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Biomedical subjects

M M Paparella

Publications and source records attributed to M M Paparella.

At least 19 recordsLinked to original sources
PubMed1992

Bacterial tympanogenic labyrinthitis, meningitis, and sensorineural damage.

Pathologic changes (sensorineural hearing loss, labyrinthitis, meningitis) can follow otitis media. Various macromolecular substances demonstrably enter the inner ear via the round window membrane, but its permeability to bacteria is less known. We inoculated Streptococcus pneumoniae type 7F bilaterally into the middle ears of two groups of chinchillas, with and without grafted round window membranes. Inner ears of inoculated animals were observed by light and electron microscopy. None with continuous grafts had labyrinthitis. Bacteria penetrated all three layers of nongrafted round window membranes and into all cochlear turns, entering Schuknecht's channels and following neuronal pathways; nerves were often degenerated, hair cells were damaged or missing, and the stria vascularis was edematous and hemorrhagic. The neural damage suggests a mechanism for the hearing loss that can follow otitis media. Absence of labyrinthitis and meningitis in grafted animals suggests a tympanogenic pathway for the bacteria.

Animals↗
PubMed1992

Mechanisms of retraction pocket formation in the pediatric tympanic membrane.

The epidemiological nature of acquired cholesteatoma in children has shown that it occurs more often in the posterosuperior quadrant of the pars tensa and in the pars flaccida. This type of cholesteatoma is rarely seen before the age of 3 years, and serous otitis media is the most important risk factor for its occurrence. In an attempt to present a pathological rationale for these clinical findings, tympanic membranes from 11 temporal bones with purulent otitis media and 13 with serous otitis media were evaluated light microscopically and compared with 14 temporal bones without disease. Ages ranged from newborn to 3 years 6 months. The persistence of mesenchyme and greater inflammatory reaction observed in the pars flaccida and the posterosuperior quadrant of the pars tensa and changes in collagen and elastin observed in purulent otitis media and serous otitis media may represent a pathological rationale for the epidemiological nature of cholesteatoma in children.

Age Factors↗
PubMed1992

Paediatric otoscopy--clinical and histological correlation.

Otoscopy is a subjective clinical method. Its subjectively has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings become more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaccida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.

Aging↗
PubMed1992

Temporal bone histopathology in chronically infected ears with intact and perforated tympanic membranes.

Chronic suppurative otitis media has been clinically defined as a chronic discharge from the middle ear in the presence of a perforation of the tympanic membrane. However, irreversible tissue pathology in the middle ear or mastoid can occur behind an intact tympanic membrane. One hundred forty-four human temporal bones with chronic otitis media were divided into two groups: those with perforated (28) and those with nonperforated (116) tympanic membranes. The histopathological findings of their middle ears were compared. Granulation tissue in various degrees was the most prominent pathological feature. It was observed in 96% of temporal bones with perforation of the tympanic membrane, and in 97% of those without perforation. Also found were ossicular bony changes (96% with perforation; 90.5% without), middle ear effusion (93% with perforation; 89% without), cholesterol granuloma (21% with perforation; 12% without), cholesteatoma (36% with perforation; 4% without), and tympanosclerosis (43% with perforation; 20% without). This study shows that the histopathological changes of the middle ear are similar in temporal bones with and without perforation of the tympanic membrane. The clinician should, therefore, be aware that an intact tympanic membrane does not necessarily preclude the presence of gross pathological changes of the middle ear cleft.

Adolescent↗
PubMed1991

Pathology of labyrinthine ossification.

Ossification of the inner ear is the result of multifactorial pathogeneses, such as infection or malignant infiltration, and otosclerosis. Ossification of the inner ear spaces is a well documented sequela of suppurative labyrinthitis. In this study of human temporal bones, sections from 14 patients (28 temporal bones) were studied. In addition to the osseous tissue within the inner ear, findings included neoplasms, otosclerosis, otitis media, trauma, and Fabry's disease. We have attempted to correlate these conditions and their influence on the formation of osseous tissue within the spaces of the inner ear. Tympanogenic infection and vascular compromise were found to play an important role in ossification. The scala tympani of the basal turn of the cochlea was frequently the site involved.

