Rupture of the round window membrane in inner ear barotrauma.
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Results regarding tympanic healing and hearing improvement are reported in a series of 84 one-stage operations on the middle ear, using thin silicone elastomer sheeting, and of 76 two-stage operations using temporary filling of the middle ear with paraffin wax, and of ten with silicone elastomer sponge. All epithelium was removed from the tympanic cleft at the primary operation. Staging of the operation gave better hearing results and resulted in fewer adhesive middle ears. Middle ear mucosal biopsies from ears with mucus production around the paraffin showed an increased number of glands and secreting epithelial cells, much as in glue ears. Residual or recurrent cholesteatoma appeared in only 2.4%, which is attributed to resection of the posterior canal wall in cases of cholesteatoma, as contrasted with the intact canal wall technique.
Two consequences of a previous fenestration militate against successful stapledectomy. They are the lessened depth of the middle ear over the stapes, and the missing incus. Twelve years' experience of using the stapedectomy for fenestrated ears in 62 patients has given generally disappointing results until, in 1962, technique of using cartilage blocks to increase the depth of the middle ear was devised.
We discuss a method of pediatric audiologic assessment that employs the "cross-check principle". That is, the results of a single test are cross-checked by an independent test measure. Particularly useful in pediatric evaluations as cross-checks of behavioral test results are impedance audiometry and brain-stem-evoked response audiometry (BSER). We present five cases highlighting the value of the cross-check principle in pediatric audiologic evaluation.
The relationship between chronic alcoholism and auditory processing problems was examined using a central auditory test battery. Fifteen carefully selected alcoholic subjects and 15 age-matched nonalcoholic control subjects were evaluated using pure-tone thresholds, spondee thresholds, speech discrimination, acoustic reflex thresholds, performance-intensity function, Staggered Spondaic Word (SSW) test, Synthetic Sentence Identification (SSI), and temporal summation. Significant differences between the groups were obtained for acoustic reflex measurement, SSW, and SSI. A significant subject-related interaction was obtained for temporal summation measurement. Approximately half of the alcoholics yielded results consistent with brainstem pathologic features.
For some bilateral hearing losses, standard audiometric techniques cannot provide sufficient data for correct otologic diagnosis. These hearing losses are termed "masking dilemmas" because sound attenuation across the head is inadequate to prevent unwanted masking of the test cochlea. In most cases, the masking dilemma can be eliminated by presenting masking through an insert phone in the ear canal, rather than through a standard earphone and cushion. Insert earphones are not standard on most audiometers, but the minimal necessary equipment and alterations are inexpensive, readily available, and require little time to implement. Test time is not increased significantly. Some masking dilemmas will not be solved by the insert masker, but, when properly constructed and used, an insert masker will provide an accurate measurement of cochlear reserve not otherwise obtainable for most cases.
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Controversy exists regarding the appropriateness of offering all residents training in stapes surgery due to dwindling case loads in residency programs nationally. A recent study indicated poorer results for stapes surgery performed by residents than results obtained by practicing otologists. One hundred consecutive stapedectomies performed by residents over a three-year period at our institution were reviewed retrospectively, with the objective of determining whether these results should be generalized.
Ossicular reconstruction was performed in 102 ears using homologous, costochondral cartilage. The cartilage was presculpted into a total ossicular replacement or partial ossicular replacement configuration by a tissue bank and stored for later use. The performed transplants were further shaped in the operating room to suit the anatomical findings during tympanoplasty. The postoperative hearing results as determined by the airbone gap were comparable with those obtained with alloplastic materials (mean gap, 18.6 dB). No extrusions occurred; an analysis of hearing after three years showed that 96.7% of the initial hearing improvement was maintained in 51 ears available for study. Homologous cartilage in the total ossicular replacement or partial ossicular replacement configuration is as effective as alloplastic materials in ossicular reconstruction and it does not resorb or extrude with time.
A volumetric study on the tympanic isthmus and its relationship to temporal bone pneumatization was conducted in 110 serially sectioned temporal bones with and without middle ear pathology. With a microcomputer and digitizing tablet, the area of the tympanic isthmus and the degree of pneumatization in sample sections were calculated. Nonpathologic temporal bones showed a significant correlation between the volume of the tympanic isthmus and the degree of pneumatization. The narrowest area of the tympanic isthmus and the degree of pneumatization were also highly correlated. The result indicated a definite inhibition of pneumatization due to chronic middle ear infection when compared with nonpathologic temporal bones.
Partial reconstruction of old radical cavities was performed in 118 ears with well-epithelialized mastoid cavities but with problematic tympanic cavities. Total reconstruction was performed in 145 ears with chronically discharging cavities. Partial reconstruction included reconstruction of only the tympanic cavity, whereas in total reconstructions both the tympanic cavity and the external auditory canal were rebuilt, in most cases with obliteration of the mastoid cavity. The patients were reexamined several times during observation periods of up to 17 1/2 years (mean, 8 1/2 years) and the long-term results were analyzed. The primary functional results were good but deteriorated with increasing observation time. In 79% of the patients, the ears remained dry following total radical reconstruction.
The long-term results of myringoplasty in children, including closure of perforation and hearing improvement, were reviewed in relation to age, condition of the operated-on ear, and condition of the untreated ear. The overall success rate in 155 operations evaluated one year postoperatively was 79%. Children in the 5- to 8-year-old age group had a success rate comparable to that of older (9- to 12-year-old) children (77.7% vs 80.4%). Where graft failure occurred, it was usually within one year of surgery. The outcome of surgery could not be related to the presence or absence of chronic otitis media in the untreated ear, the status of the operated-on ear (whether dry or discharging), or the performance of adenoidectomy before myringoplasty. Results of postoperative hearing, analyzed by calculating the postoperative air-bone gap and by speech audiometry, were similar in the two age groups. It is concluded that myringoplasty has a good chance of success in children, regardless of age.
Thirty years of treating secretory otitis media by what is presently considered an alternate approach is discussed. Early experience with using a polyethylene tube in one ear only led to a formal study of the efficacy of polyethylene tube use when combined with adenoidectomy or adenotonsillectomy. This study included 31 children with chronic bilateral secretory otitis media treated by tonsillectomy and adenoidectomy. At the time of surgery, one ear was intubated and the other served as a control with no treatment. Using audiometric criteria, it was found that there was no significant difference between the intubated and control ears after a 6- to 8-week follow-up. Also documented is a series of 425 children suffering from chronic secretory otitis media, all of whom were resistant to prior ear, nose, and throat or pediatric treatment. Fifty-three children had tonsillectomies and adenoidectomies without tube insertion and were followed up for at least 1 year. Audiometry was used to measure the result of therapy that was successful in more than 90% of the patients.