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PubMed1982

[Use of a body acoustic probe and the conduction of brain stem potentials for the determination of sound conduction during tympanoplasty].

A new procedure of evoking brain stem potentials is introduced. Contrary to evoking brain stem potentials by acoustic stimulation via earphone or loudspeaker, we touch the middle ear apparatus at various locations using a piezoelectric transducer with a screwed-on probe, thus causing physiological movements within the sound conducting structures (Fig. 3). As a reaction to this kind of stimulation--1000 clicks with a duration of 0.1 ms were given--far field brain stem potentials can be recorded. The calibration of this special sound probe--not bigger than a pencil (Fig. 1)--was made by equalizing the mechanically and acoustically evoked guinea-pig brain stem potentials (Fig. 2). The intraoperative control of sound transmission to the inner ear is ascertained by the mechanically evoked potential's latency and amplitude. In order to apply the procedure in tympanoplasty we made a number of recordings after having simulated various kinds of middle ear pathology in the guinea pig. Four cases of various kinds of ear disease (interruption of the ossicular chain - Fig. 4 -, soft tissue bridge between incus and stapes - Fig. 5 -, otosclerosis - Fig. 6 -, Torp prosthesis - Fig. 7 -) are presented. As a result of our intraoperative recordings we can demonstrate that the presented method may be a valuable contribution to the examination of acoustic transmission through the middle ear during tympanoplasty under general anesthesia.

Animals↗

PubMed1981

Mastoid obliteration with primary ossicular reconstruction.

Soft tissue mastoid obliteration was used as a means to control a persistent draining mastoid cavity that would not respond to aggressive office management using meticulous cleansing, local antibiotics, and packing. Thirty-three draining cavities which could not be controlled medically, had soft tissue mastoid obliteration performed using a Palva flap. Of the 33 cases obliterated, 31 were successful in obtaining a dry cavity but two still required cleansing every four to six months. Primary reconstruction of the hearing mechanism was performed in 21 of the 33 cases, the others having severe pre-operative cochlear damage. Of those cases reconstructed, 13 were reconstructed using a TORP and eight were reconstructed using a hemi-incus interposition.

Ear Ossicles↗

PubMed1981

Ceramic implants in otologic surgery.

We have examined the suitability of ceramic materials for reconstruction in middle ear surgery. The excellent tolerance of bio-inert aluminum oxide ceramic implanted into the middle ear has been shown by our electron microscopic studies and clinical experience. Our implants developed for ossicular chain reconstruction were covered by a delicate middle ear mucous membrane within a few weeks. We have observed no foreign body reactions. The ceramic prostheses are distinguished by the almost unlimited number of forms or shapes into which they can be ground quickly and precisely during the operation. We value Al2O3 ceramic implants because there is no bony fixation with the surrounding bone, but rather a jointlike connection with the remaining parts of the ossicular chain. The composition of resorbable tricalcium phosphate, bio-active ceramic, corresponds to the inorganic component of bone. Because it exhibits the characteristic of being replaced by autogenous bone, we consider it for the obliteration of mastoid cavities. Based on our preliminary experience, dense tricalcium phosphate ceramic might play a valuable role in the reconstruction of the posterior auditory canal wall. In addition, we have used dense tricalcium phosphate ceramic to correct minor ossicular chain defects (for example, erosion of the long process of the incus). A survey is given concerning the indications and techniques for the use of these new materials in middle ear surgery, as well as our results covering a period of three years, which are very encouraging as far compatibility and function are concerned.

Aluminum Oxide↗

PubMed1981

[Surgical reconstruction of the sound conduction mechanism in congenital atresia of the ear (author's transl)].

125 congenital atresia of the ear have been operated from 1974 to 1980 in our O.L. department. Congenital atresia of the ear have a conductive type of 70 db which is stable. 45 had a lateral canal fenestration. 22 had an hearing improvement greater than 20 db. 45 had a tympanoplasty using a temporalis fascia graft and the ossicles when the malleo incus mass was mobile and had an adequate contact with the stapes. 25 out of these 45 cases had an hearing improvement greater than 20db. The other one had a tympanoplasty using tympano ossicular homograft with an hearing improvement greater than 20 db in 14 cases.

