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At least 307 records · Page 17Linked to original sources

PubMed2003

[Revision stapedectomy for otosclerosis: report of 73 cases].

OBJECTIVE: The aim of this study was to determine causes and evaluate results of revision stapedectomy. DESIGN: Retrospective review of 73 revision stapedectomies. SETTING: Revision stapedectomies were performed in two tertiary otolaryngology departments (Fondation Adolphe de Rothschild, Paris, France, and Cliniques universitaires Saint-Luc, Bruxelles, Belgium). METHODS: Patients characteristics, indications for revision, intraoperative findings, and hearing results were noted. MAIN OUTCOME MEASURES: Hearing results were reported as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. We also reported hearing results with and without the use of a laser. RESULTS: Conductive hearing loss was the main indication for revision (78%). Mean intraoperative findings included prosthesis malfunction (50%), fibrous adhesions (32.8%), incus necrosis (8.5%), and otosclerotic regrowth (7%). When revision was performed because of cochleovestibular complication, middle ear exploration revealed three findings: oval window granuloma (30.7%), perilymphatic fistula (30.7%), and a too long prosthesis (23%). Postoperative air-bone gap (ABG) was closed to less than 10 dB in 51.5% of cases and to less than 20 dB in 68.7% of cases, with 9% of sensorineural hearing loss (not exceeding 15 dB in 80% of cases). The use of an argon laser in 14 patients (19%) showed slightly better hearing results (postoperative ABG < 10 dB in 61.5% of cases and < 20 dB in 77% of cases), but this difference was not statistically significant compared with patients operated on without the use of a laser. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but good gap closure can be expected in two-thirds of cases with an experienced surgeon.

Adult↗

PubMed1980

The temporal bone as route of infection in recurrent meningitis.

Three successive episodes of recurrent meningitis in connection with an infection of the upper respiratory tract appeared to be related to a congenital idiopathic oval window CSF leak. An inner ear dysplasia was the underlying factor and accounted for the deafness and for the absence of signs of acute labyrinthis during these infectious episodes.

Cerebrospinal Fluid↗

PubMed1997

Postnatal change in angle between the tympanic annulus and surrounding structures. Computer-aided three-dimensional reconstruction study.

Postnatal developmental relationships in human ears were studied by a computer-aided three-dimensional reconstruction and measurement method. We measured the angle, in reference to the horizontal plane, between the tympanic annulus, the oval window, and the internal auditory canal (IAC) in 20 normal temporal bones obtained from individuals between 1 day old and 76 years old. The horizontal plane was defined as the plane sloped 30 degrees infero-anteriorly from the plane of the horizontal canal in each specimen. The plane of the tympanic annulus changed from a nearly horizontal orientation (34.2 degrees from the horizontal plane) in neonates to a more vertical orientation (63.3 degrees from the horizontal plane) in adults. The tympanic annulus and oval window planes remained at the same angle to each other (11.9 degrees +/- 5.1 degrees) throughout postnatal development, as did the plane of the tympanic annulus and the IAC (68.6 degrees +/- 5.3 degrees). These findings have implications for ear surgeons, especially those operating on young children.

Adolescent↗

PubMed1994

Comparison of endoscopic and surgical explorations for perilymphatic fistulas.

A history suggestive of perilymphatic fistula (PLF) often prompts repeated tympanostomies to establish a diagnosis and perform a repair. Two patients having multiple previous explorations for perilymphatic fistulas were reoperated, comparing endoscopic and open surgical methods. A third patient with a history consistent with PLF also underwent dual assessment. Endoscopic exploration of the middle ear was performed through a myringotomy and, immediately after, by elevation of a tympanotomy flap. The endoscopic examinations were thorough yet revealed no evidence of perilymphatic fistula; however, the surgical approaches revealed pooling in the oval windows consistent with perilymphatic fistula. These findings were video documented. Recurrent and primary fistulas may be the result of artifact, such as injected anesthetic agents and transudates introduced during surgical explorations, which may interfere with an accurate diagnosis of perilymphatic fistula. Endoscopy of the middle ear is recommended as one method to minimize errors in diagnosis.

Adult↗

PubMed2003

[Oval window canal and CT-diagnosis of peripheral pareses of the facial nerve].

