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PubMed2002

[Surgical treatment of acquired external auditory canal atresia].

Acquired atresia of the external auditory canal is a relatively rare disease, that can be the result of the recurrent external otitis, chronic media otitis, ear trauma, neoplasms or iatrogenic complications. The surgical treatment results after operation in the 7 patients with acquired external auditory canal atresia were presented. The mean age of the patients was 34.1 and the female to male ratio was 2:5. In 6 cases we performed transcanal operation. The meatus atresia was removed and then the stenotic canal was widened by removing the skin and fibrous tissue. We especially focused our attention on the state of the anterior angle of the tympanic membrane. The bony canal was widened by burr in cases with bony overhangs. The bony canal walls were lined with pediculate or free skin grafts. In cases of tympanic membrane perforation we performed myringoplasty with temporal muscle fascia or tragus perichondrium. The follow-up period was from 8 to 39 months. The hearing improvement with primary closure of air bone gap within 20 dB was achieved in 43% of cases. In 28% of the patients recurrent atresia developed. The early surgical treatment is recommended in all the cases because cholesteatoma behind the atresia was found in 28% of patients.

Adolescent↗

PubMed2001

[Appraisement of the operative therapeutical effects of salpingocatheterism for refractory otitis media].

OBJECTIVE: The therapeutical effects of salpingocatheterism and the states of tubal function were studied after different middle ear operations and within different middle ear pathological changes. METHOD: Total 71 patients with tubal occlusion, 18 of myringoplasty, 20 of reconstruction of ossicolar chain followed tympanoplasty, 14 of combined approach tympanoplasty, 10 of radical mastoidectomy followed tympanoplasty, 9 of re-radical mastoidectomy followed tympanoplasty were implemented salpingocatheterism. The patients were followed up for evaluation of the postoperative therapeutical effects and the state of tubal function. RESULT: The causes of operation failure in different middle ear operations or different middle ear pathological changes had no significantly difference. The major cause for postoperative tympanic membrane perforation and tubal occlusion was the pathogenic damage being not cleared up thoroughly and/or there being nasal cavity or pharyngeal cavity pathogenic changes accompanied. CONCLUSION: Salpingocatheterism is effective for preventing eustachian tube postoperative adhesion.

Adolescent↗

PubMed2002

[The achievements of eminent Warsaw physicians in otolaryngology at the turn of the 19th and 20th century].

The scientific achievements of many Warsaw otolaryngologists in the second part of the 19th and in the beginning of the 20th century are presented. Karol Benni's (1843-1916) contribution to the world otology is described. The famous Warsaw laryngologist Teodor Heryng (1847-1925) was a creator of a new operating method of the larynx tuberculosis by curettage. He was also a propagator of the diaphanoscopy (transillumination) of maxillary sinuses. Ludwik Guranowski (1853-1926). a distinguished otiatrist performed a first myringoplasty in the Polish territories and explained the causes of external otitis by bacillus pyocyaneous. Jan Sedziak's (1861-1932) work on malignant neoplasms of larynx was given a prize at international congress in Tuluse in 1893. Zdzisław Dmochowski (1864-1924) described the pathologic anatomy changes in maxillary sinuses. Benni and Alfred Sokołowski (1849-1924) were the authors of several chapters in foreign medical textbooks. Heryng's inhalation apparatuses exhibited in Paris are described. Sedziak, Przemysław Pieniazek (1850-1916) and Teodor Heiman (1848-1917) were also the authors of articles in foreign otolaryngological journals written in connection with the jubilee of famous otolaryngologists: Leopold von Schroetter, Bernhard Fraenkel and Hermann Schwartze. The problem of focal infection in otolaryngology described by Feliks Erbrich (1874-1938) is briefly pointed out.

History, 19th Century↗

PubMed2003

Factors that affect the outcome of open-technique procedures performed in the treatment of cholesteatoma.

