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Biomedical subjects

D Plester

Publications and source records attributed to D Plester.

At least 19 recordsLinked to original sources
PubMed1989

Anti-laminin antibodies in inner ear diseases: a potential marker for infectious and post-infectious processes.

Natural antibodies against laminin (ALA) have been detected recently in some acute and chronic infectious disorders. In our present study sera of a large number of patients with inner ear disorders of unknown etiology (n = 413) were tested for ALA. Control sera were taken from patients with diseases of known infectious etiology and patients with diseases of unknown etiology in which an infectious etiology was suggested. Patients with classical autoimmune diseases as well as healthy blood donors were also included in this study. The highest frequency of ALA was found in patients with sensorineural hearing loss (SNHL) (68%), whereas the incidence of ALA was comparatively uncommon in patients with Menière's disease (14%). In patients with chronic infectious diseases ALA were detected with almost the same frequency as in patients with SNHL. The elevation of the erythrocyte sedimentation rate and the association of ALA-positive SNHL with other chronic inflammatory disorders suggest that ALA might be stimulated by a persisting infectious process. These findings suggest that certain forms of inner ear disorders might have a chronic infectious etiology.

Autoantibodies↗
PubMed1989

High antibody levels against mouse laminin with specificity for galactosyl-(alpha 1-3)galactose in patients with inner ear diseases.

Sera of 413 patients with inner ear diseases were examined for ELISA binding to mouse laminin and compared to a normal group. Strongly enhanced antilaminin antibody reactions were observed in a large number of patients with sensorineural hearing loss (68%), tinnitus (60%), and sudden deafness (46%), but not in those with Meniere's disease (14%) or normal individuals (8%). Absorption experiments demonstrated that these antibodies are also responsible for the antisarcolemmal antibody pattern in the immunofluorescence test and for the reaction with pig kidney microsomes in the ELISA. Immunochemical studies showed that laminin binding of high or low titer in sera from patients and normal individuals is due to the Gal alpha 1-3Gal epitope present in N-linked oligosaccharides of mouse laminin. No reactions were observed with human laminin, which lacks this epitope. The findings suggest that high levels of antibodies against carbohydrate structures are triggered by persistent infections, providing some new insights about the possible cause of these diseases.

Adult↗
PubMed1989

Autoimmune hearing loss.

Tissue nonspecific antibodies may give an idea about the etiopathogenesis of the inner ear disease. They are of some prognostic and therapeutic value. They are routinely tested in most inner ear patients. On the other hand, inner ear specific autoantibodies do exist. Their diagnostic, prognostic and therapeutic significance are still unclear. Cellular immunity is tested only in selected cases based upon the clinical picture and the results of humoral immunity testing. It needs whole fresh blood as well as facilities not available in all laboratories. Their main role seems to be in providing solid basis for cortisone therapy justification. Our therapeutic concept proved to be promising in some cases. Immune-mediated inner ear disorders do not form a separate clinical entity. We would rather add immune mediation to the different causes postulated for the various inner ear disorders, as a plausible explanation for a certain percentage of the group categorized as idiopathic of unknown etiology.

Adult↗
PubMed1985

[The "old radical" surgery. History and development of surgery of the mastoid].

After a brief historical outline of the radical operation of the ear, the possibilities are presented which are at our disposal to construct a mastoid cavity after removal of the posterior bony wall of the auditory canal, thus keeping the problems for the patient at a minimum. At best, a small self-cleansing well-designed cavity is formed under favourable conditions. Important prerequisites for the construction of such a cavity are: A good overview obtained by smoothening of the cavity walls; widening of the auditory canal entrance (cartilage excision); removal of excess bone covering the facial nerve; and reducing the size of the cavity by means of a Palva flap while preserving the postauricular artery and its larger branches. Postoperative management (and cleansing) must be done with an operation microscope.

Cholesteatoma↗
PubMed1984

[When should an ear not be operated on].

Despite the low morbidity of modern middle ear surgery there are some limitations in indication. The age of the patient, the function of the Eustachian tube, the fibrotic middle ear, the cleft palate, the glomus tumour, Menière's disease and "the last hearing ear" of the patient are discussed as far as middle ear surgery is concerned.

Adult↗
PubMed1983

Experiences with Al2O3--ceramic middle ear implants.

The excellent tolerance of bio-inert aluminium oxide ceramic after being implanted into the middle ear has been shown by our electron microscopic studies and clinical experience over 4 years. Our implants developed for ossicular chain reconstruction were covered by a delicate middle ear mucosa within a few weeks. We have observed no foreign body reactions. The ceramic implants are distinguished by the almost unlimited number of forms or shapes into which they can be ground quickly and precisely during operation. We value Al2O3 ceramic implants because there is no bony fixation with the surrounding bone but rather a joint-like connection with the remaining parts of the ossicular chain.

