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Biomedical subjects

M M Paparella

Publications and source records attributed to M M Paparella.

At least 109 records · Page 6Linked to original sources
PubMed1987

Experimental grafting of the round window membrane: Part I.

The histology and permeability of cats' round window membranes were described following surgical grafting with gelatin foam or fascia. An increase in the thickness of the round window membrane due to fibrosis, neovascularization, and epithelial metaplasia was observed 2 months following grafting with gelatin foam. Grafting with fascia did not increase the thickness of the round window membrane, but did form a thick layer of granulation tissue adjacent to and overlying the window membrane, with occasional adhesions between. The layer of granulation tissue consisted of cuboidal or columnar ciliated epithelial cells, fibrous tissue, lipid, and undigested grafted material. The granulation tissue did not always completely cover the round window membranes.

Animals↗
PubMed1987

Endolymphatic sac enhancement. Principles of diagnosis and treatment.

Principles of diagnosing and treating Meniere's disease using endolymphatic sac enhancement are described. Based on a current understanding of the natural history and pathogenesis of this disease, the terminology, diagnosis, and thereby are discussed. Techniques (methods) and surgical objectives of endolymphatic sac enhancement are designed to counteract the pathogenesis (endolymph malabsorption). Current surgical methods and results are presented for 100 patients selected at random from a larger group. Discussion of this method of treatment and reporting criteria follow.

Adult↗
PubMed1986

Primary and secondary tumors of the facial nerve. A temporal bone study.

Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.

Cranial Nerve Neoplasms↗
PubMed1986

Silent otitis media: clinical applications.

Silent (masked) otitis media refers to usually chronic pathological conditions behind an intact tympanic membrane which may be clinically "undetected" or "undetectable." Correlations are described for pathological changes in temporal bones and clinical considerations for silent otitis media associated with Hemophilus influenzae meningitis in infants, silent otitis media--the continuum, silent otitis media--sequelae, and chronic silent otitis media.

Haemophilus influenzae↗
PubMed1985

Sensorineural hearing loss in experimental purulent otitis media due to Streptococcus pneumoniae.

Sensorineural hearing loss (SNHL) has been described clinically following chronic otitis media with effusion, but to the best of our knowledge, no studies have demonstrated SNHL in an animal model of otitis media. Using the chinchilla model of pneumococcal otitis media, significant SNHL was demonstrated after purulent otitis media, especially at higher frequencies. Animals with otitis media received penicillin G procaine treatment for five days after otitis media with effusion (OME) was first documented; resolution of middle ear infection was confirmed by middle ear effusion culture in all animals. Both the inoculated and uninoculated ears were examined by tone burst-elicited compound action potential at threshold. The inoculated ear showed a marked hearing loss of 13 to 36 dB three to four days after OME was first documented; a hearing loss up to 24 dB persisted two to five weeks after inoculation. The change in the compound action potential was highly significant at all frequencies studied. Conductive losses were largely ruled out because there was no middle ear effusion at death and the tympanogram was normal. Purulent labyrinthitis was ruled out by histopathological study. These results indicate that purulent pneumococcal otitis media in the chinchilla model causes significant SNHL and suggest that the pathogenesis of SNHL associated with chronic OME in humans may be studied in this model.

Animals↗
PubMed1985

Vestibular Meniere's disease.

The clinical entity of vestibular Meniere's disease (VMD) is assessed and described. Twenty percent of cases eventuating in typical Meniere's disease presented with VMD first. In other patients VMD alone persisted for many years (30 or more). VMD, usually unilateral, is characterized by recurrent episodes of vertigo typical of classical Meniere's disease. Positional vertigo can occur between or during episodes. Aural pressure is second to vertigo in importance, and electronystagmographic findings are third. Although hearing is normal, tinnitus or loudness intolerance may be present. Concepts of pathogenesis are discussed.

Adolescent↗
PubMed1985

Clinical-histopathological correlations in experimental otitis media: implications for silent otitis media in humans.

