Chronic otitis media as a cause of sensorineural hearing loss.
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Adult↗
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Results for “MYRINGOPLASTY”
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Local anesthesia of the ear by iontophoresis.
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Adult↗
High-tone sensorineural losses following chronic ear surgery.
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Chronic Disease↗
Ventilating tubes in the middle ear.
One hundred children from 1 to 14 years of age had serous otitis media, the manifestations of which were bilateral in all but four patients. Thus, 196 ears were treated with aeration of the middle ear by means of a short transmyringeal tube. The mean duration of the treatment was 3.4 years, and the mean observation time was 7.3 years. Of the ears treated, 79.1% regained normal hearing, though scarring of the tympanic membrane and smaller adhesions were observed. The result was not satisfactory in 20.9% of the ears treated, the hearing losses varying from 25 to 60 dB. In 7.7% (15 ears) chronic otitis media developed; in 5.6% (11 of the 15 ears) cholesteatoma was confirmed surgically. Adhesive processes were present in 11.2%.
Adolescent↗
Mucociliary function of the eustachian tube: assessment by saccharin test in patients with dry perforations of the tympanic membrane.
The mucociliary function of the Eustachian tube was assess in 44 patients with dry perforations of the lympanic membrane by means of the saccharin test. A saccharin crystal was placed on the mucous membrane of the middle ear as close to the orifice of the Eustachian tube as possible, and the time taken for the patient to taste the saccharin was measured. The function of the Eustachian tube was also assessed by means of the aspiration test and by the Valsalva maneuver. No relationship was found between the results of the saccharin test, aspiration test, and the Valsalva maneuver. However, a correlation seems to exist between the hearing improvement obtained as determined by the postoperative air-bone gap, the positive or negative results of the saccharin test, and (in cases with positive saccharin test) the saccharin perception time.
Adolescent↗
Ossicular manipulation in chronic ear surgery. An electrocochleographic study.
Twelve patients were submitted to ossicular dissections for between 2 1/2 and 35 minutes during ear surgery. A comparison between premanipulatory and portmanipulatory electrocochleographic threshold determinations did not disclose any thrshold shifts. The results lend support to the conclusion that manipulations on ;the ossicular chain, performed with customary care, are less harmful to the inner ear than other generally recognized threats to the cochlea during surgery, eg, perilymph fistulae and acoustic traumas from the drill.
Cochlea↗
Surgery in elderly patients with chronic otitis media.
The results of surgery in 75 ears in patients over 60 years of age affected by chronic otitis media were compared with the results of surgery in 693 ears in patients under 60 years of age affected by chronic otitis media. Results in the elderly patients were found to be as good as those in the younger patients. No severe complications of surgery occurred in the patients over 60 years of age. The authors recommend that surgery should be undertaken on ears of elderly patients affected by chronic otitis media on the basis of the same indications as in younger patients.
Age Factors↗
Facial nerve palsy following tympanmastoid surgery.
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Facial Paralysis↗
Tympanoplasty in children. The Boston Children's Hospital experience.
Considerable controversy surrounds the subject of tympanoplasty in children. Conflicting opinions about the indications, patient selection, timing, and technique of surgery are supported by various published series of cases. The records of 64 consecutive tympanoplasty procedures performed at the Boston (Mass) Children's Hospital over a recent 6-year period were reviewed. The study was limited to cases of repair of uncomplicated perforation of pars tensa that did not require ossiculoplasty or mastoidectomy. Surgery was successful in 73% of cases. A number of factors that are postulated to affect the outcome of surgery have been analyzed to assess their utility in selecting successful surgical candidates. Only patient age at the time of surgery was found to have statistical significance. We conclude that tympanoplasty for repair of perforation is warranted for children 8 years of age and older.
Age Factors↗
A clinical profile of otitis media without an intact tympanic membrane.
An otitis media with effusion algorithm developed by Paradise et al has become the basis for many studies of otitis media. However, it has been shown to be too ambitious (low specificity) and too optimistic (absence of fluid does not necessarily mean normal ears). We developed a four-point profile to characterize the condition of the middle ear, but it cannot be used when the eardrum is perforated (with a functioning tube or chronic perforation). We propose a three-point profile for use without an intact tympanic membrane, and we report the validation of the profile by findings at myringotomy and by the preoperative profile. This postoperative profile and the previously described profile for ears with an intact tympanic membrane should increase the accuracy of middle ear assessment in following the course of otitis media over time.
Acoustic Impedance Tests↗
A clinical study of human type IV collagen as tympanic membrane grafting material. Preliminary noncomparative study.
