[Lesions of the round and oval window as causes of acute hearing loss and vertigo].
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Acute Disease↗
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[Use of radiology in the diagnosis of posttraumatic otoliquorrhea. A report on 33 operated cases (author's transl)].
The association of standard radiography and tomography can enable the origin of the fistula to be established with reasonable precision : complementary contrast cisternography should permit direct localization. Treatment is essentially the concern of the E.N.T. surgeon, but the problem cannot be resolved without a perfect understanding between the neurosurgeon, surgeon, E.N.T. specialist, and the radiologist.
Cerebrospinal Fluid Otorrhea↗
Spontaneous labyrinthine window rupture.
Spontaneous labyrinthine window rupture has been increasingly recognized in recent years. Seven such case histories and details of subsequent management by tympanotomy and fat graft plugging of the fistulae are reported. The importance of a history of physical stress preceding onset of symptoms is emphasized in the case of certain patients who presented with sudden hearing loss accompanied, in some cases, by tinnitus or vertigo. The first 5 patients were reported in a paper presented in October 1977 at the First South African National Otorhinological Congress in Cape Town.
Adult↗
[Obliterative otosclerosis].
In true (grade IV) obliterative otosclerosis, the limits of the oval windows are lost. The insertion of a prosthesis requires drilling and surgical ability. Thirty eight cases of the true obliterative otosclerosis operated in our Department between 1974 and 1992 have been reviewed. Only 6.2% of all the patients operated by us with the diagnosis of otosclerosis had true obliterative otosclerosis. The average preoperative gap in conversational frequencies was 39 dB. In general, the gap closure obtained (13 dB) was slightly lesser than that for otosclerosis. Reobliteration of the oval window may occur in this type of otosclerosis.
Audiometry↗
[Morphological and morphometric study of the tympanic and mastoid portions of the fallopian aqueduct].
In surgery of the temporal bone the best way to avoid injuries to the facial nerve is to be acquainted with its location in all the surgical steps of the procedure scheduled. That is to say: an exact knowledge of its normal intratemporal run, having always in mind some characteristic landmarks, is absolutely essential. This work has been done through drilling 92 human temporal bones, measuring the length of both the tympanic and mastoidal segments and also considering the bending of the 2nd knee of the nerve. In the issue the mastoidal portion resulted the most straight (by half of the cases) whereas the tympanic one was slightly sloping downwards between the lateral semicircular canal upwards and the oval window below. Topographically has not been possible to establish neither a strict correlation between the location of the pyramide and the 2nd knee nor this knee was found by uns (in contrast to other AA's findings) at higher angle than 90 degrees in our specimen.
Culture Techniques↗
A case of Tullio phenomenon in a subject with oval window fistula due to barotrauma.
The Tullio phenomenon is defined as vertigo that occurs as a result of extremely high acoustic stimuli. Stimulation of the system of semicircular canals and otoliths causes nystagmus, reflex head tilt and body sway, and vertigo to occur. This condition is quite rare. The Tullio phenomenon was diagnosed in a patient with a fistula of the oval window due to barotrauma. It was diagnosed after a careful examination by Frenzel's glasses. The complaints of vertigo disappeared after the fistula had been closed surgically.
Adult↗
[Surgical revision for otospongiosis].
Revision surgery for otosclerosis is analysed in 26 patients. Audiometric results are better in patients with recurrent rather than persistent transmission hearing loss. Total platinectomy with interposition may be a solution for patients with chronic tubal dysfunction.
Adult↗
Imaging of otosclerosis.
Imaging studies play an important role in the diagnosis of otosclerosis and in the clinical management of this disease. CT scanning at present is the tool of choice for the assessment of the labyrinthine windows and cochlear capsules. MR imaging thus far has had limited applications in the examination of the cochlear capsules but has been more useful in the assessment of the cochlear lumen prior to cochlear implant in patients with profound bilateral hearing loss.
Absorptiometry, Photon↗
Stapedectomy technique.
This article reviews the evolution of the author's stapedectomy technique from total footplate removal with single loop wire prosthesis and Gelfoam seal to small fenestra stapedectomy with platinum ribbon piston prosthesis and blood seal. The author concludes that the microdrill is effective, safe, and cost effective for performing this procedure. Since using this technique, the author has had no cases of sensorineural hearing loss and few complaints of dizziness or vertigo.
Fenestration, Labyrinth↗
Validity of spontaneous perilymphatic fistula.
In response to recent articles questioning the validity of some perilymphatic fistula diagnoses, another small series is presented, reconfirming the enigmatic clinical appearance of perilymphatic fistula. Histologic evidence and experimental pathophysiology that explain the varied symptoms are reviewed. A pressed-fat fibrin-glue technique that seems to prevent recurrences is described, as well as a technique that may be helpful in confirming the presence of inapparent fistulas in surgery. Argument is advanced that this is a safe, minor surgical procedure helpful in alleviating vestibular and/or auditory symptoms in more than 70% of patients.
Cochlear Diseases↗
Vein graft in stapes surgery.
