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Biomedical subjects

J Sadé

Publications and source records attributed to J Sadé.

At least 91 records · Page 5Linked to original sources
PubMed1983

Stapes-replacing prosthesis (S.R.P.).

Any chronic inflammatory condition of the middle ear may bring about bone destruction. Today, in the antibiotic era, this destruction concerns mostly the ossicular chain. Any one of the ossicles or all of them together may be partially damaged or completely destroyed (Sadé et al, 1981). Hearing is usually impaired if the stapes or the incus or both of them are damaged. To overcome the resulting hearing deficit, various surgical techniques, using various materials, have been introduced, with various degrees of success. The most problematic situation encountered surgically is the one in which the stapes is missing, and it is with this situation that the present study deals. The surgical solution so far advocated has been in the form of a surgical bridge or columella between the mobile footplate and the drum. The columella (Fig. 1) is made out of bone or some non-organic biocompatible material. Often, however, this solution is not very successful, for two reasons: A. Instability of the columella (prosthesis) is often unavoidable because of its slim attachment to the footplate; B. Biologically, an incompatibility between the drum and the prosthesis is all too often present, when the latter is made of plastic materials. These columellas have been found, sooner of later, to extrude. It is the purpose of this communication to report a new technique and a new concept, which tries to overcome the above shortcomings, using a different type of stapes-replacing prosthesis.

Hearing Loss↗
PubMed1983

The perilymphatic fistula.

This study attempts to establish clinical criteria that would enable physicians to decide which patients with sudden cochlear and vestibular symptoms should be explored surgically in search of a perilymphatic fistula, in the absence of history indicating trauma to the inner ears. For this purpose, we studied forty-five patients whom we operated on because of suspected perilymphatic fistulas. The patients were into two groups: Group A (twenty patients) had previously undergone stapedectomy. Group B (twenty-five patients) had not undergone surgery in the past. Most of our patients experienced a rather acute onset of vertigo, unsteadiness, hearing loss, and tinnitus. We found no significant difference in the symptoms or signs between the patients who had a fistula and those in whom a fistula was not found, nor between those who underwent stapedectomy previously and those who did not. Most of the patients in Group B (75 percent) with fistula did, however, have a history of some stress or trauma preceding the sudden onset of symptoms. Yet some did not. We had three patients with no such history, nor had they undergone a previous stapedectomy. Basically, we are left with a dilemma: whether or not to explore a particular ear with appropriate symptoms and signs but without a traumatic history--knowing that about a quarter of these patients may have a perilymphatic fistula.

Adult↗
PubMed1982

The treatment of subglottic hemangiomas of infants with prednisone.

Because of their spontaneous regression, capillary and cavernous hemangiomas of infants usually do not require treatment. However, when they interfere because of their location with important functions of the body or even threaten life, treatment becomes mandatory. This is the case in most patients with congenital subglottic hemangiomas. In the past various methods of treatment have been used. All of them have disadvantages, and some are hazardous. Most cases (74.2%) required protracted tracheostomy. Mortality rate is still high (23.8%). We report herewith 5 infants with subglottic hemangiomas successfully treated with prednisone. No remarkable side-effects were observed, besides transient moonfacing. Similar good results were previously reported in 9 cases by several authors. Prednisone therapy if instituted early may reduce the need of tracheostomy and bring about complete recovery in this sometimes severe condition. Proper dosage and sufficient length of treatment are absolutely essential for such successful outcome.

Female↗
PubMed1982

Cholesterol in cholesteatoma and in the otitis media syndrome.

Cholesteatoma derived its name, many years ago, from its association with cholesterol crystals. However, this association was not clarified, and it remained a semi-mystery. This study is an attempt to establish the topographic relationship, frequency, and source of cholesterol crystal deposits in cholesteatoma and related conditions.

Cholesteatoma↗
PubMed1981

Unrecognized infantile Meniere's disease.

We have described two patients who, from early infancy, suffered attacks of vomiting associated with fluctuating hearing loss, which ended in bilateral severe sensorineural hearing loss. The patients were treated by pediatricians as suffering from gastroenteritis or meningitis. Meniere's disease was not suspected. We want to point out that Meniere's disease, though it usually begins in middle age, may well start in childhood, as well as in infancy, and should be suspected whenever vomiting without diarrhea is associated with some hearing loss at any age--no matter how young the patient is. It is also quite possible that some sensorineural hearing losses in late childhood or adulthood are in effect the result of early burnt-out Meniere disease, as in our second case.

Deafness↗
PubMed1981

Results of mastoid operations in various chronic ear diseases.

A study of mastoid operations undertaken for various chronic middle ear entities, using closed and open techniques, revealed the following: 1. Marsupialized mastoid balls were found less disappointing than often considered; small cavities were dry in 90 percent and large ones in 70 percent of cases. 2. Residual disease (epidermoid cysts) appeared in 27 percent of the CAT-operated ears and in 13 percent when the open technique was employed. 3. Residual disease appeared twice as often when the primary disease involved the tympanic cavity and in young patients than when the attic and mastoid were exclusively involved or in older patients. 4. Residual disease did show up only in epidermoid ("attic") cholesteatomas, but not when the primary pathology was a retraction pocket (sinus tympani) cholesteatoma. 5. Up to 56 percent of the CAT-operated ears showed small, medium, or large retraction pockets. However, only large retraction pockets were of clinical significance. 6. The posterior wall, when preserved, atrophied to an important degree in about a tenth of the cases. 7. Significant atelectasis appeared in about a third of the ears once the membrana tensa was preserved, that is, in CAT or conservative radical operations. 8. About 10 percent of CAT operations performed in children may lead to an episode of acute mastoiditis.

