon Dioxide↗
PubMed1989

[Personal experience with the use of auditory ossicle transplantation in tympanoplasty].

For improvement of the mechanism of transmission of sound we use in tympanoplasty transplants of ossicles obtained from subjects who died accidentally. For preservation we use a 0.5% formaldehyde solution. In 68 patients with chronic suppurative epytympanic inflammation of the middle ear tympanoplasty was performed with transplantation of the complex of auditory ossicles: articulated incus and stapes. Positive functional results were achieved in 59 patients. Transplantation of the ossicles thus may become the method of choice; it must be, however, further improved.

Ear Ossicles↗
PubMed1989

[Revision after surgical procedures in the middle ear and mastoid].

In a group of 46 revised operations the most frequent cause of revision was persisting secretion--in 41 patients. After elimination of general causes and after failure of conservative treatment, during revision the following local causes were revealed: relapse of cholesteatoma in 44%, inflammation of the residual or repneumatized spaces in 41%, ostitis of the long process of the incus in 10% and inflammation in the divided trepanation cavities in 5%. By the first revision the authors achieved a dry trepanation cavity in 58.5% of the operated patients. By the second and third revision they increased the number of dry trepanation cavities to 83% and in the remaining ones there was only an occasional secretion. The revision involved usually a more radical procedure. In some of the patients operated by the "closed" technique the authors changed to the "open" technique. A radical approach to the auditory ossicles and the ear drum, if they were preserved during the primary operation, led to a deterioration of hearing in 22 of 41 operated patients, i. e. in 53.66%. This is the cost of obtaining a dry trepanation cavity.

Adolescent↗
PubMed1989

[Causes and results of reoperations following stapedectomy].

The records of 145 patients who underwent revision stapedectomy were analysed to determine the causes of failure of the previous operation, the hearing results and the postoperative complaints. Displacement of the prosthesis was the most common cause of failure (49%). Other surgical findings, sometimes in combination, were a short prosthesis (35%), middle ear adhesions (23%), otosclerotic regrowth (14%) and eroded incus (10%). No specific cause of failure was identified in 6% of the revisions. Thirty-eight per cent of revision operations resulted in a hearing gain to a level less than 10 dB conduction loss and 61% to less than 20 dB. Slight sensorineural hearing loss after revision surgery occurred in 5%. 'Dead ears' were encountered in 2% as against 0.6% in the primary cases. Tinnitus was the most common complaint (21%) at the 3 week postoperative follow-up, declining to 7% four months postoperatively.

Adolescent↗
PubMed1989

[Evolution of the functional axes of the middle ear in mammals].

In 44 mammalian species, the auditory ossicles have been studied in situ in the tympanic cavity and in vestibular orientation. After the lateral semicircular canal's direction and dimensions have been put in common, measurements have been undertaken leading to a comparison of 4 phylogenic stages. Thus we have observed a rotation of the stapes, of the incus and of the malleus head, a receding of the manubrium of the malleus ending in an inversion of the bone's concavity, an extension of the supposed unfolded chain, a parallelization of the malleolus handle and of the lower incudal apophysis, a slope of the functional axes towards the back, a diminution of the distance between the two lever arms due to a receding of the anterior arm and a diminution of the ratio between these lever arms. These varied changes are linked to the occipital rotation and to the receding of the jaws following humanization.

Anatomy, Comparative↗
PubMed1988

[Synopsis of a standardized, schematic analysis of the ossicles and tympanic walls, visualized with high-resolution computed tomography (using help lines and pictograms)].

As in other radiological examinations there is an essay to show the ossicles and their surrounding tympanic walls of the petrous bone in the high resolution computed tomography. This should be standardized to simplify the interpretation and to allow the comparison. For the axial imaging of the ossicles corresponding to their particular topographic situation the head is tilted to the non-examined side and a little bit dorsally flected to turn especially the stapes in the scanning plane and to image the malleus and incus axially. The standard slices of the tympanon were schematized with the help of pictogramms. This allows a faster orientation and an easier recognition of a changed topographical situation meaning a pathological condition. The coronary view is as the important second part of the HR CT of the petrous bone integrated.

Ear Ossicles↗
PubMed1988

Epidermal cyst attached to the chorda tympani nerve.

The incidental post-mortem finding of a small epidermal cyst in the middle ear of a 78-year-old female is presented. The epidermal cyst was attached to the chorda tympani nerve adjacent to the body of the incus, but was not associated with bony erosion or any other suggestion of enlargement or invasive growth. The pathological relationship of this lesion to previously reported "congenital cholesteatomas" of the middle ear is discussed.

Aged↗
PubMed1988

Imaging contribution to temporal bone anatomy.

The research programme at the Department of Otoradiology, Uppsala, has been directed towards radio-anatomic investigation of various structures of the temporal bone, such as the jugular fossa, the facial canal, the aqueducts, the internal acoustic meatus, and the extent of pneumatization. Deep-frozen temporal bone specimens have been examined by CT and multidirectional tomography in different projections. After that plastic casts have been prepared. The method allows assessment of the anatomic variations of the structures under study, and also an estimate of the reliability of radiographic reproduction. The resolution capability of CT allows satisfactory reproduction of both inner and middle ear structures. Of the ossicles the malleus and incus with their ligaments are regularly visualized. On rare occasions even the stapes can be reproduced.

Humans↗
PubMed1988

[Mechanics of the ear ossicles in static pressures. II. Impaired joint function and surgical reconstruction of the ossicle chain].

Following the presentation of ossicle chain mechanics in the normal ear, the air pressure-induced movements of the ossicles with artificially ankylosed incudomalleal joints were studied in the same static temporal bone-experiments. In this case, exaggerated inward-outward excursions also prevail at the incus and stapes. This isodirectional motion, first described by Helmholtz, and on which is based our concept of middle-ear function until now, can also be seen in insufficiently moistened temporal bone preparations. It is not inconceivable that former studies were conducted with insufficiently moistened preparations. Several quantitative comparisons also point to this possibility. Further measurements analysed the displacements in the reconstructed ossicle chain (interposition). In both these rigid transmissions between drum membrane and stapes there can be excessive air pressure-induced movements of the stapes. This might play a role in the pathomechanics of perilymph fistulas, which is frequently caused by variations of static air pressure.

Air Pressure↗
PubMed1987

The mineral content of the middle ear ossicles. A radiologic and chemical study on normal and diseased ossicles.

The underlying mechanism responsible for bone resorption in chronic otitis media with or without cholesteatoma is not sufficiently well documented. Certain areas in the middle ear are affected more often than others. The most frequent site of bony erosion in the ossicular chain is the long process of the incus. The mineral content of the ossicular chain was investigated with a clinical radiologic technique (polytomography). The findings were correlated with chemical measurements of the mineral content in normal and diseased ossicles. A poor correlation between the radiologic findings and the chemical assessment was found. The mineral content of ossicles obtained from ears with chronic otitis was similar to that of specimens obtained from healthy middle ears. The findings indicate that the demineralization process seems to be localized to a narrow zone of the ossicle and that this zone cannot be adequately visualized by standard radiologic techniques.

Absorptiometry, Photon↗