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At least 1,603 records · Page 89Linked to original sources
PubMed2005

Nitrogen accumulation during closed circuit anesthesia depends on the type of surgery.

STUDY OBJECTIVE: The aim of this study is to test the hypothesis that the amount of nitrogen that accumulates within the closed breathing system would be greater during open abdominal surgery than during superficial surgery with small wounds. DESIGN: Prospective, comparative study. SETTING: Operating rooms of a university hospital. PATIENTS: Fourteen American Society of Anesthesiologists physical status I and II adult patients scheduled for abdominal surgery (n = 7) or tympanoplasty (n = 7). INTERVENTIONS: After induction of anesthesia and endotracheal intubation, the patients were denitrogenated for 30 minutes using 100% oxygen at a fresh gas flow of 10 L/min. The breathing system was then closed and patients were anesthetized using 60% xenon in oxygen, supplemented with epidural anesthesia in the abdominal surgery group and sevoflurane in the tympanoplasty group. MEASUREMENTS: Nitrogen concentration in the breathing system was determined by gas chromatography immediately before and 2 hours after the breathing system was closed. MAIN RESULTS: The median (range) increase in nitrogen concentration during the 2-hour period of closed circuit anesthesia was greater in the abdominal surgery patients than in the tympanoplasty patients (6.5% [4.0%-10.2%] vs 2.5% [1.4%-8.4%], P = 0.035, Mann-Whitney U test). CONCLUSIONS: The amount of nitrogen accumulation during closed circuit anesthesia is greater during open abdominal surgery than in superficial surgery such as tympanoplasty. We postulate that during open abdominal surgery, nitrogen in the ambient air enters the body across the peritoneum and then diffuses into the alveoli to be exhaled.

Abdomen↗
PubMed1999

Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media.

OBJECTIVE: To assess the success rate of revision tympanoplasty with aerating mastoidectomy in patients with noncholesteatomatous chronic otitis media who had failed at least one prior tympanoplasty. STUDY DESIGN: Retrospective chart review. METHODS: Data were analyzed from 135 patients available for clinical and audiometric studies with a minimum of 18 months' follow-up. All patients had failed at least one prior tympanoplasty and presented with: 1) a persistent tympanic membrane perforation with intermittent drainage, or 2) a wet draining ear, unresponsive to systemic antibiotic and topical management. All patients underwent 1.5-mm, high-density, bone window computed tomography (CT) scanning to assess middle ear, epitympanic, and mastoid air cell pneumatization. All patients underwent revision tympanoplasty with aerating mastoidectomy via a postauricular approach. Patient charts were reviewed for information regarding preoperative radiographic findings, mucosal and ossicular findings at the time of surgery, and success or failure of revision tympanomastoidectomy. RESULTS: The tympanic membrane graft take rate for the entire group of 135 patients was 90.4% (13 grafts failed). A majority of the patients were found to have radiographic and intraoperative evidence of middle ear/mastoid disease. CONCLUSION: For patients with noncholesteatomatous chronic otitis media who have failed prior tympanoplastic reconstruction, an aerating mastoidectomy may be indicated and may improve the success rate of the surgery.

Adolescent↗
PubMed1998

[Surgical treatment of the tympanosclerosis].

Sixty-seven patients of tympanosclerosis were reported in this paper. All patients were underwent tympanoplasty. The results showed that the overall successful rate of hearing improvement following operation was 72.9 percent, there was no significant difference in postoperational hearing improvement rate between type I and II, III tympanoplasty patients, the results were better in the ears of patients without a sclerotic region around the stapes than in the ears of patients with a sclerotic region at the some site. Type II, III tympanoplasty was of benefit to patients with sclerotic regions around the stapes more than type I tympanoplasty.

Adult↗
PubMed1999

[The selection of tympanoplastic type in treating chronic suppurative otitis media].

