Speciality
Spotlight

 




 

Otolaryngology


 

    

  




Ear

    


  • Dornhofer JL (Univ of Arkansas, Little Rock)

    Diagnosis of Cohlear Meniere’s Disease with Electrocochleography

    ORL J Otorhinolaryngol Relat Spec 60: 301 – 305, 1998

      


    Patients with a diagnosis consistent with cochlear Meniere’s disease,
    fluctuating hearing loss without vertigo, were evaluated by Transtympanic electrochochleography (TT EcoG) to determine the presence or absence of endolymphatic hydrops electrophysiologically.

          


    The results of TT EcoG indicated in 67% of ears in patients with flucturating hearing loss without vertigo and are consistent with cochlear Meniere’s disease.     

        
  • Fahlbusch R, Neu M, Strauss C (Friedrich- Alexander-Univ, Erlangen-Nurnberg, Germany)

    Preservation of Hearing in Large Acoustic Neurinomas Following Removal via Suboccipito-Lateral Approach

    Acta Neurochir (Wien) 140: 771- 778, 1998

         


    Preservation of hearing, undergoing surgical removal of all acoustic neuromas is debatable especially in those patients with good preoperative hearing.

         


    In this series of 61 acoustic neuromas who had 2 cm or greater size, hearing preservation by monitoring brain stem auditory potential (BAPE) intraoperatively has been attempted. Total removal was done in all but 3 patients. Out of 58 patients, 25 patients (43.1%) hearing was preserved initially. Though 11 had delayed hearing loss, out of which 2 patients recovered late. So in all 16 patients (27.5%) had preservation of hearing. These results were better in tumours less than 3 cms. This study indicates large vestibular schwannomas, hearing preservation should be considered as a primary objective.

        

  • Lambert PR (Univ of virginia, Charlottesville)

    Congenital Aural Atresia: Stability of Surgical Results.

    Laryngoscope 108: 1801-1805, 1998

       


    Even for experienced otologic surgeons, atretic ear poses challenges as far as hearing results are concerned. This author has retrospectively studied 59 ears operated in 11 years period. The patients age was mean 2.8 yrs.

        


    Best speech reception thresholds (SRT) were compared during the 1st year and recent SRT.

       


    Short term results : SRT of 25 dB or lower was observed in 60% of patients

                                 
    SRT of 30 dB or lower was relieved in 70% of patients.

        


    Long term results: 25 dB or lower in 53%.

                                
    After revision surgery 30dB or lower in 64%.

                                
    One-third patients required revision surgery

          


    The above data supports and justifies the use of surgical approach in patients with unilateral
    atresia.

          

  • Hideaki Sakata, Yoshimasa Kojima, Satoru Koyama, Nobuhiko Furuya and Eiji Sakata (Department of Otolaryngology, Teikyo University School of Medicine, Ichihara Hospital, Ichihara, Chiba; Department of Otolaryngology, Gunnma University School of Medicine, Maebashi, Gunnma; and Center for Vertigo, Disequilibrium, and Tinnitus Diseases, Tokyo, Japan)

    Treatment of Cochlear Tinnitus with Transtympanic Infusion of 4% Lidocaine into the Tympanic Cavity


    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 46-50

         


    Abstract: Tinnitus is an otological symptom that is encountered often, yet its treatment is difficult. If tinnitus is of cochlear origin, a reasonable assumption is that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic infusion of a local anesthetic (4% lidocaine) to anesthetize the inner ear was conducted in a patient suffering from tinnitus. 

         


    Transtympanic infusion of 4% lidocaine was performed as a treatment for cochlear tinnitus, and its efficacy was investigated. The overall efficacy rate for the 292 patients with 369 affected ears was 81%. In the investigation of the treatment results in cases of different underlying ear diseases, the efficacy rate was high for tinnitus accompanying sudden deafness and labyrinthine vertigo. 

         


    However, vestibular symptoms, such as vertigo and nausea, developed after lidocaine infusion. No permanent side effects were noted. Lidocaine infusion is thought to be a useful treatment option for tinnitus and should be considered before surgical treatment. 

          

    Inner ear anesthesia into the tympanic cavity has been carried out in patients who had cochlear tinnitus and in whom conservative methods of therapy, such as oral medication, had proved unsuccessful. This treatment method is useful as a local therapy for cochlear tinnitus.

          


    Mechanism of Action: The basic mechanism of lidocaine therapy is considered to be the inhibition of abnormal excitability in the plexus tympanicus and inner ear.

         


    Lidocaine penetrates the round window membrane into the inner ear. Experimentally in animals it was demonstrated and proved. Also morphological changes occur in outer hair cells.

         

  • Jacob Ben-David, Michal Luntz, Ibrahim Magamsa, Milo Fradis, Edmond Sabo, and Ludwig Podoshin (Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel)

    Tinnitus as a Prognostic Sign in Idiopathic Sudden Sensorineural Hearing Loss


    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 62-64

         


    Abstract: Idiopathic sudden sensorineural hearing loss remains a controversial problem with respect to etiology and the factors that might predict a favorable prognosis. This study evaluated the possible prognostic factors of recovery in 67 patients with idiopathic sensorineural hearing loss treated with steroids (prednisone), plasma expanders (intravenous dextran), and vasodilators (papaverine). 

         


    Clinical recovery was estimated by contrasting the audiometric results on admission and those at discharge 10 days later. The correlation between various potential prognostic factors and audiological improvement was calculated. 

          


    Only two factors were found to be associated significantly with hearing improvement: tinnitus (p < .04) and the slope of audiogram on admission (p < .045). Tinnitus and the presence of an ascending audiogram were found to be correlated with a favorable outcome in idiopathic sensorineural hearing loss.

         

  • Abbas Mantazem, Sofflingen Hospital, ULM, Germany

    Secondary tinnitus as a symptom of instability of the upper cenical spine 


    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 130-133

         


    Tinnitus is caused by instability of the cranio-cervical junction. It manifests as high pitched whistle. These patients had instability of the cranio-cervical junction due to torn or over stretched ligaments, patients with discoligamentous damage without neurological deficit and many patients with degenerative discopathies, some with pronounced spinal stenosis.

