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Biomedical subjects

D Portmann

Publications and source records attributed to D Portmann.

At least 19 recordsLinked to original sources
PubMed2006

How to take a mastoid and retro auricular thin skin graft.

The mastoid and retro auricular thin skin graft has an excellent quality, and is easy to take. An important hydrotomu should be done in the retroauricular sulcus to obtain a plane surface that goes from the posterior face of the pinna to the skin over the mastoid surface. This plane surface is the donor site and allows the harvesting with the electric dermatome. The characteristics of this graft are: The graft have the same color of the face, the same operative field, yielding an unremarkable scar in the donor site. The thickness is limited to 3 tenths of mm, and his size to 6 x 4 cm approximately.

Ear↗
PubMed2005

[Persistent stapedial artery and chronic otitis: CTscan aspects, a clinical report].

OBJECTIVE: The authors report a case of persistent stapedial artery in a young man who had a chronic ear infection with focus on the CT scan aspects. A review of the literature is done about this rare anomaly. CONCLUSION: Some CT scan aspects (absence of the spinosum foramina, bony canal from the hypotympanum toward the promontory, enlargement of the 2nd portion of the Fallopian canal) are very likely in favor of this diagnosis and allow a preoparative suspicion. If necessary a more complete imaging check up could be performed for searching other malformations.

Adult↗
PubMed2005

[Comparative results of type II ossiculoplasty: incus transposition versus titanium PORP (Kurz)].

OBJECTIVE: The goal of this study was to compare the anatomical and functional results of two groups of patients having an ossiculoplasty type II, either with the incus, or with a PORP Bell Vario prosthesis (Kurz). MATERIALS AND METHODS: Retrospective study concerning 98 patients having had an ossiculoplasty type II with the incus (Incus group) and 50 patients having received a PORP titanium prosthesis Bell Vario from Kurz (Titanium group). RESULTS: The rate of extrusion was small (1% Incus group and 4% Titanium group). Average preoperative air bone gap of patients who received the Titanium prosthesis was 21.2 dB and 42.8 dB for the incus group. The average postoperative air bone gap was 16.9 dB Titanium group and 25.5 dB Incus group (p < 0.05). The gain was 18.7dB in the Incus group and 4.3 dB in Titanium group (p < 0.05). The difference between pre and post air conduction thresholds in both groups was statistically significant (p < 0.05). The post-op airbone gap was less on 20 dB in 62% of cases (Incus group) and 61% (Titanium group). There was no significant loss of the bone conduction thresholds in each group. CONCLUSION: Audiometric results obtained among patients with an incus transposition are better than those obtained with a PORP Titanium prosthesis. These results are to be appreciated by taking account of the greatest proportion of cholesteatoma and of reoperation in the Titanium group. The PORP titanium Bell Vario prosthesis (Kurz) is a material well tolerated by the middle ear as shown by the low rate extrusion. Its qualities (easy and precise measurement, easy positioning) make a material of choice of it when the patient's incus is not usable.

Adolescent↗
PubMed2005

[Reinforcing tympanoplasty with cartilage mosaic (differences from the palisade technique)].

OBJECTIVES: To demonstrate the interest of cartilage mosaic tympanoplasty in the reconstruction of the tympanic membrane. MATERIALS AND METHODS: Retrospective series of 103 patients; the authors analyzed their results after cartilage mosaic tympanoplasty, with a mean follow up of 3.5 years (3 to 7 years). They explain the surgical technique in detail. The average gain was calculated on the difference of the pre-and post-operative thresholds in air conduction on the four frequencies 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz. RESULTS: The authors detail and analyze their anatomical and audiologic results. The total rate of closing of the tympanic membrane is 93.2%, accounting for 96 perforations closed among 103. A tympanic retraction sitting apart from the reinforced zone was noted in 0.97%, representative only one case of 103. Then the total rate of success is 92.23%, representing 8 failures of 103. The average pre- and post-operative air bone gap were 26.5 dB and 14.6 dB. The average gain was 12.5 dB (extremes of 0 dB to 40 dB). CONCLUSION: The authors show the great reliability of cartilage mosaic tympanoplasty to reconstruct the tympanic membrane. They widen the indications with all types of tympanoplasties. Especially with the recurrent perforations, and the perforations evolving in an inflammatory context and/or dysfunction of the Eustation tube. Their results show a major interest to use this technique in the anterior and inferior perforations, and whatever the ossicular chain status.

Adolescent↗
PubMed2005

[Validation of a clinical scale for the diagnosis of perilymphatic fistula].