OBJECTIVE: To investigate the effect of different type of tympanoplasty on chronic suppurative otitis media (CSOM). METHOD: Myringoplasty, focuses clearance and myringoplasty, focuses clearance and ossiculoplasty and myringoplasty were performed in 189 cases of CSOM. RESULT: The cure rate of perforation of tympanic membrane with myringoplasty was above 99% accompanied by the varying improvement in acoustic sensibility. CONCLUSION: Different types of tympanoplasty should be used according to the CSOM. The slighter the pathological changes of CSOM, the more the hearing improve. The better effects was in tympanoplasty of simple type. The tympanic exploration is necessary to be included in tympanoplasty.

Adolescent↗
PubMed2001

[Appraisement of the operative therapeutical effects of salpingocatheterism for refractory otitis media].

OBJECTIVE: The therapeutical effects of salpingocatheterism and the states of tubal function were studied after different middle ear operations and within different middle ear pathological changes. METHOD: Total 71 patients with tubal occlusion, 18 of myringoplasty, 20 of reconstruction of ossicolar chain followed tympanoplasty, 14 of combined approach tympanoplasty, 10 of radical mastoidectomy followed tympanoplasty, 9 of re-radical mastoidectomy followed tympanoplasty were implemented salpingocatheterism. The patients were followed up for evaluation of the postoperative therapeutical effects and the state of tubal function. RESULT: The causes of operation failure in different middle ear operations or different middle ear pathological changes had no significantly difference. The major cause for postoperative tympanic membrane perforation and tubal occlusion was the pathogenic damage being not cleared up thoroughly and/or there being nasal cavity or pharyngeal cavity pathogenic changes accompanied. CONCLUSION: Salpingocatheterism is effective for preventing eustachian tube postoperative adhesion.

Adolescent↗
PubMedDate not supplied

Postoperative cholesteatoma: are claims for the canal wall down technique justified?

To discover whether removal of the canal wall would reduce the incidence of postoperative cholesteatoma in tympanoplasty, the findings in staged, intact canal wall tympanoplasties were compared with those in staged, modified radical mastoidectomies with cavity obliteration and tympanoplasty. In all, cholesteatoma was considered totally removed at the first operation. The incidence of residual cholesteatoma was not significantly different in either group. It is concluded that staging in tympanoplasty for cholesteatoma is mandatory.

Cholesteatoma↗
PubMed1976

The surgical treatment of chronic otitis media in children.

The results of 150 tympanoplasties in patients aged 12 years and under are documented. Seventy-one ears were operated on by a transcanal tympanoplasty, of which 69 were intended to be single procedures but of which 12 required a revision operation. Combined approach tympanoplasty was performed on 79 ears, in which 42 operations were planned to be single procedures, 17 of whom required at least one revision operation. The results are described from the standpoint of control of disease and improvement of hearing. It is concluded that combined approach tympanoplasty can only be justified on a staged basis which has the added advantage of improving the results of ossiculoplasty.

Child↗
PubMed1995

[Chronic otitis media].

Results of middle ear operations performed between 1984-1989 were analyzed. The operations included 139 simple mastoidectomies, 68 radical mastoidectomies, and 41 simple mastoidectomies with tympanoplasty. 342 tympanoplasties were also performed, 51 in children up to 14 years old and 291 in those over 14. We conclude that the Schuller view and CT are not conclusive as to the presence of cholesteatoma, and cannot be relied on without other confirmation in planning the type of operation. Of patients with cholesteatoma who underwent simple mastoidectomy, in 21.1% the cholesteatoma recurred and revision or radical mastoidectomy was necessary. When the Eustachian tube was patent, the graft took in more than 90% of cases. Fibrin glue did not affect the results of tympanoplasty or myringoplasty. Graft take was similar in those under and over the age of 14. Tympanoplasty in children has a good chance of succeeding, and enables most to return to a normal life (including swimming).

Adolescent↗
PubMed1995

Composite autograft "shield" reconstruction of remnant tympanic membranes.

