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PubMed1990

[Sensorineural hearing loss following the decompression of the facial nerve].

This study aims to ascertain whether sensorineural hearing loss occurs after the decompression of the facial nerve. Nine patients have undergone decompression of the facial nerve (limited to the vertical segment) by the transmastoid approach were selected as the subjects of this study because the influence of disinfectants and surgical trauma on the inner ear seems to be less severe in this operation than in tympanoplasty. Additionally, this approach seems to be more suitable for judgement of the effect of the drilling noise induced acoustic trauma on the inner ear than tympanoplasty. Though high tone abrupt sensorineural hearing loss was occurred in the operated ear in seven patients, no changes in hearing level were found in the contralateral side ear. Bekesy audiometry performed in only one case revealed Jerger II which suggested some disorder in the cochlea. Not only acoustic trauma induced by the drilling noise but also labyrinthitis occurred via the opened facial canal and the internal ear canal seemed to be the cause of sensorineural hearing loss following the decompression of the facial nerve.

Adult↗
PubMed1993

[Computerized database system for pure tone audiometry].

The management and storage of pure tone audiometry data creates a major problem for otolaryngological clinics. We have devised a new computerized database system to overcome this problem. The hardware involved includes multiple audiometers and computers interfaced with a glassfiber local area network (Pi-Net). The software used is database 3 plus, a popular database language and utility software package. Programs were written for data entry, data transfer, reference, entry of patient ID, and evaluation of tympanoplasty. The following benefits of the system are noted. 1) Data entry is possible at every terminal (audiometer and computer). 2) Storage capacity is sufficient for more than 10 years of operation. 3) All data can be retrieved rapidly at any terminal. Evaluations of pre- and post-tympanoplasty hearing loss are facilitated by this system. This system is very effective for follow up of hearing disorders.

Audiometry, Pure-Tone↗
PubMed2002

Mastoid-obliteration surgery with cartilage for suppurative cholesteatomatous ears.

BACKGROUND: Autologous cartilage has been widely used as a material for tympanoplasty and mastoid-obliteration surgery. Since it remains vulnerable to an infectious condition, this study aims to evaluate if it can be used for a chronic suppurative cholesteatomatous ear to achieve single-stage tympanoplasty with mastoidectomy and obliteration of the cavity. METHODS: From January 1988 to August 1998, the records of patients with cholesteatoma who received cartilage-obliteration surgery performed by Dr. Lien were examined for any infection-associated problems within three months after the operation. The Fisher's exact test was used to compare the difference in the incidence of post-operative infection-associated problems between suppurative ears and non-suppurative ears. RESULTS: One hundred and seven surgical procedures performed upon 96 patients were included in this study, with 97 being primary surgical procedures and ten being revision surgery for previous open cavity with cholesteatoma recurrences. The average follow-up was 47.7 months. At time of surgery, there were 59 non-suppurative ears; 48 ears were suppurative and cultured. Granulations were found in the middle ear or mastoid for 42 ears (39.3%). Five ears (4.7%) exhibited infection-associated post-operative problems within three post-operative months. Three cases (5.1%) were non-suppurative ears and two cases (4.2%) were suppurative ears. There was no significant statistical difference when examined with the Fisher's Exact test. CONCLUSIONS: In an immunocompetent patient with a cholesteatomatous chronic suppurative ear, autologous cartilage could potentially tolerate an infection condition to serve as a material for mastoid-obliteration in a single-stage surgical procedure.

Cartilage↗
PubMed2003

[Sinus tympani in surgery of the middle ear and skull base].

Tympanic sinus is located at the medial wall of the tympanic cavity. It's visualisation is difficult from most of approaches. Tympanic sinus is often filled with cholesteatoma in course of chronic otitis. Intraoperative assessment of tympanic sinus was performed in 29 patients with facial recess cholesteatoma, and in 20 patients with acoustic neuroma operated with translabyrinthine approach. In the group of patients with cholesteatoma four patients underwent canal wall up tympanoplasty with posterior tympanotomy, 25 underwent canal wall down tympanoplasty. Tympanic sinus was assessed during surgery with 30 degrees endoscope. In all cases depth of the sinus was measured with the use of calibrated hook. In 11 patients depth of the sinus exceeded 4 mm. In 6 among these features of bone destruction was found.