INTRODUCTION: The diagnosis of perilymphatic fistula (PLF) is difficult because no single clinical situation gives the diagnosis for sure. The goal of this article is to study the clinical situations where you must suspect a PLF and to support a clinical scale described in a previous work (Bussières et al 2003). METHODS: Retrospective study of 15 patients that had an exploratory tympanotomy with a PLF not confirmed preoperatively. An analysis of the symptoms, signs and complementary exams were done. The surgical technique and findings and the postoperative evolution were noted. RESULTS: There is 66.7% of hypoacusis the most frequently symptom (postoperative improvement of 26.7%); after came vertigo present in 60% (postoperative improvement of 44.4%) and tinnitus present in 53.3% (postoperative improvement of 25%). The trauma history is always positive, most of then is typical (80%) and the other one are atypical (20%).The diagnosis of PLF has been determined in 5 patients in the follow-up according to the improvement of the symptoms. These patients had a score > 7 at the clinical scale. CONCLUSION: The sensibility and specificity scores of the clinical scale are respectively 100% and 70% in this study.

Cochlear Aqueduct↗
PubMed2004

[Tinnitus: first symptom of chronic myeloid leukemia].

In this article, we present a 53 year old patient who had an acute tinnitus that led to the diagnostic of chronic myeloid leukemia(CML). This symptom allowed an early diagnostic of the disease and a more favorable pronosis. This case demonstrates the inportance of blood tests for every patient who presents a tinnitus of unknown origin.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Invasive cholesteatoma of the old radical mastoidectomy].

OBJECTIVE: The aim of this study is to show the importance of computed tomography scanning (CT) and magnetic resonance imaging (MRI) in ancient radical cavities and to determinate the risk factors of an invasive cholesteatoma recurrency. MATERIAL AND METHOD: We present 4 cases of medial invasion in the petrous bone of a cholesteatoma without specific symptomatology which appeared many years after undergoing radical mastoidectomy for an acquired cholesteatoma. CONCLUSION: The analysis of this series allowed to put in evidence the factors of suspicion of an underlying cholesteatoma. They are: the age, an aural discharge, numerous surgical interventions, immunodeficiency, cholesteatoma in childhood and antecedent of facial nerve palsy. This trial emphasizes the importance of imaging (CT and MRI) in front of an ancient radical cavity which presents one or some of these factors in order to eliminate a recurrence of an invasive cholesteatoma. Let us note that the demand of the patients is sometimes aesthetic or functional.

Adult↗
PubMed2003

Otoplasty for prominent ears in children. The technique adopted in the Portmann Institute.

The Otoplasty technique adopted in the Portmann Institute is a simple rapid technique that maintains the natural contours of the auricle with minimal risk of infection. The technique involves excision of a large ellipse of skin from the mastoid surface of the auricle and reflection of remaining skin to the edge of the helix. The subcutaneous and muscular tissues on the mastoid bone are excised and the mastoid surface of the auricular cartilage scored with monopolar diathermy. After haemostasis, the wound is closed using continuous long-term absorbable sutures. A dressing and bandage are applied and the child is monitored for 10 days. A head bandage is applied at night for one month with use of a sun-screen cream on the scar at daytime.

Academic Medical Centers↗
PubMed2003

[When to suspect a perilymphatic fistula?].

INTRODUCTION: The diagnosis of perilymphatic fistula (PLF) is difficult since no single clinical situation gives the diagnosis for sure. The goal of this study is to clarify the clinical situations where you must suspect a PLF. METHODS: Retrospective study of 20 patients that had an exploratory tympanotomy with a PLF confirmed peroperatively. An analysis of the symptoms, signs and complementary exams was done. The surgical findings and the postoperative evolution were noted. RESULTS: 100% of patients reported a hearing loss, 80% vertigo, 70% a tinnitus and 35% equilibrium problems. Every patient had an etiological event to explain the PLF (trauma 85%), stapedotomy (10%), other ear surgeries. Five patients had a positive fistula or Vasalva test. All patients except one had an hearing loss on the audiogram (sensorineural, mixte or conductive). 50% had a CT scan, 70% of which were abnormal. A VNG was done on 3 patients. The sites of the PLF were as follows: 90% oval window, 5% round window and 5% both windows. The hearing got better or was stabilised in 95% of patients after the operation. 64% saw an improvement of their tinnitus and 87% of their vertigo. CONCLUSION: The diagnosis of PLF is difficult and a high index of suspicion is mandatory. One must look for an etiologic situation to explain the PLF. The audiogram is almost always modified, a mixte hearing loss being common due to the high incidence of ossicular trauma associated with PLF. The clinical clinical situations where you must suspect a PLF were identified as follows: An old trauma, a recent trauma, a history of otologic surgery particularly on the stapes and a preexisting hearing loss that aggravates. A diagnosis scale to evaluate the risk of PLF, based on clinical situations, physical exam and complementary exams was done to help the clinician in the evaluation of PLF.

