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PubMedDate not supplied

Surgical strategy of cochlear implantation in patients with chronic middle ear disease.

We report 10 postlingually deafened adults in whom the electrophysical criteria for cochlear implant were fulfilled, except that they showed the following unfavorable middle ear lesions: otitis media with effusion, chronic perforative otitis media, cholesteatoma and previous radical ear operation. Staged operations for cochlear implant were performed in 8 cases, and 2 patients who had undergone radical ear operation had a single-stage operation. As a first step, one of the following was performed in each patient as surgically indicated: myringoplasty with or without mastoidectomy, mastoidectomy with reconstruction of the posterior wall of the external canal, mastoidectomy with the insertion of a ventilation tube, radical mastoidectomy or surgical cleansing of the radical cavity. From 6 months to 2.5 years after the first operation, the actual cochlear implant was performed in the second or third stage. There was no major complication as a result of electrode insertion into the cochlea and the results of speech perception in these cases were not different from those in patients with normal middle ears. In our experience, it was considered that the staged operations would enable successful cochlear implants in selected patients with pathological middle ear lesions even if they had previously been diagnosed as contraindicated for this procedure. In a case with radical ear cavity a single-stage operation could be performed when there was no cavity problem.

Adolescent↗

PubMed2000

Effect of pentoxifylline on the healing of guinea pig tympanic membrane.

Although most tympanic membrane perforations heal spontaneously, persistent perforations frequently require treatment by otolaryngologists. Initial management strategies include keeping the ear dry, ensuring aural hygiene, and using topical antibiotics. For persistent perforations, paper patching or myringoplasty may be required. Recently, agents such as hyaluronic acid and epidermal growth factor have been used to promote tympanic membrane healing. Similarly, pentoxifylline, a pharmaceutical agent with hemorrheological and antithrombotic properties, has been shown to increase perfusion and accelerate wound healing. This double-blinded prospective study attempts to examine the effect of pentoxifylline on tympanic membrane healing of 50 guinea pigs subjected to myringotomy. Serial examinations and histopathologic sectioning of the tympanic membranes revealed no significant difference in rate of healing or quality of repair between the pentoxifylline and control groups.

Animals↗

PubMedDate not supplied

Comparative preoperative evaluation of eustachian tube function in pathological ears.

On 100 pathological ears with tympanic membrane perforation, eustachian tube functions was measured by using sonotubometry and the negative pressure equalization test in an attempt to compare these two methods. The pressure equalization test did not appear to be a reliable tool for preoperative clinical determination of tube function because sonotubometry showed tubal opening in 85% (myringoplasty group) and in 49% (radical surgery group) of patholoical ears, which were not able to equalize negative middle ear pressure at all during swallowing. The negative pressure equalization test is considered to be unphysiological and may produce a locking phenomenon of the tube. Even a small negative pressure can act like a valve, producing an obstruction that muscle activity of the tube is no longer able to overcome particularly when mucosal changes are present in the tubal orifice. Sonotubometry is a physiological test and as such gives a reliable picture of the opening of the tube during swallowing. Data on tympanic aeration postoperatively will be reported later.

Adolescent↗

PubMed1985

Traumatic perforations of the tympanic membrane: early closure with paper tape patching.

There is a difference of opinion about treating traumatic perforations of the tympanic membrane expectantly or with early surgery. Those who treat expectantly argue that most of the perforations will heal, given enough time. Those who argue for early closure note the occasional finding of middle ear damage, high closure rates, and faster healing. We present 50 consecutive traumatic perforations seen over a 3-year period and initially treated with paper tape patches (3M Micropore) applied in the office under local anesthesia. The success rate was 92%. Three of the four patients whose treatments failed, presented with a draining ear the night of patch placement, suggesting prior infection. All four failures were successfully treated with myringoplasties. Surprisingly, meticulous attention to aligning the perforation margins did not appear to affect the outcome. Healing usually occurred within 2 to 3 weeks. We contend that this method of treatment is quick, inexpensive, highly successful, identifies potential complications, is accepted by most patients, and promotes early healing.

Humans↗

PubMed2002

An observational study of the management of traumatic tympanic membrane perforations.

