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At least 847 records · Page 47Linked to original sources
PubMed1994

[Osteoma of the middle ear].

Osteomas of the middle ear are extremely rare. Those of the mastoid process being most frequent encountered als the tympanic sitting. Extracanalicular osteomas of the temporal bone are scarce. Bibliography about this particular subject account for 60 communications, only 9 with reference to the middle ear. The AA. report the case of an osteoma of the left incus in an 17-years-old boy, suffering a progressive deafness dating from 3 years term. The otoscopy showed a reddish mass protruding in the tympanum. TC and MNR provided evidence of a mass involving de auditory ossicula. Through an exploratory tympanotomy could be removed the anomaly. Histopathology make sure the diagnosis of osteoma. The AA. remark some clinical and surgical features of the piece compared with the other 10 cases reported in the literature reviewed.

Adolescent↗
PubMed1994

Bondy's modified radical mastoidectomy revisited.

The original criteria for modifying a radical mastoidectomy were: (1) an intact pars tensa and a defective pars flaccida with cholesteatoma; (2) normal or near normal hearing; and (3) an intact, functional ossicular chain. We propose a fourth criterion: that the cholesteatoma site be delineated lateral to the body of the incus. Control of the disease process is easily assured if the lesion is in that area. Our recommended fourth criterion is based on the results of a five-year study of fifty-two cases that met the original criteria. The cholesteatoma reoccurred in the middle ear in only one case. In six cases, periodic care is necessary because of retraction to the grafted attic area. The procedure and technique used in these patients and the excellent results are discussed in this article.

Austria↗
PubMedDate not supplied

Spiral CT of the temporal bone in unsedated pediatric patients.

PURPOSE: To determine the feasibility of performing rapid, high-resolution, low-radiation-dose spiral CT scans of the temporal bone in unsedated pediatric patients. METHODS: Axial spiral CT examinations with an effective section thickness of 1.25 mm were performed in 41 infants and children. Multiplanar reconstructions were generated using 360 degrees and 180 degrees linear interpolation algorithms. Three-dimensional reconstructions of the middle ear were also performed. RESULTS: Complete axial spiral scans were performed without sedation in all patients. Three hundred sixty-degree linear interpolation images had comparable resolution to conventional CT; 180 degrees linear interpolation images with an effective section thickness of 1.0 mm at 0.2-mm intervals showed good detail of middle and inner ear anatomy, and multiplanar reconstructions from this algorithm were comparable to direct scans. Three-dimensional reconstructions clearly displayed the oval window, malleus, and incus. CONCLUSION: Spiral CT is a clinically feasible method for rapidly evaluating the temporal bone in pediatric patients, eliminating the need for sedation. The images obtained from this technique are comparable to conventional CT. High-quality multiplanar reconstructions can be generated from the spiral data set, providing an alternative to direct scans in multiple planes. Additionally, three-dimensional images of internal temporal bone anatomy can be generated from the spiral data.

Child↗
PubMed1993

[Development of the auditory ossicles in the human embryo: correlations with data obtained in mice].

The comparison of human middle ear ossicles developmental features with morphological and experimental data obtained in the mouse embryo reveals some points of convergence. The stapes develops mainly form Reichert's cartilage, but the malleus and incus derived partially from the first arch cartilage (Meckel's) and from a Reichert's cartilage-derived blastema parallel to the tubo-tympanic recess. These results permit to validate the mouse model in teratological studies.

Animals↗
PubMed1993

[Anatomical and functional results of middle ear reconstruction with tympano-ossicular allografts].

Twenty five patients with severely damaged middle ears underwent reconstructive surgery with using total tympano-ossicular allografts. Two years long follow-up showed average air-bone gap about 20 dB or better in 44% of patients. Materials and methods used for reconstruction in two groups (part I and II) were compared, basing on anatomical and functional results. In patients with total perforation and lack of malleus, reconstruction with the tympanic membrane allograft attached to the malleus handle and shaped incus columella revealed long-term hearing results improvement (63.6% closure of air-bone gap within 20 dB) better than in similar patients with a total tympano-ossicular allograft (44% closure of the air-bone gap within 20 dB) during 2 years long follow-up.

Adult↗
PubMedDate not supplied

[Computerized study of perioperative difficulties of stapedectomy].

