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Oto-acoustic responses were observed in normal ears in the presence of a static pressure applied to the external canal. The influence of pressure on the amplitude and spectral composition of the response is described.
OBJECTIVES: To evaluate a change in the classical technique for local-regional anesthesia (periauricular "V" infiltration) for surgery on the outer ear, specifically adding a new infiltration of the osteocartilaginous juncture of the external acoustic meatus and the auditory foramen, as an alternative to general anesthesia in adults, including assessment of postoperative analgesia. PATIENTS AND METHODS: The new technique was used in 45 operations on 23 patients. We analyzed pain during and after surgery on a simple verbal scale. RESULTS: After modifying the technique it was possible to perform surgery on the outer ear without causing pain, patients reporting "0" pain on a scale of 0 to 10. Eight patients reported "0" for postoperative pain, while one assessed pain as "4" and one as "2". No signs of emesis or cardiac events were observed. CONCLUSIONS: The described local-regional blockade of the outer ear used as the only anesthetic method, is indicated for both cosmetic surgery and repair of outer ear injuries, given its excellent analgesia during and after surgery. The characteristics of this type of block of the pavilion make it ideal for major outpatient surgery and a valid alternative to general anesthesia in adults.
Various methods for treatment of classic microtia are known. Beside a prosthesis, the most common way of auricle reconstruction is the use of autogenous rib cartilage; a process that requires two to three operations. In the first operation, rib cartilage is harvested from the 6th to the 9th rib. The base of the framework is the 6th and 7th rib cartilage which is taken under preservation of the synchondrosis. To mimic a 3-dimensional structure, the triangular fossa and scapha are carved into the groundplate and the 8th rib is fixed as a helical rim. After optimising the framework, it is placed in a subcutaneous pocket on the mastoid plane. In a second operation, approximately three months later, the auriculocephalic angle is reconstructed with a cartilage wedge, which is covered by a temporalis fascia flap and split skin-graft from the hairbearing skull. Commonly, a third operation is needed for minor refinements. Currently, autogenous rib cartilage is the ideal material available for ear reconstruction resulting in an excellent cosmetical outcome, although harvesting of the cartilage causes a specific donor-site morbidity. Operations improving the hearing ability by building up the external hearing channel and middle ear are mainly done in cases of bilateral microtia. Ear reconstruction with autogenous rib cartilage produces a replicable aesthetic result. The patients should be at least eight years old.
This paper describes a new technique using a Medpor porous polyethylene pivoting helix framework for reconstruction of the burned auricle. The polyethylene framework is composed of two distinct components, a curved shape that represents the helical rim which pivots around a base component. This framework is covered with a temporoparietal fascia flap and a skin graft that is chosen to match the adjacent resurfaced facial burn. The porous framework then becomes rapidly vascularized with soft-tissue ingrowth and collagen deposition. The pivoting helix design can be used to create an auricle of almost any size or projection. The helix can move independently and can be compressed against the head in the event of external pressure on the ear. The resultant ear reconstruction is extremely durable and remains flexible over time. Twenty-six consecutive ear reconstructions were performed using this method over a 2-year period. Two exposures occurred which were managed without removal of the implant. All reconstructions successfully restored an ear that was both aesthetically pleasing and functional so as to provide support for a pair of eyeglasses. The Medpor porous polyethylene pivoting helix framework offers an excellent solution for a difficult reconstructive problem.
A combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full-therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision-making process, is described. Twenty-four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone. This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%. It is concluded that a step-wise removal of all gross tumor, as opposed to an en bloc dissection of the temporal bone and skull base, followed by full-therapy irradiation gives equally as good, or even better, long-term survival for this malignancy of the external auditory canal and middle ear.
Cutaneous melanomas are the tumours that have increased more their incidence in the last fifty years. Melanomas arising from the external auditory canal are extraordinariously unfrequent. These tumours show an aggressive and silent behaviour, and due to this the diagnosis is frequently made in an advanced stage. A male with a malignant melanoma arising from his left external auditory canal was attended in our department, suspecting an epidermoid carcinoma. The clinical findings and the extension of the lesion required a lateral temporal bone resection, parotidectomy and neck dissection to achieve a total resection. We present a review of the literature about this entity and an analysis of the incidence, significance of the lymph node metastases and value of the elective neck dissection.
External ear canal volumes of 50 dogs were measured by tympanography. Comparison between each dog's weight and ear volume revealed a linear increase in volume with increasing weight up to 10 kg. At weights greater than 11 kg, ear volumes did not increase. After ear canal measurement, the tympanic membranes of 30 of the dogs were punctured, permitting determination of the combined volumes of the external ear canal and middle ear. This combined volume increased with increasing weight.
The object of this investigation was to assess the frequency of itching in the external auditory meatus in individuals who use hearing aid ear plugs (OP) and, simultaneously, to assess the cause of the itching. Seventy-six of the patients examined consecutively in the audiological department (ages 34-89 years) were questioned about itching and were submitted to an objective ear, nose and throat examination, audiometry and culturing from the external meatus for bacterial and fungal growth. In 20 patients, patch tests were made for allergic reactions from which the ear plugs were made (heat polymerized methyl methacrylate). None of the 20 patients had become sensitized. Itching in the external auditory meatus was found to be a side effect of employment of ear plugs with an incidence of 39% as opposed to only seven in ears without ear plugs (p less than 0.05). The incidence of itching was not reduced in ears with a ventilation channel in the ear plug. In 38% of the itching ears no objective changes were observed and, in the remaining cases, the changes were frequently limited. Potentially pathological bacterial growth was found to be significantly more in ears with ear plugs (1- greater than 16%, p less than 0.05) and in itching ears (4- greater than 24%, p less than 0.05). In ears with potentially pathogenic bacteria, objective changes were nearly always found. In the vast majority of cases, the potentially pathogenic bacteria were Gram-negative, corresponding to the findings in external otitis in the tropics and mixed infections with fungi were frequently present.(ABSTRACT TRUNCATED AT 250 WORDS)
Osteoid osteoma of the temporal bone is an infrequent benign bone tumor. The suspected diagnosis is based on clinical findings (occasionally pain, cosmetic deformities, repeated external otitis and conductive hearing loss), otoscopy, the radionuclide bone scan, and computerized tomography. Histopathology confirms the diagnosis of osteoma. Pain responds to acetylsalicyclic acid. Treatment is surgical excision by curettage and eburnation of the bone margins using an endaurul approach. We report a complete obliteration of the outer ear canal by an osteoid osteoma in a 32-year-old patient. A postauricular approach was required because of the large size of the tumor.
