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Otoadmittance measurements in cases of dual ossicular disorders.

Audiologic evaluations, including otoadmittance measurements, were obtained on two patients, each of whom had dual, series-connected disorders of ossicular fixation and disarticulation. In one case, the disarticulation was the lateral-most disorder; in the other case the fixation was the lateral-most disorder. In both cases, it was the lateral-most disorder that had the dominant effect on the otoadmittance of the tympanic membrane, due to the fact that the sites of the two disorders were connected in series with the tympanic membrane.

Adult↗

Central perforations-safe or unsafe?

An analysis of 227 consecutive tympanomastoldectomies was undertaken to compare the types and degree of middle ear pathologic features that are found behind central perforations as compared with attic or marginal perforations. In this series, little difference was found between the two groups. A great deal of disease occurred behind all types of tympanic membrane perforations. Near-normal audiogram results did not guarantee a normal middle ear. Central perforations are not necessarily safe and should be treated with the same caution as attic or marginal perforations.

Cholesteatoma↗

Experience with a polyethylene total ossicular replacement prosthesis.

Surgical reconstruction of ossicular defects in chronic middle ear disease is a difficult problem. We have reviewed our results with the use of the Plastipore total ossicular replacement prosthesis (TORP). Of 29 procedures that were analyzed, nine were considered successful. None of our patients had a stapes superstructure, and 13 had no malleus. Placement of the TORP under the malleus handle and use of extra tissue between the prosthesis and the tympanic membrane provided better hearing results, but extrusion of the prothesis still occurred. Positioning of the prosthesis and contraction of the middle ear space, which causes extrusion of the prosthesis, remain problems in this type of reconstruction.

Adolescent↗

Tympanoplasty. Nasal cartilage homografts.

Permanent restoration of hearing is the goal of functional reconstruction in tympanoplasty. Nonbiologic prostheses have been abandoned for otic grafts. This is a long-term study of a group of 32 patients with type II tympanoplasties in which homografts of septal cartilage are used to reconstruct the sound conduction system. The good audiologic results obtained, with absence of immune reactions, allow recommendation of this technique in middle ear surgery.

Adolescent↗

Middle ear involvement in children with chronic rheumatoid juvenile arthritis.

In a selected sample of patients affected by juvenile rheumatoid arthritis (JRA) little is known about middle ear involvement, even though many synovial joints are affected. Multifrequency tympanometry was used to measure admittance, conductance, susceptance and phase angle at different probe frequencies and resonant frequencies. In all, 35 children with JRA and a control group (30 children) were studied. Findings showed that mean resonant frequency values in all children with JRA were greater than in the control children. The multifrequency tympanometry parameters measured in acute JRA subjects are not different from parameters of remission JRA subjects except for a change in the phase angle. The changes found are due to involvement of the incudomalleolar and incudostapedial joints.

Acoustic Impedance Tests↗

Production of parathyroid-hormone-related protein by cholesteatoma cells in culture.

Specimens of cholesteatoma were removed at surgery from five patients who had evidence of bone resorption. Parathyroid-hormone-related protein (PTHrP) was detected, by radioimmunoassay, in conditioned media from keratinocyte cultures derived from all five samples. Concentrations of PTHrP in conditioned media from secondary cultures were higher for the cholesteatoma cells than for normal keratinocytes from controls matched for age and sex. Thus, production of PTHrP by cholesteatoma may be a contributory factor in the bone destruction commonly associated with this disorder.

Adolescent↗

Surgery for congenital stapes ankylosis with an associated congenital ossicular chain anomaly.

The surgical findings and results are presented on 32 ears with congenital stapes ankylosis with an associated congenital anomaly of the ossicular chain. One third of the patients had a syndromal diagnosis. In 26 ears, stapedectomy could be performed. In 2 other ears, stapes ankylosis to the bony facial canal was mobilized successfully. In the 4 remaining ears, surgical intervention had to be limited to an exploratory tympanotomy for various reasons. The average hearing gain was 23 dB for the 28 ears on which stapes surgery had been performed. A substantial hearing gain of at least 15 dB was achieved in 19 of these 28 ears (68%). The end result was limited to a small extent by an average preoperative sensorineural component of 16 dB in the hearing loss. A review of the findings and results from other larger series in the literature are presented.

Adolescent↗