Controversies of how best to treat fresh tympanic membrane perforations have always existed. While some otolaryngologists prefer the paper patch method, others prefer modified myringoplasty. A prospective study is needed to investigate the most effective and least expensive management of this common ear trauma. This study examined prospectively, in three sections, a group of patients with a cellophane patch (n = 6), another group with a gentamicin ointment seal (n = 15) and a control group (n = 9) with a gentamicin plug placed at the distal end of the external auditory cavity. Successful healing of the traumatic tympanic membrane perforations was achieved in 50 per cent of the cellophane seal group, 86.7 per cent of the gentamicin ointment seal group and 77.8 per cent of the control group. This study shows that the management of a fresh tympanic membrane perforation should be limited to cleaning the traumatized ear and preventing infection.

Administration, Topical↗

PubMed2002

Middle-ear reconstruction: a review of 150 cases.

This study is based on a retrospective analysis of 150 cases of tympanoplasty and ossicular chain reconstruction as a one-stage procedure. It was conducted at the Federal Government Services Hospital, Islamabad from 1983 to 1999. Temporalis fascia was used for myringoplasty and a sculptured autologous incus to bridge the malleus to stapes head and malleus to footplate gap. These interpositions have produced stable ossicular assemblies and provided satisfactory post-operative hearing gains. One hundred and twenty-six (84 per cent) patients achieved a healed tympanic membrane three months post-operatively. One year post-operatively, 121 (81 per cent) patients had an intact tympanic membrane and at five years 119 (79 per cent) had an intact tympanic membrane. The success rate was based on an intact tympanic membrane and an air-bone gap of less than 30 dB one-year post-operation. Accordingly, the overall success rate was 80 per cent (120 cases). Hearing gains in cases with an absent stapes arch were poorer than in cases with an intact arch. Early (one to three months) post-operative complications included tympanic membrane perforation, lateralization of the graft and persistence of infection. Late (one to five years) complications included the appearance of an anterior perforation and retraction and thinning of the tympanic membrane.

Adolescent↗

PubMed2003

Simple, painless, cosmetic closure of endaural incisions.

Endaural incisions provide a cosmetic approach to the middle-ear cleft, tympanic membrane for myringoplasty, and attic and antrum for small cavity mastoidectomy. These wounds have traditionally been closed with sutures, but platelet or fibrin adhesives provide an alternative. However, discomfort at the time of suture removal, particularly in children, and the risk of transmission of blood-borne infections in gels are limitations to these wound closure techniques. This paper describes our experience with Histoacryl glue (butyl-2-cyanoacrylate) in closing endaural incisions.

Ear, External↗

PubMed2004

Disaster avoided: otalgia warns of potential electrode extrusion.

Cochlear implantation is usually a safe procedure but, as in most surgical interventions, it can carry some risk of complications. These can be divided into major and minor that, in turn, in turn can present early or late. This case report highlights a potential late, major complication of cochlear implantation namely extrusion, which was averted by prompt intervention. The patient presented with a three months' history of otalgia some six years after successful implantation. The posterior half of the tympanic membrane was found to be retracted on the electrode, which appeared to be on the point of extruding through the drum. A tragal cartilage myringoplasty was performed to separate the electrode from the medial surface of the tympanic membrane. There was immediate and lasting relief of the otalgia, the electrode was well protected and performance with the device was unchanged. The authors recommend reinforcing an atrophic tympanic membrane at the time of the cochlear implantation by a cartilage graft to avoid this potentially serious complication. The case also highlights the need for regular otoscopy for all implanted patients.

Child↗

PubMed1979

Bone conduction changes following successful tympanoplasty type I.

Pre and one year postoperative bone conduction (b.c.) thresholds were compared for 50 ears of 48 patients, ranging in age from 14 to 42 years, in whom successful tympanic grafts resulted in at least an average improvement of 10 db for 500 to 4000 Hz. While pre and postoperative data are included for all ears and test frequencies, significant BC improvement is seen only at those frequencies, in each case, where the pre-op BC thresholds were worse than 10 db. Normal pre-op BC thresholds cannot show substantial improvement because of audiometric limitations. The amount of BC shift at each frequency for those with pre-op BC thresholds that were subnormal averaged 6 db at 500 Hz, 13.3 db at 1000 Hz, 13.8 db at 2000 Hz and 9 db at 4000 Hz, all highly significant statistically. There were no significant postoperative BC shifts related either to duration of the disease process, length of postoperative period before final test (all were more than one year) or whether the surgical procedure was tympanoplasty type I or myringoplasty.