Computed tomography (CT) has examined 200 patients (400 temporal bones) at the age of 0-74 with unaffected facial nerve and 28 patients with symptoms of peripheral paresis or paralysis of the facial nerve of different genesis. Polyposition CT of the temporal bone is an intravital noninvasive method of the Fallopius' canal visualization. The canal is visualized on the tomograms in 100% cases irrespective of the patients' age. The following causes of n. facialis paresis were revealed: neurinoma of the facial nerve, sarcoma of the temporal bone, destruction of the tympanic canal wall in chronic otitis media, fractures of the temporal bone, malformations of the Fallopius' canal in malformations of the temporal bone, stenosis of the canal in fibrous dysplasia. The above alterations of n. facialis canal determine further therapeutic policy.

Brain Injuries↗

PubMed1992

Middle ear development. III: Morphometric changes in the conducting apparatus of the Mongolian gerbil.

Middle-ear structural ontogeny was examined in 12 age groups of Mongolian gerbils between 2 and 42 days after birth. Measurements of tympanic membrane surface area; depth of the tympanic membrane cone; the lengths of the malleus and incus long processes; and stapes footplate, annular space, and oval window areas were obtained using video micrographs and computer digitization techniques. The incus long process matured first at 3.5 days after birth, while the pars flaccida surface area was the last middle-ear variable studied to reach adult size (26 days after birth). The incus long process increased its length by 30% from 0.5 mm to 0.65 mm. The malleus long process, however, demonstrated much more relative growth (47%). Pars tensa area expanded from 6.35 mm2 at two days after birth to its adult size of 16.9 mm2 and the stapes footplate expanded by 50%. The developmental changes observed in middle-ear anatomy are then discussed with regard to their contribution to the functional maturation of both the middle ear and more central auditory function.

Animals↗

PubMed1987

Preservation of cochlear function in the surgery of cholesteatomatous labyrinthine fistulas and oval window tympanosclerosis.

Anakusis is reported as a not uncommon complication of the surgical treatment of cholesteatomatous fistula of the labyrinth. Likewise, although published results on the surgical treatment of tympanosclerotic ears are infrequent, most otologists are aware of greater than usual risks of severe sensorineural impairment from ossiculoplasty in this type of middle ear disease. Because of recent developments in implanted aids-to-hearing, in tympanoplasty operations, when they fail to adequately improve hearing, preservation of eighth nerve function becomes ever-increasingly important. This article concerns two types of middle ear disease in which surgical treatment threatens hair cells and neurons, to the extent that surgical complications might prejudice the eventual possible benefits of a standard hearing aid or any implanted device, if either was indicated.

Adolescent↗

PubMedDate not supplied

Dehiscences of the horizontal segment of the facial canal in otosclerosis.

Dehiscences of the bony horizontal segment of the facial canal are rather common in human adults. These facial canal dehiscences occur most often in the region of the oval window. This study presents the observations of the facial canal in the oval window region in 427 operations for otosclerosis. The incidence of dehiscences in the facial canal to the middle ear space in otosclerosis was studied. Dehiscences were observed in 14 of the 427 patients (3.27%) who had a stapedotomy. This incidence is very low compared to the anatomical studies of the facial nerve in human cadaver temporal bones. Dehiscences of the facial canal are a variation of the normal anatomy of the facial nerve and these dehiscences occur sporadically in otosclerosis.

Adult↗

PubMed1990

[Recurrence of perilymphatic fistula].

Recurrence of the perilymphatic fistula is not rare and may be a tough problem for surgical treatment. This is because a graft is usually applied on the ruptured window(s) from the middle ear and therefore the perilymphatic pressure directly acts on the graft. The recurrence may be caused by a technical failure, use of an unsuitable graft material, poor postoperative bedrest, trauma, increased inner ear pressure, etc. In our clinic, the recurrence occurred in 7 of 48 cases surgically treated. Vertigo accompanied with spontaneous or positional nystagmus was seen in all 7 recurrent cases, while only 2 of them complained of worsening of the existing hearing loss. Re-operation was carried out in two patients. In the first case, closure of the round window by the previous operation was found incomplete, and the perilymph leaked through the gap around the graft. In the second case, closure of the round window was complete, but perilymph leaked from the oval window. In order to prevent the recurrence, the operation should be carefully performed by using strong and adhesive tissue as a graft material, applying a glue between the graft and the inner ear window(s), and keeping strict postoperative bedrest.

Adolescent↗

PubMed1993

Intravenous fluorescein for detection of perilymphatic fistulas.