Clinical-histopathological correlations were sought in an experimental animal model of otitis media. Among 20 chinchillas inoculated intranasally with wildtype influenza A/Alaska virus (H3N2) and type 7F Streptococcus pneumoniae, 15 animals (18 ears) developed otoscopic and tympanometric signs of otitis media with middle ear effusion. Middle ear inflammation was most intense 10 days after virus inoculation. Twenty-two days after virus inoculation, eight ears showed diffuse middle ear histopathology and contained effusion, which cultured pneumococcus, five ears showed focal histopathology, and four of the five contained no effusion. Clinical manifestations of otitis media had disappeared in four of the 13 ears with pathology at sacrifice; otoscopy was normal in all four ears, tympanometry was normal in three ears, and both otoscopy and tympanometry were normal in one ear. All four of these ears with clinically "silent" middle ear histopathology had shown abnormalities of ear drum appearance or tympanometry between 7 and 14 days after inoculation. Discordance between histopathology and the clinical examination performed at sacrifice was greatest for ears with focal pathology.

Acoustic Impedance Tests↗
PubMed1985

Subepithelial space in otitis media.

The role of the subepithelial space (SES) has not received sufficient attention in assessing pathogenesis, pathology, and therefore, clinical diagnosis and treatment of the various forms of otitis media (OM). Temporal bones from patients with OM were classified as cases of acute purulent (POM), serous (SOM), mucoid or secretory (MOM), or chronic otitis media (COM). Controlled morphometric studies were made of cellular components of the SES, along with studies of the epithelium and middle ear space. Corollary studies of biochemistry, cellular components, and prostaglandins (PGs) were done on fluid from the human middle ear. Middle ear effusions (MEE) from animal models of SOM, MOM, and POM were analyzed biochemically. Findings are surprising in that the SES was more actively involved in all forms of OM than had been thought, especially in MOM and COM. Implications are discussed.

Animals↗
PubMed1984

The human round window membrane. An electron microscopic study.

The normal adult human round window membrane was examined by transmission electron microscopy. The membrane consists of the following three layers: (1) an outer squamous epithelial layer with an underlying basement membrane; (2) a middle fibrous layer containing collagen, elastin, fibrocytes, vessels, and nerves; and (3) an inner layer of mesothelial cells. Mucosal membrane veils that cover the round window membrane, forming "false" round window membranes, are also described. These membranes are also three layered, including (1) an outer epithelial layer with an underlying basement membrane, (2) a middle fibrous layer containing collagen, elastin, fibrocytes, vessels, and nerves, and (3) an inner epithelial layer with an underlying basement membrane. Ultrastructural differences between these two structures are discussed.

Aged↗
PubMed1984

Intact-bridge tympanomastoidectomy.

In recent years closed-cavity (intact wall) tympanomastoidectomy has been described and recommended by many. The pendulum now is swinging back to open-cavity tympanomastoidectomy. The literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with a dry, safe ear; a concomitant but secondary objective is hearing retention and restoration with tympanoplasty techniques. Over a 3-year period we have used a one-stage procedure called intact-bridge tympanomastoidectomy (IBM) that fulfills the desirable objectives of both open- and closed-cavity tympanomastoidectomy. The salient features include good exposure as in open-cavity tympanomastoidectomy, maintenance and widening of the middle ear space by bony bridge retention and facial buttress sculpturing to enhance grafting and ossiculoplasty such as TORP or PORP as in canal-up tympanomastoidectomy, and enhancement of mastoid obliteration for large cavities by blocking the aditus with bone paté or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques, and results will be presented and discussed.

Adolescent↗
PubMed1984

Pathogenesis of Meniere's disease and Meniere's syndrome.

