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PubMed1987

Stapedectomy in tympanosclerosis. A report of 67 cases.

Stapedectomy was performed in sixty-seven ears with tympanosclerotic footplate fixation. This was confined to the footplate in 90% of ears, and there was an association with cholesteatoma and chronic infection. Large fenestra stapedectomy was performed in 91% of cases and the surgical procedure performed was tympanoplasty in 91% of cases. Three cases (4.5%) suffered a dead ear by three years following the procedure, but only one immediately. A variety of surgical procedures were used to reconstruct the tympanic membrane to oval window connection, and the air-bone gap did not depend on the choice of prosthesis in the short term. Retention of the incus led to later increasing air-bone gap, probably due to refixation by tympanosclerosis. Long-term results are analyzed for each method of reconstruction and each category of ossicular status identified at surgery. Small fenestra procedures produced less cochlear hearing loss at high frequencies. Surgical technique is discussed with reference to the pathophysiology of tympanosclerosis, and the role of hearing aids is considered.

Adolescent↗
PubMed1986

[Ankylosis of the malleus head. Etiology, therapeutic indications and results].

A review of 62 cases of blockage of head of malleus showed that apart from secondary lesions (post-traumatic, postoperative, postinfectious), primary blockades were a definite entity. The latter were either isolated or associated with stapedo-vestibular ankylosis. Isolated blockade of head of malleus provoties only direct transmission deafness, and is associated in nearly all cases with a cochlear lesion, often bilateral, at least in the primary forms. Instead of simple unblocking of the attic, the treatment preferred is an ablation of the incus, section of head of malleus and subsequent functional gestures that are described.

Adult↗
PubMed1986

[Stapes anomaly, Gorlin-Goltz and hand-foot-uterus syndrome as partial aspects of a generalized ectodermal-mesodermal abnormality syndrome with variable expression].

A case of a Gorlin-Goltz-syndrome with anomalies of the stapes and incus of one ear is described for the first time. In the reported case, the hand-foot-uterus-syndrome could be recognised simultaneously. In the literature, about 250 cases of the syndrome are known, first published by Gorlin and Goltz in 1960. Malformations of the middle ear, however, have not yet been described in the Gorlin-Goltz-syndrome. As in the reported case both of the syndromes, the Gorlin-Goltz-syndrome and the hand-foot-uterus-syndrome, could be diagnosed, it must be discussed whether there are two independent syndromes or only one syndrome of polyvalent malformations characterised by variable expressivity.

Adult↗
PubMed1985

Microsurgery of the middle ear.

Microsurgery of the middle ear has evolved over the past three decades through the art of the technically possible to the art of the clinically advisable. Stapedectomy has been refined to achieve an acceptably high level of success. Tympanoplasty in its simpler forms (myringoplasty +/- incus transposition) is very successful in the restoration of a dry hearing ear. Reconstruction in the absence of a mobile stapes remains an unresolved problem. The safe avoidance of an open cavity in cholesteatomatous disease continues to be an elusive goal.

Biocompatible Materials↗
PubMed1985

Revision stapes surgery: problems with some solutions.

A review of 217 consecutive revision stapes operations performed during a ten-year period revealed that the surgeon encounters more pathological variables than he does during primary operations. Hence, the technical solutions are less stereotyped and the net results less predictable. Prosthesis displacement, with or without incus tip erosion, was the most common primary cause of failure (82%). However, oval window problems such as footplate refixation, perilymph fistula, otosclerotic regrowth, and lateralized oval window membrane in 60% of cases often complicated prosthesis displacement. First revision operations in 174 cases resulted in postoperative bone-air deficit of 10 dB or less in 65% of cases, much better than the 45% for second revision results, and the 25% for third revisions. These statistics provide our practice with a realistic prognosis when discussing revision stapes surgery with the individual surgical candidate.

Bone Conduction↗
PubMed1985

Transmastoid extralabyrinthine approach in traumatic facial palsy.