OBJECTIVES: We evaluated the factors that have considerable significance on the outcome of open cavity procedures in the treatment of cholesteatoma. PATIENTS AND METHODS: The study included 66 patients (43 males, 23 females; mean age 47 years; range 21 to 69 years) who underwent surgery for cholesteatoma. Of these, 56 patients completed at least a five-year follow-up. RESULTS: Mucosal infections and granulation tissue formation occurred in seven patients (10%) in the early postoperative period. Retraction pockets developed in three patients (4%); of these, only one patient required excision because of deep localization. Drum perforations that occurred in two patients (3%) were repaired by myringoplasty. Revision surgery was performed in four patients (7.1%) due to residual cholesteatoma within a five-year follow-up. CONCLUSION: The height of the facial ridge was found as the most important factor related to a successful outcome of open-technique procedures. Other factors included the creation of a smooth mastoid cavity with round edges, removal of all diseased mastoid cells, and an extensive conchameatoplasty.

Adult↗

PubMed2004

[Clinical practice guidelines: surgical treatment of tympanic membrane perforations in children].

A study group emanating from the French Society of Otolaryngologists and Associated Paediatric Otologists, anaesthetists and bacteriologists carried out a review of the world literature regarding the indications, technique and results of simple myringoplasty in children. The group assessed the levels of evidence present in published articles and the opinions of experts in the field, due to the lack of sufficient evidence. The study group then established recommendations for good practice. These were sent to otolaryngologists, paediatricians, general practitioners and anaesthetists involved in the care of children under the age of 15 presenting with a simple non-infected tympanic membrane perforation and without affection of the ossicular chain. The full text of the recommendations is provided.

Child↗

PubMed2005

[Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis].

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.

Acoustic Impedance Tests↗

PubMed1990

[Use of human placental type IV collagen in tympanoplasty. Results of initial animal experimentation].

This study presents the use of human type IV collagen film in myringoplasty in dogs. Evaluation criteria were clinical (repeated otoscopies) and histological (histological analysis of cicatrised membranes). This new biomaterial should seem to be a technological advance on temporal bone aponevrosis or perichondria auto-grafts. This study constitutes the necessary preliminary research to any application in man.

Animals↗

PubMed1986

[Our postoperative care and surveillance in surgery of stable sequelae of chronic otitis].

After a brief summary of the technique used for myringoplasty (enlarged endaural approach, large flattened aponeurotic graft applied to deep surface of tympano-meatal flap after a "request" for boring) emphasis is given to the need for strict surveillance and postoperative care by the surgeon. Immediate postoperative care starts in the operating room and involves a deep intra-meatal dressing (1 or 2 Popes oto-wicks placed on a thin film of silastic or simply surrounded by Gelfoam) and a superficial dressing. The dressing is renewed on the 3rd day with the patient in bed and involves only the superficial one. Secondary postoperative care extends to the 10th or 15th day and includes exeresis of the deep pope-Gelfoam assemblage under careful binocular microscope control followed by audiometric examination. Hospital stay is a mean of 5 days and medical treatment (antibiotics, vasodilators, corticoids) is given as required. Late postoperative care can be summarized as involving regular surveillance and the application of certain rules that cause little disturbance in the patients life. Various rare and even exceptional incidents, benign in the majority of cases, are reviewed.

Chronic Disease↗

PubMed1985

Microsurgery of the middle ear.

Microsurgery of the middle ear has evolved over the past three decades through the art of the technically possible to the art of the clinically advisable. Stapedectomy has been refined to achieve an acceptably high level of success. Tympanoplasty in its simpler forms (myringoplasty +/- incus transposition) is very successful in the restoration of a dry hearing ear. Reconstruction in the absence of a mobile stapes remains an unresolved problem. The safe avoidance of an open cavity in cholesteatomatous disease continues to be an elusive goal.

Biocompatible Materials↗

PubMed1985

[Osteomatous chronic otitis. 27 new cases. 2 new forms].

