The eustachian tube profile in children. A quantitative histopathological study of the ET lumen and mucosal lining involvement in acute and secretory otitis media.
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Acute Disease↗
Biomedical subjects
J Sadé
Publications and source records attributed to J Sadé.
Nystagmus episodes related to sea sickness.
In order to test the possible presence of nystagmus during episodes of sea sickness, we performed electronystagmography (ENG) on nine subjects before and during sailing on a 35-ton vessel in a somewhat heavy sea. In addition, the accelerations of the x, y and z axes of the ship were also monitored and simultaneously recorded. Nystagmus was not detected in pre-sailing recordings, while all of the subjects demonstrated clear positional nystagmus during sailing. The nystagmus was episodic, direction-fixed and its intensity was greater in sea-sick than in non-sick subjects. Our findings suggest that the nystagmus recorded is labyrinthine in origin and stems from temporary peripheral vestibular dysfunction elicited by sea sickness.
Adolescent↗
The biochemical composition of tympanosclerotic deposits.
We have studied the quantitative analysis of calcium, phosphate and cholesterol in the tympanosclerotic plaques removed from 25 patients. Our findings confirm that tympanosclerosis has a partly calcified organic matrix, in which the calcification process is probably similar in its qualitative chemical structure to that occurring in other calcified pathological tissues. The degree of calcification varies from one case to another and is even different in various locations of the same sampling. However, calcium levels are usually lower than in other pathological tissues which are calcified. The average quantity of calcium in our studies was 2 mg in 100 mg tissue or 12 mg in 100 mg protein. The average molar ratio between calcium and phosphate was 3, corresponding to the hydroxyapatite ratio. The average total quantity of cholesterol present was only 15 micrograms in 100 mg protein.
Calcinosis↗
Malignant external otitis.
During the years 1972-1985, 50 patients with malignant external otitis (MEO) were seen in our department. All our patients complained of severe earache; they presented initially with an apparently simple external otitis, but failed to improve when the usual measures were adopted. They all presented with granulation tissue in the external ear canal, and five of our patients had multiple cranial nerve involvement. MEO is in effect a severe external otitis which, if untreated, proceeds towards an osteomyelitis of the skull base. MEO is more prevalent in the summer, when external otitis is rampant. In some years, a relatively large number of these patients appear; in others there are none. The reason for this is unknown. In Israel, the disease is more prevalent in Jews than in Arabs. Diabetes was present in 68 per cent of our patients-severe diabetes in 42 per cent, mild diabetes in 26 per cent but 32 per cent of our patients were diabetes-free. The only otological past history in our patients was of a recent traumatic insult to the external ear canal; this was the case in about 8 per cent of them. Today, the treatment of choice of this important disease is local debridement supplemented by appropriate antibiotic treatment for 6-8 weeks. This should include some semi-synthetic penicillin to which pseudomonas aeruginosa is sensitive, combined with an appropriate aminoglycoside. During the earlier years of our encounter with MEO, two of our 10 patients died of it; later on, when we learned better how to treat it, the mortality rate decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Treatment of cholesteatoma.
Clinicians view cholesteatoma as a middle ear condition in which stratified squamous epithelium produces non-self-cleansing amounts of keratin. This clinical definition includes retraction pockets as well as big, deep-seated epidermoids. The two may have different origins, and they often require different therapeutic approaches. Clearance and control of shallow retraction pockets may be achieved with suction cleaning. Larger or longstanding retraction pockets, if not too deep, may be excised, and the tympanic membrane grafted. Deep-seated cholesteatomas require more elaborate surgery, whether they involve advanced retraction pockets or big and deep-seated middle ear epidermoids. The intact wall technique, though elegant, has about a 50% failure rate, regardless of the surgeon's skill. The failures are due to either retraction pocket formation, with or without posterior wall atrophy or the reappearance of epidermoids (so-called residual disease). Reconstruction of the bony defect in the scutum does not prevent retraction pocket formation. It is obvious that an approach that envisages successful removal of the matrix as curing the disease is too simplified. The intact wall operation should be reserved for ears with extensive mastoid pneumatization and small cholesteatomas. Most ears with cholesteatoma (85%) are, however, poorly pneumatized and they fare best with a small radical conservative (modified) mastoidectomy. The procedure should aim at creating the smallest mastoid cavity possible. Small mastoid cavities, possessing a tympanic membrane, an adequate mastoplasty, and no recess behind the facial ridge, will be found to be dry in about 90% of cases. A technique for achieving a minimal mastoid cavity is described.