Our experiences with thirty-six cases of intratemporal facial nerve palsies using the transmastoid extralabyrinthine (TMEL) approach are reported. Palsies were mostly traumatic in origin. The technique, first developed by us and reported in May 1980, spares the labyrinth and has the same indications for use as the middle cranial fossa approach to the seventh nerve. It avoids craniotomy and overcomes the limitations of the classic transmastoid approach, allowing exploration of the nerve from the descending portion to the geniculate ganglion and surrounding regions. When the ossicular chain is already damaged by trauma, surgery is made easier by removal of the head of the malleus and of the incus, which are then transposed at the end of surgery to reconstruct the chain. In particular cases the technique can also leave the chain intact. The TMEL approach has been used in 89% of patients with traumatic palsies due to longitudinal temporal bone fractures, with either an intact or, more often, a disconnected chain. Results of facial nerve and hearing function tests at twelve months are reported in detail. Our approach and similar techniques used by other authors represent an alternative to House's middle cranial fossa and Pulec's combined operations. Morbidity rate is lower and the operation can be performed by the majority of otologic surgeons.

Ear Ossicles↗
PubMed1985

"Three cartilages" technique in intact canal wall tympanoplasty to prevent recurrent cholesteatoma.

Residual cholesteatoma is the consequence of leaving squamous epithelium in the mastoid and middle ear cleft. It has been demonstrated that the only effective way to reduce the risk of epidermoid cyst neoformation is meticulous and radical removal of cholesteatoma matrix and staging of the operation, regardless of whether a closed or open mastoid cavity tympanoplasty technique has been performed. Recurrent cholesteatoma usually occurs after intact canal wall tympanoplasty secondary to middle ear, attic, and mastoid retraction of the graft, especially in cases with destruction of the scutum or absence of malleus and incus; this is still considered a major problem with this surgical technique. During the last five years we have been performing a procedure we have developed to avoid this retraction. Concave autogenous cartilage from the upper part of the concha auriculae trimmed in three pieces to protect attic, mastoid, and middle ear for graft retraction has been successfully used in 106 surgical procedures. This study describes the surgical technique and analyzes the anatomic and hearing results.

Cartilage↗
PubMed1985

Malleus to stapes assembly.

The malleus to stapes assembly is the ideal ossicular reconstruction because of its high degree of success. Unfortunately, both the malleus and the stapes have to be in good position to use this type of reconstruction making it much less common than other forms of ossiculoplasty. Over a six year period, 1976-1982, there were 20 such procedures performed, as compared to 85 cases of hemi-incus interposition ossiculoplasty in the same period. The malleus to stapes assembly technique and indications are described in this report. Reconstruction results show an 80% air-bone gap closure within 10 dB with an average improved speech reception threshold of 18 dB.

Adult↗
PubMed1976

[Experimental studies on the reaction of the immunological system during chronic otitis media and about the course of this disease (author's transl)].

During chronic otitis media intact immunoglobulins are split due to the proteolytic activity of extracellular bacterial proteinases into fragments of different molecular weight. The most malignant bacterial proteinases are the proteinases of pseudomonas aeruginosa (pyrocyanea). These proteinases can only be inhibited by alpha-2-macroblobulin of human blood serum. Because of its high molecular weight we find this inhibitor only in a very low concentration in the middle ear secretion. The destruction of the immunoglobulins is certainly one of the factors of weakening the immunological system in the middle ear. The inhibitory system with alpha-1-antitrypsin, inter-alpha-trypsin inhibitor and alpha-1-antichymotrypsin is unable to inhibit these bacterial proteinases of pseudomonas aeruginosa. The only possibility to get a high concentration of alpha-2-macroglobulin in the middle ear secretion is the liberation of this inhibitory by injuring blood vessels during a tympanoplasty. By this procedure the proteinases of pseudomonas aeruginosa with maximum activity at pH 7.8 and with a high proteolytic activity are almost completely inhibited. By blocking these proteinases combined with an appropriate antibiotic therapy and with the reconstruction of the destroyed parts of the middle ear by a tympanoplasty we can produce a preponderance of the immunological system as compared with the proteolytic activity of the proteinases. This high proteolytic activity can be a cause of the destruction of the small processes of the ossicular bones, especially of the lenticular process of incus. In order to demonstrate that there are proteolytic splitting processes of intact immunoglobulins, a quantitative analysis of the immunoglbulins IgG, IgA and IgM was done pre- and postoperatively. By these studies we found postoperatively a much higher level of intact immunoglobulins, particulary in cases of chronic otitis media associated with cholesteatoma. The blocking of the proteinases and the increase of the level of intact immunoglobulins combined with the reconstruction of physiological conditions in the chronically inflamed middle ear by a tympanoplasty lead to a stabilsation of the immunological and inhibitory system and create the prerequisites for a healing process in chronic otitis media. It is the purpose of further studies to learn about the capability of the split-products of the immunoglobulines to attach and to absorb antigens and toxins during a chronic inflammation in the middle ear.

