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At least 127 records · Page 7Linked to original sources

Unplanned admissions following outpatient otologic surgery: the University of Arkansas experience.

We analyzed the outpatient otologic surgery experience at our institution to identify those factors that are associated with a high risk of postoperative complications that require an unplanned hospital admission. We found that among a group of 662 patients who underwent group II otologic procedures (i.e., tympanoplasty with or without mastoidectomy, stapedotomy, and middle ear exploration), the overall admission rate was 4.7%, of which 3.9% were unplanned. A significantly larger percentage of children were admitted than adults (5.7 vs. 2.3%), primarily for nausea and vomiting. Three factors were significantly associated with unplanned admissions: the type of surgery (tympanomastoidectomy with ossicular reconstruction), the duration of general anesthesia (> 2 hr), and asthma as a coexisting condition. The choice of antiemetic administered (ondansetron or droperidol) and the specific agents used for general anesthesia did not appear to have any significant impact on unplanned admissions. We recommend that the three predisposing factors be taken into consideration when formulating the treatment plan. Scheduling an inpatient procedure for patients who have risk factors for complications requiring hospitalization would avoid the extra costs and stress associated with unplanned admissions.

Adult↗

Advances in otologic microsurgery.

Recent advances in otologic microsurgery have brought progress in the improvement of hearing impairment, alleviation of vertigo, and removal of skull base tumors. Refinement of stapedectomy techniques, use of new biocompatible prostheses, and other advances promise improved results with established otologic procedures. In addition, implantable hearing aids and cochlear implants will increasingly improve hearing in patients who previously could not be helped. The surgical methods for vestibular nerve section continue to be refined to help the surgeon and minimize risk to the patient. The challenging new field of skull base surgery has been opened through the combined efforts of otologists and other specialists. The recent advances in these fields are reviewed.

Ear, Inner↗

Otologic impairments in achondroplasia: a nosologic assessment.

The AA report a clinical and radiological study performed in 18 achondroplastic patients in order to achieve a nosological settlement of the otological impairments. They found two main otological syndromes; one, a congenital dysplasic syndrome, showing permanent conductive or sensory-neural hearing loss due to malformations of the middle ear or of the inner ear; the other, an inflammatory tubal tympanic syndrome with transient conductive hearing loss, which is relatively frequent in achondroplastic patients, but seems not related to the main disease.

Achondroplasia↗

[The neuro-otological findings of the multiple sclerosis (author's transl)].

The present paper is based on an exact analysis of the neurootological findings in 30 cases of multiple sclerosis (MS). Ms-diagnosis was verified using Schumacher's criteria and cerebro-spinal fluid findings. Central vestibular disorders were found in most of the cases. From our observation it may be assumed that the brainstem is an early site of involvement causing imbalance which can only be verified by an accurate neuro-otological evaluation. The most important pathological findings are the following: central spontaneous nystagmus, gaze-deviation nystagmus, positional nystagmus, disinhibition of induced (caloric and galvanic) nystagmus, delay of the reversal phenomenon of galvanic nystagmus,dysrhythmia as well as distorted optokinetic nystagmus. An extensive neuro-otological investigation is of clinical importance with respect to detecting cases of MS at an early stage of this disease.

Brain Stem↗

Hypercoagulability in otologic patients.

INTRODUCTION: Three patients with otologic disorders developed complications related to hypercoagulability. This report was prepared to increase the awareness among otolaryngologists of the diagnosis and management of hypercoagulable states, and to encourage expert consultation when indicated. MATERIALS AND METHODS: One patient with dural venous sinus thrombosis complicating an otitis media, one patient with a large glomus jugulare tumor, and one patient with a sudden sensorineural hearing loss were treated by the otolaryngology service. Suspicious thromboembolic events were evaluated by the hematology service, and appropriate anticoagulative therapy was recommended. RESULTS: One patient with an inherited hypercoagulopathy and two patients with acquired hypercoagulopathies were treated for otologic problems. Two of the patients were stabilized and discharged on life-long anticoagulation therapy. The third patient, in spite of intensive medical and surgical support, eventually succumbed to complications to which an acquired hypercoagulable state made a significant contribution. Expert consultants made the hematologic diagnoses and treatment recommendations. CONCLUSION: Otolaryngologists should be aware that hypercoagulable states may now be more accurately diagnosed and characterized, and that thorough investigation of thromboembolic events may affect treatment decisions.