Child↗

PubMed1981

[Severe damage of middle and internal ear, caused by a knitting needle (author's transl)].

Report on severe damage of the left middle and internal ear, caused by a knitting-needle. Stapes together with footplate had been torn out of the oval window, incus and stapedial articulation had been disconnected. This damage caused tinnitus, severe giddiness and deafness. After the ear had been operated, giddiness and tinnitus ceased within a few hours. Using infusions after the operation (Rheomacrodex and Trental), hearing largely recovered.

Adult↗

PubMed1980

[Analysis of the usefulness of different methods of the evaluation of heart rate during work in work load studies].

The load of the circulatory system during work is usually evaluated basing on the heart beats above the heart rate at rest (i.e. the difference between the heart rate during work and at rest). To differentiate this evaluation according to the subjects' age, the percentage of heart rate reserve (the difference between the maximum heart rate and that at rest), constituted by the heart beats above the heart rate during work and at rest). To differentiate this evaluation according to the subjects' age, the percentage of heart rate reserve (the difference between the kers as well as at the model exercise on cycle ergometer in the group of students and female whitecollar workers has demonstrated that the heart rate before work is often higher than at breaks during the working day, whereas the heart rate during work depends on the output level when work results in a slight tachycardia. It was also found that incusion of the maximum heart rate results in much greater changes in evaluating individual groups--when it is calculated what percentage of this value constitutes heart rate at work, then when calculating the heart rate reserve percentage constituted by the difference between the maximum heart rate and that at rest. Therefore the calculation of the percentage of the maximum heart rate is promoted for evaluating the load of the circulatory system during work.

Analysis of Variance↗

PubMed1980

[Tympanometry when decomposing the sound conduction apparatus (author's transl)].

It is reported on tympanometric investigations of 21 postmortem temporal bones. Tympanograms (220 Hz probe tone) show increasing compliance maxima with stepwise destruction of the sound conduction apparatus. After sucking off peri and endolymph, opening the tympanic cavity and cutting the middle ear muscles compliance increments, however, are rather small and we get tympanograms within normal range. Only when cutting incus-stapes-connection tympanograms exhibit abnormal high compliance maxima. Therefore the value of tympanometry with 220 Hz probe tone should not be overestimated for clinical middle ear diagnosis.

Acoustic Impedance Tests↗

PubMed1980

[Adhesive process and cholesteatoma in the sequel of tubal disfunction (author's transl)].

By means of histological studies we could show: 1. Malfunction of the auditory tube is a reason for the development of the adhesive process and the retraction pocket. 2. The retraction pocket is the precursor of cholesteatoma, because of best conditions for the epithelial ingrowth. 3. Granulation tissue within the tympanic cleft is nutritive basis for the socalled matrix and allows the growth of the cholesteatoma. 4. We may have shown, that a cholesteatoma can develop inspite of an intact membrane, first of all if the pars fibrosa is lacking. 5. The cholesteatoma pushes inwards the distended tympanic membrane of the remnants of it. Resisting structures as the enwrapped long process of incus, the malleus or the tensor tendon allow the neck formation of the cholesteatoma. So the way is shown, which leads from serotubotympanitic catarrh and otitis media adhaesiva to adhesive process and cholesteatoma. The starting point is a tubal malfunction.

Cholesteatoma↗

PubMedDate not supplied

[The surgical treatment of cholesteatoma by a closed technique (author's transl)].

For the last ten years the closed technique (Combined Approach Tympanoplasty of Intact Canal Wall Tympanoplasty) has provided us with the best method for the treatment of cholesteatoma. Our objective during this discussion is to report on three technical features which produced significant progress in the quality and reliability of the results which we obtained: 1 - Enlargment of the posterior tympanotomy, 2 - Restoration of the attic wall, 3 - Using incus homograft for functional restoration in cases of missing crura of the stapes.