Enzyme Inhibitors↗
PubMed1978

[Mathematical relationship between the dimensions of the auditory ossicles and fetal age].

Having applied morphometric data obtained on more than 400 auditory ossicles from prefetuses and fetuses at different stages of intrauterine development, the dynamic changes of the greatest size of the malleus, incus and stapes were investigated in age aspect. Increase in size of the auditory ossicles was stated to occur unevenly, every bone having certain periods of the most intensive growth. Mathematical relation of the auditory ossicles growth has been revealed and presented graphically, in an equation. This relation makes it possible to establish mathematically the dementions of the auditory ossicles at any stage of their development. And, according to the auditory ossicles dementions, it is possible to ascertain the fetus age, the data useful for medicolegal practice.

Ear Ossicles↗
PubMed1978

[Animal experiments about chondrogenesis in allogenic (homologous) auditory ossicles (author's transl)].

After the transplantation of allogenic ossicular transplants chondrogenesis could be observed during the integration process. This chondrogenesis in the allogenic (homologous) transplants could be demonstrated mainly in the area of the joint between incus and malleus. It is probable that the contact with a cartilaginous transplant bed of the host is very important for the chondrogenesis in the ossicular homografts.

Animals↗
PubMed1984

Conductive hearing loss, middle ear ossicular anomalies, malformed thickened lop auricles, and micrognathia. A rare autosomal dominant congenital syndrome.

A rare congenital autosomal dominant syndrome of thickened bilateral lop auricles, conductive hearing loss, ossicular anomalies, and micrognathia is reported. The anomaly is presumably a defect in the first and second branchial arch development during the sixth and seventh weeks of gestation with an auricle abnormality (first and second arch), abnormal incus and malleus (first and second arch), abnormal stapes (second arch), and micrognathia (first arch). Recognition of low-set or malformed auricles with a unilateral or bilateral conductive hearing loss should alert the otolaryngologist to possible middle ear abnormalities and other associated branchial cleft anomalies. Surgical correction of the congenital conductive hearing loss may include prosthetic ossicular reconstruction and otoplasty. The possibility of associated congenital anomalies of other systems (for example, vestibular, cardiac, genitourinary, reproductive, and so on) should be evaluated. An accurate pedigree and family medical and genetic history should be obtained to screen for other involved family members and for assessment of genetic passage of the trait.

Adult↗
PubMed1984

[Conduction deafness and collapse of the auditory meatus. Value and limitations of the stapedial reflex in conduction deafness].

Collapse of the auditory meatus constitutes an audiometric trap provoking a false transmission deafness. It can also permanently affect audition, whether it be primary in origin or post-mastoidectomy. The association of conservation of the stapedial reflex and transmission deafness is noticed immediately, but this is in fact compatible with an interruption in the chain by incus luxation. These notions must be known in order to avoid operation in false transmission deafness, and inversely to decide when to explore the cavity in certain post-mastoidectomy sequelae with meatal collapse.

Adolescent↗
PubMed1984

Reconstruction of hearing when malleus is absent: TORP vs. homograft TMMI.

To study the most appropriate ossicular reconstruction of patients with an absent malleus, a comparison was made utilizing a homograft tympanic membrane with attached malleus and shaped incus (TMMI) columella and the alternative use of underlay fascia tympanoplasty with a cartilage covered TORP. Forty-six patients were reconstructed with a homograft TMMI and 38 with cartilage covered TORP and underlay fascia technique; 4.5 years postoperatively, 84% of those patients reconstructed with a homograft TMMI maintained an average A/B gap of 25 dB or better. Though 1 year postoperatively the TORP hearing results were satisfactory, only 18% of the TORP patients maintained a hearing level within 25 dB A/B gap at 4 years postoperatively. Primary causes of failure of the TORP were instability with migration off the stapes footplate, protrusion or extrusion through the TM and finally, long-term softening and bending secondary to biodegradation of the Plastipore. The discouraging long-term hearing results found in the TORP patients in this study confirm similar findings reported in 1982 by Smyth in a 5 year follow-up on 116 TORP patients.

Cholesteatoma↗
PubMed1984

[Translabyrinthine approach in the surgery of acoustic neurinoma. How to shorten the operative time].