Adult↗

Ondansetron versus droperidol or placebo to prevent nausea and vomiting after otologic surgery.

This study compares the preoperative administration of ondansetron with that of droperidol or saline solution for the prevention of nausea and vomiting in otologic surgery patients. A total of 120 otherwise healthy individuals were randomly assigned to receive either saline solution, ondansetron (4 mg intravenously), or droperidol (25 microg/kg intravenously) before anesthetic induction. Intraoperative and postanesthesia care unit times were recorded along with incidence of nausea, vomiting, pain, nausea and recovery scores, and the administration of rescue antiemetics. Similar assessments were made during the next 24 hours. Demographics were similar, but more males received ondansetron. Anesthetic recovery scores were lower after administration of droperidol than after ondansetron. Incidence of nausea was similar between groups, but severity was greater with placebo and droperidol than with ondansetron. More vomiting occurred with placebo than with ondansetron or droperidol. No intergroup differences in rescue antiemetic administration were noted, however. Twenty-four hours later, more patients receiving placebo had nausea or vomited than patients receiving droperidol or ondansetron. Fewer women in the ondansetron group vomited than in the other two groups. Ondansetron 4 mg intravenously is as effective as droperidol and better than saline solution in preventing nausea and vomiting in patients undergoing otologic surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter postanesthesia care unit times was noted after ondansetron therapy.

Adult↗

Automobile airbag impulse noise: otologic symptoms in six patients.

Automobile airbag safety systems have successfully reduced the number of occupant injuries from motor vehicle accidents. Unfortunately, airbags are also associated with some inherent risk, including a high-amplitude, short-duration noise from airbag deployment. A review of the available research in the automobile industry indicates that the peak amplitude of this noise may exceed 170 dB sound pressure level. Despite the increasingly wide application of airbags in automobiles, there have been no previous reports of airbag-related otologic injuries. We have encountered six patients with otologic symptoms that appear to be related to airbag impulse noise. Five of these patients have documented hearing loss, one patient reported persistent tinnitus, and two patients have significant dysequilibrium. Although permanent hearing loss from airbag noise appears to be rare, temporary threshold shifts are probably much more common. It is important, therefore, that the clinician be aware of the noise associated with airbag inflation and the possibility of acoustic trauma from these safety devices.

Accidents, Traffic↗

Otologic injuries caused by airbag deployment.

Airbags are clearly successful at mitigating injury severity during motor vehicle accidents. Deployment unfortunately has introduced new injury-causing mechanisms. A retrospective review of 20 patients who sustained otologic injuries resulting from airbag inflation was conducted. The most common symptoms were hearing loss in 17 (85%) and tinnitus in 17 (85%). Objective hearing loss was documented in 21 of 24 (88%) subjectively affected ears; this included unilateral and bilateral sensorineural, unilateral conductive, and mixed hearing losses. Ten patients (50%) had dysequilibrium. Four subjects (20%) had a tympanic membrane perforation; each required surgical closure. Ear orientation toward the airbag was found to be associated with hearing loss (P = 0.027), aural fullness (P = 0.039), and tympanic membrane perforation (P = 0.0004). A wide variety of airbag-induced otologic injuries occur and may have long-term sequelae. It is important for health care personnel to be aware of these potential problems.

Accidents, Traffic↗

Antiemetic effects of granisetron, droperidol and dexamethasone in otologic surgery.

The objective was to assess the antiemetic activity of granisetron, dexamethasone and droperidol in the otologic surgeries. Sixty patients in ASA (American Society of Anesthesiologists) I and II risk groups who underwent surgery for chronic otitis media were assessed in a double blind and randomized trial. The patients were divided into three equal groups. Single intravenous dose of granisetron (3 mg), granisetron (3 mg) plus dexamethasone (8 mg) and droperidol (1.25 mg) were prophylactically administered to the patients in group 1, group 2 and group 3, respectively, and their antiemetic actions were compared. The antiemetic effects of the drugs were not significantly different between the groups (P>0.05). The antiemetic effects also did not differ significantly in the early and late postoperative periods (P>0.05). In conclusion, the results of prophylactic use or side effects of granisetron, granisetron plus dexamethasone or droperidol are similar in middle ear surgery. Therefore, cost effectivity of the antiemetic prophylaxis should be reconsidered in otologic surgery in the light of the results of this study.