A retrospective study of 1035 stapedectomies was performed to assess the incidence of intraoperative complications between 1972-1990. We found 45.89% of complications. We divided this alterations in 6 groups: 1) hemorrhage (20.67%), 2) stapes, foot plate, oval window (8.40%), 3) alterations in the middle ear (6.85%), 4) alterations in the incus (3.76%), 5) alterations in the external ear canal (3.57%) and 6) problems with protesis or graf (2.60%). We have analyzed these complications. We propose to carry out the solutions.

Adolescent↗
PubMed1994

Osteoma of the malleus.

Osteomas of the temporal bone are benign neoplasms that may be encountered by otolaryngologists. Clinically they should be distinguished from exostoses, which involve the external auditory meatus and are a well recognized entity. Osteomas involving the middle ear and ossicles are extremely rare. There is only one case report in the literature of an osteoma involving an ossicle and in that patient, who presented with conductive loss, the incus was involved. The present report presents a 48-year-old white male, who on routine examination was found to have a mass in his left tympanic membrane. Under local anesthesia the mass was totally excised, after it had been separated from the umbo. Histopathologic sections of the mass revealed a benign osteoma. A brief review of osteomas and exostoses of the temporal bone is presented.

Audiometry↗
PubMed1994

Neuroma of the facial nerve masked by chronic otitis media.

The absence of facial twitching, weakness, or palsy makes the diagnosis of facial neuroma difficult. The authors report a case of neuroma of the horizontal portion of the facial nerve masked by the presence of a chronic ear. A woman with a long history of discharge and hypoacousia in her left ear presented with acute dizziness. Examination revealed grade 3 horizontal right nystagmus, left anacousia, and the appearance of an epitympanic cholesteatoma. Computed tomography (CT) was performed after the vestibular condition improved. The clinical diagnosis of chronic otitis media with cholesteatoma together with the radiologic finding of the mastoid and tympanic cavity completely occupied by soft tissue were enough to send the radiologist astray. The radiologic diagnosis confirmed that the bony destruction of the vestibule and lateral semicircular canal could be caused by a cholesteatoma. A neuroma of the horizontal portion of the facial nerve was discovered during surgery performed for the chronic ear. The postoperative study of the CT scans showed that there was no erosion of the malleus or incus, despite wide erosion of the vestibule and lateral semicircular canal. This finding would be enough to suggest the presence of pathology other than cholesteatoma. The patient refused exeresis of the neuroma. The authors recognize the difficulty in urging a patient to an operation that surely will result in worsening of the facial function. Follow-up in this case has revealed no change in tumor dimension or facial function over 3 years.

Cholesteatoma↗
PubMed1996

Successful revision of failed cochlear implants in severe labyrinthitis ossificans.

Labyrinthitis ossificans may complicate the insertion of a multichannel cochlear implant in patients deafened after meningitis. Two children who initially underwent partial insertion of a 22-channel cochlear implant because of severe cochlear ossification required revision surgery after several months of unsuccessful device use. At the time of revision, resection of the car canal, tympanic membrane, malleus, and incus provided access to the lateral wall of the cochlea, permitting extensive drilling of the basal turn and a circumodiolar placement of the electrode. Functional integrity of the electronic components of the original device was documented intraoperatively, avoiding the expense of a new receiver-stimulator. Complete insertion of the active electrodes was accomplished in both cases, and electrophysiologic responsiveness to the implant was documented using intraoperative electrically evoked auditory brainstem response recordings. Postoperative performance has been similar to that of cochlear implant patients with nonossified ears. Experience with these two cases suggests that efforts to optimize electrode insertion at the original surgical procedure are appropriate and may help to avoid the disappointment of an unsuccessful cochlear implant.

Child↗
PubMed1996

Ossiculoplasty by interposition of a minor columella between the tympanic membrane and stapes head.

This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded. The residual air-bone gap was < 20 dB in 86.1% of cases 2 months after surgery, in 77.0% 1 year later, and then remained stable over time, even in patients seen 5 to 15 years after the operation. Complications were rare. A total sensorineural hearing loss occurred in two cases (0.4%), the cause of which remained unexplained. Other complications included a high-frequency hearing loss in 10 (2.3%) cases, tinnitus in 12 (2.7%), and transitory vertigo in two (0.4%). We conclude that this type of ossiculoplasty is a simple but adequate procedure for primary restoration of hearing in chronic otitis media if the stapes is intact and mobile.

