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Biomedical subjects

M M Paparella

Publications and source records attributed to M M Paparella.

At least 127 records · Page 7Linked to original sources
PubMed1983

Intact bridge tympanomastoidectomy (I.B.M.)--combining essential features of open vs. closed procedures.

In recent years, closed cavity intact wall tympanomastoidectomy or combined approached tympanoplasty--(CAT)--has been described and recommended by many. The pendulum now appears to be swinging back again to open cavity tympanomastoidectomy. Pertinent 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 the achievement of a dry safe ear while a concomitant but secondary objective is hearing retention and restoration utilizing tympanoplasty techniques. Over a three-and-a-half year period we have utilized a one-stage procedure which provides the desirable objectives of both open and closed cavity tympanomastoidectomy called intact bridge tympanomastoidectomy (I.B.M.). The salient features include: (1) good exposure, as in open cavity tympanomastoidectomy; (2) maintaining and widening 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; (3) 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 are presented and discussed. The results have been gratifying to date. In comparison to intact wall tympanomastoidectomy, this one-stage operation avoids the cost and discomfort of a second and sometimes third stage; surgery for recurrent pathology has been avoided and hearing results have been at least comparable if not improved.

Adolescent↗
PubMed1983

Trauma and Meniere's syndrome.

Thirty-seven patients who developed Meniere's syndrome following acoustic (18) and physical (19) trauma are described and discussed. Histopathologic characteristics, which appear identical to idiopathic Meniere's disease, are described in a gentleman who developed Meniere's syndrome after head trauma. Concepts of cause and effect relationships and pathogenesis are discussed.

Adult↗
PubMed1983

Meniere's syndrome and otitis media.

We here present a clinical study of 37 patients with Meniere's syndrome. Meniere's syndrome can occur subsequent to and in some cases simultaneously with chronic otitis media. When otitis media which has occurred many years earlier in childhood becomes inactive, leading to sequelae of Meniere's later in life, full-blown Meniere's symptom-complex with vertigo tends to occur; whereas when active chronic otitis media accompanies Meniere's, cochlear Meniere's syndrome tends to predominate. Endolymphatic hydrops is described in pathological cases of labyrinthitis and in 11 human temporal bone cases where there is evidence of chronic otitis media in the absence of visible labyrinthitis. A discussion of pathogenic factors includes considerations of quantity of endolymph due to hypodevelopment of the endolymphatic duct and sac related to mastoid hypocellularity and otomastoiditis in childhood and to other endolymphatic malabsorptions and also considerations of endolymph quality which can influence endolymph production as well as absorption.

Adolescent↗
PubMed1982

Ganglia and ganglion cells in the middle ear. Their presence in the human and the cat.

One hundred human and 100 cat temporal bones were studied for the presence of ganglia and/or ganglion cells. These structures were found at the following two main locations: (1) the promontory wall, both anterior to and below the stapes, and (2) the vertical portion of the facial nerve. In the cat, additional ganglion cells were found within the capsule of the musculus tensor tympani, proximal, medial, and lateral to muscle fibers. The consistent presence of ganglion cells in the mucoperiosteum suggests that they play important roles in the middle ear itself; their presence in the vertical portion of the facial nerve supports the concept that the parasympathetic innervation of the parotid gland is not exclusively via the ninth nerve and/or lends anatomical support to atypical facial pains.

Animals↗
PubMed1982

The normal chinchilla round window membrane.

The chinchilla round window membrane consists of three layers: (1) an outer epithelial layer facing the middle ear cavity with tight junctions and numerous desmosomes, (2) a middle connective-tissue layer consisting of fibroblasts, fibrocytes, collagen, elastin, capillaries, and myelinated and unmyelinated nerves, and (3) an inner cellular layer with thin cytoplasmic processes containing numerous micropinocytotic vesicles and dark granules similar in form to alpha-type glycogen. Studies of the fine structure of the normal round window membrane in animals are prerequisites to understanding the role of the round window membrane in both normal function and in diseased states such as otitis media.