Adolescent↗

PubMed2005

Anaphylaxis to aprotinin in fibrin sealant.

A 50-year-old man with chronic otitis media was admitted to our hospital for investigation of lung cancer. He had received repeated instillations of fibrin sealant (Bolheal) in myringoplasty 7 times over 12 months. During the lower lobectomy, soon after fibrin sealant was applied to seal bronchopleural fistulas, systolic blood pressure decreased to 60 mmHg. Treatment with epinephrine and dopamine was required until his condition improved 2 days later. The specific IgE antibody was detected for the solution for fibrinogen and factor XIII containing bovine aprotinin. Cross-reactivity between purified aprotinin and the solution was noted by competitive ELISA inhibition tests.

Anaphylaxis↗

PubMed1987

Treatment of tympanic membrane perforations with hyaluronan in an open pilot study of unselected patients.

Twenty-five unselected tympanic membrane (TM) perforations of varying size and duration, from one day to 10 years, were treated by local application of the glycosaminoglycan, hyaluronan, 1%. The treatment was well tolerated without any side-effects. Seventeen of the perforations were closed, though two drums were re-perforated. Four perforations not completely covered were markedly reduced in size. No effect of hyaluronan could be observed on moist perforations. The scar formed after treatment with hyaluronan 'normal' appearance. Hyaluronan treatment seems to be an alternative to myringoplasty when treating small and medium-sized dry perforations.

Adolescent↗

PubMedDate not supplied

An alternative treatment for the reduction of tympanic membrane perforations: sodium hyaluronate. A double blind study.

Topical treatment with 1% sterile sodium hyaluronate solution applied on the tympanic perforation membrane has been suggested as an alternative to surgical treatment in one study only. To further investigate the effects of such a treatment, we designed a double blind study comparing topical administration of 1% sodium hyaluronate with that of 2% methylcellulose solution (placebo). After treatment the degree of perforation healing was evaluated and expressed in percentage of reduction area. The reduced area turned out to be significantly different in the group treated with sodium hyaluronate solution as compared to the placebo group. We believe that sodium hyaluronate is an alternative to myringoplasty for selected tympanic membrane perforations.

Adolescent↗

PubMed1991

[Inverted caloric nystagmus of perforated ears upon air caloric stimulation].

It is well known that inverted caloric nystagmus is seen during air caloric testing in cases of chronic otitis media. The mechanism of inversion and its clinical significance are discussed here. Temperature changes in the tympanic cavity and external ear canal were measured with a microthermister and a digital tester in seventeen ears with tympanic membrane perforation, during bithermal air caloric testing. The tympanic cavity mucosa was cooled by hot stimulation because of the evaporation of heat. When the perforation was closed or humidified air was used, the tympanic cavity mucosa was not cooled by hot stimulation and the inverted caloric nystagmus changed to a normal response. Inverted caloric nystagmus occurred in 30.4% of 335 ears affected by chronic otitis media with perforation. Inverted caloric nystagmus occurred in 90 ears with hot stimulation and in 12 ears with cold stimulation. Inverted caloric nystagmus turned to normal response after myringoplasty in all of 10 ears. The cooling effect caused by evaporation of water from the moist middle ear mucosa during dry air blowing and direct thermal conduction to the vestibulum through a perforation of the ear drum and inversion of the endolymphatic convection seemed to cause the inversion.

Adolescent↗

PubMed1996

[Tympanoplasty on only hearing ears].