The authors report 27 new cases of osteomatous chronic otitis, with (15) or without (12) cholesteatomas, with perforated (13) or intact (14) drum, the latter sometimes having a very atypical appearance (2), frankly purulent or simply inflammatory. This results in a wide range of clinical appearances. There are two macroscopic forms: the diffuse attico-antral form and localized forms (drum - C.S.C.L.). The authors emphasize: the primordial interest of tomography (or CT scan), the keystone of their discovery, as well as the dangers of their surgical treatment. In addition to review of these known concepts, two forms have been identified: 1) Osteomatous attico-chain monoblock, where the ossicles of the ear are adherent in their entirety, either to the external attical wall or, much more rarely, to the medial attical wall. They describe 13 cases, the pattern of which is very different, according to whether the diagnosis is one of cholesteatomatous chronic otitis or not. In the absence of cholesteatoma (8 cases), the clinical picture is suggestive of otospongiosis or of chronic otitis with intact drum. The surgical procedure is related to these findings: 1 completion of myringoplasty, 7 piston-malleus. In cases of cholesteatomatous chronic otitis (5 cases), the picture is completely different, the cholesteatoma developing at leisure, behind the impenetrable osteomatous shield. Once again, the surgical procedure is modified: 4 vast evacuation cavities and one mastoatticotomy for giant cholesteatoma with intact drum. 2) Diffuse and "progressive" osteomatous stenosis of the walls of the E.A.M. The authors describe 6 cases occurring either during cholesteatomatous chronic otitis, or within a few weeks, simulating chronic otitis with intact drum.

Adolescent↗

PubMed1985

[Rare diseases of the ear: fibrous dysplasia of the tympanic bone, extensive papillomatosis, ceruminoma, aspergilloma, spontaneous évidement of the tympanic bone].

The authors report six cases of rare ear diseases: fibrous dysplasia of the tympanum mimicking an partially obstructive osteoma of the external auditory canal. The authors draw a parallel between the rarity of these monostotic forms of the temporal bone which are strictly localised to a single region (tympanum-mastoid-atrium) and the diffuse forms which involve several regions at the same time; extensive papillomatosis of the external and middle ear, a rare condition with serious repercussions; two ceruminomas with very different clinical presentations and outcomes; an atrial pseudo-tumoral aspergilloma which was easily excised ans repaired with a myringoplasty with a good long term result; hypoplasia of the tympanum, which constituted a spontaneous évidement, discovered at operation for an attic cholesteatoma. This finding was sufficiently unusual to warrant reporting.

Adenocarcinoma↗

PubMed1979

[Thermal injuries of the middle ear in welders].

In the years 1970--1976 19 cases of middle ear burns due to sparks or incandescent foreign bodies were treated. All patients were metal welders. In the first period of treatment conservative procedures were used and 5 patients were surgically treated (antromastoidectomy, myringoplasty).

Accidents, Occupational↗

PubMed1982

Residual perforations after tympanoplasty: office technique for closure.

The author and his associates still strongly recommend an office closure treatment for central tympanic membrane perforations, which has resulted in 1449 healed perforations over a period of 36 years. A particularly gratifying segment of the healed perforation population has been the 247 residual or recurrent perforations following myringoplasty or tympanoplasty surgery that were closed by office treatment. Thus, the patients were spared a second operation. After reviewing his own and his associates' surgical failures, the author found two factors that seem to predispose to surgical failure. Primary failures or recurrent perforations following surgical repair occur most frequently in patients with neglected or inadequately treated upper respiratory tract allergy. There also appears to be a higher incidence of primary failure or recurrent perforations when an operative approach does not provide an excellent view of the anterior annulus during surgery. This would seem to be the case with the routine use of the transcanal or endomeatal approach. Furthermore, the author also objects to the routine use of a combined endomeatal and postauricular approach, which may permit an unobstructed view of the anterior annular region by tilting the patient away from the surgeon during surgery. If there is a prominent anterior bony canal wall bulge, and there is an anterior graft failure or recurrence, reoperation, rather than a few office treatments, is the only recourse. The visualization problems both during and following surgery as described have led the author to continue his use of the endaural approach and meatoplasty learned during years of fenestration surgery and to adhere to the surgical technique described.

