Biomedical subjects
Publications and source records attributed to M Bré.
An original technique for histological study of the human temporal bone is presented. It allows faster and better results than previous methods. It becomes obvious that the systematic study of the temporal bone may give important data in the field of pathology, foeto-pathology and forensic medicine.
Three patients were noted to have unusual zones of osteitis during salvage myringoplasty. The first case involved the whole upper wall of the bony canal and was camouflaged by a weeping mucopolypoid carpet. In the second case there was a wide zone of osteitis of the posterosuperior angle of the canal and another smaller zone in the anteroinferior tympanic region. The osteitis in the third case had invaded the total mastoid cortex producing a vast plaque of superficial osteitis which could be removed without difficulty. Diffuse osteomatous reaction of the wall of the canal had resulted. In all three cases a salvage myringoplasty was possible after elimination of the osteitic lesions, although a glue ear persisted with a punctiform perforation in one patient, suggesting tubal dysfunction.
The authors report 15 cases collected over a period of 13 years (1972 - 1984) of a particularly serious eventuality affecting certain evacuation cavities: Early recurrence of diffuse hypertrophic osteitis (E.R.D.H.O.). This is a rare complication, occurring in 1.5% of cases of chronic otitis. However, the fact of having operated upon 7 cases in 1984 alone, whilst during the previous 12 years, only 8 had been seen, raised the alarm. The classical pattern of this complication occurs in 3 stages, each involving surgical operation: at the outset, chronic otitis with cholesteatoma or osteitis, most often mixed, for which an "inadequate" surgical procedure is performed. then, after a variable period which may exceed 10 years, a very large evacuation cavity was created by the authors. finally, 3rd and final stage: within 6 months, this cavity filled progressively and, at operation, the authors discovered a cavity virtually completely filled with a "fantastic" "moist sugar" osteitis, requiring a new evacuation cavity, even larger than that created before. In all cases, a successful result was obtained within a varying period, sometimes accompanied by spectacular improvement in general condition. The most plausible etiopathogenic hypothesis advanced to attempt to explain this phenomenon is that of secondary infection by a varied microbial flora, including, on the one hand, aerobic organisms usually discovered in such cases (pseudomonas pyocyaneus, proteus mirabilis) and, secondly, this being of essential importance, "anaerobic" bacteria, the bacteriological diagnosis of which requires application of a strict protocol. The authors have taken three decisions following their bibliographic investigations.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors report 27 new cases of osteomatous chronic otitis, with (15) or without (12) cholesteatomas, with perforated (13) or intact (14) drum, the latter sometimes having a very atypical appearance (2), frankly purulent or simply inflammatory. This results in a wide range of clinical appearances. There are two macroscopic forms: the diffuse attico-antral form and localized forms (drum - C.S.C.L.). The authors emphasize: the primordial interest of tomography (or CT scan), the keystone of their discovery, as well as the dangers of their surgical treatment. In addition to review of these known concepts, two forms have been identified: 1) Osteomatous attico-chain monoblock, where the ossicles of the ear are adherent in their entirety, either to the external attical wall or, much more rarely, to the medial attical wall. They describe 13 cases, the pattern of which is very different, according to whether the diagnosis is one of cholesteatomatous chronic otitis or not. In the absence of cholesteatoma (8 cases), the clinical picture is suggestive of otospongiosis or of chronic otitis with intact drum. The surgical procedure is related to these findings: 1 completion of myringoplasty, 7 piston-malleus. In cases of cholesteatomatous chronic otitis (5 cases), the picture is completely different, the cholesteatoma developing at leisure, behind the impenetrable osteomatous shield. Once again, the surgical procedure is modified: 4 vast evacuation cavities and one mastoatticotomy for giant cholesteatoma with intact drum. 2) Diffuse and "progressive" osteomatous stenosis of the walls of the E.A.M. The authors describe 6 cases occurring either during cholesteatomatous chronic otitis, or within a few weeks, simulating chronic otitis with intact drum.
44 cases of tympanic involvement in the context of chronic otitis are described. 34 occurred during active chronic otitis. This is a rare possibility (approximately 4% of our own cases of chronic otitis). The following may be mentioned amongst them: 21 cases of osteitis, for which the following concepts should be borne in mind: the extreme severity of the chronic otitis responsible, in most instances, ears which had undergone multiple surgery (17/21), lesions exclusively of osteitis, but very extensive in 2/3 of cases (14/21). 7 cases of osteolytic disease, occurring severe or atypical cholesteatomatous chronic otitis and quite often involving associated osteolysis affecting the main VII, the promontory, the bulb of the internal jugular vein, or even the carotid canal. 4 cases of diffuse sub-obstructive osteomatous disease of the walls of the E.A.M., "progressive" development of which over several months was noted in 3 cases. Finally, 2 cases of mixed disease: (osteitis--osteomatoma and osteitis--osteolysis). 8 cases occurred following myringoplasty: this is a rare eventuality (approximately 1%), 1 case only of osteolysis due to iatrogenic cholesteatoma, 7 cases of osteitis, either highly localized and not preventing further myringoplasty (4 cases), or very extensive, finally resulting in a vast evacuation cavity. In 2 cases, a malformation is the origin of involvement of the tympanic at the origin of chronic otitis was felt probable, without it being possible to reach any definite conclusion concerning auriculobranchial fistula or Huschke foramen.
The authors undertook a study of changes in bone conduction (BC) during 800 operations carried out over a 5 years period (1979-1984) for chronic otitis or sequelae of chronic otitis. After elimination of ears with deafness (47) and cases unsuitable for evaluation (39), they finally included 714 records in the study. Only comparison of free and post-operative BC was made and using 4 conversational frequencies, not taking into account a deviation of 5 DB for each of these 4 frequencies. The study involved 317 myringoplasties: In 271 (i.e. 85,5%) there was no change in BC. Amongst them, 37 patients nevertheless showed a transient fall in BC. Of particular importance is the fact that almost 1/3 (11 to be exact) recovered only during the 2nd semester following surgery, a period which was even exceeded in the other 5 cases. 46 (i.e. 14.5%) were classified as "permanent" falls in BC. Amongst these in only 17 (i.e. 5%) were there "only" the three standard aggression factors for the I.O.: aspiration--scraping--manipulation of the tympano-ossicular system, without it being possible to attribute a predominant role to one more than the other. With regard to reaming of the E.A.M., those cases in which this could be considered responsible appeared to be infinitesimal. Furthermore, there was no statistically significant difference (reduced deviation test--"chi"2 test) between the number of falls in BC seen following myringoplasty with or without reaming. 83 tympanoplasties by Piston-Malleus, study of which led to the same conclusions as for myringoplasties. 118 masto-atticotomies, including 23 with posterior tympanotomy. Despite peri-labyrinthine and peri-ossicular scraping, results were essentially identical. 196 evacuation cavities (227-31 deafness) of which somewhat less than half only (46%) were ears undergoing surgery for the first time. Percentage of unchanged BC was here much more unfavourable, with 49 "permanent" falls in BC, i.e. 25%, of which, it must be said, 5 were minimal falls, and with, in 25 cases, a follow-up of less than 3 months.