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At least 217 records · Page 12Linked to original sources

PubMed2003

Palatal and middle-ear myoclonus: a cause for objective tinnitus.

The cause of objective tinnitus provoked by palatal and middle-ear myoclonus may be identified by magnetic resonance imaging of the central nervous system in the Guilliain-Mollaret triangle or it may be idiopathic. The idiopathic cases are rare. From the literature, one can perceive the following unanswered questions: (1) Are palatal and middle-ear myoclonus different entities or do they usually appear together? (2) Are the clicks being produced by the palatal myoclonus (walls of the eustachian tube slapping together) or by the tensor tympani muscle contractions or by both? (3) Is stapedius muscle myoclonus important in the production of the clicks? (4) What should be the treatment for palatal and middle-ear myoclonus? We present two cases of idiopathic palatal and middle-ear myoclonus and discuss these cases in light of the literature and of some ideas of our own.

Adult↗

PubMed2003

Bilateral tinnitus due to middle-ear myoclonus.

Tinnitus is a common otological symptom. Usually it is subjective (perceived only by the patient); very rarely is it objective (heard by both the patient and the examiner) Objective tinnitus due to middle-ear myoclonus is extremely rare, with only a few case reports published in the literature. We present three cases of objective tinnitus caused by middle-ear myoclonus. All patients were cured by tympanotomy with stapedial and tensor tympani tendon section.

Adolescent↗

PubMedDate not supplied

High-resolution 3DFT MR imaging of the endolymphatic duct and soft tissues of the otic capsule.

This study compares the visualization of otic capsule anatomy by thin-section three-dimensional Fourier transformation (3DFT) MR imaging with that by high-resolution CT. The osseous margins of the otic capsule are delineated by high-resolution CT, while MR displays the soft-tissue structures. Routine two-dimensional Fourier transformation (2DFT) spin-echo MR techniques have been limited by slice thickness and signal to noise. Previous longer TE 3DFT gradient-echo MR images of the otic structures have been degraded by magnetic susceptibility effects, which limit spatial resolution and decrease signal to noise. These effects are especially prevalent in the otic capsule, where small soft-tissue structures interface with surrounding air and bone. We developed a high-resolution 3DFT MR technique to image five normal subjects. MR images were compared with high-resolution CT images of the same subjects. Axial, sagittal, and coronal 3DFT gradient-echo MR images with a short TR/TE and 15 degrees flip angle were acquired on a General Electric 1.5-T Signa unit using a 3-in. circular, receive-only surface coil. Axial, sagittal, and coronal 1.5-mm-thick contiguous high-resolution CT bone-algorithm images were obtained also. There was a high correlation between the MR and CT findings. The 3DFT MR images demonstrated significantly higher spatial resolution and soft-tissue detail than the high-resolution CT images did. For example, the endolymphatic duct was seen on twice the number of consecutive sagittal and axial MR slices. Other soft-tissue otic capsule structures routinely seen on the 3DFT MR images included the entire facial nerve, membranous labyrinth including cochlea, and tensor tympani muscle. This study demonstrates a new high-resolution 3DFT MR technique for visualizing the soft-tissue microstructures of the otic capsule and achieves a level of spatial resolution beyond that possible with high-resolution CT.

Adult↗

PubMed1988

[Tympanoplasty with incus interposition].

We report on a 5-year experience with 44 patients (1980-1985) with incus interposition using a modelled or sculptured incus, either autograft or homograft, to correct ossicular discontinuity when a functional malleus and stapes are present. After a period of 21 months, 75% of our patients achieved an air-bone gap closure between 1 and 10 dB. The postoperative hearing results of patients with trauma and middle ear atelectases were better than the hearing results of patients with cholesteatomas. These long-term results are dependent upon intact malleus attic ligaments and an intact tensor tympani tendon. It is very important that the modelled incus is repositioned under the malleus handle neck.

Adolescent↗

PubMed1983

The anatomy of the auditory tube and paratubal musculature in a one month old cleft palate infant.

The auditory tube, middle and inner ear, and paratubal musculature were removed en bloc at autopsy from a 1 month old white cleft palate female. The specimen was serially sectioned in a coronal plane and studied under light microscopy. Severe inflammatory changes were observed in the middle ear and osseous portion of the auditory tube in association with the presence of a middle ear effusion. While the posterior tubal lumen, tubal cartilage, and tensor veli palatini (TVP) and tensor tympani muscles were similar to those of an age-matched control specimen, the anterior tubal lumen was seen to be superoinferiorly abbreviated with a large intrusive malpositioned levator veli palatini (LVP) muscle occupying the inferior tubal floor. This muscle was noted to divide into two bundles on proceeding posteriorly with the more superior bundle taking an abnormal origin from the inferior surface of the tube. The luminal compression observed in this specimen is reminiscent of that previously described in cleft fetuses though the abnormal morphology of the LVP muscle has not been reported for the few cleft palate specimens studied. It is probable that this morphology is idiomatic to the present specimen and not a characteristic of the cleft palate condition.

Cleft Lip↗

PubMed1982

[Surgical anatomy of the greater petrosal nerve].