The authors present their combined experience with large cartilage-perichondrial composite grafts used to reconstruct total tympanic membrane perforations in 294 ears. Patients chosen for this procedure had failed earlier tympanoplasty surgery or were identified as poor candidates for conventional facial tympanoplasty because of the perforation size. Successful perforation closure was achieved in 97% of ears with chronic otitis media characterized by absence of the tympanic membrane, including portions of the anterior annular ligament. Hearing results in general were good, considering the advanced stage of the disease, which required the use of alloplastic ossicular prostheses (PORP and TORP) in 76% of ears. Hearing improvement was maximal at 2000 Hz regardless of the method of ossicular reconstruction. Closure of the air-bone gap at this frequency to within 10 dB was achieved in 87% of type I tympanoplasties, 73% of type III (PORP), and 70% of type III (TORP) tympanoplasties. Although cartilage autografts have also been promoted to reverse tympanic membrane atelectasis, the authors believe that the above preoperative conditions are strong indications for this grafting technique, which is described in detail.

Chronic Disease↗
PubMed1997

Analysis of middle ear mechanics and application to diseased and reconstructed ears.

OBJECTIVE: To review current concepts of the mechanical processes of the human middle ear, and to apply them to practical issues in clinical otology and tympanoplasty surgery. BACKGROUND: The wide range of conductive hearing losses associated with middle ear pathology and reconstruction cannot be adequately explained by simple models of middle ear function. METHODS: Variables used to describe the system are sound pressure, volume velocity, and acoustic impedance. The relationship between specific middle ear structures and these variables is described such that inferences can be drawn regarding sound conduction in the normal, diseased, and reconstructed middle ear. RESULTS AND CONCLUSIONS: Sound can be transmitted from the car canal to the cochlea via two mechanisms: the tympano-ossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. In the normal ear, middle ear pressure gain (which is the result of ossicular coupling) is frequency-dependent and less than generally believed. The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapescochlear input impedance are altered. Hearing after type IV and V tympanoplasty is determined solely by acoustic coupling. The difference in magnitude between the oval- and round-window pressures is more important than the difference in phase in determining cochlear input. In tympanoplasty types I, II, and III, adequate middle-ear and round-window aeration is necessary and the tympanic membrane-ossicular configuration may be less crucial.

Acoustics↗
PubMed1997

[More than 10 years of revision-cleaning and revision-reconstructive ear surgery in chronic otitis media; good long-term results].

OBJECTIVE: To describe the long-term results of revision surgery in patients with chronic otitis media. SETTING: University Hospital, Utrecht, the Netherlands. METHODS: A personal series of 323 revision mastoidectomies and (or) revision tympanoplasties was evaluated. Surgery was performed between 1981-1995 with a follow-up of one (minimal) to 14 years (maximal). Anatomical and functional results of various subgroups were compared. RESULTS: A preoperative incidence of cholesteatoma of 34% (n = 99) dropped after revision surgery to 11% residual/recurrent cholesteatomas (n = 9). A dry, safe and disease-free ear with a closed tympanic membrane was obtained in nearly 90% of the cases. However, in 5% (n = 10) without pre-existent cholesteatoma (n = 199), a cholesteatoma developed de novo after revision surgery. A residual air-bone hearing gap < or = 30 dB resulted in 79% of the patients after revision tympanoplasty only (n = 27). Revision mastoidectomy with revision tympanoplasty in open (n = 91) and closed (n = 92) procedures lead to a residual air-bone gap < or = 30 dB in 56% of the open cases (n = 91) and in 73% of the closed cases (before the operation the figures were 37% and 55% respectively). CONCLUSION: Revision mastoid surgery and (or) revision tympanoplasty can be quite rewarding and successful.

Adolescent↗
PubMed1998

Intracranial facial nerve neurinoma: surgical strategy of tumor removal and functional reconstruction.