         


    Lower cervical spine with degenerative changes had no symptoms and tinnitus, but the changes mentioned above in cranio-cervical junction had unilateral or bilateral high pitched whistle. Dysfunction at C2-C3 or C3-C4 level, also reported tinnitus of different character manifesting as splashing or crackling noises.

         


    Results: Operative stabilisation of these regions by dorsal approach and rehabilitation, tinnitus disappeard completely and permanently in all but 2 patients in all 134 patients who were operated with secondary
    tinnitus.

          

  • Dr. V. Rupa 

    Utility of Brainstem Anclitory Evoked Response Testing in Clinical Practice


    Kerala Journal of ENT-Head and Neck Surgery April-June 2000 Pg. 32-36

         


    The auditory brainstem response is a measure of the electrical events generated in response to an auditory stimulus by components along the auditory pathway picked up using surface electrodes.

         


    Brainstem auditory evoked response (BAER) testing has, over the years, developed into an attractive tool for the investigation of hearing related disorders and neurological disease.

        


    It was first described by Jewett in 1970.

        


    The various applications are –

    (1) Screening for vestibular Schwannama.

        


    (2) Estimation of auditory thresholds in infants and children with suspected hearing loss.

        


    (3) Assessment of maturation of the central auditory pathways. Serial recording enables the degree of maturation that is occurring and is of good prognostic value.

        


    (4) Detecting brainstem lesions. It has sensitivity of up to 74%.

        


    (5) Detection of malingering/non organic hearing loss. Especially useful in medicolegal issues.

        


    (6) Detection of cochlear disorders. Cochlear disorders like Meniers disease, ototoxicity, Presbycusis etc whenever reduction in amplitude of wave I and shortening of the interwave latency May be seen.

        


    (7) Intraoperative moniteering of 8th nerve function during excision of small vestibular schwannamas.

        


    (8) Acute brain injury. It can localize the site of brainstem injury with patients in a comatose condition.

        


    (9) Hearing aid fitting particularly in very young children wherein subjective responses are difficult to obtain. 

          

  • Rosingh H. J., Albers FWJ, Wit HP (Isala Clinics, Zwolde, The Netherlands; Univ Hosp, Groningen, The Netherlands)

    Noninvasive Perilymphatic Pressure Measurement in Patients With Meniere’s Disease and Patients With Idiopathic Sudden Sensorineural Hearing Loss (ISSHL)

    Am J Otol 21: 641-644, 2000

         

    It was thought that assessment of hydrostatic pressure of the inner ear will help in understanding physiologic and pathophysiologic aspects of inner ear.

         

    This was done in noninvasive manner by MMS-10 Tympanic Displacement Analyser (Marchbanks Measurement Systems, Southampton, England) in patients with Meniere’s disease (TT) and with ISSHL patients (28) and 50 normal subjects.

         

    Conclusion was that no significant difference was found, therefore tympanic membrane displacement technique doesn’t help in diagnosis of Meniere’s disease or ISSHL.

          

  • Gross EM, Ress BD, Viirre ES, et al (Univ of California, San Diego)

    Intractable Benign Paroxysmal Positional Vertigo in Patients With Meniere’s Disease

    Laryngoscope 110: 655-659, 2000

         

    This retrospective study of 162 patients of Meniere’s disease between January 1998 and January 1999 identified 9 patients with both
    “definitive” Meniere’s disease and
    “certain”
    B.P.P.V.

         

    The findings indicate that endolymphatic hydrops (E. H) predisposes to B.P.P.V. Improper canalith repositioning procedure didn’t appear to be the factor in intractability of B.P.P.V.

         

    Possible mechanism of coexistence of these both conditions is hydrops which induced damage to the maculae of the utricle and saccule and partial obstruction of the membranous labyrinth. 

          

    According to M. M. Paparella this article indicates to be an important additional feature of Meniere disease. It should be differentiated from the
    “true B.P.P.V” that doesn’t occur with Meniere disease.

            

  • Tsuji K, Velazquez –Villasensor L, Rauch SD, et al (Harvard Med School, Boston)

    Temporal Bone Studies of the Human Peripheral Vestibular System Meniere’s Disease

    Ann Otol Rhinol Laryngol 109: 26-31, 2000

          

    A quantitative assessment of type I and type II hair cells and Scarpa’s ganglion cells was performed in temporal bones from 24 patients with Meniere’s disease, 6 with bilateral disease.

          

    It was concluded that significant losses of type II hair cells and Scarpa’s ganglion cells were observed. Structure and functional relationship within the vestibular end organs remain to be elucidated.

           

    This is an interesting finding, in contrast to the understanding that intact cellular anatomical structures in Meniere’s disease existed. Further studies will add to our understanding of this disease and its management.

          

  • Derebery MJ (House Ear Clinic and House Ear Inst, Los Angeles)

    Allergic Management of Meniere’s Disease: An Outcome Study

    Otolaryngol Head Neck Surg 122: 174-182, 2000

         

    The effect of allergy immunotherapy and the avoidance of suspected food allergies were examined in 137 patients with Meniere’s disease. 113 patients received allergy treatment.

          

    Non treated 24 acted as control. Treated patients had significant improvement in allergy and Meniere’s disease symptoms. Attacks of vertigo were less severe, with less frequency, and stable or improved hearing. It is possible that inner ear is directly or indirectly the target of allergic reactions.

          

    Allergic manifestations if present should be treated. No histopathologic evidence of the inner ear to have allergic diathesis.

         

    Most patients seen of Meniere’s have anomalies that are genetically induced and are certainly not caused by allergies.