In 40 preparations of mature persons' corpses of both sex by means of the preparation method under binocular microscope MbC-2 under water, surgical anatomy of the geniculate node and the nervus petrosus major has been studied in reference to neurotomy with a transtympanic approach. The geniculate node and the beginning of the n. petrosus major are projected on the angle between the tegmental and labyrinthine walls of the tympanic cavity on the bone part seen from the side of the external auditory meatus between the caput mallei and the tendon of the m. tensor tympani. The projection point is 3.7-5.2 mm forward the inferior edge of the vestibular fenestra and 0-4 mm behind the tympanic opening of the auditory tube. These dimensions depend on the form of the n. facialis geniculum and the temporal bone pyramid, as well as on the size of the tympanic cavity. The thickness of the bone separating the beginning of the n. petrosus major and the tympanic cavity is not more than 1-2 mm.

Adult↗

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↗

PubMed1996

[Sub-temporal supra-petrous approach to the horizontal portion of the sub-petrous internal carotid artery. Technique, indications, incidents and accidents].

Cavernous sinus exploration, anterior middle fossa transpetrous approach, and saphenous vein graft bypass require proximal control of the horizontal segment of the petrous internal carotid artery. Exposing the petrous portion of the internal carotid artery is not without the potential for serious complications (cochlea, facial nerve, auditory tube, musculus tensor tympani). With guidance from the classicaly landmarks within Glasscock's triangle, the bony petrous carotid canal can be unroofed. The authors describe an alternative method for obtaining direct vascular control under the trigeminal ganglion, safety unroofing of the carotid canal and control of the posterior face of the carotid bend. The indications, advantages, and disadvantages of this approach are described in details, along with its use in seven patients.

Carotid Artery, Internal↗

PubMed1997

Intact canal wall drill-out procedure for implantation of the totally ossified cochlea.

OBJECTIVE: To describe a simplified drill-out technique for insertion of a multichannel electrode in the completely ossified cochlea without radical mastoidectomy and obliteration. STUDY DESIGN: Description of a new surgical technique and case report. SETTING: Temporal bone dissection laboratory and tertiary referral center. PATIENTS: Adult and pediatric cochlear implant (CI) recipients. MAIN OUTCOME MEASURES: Access for circum-modular drill-out and electrode insertion without radical mastoidectomy and adequate function of multichannel CI. RESULTS: Dissection of 10 cadaver temporal bones demonstrated feasibility of this technique. Highlights include facial recess cochleostomy and 8 mm tunnel; elevation of superiorly based tympanomeatal flap; removal of incus, cochleariform process, and tensor tympani; and identification of carotid canal and use of facial nerve monitor. A case report of an 11-year-year old child with total cochlear ossification and previous failure of a short (8 electrode) CI electrode insertion is presented. Complete insertion of a 22-channel electrode was successful and open-set word recognition is commencing. CONCLUSIONS: The canal wall-up drill-out procedure allows complete electrode insertion without mastoid obliteration in patients with obliterated cochleas. Appropriate attention to the carotid artery and facial nerve is essential.

Child↗

PubMed1998

Beyond the promontory: the multifocal origin of glomus tympanicum tumors.

PURPOSE: We examined other middle ear locations of glomus tympanicum tumors, which arise from glomus bodies accompanying the tympanic (Jacobson's) nerve through the middle ear. Most descriptions place these tumors on the promontory over the basal turn of the cochlea. METHODS: We identified seven patients (all women) with small surgically confirmed glomus tympanicum tumors (not completely filling the middle ear) for whom CT scans were available for retrospective review. Patients' ages ranged from 23 to 78 years at the time of the high-resolution CT study (1.0- to 1.5-mm-thick sections). RESULTS: All tumors arose on the medial wall of the middle ear. One was anterior to the promontory, beneath the cochleariform process and the semicanal of the tensor tympani. Two were inferior to the promontory, in the recess beneath the basal turn of the cochlea. Four were anteroinferior. None was actually on the apex of the promontory. CONCLUSION: Glomus tympanicum tumors may arise in various locations on the medial wall of the middle ear, where Jacobson's nerve runs. The promontory is only one middle ear location in which glomus tympanicum tumors may arise. Familiarity with the course of the tympanic nerve helps tailor the search for, and facilitates accurate identification of, tiny glomus tympanicum tumors.

Adult↗

PubMed1998

[Endoscopic anatomy of the tympanic cavity].

Development of modern diagnostic procedure requires inframacroscopic description of tympanic cavity. This description has to suit the special requirements of diagnostic endoscopy, too. The authors made an attempt to describe clinical anatomy of the tympanic cavity. For endoscopic investigation transtympanic, transtubal and transmastoidal approaches were used, out of which the transmastoidal has the least clinical importance. Using the transtympanic approach, detailed anatomical description of the medial wall, the auditory ossicles and the stapedius muscle can be given. Using the transtubal approach, the epitympanic region, stapedius and tensor tympani muscle and two major nerves, chorda tympani and tympanic nerve can be also investigated. Using transmastoidal approach, auditory ossicles were seen, but it was possible to identify lateral part of epitympanic recess, as well.

Ear Diseases↗

PubMed1998

Continuous, high-frequency objective tinnitus caused by middle ear myoclonus.

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.

Adult↗

PubMedDate not supplied