Indirect determination of variations in the inner ear pressure in man. An experimental study.
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Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadolinium T1-weighted MR images and/or echo-planar (EPI) diffusion-weighted (DWI) MR images. We describe the appearance of a case of a complicated attical middle ear cholesteatoma on single-shot (SS) turbo spin-echo (TSE) DWI compared with EPI-DWI. This case suggests a higher reliability of SS TSE-DWI in the diagnosis of acquired middle ear cholesteatoma.
The authors give a review of their experience with the surgical treatment of developmental disorders of the middle ear. They introduce to the findings and surgical solutions in the tympanum of their cases. In shaping the acoustic meatus they recommend the closed approach developed by Marguet.
The mechanical rigidity (breaking strength) of normal human ossicles, preserved with cialit and formalin, was studied in a tension compression testing machine. The bony structure of the ossicles before and after crushing was examined via high-grade magnifying radiography. With this new technique, minute bony details of the ossicles, which up to now could be demonstrated only histologically--consequently destroying the object--can be visualised without inflicting any changes to the ossicle. The different preservation methods had no effect on the structure or the mechanical strength of the ossicles. The fracture lines were distributed at random, with no preferential direction. In further experiments, defects in the ossicles' surfaces, which were cut with diamond burrs, were investigated radiographically and with a scanning electron microscope. The compressed bone dust seals up the opened marrow spaces. This reduces bone resorption significantly, as could be demonstrated with removed ossicular transplants similarly prepared, with had been implanted several years ago. The high grade radiographic magnification revealed that several ossicles which were removed during typical middle ear operations, were covered with metallic powder, originating from the intra-operative contact of the burr with the metallic suction tube. The 10% nickel component of the alloy may cause problems in patients with known nickel allergy, considering the intensive contact with the vast surface of the disseminated metallic dust particles.
The world literature was reviewed to determine which materials in ossicular reconstruction provided good long-term results. Several key publications were selected to illustrate particular points. Attention was paid to numbers of cases reported, reconstruction used, length of follow-up, and influence of middle ear disease. The review concentrated on three materials: bone, Plastipore, and bioglass. Results suggest that bone-to-bone ossicular reconstruction by experienced otologists can provide good long-term results even in high-risk ears. The review also suggests that other materials can provide similar long-term results in low-risk ears. Prospective studies with longer follow-up are needed to determine whether all materials provide comparable results in patients with comparable middle ear disease.
High-resolution CT scanning accurately depicts the status of the structures of the temporal bone, allowing delineation of pathology prior to surgical exploration of ears with cholesteatoma. It provides information concerning location and extent of disease as well as possible anatomic variations and complications that may be encountered. The main advantages of CT scanning over polytomography are superior soft-tissue contrast resolution and improved spatial detail at a reduced radiation dose for the patient.
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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.