OBJECTIVE: To evaluate tolerance for this middle-ear implant and its effectiveness in eardrum healing under various pathologic conditions. SETTING: A 12- to 18-month follow-up case series at an institutional referral center offering hospitalized care. PATIENTS: Twenty-six eligible volunteers suffering from tympanic perforation or tympanic pocket retraction class II and III in Tos' classification. INTERVENTION: Patients underwent implantation with the type IV collagen film (film called "MTY" from the French membrane tympanique). The surgical procedure was similar to those using the temporal aponeurosis or the tragal perichondrium. OUTCOME MEASURE: Anatomic criteria was determined by otoscopy, and functional audiometric criteria was determined by air-borne gap measurements and by effects on cochlear function. RESULTS: Twenty-two of 26 patients were completely healed after 6 months, with no subsequent evolution. Nineteen of 26 subjects underwent a 1-year postoperative audiometric follow-up examination: 13 (68%) had an air-borne gap less than 10 dB, four (21%) had between 11 and 20 dB, and two (11%) had between 21 and 30 dB. Adverse effects included one patient whose MTY fell into the middle ear, three patients with transient myringitis, and one patient with otitis media with effusion. CONCLUSIONS: A human type IV collagen film may be a possible alternative to autologous tissue in tympanic membrane reconstruction. This new biomaterial was tested on patients with various diseases common in clinical otology, and demonstrated a good biocompatibility of MTY in the different pathologic conditions of chronic otitis media. A future randomized, controlled trial will randomly allocate patients to receive either MTY collagen film or tissue from the temporal aponeurosis.
Adolescent↗
Otitis media with effusion in patients with nasopharyngeal carcinoma, postirradiation.
Eighteen patients with nasopharyngeal carcinoma were subjected to eustachian tube function testing before and 6 months and 5 years after irradiation at the university hospital to investigate the chronological changes of tubal function induced by irradiation and to study the development of otitis media with effusion after irradiation. Improvement of tubal function was found 5 years after irradiation in those ears without otitis media. However, in patients who had otitis media with effusion after irradiation, deterioration of tubal function was persistent, and inflammatory reaction was detected in the upper respiratory tract, including the maxillary sinus and nasopharynx. Thus, the development of otitis media with effusion after irradiation in patients with nasopharyngeal carcinoma is attributable to both tubal and inflammatory factors. Insertion of a ventilatory tube in ears can relieve tubal obstruction but can possibly aggravate the inflammatory process. Therefore, it is our opinion that myringotomy plus local treatment may be preferable to insertion of a ventilatory tube in patients with nasopharyngeal carcinoma who have otitis media with effusion.
Adult↗
Postinflammatory ossicular fixation in tympanoplasty.
Postinflammatory ossicular fixation in chronic ear surgery is a common problem faced by the otologic surgeon. This thesis presents a review of the evolution of the three forms of postinflammatory ossicular fixation. The surgical techniques used to correct ossicular fixation are discussed. A detailed evaluation of 311 patients diagnosed as having clinical tympanosclerosis is presented.
Acute Disease↗
Middle ear effusions and the nitrous oxide myth.
Myringotomies were performed on 75 ears suspected of having chronic or recurrent otitis media with effusion. Preanesthesia and intraoperative tympanograms with halothane, nitrous oxide, and oxygen anesthesia were compared for possible changes in middle ear pressure due to anesthesia. In addition, preanesthesia tympanograms were compared with tympanograms taken 2 weeks before hospital outpatient surgery. Tympanograms of 11 ears were found to shift from a flat type recorded at the office visit to normal range at pre and postinduction anesthesia. Middle ear fluid was not present in any of these 11 ears. The remaining 64 ears were broken down into three abnormal tympanogram configurations; flat, roll-over, and peaked negative pressure types. Comparing the tympanograms done in the office, preanesthesia and intraoperatively, only one of the 64 ears showed a change after induction of anesthesia. Three of the 64 ears revealed an unpredictable result with negative myringotomies. These results tend to support tympanometry as a means in predicting myringotomy findings, and also refute the contention that short-term nitrous oxide anesthesia changes the middle ear effusion during myringotomy.
Acoustic Impedance Tests↗
Ossicular discontinuity.
Because of the numerous and varied surgical approaches to ear pathology devised and expanded in the past two decades, we are destined to be confronted with increasingly frequent cases of ossicular defects behind an intact eardrum. Using a technique which is the converse of the established "patch" test a simple office procedure is described which may help establish the diagnosis of ossicular discontinuity in the adult with an intact eardrum. An audiogram is obtained and then a myringotomy performed with insertion of a large ventilation tube. A second audiogram is then done. A rise in the air conduction level, in the absence of fluid, is suggestive of ossicular discontinuity.
Audiometry↗
Surgical treatment of tympanosclerosis.
Tympanosclerosis as a cause of conductive hearing loss may require corrective surgery in carefully selected cases, although results of treatment have been controversial and must be viewed with caution. Currently available surgical techniques are reviewed and outcomes discussed.
Ear Ossicles↗
A planimetric study of temporal bone pneumatization.
The present study is based on the results of planimetric measurements of temporal bone pneumatization in 60 children. Radiological and clinical follow-up studies show that a myringotomy is sufficient therapy for cases of serous effusions. In contrast, mucous effusion require long-term middle ear ventilation with tympanostomy tubes to get approximately the same increase in temporal bone pneumatization.
Child↗
Our experiences at Semmelweis University with different techniques and materials in the surgery of chronic otitis media.
Different techniques and materials used in the surgery of chronic otitis media have been evaluated in a large clinical experience at Semmelweis University, Budapest. Data from 1572 operations performed during the last 5 years (1983-1988) are summarized. In the 870 non-cholesteatomatous processes (55.3%), mastoidectomies and tympanoplasties were performed, with the latter primarily using temporalis fascia and cortical bone. Out of the 250 cholesteatoma cases (15.9%), one-fourth was solved by a primary wall-up technique followed by a second stage revision and tympanoplasty within 1.5 years later.
Child↗