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Biomedical subjects

M Portmann

Publications and source records attributed to M Portmann.

At least 37 records · Page 2Linked to original sources
PubMed1991

Results of middle ear reconstruction surgery.

Reconstructive surgery of the middle ear comprises two types of operations, i.e. reconstruction of the surroundings of the middle ear (external auditory canal) and reconstruction of the tympano ossicular contents of the middle ear (tympano-ossiculoplasty). Reconstruction of the external auditory canal may be total after certain open techniques, or partial after certain closed techniques. The results are markedly better when cortical bone autografts are used rather than materials such as Ceravital or Hydroxylapatite. Furthermore, cavity obliteration gives excellent results in 90% of cases (using bone powder, biomaterial powder, fibrin glue and covering muscular flaps). Tympano-ossiculoplasty gives on the whole, good results. Based on statistics of over 2200 cases, the author dwells in particular on the use of ossicular homografts, the results of which are generally superior to those of the best biomaterial (Ceravital and Hydroxylapatite).

Ear Diseases↗
PubMed1991

[Post-traumatic facial paralysis without any fracture of the petrous bone].

Post-traumatic facial palsies are generally observed after a transverse, longitudinal or comminuted fracture of the pars petrosa. Occasionally, the fracture does not involve the Fallopian aqueduct and another mechanism must be sought. The authors present a case of facial palsy that occurred after a Le Fort's fracture of the base of the skull, not involving the Fallopian aqueduct on the CT scan. This was confirmed by surgical exploration. The authors recall the possibility of a facial palsy through the stretching of the nerve by the petrosal nerve.

Adult↗
PubMed1991

[Exostosis of the external auditory canal: clinical and therapeutic aspects].

Based on the study of 25 cases, the authors recall the frequency and pathogeny of these lesions, specifying the surgical technique and presenting their results. The risks of this surgery lie in the ever possible impairment of the facial nerve and labyrinthization on treble frequencies (2 cases). The incidents are tympanic perforation (1 case) and the opening of the temporomandibular joint. It is not always possible to preserve the skin of the external auditory canal. It can be reconstructed by a free (3 cases) or pedicle (3 cases) graft of more simply in case of small loss of substance by a temporal fascia graft.

Adolescent↗
PubMed1991

[Bulbar auditory nuclei: morphological study, consequences for implantation of electrodes].

Many bilaterally profoundly deaf individuals cannot benefit from a cochlear implant because the eight nerve is not intact from the cochlea to the brain stem. For these individuals, electrical stimulation of the cochlear nuclear complex (CNC) may partially restore the sensation of hearing. Histological studies were done on 12 brain stems containing the region of the CNC and findings of this study seems important to accurate implantation of the prosthesis on the CNC for chronic electrical stimulation. Apparently the spheroid cells of the inferior ventral cochlear nucleus (IVCN) represents the site of the CNC for such stimulation.

Adult↗
PubMed1990

[Synergism between noise and ototoxic drugs: new experimental data].

Results of experiments investigating, in the guinea pig, the effects of combinations of gentamicin (GM), ethacrynic acid (EA) and acoustic stimulations are reported. They indicate that functional and morphological alterations develop only after GM has penetrated specifically into the sensory cells, that this penetration is indirectly facilitated by EA, since it is known to increase GM concentration in endolymph, and directly by functional depolarization of the cell, as it occurs during normal acoustic stimulation.

Animals↗
PubMed1990

[Ménière's disease].

Ménière's disease is based upon a clinical definition: the traditional Ménière's triad, a physiopathological definition, and the presence of hydrops. If all cases of Ménière's disease suffer from hydrops, not all cases of hydrops suffer from Ménière's disease. Recent progress thanks to electrocochleography, determination of the summating potential and its possible reversability under the effect of glycerol, enables a more reliable diagnostic approach, which furthermore includes the usual clinical and para-clinical examinations. Medical treatment has several objectives: the action of water on the metabolism, action on the behaviour of the labyrinthine capillaries and the biology of neurosensorial cells, action on vestibular information and the receptivity of the nerve centres and finally on the patients' lifestyle. There are two predominant surgical techniques: decompression of the endolymphatic sac and transcranial neurectomy. Two other techniques are employed in more exceptional circumstances, and only in cases of very severe deafness: transoval destruction and translabyrinthine neurectomy. The ideal clinical profile corresponding to the indications for these four surgical methods is explained.