Animals↗
PubMed1982

Meniere's disease and the peak audiogram.

Pure tone audiograms of 300 patients with Meniere's disease and 400 patients without Meniere's disease were compared for prevalence of a high-frequency peak configuration. Prevalence rate of 42% for a peak audiogram was observed in ears diagnosed with Meniere's disease compared with 6% for patients with cochlear hearing loss not attributed to Meniere's disease, and 7% for normal hearing patients. Prevalence of the peak audiogram in patients with Meniere's disease was significantly greater than either of the patient groups without Meniere's disease. Prevalence of peak audiogram was affected by duration and bilaterality of Meniere's disease, but not by the degree of hearing loss. A classification system is proposed for describing the peak audiogram based on the severity of the peak configuration and the degree of hearing loss.

Adolescent↗
PubMed1982

Epidemiology of otitis media with effusion in children.

The recently accepted international classification for otitis media was applied to a study population of 898 children less than 12 years of age having otitis media with effusion persisting at least three months. Mucoid effusion was aspirated from 48% of ears, was found more often in younger than older patients, was more often bilateral, and was a more stable state during longitudinal observation than was serous otitis media or purulent otitis media (POM). Serous otitis media occurred in only 10% of ears, but was found more often than in younger patients; POM was found in only 7% of ears. Otoscopy did not distinguish among the three effusion types. Known middle-ear pathogens were cultured more often behind red and bulging tympanic membranes from these cases of chronic effusion than behind membranes lacking these characteristics. These observations provide an epidemiologic and clinical base for further investigations of these otitis media types.

Child↗
PubMed1982

Exploratory tympanotomy revisited.

The history of exploratory tympanotomy is somewhat obscure. Methods and findings of exploratory tympanotomy were described and assessed for unexplained conductive and occasional sensorineural hearing losses. Of 316 recent cases positive findings leading to diagnosis and therapy occurred in all 250 cases of conductive hearing losses and in 43 of 63 cases of sensorineural hearing losses. In decreasing order of occurrence findings were sequelae of otitis media, otosclerosis, oval and round window changes including perilymph leakage, congenital and traumatic fixation and disarticulation of ossicles. These observations and indications are discussed.

Ear Diseases↗
PubMed1981

Passage of albumin from the middle ear to the inner ear in otitis media in the chinchilla.

A study of the permeability of the middle ear-inner ear interface for macromolecules was carried out in chinchillas with open and obstructed eustachian tubes utilizing tritiated human serum albumin and immunoelectrophoresis. Tritiated albumin was placed in the round window niche area or normal animals and animals in which the eustachian tubes had been obstructed for 24 hours or 14 days. The tritiated albumin was allowed to remain in the middle ear cavity for 24 hours, Samples of middle ear effusion, perilymph, blood and cerebrospinal fluid were collected and measured for radioactivity. Radioactivity was demonstrated in the perilymph. Samples of middle ear effusions and perilymph were also studied by immunoelectrophoresis with goat antihuman albumin. Albumin placed in the round window niche of an experimental animal could be recovered unchanged in the perilymph. The results suggest a pathophysiologic explanation for the association of otitis media and sensorineural hearing loss or endolymphatic hydrops.

Animals↗
PubMed1981

Clinical evaluation of Ménière's disease.