Cholesteatoma, Middle Ear↗
PubMed2001

[Research of the chorda tympani nerve in cholesteatoma].

OBJECTIVE: To investigate the ultrastructure of the chorda tympani nerve and analyze the taste and facial nerve functions in patients with cholesteatoma. METHODS: 1. The tympanic segments of chorda tympani nerves were collected for ultrastructural investigations in 19 cholesteatoma cases who underwent canal-wall-down tympanoplasty. 2. All these patients received a spatial (regional) taste test preoperatively and postoperatively, respectively. Multiple loci were tested in a given order (front of the tongue, foliate papillae, circumvallate papillae, and soft palate). The solutions used in this study were 1.0 mol/L sodium chloride (salty), 1.0 mol/L sucrose (sweet), 0.032 mol/L citric acid (sour) and 0.001 mol/L quinine hydrochloride (bitter). The analyses of variance was used. 3. House-Brackmann facial nerve grading system was conducted to evaluate the facial nerve function preoperatively and postoperatively. RESULTS: 1. There were obvious ultrastructural damages in all the chorda tympani nerves, such as swelling (100%), disarrangement (100%), vacuoles formation of myelin (89%), edema of Schwann cells (95%), intracytoplasmic vacuoles in Schwann cell (89%) and proliferation of the collagen tissue (89%). 2. Two patients complained of change of taste after operation. The analyses of variance showed that the taste function of the ipsilateral side of tympanoplasty were not statistically altered for each stimulus at each locus (P > 0.05). 3. No facial palsy occurred postoperatively. CONCLUSION: This research suggested that the chorda tympani nerves underwent ultrastructural changes in patients with cholesteatoma. The dissection of chorda tympani nerve would not affect the taste and facial nerve functions.

Adolescent↗
PubMed1977

[Eustachian tube function and middle ear pressure with adhesive tympanic membrane (author's transl)].

The function of the Eustachian tube and the corresponding middle ear pressure are significant factors in the etiology of adhesive ear drums as well as in the prognosis of a possible tympanoplasty. In 58 patients with adhesive tympanic membrane tubal function and middle ear pressure were determined by means of the air pressure equalization technique respectively by direct punction. Normal or only slightly impaired tubal function as well as the middle ear pressure was found in one third of the cases, whereas in the majority of the patients an impaired tubal function and underpressure in the middle ear was registrated. As a precondition for a successful tympanoplasty the ventilation of the middle ear must be improved in these cases. At present this is achieved by a polyethylene tube inserted in the tympanic membrane during the operation.

Ear Diseases↗
PubMed2004

[Congenital and acquired cholesteatoma middle ear in children].

Cholesteatoma of the middle ear in children may cause hypoacusis. Early diagnosis and optimal treatment is neccessary for good functional effect. We present 57 children (58 ears) with cholesteatoma treated in ENT Department of Medical University in Gdańsk in 1991-2002. The age of patients ranged between 3 and 16 years, the most common 11-15 years. In 52 (89.6%) cases acquired cholesteatoma and in 6 (10.4%) congenital cholesteatoma was diagnosed. Epitympanal cholesteatoma was found in 32 children (55.1%) whereas in posterior part of tympanic cavity--in 20 children (34.5%). In 6 cases (10.4%) intact tympanic membrane was found. Mean air-bone gap in acquired cholesteatoma before treatment was 18.7 dB, after treatment 15.7 dB. In congenital cholesteatoma mean air-bone gap before treatment was 13.6 dB, after treatment 14 dB. The most frequent symptom was hearing loss (98.3%) and purulent otorrhea (85.4%). Positive bacteriological culture was obtained in 43.1% of the cases. X-ray revealed sclero-pneumatic mastoid in 26 (34.5%) cases, sclerotic in 25 (43.1%) and pneumatic mastoid in 7 (12.1%) cases. Intracranial complications were found in 2 cases, intratemporal in 2 cases and extracranial complication in 1 case. Radical surgery was performed in 23 cases (39.7%) and in each case, which required reoperation, modified radical mastoidectomy in 20 cases (34.4%), in another 15 children (25.9%) tympanoplasty was done. The most frequent failure was purulent otorrhea in 21 (36.2%) cases. Reoperation in cholesteatoma recurrence was performed in 17 children (29.3%). Improvement or the same as preoperatively hearing level was obtained in 35 (60.3%) ears, hearing loss was revealed in 23 (39.7%) ears. Treatment of temporal bone cholesteatoma in children is difficult due to silent beginning, aggressive growth and frequent recurrence. The best treatment results in children cholesteatoma are obtained in early clinical stage and with open tympanoplasty procedure.