A rare case of polyotia in a 7-year old boy associated with first arch syndrome is reported. The accessory auricle formed a well defined helix and conchal bowl located anterior to a normal auricle and an atretic external auditory meatus. Surgical resection and reconstruction resulted in a good cosmetic outcome.
In the years 1974-1988 in the Department of Otorhinolaryngology Medical Academy in Cracow 60 patients were treated surgically for malignant tumours of the auricle. Their mean age was 61.9 years, males prevailed (82%). In 1 case the malignant lesion involved also the external auditory meatus and in 4 cases it spread to the skin near the auricle. Histological examinations demonstrated basal cell carcinoma in 22 cases (37%), spinocellular carcinoma in 31 cases (52%), basal-spinocellular carcinoma in 6 cases (10%) and malignant melanoma in 1 case. In 3 cases of spinocellular carcinoma metastases to lymph nodes were found. In 30 cases partial amputation of the auricle was done, in one of them recurrence developed after over 5 years. Advanced malignant lesions in 30 cases required extensive operation with removal of the lesion within margins of healthy tissue, removal of lymph nodes with metastases and one-step plastic operation. Recurrences developed in 2 cases. Hyperkeratotic foci near the malignant tumour were present in 64% of these patients. They made difficult preoperative qualification and required more extensive excision of the neoplasm. After tumour removal from the external meatus the resulting tissue defect must be filled with a skin graft since healing by granulation tissue development leads to obliteration of the meatus. Two out of 7 patients required additional interventions for maintenance of the patency of the meatus.
Tumors of the ceruminous glands can affect the auricula and periauricular skin and should be included in the differential diagnosis of lesions of these regions. Correct management of these tumors depends on precise histopathologic classification and diagnosis of their extension. We report a case of cystic adenoid carcinoma of the external auditory canal. Signs and symptoms, histopathology, and treatment of these lesions as reported in the literature are reviewed.
The study of the topographical and three dimensional anatomy of the human external auditory canal and tympanic membrane has been simplified by applying a dental impression technique to the cadaver ear. A light silicone resin was catalyzed and syringed into the anterior recess and then into the entire external canal. Analysis of these impressions showed them to compare well with earlier morphological techniques, and to provide a durable and reliable replica of the surface of the tympanic membrane, the interior of the external auditory canal, and the lateral surface of the pinna. The resulting impressions displayed the anatomical features of the external auditory canal in a unique three-dimensional fashion which was also suitable for measurement of the anatomical features of the canal.
The cephalometric roentgenograms of persons with the syndrome of XO gonadal dysgenesis and its variants, and of those with Noonan's syndrome, were compared with a control sample of unaffected females matched for age. Posterior craniofacial relationships differ between XO and normal individuals, particularly in the region of the external auditory meatus, which is located relatively more inferiorly and anteriorly in XO gonadal dysgenesis subjects than in chromosomally normal persons. Individuals who are mosaics, and those with Noonan's syndrome, do not differ from the unaffected population to the same extent. Although the position of the auricle often changes appreciably with growth when judged by clinical criteria alone, cephalometric analysis of relative ear position may still support the diagnosis of "low-set" ears.
In this 5-year follow-up study, 60 auricular non-melanoma skin cancers, selected at a skin tumour clinic, were treated by a thorough curettage with different sized curettes followed by cryosurgery in a double freeze-thaw cycle. Tumours of the external auditory canal were excluded. Forty-seven basal cell carcinomas (BCCs), nine squamous cell carcinomas (SCCs), three Bowen's disease and one basisquamous cancer were included. The mean diameter of the malignancies was 18 mm (range 5-70). Morphoeiform BCCs, recurrent BCCs with fibrotic component and most of the SCCs were selected for Mohs' micrographic surgery. Forty-two patients with 47 tumours were followed-up for at least 5 years with only one recurrence. Thirteen patients, followed-up for 2-4 years, died from other causes with no sign of recurrence at their last visit. No major problems after treatment were registered and the cosmetic result was good or acceptable in all patients.
In the majority of individuals, impaction of cerumen in the external auditory canal does not occur, and it is only a fraction of the population who regularly need to consult their physician for aural toilet. In this study we looked at the clinical features associated with recurrent cerumen impaction in 20 individuals. This was complemented by an examination of the cerumen plugs taken from their ears and hydrated to analyze the morphology of the keratin sheets, which had been observed in a previous study to constitute over one-half of the volume of impacted cerumen. In a further eight patients with cerumen, impaction plugs of cerumen were removed and subjected to histological examination. We observed that excessively long sheets of undivided keratin could be isolated from the hydrated cerumen plugs and that these sheets of keratin morphologically resembled the superficial layers of the stratum corneum of normal human deep external auditory canal skin. Based on these observations, we propose that cerumen impaction is the result of a failure in the normal keratinocyte separation which occurs in the superficial external auditory canal.
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