Adolescent↗
PubMed2003

Delayed labyrinthine fistula in canal wall down mastoidectomy.

PURPOSE OF THE STUDY: This article is a retrospective review of 5 cases of delayed labyrinthine fistula in patients with a longstanding canal wall down mastoidectomy. MATERIAL: All patients had a long-term postoperative follow up with no evidence of complications till they suddenly started to have vertigo. The symptoms were caused by a bony erosion of the lateral semicircular canal detected on physical examination or by a CT-scan. There was no evidence of a recurrent cholesteatoma. RESULTS: The patients underwent surgery in order to close the fistula, with a good result. In all cases, a factor such as an infection or trauma, seems to have triggered off the bone erosion. CONCLUSION: Late complications may occur in the canal wall down mastoidectomy technique, after a long period of follow up in the absence of recurrent cholesteatoma. For this reason, it is advisable to look for a labyrinthine fistula in patient who develop vertigo a long time following mastoid surgery with a resultant radical cavity.

Aged↗
PubMed2001

[Bone-anchored hearing aids BAHA: 10 years' experience].

Bone anchored hearing aid (BAHA), based on the concept of osseointegration, offers the possibility of restoring hearing in case of conduction or mixed deafness. We report our experience with 87 in 74 patients implanted from 1989 to 1999. The patients were divided into two major groups, with bilateral agenesia (22 cases) or chronic otitis media (52 cases). Anatomical results are very good. We got 3 extrusions with no osseointegration, 10% local infections and 3 traumas. Functional outcome was excellent, with 73 patients being fitted with 81 HC200, HC300 or HC360 prostheses. One patient had a functional failure. We stress the importance of rigorous audiometric criteria and the determinant factors of osseointegration, essentially the surgical technique. In patients with chronic otitis, BAHA offers a functional solution for those with no benefit from an air conduction hearing aid and who are not operable or decline a new operation for tympano-ossicular reconstruction. For cases of ear malformation, BAHA can be a temporary solution that does not damage the inner ear. Indeed, rehabilitation with a BAHA does not exclude the possibility of functional tympano-ossicular surgery when the child is older and if the anatomic conditions are favorable.

Adolescent↗
PubMed2000

Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years.

OBJECTIVES: To evaluate clinical data, extensions, residual and recurrent lesion rates, and functional results in cases of cholesteatoma in pediatric patients. DESIGN: A retrospective study at a single tertiary care center over a decade. PATIENTS: In 199 children (mean age 9.6 years), 215 cholesteatomas were treated surgically, and the children were followed up for an average of 70 months (range 25-118 months). INTERVENTIONS: Therapeutic and rehabilitative surgical procedures were done, using either a closed technique (CT) or an open technique: tympanoplasty in open technique (TOT), radical mastoidectomy (RM), or Rambo's technique) MAIN OUTCOME MEASURES: Surgical findings, residual and recurrent lesions rate, and hearing assessment. RESULTS: The first surgical procedure was CT in 88% of cases, TOT in 10%, RM and Rambo's technique in 1%. Two operations were done in 61.8% of children; 21% had three operations and 4.5% had four. Residual lesions were observed in 21.5% of all children, 32.8% in those undergoing a planned second look. Recurrence rate was 9.8%. Surprisingly, residual and recurrent lesion rates were higher after TOT (23.8% and 19%) than after CT (20.5%, 8.9%), but TOT-treated children had much more extensive lesions. A speech reception threshold (SRT) <30 dB hearing loss (HL) was achieved in 63.7% of patients, and normal hearing was obtained in 12.1%; SRT was significantly better after CT (mean 26.7 dB) than after TOT (mean 37.4 dB), after type II (mean 27 dB) than after type III (35 dB). A high-frequency pure-tone hearing loss >10 dB was uncommon (7.6%). CONCLUSION: These results support the continued use of CT in most cases of cholesteatoma in children in developed countries.

Adolescent↗
PubMed2000

[Acceptability of local treatment of allergic rhinitis with a combination of a corticoid (beclomethasone) and an antihistaminic (azelastine)].