         

  • Bath AP, Walsh RM, Ranalli P, et al (Univ of Toronto)

    Experience From a Multidisciplinary “Dizzy” Clinic 

    Am J Otol 21: 92-97, 2000

          

    812 consecutive patients seen between 1st January 1993 to 31st December 1998 were evaluated. 525 (64.7%) had peripheral vestibular cause, 66 (8.1%) has central cause. 108 (13.3%) unknown and 73 (9.0%) of psychogenic origin.

          

    Conclusion : Most are of peripheral aetiology central causes are rare. Serious disorders (tumors, multiple selerosis, encephalitis) are unlikely to have other symptoms predominant to dizziness. Patient can have more than one type of disorder.

         

    M. M. Paparella states that there was a similar experience in his clinic.

         

  • Kringlebotn M (Norwegian Univ, Trondheim, Norway)

    Rupture Pressures of Membranes in the Ears

    Ann Otol Rhinol Laryngol 109: 940-944, 2000

          

    These studies of rupture pressures were carried out in cadaveric ears of Norwegian cattle. Rupture pressures of tympanic membrane, Reissner’s membrane, the round window membrane and the annular ligaments were assessed. 

          

    0.39 standard atmosphere (atm) for tympanic membrane, 0.047 atm for Reissner’s membrane, more than 2 atm for the round window membrane and 29.4 atm for the annular ligament. The tympanic membrane rupture occurred as tears in pass flaccida. 

          

    This study helps to understand the characteristics of the pressure relating to such ruptures, and can be transposed to clinical symptomatology.

          

  • Walsted A (Gentofte Univ Hospital, Denmark) 

    Effects of Cerebrospinal Fluid Loss on Hearing

    Acta Otolaryngology (Stockh) Suppl 543: 95-98, 2000

         

    CSF leaking causing loss and CSF will affect the inner ear fluids. 

          

    The study was done on 126 patients with CSF loss and 32 control subjects. Four groups were designed. Pre and post surgery audiometric examination was done. The amount of CSF loss was noted. 

         

    Conclusion : Increasing hearing impairment with increase in CSF loss was noted. Though irreversible hearing losses have been reported, in this series all hearing losses were reversible and were attributed to changes in the inner ear fluids.

          

    The author mentions that there is a direct communication between CSF and perilymph through cochlea aqueduct. This is not true as the duct is always closed. If it is open CSF-otorrhea will take place. Perhaps more important is the thin barrier between CSF and internal auditory canal and perilymph in the scala tympani at the basal turn.

          

  • Matteson EL, Tirzaman O, Facer GW, et al (Mayo Clinic and Found, Rochester, Minn) 

    Use of Methotrexate for Autoimmune Hearing Loss

    Ann Otol Rhinol Laryngol 109: 710-714, 2000

          

    The conventional treatment refractory 11 patients with autoimmune hearing loss underwent therapy with low dose oral methotrexate (MTX) (7.5 to 17.5 mg/wk). Improvement was considered an increase of 10 dB pure tone threshold or increase by 15% in speech discrimination. Hearing was improved in 9 patients, 1 worsened, and 1 no change was noted.

          

    It is worth considering this therapy in treatment of refractory cases of autoimmune induced hearing loss. 

          

    Autoimmune hearing loss requires a diagnosis, which is difficult to make. The results are not satisfactory as reported by the author but it can be continued to assess this modality in future.

           

  • Kiefer J, Weber A, Pfennigdorff T, et al (Johann-Wolfgang-Goethe- Universitat, Frankfurt am Main, Germany)

    Scala Vestibuli Insertion in Cochlear Implantation
    – A Valuable Alternative for Cases With Obstructed Scala Tympani 

    ORL J Otorhinolaryngol Relat Spec 62: 251-256, 2000

             

    In 4 cases this was done and the results assessed and were comparable to conventional scala tympani insertion.

           

    Though rare this alternate route can be used. It is wise to isolate scala vestibuli to the pars inferior, not the pars superior where vestibular symptoms and vertigo might be incited and might occur.

           

  • Sataloft RT, Zavod MB, Myers DL (Thomas Jefferson Univ, Philadelphia; Univ of Vermont, Burlington; Graduate Hospital, Philadelphia)

    Otogenic Cerebrospinal Fluid Rhinorrhea: A New Technique For Closure of Cerebrospinal Fluid Leak 

    Am J Otol 21: 240-243, 2000

           

    This report of closure of CSF leak by distal eustachian tube ligation in 5 ears who had undergone total temporal bone resection. It is effective, rapidly performed and minimally invasive. 

           

    It is an Interesting technique, though other techniques will be more useful to avoid flow of CSF in middle ear and making it vulnerable to infection and meningitis.

          

  • Casselbrant ML, Furman JM, Mandel EH, et al (Univ of Pittsburgh, Pa)

    Past History of Otitis Media and Balance in Four-Year-Old Children 

    Laryngoscope 110: 773-778, 2000

          

    Pneumatic otoscopy, tympanometry, audiometry, and vestibular and balance tests were performed on 71 children with a history of recurrent or persistent middle ear effusion (MEE), in this 40 children had MEE history.

         

    Conclusion : Children with MEE have significantly poorer vestibular or balance function than children without MEE. Early intervention may be necessary to treat MEE to avoid long-term vestibular impairments. 

          

    Round window being permeable, toxins, enzymes in MEE will cause either subtle or more clinically manifest dysfunction in the inner ear. This is worthy for the practitioner to know. 

           

    A small child with poor balance should undergo myringotomy and insertion of ventilation tube or other procedures as appropriate to remedy the same to avoid future impairment.

           

  • Conlon BJ, Smith DW, (Duke Univ, Durham, NC)

    Topical Aminoglycoside Ototoxicity: Attempting To Protect the Cochlea 

    Acta Otolaryngol (Stockh) 120: 596-599, 2000

           

    Animal experiments and clinical reports have shown cochlear damage after application of aminoglycoside antibiotics to round window membrane. Increased evidence that intracellular free radical generation is the mechanism which causes cochlear damage.

         

    To prevent this damage ability of a lipoic acid, a free radical scavenging agent has been found. The possible protective effect of a lipoic acid administered topically is evaluated in 16 guinea pigs.

