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At least 865 records · Page 48Linked to original sources
PubMed1997

Tensor fold and anterior epitympanum.

HYPOTHESIS: The aim of this study was to investigate the anatomy and pathology of the anterior epitympanum and of the tensor fold. BACKGROUND: Early studies reported data that are primarily still relevant, but contemporary reports present conflicting data, including several erroneous concepts. METHODS: Fifty-one temporal bones were dissected, and the anatomic details were photographed in 42 normal and nine infected bones. Histology was documented from seven serially sectioned bones, five normal and two infected. RESULTS: The tensor fold formed the frontal wall of the anterior epitympanum between tensor tendon and attic bony wall, the anterior insertion consisting of composite connective and fatty tissue with some bone trabeculae. The transverse crest was posterior to it and extended from the anterior tympanic spine to the facial canal. The tensor fold angle in 78% of the specimens was between 45 degrees and 80 degrees, seldom horizontal, and the size of the supratubal recess (or space) increased as the fold angle increased. In 14 ears (27%) the fold had a membrane defect connecting the two spaces. Blockade of the tympanic isthmus caused inflammatory obliteration of the anterior epitympanum when the tensor fold was intact. CONCLUSIONS: The anterior epitympanum, a closed space around the anterior half of the head of the malleus, is normally closed by an intact tensor fold, but about one fourth of ears may show membrane defects. Aeration occurs via the tympanic isthmus through a constriction formed by the head of the malleus with the medial attic wall. In surgery for ears with epitympanal pathology, incus transposition should be combined with resection of the thin portion of the tensor fold for safeguarding permanent attic aeration.

Humans↗
PubMed1997

Semi-implantable middle ear electromagnetic hearing device for sensorineural hearing loss.

A semi-implantable middle ear electromagnetic hearing device (SIMEHD) is proposed for limited clinical trial in adult patients to evaluate the implantable hearing device for moderate to severe sensorineural hearing loss. Food and Drug Administration (FDA) investigational device exemption (IDE) approval has been granted (May 1996) for clinical trials. The implant unit has been evaluated acutely and chronically in animals (cats) with excellent results. Five cats undergoing chronic implantation were allowed to survive an average of 9.6 months, showing that the SIMEHD is biocompatible, functional and without untoward complications. All implant units recovered from the cats were functional, except for wire breakage of the internal antenna. A new antenna was redesigned for human implantation. The SIMEHD system consists of an external and internal unit. The external unit consists of a microphone, audio amplifier, modulator, radio frequency (RF) amplifier, antenna and battery. The internal unit is composed of a receiving antenna, hybrid electronic circuit, air core driving coil, and a target magnet cemented to the incus. All materials in contact with the body are biocompatible and expected to survive indefinitely. The implant unit is miniaturized and manufactured with existing fabrication technology by our industrial collaborator, Wilson Greatbatch, Ltd. The specific aims and major tasks of the proposed research are: a) to evaluate reliability, safety and efficacy of the SIMEHD system in a selected group of patients diagnosed with sensorineural hearing loss, due mainly to presbycusis or aging of the inner ear; and b) to obtain objective and subjective evaluation of audiologic and psychoacoustic performance as compared to the acoustic hearing aid. This paper describes the design, illustrates the actual device (newest prototype) and details the technique for surgical implantation in the attic and mastoid antrum in humans.

Adult↗
PubMed1997

Nucleus double electrode array: a new approach for ossified cochleae.

INTRODUCTION: The ossified cochlea is still a special surgical issue that requires a special surgical procedure. The current cochlear implants only have one electrode lead, which can be placed only partially in the drilled out basal turn. The small number of used active electrodes leads to worse performance as compared with patients with full insertion. METHODS: To overcome this limitation, a special electrode was developed consisting of two arrays. One array with 11 active electrode rings is placed in the drilled out basal turn, the second array with 10 active electrodes in the opened second turn. The number of inserted electrodes can be significantly increased. The surgery is similar to that in nonossified cochleae. After the posterior tympanotomy, the bridge is removed and the incus is located. A cochleostomy is performed at the basal turn and the new-built tissue removed. A second cochleostomy is placed below the cochleariform process. In most cases, the second turn is not obliterated and the second electrode array can be fully inserted. RESULTS: The surgical procedure was in all nine cases uneventful. Intraoperative stapedius reflex could be recorded with elevated thresholds. The wide variety of stimulation modes and sites allows an individual fitting to maximize the performance. All patients show a gap in the pitch scale between the apical and the basal array. The pitch variation is much smaller in the apical array. All patients have some benefit from the additional apical array and an improved performance. CONCLUSION: The nucleus double electrode array is an advanced treatment option for patients with ossified cochleae. The receiver/stimulator is a regular nucleus cochlear implant.

Cochlea↗
PubMed1997

Intact canal wall drill-out procedure for implantation of the totally ossified cochlea.

OBJECTIVE: To describe a simplified drill-out technique for insertion of a multichannel electrode in the completely ossified cochlea without radical mastoidectomy and obliteration. STUDY DESIGN: Description of a new surgical technique and case report. SETTING: Temporal bone dissection laboratory and tertiary referral center. PATIENTS: Adult and pediatric cochlear implant (CI) recipients. MAIN OUTCOME MEASURES: Access for circum-modular drill-out and electrode insertion without radical mastoidectomy and adequate function of multichannel CI. RESULTS: Dissection of 10 cadaver temporal bones demonstrated feasibility of this technique. Highlights include facial recess cochleostomy and 8 mm tunnel; elevation of superiorly based tympanomeatal flap; removal of incus, cochleariform process, and tensor tympani; and identification of carotid canal and use of facial nerve monitor. A case report of an 11-year-year old child with total cochlear ossification and previous failure of a short (8 electrode) CI electrode insertion is presented. Complete insertion of a 22-channel electrode was successful and open-set word recognition is commencing. CONCLUSIONS: The canal wall-up drill-out procedure allows complete electrode insertion without mastoid obliteration in patients with obliterated cochleas. Appropriate attention to the carotid artery and facial nerve is essential.