Cholesteatoma↗
The infant's eustachian tube lumen: the pharyngeal part.
A study of Eustachian tube measurements in infants and children is presented. The study included 33 Eustachian tubes from normal temporal bones and 10 Eustachian tubes from temporal bones harbouring acute otitis media. The temporal bones underwent histologic serial sectioning. The lumen of the Eustachian tube's first portion, i.e. the pharyngeal part, was measured with the aid of a grid mounted on a microscope. These measurements show: A. The Eustachian tube lumen grows and enlarges to a small extent with age. B. Each age group presents a considerable variation in the range of area of the lumen comparable with the natural biological distribution. C. No statistical difference was found between the size of the pharyngeal portion of the lumen of the Eustachian tube from temporal bones which had acute otitis media and those coming from non-pathological ears. This comparison took into consideration age and physiological distribution. These findings are similar to our earlier findings regarding the isthmic region.
Acute Disease↗
Results of preservation of the posterior canal wall in cholesteatoma surgery as related to middle-ear aeration.
The last otological generation witnesses a fierce discussion concerning the treatment of choice of cholesteatomatous ears--closed versus open technique being the issue. The reports of the success and failure of these two opposed techniques varied greatly (McCabe, 1977; Sadé, 1982a). It is the purpose of this study to clarify this issue further by reviewing the fate of 100 cholesteatomatous ears treated by the closed technique and followed up for as long as 13 years--a length of follow-up which has not hitherto been reported. We will also try and attempt to correlate the success and failure of this method with the ability of these ears to aerate--a clinical status which may be regarded as indicating the 'Eustachian function' of any particular middle ear in question.
Cholesteatoma↗
Large perilymph fistulas.
Perilymph fistulas may manifest themselves either by otologic symptoms, as in cases of small fistulas, or primarily through neurologic symptoms, as with large fistulas. A case history is presented of a 3-year-old girl with recurrent bouts of meningitis who was found to have a large perilymph fistula. She had a right undeveloped cochlea and labyrinth, as well as multiple defects of the medial wall of her middle ear. The only way of preventing the recurrent bouts of bacterial meningitis in cases of large perilymph fistulas is surgical repair. Our conclusion is that, considering the problems involved in cases of large congenital perilymph fistulas, a simple closure of the fistula is not sufficient and the method of choice is obliteration of a deeper structure--such as the vestibule itself.
Child, Preschool↗
The infant's "post-isthmus" region of the eustachian tube in health and disease.
The size of the eustachian tube post-isthmic lumen in infants and children less than 2 years old is discussed. The material in our study consisted of serially sectioned eustachian tubes of twenty-six normal temporal bones and fourteen temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: There is no increase in the lumen size of the post-isthmic region of the eustachian tube from birth to 2 years of age. Each age group presents a considerable range in luminal area, compatible with the natural biologic distribution. No obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens. There is no significant statistical difference between the lumen size of the post-isthmic region coming from normal temporal bones as compared with those from temporal bones with acute or secretory otitis media.
Acute Disease↗
The eustachian tube lumen in chronic otitis media.
The measurements of the size of the eustachian tube lumen, in its various regions, in adults are presented. The material consisted of serially sectioned eustachian tubes of 26 normal temporal bones and four pathologic temporal bones, three of them with simple chronic otitis media and one with cholesteatoma. These measurements reveal: (1) in adults (as in children) that there is a considerable variance of the eustachian tube lumen sizes corresponding to other variations in sizes of other organs; (2) no obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens; and (3) there was no significant statistical difference between the lumen size of the eustachian tube retrieved from normal temporal bones compared with those from temporal bones with chronic otitis media.
Adolescent↗
Caliber of the lumen of the eustachian tube pre-isthmus in infants and children.