BACKGROUND: Three cases with intracranial facial neurinoma underwent tumor removal and facial nerve reconstruction with or without tympanoplasty. Surgical strategy for each case was tailored to: (1) the site of main tumor mass, (2) its extension along the facial nerve, and (3) involvement of the auditory organs. METHODS: Surgeries adopted in the three cases were: transpetrosal approach with intracranial-intratemporal facial nerve anastomosis, middle fossa and transmastoid approach with intratemporal facial nerve anstomosis and tympanoplasty, and middle fossa and transmastoid approach with intracranial-intratemporal facial nerve anastomosis and tympanoplasty. The greater auricular nerve was used as the nerve graft for all three cases. RESULTS: In the follow-up period of 8-13 months there was no tumor recurrence; facial function was scored 20/90 in modified May's scoring system in each case, but two are still in the process of functional recovery. One of the two cases who underwent tympanoplasty showed complete recovery of hearing within 1 month, and the other showed worsened hearing, which was not serviceable at 3 months postoperatively. CONCLUSION: Systematic surgical approach for tumor removal, facial nerve reconstruction, and auditory reconstruction should be considered in cases with intracranial facial neurinoma due to its varied clinical features.

Aged↗
PubMed1993

[Ear manifestations in adolescents after closure of lip-jaw-palate- or isolated palatal clefts].

We examined two groups of teenagers who had been surgically treated as small children for cleft palate. Most patients were between 13 and 21 years of age. One group had been looked after by the Dept. of Orthodontics at the University of Erlangen-Nürnberg, the other by the Dept. of Orthodontics at the University of Rostock. There were differences in sequence and time of the surgical closure between the two departments. Additionally, 60% of the people treated in Rostock had a velopharyngoplastic, which was rarely the case in Erlangen. In both groups only a few patients had been seen by an ENT-doctor regularly. Only some patients had been previously treated with tubes. There was one patient in each group with a bilateral, most likely genetically determined, sensorineural hearing loss. In Erlangen we examined 66 teenagers (132 ears). Six ears had been previously treated with one or more tympanoplasties. 10 ears needed further treatment due to a seromucotympanon, adhesions, perforations of the ear drum, suspicion of cholesteatoma or insufficient improvement of hearing after previous tympanoplasty. Another 18 ears showed signs of former inflammations. The control group in Rostock included 63 patients (i.e. 126 ears). 14 of the ears examined had undergone one or more tympanoplasties previously. 13 other ears needed further treatment for seromucotympanon, adhesions, perforations of the ear drum, insufficient improvement of hearing after tympanoplasty or cholesteatoma. Residuals due to prior inflammations were found in another 26 ears. Possible reasons for the different occurrence of middle ear problems in both groups are discussed.

Acoustic Impedance Tests↗
PubMed1997

The Er:YAG laser in ear surgery: first clinical results.

BACKGROUND AND OBJECTIVE: The goal of this study was to gain experiences about the possibilities and limits of the Er:YAG laser for ear operations. STUDY DESIGN/PATIENTS AND METHODS: Eighty-three ear operations were performed with the aid of an Er:YAG laser: 32 stapedotomies, 15 tympanoplasties type III, 10 tympanoplasties type I, 18 ear operations in cholesteatoma, and 8 removals of hyperostosis in the outer ear canal. RESULTS: The Er:YAG laser facilitated stapedotomies and removal of hyperostosis from the outer ear canal. In cases of beginning cholesteatoma, the Er:YAG laser allowed matrix removal of the ear ossicles left in situ. Furthermore, in tympanoplasty it was possible to achieve an osteosynthesis of the auditory ossicles, which was done for the first time during this study. No hearing loss attributable to laser dose was found during postoperative hearing tests. CONCLUSION: The Er:YAG laser seems to become a useful tool in middle ear surgery.

Adolescent↗
PubMed1991

The effect of mastoid surgery on atelectatic ears and retraction pockets.