It has been reported, in animal models and recently in human beings, that intravenous fluorescein is taken up in perilymph and may be useful as a tracer for the detection of perilymphatic fistulas. We attempted to reproduce the results of these animal experiments. Twenty-one middle ears of eight cats and four dogs were exposed. Fluorescein was given intravenously. Fluorescence was initially noted in transudates pooling in the oval and round window niches. Fistulas created with a straight pick produced a bright fluorescence in the leaking fluids, possibly from a ruptured small membrane vessel. Fistulas created with the carbon dioxide laser and with complete hemostasis demonstrated no fluorescence. We concluded that intravenously administered fluorescein causes dramatic fluorescence of vessels and transudates that may be interpreted falsely as fluorescence of perilymph. Fluorescence was not evident in perilymph when complete hemostasis was obtained.

Animals↗

PubMed1994

Middle-ear development. VI: Structural maturation of the rat conducting apparatus.

BACKGROUND: The contribution of middle-ear development to the overall development of hearing has not been explored in great detail. This presentation describes the maturation of conductive elements in the rat middle ear, and provides the basis on which future studies of middle-ear functional development will follow. METHODS: The middle-ear apparatus was examined at nine different ages (between 1 and 80 days postpartum) in Long Evans rats. At each age elements of the conducting apparatus was observed with either light or scanning electron microscopy (SEM), and quantitative measurements were made from video enhanced photomicrographs. Tympanic membrane area and cone depth, the length of the malleus and incus arms, ossicular weight, stapes foot plate and oval window areas, and bulla volume were all measured. Development of the area and lever ratios were derived from these measurements. The data were fitted to exponential equations and the time in days required to reach 90% of the adult level determined. RESULTS: The pars tensa achieved 90% of total area by 17 days. The oval window achieved the 90% criterion by 13 days, while the area ratio was within 10% of its adult size by 8 days. The ossicles took between 26 and 34 days, while bulla volume took 59 days to reach the 90% level. CONCLUSIONS: Middle-ear growth was very orderly and systematic in the data reported. When maturation of the area ratio was considered against development of the endocochlear potential or the round window compound action potential, it was clear that the growth of this important aspect of the middle ear preceded the onset of cochlear function.

Aging↗

PubMed1983

Auditory development in the mouse: structural maturation of the middle ear.

The development of middle-ear structures in the mouse was examined in nine groups of pups between 1 and 45 days of age. The area of the tympanic membrane (pars tensa and pars flaccida), the length of the lever arms of the malleus and incus, the surface area of the oval window, and the volume of the bulla all showed systematic changes during neonatal life. The area of the oval window reached maturity first and the lever arms achieved 90% of their adult size on day 11. The tympanic membrane achieved the same criterion on day 18. These data help us further to understand the processes that contribute to the functional ontogeny of the middle ear.

Age Factors↗

PubMed2001

The other ear: findings and results in 1,800 bilateral stapedectomies.

OBJECTIVES: To determine the incidence of middle ear abnormalities in patients with bilateral otosclerosis, which could potentially affect successful stapedectomy, and the rates of success in these patients, including the chance of overclosure in the second ear. STUDY DESIGN: Retrospective case review of operative and audiologic records. SETTING: Private otology practice. PATIENTS: One thousand eight hundred patients underwent 3,600 primary stapedectomies for bilateral otosclerosis. INTERVENTION: Analysis of perioperative and follow-up audiograms with associated operative findings, including obliterative otosclerosis and solid footplates, dehiscent or overhanging facial nerve, narrow oval window niche, promontory overhang, and ossicular fixation or malformation. MAIN OUTCOME MEASURES: Audiologic stapedectomy success was determined as overclosure or closure of preoperative air-bone gap to less than 10 dB at 1 year or more of follow-up. RESULTS: The rate of finding any abnormality was 25%. Abnormalities present bilaterally were found in 135 patients (7%), with otosclerosis requiring an oval window drillout as the most common finding (41%), followed by dehiscent or overhanging facial nerves (25%). Success in patients with abnormalities was 78% overall, with bilateral overclosure in 40%. CONCLUSIONS: Abnormal middle ear findings during stapedectomy occur in a significant percentage of patients. Reasonable rates of success and overclosure can still be expected, but this is somewhat finding-specific. The predictive value of these findings, the associated rates of success with potential impact on surgical counseling, and planning for the "other ear" are discussed.

Ear Ossicles↗

PubMed1992

Perilymphatic fistula induced by barotrauma.