Adult↗

Neuro-otological study of positional vertigo caused by head injury.

A neuro-otological examination was given to 22 patients with paroxysmal positional vertigo within 1 week of head injury. In all cases, reverse rotatory positional nystagmus accompanied by a vertiginous sensation was observed in the positional nystagmus test. No relationship between the affected side and the direction of eye movement in the head-hanging position was found in the positional nystagmus test. From the prognosis and the nystagmus findings, the cause of the vertigo was thought to be partial damage to the inner ear. The clinical course was generally favorable, but recovery was slower in the 11 cases with neuro-otologically demonstrated central nervous system disorders than in the other 11 cases.

Brain Diseases↗

Otological manifestations of thalassaemia intermedia: evidence of temporal bone involvement and report of a unique cholesteatoma-like lesion.

Thalassaemia intermedia should be considered in any chronically anaemic patient presenting from the Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed two more anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sensori-neural hearing loss. Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineural hearing loss may complicate the thalassaemias is raised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest a more extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.

Adolescent↗

Bilateral sudden sensorineural hearing loss following non-otologic surgery.

Hearing loss as a complication of non-otological surgery is rare. The majority of described cases have followed cardiac bypass surgery. To date there have been only 25 reported cases of non-otological surgery associated hearing loss (NOSAHL) which have not involved cardiopulmonary bypass. Only two cases of bilateral NOSAHL have been previously described, and neither resulted in permanent severe bilateral hearing deficit. We describe a case of permanent bilateral severe hearing loss following metatarsal pinning in a patient with pre-existing non-operated otosclerosis.

Audiometry↗

Spontaneous otitis media in Wistar rats: an overlooked pathology in otological research.

The rat is commonly employed in otological research, but spontaneous ear infections can confound the results of experimental procedures--wasting time, money, and animals. The authors focus on the incidence of spontaneous otitis media in Wistar rats. They compare disease incidence in animals housed in standard cages with those housed in barrier units, showing that 20% of their conventionally housed animals developed spontaneous otitis media, whereas only 5% of their animals housed in isolated units were infected. These results underscore the importance of strict control of the shipping, housing conditions, and manipulation of animals to be used in otological research.

Animal Husbandry↗

Otological manifestations of primary ciliary dyskinesia.

Primary ciliary dyskinesia is a hereditary defect in the ultrastructure of cilia, leading to poor ciliary motility. The sinonasal and the bronchial manifestations of the disease are well documented; whereas its otological aspects have received less attention. In this report, we describe the clinical profile of 16 patients with primary ciliary dyskinesia laying particular emphasis on the otological manifestations. All children (11 patients) had bilateral otitis media with effusion. Of the five adults, three had tympanosclerosis; one had bilateral cholesteatoma; and one patient had bilateral keratosis obturans in combination with tympanosclerosis. Hearing improvement and a dry ear was achieved in all the children treated by tympanostomy tube insertion. The study suggests that otitis media is a prominent feature of this disorder. Most subjects suffer from protracted bilateral otitis media with effusion throughout childhood.

Adolescent↗

A retrospective case-controlled study of 1490 consecutive patients presenting to a neuro-otology clinic to examine the relationship between blood lipid levels and sensorineural hearing loss.

This study set out to test the null hypothesis that the distribution of blood lipid levels is the same in a population with a sensorineural hearing loss (SNHL) as in a control population. Hyperlipidaemia has been implicated as an aetiological factor in SNHL; however, the majority of reports are retrospective, lack adequate controls, or are based on a series of cases which may represent incidental findings and not a true causal relationship. In all, 1490 consecutive patients who presented to a neuro-otology clinic were studied retrospectively. This group is exceptional in that all patients had had fasting lipid profiles done regardless of their presenting problem. Those with a mean SNHL > 25 dB (0.5, 1, 2 and 4 kHz) were compared with those with hearing thresholds < or = 25 dB. An analysis of variance was also done. The study group was also compared with the National Study of Hearing data set to add external validity. Simple correlations were found between hearing thresholds and many parameters such as blood pressure, fasting glucose, triglyceride or fasting cholesterol. Analysis of variance of the neuro-otology group, controlling for variables such as age and sex, showed no significant association between hearing and blood pressure, packed cell volume, mean corpuscular volume, fasting glucose, triglyceride or fasting cholesterol. However, when general linear interactive modelling was used to analyse hearing thresholds, raised total fasting cholesterol was associated with significantly better hearing threshold levels. This study leads to a rejection of the Null hypothesis that the distribution of lipid levels is the same in a population with a hearing loss as in a control population, as hearing thresholds were found to be significantly better in those with raised cholesterol levels.