Tympanoplasty on only hearing ears was performed on 11 patients in Osaka University Hospital and Osaka Rosai Hospital during 1986 1994; this was 0.68% of all cases of middle ear surgery. The patients consisted of 5 with cholesteatoma, 5 with chronic otitis media and 1 with cholesterin granuloma. The mean age was 47.6 years (13-68 years) and the mean follow-up period was 2 years and 7 months (6 months-4 years). Postoperative hearing results was obtained in 9 patients (81.8%) according to the criteria of Otology Japan (1987), and all ears were dry at the final examination. Compared with the preoperative hearing level, postoperative hearing level showed improvement in 3 cases, not in 7 cases (within difference of 5 dB) and deterioration by 10-15 dB in 1 case. Although indications for surgery on only hearing ears are still controversial, we suggest the following: 1) patients with cholesteatoma should be operated on in the ordinary way; 2) patients with chronic otitis media should be operated on only by myringoplasty; 3) all patients must be operated on very carefully by skillful surgeons.

Adolescent↗

PubMed2000

[A century in the history of chronic ear surgery].

Although some advocated surgery of the tympanic membrane and stapes as early as early as the end of the nineteenth century, it took a long time for widespread development. Mastoid surgery had just been born and was to be greatly improved over the next century. Preservation of the tympano-ossicular its later reconstruction gradually came into use with the creation of the tympanomeatal flap and the recent development of middle ear surgery, followed by posterior tympanotomy and myringoplasty, thus allowing closed tympanoplasty. Likewise, the ventilation tube, forgotten for more than half a century, has found an important place in the treatment of chronic otitis with a closed ear drum.

Chronic Disease↗

PubMed2001

[Deafness, as a complication of Pseudomonas aeruginosa septicemia in a 9-year old boy with acute lymphoblastic leukemia].

We described natural history of Pseudomonas aeruginosa septicemia in 9 year old boy, who was treated for acute lymphoblastic leukemia (ALL). After 14 day treatment of ALL the following signs and symptoms occurred: fever, earache with otorhoea, deafness, bilateral peripheral paralysis of n. VII, erythema, pneumonia, paralytic ileus. After 4 weeks of antimicrobial and supportive therapy, in the 10th week of chemotherapy, he achieved haematological remission. During continuation therapy, two-stage bilateral myringoplasty was performed. At present the maintenance therapy is continued, and in the future hearing aid and cochlear implant, will be applied.

Child↗

PubMed2001

[Reconstruction of the chain of the auditory ossicles after radical operation on the middle ear].

As restoration of hearing in patients after radical surgery on the middle ear for otitis media purulenta chronica remains topical, we tried to increase the efficacy of ossiculoplasty in such patients by staged reconstruction of the middle ear. A total of 102 patients were examined and operated on. A modified classification of osseous chain defects was used to evaluate the degree of damage to the osseous system. The following policy was employed for reconstruction of the middle ear: in patients with large trepanation cavities (more than 5 ml) mastoidoplasty was carried out as the first stage using a musculo-periosteal flap with an anterior or inferior pedicle; at the second stage, myringoplasty was performed using a two-layer graft followed by ossiculoplasty with autotransplants (fingernail plate, auricular or tragal cartilage, cortical layer bone). Long-term follow-up of the patients showed that good and satisfactory hearing levels were obtained in 79.4% of the patients. The air-bone gap was closed by 10 dB or more in the speech frequency range in 80.4% of the patients. Staged reconstruction of the middle ear using autotransplant materials significantly decreased the number of postoperative complications (perforation of the plastic flap, cicatrical displacement of the prosthesis and graft rejection).

Adolescent↗

PubMed2002

[Early complications of surgery for chronic suppurative otitis media].

OBJECTIVE: To explore early post-operative complications following surgery for chronic suppurative otitis media. METHOD: From Jan 1992 to July 2000, 291 cases of chronic suppurative otitis media have been treated in our department. 79 cases underwent myringoplasty, 82 cases tympanoplasty, 88 cases modified radical mastoidectomy and 42 cases radical mastoidectomy. RESULT: Facial nerve palsies occurred in 3 cases (1.03%), bone conduction threshold elevation occurred in 13 cases (4.47%), wound infection occurred in 11 cases (3.78%), 7 patients (2.41%) reported symptoms related with chorda tympani trauma, symptoms of jaw discomfort were reported by 7 patients (2.41%) and imbalance or vertigo by 13 patients(4.47%). CONCLUSION: The incidence of early complications of surgery for chronic suppurative otitis media in this report was similar to previous reports.

Adolescent↗