         

    This interesting study may not have ultimate application in humans. The cochleotoxic effect can be counteracted by a lipoic acid a free radical scavenging agent in patients who are administered amino glycoside antibiotics systematically remains to be seen in humans.

          

  • Hone SW, Nedzelski J, Chen J (Univ of Toronto)

    Does Intratympanic Gentamicin Treatment for Meniere’s Disease Cause Complete Vestibular Ablation?

    J Otolaryngology 29: 83-87, 2000

          

    Intratympanic gentamicin (ITG) ablation and vestibular system used as treatment in intractable cases of Meniere’s. The vertigo control is reported from 83% to 100% and causes hearing loss in 15% to 50% of patients.

          

    Caloric testing to assess changes in vestibular system was done. The changes were prospectively correlated with the need for further treatment. 103 patients were studied before and after treatment. 

         

    It was concluded that patients who did not have ice cold caloric response were unlikely to need any further treatment. 

         

    Note of Warning
    : As the basal turn of cochlea occupies substantial portion of damaged cochlea, high frequency hearing loss may not be demonstrated until later in patients life.

         

  • Alzamil KS, Linthicum FH Jr (House Ear Inst, Los Angeles)

    Extraneous Round Window Membranes and Plugs: Possible Effect on Intratympanic Therapy

    Ann Otol Rhinol Laryngol 109: 30-32, 2000

            

    To assess the therapeutic effects of intratympanic perfusion of drugs through round window, the conditions of round windows of 202 sequential pairs of temporal bones from 117 patients were studied by postmortem studies. 

           

    The presence of fibrous or fatty plugs or extraneous round windows was determined. 

          

    Overall 33.2% prevalence was noted, 1.5% fatty plugs, 10.4% fibrous plugs and 21.3% extraneous round windows were noted.

           

    Conclusion was anatomical differences in round windows may explain variations in dosage of medication, was needed to produce desirable clinical effects. 

            

    This thus creates another problem when one tries to perfuse, e.g. ototoxic drugs through the round window and into the vestibular labyrinth.

          

  • Kawano H, Paparella MM, Ho SB, et al (Univ of Minnesota, Minneapolis)

    Identification of MUC5B Mucin Gene in Human Middle Ear With Chronic Otitis Media 

    Laryngoscope 110: 668-673, 2000

            

    Of the 9 or more mucin genes that have been identified MUC5B in major mucin expressed in rat and human middle ear and has not been well studied. It was identified and the correlation between infiltration cells in the submucosa and expression of the mucin gene was established.

          

    Specimens from inferior
    tympanic promontory were studied from 19 patients with chronic otitia media. 

         

    Conclusion- The MUC5B mucin gene and MUC5B mucin were extensively expressed and were significantly correlated with the degree of inflammatory cell infiltration in the submucosa of the middle ear cleft.

          

    The MUC5B mucin gene was identified in secretory cells. Such studies will lead to better understanding of the pathogenesis and ultimately the treatment and prevention of this common ear problem.

         

  • Moyse E, Lyon M, Cordier G, et al (Universite Claude Bernard, Villeurbanne, France; Hopital E Herriot, Lyon, France)

    Viral RNA in Middle Ear Mucosa and Exudates in Patients With Chronic Otitis Media With Effusion 

    Arch Otolaryngol Head Neck Surg 126: 1105-1110, 2000

         

    Chronic otitis media (OME) is believed to be the result of a blockage and infection of eustachian tube, which results in a persistent inflammatory process in the middle ear that may appear after either bacterial or viral acute otitis media. 

         

    Viruses are those which commonly affect rhinopharynx viz. adenoviruses, human respiratory syncytial virus and human parainfluenza viruses 1, 2, and 3. These are found at moderate to high frequencies in OME. 

          

    Mucosal biopsies, samples of fluid and exudates from 26 children with middle ears were subjected to reverse transcriptase – polymerase chain reaction analysis.

          

    RNA was extracted. The evidence of viruses in effusions, inflammatory excludates but not any of cells of biopsy samples.

          

    Conclusion : Viral contributes to OME. It is suggested that inflammatory cytokines are derived from cells of inflammatory exudates and not from cells of the middle ear mucosa.

          

    This study suggests a strong evidence of viral contribution involved in pathogenesis of OME. Genetic factors may predispose to eustachian tube dysfunction. Virus inflammatory process also may play a role as not suprising because middle ear cleft is part of respiratory system, which is commonly involved, in viral inflammation.

           

  • Ikui A, Sando I, Haginomori S-I, et al (Univ of Pittsburgh, Pa)

    Postnatal Development of the Tympanic Cavity: A Computer-Aided Reconstruction and Measurement Study 

    Acta Otolaryngol (Stockh) 120: 375-379, 2000

          

    Knowledge of the tympanic cavity is important in all surgical procedures on it. This study was conducted on 14 temporal bones, 6 of infant (£ 1 year old) and 8 adults (18-76).

          

    Results : The volumes of cavities between infants and adults differed considerably and increased in various regions with age. It was 1.5 times larger in adults. 

          

    This is an important contribution especially when cochlear implant is done in young children. M. M. Paparella also believes that there is hypoplasia of the middle ear and the mastoid air cell system that leads to otitis media in childhood or adulthood. 

          

    This study if applied to study of otitis media, will be of immense help.

          

  • Booth TN, Vezina LG, Karcher G, et al (Children’s Med Ctr of Dallas; Children’s Natl Med Ctr, Washington DC)

    Imaging and Clinical Evaluation of Isolated Atresia of the Oval Window 

    AJNR 21: 171-174, 2000

          

    Hearing loss in children is commonly congenital. CT is done in cases of unknown cause. The clinical and high-resolution CT (HRCT) findings in children with oral window atresia, not associated external auditory canal (EAC) anomalies are presented. Nine children were studied.

         

    HRCT revealed a well-defined bony plate in the oral window, between the middle ear cavity and the vestibule. There were associated anomalies of incus, stapes and the facial nerve.