Adult↗
PubMed1991

Otosclerosis: the University of Minnesota temporal bone collection.

A study of 1452 human temporal bones revealed a previously unpublished material of 144 bones with otosclerosis. After exclusion of infants and individuals of races other than white, the incidence of otosclerosis was 12.75%. Of the bones with otosclerosis, 56.1% belonged to men and 43.9% to women. The incidence of clinical and histologic otosclerosis was practically the same for men (44.7% to 55.3%) as for women (47% to 53%). However, the incidence of bilateral otosclerosis was higher in women (88.9%) than in men (65.2%). Bilateral otosclerosis was present in 75.6%, whereas it was unilateral in 24.4%. Sixty-six (66) ears (45.8%) had clinical otosclerosis, whereas 78 (54.2%) had histologic otosclerosis--frequently unifocal lesions. The most common site was anterior to the oval window (117 ears, 81.25%), followed by round window niche (52 ears, 36.11%), apical and medial cochlear wall (31 ears, 21.52%), and anterior wall of the internal auditory canal (27 ears, 18.75%). The activity of lesions was directly related to their size. Smaller lesions were predominantly inactive, whereas medium and larger lesions were predominantly active. There was a positive correlation when the size of the lesions, activity, and degree of cochlear endosteal involvement were compared with bone conduction thresholds (37 cases). Correlations between size and activity, and between activity and associated sensorineural hearing loss did not necessarily follow the sequence of an initial active stage (spongiotic) to a final inactive one (sclerotic). Comparison of cases of otosclerosis with equivalent age groups of the normal population yielded worse bone conduction thresholds for the otosclerosis cases only in the age group 60 to 69 years and older. Comparison of average bone conduction thresholds between bones with one site of endosteal involvement (28.26 dB HL) revealed no significant differences. Bones with two or more sites of endosteal involvement had significant differences. Bones with two or more sites of endosteal involvement had significantly worse bone conduction thresholds (62 dB HL). The overall results are not suggestive of an association of sensorineural hearing loss with otosclerosis without stapedial fixation.

Adolescent↗
PubMed1991

A histopathological study of the relationship between otitis media and mastoiditis.

From a total of 1408 human temporal bones, 229 with otitis media or mastoiditis were selected; other contributing diseases were excluded. Of this group, 19.2% had an obstruction of the aditus ad antrum with pathologic tissue, usually granulation tissue. Although pathologic fluid and tissue were usually distributed throughout the middle ear and mastoid, in some cases, the most severe conditions were restricted to the mastoid. Pathologic conditions were more severe in cases with obstruction. An interesting observation was that columnar epithelial cells, goblet cells, and mucoid effusion were not observed in the mastoid, suggesting a restriction of secretory cells to the middle ear proper. It appears that obstruction of the aditus ad antrum contributes to the pathogenesis and accentuates pathologic conditions in otitis media.

Granulation Tissue↗
PubMed1991

Pathogenesis and pathophysiology of Meniére's disease.

Meniére's disease, neither spontaneous nor inducible in animals, is studied only in patients. Natural history (epidemiology) shows a triad of major symptoms: vestibular, auditory, and aural pressure. One in 3 patients has bilateral Meniére's; over full lifespans, bilaterality approaches 50%. Aural pressure (74.1%) and positional vertigo during/between attacks (85.9%) are common. Clinical variants can persist for 25+ years. All forms have delayed onset and can occur years after incitement, after otosclerosis, infections like otitis media, syphilis, or trauma. Endolymphatic hydrops is found in all, most importantly in pars inferior (cochlear duct and saccule). Some (not most) cases show ruptures. The saccule can distend into the lateral semicircular canal. Symptomatic attacks are explained on physical/biochemical bases. Both longitudinal (slow) and radial (fast) flow seem operational, longitudinal in advanced Meniére's where membranous labyrinth replaces perilymph in scala vestibuli and vestibule. All forms result from endolymphatic absorptive dysfunction (in duct and sac), with mastoid and periaqueductal hypocellularity, hypodevelopment of Trautmann's triangle, and anterior displacement of lateral sinus. Secondary obstructions in ductus reuniens or utricolo-endolymphatic valve may explain atypical Meniére's (vestibular or cochlear alone).