Adolescent↗
PubMed1995

[Contribution and role of the scanner in the preoperative evaluation of chronic otitis. Radiosurgical correlation apropos of 85 cases].

High resolution computed tomography (CT) is today the best imaging to study chronic middle ear diseases. In a retrospective analysis of 85 chronic otitis media (cholesteatoma or not), the authors emphazise the diagnostic value of CT scan, its preoperative's role and the radiologic imaging of cholesteatoma. In our study, the radiosurgical correlation rate is 0.6 regarding positive diagnosis in chronic otitis or cholesteatoma. The malleus and incus analysis is correct, but stapes is not observed in 40% of cholesteatoma. The correlation of surgical and radiographic findings is excellent regarding the scutum, the horizontal semicircular canal (> 0.7), the tegmen (= 0.6), bad for the canal of facial nerve (< 0.5). The actual extent of chronic otitis media lesions is overestimated by CT scan in 70% of cases. The correlation's rate is reliable for epitympanum and aditus. To conclude, the preoperative CT is necessary in those cases: closed eardrum cholesteatoma, single functional ear, clinical complications and doubtful diagnosis.

Adolescent↗
PubMed1996

Acoustic input impedance of the stapes and cochlea in human temporal bones.

The acoustic input impedance of the stapes and cochlea ZSC represents the mechanical load driven by the tympanic membrane, malleus and incus. ZSC was calculated from broad-band measurements (20 Hz to 11 kHz) of stapes displacement made with an optical motion sensor and of sound pressure at the stapes head in a human temporal-bone preparation. Measurements were made in 12 fresh temporal bones with the round window insulated from the sound stimulus. Below 1 kHz, the magnitude of ZSC was approximately inversely proportional to frequency, and ZSC angle was between 0.10 and -0.20 periods. This behavior is consistent with a mixed stiffness and resistance. Between 1 and 4 kHz, ZSC was resistance-dominated with a magnitude between 40 and 100 mks acoustic G omega that was roughly independent of frequency, and its angle was between -0.12 and 0 periods. Between 4 and 7 kHz, the magnitude of ZSC was either constant or increased with frequency while ZSC angle was near 0. Between 7 and 8 kHz, both ZSC magnitude and angle decreased sharply with frequency, and both increased somewhat at higher frequencies. The input impedance of the cochlea ZC was estimated in one ear from ZSC measurements made before and after draining the inner ear fluids. ZC was stiffness-dominated below 100 HZ, and resistance-dominated from 100 Hz to 5 kHz. The frequency-dependent magnitude of ZSC in our bones is similar to those reported by other investigators in cadaver temporal bones (Nakamura et al., 1992; Kurokawa and Goode, 1995). Our ZSC measurements are qualitatively similar to theoretical predictions (Zwislocki, 1962; Kringlebotn, 1988), but are a factor of 3 greater in magnitude, implying that ZSC may be more resistive and stiffer than previously thought. We found inter-ear variations of a factor of 4 (12 dB), which may explain some of the clinically observed variations in size of the air bone gap in individuals with middle ear lesions or after middle-ear reconstructive surgery.

Acoustic Impedance Tests↗
PubMed1996

Incudal folds and epitympanic aeration.

Thirty-seven temporal bones were dissected, and the posterior tympanic and epitympanic folds recorded and photographed. Histologic details were documented from four serially sectioned temporal bones, two normal and two inflamed. Of these 41 specimens, 31 were normal, and 10 showed signs of inflammation. The type for the lateral fold was incudomalleal in 16 and incudal in 25 ears. Incus intercrural and incudostapedial folds appeared only exceptionally. Medial and superior incudal folds were not present in normal ears. The anterior tympanic isthmus was a constant, large aeration pathway. In chronically inflamed ears, its partial or total block was caused by polypoid or large sheet-like folds. Inactive sequelae appeared as mature, simple, one-layer or extensive multilayer networks of webs, connected with a deeply indrawn incudomalleal fold. The small posterior isthmus was open to the incudal fossa in 13 ears, and in 28, it was sealed off by a posterior incudal fold. The mastoid air cell tracks were (in ten of 37 dissected ears) open to the incudal fossa, or directly, to the posterior tympanum. Auxiliary pathways due to membrane defects were found in both the horizontal and descending portions of the incudomalleal fold. Excepting the chordal, incudomalleal, and posterior incudal folds, fold-like webs in the posterior tympanum and epitympanum are of inflammatory origin.