         

    Such CT findings are useful in assessing anomalies in the middle ear of children with congenital hearing loss and useful while doing exploratory tympanotomy. 

         

    A word of caution – If stapes is fixed, central hole to mobilize stapes should be done. Stapedectomy can be hazardous as it may cause perilymph gusher.

          

  • Ohishi Y, Komiyama S, Shiba Y (Hiroshima Univ, Japan; Kyushu Univ, Fukuoka, Japan)

    Predominant Role of the Chorda Tympani Nerve in the Maintenance of the Taste Pores: The Influence of Gustatory Denervation in Ear Surgery 

    J Laryngol Otol 114: 576-580, 2000

         

    Disturbance in taste in patients following surgery of the middle ear resulting from denervation of the chorda tympani nerve. The effect and the actin filaments of taste pores was studied histologically.

         

    Chorda tympani nerve and a lingual nerve section were carried out in rats. The study of specimens was by scanning electron microscopy.

         

    Conclusion: Actin filaments were more quickly disrupted after chorda tympani section than after lingual nerve section. Thus it is clear that chorda tympani is required for taste pore maintenance and should be preserved.

         

    Though this demonstrates the importance of maintenance function of chorda tympani, in vast majority of cases have no difficulty, probably because the lingual nerve takes over to avoid permanent disability. No doubt there will be temporary aberration in taste following chorda tympani section.

           

  • Tekin M, Mutlu C, Paparella MM, et al (Univ of Minnesota, Minneapolis; Internatl Hearing Found, Minneapolis; Minnesota Ear, Head and Neck Clinic, Minneapolis)

    Tympanic Membrane and Middle Ear Pathologic Correlates in Mucoid Otitis Media 

    Otolaryngol Head Neck Surg123: 258-262, 2000

         

    A retrospective study of tympanic membrane and middle ear pathologies was done in 40 patients with mucoid otitis media and 56 control ears.

          

    Results: The thickness of tympanic membrane increased in all quadrants except at umbo.

         

    Conclusion: Changes in the tympanic membrane are likely to occur in patients with MOM. The changes should be taken as evidence of middle ear pathologic process.

         

    This underlying process may be silent or subclinical.

         

  • Horn KL (Presbyterian Ear Inst, Albuquerque, NM)

    Intracranial Extension of Acquired Aural Cholesteatoma 

    Laryngoscope 110: 761-772, 2000

          

    It is either congenital or acquired. Records of 6 patients and of 477 patients with cranial extension of aural petrosal cholesteatoma treated between 1985 to 1999 were reviewed. Patients were followed up with CT and MRI at 2 years interval.

         

    CT was done to demonstrate extension of the tumor and MRI was done to help differentiate petrous cholesteatoma from other petrous bone tumors.

          

    Intracranial acquired cholesteatoma most commonly spread through anterior epitympanic air cells or supratubal recess.

         

  • Tos M,
    frntoft S, Stangerup S-E (Gentofte Univ, Hellerup, Denmark)

    Results of Tympanoplasty in Children After 15 to 27 Years 

    Ann Otol Rhinol Laryngol 109: 17-23, 2000

          

    A total of 124 ears from 116 children from 2.5 years to 14 years, 26 ears from children age 2.5 to 7 years and 98 ears from children aged 8 to 14 years.

           

    Surgery was performed between 1968 and 1980. Perforations were anterior (22%), posterior (21%) and total (38%). All dry ears were operated by transcanal tympanoplasty and only temoralis fascia was used.

          

    Results- The perforation rate was 4% at 2 to 15 years and 6% at 16 to 27 years. Hearing was good and stable.

          

    M. M. Paparella agrees that results in children can be long-standing and comparable to long-term results in adults.

         

  • Ruhl CM, Pensak ML (Univ of Otolaryngology, Providence, RI; Univ of Cincinnati, Ohio)

    Role of Aerating Mastoidectomy in Noncholesteatomatous Chronic Otitis Media

    Laryngoscope 109: 1924-1927, 2000

          

    Objective was to improve tympanoplasty results in noncholesteatomatous otitis in revision cases by doing aerated mastoidectomy. In these cases previous tympanoplasty had failed.

          

    135 patients between 1986 to 1996 were revised with cortical mastoidectomy with regrafting of tympanic membrane. CT scanning was performed on all patients 90.4% success rate was achieved.

          

    It was concluded in otitis with poorly pneumatized mastoids with failure of surgery were benefited by doing mastoidectomy. Those who had normal looking mastoids did not benefit from revision surgery by doing cortical mastoidectomy.

          

    The other ways of aerating middle ear is to increase depth and width of middle ear. The mastoidectomy aeration may not be needed, when it is observed that those with normal hearing and tympanogram have poor mastoid areation.

          

  • Darrouzet V, Duclos J-Y, Portmann D, et al (Univ Hospital of Bordeaux, France; Clinique Saint-Augustin, Bordeaux, France)

    Preference for the Closed Technique in the Management of Cholesteatoma of the Middle Ear in Children: A Retrospective Study of 215 Consecutive Patients Treated Over 10 Years

    Ann J Otol 21: 474-481, 2000

           

    The controversy of closed vs. open technique in cases of cholesteatoma in children continues to be debated.

         

    A retrospective analysis of 215 cholesteatoma in 199 children with mean age of 9.6 year and follow-up of 70 months has been presented. Initial treatment was closed technique in 88%, while 10% had open technique. 

        

    Multiple surgical procedures were needed as follows: 

         

    61% 2, 3 in 21%, 4 in 4.5%.

         

    Results- The rate of residual lesions was 23.8% in open technique vs. 20.5% in closed. The rate of was recurrence was 19% vs. 8.9% in open vs. closed. 

         

    For most children closed treatment is preferable. The primary goal was to achieve socially acceptable hearing. The role of second stage surgery to improve results is emphasized.

          

    M. M. Paparella found it more useful to custom make procedure to adapt pathologic tissues and anatomical pathologic conditions found. It is useful to be as conservative as possible and therefore closed technique in children is used.