Sealing the opening of the oval window during stapes surgery is essential; it prevents postoperative complications, such as perilymph fistula and sensorineural hearing loss. In this small series of 269 cases with otosclerosis, tympanosclerosis, and congenital ossicular abnormality, vein grafting was used to seal the opening of the footplate. Hearing improvement after surgery was acceptable, and none had total hearing loss or perilymphatic fistula. World literature from the last half of this century on grafting the oval window is reviewed. Absorbable gelatin sponge (Gelfoam) seems to be causing more complications, so its use is highly discouraged. Temporalis fascia, fat, and perivenous loose areolar tissue have been used by different authors at different times in footplate surgery. The opening created in the oval window during stapes surgery must not be left uncovered.
Audiometry, Pure-Tone↗
Perilymphatic fistula--a definitive and curable cause of vertigo following head trauma.
Vertigo or disequilibrium occurring in patients after concussive and nonconcussive head trauma may be due to a pathologic perilymphatic fistula from the inner ear through the oval and round window areas of the middle ear. Of 33 patients who had successful grafting of the fistulous area at middle ear exploration, 32 had resolution of vertigo, and 12 of 23 who had an associated hearing loss had improved hearing. Perilymphatic fistulas associated with vertigo and hearing loss after head trauma can be diagnosed with great certainty and are surgically curable in the great majority of cases. Patients with post-concussive syndrome, whose symptoms include vertigo or disequilibrium, should have a thorough otologic evaluation for the possibility of a perilymphatic fistula.
Craniocerebral Trauma↗
Temporal bone histopathologic findings in oculoauriculovertebral dysplasia. Goldenhar's syndrome.
The right temporal bone of a 6-month-old patient with oculoauriculovertebral dysplasia (Goldenhar's syndrome) was examined histopathologically. The most striking abnormalities were deformity of the auricle, atresia of the external auditory canal, severe malformation of middle ear structures, and incomplete development of the oval window. No inner ear abnormalities were identified in this case.
Goldenhar Syndrome↗
The effect of butyl 2-cyanoacrylate on the middle and inner ear of the chinchilla.
Butyl 2-cyanoacrylate was placed on the oval and round window of the ear of the chinchilla and was also used as an adhesive for myringoplasty with autogenous muscle fascia. Butyl 2-cyanoacrylate was found to be difficult to manipulate and moderately toxic to the middle ear; there were occasional significant reactions in the inner ear.
Animals↗
Sound transmission in the salamander ear.
The mode of stimulation of the ear by sounds is considered in Amphibia, in which it differs among the three Recent orders. Of special interest is the order Caudata, in which this stimulation takes a unique form: sounds applied to the oval window of one ear produce a path of vibratory motion that passes through the brain cavity to the oval window on the opposite side. In this course the vibratory movements traverse both right and left amphibian papillae, and both basilar papillae also in species that contain these endorgans. Thus, in the salamander the hearing is invariably binaural.
Animals↗
[Posterior crus stapedectomy: an obsolete method in otosclerosis surgery?].
BACKGROUND: Stapedectomy and stapedotomy with interposition of prostheses are the methods of choice for surgical treatment of otosclerosis. For the present study we resumed and reevaluated the posterior crus stapedectomy, a method based on the principal of renouncing a prosthesis by cutting the posterior crus of the stapes close to the footplate and the anterior crus close to the stapes head. METHODS: The posterior crus is temporarily transposed with the incudostapedial joint remaining intact. After performance of platinectomy and sealing of the oval window with fascia it is repositioned onto the center of the window. RESULTS: 19 of 20 ears operated on applying this technique showed good results (closure of air bone gap) after a mean follow up of 24.6 months. One patient showed persistence of air bone gap of 32.5 dB. Revision surgery revealed that the posterior crus had migrated to the posterior rim of the oval window. No inner ear affection, perilymph fistula or sensorineural hearing loss were observed. CONCLUSIONS: The major advantage of this technique is the avoidance of incus necrosis and foreign body reactions related to the material of the prosthesis. Disadvantages are technical plus the longer duration of the procedure.
Adult↗
Subarachnoid space: middle ear pathways and recurrent meningitis.
Congenital bony abnormalities of the inner ear may result in a communication between the middle ear and the subarachnoid space. Patients with this anomaly often present with recurrent meningitis associated with acute otitis media or with middle ear fluid. This article presents three cases of recurrent meningitis with open middle ear--subarachnoid space connections. The first two cases involve a cerebrospinal fluid leak into the middle ear via the oval window, both patients having a Mondini-type of inner ear deformity. The pathway in the third case opened into the middle ear along the horizontal portion of the facial nerve. Computed tomography (CT) scanning with metrizamide and differential density calculations helped to identify the abnormal pathway and to confirm that the leak has been closed postoperatively. Use of the CT scanner in these cases can be helpful in planning the surgical closure and in postoperative follow-up.
Adolescent↗
[Study on treatment of absence of the oval window].
From March 1983 to June 1991 ten cases (twelve ears) underwent middle ear exploration for severe conductive hearing loss. Absence of oval window was found. Vestibulotomy and reconstruction of the ossicular chain were performed. Among patients with horizontal segments of the facial nerve displaced downward over the oval window region, or those after operation the inital gain of the hearing gradually reduced as a result of ablitecation of new fenestra, fenstration operation on the horizontal semicircular canal was performed. Vestibulotomy (10 ears) had resulted in elevated spech reception thresholds of 10-30 dB or more in 7 ears. Four of these patients had initial gain of the hearing reduced after 3 months. Fenestration in four cases resulted in elevated SRT of 20-45 dB. So fenestration is preferred. The authors have also presented their experience in the management of absence of the oval window.
Adolescent↗