A prospective multicentre study involving 219 patients with seasonal or aperiodic rhinitis was performed to assess the acceptability of a local treatment combining antihistamine (azelastine) and corticoid (beclomethasone) drugs. The drugs were administered either together (morning and evening, with a 5-minute interval) or separately (azelastine in the morning and evening, and beclomethasone later during the morning and in the afternoon) for 15 days. Treatment acceptability was measured by a nine-fold questionnaire (7-point scale, mean score per question). Patient participation, protocol and therapy compliance, and treatment efficacy and tolerance were also studied. The acceptability of the association was satisfactory (mean score for general facility of treatment: 4.7/6) and did not differ between administration schedules. Patients found treatment easy, and were not bothered by the bulk of the bottles or the risk of mixing them up. This acceptability was confirmed by the low percentage (4%) of patients refusing to be included in the study (refusing any treatment by nasal spray). The general acceptability was confirmed by the results for therapy compliance, general efficacy and tolerance: 94.9% of the patients took more than 75% of the administrations prescribed, 77.6% of the patients and 85.2% of the practitioners judged treatment efficacy as good or excellent, and 84.6% of the patients and 91.4% of the practitioners judged tolerance as good or excellent. Moreover, most of the adverse events consisted of minor signs of local intolerance, and were identical to those observed when the two treatments were administered alone.

Administration, Inhalation↗
PubMed1999

[Congenital cholesteatoma of the ear in the child. Clinical, follow-up and therapeutic analysis of a series of 34 cases].

Long a subject of debate, congenital cholesteatomas of the middle ear appear to be a specific clinical entity different from the much more frequent classical acquired cholesteoma. Characteristic features of congenital cholesteatomas are young age at diagnosis, typical peroperative presentation, satisfactory mastoid air cells in almost all cases, and associated congenital malformations, which may involve the otology system or not. Diagnosis is a difficult task due to the long latency period with no clinical manifestations. These congenital cholesteatomas appear to be more aggressive in a mastoid with functioning air cells. Thus open excision does not appear to be appropriate and should be reserved for selected cases. For us, the closed technique with two procedures is more adapted but requires good cooperation with the family. The risk of recurrence is however significant and at least comparable to that of acquired cholesteatomas in children. Follow-up should be persuade as long as possible. Functional results have been encouraging even though ossicular destruction is frequent. The quality of the auditory tube appears to be a determining factor.

Adolescent↗
PubMed1999

[Multi-frequency impedance measurement and Meniere's disease. Analysis of the results of TEFLAG].

We present today our preliminary results of the TEFLAG test performed on 58 patients suffering from Meniere's disease. This test completed in 1993 has already led to a 4-stage classification of noise induced hearing losses. On the one hand, it is based on the morphological study of susceptance B curves, and on the other hand, on the study of the resonant frequency (RF) of the annular ligament of the stapes, provided by a multifrequential impedancemeter. The endolymphatic hydrops coming with the Meniere's disease practically always cohabits in the intercritical period with the decrease of the perilymphatic pressure of the scala vestibuli, which is shown in the morphology of Stage IV curves especially, and the decrease of the annular ligament rigidity. Inversely, during the vertigo or around, we mainly have stage I curves, and an increase of the stapes annular ligament resonant frequency (RF), testifying the labyrinthic hydrops, which is the physiopathological essence of the Meniere's disease.

Acoustic Impedance Tests↗
PubMed1997

Anatomical results with titanium implants in the mastoid region.

We report our experience with titanium implants for extra-aural rehabilitation in the mastoid region with a bone-anchored hearing aid (BAHA) and auricular prosthesis. The purpose of this study was to evaluate the clinical status of the soft tissue adjacent to 63 skin-penetrating devices in 43 patients and to compare our findings with those of other reports. Forty-four fixtures have been implanted in 36 patients for the BAHA and 19 in seven patients for the auricular prostheses. The evaluation concerns osseointegration, pain in the mastoid area, skin reaction around the abutment and removal of the abutment. Three implants extruded; one due to trauma and two with no explanation. Follow-up ranged from 3 to 60 months after surgical implantation. The first outpatient check-up was performed at three months after implantation and then every six months. The soft tissue reaction around the percutaneous unit was classified at each control according to the classification proposed by Holgers et al. There was no irritation (type 0) in 87.5% of the controls for the BAHA group and in 87.2% for the group of auricular prostheses. No adverse skin reactions were noted in 61.36% of the BAHA group and in 66.66% of the auricular prosthesis group. Results of this study confirm the skin's ability to tolerate a skin-penetrating unit made of pure titanium. The importance of reducing the thickness of the skin around the implant and of local hygienic conditions is emphasized.

Adolescent↗