Aluminum↗
PubMed1981

Idiopathic malleus head fixation as a cause of a combined conductive and sensorineural hearing loss.

Osseous fixation of the malleus is discussed as a cause of combined conductive and sensorineural hearing loss. The characteristic clinical, audiological and histological findings, as well as the aetiology of 66 patients with an idiopathic fixation of the head of the malleus is described. Ninety-four per cent of these patients had a sensorineural component to their hearing loss far greater than the loss that could be attributed to presbyacusis. Idiopathic fixation of the head of the malleus was the second most common of the fixed malleus syndrome in the series of 168 ears operated on in the Ear Nose and Throat Department of the University of Tübingen between 1972 and 1977. The treatment of choice is to keep the ossicular chain intact. Reconstruction of the disrupted chain is preferred in patients with poorly pneumatized mastoids. Only 15% of the patients with idiopathic fixation showed a significant improvement in their bone-conduction after surgery.

Adult↗
PubMed1981

The anterior tympanomeatal angle: the aetiology, surgery and avoidance of blunting and annular cholesteatoma.

Forty-eight cases of anterior annular cholesteatoma were treated surgically. All these cholesteatomas had occurred following surgical repair of the tympanic membrane by the onlay method. To confirm the likely aetiological causes, 49 specimens of the anterior annular sulcus were studied histologically. It was found that in 31% of specimens there was a fold of epithelium penetrating deep into the subepithelial tissue. In 6 specimens there were epithelial cones present and in 9 specimens excessive subepithelial fibrous tissue was noted. The complication of "blunting" caused by the onlay technique is almost impossible to avoid. A more dangerous complication is annular cholesteatoma. The surgery of blunting and annular cholesteatoma and the principles of the underlay method of grafting are described.

Cholesteatoma↗
PubMed1981

Tullio phenomenon with torsion of the eyes and subjective tilt of the visual surround.

A 44-year-old male patient had an acoustic trauma three years previously, after which he suffered from vertigo and tilting of the environment to the right when uttering the vowels u or e. At such times, a tonic eye torsion to the left, which lasted throughout the utterance, was observed under Frenzel's glasses along with head tilt to the left. The phenomenon could be elicited experimentally by right-ear stimulation with low-frequency noise (mean frequency, 125 Hz; 90 dB), as well as by constant pressure. The patient also reported observing the phenomenon with loud noises, nose blowing, obstruction of his right external meatus with the finger, and with altitude pressure changes in a car. This suggests that the phenomenon is elicited via the eardrum and the ossicular chain. Since lateral head tilt and counterrolling were tonic and without nystagmus, it is unlikely that one of the semicircular canals is involved as in usual Tullio cases. Rather, the otoliths may play a role in pathogenesis. Possible causative mechanisms are discussed along with the relevant literature.

Acoustic Stimulation↗
PubMed1981

Ceramic implants in otologic surgery.

We have examined the suitability of ceramic materials for reconstruction in middle ear surgery. The excellent tolerance of bio-inert aluminum oxide ceramic implanted into the middle ear has been shown by our electron microscopic studies and clinical experience. Our implants developed for ossicular chain reconstruction were covered by a delicate middle ear mucous membrane within a few weeks. We have observed no foreign body reactions. The ceramic prostheses are distinguished by the almost unlimited number of forms or shapes into which they can be ground quickly and precisely during the operation. We value Al2O3 ceramic implants because there is no bony fixation with the surrounding bone, but rather a jointlike connection with the remaining parts of the ossicular chain. The composition of resorbable tricalcium phosphate, bio-active ceramic, corresponds to the inorganic component of bone. Because it exhibits the characteristic of being replaced by autogenous bone, we consider it for the obliteration of mastoid cavities. Based on our preliminary experience, dense tricalcium phosphate ceramic might play a valuable role in the reconstruction of the posterior auditory canal wall. In addition, we have used dense tricalcium phosphate ceramic to correct minor ossicular chain defects (for example, erosion of the long process of the incus). A survey is given concerning the indications and techniques for the use of these new materials in middle ear surgery, as well as our results covering a period of three years, which are very encouraging as far compatibility and function are concerned.

Aluminum Oxide↗
PubMed1980

Middle ear tuberculosis.

Fourteen cases of tuberculous otitis media are reported. With the declining incidence of pulmonary tuberculosis, the number of reported cases of tuberculous otitis media has become scanty. Nowadays the so-called classical signs of the lesion such as a profuse discharge, profound hearing loss, facial paralysis and multiple perforations, are hardly ever seen. Surgical intervention when done under cover of anti-tubercular drugs has no deleterious effect on the result of surgery. In order not to miss tuberculous otitis media, whenever the otologist is dealing with chronic middle ear disease, the following points should always be kept in mind: (a) A dull ache in the ear without obvious inflammatory signs. (b) A whitish-grey appearance of the mucosa. (c) Bulging of granulation tissue from the mastoid cells during surgery.

Adolescent↗