Cholesteatoma↗

PubMed1995

[An experimental study of middle ear implantable hearing device].

The partially middle ear implantable hearing device was designed and tested in 7 cats with conductive hearing loss and 5 cats with mixed hearing loss. It was composed of sound processor, connector and ossicular vibrator. The ossicular vibrator was made from piezoelectric ceramic bimorph which was constructed in the form of flat chip 6mm in length, 1mm in width and 0.5mm in thickness. The incus of cat was removed and the lip attachment of the vibrator was attached to the head of the stapes. The base of the vibrator was fixed to the bone wall of bulla with medical glue. The average values of the response threshold of ABR evoked by click via this vibrator got reduction of 37dB and 39dB respectively in conductive hearing loss group and mixed hearing loss group. The gain curve of hearing was flat in the range from 0.5 to 8kHz frequencies. The ABRs evoked by click via ossicular vibrator was similar to that recorded preoperatively in the wave shape. This result indicates that this device is a highly efficient sound conducting divice to inner ear.

Animals↗

PubMed1995

Preventive tympanoplasty in children: a new approach.

Chronic middle ear effusion with serous or mucus accumulation but without other associated tympanic and middle ear pathology can be successfully treated in many cases with myringotomy and ventilating tubes. But there are cases on which there are atrophic tympanic membrane areas with retraction into the middle ear, tympanic membrane adhesions to the long process of incus and incudo-stapedial joint with or without retraction toward the facial and tympanic recesses and shallow attic retraction pockets, which eventually will lead to cholesteatoma formation. All these minor anatomical distortions are usually asymptomatic, but with a potential to generate cholesteatomas throughout the years and cannot be corrected with a simple myringotomy and ventilation tube insertion. In these particular cases we have developed some types of tympanoplasty procedure that may prevent further progression to cholesteatoma formation. The purpose of this presentation is to describe these preventive tympanoplasty techniques and analyze the short and long term results in 68 surgical procedures.

Adolescent↗

PubMed1995

Hydroxylapatite implants for otologic surgery.

This article reviews the evolution of ossicular reconstruction from the autograft incus through homografts to hydroxylapatite prostheses in use today. In this way, a tried and true design has been combined with a mass-produced biocompatible material to produce a versatile prosthesis that will give excellent and consistent hearing results.

Biocompatible Materials↗

PubMed1995

Contactless semi-implantable electromagnetic middle ear device for the treatment of sensorineural hearing loss. Short-term and long-term animal experiments.

A contactless electromagnetic hearing device has been designed following basic science experiments, improvement of electronics, and precision micromechanics. Different prototypes have been developed and tested in the laboratory, fresh human temporal bones, and acute and chronic animal experimentation. A conductive hearing loss model was first developed in the cat using samarium cobalt as the target magnet. Later, a highly efficient electromagnetic air-core coil was selected to vibrate a neodymium iron boron magnet cemented to the body of the incus and tested in acute and chronic experiments using the cat as the model. In this group of animals, the ossicular chain was left intact. There was no failure of the target magnet, driving coil, or implanted electronics. The only problem encountered in this evaluation was a malfunction of the receiving antenna that had to be redesigned and retrofitted into the implanted units. This system would be suitable for the treatment of moderate to severe sensorineural hearing loss. Planning to begin human clinical trials is ongoing.

Animals↗

PubMed1995

[Preoperative X-ray computed tomographic evaluation of major aplasia of the ear in children].