Cholesteatoma↗
PubMed1996

[Malformation processes in the middle ear. Branchio-oto-renal syndrome (BOR)].

The present report concerns a case of Branchio-Oto-Renal (BOR) dysplasia. The syndrome is an autosomal dominant inherited disorder characterized by external ear malformations, branchial fistulas, conductive mixed or sensorineural hearing loss and renal anomalies of varying severity. The types of abnormalities that may be present are numerous and often difficult to identify preoperatively, despite modern imaging techniques. From the literature the reconstructive surgery of the middle ear in patients with the BOR Syndrome often has not been successful. In particular, the Authors report their experience in the surgical treatment of a case of BOR Syndrome. During intraoperative investigation a complex malformation of incus-malleus system was detected; thus, an ossiculoplasty, with PORP interposition, was carried out. Hearing results obtained with such intervention were successful, but they did not allow a complete closure of the cochlear reserve. Lastly, the Authors recommend a careful study of the different malformations of the middle ear, so that a more suitable preoperative therapeutic procedure may be planned.

Adult↗
PubMedDate not supplied

[Results of 769 stapedectomies performed between 1975 and 1993].

A retrospective review was made of 719 primary stapedectomies and 48 re-operations carried out between 1975 and 1993. Preoperative and postoperative audiograms (6-12 months) were studied, analyzing 250, 500, 1000, 2000 and 4000 Hz, auditory gain and closure of the air-bone gap < or = 10 dB. Ninety percent had an auditory gain of > or = 10 dB at conversational frequencies. Age, the surgeon, and average preoperative pure tone did not influence the final result. Polyethylene prostheses (70.9%) and steel and teflon pistons (21.1%) were the prostheses used most often. Neurosensorial hearing loss (> 10 dB) occurred in 24 cases (3.3%). In revision stapedectomy, 66.6% of patients had air-bone gap closure of < or = 20 dB and 71% had a hearing gain of < or = 10 dB. Prosthesis displacement (43.7%) and incus necrosis (18.7%) were the most common findings in revision stapedectomy.

Adult↗
PubMed1996

Development of a finite element model of the middle ear.

A representative finite element model of the healthy ear is developed commencing with a description of the decoupled isotropic tympanic membrane. This model was shown to vibrate in a manner similar to that found both numerically (1, 2) and experimentally (8). The introduction of a fibre system into the membrane matrix significantly altered the modes of vibration. The first mode "remains as a piston like movement as for the isotropic membrane. However, higher modes show a simpler vibration pattern similar to the second mode but with a varying axis of movement and lower amplitudes. The introduction of a malleus and incus does not change the natural frequencies or mode shapes of the membrane for certain support conditions. When constraints are imposed along the ossicular chain by simulation of a cochlear impedance term then significantly altered modes can occur. More recently a revised model of the ear has been developed by the inclusion of the outer ear canal. This discretisation uses geometries extracted from a Nuclear Magnetic resonance scan of a healthy subject and a crude inner ear model using stiffness parameters ultimately fixed through a parameter tuning process. The subsequently tuned model showed behaviour consistent with previous findings and should provide a good basis for subsequent modelling of diseased ears and assessment of the performance of middle ear prostheses.

Biomechanical Phenomena↗
PubMed1997

Acute human trial of the floating mass transducer.

Five patients underwent acute implantation of the Floating Mass Transducer (FMT) to evaluate the ability of the FMT to produce measurable auditory thresholds when temporarily placed in the middle ears of patients undergoing routine stapedotomy procedures. The FMT was placed on the long process of the incus in an inferior position, as is planned for clinical application, and in two additional positions. The ability of the FMT to produce measurable auditory thresholds was demonstrated in all patients. Results were affected by the lack of a healing period, the presence of a fixed stapes and an open middle ear space, and patient sedation.

Audiometry↗