Forty children and 53 adults with a total of 111 atelectatic ears were operated on and followed up. Eight-four ears underwent tympanoplasty, while 27 ears underwent both a tympanoplasty and a mastoid operation. There were no statistically significant differences between the two operation groups as far as their age groups and the extent of the disease present. After follow-up of over 4 years, aeration of the middle ear was found to be better in the tympanoplasty group alone when compared with ears with also had mastoid operations.

Adolescent↗
PubMed1998

Preoperative hearing predicts postoperative hearing.

Optimal hearing is one goal of otologic surgery. It is generally presumed that hearing thresholds after tympanoplasty-mastoidectomy surgery are determined by remaining anatomy. We assessed the effect of the disease process on hearing after surgery, and our data do not support this presumption. We studied the relationship between preoperative and postoperative hearing across tympanoplasties with differing anatomies in 124 patients without ossicular reconstruction with prostheses or bone. Our results indicate that poor hearing before surgery is associated with poor hearing after surgery, regardless of anatomy (type of tympanoplasty). This relationship holds for both the airbone gap and the speech-reception threshold. When considering ossicular reconstruction, the surgeon should remember that the disease process itself affects hearing in addition to the physical attributes of the ear. These results should be considered in preoperative counseling, as well as in the interpretation of the otologic literature.

Audiometry↗
PubMed2000

Surgical management of the atelectatic ear.

OBJECTIVE: The surgical management of the atelectatic ear is controversial because the natural course toward cholesteatoma development cannot be predicted, and hearing acuity remains normal until later in the disease course. Consequently, surgery is often delayed until there is a clear indication, such as hearing loss or frank cholesteatoma development, but such delay often necessitates more extensive surgery. Because earlier intervention appears to be in the best interest of the patient but is often avoided because of near normal hearing levels at this stage, the author proposes a staging system for classification and management of the atelectatic ear. Hearing results and complications in patients undergoing tympanoplasty with or without ossicular reconstruction are reported for patients with type III and IV retractions. STUDY DESIGN: A retrospective study using a computerized otologic database to identify patients who meet the inclusion criteria. SETTING: A tertiary referral center. PATIENTS: A total of 55 patients (63 ears) aged 5 to 78 years underwent cartilage tympanoplasty with or without ossicular reconstruction. INTERVENTIONS: Elevation of the ear drum, followed by cartilage reconstruction of the tympanic membrane, with ossicular reconstruction as indicated. MAIN OUTCOME MEASURES: Postoperative pure tone average air-bone gap for four frequencies (500, 1000, 2000, 4000 Hz) compared with preoperative levels. RESULTS: There was a statistically significant improvement in hearing (p < 0.05). CONCLUSIONS: This staging system offers an effective treatment algorithm for pars tensa retractions and management of type III and IV retractions via cartilage tympanoplasty with or without ossicular reconstruction and is a proven treatment modality.

Adolescent↗
PubMedDate not supplied

Canalplasty for chronic tympanic membrane atelectasis.

PURPOSE: Canalplasty to prevent accumulation of squamous debris has been proposed as an alternative to tympanoplasty for the treatment of tympanic membrane atelectasis and early cholesteatoma. The goal of this article is to report our experience with canalplasty for the treatment of advanced middle ear atelectasis. MATERIALS AND METHODS: A retrospective review was performed on all patients that underwent tympanoplasty or canalplasty at the University of Florida since 1992. Eight ears (seven patients) with severe atelectasis were found to have been treated with canalplasty (without middle ear reconstruction) to marsupialize the retraction pockets. RESULTS: Follow-up was conducted at an average of 22 months. Four ears required repeat surgical intervention after an average of 12 months: three required canal wall down mastoidectomies for cholesteatoma, and a tympanoplasty was necessary in one case for persistent perforation. Four ears not requiring revision were without cholesteatoma or perforation at an average follow-up time of 26 months. Mean audiometric thresholds were stable or improved, irrespective of the need for revision surgery. CONCLUSIONS: Canalplasty may be an alternative for the treatment of atelectasis in selected patients; however, close follow-up after surgery is necessary because of the potential for progression to cholesteatoma.

Adolescent↗