Adolescent↗
PubMed2005

[Long-term results of functional surgery for attic cholesteatoma].

OBJECTIVES: We evaluated the long-term results of functional surgery for attic cholesteatoma. PATIENTS AND METHODS: In this study, we presented the results of 81 patients (42 males 39 females; mean age 34 years; range 8 to 59 years) who underwent functional surgical techniques for attic cholesteatomas between January 1992 and January 1998. All the patients were followed-up for at least five years. RESULTS: For eradication of attic cholesteatoma, canal wall-down technique tympanoplasty was required in the majority of the patients. After surgery there was a statistically significant hearing improvement in all but four cases. In the postoperative period, residual cholesteatoma and graft perforation were found in five and six patients, respectively. Two patients required revision meatoplasty for problems related with cavity clearance. CONCLUSION: Apart from satisfactory hearing improvement with functional surgery, a successful self-clearance was obtained in mastoid cavities with saucerization and meatoplasty. Canal wall-down tympanoplasty is associated with very low incidences of residual or recurrent cholesteatoma in the majority of patients.

Adolescent↗
PubMedDate not supplied

[Infantile cholesteatoma].

We present the results obtained in a group of 52 patients (55 ears), 15 years old or younger, diagnosed with middle ear cholesteatoma. After the evaluation of their clinical records, audiometry and X ray, surgery was performed by means of canal wall up procedures in 40 ears (72%) and canal wall down procedures in 15 (27%). The cholesteatoma was eradicated in 62% of the first group and in 86% of the second one. In 17 patients there was a recurrence. In those cases of canal wall up procedures they were transformed in canal wall down, or in the canal wall down the cavity was cleaned up. Only in 2 of these 17 recurrences, there was a second recurrence. In 7 cases a tympanoplasty was performed and the audiometric GAP was reduced in 57% and only in 19% when tympanoplasty wasn't performed.

Adolescent↗
PubMed1989

Incus replacement prostheses of hydroxylapatite in middle ear reconstruction.

Hydroxylapatite is a calcium bioceramic that has the same chemical composition as living bone, Ca10 (PO4) 6 (OH) 2. Since 1970 it has been used as a material in reconstructive prostheses and augmentation of lost tissues in various surgical specialties including maxillofacial surgery, plastic surgery, otolaryngology, and orthopedics. For over 20 years the author has used autograft and homograft ossicles in tympanoplasty. These incudi have been modified into prostheses that were utilized in ossicular reconstruction. During this time two principle prostheses have evolved, the notched incus with short and long processes. The short process prosthesis is used with an intact stapes, whereas the notched incus with long process carries the sound pressure directly to the stapedial footplate. These prostheses have been successful in improving and maintaining hearing following tympanoplasty. Unfortunately, however, the use of human tissue has certain limitations: it is not readily accessible and has a limited shelf life. Furthermore, clinicians are wary of using homograft tissue as concern over the AIDS virus spreads. Therefore it was felt prudent to develop a manmade prosthesis that would as nearly as possible match the advantages of living bone. Hydroxylapetite most nearly met those qualifications.

Adult↗
PubMed1987

[Cholesteatoma in childhood. Surgical treatment and results].