Ambulatory Care↗

PubMed1980

[The influence of tympanoplasty on bone conduction (author's transl)].

Seldom tympanoplasty damages the inner ear in a substantial amount: From 1814 operations upon chronic inflamed ears 4 patients (0.22%) became deaf, among the other patients bone conduction (b.c.) in the mean increased at 1000 cps for + 0.8 dB and decreased at 4000 cps for - 2.2 dB. In 9.8% b.c. showed an improvement for 10 dB or more at 1000 and 4000 cps, 9.7% showed an corresponding deterioration. For patients it was confirmed on a statistical base, that the influence on bone conduction demonstrated by animal experiments (Tonndorf), was mainly the result of changing the compliance of oval window and of increasing ossicular inertia. By relieving a mobile stapes of an incus which was fixed in the attic, there results an improvement of mobility of the stapedial footplate with increasing b.c. at 1000 and 4000 cps. By interposition of an incus between tympanic membrane and stapes and by myringoplasty with fascia there results an increasing ossicular inertia with increasing b.c. at 1000 cps and decreasing b.c. at 4000 cps. Noise trauma, mechanical trauma and infection are only of slight importance, only in some single cases they will damage the inner ear in a substantial amount.

Bone Conduction↗

PubMed1980

[Steroid anesthesia in microsurgery of the middle ear].

The essential requirements for correct anaesthesia in microsurgery of the middle ear are described and results obtained with an association of Althesin and NLA drugs in 52 stapedectomies, 27 tympanoplasties, and 14 myringoplasties are presented. Althesin was injected i.v. to induce anaesthesia. Maintenance was obtained by means of the continuous venous perfusion of a 10% solution. The usefulness of the association was apparent from the good cardiac stability noted throughout anaesthesia, during which adrenaline was routinely infiltrated via the external meatus. In addition, the manageability of Althesin enabled a modest degree of hypotension to be established during certain stages of the operation. This enabled the intraoperative bleeding that is one of the major snags in this type of surgery to be reduced in some cases. Other benefits related to the degree of postoperative sedation required and the low toxicity of the drugs employed.

Adolescent↗

PubMedDate not supplied

[Therapy of middle ear injuries caused by explosive devices].

Forty nine wounded with the explosive injury of the middle ear were treated. The largest number of injuries were ruptures of the ear drum (79.35%), followed by the break of the ossicular chain (15.87%) and the fractures of the mastoid, along with the paralysis of the facial nerve (4.77%). In therapeutic procedure the reposition and connection of the eardrum parts and 'patch' technique were performed, and in case of perforation persistence longer than four months myringoplasty was done. Injuries of the auditory bones were solved by ossiculoplasty, and injuries of facial nerve by decompression and neuro suture. In 66% spontaneous healing of rupture occurred and the ossicular chain was successfully fixed in 80% of injuries while the reparation of the facial nerve was partially achieved. The acute secondary infection developed in 18% and the chronic otitis in 10% of cases. The early reposition of the eardrum rupture is recommended due to infection prevention of the middle ear and in order to stimulate the spontaneous improvement, while the surgical treatment is recommended in cases with persistent rupture or conductive loss of hearing lasting longer than four months.

Adolescent↗

PubMed1994

[Tympanoplasty using chondro-perichondral graft. Indications, techniques and results. Apropos of a series of 127 cases].

In an attempt to avoid recurrence, the authors have used chondro-perichondral grafts for more than 10 years for tympanoplasty of retraction pouches. Early results were published in 1987. This new retrospective series of 127 tympanoplasties, performed from 1987 to 1991 reports the anatomic and functional results obtained and the technical modalities used. After a mean follow-up of 18 months, the results appear encouraging. Indications of this chondro-perichondral graft have been widened to cases of unsuccessful first intention myringoplasty and to certain cases of progressive perforations occurring in a setting of inflammation or tubal dysfunction. The results must be confirmed on the basis of long term outcomes.

Adolescent↗

PubMed1994

The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck.

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

Adipose Tissue↗