Child↗
PubMed1980

Acute mastoiditis after a combined approach tympanoplasty operation.

Four of 112 ears on which a combined approach tympanoplasty (CAT) operation was performed had acute mastoiditis six to 24 months after operation. All four patients were younger than 13 years. This represents 12.5% of acute mastoiditis cases after CAT operations in this age group, or 3.5% of the total group. On reoperation, all four ears expressed pus under pressure in the mastoid cavity. There was also fibrosis and granulation tissue blocking the attic inlet. It is probable that the cause of the acute mastoiditis may be related to this partial or total stenosis. Two of the patients were found to have an aerated, noninflamed tympanic cavity, and only in two was the acute mastoiditis associated with residual cholesteatoma.

Acute Disease↗
PubMed1980

Retraction pockets and attic cholesteatomas.

An attic cholesteatoma is defined as an epidermoid cyst found in the attic. This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma. Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities, such as metaplastic islands of the mucosa in chronic ears with central perforations. Histological examination of 22 temporal bones with attic cholesteatomas has shown them to reside mainly medial to the ossicular chain. This explains the difficulty they have in self-cleansing, as well as the ensuing secondary infection. When a similar process occurs lateral to the ossicles, a self-cleansing nature's atticotomy may be formed. The aetiology of an attic epidermoid cyst, i.e., an attic cholesteatoma, is usually considered to be an invasive retraction from the external ear. However, it is difficult to accept invasion of external canal skin into the upper medial attic. This is especially so in the face of such biological phenomena as epithelial contact inhibition, or the invariable outward migration of stratified squamous epithelium from the edges of retraction pockets as well as from cholesteatoma perforations. Also, large cholesteatomas usually present themselves from the "beginning" simultaneously with their perforations; no documentation of an evolving process from a pre-existing perforation exists at present. Marginal perforations, which have later evolved into attic cholesteatomas have so far not been documented. On the other hand, retraction pockets of the pars tensa or pars flaccida associated with some middle ear negative pressure do occur, however, it is yet to be shown that such retractions can reach the medial part of the ossicular chain and form epidermoid-like cysts there. Therefore, the possibility that an attic cholesteatoma often arises primarily in the attic and presents itself secondarily in the external canal as a "perforated" epidermoid cyst, is to be considered. The possibility that a congenital rest is responsible for such an epidermoid cyst has often been put forward, but evidence that such rests actually exist has not yet been presented. The frequency with which cholesteatoma sacs found in the attic show mucosal cells as part of their lining, suggests a metaplastic phenomenon. This means that the epithelial cells of the middle ear lining may have changed from mucosal into keratinizing cells (or even vice versa). Metaplastic changes of mucosas into keratinizing epithelium occur very frequently in the bronchi, nose, ears and genitourinary system. Attic epidermoid cysts may, therefore, be seen as an analogous formation to glandular cysts in the attic -- the latter being very frequently seen in there in chronically infected ears. Such "organ" formations (glands or epidermoid cysts) may arise when their respective cells (forming mucus or keratin) grow in the midst of connective tissue rather than on the surface...

Cholesteatoma↗
PubMed1979

Prognostic evaluation of secretory otitis media as a function of mastoidal pneumatisation.

Fifty-two secretory otitis media (S.O.M.) ears with protracted course were compared roentgenologically (Schuller projection) with 52 S.O.M. ears which recovered after insertion of a single ventilating tube. Measurements were done first by comparing the pneumatised area millimetrically and later semiquantitatively according to the size of the mastoid cells--grading the mastoid cells from 1 (eburnize) to 10 (very big mastoid cells). S.O.M. ears with protracted chronic course showed an average mastoid area of 312 mm2, their cell size showing on the average a diploic or small-diploic cells--corresponding to grade 3.5. On the other hand, S.O.M. ears which recovered promptly had an average mastoid area of 440 mm2, and their mastoid cells began to show as actual cells (small up to medium cells), corresponding to grade 5.7. The difference, both millimetrically and grade-wise, between the two groups was found to be very significant (P greater than or equal to 0.01). We may conclude that the prognosis of S.O.M. is related to the size of their mastoid cells or alternatively to the amount of air in the middle ear cleft as a whole.

Child↗
PubMed1979

Clearance by the mucociliary system in 'simple chronic otitis media'.

This is a study of the rate of middle ear clearance in chronic otitis media and atelectatic ears. The clearance rate was measured with the aid of non-soluble saccharin, introduced into the middle ear through an existing perforation in 'chronic ears', or through a ventilating tube in atelectatic ears. Cholesteatomatous ears were excluded. Altogether 122 ears were examined and about two-thirds of the subjects felt the sweet taste in their mouths thereafter. The average time it took for the saccharin to be transported from the middle ear to the taste buds was 33' 22" minutes in non-infected (i.e. dry) chronic ears (38 patients or 66 per cent). Wet or infected ears with chronic otitis media (30 patients, or 58 per cent) showed a slower transport rate, averaging 54' 22" minutes--the difference was significant at the 0.01 level. 8 (63 per cent) of the atelectatic ears transported the saccharin at an average rate of 50' 25". This study demonstrated that most ears with 'simple' chronic otitis media and atelectatic ears have a patent eustachian tube and that their mucociliary system can transport foreign particles through it. When the ear is infected, transport tends to be slowed down.

Chronic Disease↗