We measured the eustachian tubes in temporal bones taken from infants and children. These specimens included eustachian tubes from 35 normal temporal bones and 13 temporal bones containing acute and secretory otitis media. All temporal bones were serially sectioned for histological studies. The lumen of the third portion of each eustachian tube (i.e., the pre-isthmus or the physiological isthmus) was measured with the aid of a grid mounted on a microscope. These measurements showed: (1) the eustachian tube lumen grows and enlarges to a small degree with age; (2) each age group has a considerable variation in the size of the lumen which is compatible with natural biological distribution; (3) no statistical differences were found in the size of the pre-isthmus lumina of those eustachian tubes from temporal bones showing acute or secretory otitis media when compared with the lumina of eustachian tubes in non-pathological ears.
Ear, Middle↗
The infant's pre-tympanic region of the eustachian tube in health and disease.
The size of the eustachian tube lumen of the pre-tympanic segment in infants and children from birth up to two years is presented. The material consisted of serially sectioned 28 eustachian tubes of normal temporal bones and 13 eustachian tubes of temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: there is no increase in the lumen size of the pre-tympanic region of the auditory tube from birth to two years of age. Each age group presents a considerable range in luminal size, compatible with a natural biological distribution. No obstruction of the eustachian tube lumen was encountered in any of the pathological specimens. There is no significant statistical difference between the lumen size of the pre-tympanic region coming from normal temporal bones as compared to those from temporal bones with acute or secretory otitis media.
Acute Disease↗
The infant eustachian tube lumen--pharyngeal part.
A study of Eustachian tube measurement in infants and children is presented. The study included 33 Eustachian tubes from normal temporal bones and 10 Eustachian tubes from temporal bones harboring acute otitis media. The temporal bones underwent histologic serial sectioning. The lumen of the first portion of the Eustachian tubes, i.e., the pharyngeal part, was measured with the aid of a grid mounted on a microscope. These measurements show: A) the Eustachian tube lumen grows and enlarges to a small degree with age; B) each age group presents a considerable variation in the range of the area of the lumen compatible with natural biological distribution; C) no statistical difference was found in the size of the pharyngeal portion of the lumen of the Eustachian tube from temporal bones which have acute otitis media when compared with lumens of the pharyngeal portion of Eustachian tubes coming from non-pathological ears.
Acute Disease↗
Missing stapes and stapes-replacing prosthesis.
Our study of 205 ears with missing stapes, secondary to some type of chronic ear disease, showed that only 40% of such ears are suitable for ossiculoplasty. The remaining 60% are unsuitable because of a fixed footplate, severe atelectasis, hearing better than 25 dB (these patients do not need the operation), or poor discrimination. A new stapes replacement prosthesis (SRP), which we term Tabor, is described for use where indicated. The prosthesis has two parts: The lower part (or base) is made of a broad inorganic, biocompatible material (Teflon). This part fits and covers most of the footplate, ensuring maximal stability. The upper part of the prosthesis is made of autograft or homograft bone--usually a malleus head--the contact of which with the drum prevents extrusion. In twelve out of fourteen ears insertion of this prosthesis was successful; the average postoperative air conduction went from 56 dB to 29 dB, leaving an average air-bone gap of 16 dB. The bone conduction also improved, from an average of 20 dB to 13 dB.
Bone Conduction↗
A simple and time saving cold mini caloric test.
A simple and time-saving office procedure is presented. The test consists of placing a small piece of cotton-wool soaked in ice water against the tympanic membrane. We term this test the Cold mini caloric test. Our method has been compared quantitatively with the Bithermal caloric test in 20 normal controls, 50 unspecific dizzy patients with no vestibular or obvious neurological disorder, 22 Menière ears, 12 acoustic neuromas and 20 cases of vestibular neuronitis. The comparison between the two methods has shown the Cold mini caloric test to present consistently similar, though somewhat shorter, nystagmic reactions. There was no difference in the clinical information obtained by the two methods.
Caloric Tests↗
Eustachian tube function.
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Eustachian Tube↗
The use of thoracoabdominal staplers in ENT surgery.
Two patients, one with a Zencker diverticulum, the other with a large transglottic carcinoma, are presented to demonstrate the use of the thoracic abdominal (TA) automatic stapler for suturing the mucosal line. We found the method described to be very suitable for these cases, shortening significantly the operation time in laryngectomy and in resection of Zencker diverticulum. The instrument makes a perfect suture line, and convalescence is very short as well. An increased use for the TA automatic suture in future seems likely.
Aged↗
Glomus tympanicum tumors in a child.
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Child↗