Meniere's disease can only be studied in patients, since it does not occur spontaneously in animals nor can it be induced in them. However, aspects of the disease such as endolymphatic hydrops can be usefully studied in animals. A study of the natural history (epidemiology) of Meniere's disease demonstrated the three major symptoms (triad) to be vestibular symptoms, auditory symptoms, and aural pressure. Bilaterality occurs in at least one out of 3 patients, and may approach 50% over full lifespans. Aural pressure (74.1%) was common, as was positional vertigo (85.9%) during and/or between attacks. Clinical variants such as vestibular Meniere's disease could persist for 25 years or more. Understanding the pathogenesis of Meniere's requires a study of known and unknown causes. In this study, Meniere's disease (cause unknown) was differentiated from Meniere's syndrome (cause known). Meniere's disease or syndrome can occur years after some inciting cause; thus all forms of Meniere's can be considered to have a delayed onset. Meniere's syndrome can occur as a sequel to syphilis, otosclerosis, infection (for example otitis media), or trauma. Endolymphatic hydrops explained on the basis of quantity and quality of endolymph is found in all forms of Meniere's disease and syndrome. Representative cases and pathological examples are discussed. Hydrops of the pars inferior (cochlear duct and saccule) is the most important finding in Meniere's disease. In some (but not most) cases, ruptures of the membranes are seen. The saccule can distend into the lateral semicircular canal. Symptomatic attacks are explained on the basis of both physical and biochemical phenomena. This study discusses concepts of pathogenesis of the disease, finding both theories of longitudinal (slow) and radial (fast) flow to be operational. Longitudinal flow, however, appears to be more important than radial flow, especially in advanced Meniere's where perilymph in the scala vestibuli and vestibule disappears and is replaced by membranous labyrinth. Meniere's disease (idiopathic) and Meniere's syndrome (cause known) probably occur as a result of endolymphatic absorptive dysfunction (the site being endolymphatic duct and sac). Hypocellularity of the mastoid and periaqueductal air cells, hypodevelopment of Trautmann's triangle, and anterior displacement of the lateral sinus are likely to be important findings associated with developmentally dysfunctional absorption of endolymph.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1984

A metastatic glomus jugulare tumor. A temporal bone report.

The clinicopathologic findings in the temporal bone of a patient with a highly malignant metastasizing glomus jugulare tumor are reported. The patient exhibited all the symptoms of primary malignant tumors of the ear, including facial paralysis, otorrhea, pain, hearing loss, tinnitus, dizziness, and vertigo. He was treated with cobalt irradiation followed by radium implant in the ear canal for a residual tumor; then a left-sided radical mastoidectomy was performed.

Adult↗
PubMed1984

Otosclerosis and Meniere's syndrome: diagnosis and treatment.

Occasionally a patient with otosclerosis and a conductive hearing loss will develop typical findings of Meniere's syndrome in the involved ear, years later. A review of clinical and pathological studies in the literature and in our laboratory and clinic indicates a likely cause-and-effect relationship for these cases. The pathology and pathogenesis of the syndrome of otosclerosis and Meniere's syndrome is discussed. A stapedectomy/sacculotomy was used to treat 17 patients, 13 of whom acquired a satisfactory result in terms of improvement of hearing and control of vertigo. This technique and findings are described and discussed.

Adult↗
PubMed1984

Otosclerosis and endolymphatic hydrops.

It has been postulated that otosclerosis may produce vertigo by several mechanisms. One mechanism is by causing endolymphatic hydrops. We present six temporal bones in which otosclerosis and endolymphatic hydrops coexist. We consider that there is a spectrum-like interrelationship between these two entities. At one end of the spectrum the relationship is coincidental, while at the other end of the spectrum we consider the massive amount of active otosclerosis to be a causative factor in the development of the endolymphatic hydrops.

Aged↗
PubMed1983

Children with persistent otitis media. Audiometric and tympanometric findings.

Audiometric and tympanometric findings were compared among 129 patients with clinically manifest persistent otitis media (OM) with effusion. Ears with thick effusion (mucoid OM) had significantly larger air-bone gaps and higher prevalence of flat tympanograms than either of the thin effusion types (purulent [POM] or serous OM [SOM]) or ears with no effusion (dry). Ears with thin effusion (POM and SOM) had similar air-bone gaps, thresholds for air and bone conduction, and prevalences of flat and underpressure tympanograms. Ears with no effusion had significantly smaller air-bone gaps, slightly poorer bone conduction thresholds, and lower prevalence of flat tympanograms than ears with effusion (MOM, POM and SOM). Ears with clinically manifest OM and no effusion at tympanocentesis appear to represent patients with a spontaneously resolved episode of OM with thin effusion (POM or SOM) or with ears that evacuated during anesthesia prior to tympanostomy.

Acoustic Impedance Tests↗