PURPOSE: To describe computed tomography (CT) findings in congenital aural atresia (CAA) and to illustrate the impact of these findings in the preoperative evaluation. MATERIALS AND METHODS: Sixty-seven congenital aural atresia (bilateral: 10) in 57 children were studied using high resolution CT. Sections 1.5 mm thick were removed from the coronal and the axial plans without sedation (mean age: 9, 6 years). RESULTS AND DISCUSSION: A narrow bony external auditory canal (EAC) was present in 24% of the cases. In one of these cases, the EAC contained a cholesteatoma and was consequently a clear indication of surgery. An hyperpneumatized mastoïd (22%), a posterior position of the temporo mandibular joint (16%), and a bulging medial temporal fossa (12%) made the operation much more difficult. The tympanic cavity was small in 68% of the cases, normal in 28% and absent in 4% of the cases without any detectable ossicular chain. Ossicular chain anomalies were present in 91% of the cases. This consisted most frequently of a fusion of the malleus and the incus (76%) with or without fusion to the tympanic wall (33%). Lateral and anterior displacement of the descending portion of the facial nerve was present in 62%. Oval and round windows were normal in 86% of the cases. A soft tissue opacity (33%) in the tympanic cavity made it difficult to evaluate the stapes, the incudo stapedial articulation, and the facial nerve. Simultaneous abnormalities of inner ear were exceptional (1 case). CONCLUSION: High resolution CT is the best method in CAA evaluation and for guiding the planning of the surgical correction.

Child↗

PubMed1994

Pathological profile in chronic suppurative otitis media--the regional experience.

Peroperative findings in 145 consecutive cases of chronic suppurative otitis media, operated at Civil Hospital, Karachi were recorded. The mean age was 24 years. More than half of the patients (51%) had subtotal perforations and majority had damage of more than one ossicle. Involvement of all the three ossicles was seen in 30 (40%) cases. The frequency of damaged malleus along with incus was higher than other series. Granulations and subtotal perforations were commoner and could account for it. Extensive cholesteatoma was present in 30 cases.

Adolescent↗

PubMed1994

Ossiculoplasty in congenital hearing loss.

We have presented an extensive review of congenital ossicular anomalies. These deformities occur in combination with one another or as isolated problems with equal frequency. They are so rare that even the busiest otologists have limited clinical experience with them. The astute otologist will keep these facts in mind when assessing congenital middle ear problems in the office and in the operating room. Careful, detailed history taking may reveal the presence of familial conductive hearing loss or other congenital syndromes. Complete head and neck examination as well as observation of the extremities may provide clues to the otologic diagnosis. Microscopic examination of the ear reveals abnormalities of the tympanic membrane, malleus, and incus. Audiometric and radiologic evaluation augments physical examination. At surgery, the otologist must be prepared to perform a variety of possible surgical procedures, from traditional ossiculoplasty and stapedectomy to fenestration. Hearing aids are an option for patients with congenital ossicular anomalies, and the possibility of inoperability must be kept in mind; the patient must be prepared for this eventuality. Congenital ossicular anomalies present a challenge to the otologic surgeon, and their successful treatment, the greatest reward.

Child, Preschool↗

PubMed1994

[Evaluation of tympano-ossicular allografts in reconstructive surgery of the middle ear].

The results of 47 patients operated in I Clinic of Laryngology in Katowice was shown. They divided into two groups, depending on kind of allograft and type of reconstructive operation. In first group (25 patients) a total tympano-ossicular allograft had been applied. In second group (22 patients) implantation of eardrum with malleus handle and shaped incus allograft was performed. 39 patients operated by conventional method by using plastipor prosthesis served as a control. The functional results (mean values of pre and post operation air-bone gaps, and value of air-bone gap decrease) proved that the allograft application gave significantly better results in hearing improvement in comparison with a control.

Ear Ossicles↗

PubMed1994

[Salivary gland choristoma in the middle ear].

A choristoma is a non-neoplastic proliferation of histologically normal tissue occurring at an abnormal site. The first known Danish case of a salivary gland choristoma in the middle ear is presented. This is a very rare condition of which only 20 cases have been reported. A 16-year-old male was referred to the ENT clinic with a 60-70 dB mixed hearing loss on the right ear. Exploratory tympanotomy showed a lobulated mass attached to the horizontal portion of the facial nerve, which had an abnormal course lateral to the stapes. The incus and stapes were abnormal with no continuity. Biopsy showed salivary gland choristoma. Complete excision was not attempted. Postoperatively the conductive hearing loss was for some reason reduced by 20 dB. The facial nerve function was normal.

Adolescent↗