A procedure was sought for shortening duration of operation through an enlarged translabyrinthine (ETL) approach in acoustic neurinoma surgery. Two factors appear to be of primary importance. First, the equipment used must be adapted for the purpose and of reliable quality: the 3 M craniotome for the extralabyrinthine phase, the Zimmer AMSCO ototome for the labyrinthine phase, and Yasargil's autostatic retractor to maintain retraction of the temporal lobe and lateral sinuses. Second, a precise operative methodology: wide exposure and retraction of the temporal lobe and lateral sinus in all cases to provide a panoramic view of the labyrinthine region; ablation of the incus and initiation of a posterior tympanotomy to assist dissection to expose the 2nd and 3rd portions of the facial nerve; labyrinthectomy and identification of the internal auditory canal (IAC) in the region of the small fossa of the hemisphere as an aid to continuation of the operation; identification of Limaçon's aqueduct, which is a barrier that must not be crossed when exposing the jugular bulb and mixed nerve regions; isolation of the facial nerve in the base of the IAC by reclining the superior restibular nerve, the facial nerve lying just behind the latter.

Ear, Inner↗
PubMed1983

[Tympanoplasty with tragus cartilage transplant: "cartilage cover plasty"].

Transplants composed in three layers of tragus cartilage and perichondrium are ideally suited for eardrum transplants. They are easily prepared, well-nourished, stable and withstand retraction tendencies due to negative middle ear pressure. One overlapping perichondrium layer forms, so to speak, the live rail for the eardrum epithelium. To this perichondrium layer the cartilage disk is safely attached. The cartilage disk attached to its outer perichondrium layer--also covered by the perichondrium towards the middle ear--is thus fastened like a circular tape in the eardrum frame similar to the foot plate of the stapes. The eardrum seal is safe; in 87 operations we observed only one case of the edge coming away which was due to the transplant being too small. This type of transplant has proved its worth especially when reconstructing the ossicle chain with column protheses (TORP, PORP). The excellent hearing results may be explained by the optimum transformation of air pressure from the large cartilage via the medium-sized prosthesis screen, which is attached to the surface, to the small foot plate of the stapes. The "tragus" transplant can also be used in case of a Type III interposition of incus.

Cartilage↗
PubMed1982

[Piston-malleus. II (author's transl)].

The malleus appears to provide an effective solution in cases where the incus is absent and the upper part of the stapes cannot be employed, and when sound energy has to be retransmitted from the drum and the handle of the malleus to the labyrinth fluid. Total removal of the foot of the stapes with vein interposition is associated in nearly all cases. The method is not employed in patients with unfavorable positions of the ear-drum or handle of the malleus, the preferred procedure in the cases being the establishment of a direct communication between the ear-drum and the fenestra vestibuli, good results have been obtained.

Cochlear Implants↗
PubMed1982

Assessment of postoperative hearing in 528 middle ear and mastoid surgery cases in Tokai University Hospital.

The postoperative hearing results in cases of tympanoplasty, radical mastoidectomy, modified radical mastoidectomy and tympanoplasty combined with modified radical mastoidectomy on 528 ears, performed in the Tokai University Hospital between 1975 and 1980 were assessed. The assessment was based on pure-tone audiograms taken 3 months to 5 years after the operation. Out of 528 cases 70.5% gained better postoperative hearing, 6% showed no change of hearing and 23.5% showed deterioration of hearing. Auditory success of those who attained social hearing, air-bone gap closure to within 20dB or gained hearing of 20 dB or more was 53.4%. The results in cholesteatoma cases were poorer than those of non-cholesteatoma cases. In 44% of the cases, ossiculoplasty was performed, and the most successful ossiculoplasty results were obtained when the malleus was repositioned to the head of the stapes. Fairly good results were achieved when an artificial prosthesis, such as a Teflon-piston, Gelfoam-wire or platinum-piston, was used. The least successful results were found when the incus was transpositioned. In the non-ossiculoplasty group, type I tympanoplasty produced 59.5% auditory success whereas 37.3% auditory success was achieved in radical mastoidectomy. Better auditory success rates were obtained when the bony bridge was preserved than when it was removed. The results were identical in cases where the mastoid cavity was obliterated or when it was kept open. A new technique, "scutumplasty", was used for reconstructing the scutum. Revision surgery was required in only 3.4% of the cases.

Hearing↗