261 children with 281 cholesteatoma operations performed between 1970 and 1982 in the ENT-Clinic of the University of Tübingen were followed-up. In 77 ears an open technique (attico-antrotomy with removal of the posterior canal wall) was employed. In 103 ears a combined approach with posterior tympanotomy and preservation of the posterior canal wall was performed. In 47 ears an atticotomy with reconstruction of the lateral attix wall defect with tragal cartilage and perichondrium was done. The cholesteatoma was limited to the middle ear in 54 patients; treatment consisted of a transcanal tympanoplasty. 36.3% of the children had a residual or a recurrent cholesteatoma, 19.5% after open technique, 61.2% after a combined approach operation, 17% after atticoantrotomy and reconstruction of the scutum and 29.6% after a transcanal tympanoplasty. We therefore conclude that a second look operation is necessary especially after closed technique surgery.

Adolescent↗
PubMed1981

Deliberate hypotension for middle ear microsurgery.

By means of groups of one hundred patients undergoing middle ear microsurgery, we compared two hypotensive anesthesia techniques combining halothane, a non-depolarising myorelaxant and a beta adrenoreceptor blocking agent. Practolol, a beta 1 receptor blocker was administered to the patients of group A while those of group B received labetalol, a more recently introduced alpha and beta receptor blocker. The duration of microsurgery for each type of pathology was identical in both groups but the operation conditions (mostly the amount of bleeding) were better in group B (statistically significant). Moreover, the mean delivered halothane concentration could be reduced by 20% (from 0.85% to 0.68%). Thirty patients undergoing tympanoplasty were followed up for several months to determine the the importance of peroperative conditions in relation to the functional result of these operations. Excessive bleeding hinders the surgeon and the positioning of the implant and also, as confirmed by this study, makes the success of the tympanoplasty uncertain. Two factors likely to predispose the patient to bleeding (and able to be brought under control preoperatively) have been highlighted: these are overweight (obese status about 80 kg) and a systolic arterial blood pressure at rest above 140 torr. The various agents which were used and the reasons for their choice are discussed.

Adrenergic beta-Antagonists↗
PubMed1976

[The effect of ear surgery to the immunologic defense system of the middle ear during chronic otitis media (author's transl)].

Alpha-1-antitrypsin and alpha-2-macroglobuline are very important proteinase inhibitors for the healing process in chronic otitis media, because they can inhibit numerous bacterial and leukocytic proteinases: Alpha-2-macroglobuline can block the malignant proteinases of pseudomonas aeruginosa, staphylococcus aureus and proteus vulgaris. In 58 cases in the middle ear secretion was examined and the level of alpha-1-antitrypsin and alpha-2-macroglobulin investigated pre- and postoperatively. By these investigations we could demonstrate that the postoperative level of these two inhibitors is higher than preoperatively. In a couple of cases with cholesteatoma the postoperative concentration of alpha-2-macroglobuline was nearly three times higher than prior to the tympanoplasty. We believe that one of the causes for this high inhibitor level is the liberation of alpha-2-macroglobuline by injuring blood vessels during a tympanoplasty. It is our opinion that the increase of the inhibitor level in the postoperative phase is one of the prerequisites for the healing process in chronic otitis media.

Antibody Formation↗
PubMed1980

[Middle ear tuberculosis (author's transl)].

With the decrease in tuberculosis in general that of the middle ear has become a rarity, such that it is almost unknown to the younger generation of doctors. Nevertheless one must consider this diagnosis in all relapsing and treatment-resistant inflammations of the middle ear, especially when tympanoplasty procedures have been unsuccessful. Bacteriological findings are less reliable than histological proof and therefore examination of granulation tissue is always indicated. A precise history into earlier tuberculosis is important, since the disease is mostly disseminated haematologically. Two clinical examples with pathological descriptions are presented. In the first case fresh exudative disease similar to that of tubotympanitis occurred and quickly passed on to a chronic destructive middle ear inflammatory process. One year previously the patient had pleurisy. A complete cure followed surgery and antituberculosis therapy. In the second case a chronic proliferative and destructive inflammatory process was present with obviously less favourable reparative properties since two tympanoplasties were ineffectively performed.