Cochlear Diseases↗
PubMed1991

Interactive inner-ear/middle-ear disease, including perilymphatic fistula.

Pathologic interactions between the middle ear and inner ear occur with 1) congenital anomalies, 2) trauma, 3) infection/inflammation, 4) tumors, 5) granulomas, 6) ototoxic eardrops, 7) cochlear implants, 8) otosclerosis, 9) Meniere's disease (decompensated) and Meniere's disease (with perilymphatic fistula), and 10) perilymphatic hypertension. Clinical and pathological characteristics are briefly categorized in this survey. Comments are made concerning the clinical utility of exploratory tympanotomy in diagnosis and treatment of pathologic conditions in the middle ear and pathologic conditions that are interactive between middle ear and inner ear.

Ear Diseases↗
PubMed1991

Methods of diagnosis and treatment of Meniére's disease.

Methods and principles of diagnosis and treatment of Meniére's disease are described and discussed. Terminology, diagnosis, and therapy are discussed on the basis of current understanding of the natural history and pathogenesis of this disease. Techniques (methods) and surgical objectives are designed to counteract the pathogenetic process (malabsorption of endolymph).

Audiometry, Evoked Response↗
PubMed1979

Infiltration of the tensor tympani and stapedius muscles in otitis media. An experimental study in the cat.

A longitudinal sequential study of otitis media was done in an experimental animal (cat) using eustachian tube obstruction. Fifty animals were used. Cellular infiltration of the tensor tympani and stapedius muscles was studied in a continuum from day 1 to 6 months after inducing otitis media. We observed that there is infiltration of the connective tissue of both muscles in otitis media, and that the cellular changes follow the same pattern as that seen in the mucoperiostium and the round window of the middle ear, although to a lesser degree. In this first report of sequential changes in middle ear muscles in otitis media, clinical implications of these findings are discussed.

Animals↗
PubMed1979

Endolymphatic hydrops and otitis media.

Clinical observation of patients with fluctuant sensorineural hearing loss following or occurring with chronic otitis media led to the hypothesis that endolymphatic hydrops can result from chronic otitis media. Illustrative case reports are described. This hypothesis resulted in a temporal bone study of 560 cases in which 109 temporal bones demonstrated the presence of hydrops and 194 evidenced otitis media. Seventy-five cases demonstrated both otitis media and hydrops, of which 20 cases were selected for more detailed histopathological study. An interesting finding was the presence of apical hydrops in every case of the latter group. Statistical interpretation of this data helped rule out a coincidental or chance occurrence. A discussion of this clinical relationship included the significance of subclinical (silent) otitis media as a possible cause of endolymphatic hydrops.

Adult↗
PubMed1979

Air caloric testing in otitis media. (preliminary studies).

On certain occasions it becomes important to evaluate vestibular function in a patient with otitis media. The potential application of the air caloric test in evaluating such patients was examined. Patients with unilateral otitis media before and after surgery were studied to answer certain clinical questions. More questions were raised than answers provided. The preliminary conclusions from this study are: 1. Patients with tympanostomy tubes or small perforation of one ear may show a caloric response in the perforated ear equal to that of the intact ear. 2. Patients with a large tympanic membrane perforation on one side may show hyperactive caloric responses on the perforated side. 3. Patients with a moist ear may show inverted horizontal nystagmus to warm air caloric testing. This applies to patients with a large perforation or mastoidectomy cavity. 4. Patients with a dry open mastoid or fenestration cavity are likely to show a hyperactive caloric response on the side of previous surgery, accompanied by vegetative symptoms. This size of the cavity appears to be less important than the presence of the cavity per se. 5. Patients may be safely tested in the early postoperative period.

Air↗