The association between diving, barotrauma, and the production of perilymphatic fistula has been known for almost 20 years. Forty-eight cases of round and oval window fistulas following diving have been reviewed and essentially corroborate previous findings. Any patient with a history of diving and subsequent sensorineural hearing loss within 72 hours should be suspected of having a round or oval window perilymphatic fistula and surgical exploration and closure of the fistula should be undertaken. Patients who have a loss of hearing, vertigo, nausea, or vomiting following a decompression dive should be re-compressed and if symptoms do not clear, exploration should be performed. Surgical treatment should be executed as soon as possible after the diagnosis is suspected for the best possible results.

Acute Disease↗

PubMed1986

Two emerging perilymph fistula "syndromes" in children.

This paper proposes two relatively common "syndromes" seen in children with perilymph fistulas using illustrative case reports. One, a 2 1/2-year-old child with bilaterally symmetric progressive sensorineural hearing loss, was found to have bilateral oval and round window fistulas. The other was a child who presented originally with an unexplained unilateral sensorineural loss. It was only when hearing deteriorated in the opposite ear several years later that a perilymph fistula was suspected and confirmed by tympanotomy. The clinical presentations and other details of these cases diverge widely, but may represent two emerging syndromes of perilymph fistulas in children: 1. a congenital or hereditary predisposition, and the other, 2. sudden hearing loss in the "good" ear of children with an unexplained sensorineural hearing loss in the opposite ear.

Audiometry↗

PubMedDate not supplied

[Granuloma of the oval window after stapedectomy].

A case report is presented of a female patient who underwent stapedotomy with bad functional results Reoperation revealed a dislocated prosthesis and there was no successful hearing. Besides conduction deafness perceptive deafness occurred as well. The second reoperation disclosed reparative granuloma around the prosthesis, while histological analysis showed foreign-body granuloma. Foreign-body granuloma by stapedectomy is extremely rare and it was the first case in our 810 surgically treated ears.

Adult↗

PubMed2003

Imaging of congenital middle ear deafness.

INTRODUCTION: Conductive hearing loss, in the presence of a normal external ear, is usually due to an interference with the normal transmission of sound from the tympanic membrane across the ossicular chain to the oval window. If conductive hearing loss occurs in a young child, congenital middle ear pathology is the most likely cause. MATERIALS AND METHODS: High resolution computed tomography of the middle ear is the diagnostic modality of choice. Details of the imaging technique are outlined in this article. Eight cases of congenital middle ear deafness imaged in the radiological departments of Changi General Hospital and Tan Tock Seng Hospital in Singapore are illustrated. RESULTS: Congenital middle ear deafness may be classified into ossicular chain abnormalities, congenital ossicular fixation, congenital oval window atresia and congenital round window atresia. The imaging features for each category are described. CONCLUSION: With proper imaging technique and a systemic analysis of the images, the abnormalities that result in congenital middle ear deafness can usually be demonstrated on most occasions.

Deafness↗

PubMed2003

Bilateral congenital absence of stapes and oval window in 2 members of a family: etiology and management.

OBJECTIVE: To date, bilateral congenital absence of stapes and oval window in 2 members (brother and sister) of a family has not been reported in the literature. Carhart's notch as one of the indications for the diagnosis of this disease is proposed. The etiology and management of this condition are discussed. MATERIALS AND METHODS: The older brother and younger sister of a family had severe bilateral hearing loss and concomitant speech disability since early childhood. Their parents are first cousins and have 2 sons and 1 daughter, but the younger son is in good health with normal hearing. No similar disease was found among other relatives. Physical examination showed that the older brother and the younger sister had normal external ears and tympanic membranes. Congenital bilateral absence of stapes and oval window were confirmed by history, audiologic examination, high-resolution computed tomography scanning, and/or surgery. The modified Lempert's fenestration operation on the horizontal semicircular canal was performed on 1 ear of each patient. RESULTS: Postoperative hearing threshold was 25 dB for speech frequencies with a gain of 47 dB for the older brother and 28 dB for speech frequencies with a gain of 52 dB for the younger sister. Follow up at 5 to 13 years individually, their hearing gains were steady. Both sister and brother now enjoy a normal life. CONCLUSIONS: Bilateral congenital absence of stapes and oval window in the 2 family members may be related to inheritance. This report points out Carhart's notch as noted in otosclerosis as an important indication for diagnosis of this disease. The modified Lempert's fenestration operation of the horizontal semicircular canal is a safe and good choice for these patients and a better choice than a hearing aid throughout life.

Adolescent↗