          

    By endaural approach the cholesteatoma can be followed to remove it up to the anatomical involvement and leave the rest as it is.

          

 



 

Speciality Spotlight

 

    
  

Ear
    

  • Dornhofer JL (Univ of Arkansas, Little Rock)
    Diagnosis of Cohlear Meniere’s Disease with Electrocochleography
    ORL J Otorhinolaryngol Relat Spec 60: 301 – 305, 1998
      

    Patients with a diagnosis consistent with cochlear Meniere’s disease, fluctuating hearing loss without vertigo, were evaluated by Transtympanic electrochochleography (TT EcoG) to determine the presence or absence of endolymphatic hydrops electrophysiologically.
          
    The results of TT EcoG indicated in 67% of ears in patients with flucturating hearing loss without vertigo and are consistent with cochlear Meniere’s disease.     
        
  • Fahlbusch R, Neu M, Strauss C (Friedrich- Alexander-Univ, Erlangen-Nurnberg, Germany)
    Preservation of Hearing in Large Acoustic Neurinomas Following Removal via Suboccipito-Lateral Approach
    Acta Neurochir (Wien) 140: 771- 778, 1998
         

    Preservation of hearing, undergoing surgical removal of all acoustic neuromas is debatable especially in those patients with good preoperative hearing.
         
    In this series of 61 acoustic neuromas who had 2 cm or greater size, hearing preservation by monitoring brain stem auditory potential (BAPE) intraoperatively has been attempted. Total removal was done in all but 3 patients. Out of 58 patients, 25 patients (43.1%) hearing was preserved initially. Though 11 had delayed hearing loss, out of which 2 patients recovered late. So in all 16 patients (27.5%) had preservation of hearing. These results were better in tumours less than 3 cms. This study indicates large vestibular schwannomas, hearing preservation should be considered as a primary objective.
        

  • Lambert PR (Univ of virginia, Charlottesville)
    Congenital Aural Atresia: Stability of Surgical Results.
    Laryngoscope 108: 1801-1805, 1998
       

    Even for experienced otologic surgeons, atretic ear poses challenges as far as hearing results are concerned. This author has retrospectively studied 59 ears operated in 11 years period. The patients age was mean 2.8 yrs.
        
    Best speech reception thresholds (SRT) were compared during the 1st year and recent SRT.
       
    Short term results : SRT of 25 dB or lower was observed in 60% of patients
                                  SRT of 30 dB or lower was relieved in 70% of patients.
        
    Long term results: 25 dB or lower in 53%.
                                 After revision surgery 30dB or lower in 64%.
                                 One-third patients required revision surgery
          
    The above data supports and justifies the use of surgical approach in patients with unilateral atresia.
          

  • Hideaki Sakata, Yoshimasa Kojima, Satoru Koyama, Nobuhiko Furuya and Eiji Sakata (Department of Otolaryngology, Teikyo University School of Medicine, Ichihara Hospital, Ichihara, Chiba; Department of Otolaryngology, Gunnma University School of Medicine, Maebashi, Gunnma; and Center for Vertigo, Disequilibrium, and Tinnitus Diseases, Tokyo, Japan)
    Treatment of Cochlear Tinnitus with Transtympanic Infusion of 4% Lidocaine into the Tympanic Cavity
    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 46-50
         
    Abstract: Tinnitus is an otological symptom that is encountered often, yet its treatment is difficult. If tinnitus is of cochlear origin, a reasonable assumption is that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic infusion of a local anesthetic (4% lidocaine) to anesthetize the inner ear was conducted in a patient suffering from tinnitus. 
         
    Transtympanic infusion of 4% lidocaine was performed as a treatment for cochlear tinnitus, and its efficacy was investigated. The overall efficacy rate for the 292 patients with 369 affected ears was 81%. In the investigation of the treatment results in cases of different underlying ear diseases, the efficacy rate was high for tinnitus accompanying sudden deafness and labyrinthine vertigo. 
         
    However, vestibular symptoms, such as vertigo and nausea, developed after lidocaine infusion. No permanent side effects were noted. Lidocaine infusion is thought to be a useful treatment option for tinnitus and should be considered before surgical treatment. 
          
    Inner ear anesthesia into the tympanic cavity has been carried out in patients who had cochlear tinnitus and in whom conservative methods of therapy, such as oral medication, had proved unsuccessful. This treatment method is useful as a local therapy for cochlear tinnitus.
          
    Mechanism of Action: The basic mechanism of lidocaine therapy is considered to be the inhibition of abnormal excitability in the plexus tympanicus and inner ear.
         
    Lidocaine penetrates the round window membrane into the inner ear. Experimentally in animals it was demonstrated and proved. Also morphological changes occur in outer hair cells.
         

  • Jacob Ben-David, Michal Luntz, Ibrahim Magamsa, Milo Fradis, Edmond Sabo, and Ludwig Podoshin (Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel)
    Tinnitus as a Prognostic Sign in Idiopathic Sudden Sensorineural Hearing Loss
    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 62-64
         
    Abstract: Idiopathic sudden sensorineural hearing loss remains a controversial problem with respect to etiology and the factors that might predict a favorable prognosis. This study evaluated the possible prognostic factors of recovery in 67 patients with idiopathic sensorineural hearing loss treated with steroids (prednisone), plasma expanders (intravenous dextran), and vasodilators (papaverine). 
         
    Clinical recovery was estimated by contrasting the audiometric results on admission and those at discharge 10 days later. The correlation between various potential prognostic factors and audiological improvement was calculated. 
          
    Only two factors were found to be associated significantly with hearing improvement: tinnitus (p < .04) and the slope of audiogram on admission (p < .045). Tinnitus and the presence of an ascending audiogram were found to be correlated with a favorable outcome in idiopathic sensorineural hearing loss.
         