Child↗
PubMed1998

Prognostic factors in tympanoplasty.

OBJECTIVE: To assess the prognostic value of pathologic and technical variables influencing the functional outcome of tympanoplasty. PATIENTS AND STUDY DESIGN: Retrospective review of the records of 544 patients affected by chronic otitis with or without cholesteatoma, operated on by the senior author in a city hospital ENT department. Follow-up was provided systematically by the same institution. INTERVENTIONS: These included tympanoplasty without mastoidectomy in 339 cases, canal wall up technique in 134 cases, and canal wall down in 71 cases. Three hundred twenty-six (60%) were primary, and 218 (40%) were revision procedures. Myringoplasty was performed with autologous temporalis fascia, ossiculoplasty with incus interposition, or partial or total ossicular prostheses. Mean follow-up was 14 months (range, 12-50 months). MAIN OUTCOME MEASURES: Hearing results were defined according to the Committee on Hearing and Equilibrium Guidelines. A one-way analysis of variance was used to determine group differences. Multiple logistic regression analysis was subsequently carried out on the different pathology groups via the hierarchical log linear model. A probability value of p < 0.05 was the level of significance. RESULTS: The status of the mucosal lining, the mastoidectomy, the availability of the malleus handle, and the tympanic membrane perforation were all significantly predictive of the hearing outcome but with differing weight according to the pathologic condition. CONCLUSIONS: Anatomic and technical factors diversely affect the functional outcome of tympanoplasty. A better knowledge of their predictive roles and weights may be useful in both the surgeon's judgment and in the information given to the patient.

Adolescent↗
PubMed1998

Tympanoplasty for pars flaccida.

BACKGROUND: The formation of a retraction pocket of the pars flaccida remains a difficult problem for otologists to treat. It may lead to ossicular erosion and the development of a cholesteatoma, especially when the pocket is adherent to the malleus neck. We designed a new method of surgery for the treatment of small attic cholesteatomas. METHODS: From 1986 to 1996, 20 patients with a retraction pocket of the pars flaccida or a small attic cholesteatoma underwent surgery as described below. The complete lesion was removed after widening the posterior-superior bony external ear canal wall and placing pieces of conchal cartilage (usually less than 10 pieces, according to their scutum defect) lateral to the malleus neck or incus. The temporalis fascia was then laid. RESULTS: The average follow-up period was 32 months. The paired t-test was used to compare the results of preoperative and postoperative air conduction and air-bone gap. The preoperative average air conduction was 31.17 dB and the air-bone gap was 15.09 dB. The postoperative average air conduction was 20.66 dB and the air-bone gap was 3.09 dB. The difference between preoperative and postoperative measurements was considered significant (p < 0.05). No recurrent retraction pockets or cholesteatomas were noted during follow-up. CONCLUSIONS: Tympanoplasty for correction of a retraction pocket of the pars flaccida can prevent further attic retraction and the development of cholesteatomas. Postoperative hearing results were also encouraging.

Adolescent↗
PubMed1998

Abnormal branching of facial nerve with ossicular anomalies: report of two cases.

Two cases with almost identical anomalies of the facial nerve and ossicles were reported. The two girls, ages 9 and 14 years, with unilateral hearing loss underwent exploratory tympanotomy. A huge suprameatal spine and tumor-like swelling of the facial nerve at the tympanic portion as well as its abnormal branching at the pyramidal bend were noted; one of the branches of the facial nerve appeared on the surface of the temporal bone running through the tympanomastoid suture. The distal parts of the long process and lenticular process of incus were missing as if they were eroded by the swollen facial nerve, and the superstructure of the stapes also was absent. No anomaly was seen in any other part of their ears or bodies. This specific type of anomaly is considered rare and important in that surgeons may misdiagnose the swollen facial nerve as a tumor, resulting in facial nerve paralysis due to injury or unnecessary biopsy.

Abnormalities, Multiple↗
PubMed1998

[THe Laumonier wax model of the ear (Collections of the Museums of the Anatomy Laboratory of Saints Pères, Paris)].

Authentified by the name of Laumonier (fecit), written on the zygomatic process of the temporal bone, a model in wax of the medial, middle and lateral ears, belongs to the collection of the "Musées Delmas, Orfila et Rouvière" in Paris. This model presents large dimensions with a great anatomical rightness. The entire temporal bone is represented with the upper part of the endocranial petrous bone removed in order to demonstrate the main elements of the internal ear (cochlea and semi-circular canals) and of the middle ear (malleus and incus). Also were represented the temporal muscle and temporal vessels, the emergency of right cranial nerves, the superior orbital fissura and its elements; the internal carotid artery and the internal jugular vein, the upper part of the sterno-cleido-mastoidal muscle and of the styloïd muscles; the middle internal part of the basis of the cranium with the trunk of the trigeminal nerve, the Gasser's ganglion with its trifurcation, the sigmoïd sinus. The dimensions are greater than the real size: total highness: 22 cm; total length: 46.5 cm; maximal highness of the ear cartilage: 16.5 cm; hemicranium width: about 22 cm. Thus the magnification of size is 2 or 3 if calculated on the basis of the external ear and 3 or 4 with reference to the half width of the cranium. The sample is fixed by two screws on a single wood board measuring 46.5 cm on 29.2 cm with two supplementary boards of 2.4 cm width under the two extreme of width, with a thickness of 1 cm.

Ear↗