Audiometry, Evoked Response↗
PubMed1990

[Efficacy and tolerability of morniflumate in acute otitis in infants: results of a randomized study versus placebos].

In a randomized double-blind placebo-controlled, parallel group study, 79 infants with acute otitis media received treatment with suppositories containing either Nifluril (400 mg daily, morniflumate) or placebo for five days. Both groups of patients also received amoxicilline (50 mg/kg daily) for eight days. The combination of Nifluril with antibiotic therapy gave significantly greater relief from abnormalities of the tympanic membrane (after two days treatment), inflammation of the throat and nasal congestion than did antibiotic therapy alone. Overall clinical assessment confirmed a significantly greater recover rate in the Nifluril group compared with the placebo group. Very few side effects were recorded, limited to diarrhoea, without any drug interruption. Nifluril may be recommended as an effective safe adjuvant to the antibiotic treatment of acute otitis media in infants.

Acute Disease↗
PubMed1990

[Use of the Musco NT3 tympanic isopressor in tubal dysfunction. Apropos of 30 cases].

We have studied the tolerance and efficacy of tubal insufflations with the MUSCO NT3 isopressor (Bexen) in a sample of 30 patients suffering from chronic tubal pathology. The apparatus was modified for use with an Itar Catheter. We recorded a favourable evolution of serous otitis (9 cases of normalization), with little modification of the retraction pockets. The paraclinical study revealed a major and significant overall, audiometric and tympanometric improvement.

Adolescent↗
PubMed1990

[Management of open and closed cavities in otology].

Surgery of chronic otitis follows a few basic principles, some of which are long-standing but still topical. In the majority of cases, opening of the cavities of the middle ear uses one of the following two techniques: the open technique (radical mastoidectomy), or the closed technique (transmastoid approach or canal up technique). Whatever the technique used, a readjustment of the cavity is often indispensable to avoid any recurrence of the pathology (cholesteatoma) or the appearance of a new pathology (chronic otorrhea) and facilitates a functional step if required. Open techniques must therefore always follow the rule of the ratio V/S (where V = the volume of circulating air coming from outside, and S = the surface area of the skin of the cavity). This ratio is specific to each individual. The readjustment must enable either an increase of V (meatoconchaplasty) or a decrease of S (reconstruction of the posterior auditory canal, obliteration of the cavity), or a combination of the two. Closed techniques must also be adjusted to avoid any retraction towards the posterior or upper cavities. Depending on the clinical background and on the aggressivity of the pathology, the posterior tympanotomy can be closed, and the attic and aditus cavities of the middle ear separated by a bony fragment leaving the protympanum open upwards to enable normal ventilation towards the attic, the aditus and the antrum, or much more rarely, these cavities can be completely closed.

Chronic Disease↗
PubMed1990

The prognostic value of the stapedius reflex in peripheral facial palsy.

Stapedius reflex can provide useful prognostic information in FPs when the middle ear is normal. Its preservation may have a favorable significance in partial FP and Bell's palsy. Its loss, even though less reliable, can also have some value as an indicator for a poor prognosis in patients with total and herpes zoster FPs. Most importantly, our findings have shown that the SR alone is not sufficient to be of prognostic value, but is useful if combined with other clinical parameters and electrical responses.

Adolescent↗
PubMed1989

Modern diagnostic strategy for acoustic neuromas.

We have reviewed the most recent 120 cases of acoustic neuromas operated upon in Bordeaux, France. In so doing, we have defined the strategy required to reach an accurate diagnosis as essentially comprising three stages. The first of these is to understand that the presenting symptom complex may be typical with progressive unilateral hearing loss, tinnitus, etc., or atypical with sudden hearing loss (10%), recovering facial paralysis (3.3%) or a Menière's syndrome (3.3%). Included in the first stage of diagnosis are audiovestibular investigations. An absent stapedial reflex was noted in 41% of our cases and an abnormality in vestibular testing in 95% of cases tested. These findings would be clear indicators to proceed to the second stage of the diagnostic strategy. This second stage comprises electric response audiometry consisting of auditory brainstem response (ABR) testing and electrocochleography (ECochG) employed as a filter for determining which patients should proceed to the third stage of testing. A combination of ABR and ECochG provides the clinician with results of high sensitivity and specificity. The false-negative rate for combined results in our experience has been less than 1%. The final diagnostic stage is radiological imaging, in particular using magnetic resonance imaging (MRI) with gadolinium contrast as the modality of choice. MRI is superior to CAT scanning, especially in the diagnosis of stage I intracanalicular tumors.