A retrospective review of 211 consecutive patients with classic Meniere's disease was performed to determine the efficacy of diagnostic studies. The patients' ages averaged 47 years and ranged between 8 and 86 years. Females outnumbered males 1.3 to 1. Left and right ears were affected with equal frequency and, in 12% of patients, the disease was bilateral. Audiologic patterns were flat in 42%, rising in 7%, peaked in 32%, and sloping downward in the remaining 19%. Electronystagmography was normal in 21% of the patients and demonstrated canal paresis in 65% and directional preponderance in 14%. Studies of glucose metabolism were abnormal in 2 of the 204 patients tested. The 7 patients not tested had a previous diagnosis of diabetes mellitus. Thyroid function studies were abnormal in 1 of the 208 patients studied. The 3 patients not studied were known hypothyroid. FTA-abs was positive in 12 patients and special radiographic studies of the petrous apex were normal in all cases. Conclusions suggested by this study are that audiology, electronystagmography, and treponemal antigen tests for syphilis are cost effective in evaluating patients with Meniere's disease. Studies of glucose metabolism and thyroid function, however, are probably not indicated in patients without a history suggestive of a metabolic disorder and specialized radiographs of the petrous apex should be reserved for patients suspected of having acoustic neuroma.

Adolescent↗
PubMed1981

The round window membrane following application of staphylococcal exotoxin: an electron microscopic study.

The round window membrane has been considered as a pathway for the passage of toxic substances from the middle ear cavity to the vestibular labyrinth in cases of otitis media. To determine the role of the round window membrane in this passage, chinchillas were given intrabullar inoculations with staphylococcal exotoxin and the round window membranes were examined electron microscopically. We observed cytoplasmic vacuolization, intercellular edema, cellular and nuclear swelling of the surface epithelia and polymorphonuclear leukocyte (PMN) infiltration of the fibrous layer. Light microscopic observation of the labyrinth revealed PMN infiltration of the most basal portion of the scala tympani. These findings demonstrate a chemotactic effect of the toxin for PMNs and support the concept of the round window membrane as an important avenue of entry.

Animals↗
PubMed1981

Experience with tympanoplasty for atelectatic ears.

Atelectasis is, unfortunately, still a common sequela of otitis media with effusion (OME)--including serous otitis media (SOM) and mucoid otitis media (MOM). When atelectatic ears provide a functional deficit, i.e., a conductive loss of sufficient magnitude or a residual conductive loss after aerating the middle ear with ventilation tube or early or strongly suspected attic cholesteatoma, a simple corrective procedure has been used which has stood the test of time. The procedure as well as experience with 51 patients (60 ears) will be described and discussed. The procedure consists of re-establishing the mesotympanic space, strengthening the tympanic membrane by an underplant fascial graft, cutting the tensor tympani, extirpation of any disease, re-establishment of ossicular mobility and continuity and the insertion of a ventilation tube in the anterior drumhead remnants along with silicone rubber sheeting and a moist Gelfilm implant. Methods and results are discussed.

Adolescent↗
PubMed1980

Ganglia and ganglion cells in the middle ear of the cat: preliminary report.

Twenty-five temporal bones of cats were studied for the presence of ganglia and/or ganglion cells in the middle ear. These structures were found at the following three main locations: (1) the promontory wall, both anterior to and below the stapes; (2) the capsule of the musculus tensor tympani, proximal, medial, and lateral to muscle fibers; and (3) the vertical portion of the facial nerve. To the best of our knowledge, ganglion cells in the capsule of the musculus tensor tympani, which is located proximal and lateral to the muscle fibers, have not been described previously.

Animals↗
PubMed1980

Permeability of the round window membrane in otitis media.

A round window membrane permeability study of macromolecules in otitis media, using tritiated normal human serum albumin, was done in cats. Eustachian tube obstruction was used to induce otitis media in ten animals. Samples of perilymph in obstructed and normal control ears were studied after 25 minutes of exposure of the round window to tritiated albumin. Twelve additional animals were obstructed, and their round window membranes studied to provide histopathologic evidence for our permeability studies. In this first report of round windon membrane permeability to macromolecules in otitis media, we observed an increased permeability to tritiated albumin in diseased ears. Evidence suggests a pathophysiological explanation for the association of otitis media and sensorineural hearing loss and/or endolymphatic hydrops. Proof that large molecules pass suggests the feasibility of diffusion of smaller molecules (toxins and enzymes) through the round window membrane.

Animals↗