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Rigid stapes fixation is not uncommonly found in chronic otitis media and can be caused by several conditions. Careful stapedectomy with some form of ossicular chain reconstruction is the treatment of choice, usually as a second stage procedure. Hearing results to date have been gratifying.
The technique of reconstructing the posterior canal wall with homograft knee cartilage originally described in 1972 is reviewed and refinements are presented along with additional cases. The homograft knee cartilage is used in conjunction with the homograft tympanic membrane and ossicles to rebuild the middle ear and mastoid as near as possible to anatomical configuration and function. Anatomical follow-up of one year or more is reported on 63 ears. Satisfactory results were obtained in 36 of these ears or 57% of the total. Hearing results are reported overall and in relation to different types of reconstruction. One year or more follow-up demonstrates satisfactory hearing with an air-bone gap of 20 db or less in 77% of the postoperative ears.
Transmeatal atticotomy, a common otosurgical procedure near the turn of the century, has since enjoyed only sporadic periods of popularity. An earlier report illustrated the efficacy of the atticotomy operation in ablating cholesteatoma in 83% of cases. However, the ossicular chain usually suffers discontinuity either through erosion by cholesteatoma or surgical disarticulation. In ears with an intact chain, the incudostapedial joint is usually separated to avoid injury that may be transmitted to the inner ear if the rotating burr contacts the ossicles. The purpose of this paper is to portray the types of hearing restoration attempted and the results achieved in 55 patients who had an atticotomy procedure and had been followed for six months to eight years. The number of patients who attained serviceable hearing are compared to those that did not, with regard to such factors as the hearing level and state of the ossicles preoperatively as well as the extent of the surgery required for removal of the disease. The hearing results in these patients who underwent atticotomy compare favorably to those cited in the literature for tympanoplasties done with the modified radical mastoidectomy or the intact canal wall tympanomastoidectomy.
High frequency conductive hearing loss can result from partial obstruction of the external auditory canal, ear canal "collapse," or partial ossicular discontinuity. This report describes the evaluation and management of an unusual case of partial ossicular discontinuity with resultant high frequency conductive hearing loss.
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This report describes the diagnosis and surgical management of two patients with similar inner ear malformations resulting in recurrent otitic meningitis. Each patient had a meningocele presenting through the oval window associated with Mondini's anomaly. Details of radiographic diagnosis and surgical management strategies will be discussed and long-term follow-up presented.
A one stage reconstruction of the tympanic membrane and the ossicular chain using a composite graft of tragal perichondrium with cartilage is described (Type III tympanoplasty). The long-term results in 18 operated cases reveals closure of the air-bone gap to within 0 to 10 dB in 72% of the cases. The above procedure used autologous graft material, does not disturb the remaining middle ear structures, can be performed under local anesthesia, and in most cases is done on an outpatient basis.
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Gantz, et al, reported two patients with extensive cochlear ossification in which cochlear implantation was done with a Nucleus 22-Channel Cochlear Implant after extensive cochlear drill-out. One of the patients did well with 20 functioning electrode pairs. We report an additional three patients with extensive cochlear ossification who received Nucleus 22-Channel Cochlear Implants. All three patients had extensive cochlear drill-out as described by Gantz, et al. All three patients have use of all 21 electrode pairs with amperages typical of conventional implantation in two of the three and slightly increased levels in the third. Extensive bilateral cochlear ossification does not seem to be an absolute contraindication for multi-channel cochlear implantation.
The incudostapedial joint was studied in tomograms of 370 normal and 80 diseased middle ears. The Guillen view was found to be superior to the anteroposterior view in demonstrating this joint in normal middle ears (85% and 62% visualization, respectively). In the presence of disease, visualization was markedly reduced to 19%; this lack of visualization is a nonspecific finding since early cholesteatomas, chronic otitis media, and retraction pockets could not be differentiated radiologically. Nonvisualization of the incudostapedial joint in the Guillen view is a more objective indicator of middle ear disease than such terms as "indistinct of hazy" middle ear cavities.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.