Adult↗
PubMedDate not supplied

[The surgical treatment of cholesteatoma by a closed technique (author's transl)].

For the last ten years the closed technique (Combined Approach Tympanoplasty of Intact Canal Wall Tympanoplasty) has provided us with the best method for the treatment of cholesteatoma. Our objective during this discussion is to report on three technical features which produced significant progress in the quality and reliability of the results which we obtained: 1 - Enlargment of the posterior tympanotomy, 2 - Restoration of the attic wall, 3 - Using incus homograft for functional restoration in cases of missing crura of the stapes.

Cholesteatoma↗
PubMed1993

[Two-stage repair of microtia].

Modifications of the total ear reconstruction technique allowing a two-stage procedure is described. However this is only possible if the soft tissue has not yet been damaged by previous plastic surgery or tympanoplasties. The framework sculpture is improved in order to obtain a posterior conchal wall at the first stage without using a skin graft. A tissue expander is used during the operative time in order to improve the framework coverage. A bone anchored hearing aid is preferred to tympanoplasty when necessary, for bilateral microtia. This method is effective and does not compromise the skin qualities. The osteointergrated implant is put in place during the second external ear reconstruction stage. The total hospitalisation period is no longer than 8 days.

Ear, External↗
PubMed1995

[Tympanosclerosis--clinical and pathological investigation].

Fifty-nine cases of tympanosclerosis were investigated clinically and pathologically, and the following results were obtained: 1) The male to female ratio was about 1:1.8 2) Calcification in the tympanic membrane was most common in the upper quadrants of the pars tensa, and never seen in the pars flaccida. 3) Calcification in the middle ear cavity was most common around the malleus. 4) Chronic otitis media was the most common complication of tympanosclerosis. 5) Preoperative audiometry revealed a stiffness curve with elevated bone conduction thresholds. 6) 54% of the patient had chronic otitis media in the contralateral ear. 7) Microscopic examination revealed calcification in the submucosa of the middle ear. 8) Postoperative hearing was improved in 49 ears (79.7%). Because there was no difference in the average postoperative hearing gain after type I and type III tympanoplasty, type III tympanoplasty is recommended to remove sclerotic masses completely.

Adolescent↗
PubMed1995

Correlation of beta-2 transferrin and middle ear abnormalities in congenital perilymphatic fistula.

Congenital perilymphatic fistula (PLF) as a diagnosis for progressive, fluctuating, or sudden sensorineural hearing loss with or without vertigo is still controversial. Beta-2 transferrin is a protein that is unique to cerebrospinal fluid, aqueous humor, and perilymph. A recent pilot study demonstrated that beta-2 transferrin may be an objective test to determine the existence of a congenital PLF. The authors prospectively evaluated and recommended surgery for 43 children with suspected PLF over the past 3 years. A prospective, blinded study was performed by having the attending otolaryngologist evaluate the middle ear at the time of surgery for a PLF and any middle ear abnormalities. Samples of fluid were collected from the oval and round windows and were tested for beta-2 transferrin. Of 16 patients undergoing tympanoplasty or tympanomastoidectomy who served as controls, none were positive for beta-2 transferrin. Of the 43 patients undergoing exploratory tympanoplasty for PLF, 20 (46.5%) were considered to be negative for PLF on microscopic visualization; 23 (53.5%) were found to be positive. Of the 20 patients thought to be negative for PLF, 18 (90%) tested negative for beta-2, but 2 of these patients were positive for beta-2, and both had a congenital middle ear abnormality. Of the 23 patients found to have a PLF at surgery, 6 (26.1%) tested positive for beta-2, and all of these 6 had middle ear abnormalities. Of the 17 patients negative for beta-2, 9 had normal anatomy; 6 had middle ear abnormalities, and 2 had erosive changes. The authors conclude that beta-2 transferrin, an objective test, confirms the existence of congenital PLF in children, which is associated with middle ear abnormalities.

Adolescent↗