Audiometry, Evoked Response↗
PubMed1989

Aesthetic surgery for microtia.

We describe here a technique for reconstruction of the external ear based upon an autogenous costal cartilage graft which is inserted into a cutaneous pocket dissected in the auricular area. Three subsequent procedures are then performed: rotation of the ear-lobe; reconstruction of the tragus; and elevation of the auricle. The ideal age for reconstruction is about 7 years. This technique was originally described by Brent, who has a very extensive experience with this kind of surgery. Skin deficiencies can be overcome by using either a temporo-parietal fascial flap or a skin expander.

Cartilage↗
PubMed1989

[Mérocel's method in otorhinolaryngology].

Merocel intra-nasal pack are very effective in controlling epistaxis. Different forms of Merocel are very usefull in external otitis and after endonasal and middle ear surgery. They can protect some particular structures during oto-neuro and head and neck surgery.

Bandages↗
PubMed1989

[Cochlear and facial nerve function after surgery of acoustic neuroma].

Oto-neuro-surgical teams of Bordeaux University Hospital operated at this day, 700 acoustic neuroma. A retrospective study of the 120 last cases has shown the facial function be abnormal clinically in 16% of cases and in 50% from the electrophysiological point of view. Immediately after surgery: 39% have normal function (grade I), 22% have partial palsy (grades II, III, IV), 39% have total palsy. With 3 months follow up these percentages improve to become respectively 53%, 34% and 13%. For the cochlear function, 28 patients had good hearing before surgery (average pure tone threshold less than or equal to 35 dB and speech discrimination score greater than or equal to 70%). Results depend on the size of the tumour and on the difficulty of dissection during surgery. The hearing could be preserved at a good level in 8 patients (28.5%).

Cochlear Nerve↗
PubMed1989

Techniques of tympanomastoidectomy.

The authors describe the various techniques of tympanomastoidectomy that can be used to eradicate chronic disease processes. The techniques are either open or closed operations; the factors in determining the choice of technique for specific conditions are presented.

Humans↗
PubMed1989

[Use of a temporoparietal fascial flap in difficult reconstructions of the external ear].

Temporo parietal fascial flap is a way of total ear reconstruction when there is not a sufficient quantity of available skin in auricular region. This flap very thin, supplied by superficial temporal vessels is located above the auricle and can cover the framework's convolutions. This technique has been well described by Burt Brent. Our experience is based upon 12 total ear reconstruction with this kind of flap. When there is an extreme skin shortage, but of good quality, we discuss the technique of skin expander.

Ear, External↗
PubMed1988

Limits of ABR and contribution of transtympanic electrocochleography in the assessment of cerebellopontine angle tumours.

Auditory brainstem responses (ABR) and transtympanic electrocochleography (ECochG) were analysed for 63 patients with tumours of the cerebellopontine angle (CPA) and/or internal auditory meatus (IAM). ABR recordings indicated a clearly prolonged wave I-V interval (above 4.3 ms) in half of the patients, hence suggesting a retrocochlear disorder. For the remaining patients ABR alone was not sufficient for clear diagnosis and ECochG was therefore used in addition. When the latency of wave V was uncertain due to the absence of wave I, the latency of wave N1 was always measurable by ECochG. The NI-V interval evaluated in this way was always significantly prolonged (above 4.5 ms) relative to a control group of patients with a sensorineural hearing loss. In 9 of the 13 subjects without any discernible ABR, an ECochG response could be recorded and its threshold was often better than the mean pure tone audiogram. This study confirms the validity of transtympanic ECochG in the diagnosis of retrocochlear disorders. The time difference observed between wave N1 (ECochG) and wave I (ABR) in CPA tumours is discussed and a possible explanation is proposed.

Audiometry, Evoked Response↗