  • Abbas Mantazem, Sofflingen Hospital, ULM, Germany
    Secondary tinnitus as a symptom of instability of the upper cenical spine 
    The International Tinnitus Journal Vol. 7 (1) 2001 Pg. 130-133
         
    Tinnitus is caused by instability of the cranio-cervical junction. It manifests as high pitched whistle. These patients had instability of the cranio-cervical junction due to torn or over stretched ligaments, patients with discoligamentous damage without neurological deficit and many patients with degenerative discopathies, some with pronounced spinal stenosis.
         
    Lower cervical spine with degenerative changes had no symptoms and tinnitus, but the changes mentioned above in cranio-cervical junction had unilateral or bilateral high pitched whistle. Dysfunction at C2-C3 or C3-C4 level, also reported tinnitus of different character manifesting as splashing or crackling noises.
         
    Results: Operative stabilisation of these regions by dorsal approach and rehabilitation, tinnitus disappeard completely and permanently in all but 2 patients in all 134 patients who were operated with secondary tinnitus.
          

  • Dr. V. Rupa 
    Utility of Brainstem Anclitory Evoked Response Testing in Clinical Practice
    Kerala Journal of ENT-Head and Neck Surgery April-June 2000 Pg. 32-36
         
    The auditory brainstem response is a measure of the electrical events generated in response to an auditory stimulus by components along the auditory pathway picked up using surface electrodes.
         
    Brainstem auditory evoked response (BAER) testing has, over the years, developed into an attractive tool for the investigation of hearing related disorders and neurological disease.
        
    It was first described by Jewett in 1970.
        
    The various applications are –
    (1) Screening for vestibular Schwannama.
        
    (2) Estimation of auditory thresholds in infants and children with suspected hearing loss.
        
    (3) Assessment of maturation of the central auditory pathways. Serial recording enables the degree of maturation that is occurring and is of good prognostic value.
        
    (4) Detecting brainstem lesions. It has sensitivity of up to 74%.
        
    (5) Detection of malingering/non organic hearing loss. Especially useful in medicolegal issues.
        
    (6) Detection of cochlear disorders. Cochlear disorders like Meniers disease, ototoxicity, Presbycusis etc whenever reduction in amplitude of wave I and shortening of the interwave latency May be seen.
        
    (7) Intraoperative moniteering of 8th nerve function during excision of small vestibular schwannamas.
        
    (8) Acute brain injury. It can localize the site of brainstem injury with patients in a comatose condition.
        
    (9) Hearing aid fitting particularly in very young children wherein subjective responses are difficult to obtain. 
          

  • Rosingh H. J., Albers FWJ, Wit HP (Isala Clinics, Zwolde, The Netherlands; Univ Hosp, Groningen, The Netherlands)
    Noninvasive Perilymphatic Pressure Measurement in Patients With Meniere’s Disease and Patients With Idiopathic Sudden Sensorineural Hearing Loss (ISSHL)
    Am J Otol 21: 641-644, 2000
         
    It was thought that assessment of hydrostatic pressure of the inner ear will help in understanding physiologic and pathophysiologic aspects of inner ear.
         
    This was done in noninvasive manner by MMS-10 Tympanic Displacement Analyser (Marchbanks Measurement Systems, Southampton, England) in patients with Meniere’s disease (TT) and with ISSHL patients (28) and 50 normal subjects.
         
    Conclusion was that no significant difference was found, therefore tympanic membrane displacement technique doesn’t help in diagnosis of Meniere’s disease or ISSHL.
          

  • Gross EM, Ress BD, Viirre ES, et al (Univ of California, San Diego)
    Intractable Benign Paroxysmal Positional Vertigo in Patients With Meniere’s Disease
    Laryngoscope 110: 655-659, 2000
         
    This retrospective study of 162 patients of Meniere’s disease between January 1998 and January 1999 identified 9 patients with both “definitive” Meniere’s disease and “certain” B.P.P.V.
         
    The findings indicate that endolymphatic hydrops (E. H) predisposes to B.P.P.V. Improper canalith repositioning procedure didn’t appear to be the factor in intractability of B.P.P.V.
         
    Possible mechanism of coexistence of these both conditions is hydrops which induced damage to the maculae of the utricle and saccule and partial obstruction of the membranous labyrinth. 
          
    According to M. M. Paparella this article indicates to be an important additional feature of Meniere disease. It should be differentiated from the “true B.P.P.V” that doesn’t occur with Meniere disease.
            

  • Tsuji K, Velazquez –Villasensor L, Rauch SD, et al (Harvard Med School, Boston)
    Temporal Bone Studies of the Human Peripheral Vestibular System Meniere’s Disease
    Ann Otol Rhinol Laryngol 109: 26-31, 2000
          
    A quantitative assessment of type I and type II hair cells and Scarpa’s ganglion cells was performed in temporal bones from 24 patients with Meniere’s disease, 6 with bilateral disease.
          
    It was concluded that significant losses of type II hair cells and Scarpa’s ganglion cells were observed. Structure and functional relationship within the vestibular end organs remain to be elucidated.
           
    This is an interesting finding, in contrast to the understanding that intact cellular anatomical structures in Meniere’s disease existed. Further studies will add to our understanding of this disease and its management.
          

  • Derebery MJ (House Ear Clinic and House Ear Inst, Los Angeles)
    Allergic Management of Meniere’s Disease: An Outcome Study
    Otolaryngol Head Neck Surg 122: 174-182, 2000
         
    The effect of allergy immunotherapy and the avoidance of suspected food allergies were examined in 137 patients with Meniere’s disease. 113 patients received allergy treatment.
          
    Non treated 24 acted as control. Treated patients had significant improvement in allergy and Meniere’s disease symptoms. Attacks of vertigo were less severe, with less frequency, and stable or improved hearing. It is possible that inner ear is directly or indirectly the target of allergic reactions.
          
    Allergic manifestations if present should be treated. No histopathologic evidence of the inner ear to have allergic diathesis.
         
    Most patients seen of Meniere’s have anomalies that are genetically induced and are certainly not caused by allergies.
         

