THERE ARE THREE FACTORS RESPONSIBLE FOR PERSISTENCE OF DISCHARGE FROM A CHRONICALLY DRAINING EAR: Moisture, opportunistic bacteria, and debris and diseased tissue. In most cases, the discharge may be temporarily controlled or eliminated by office treatment:* Instruction of the patient in aural hygiene and impressing upon him the importance of avoiding getting water in the ear.* Thorough cleaning of the ear, by the physician initially, and by the patient as frequently as necessary to keep the ear free of discharge.* Antibiotics, used locally rather than systemically, and usually in the form of a powder applied by the patient daily at home.* Culture and sensitivity tests when the problem does not respond to routine office treatment as outlined.

Humans↗

PubMedDate not supplied

The negative on/off effect in cochlear and early stapedial otosclerosis.

Acoustic reflex patterns were reviewed for 100 patients suspected of having cochlear otosclerosis (group 1) and 73 patients with confirmed stapedial otosclerosis and conductive hearing losses of less than 5 years duration (group 2). Three abnormal reflex patterns were exhibited by these patients--"negative on/off," "no response when the probe was in the affected ear," and "no response when the stimulus was in affected ear." Results showed that the negative on/off pattern was equally as common for the two subject groups. The "no response" patterns were more common for the early stapedial otosclerosis group. The presence of acoustic reflex patterns classically associated with stapedial otosclerosis in patients with cochlear otosclerosis leads us to predict that some degree of stapedial fixation is common in many cases of cochlear otosclerosis. Based upon these findings, the presence of the negative on/off pattern in patients with mild sensorineural hearing loss, excellent speech discrimination, and a family history of hearing loss, is now considered indicative of cochlear otosclerosis.

Adolescent↗

PubMedDate not supplied

Cholesteatoma surgery: residual and recurrent disease. A review of 1,024 cases.

This is an analysis of 1,024 primary cases of mastoid surgery for cholesteatoma operated upon during a ten-year period at the Otologic Medical Group, Inc. Our philosophy of management of the mastoid in these cases has been as follows: 1) avoid an open mastoid cavity when possible; 2) perform the operation in two stages if necessary; 3) reexplore the mastoid and middle ear for residual cholesteatoma when indicated. One-third of 380 revised cases had residual cholesteatoma, disease left by the surgeon. In 260 cases in which the surgeon felt it unlikely that there was residual disease he found it in 23%. In 4% this residual cholesteatoma was found in the mastoid. The incidence of residual cholesteatoma was higher in children and in planned, as opposed to unplanned, revisions. Residual cholesteatoma was detected in the middle ear more frequently than in the epitympanum, and in the epitympanum more frequently than the mastoid. Indications for, and timing of, the reexploration are discussed. Recurrent cholesteatoma refers to a retraction pocket and must be differentiated from residual cholesteatoma; the causes, prevention and treatment are different. Recurrent cholesteatoma was detected in 5%. The most common complication of the disease was a labyrinthine fistula (10%). Operative facial nerve damage occurred in one case. The most common postoperative complication was graft failure (3%). Intact canal wall tympanoplasty with mastoidectomy should be performed as a two-stage procedure in most cases when used in the treatment of aural cholesteatoma.

Adolescent↗

PubMedDate not supplied

Myringoplasty. A review of 472 cases.

We reviewed the records of 472 patients who had undergone myringoplasty during an 11-year period at the Otologic Medical Group. There was a statistically significant relationship between the size of the perforation and the degree of hearing impairment, but no relationship between the degree of impairment and the complaint of tinnitus. The majority of operations were performed using the lateral surface fascia grafting technique. Those 168 operations performed postauricularly were successful in closing the tympanic membrane perforation in over 97% of the cases and in reducing the conductive deficit to 10 dB or less in 88%. There were no total sensorineural impairments, although 3% of the patients developed a high tone sensorineural impairment. Blunting in the anterior sulcus and lateral healing of the graft were very uncommon. Canal skin was used as a graft in 16% of the patients. The graft take results and hearing results were less favorable than with fascia.

Adolescent↗

PubMedDate not supplied

Testing eustachian tube function.

This paper reviews the concepts, attitudes and experience at the Otologic Medical Group (OMG) in regard to testing eustachian tube function. AT OMG eustachian tube function tests are not performed prior to reconstructive surgery in cases of chronic otitis media and the reasons for this are reviewed. The lack of significant incidence of serous otitis media in postoperative patients substantiates the conclusion that there is no rationale for preoperative eustachian tube function tests in patients who are to undergo reconstructive surgery for chronic otitis media.

Adult↗

PubMedDate not supplied

Cholesteatoma surgery: canal wall down procedures.

We prefer the intact canal wall technique for tympanoplasty with mastoidectomy, but use a canal wall down procedure in up to 25% of cases. Creating a round cavity with a large meatus is imperative if one is to obtain a trouble-free ear. The five types of canal wall down procedures are defined, as are our indications for using them. Results in 19 only hearing ears and 19 labyrinthine fistula cases are presented, along with 64 tympanoplasty cases.

Adolescent↗

PubMedDate not supplied

Otologic homografts.

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Cartilage↗