Adolescent↗

Otological trauma resulting from the Soho Nail Bomb in London, April 1999.

We report the otological effects of the April 1999 Soho Nail Bomb on 17 patients. Twenty-one (62%) tympanic membranes were perforated (pars tensa only); 78% closed spontaneously within 6 months. The mean size of the perforation in the tympanic membrane nearer to the blast was significantly larger than the opposite side [33% +/- 8.3 (mean +/- SD) and 13% +/- 4.1 respectively; P = 0.02]. All patients reported hearing losses that were mixed conductive and sensorineural but mainly high-frequency sensorineural (4, 6 and 8 kHz, pure tone average 42.3 dB +/- 20.5). The sensorineural hearing loss correlated inversely with the distance from the explosion but not with the size of perforation. There was no significant difference in the hearing loss between the ear facing the blast and the opposite ear. Fifteen patients (88%) had temporary tinnitus. No patient complained of any vestibular symptoms. The otological effects of a nail bomb in an enclosed space have not been previously reported. Furthermore, an inverse correlation between hearing loss and distance from the explosion and a significant difference in perforation size facing the blast, compared with the opposite side, are also presented for the first time. The high spontaneous closure rate of perforations and minimal ongoing disability from sensorineural losses favour conservative management in most cases.

Adult↗

[Ear thermometry from the otologic viewpoint].

Tympanic thermometry (TT) detects infrared emissions reaching a probe placed in the ear canal directed toward the tympanic membrane. This has been reported to be an ideal site for clinical temperature measurements. TT provides results rapidly, taking only one second. It is clean, safe, and there is no mucous membrane contact. Studies have primarily focused on the use of TT in pediatric office and emergency room settings. In the literature published to date, the otological viewpoint has not played an important role. Specially there is no systematic investigation of the influence of cerumen on TT. Twenty patients were examined. All of them had a complete obstruction of the auditory canal by cerumen. TT was performed before and after the removal of cerumen. It was found to have a significant impact on the ear temperature reading. After the removal, the temperature was higher by 0.5 degree C. In conclusion, one should consider that there can be a systematic error when using TT to determine body temperature. Nevertheless there are some important advantages compared to other methods of temperature measurements. Especially in the hands of physicians and nurses TT is accurate and can be recommended. However, at home in the hand of non-professionals there are some limitations and restrictions, particular when used in children. Further studies will have to be performed with a focus on otological problems and to determine the accuracy of TT in the non-professional user.

Adult↗

[True and artificial leeches and their use in otology. Images from the history of otorhinolaryngology, presented with instruments from the Ingolstadt German Medical History Museum collection].

Based on the concepts of humoral pathology in former centuries bloodletting was used as remedy to great extent, systematically by puncturing a vein or locally by scarification and cupping glasses. In the 18th and 19th century leeches were introduced and applied in huge numbers to cure all conceivable affections including diseases of the ear. J. M. G. Itard in Paris in 1821 for treating various types of hearing disorders recommended to place leeches at the anus or in the nose to imitate bleeding of haemorrhoids or nose-bleeds, which were considered natural resources of the body to cope with disorders of the humours. H. Schwartze in Halle in 1885 still followed this suggestion. W. R. Wilde in Dublin in 1842 and A. F. von Tröltsch in Würzburg 1867 advocated local blood-letting by leeches around the external ear. The surgeon Ch. L. St. Heurteloup in Paris 1840 invented an artificial leech, which was soon widely used in otology and ophthalmology. After the first World War the application of leeches became obsolete. The humoral pathology had found new approaches: immunology including stimulation of the inherent bodily means of defence, and rheology, particularly haemodilution. The historical development and the technique of applying live and artificial leeches in otology are described in detail.

Animals↗