  • Bath AP, Walsh RM, Ranalli P, et al (Univ of Toronto)
    Experience From a Multidisciplinary “Dizzy” Clinic 
    Am J Otol 21: 92-97, 2000
          
    812 consecutive patients seen between 1st January 1993 to 31st December 1998 were evaluated. 525 (64.7%) had peripheral vestibular cause, 66 (8.1%) has central cause. 108 (13.3%) unknown and 73 (9.0%) of psychogenic origin.
          
    Conclusion : Most are of peripheral aetiology central causes are rare. Serious disorders (tumors, multiple selerosis, encephalitis) are unlikely to have other symptoms predominant to dizziness. Patient can have more than one type of disorder.
         
    M. M. Paparella states that there was a similar experience in his clinic.
         

  • Kringlebotn M (Norwegian Univ, Trondheim, Norway)
    Rupture Pressures of Membranes in the Ears
    Ann Otol Rhinol Laryngol 109: 940-944, 2000
          
    These studies of rupture pressures were carried out in cadaveric ears of Norwegian cattle. Rupture pressures of tympanic membrane, Reissner’s membrane, the round window membrane and the annular ligaments were assessed. 
          
    0.39 standard atmosphere (atm) for tympanic membrane, 0.047 atm for Reissner’s membrane, more than 2 atm for the round window membrane and 29.4 atm for the annular ligament. The tympanic membrane rupture occurred as tears in pass flaccida. 
          
    This study helps to understand the characteristics of the pressure relating to such ruptures, and can be transposed to clinical symptomatology.
          

  • Walsted A (Gentofte Univ Hospital, Denmark) 
    Effects of Cerebrospinal Fluid Loss on Hearing
    Acta Otolaryngology (Stockh) Suppl 543: 95-98, 2000
         
    CSF leaking causing loss and CSF will affect the inner ear fluids. 
          
    The study was done on 126 patients with CSF loss and 32 control subjects. Four groups were designed. Pre and post surgery audiometric examination was done. The amount of CSF loss was noted. 
         
    Conclusion : Increasing hearing impairment with increase in CSF loss was noted. Though irreversible hearing losses have been reported, in this series all hearing losses were reversible and were attributed to changes in the inner ear fluids.
          
    The author mentions that there is a direct communication between CSF and perilymph through cochlea aqueduct. This is not true as the duct is always closed. If it is open CSF-otorrhea will take place. Perhaps more important is the thin barrier between CSF and internal auditory canal and perilymph in the scala tympani at the basal turn.
          

  • Matteson EL, Tirzaman O, Facer GW, et al (Mayo Clinic and Found, Rochester, Minn) 
    Use of Methotrexate for Autoimmune Hearing Loss
    Ann Otol Rhinol Laryngol 109: 710-714, 2000
          
    The conventional treatment refractory 11 patients with autoimmune hearing loss underwent therapy with low dose oral methotrexate (MTX) (7.5 to 17.5 mg/wk). Improvement was considered an increase of 10 dB pure tone threshold or increase by 15% in speech discrimination. Hearing was improved in 9 patients, 1 worsened, and 1 no change was noted.
          
    It is worth considering this therapy in treatment of refractory cases of autoimmune induced hearing loss. 
          
    Autoimmune hearing loss requires a diagnosis, which is difficult to make. The results are not satisfactory as reported by the author but it can be continued to assess this modality in future.
           

  • Kiefer J, Weber A, Pfennigdorff T, et al (Johann-Wolfgang-Goethe- Universitat, Frankfurt am Main, Germany)
    Scala Vestibuli Insertion in Cochlear Implantation – A Valuable Alternative for Cases With Obstructed Scala Tympani 
    ORL J Otorhinolaryngol Relat Spec 62: 251-256, 2000
             
    In 4 cases this was done and the results assessed and were comparable to conventional scala tympani insertion.
           
    Though rare this alternate route can be used. It is wise to isolate scala vestibuli to the pars inferior, not the pars superior where vestibular symptoms and vertigo might be incited and might occur.
           

  • Sataloft RT, Zavod MB, Myers DL (Thomas Jefferson Univ, Philadelphia; Univ of Vermont, Burlington; Graduate Hospital, Philadelphia)
    Otogenic Cerebrospinal Fluid Rhinorrhea: A New Technique For Closure of Cerebrospinal Fluid Leak 
    Am J Otol 21: 240-243, 2000
           
    This report of closure of CSF leak by distal eustachian tube ligation in 5 ears who had undergone total temporal bone resection. It is effective, rapidly performed and minimally invasive. 
           
    It is an Interesting technique, though other techniques will be more useful to avoid flow of CSF in middle ear and making it vulnerable to infection and meningitis.
          

  • Casselbrant ML, Furman JM, Mandel EH, et al (Univ of Pittsburgh, Pa)
    Past History of Otitis Media and Balance in Four-Year-Old Children 
    Laryngoscope 110: 773-778, 2000
          
    Pneumatic otoscopy, tympanometry, audiometry, and vestibular and balance tests were performed on 71 children with a history of recurrent or persistent middle ear effusion (MEE), in this 40 children had MEE history.
         
    Conclusion : Children with MEE have significantly poorer vestibular or balance function than children without MEE. Early intervention may be necessary to treat MEE to avoid long-term vestibular impairments. 
          
    Round window being permeable, toxins, enzymes in MEE will cause either subtle or more clinically manifest dysfunction in the inner ear. This is worthy for the practitioner to know. 
           
    A small child with poor balance should undergo myringotomy and insertion of ventilation tube or other procedures as appropriate to remedy the same to avoid future impairment.
           

  • Conlon BJ, Smith DW, (Duke Univ, Durham, NC)
    Topical Aminoglycoside Ototoxicity: Attempting To Protect the Cochlea 
    Acta Otolaryngol (Stockh) 120: 596-599, 2000
           
    Animal experiments and clinical reports have shown cochlear damage after application of aminoglycoside antibiotics to round window membrane. Increased evidence that intracellular free radical generation is the mechanism which causes cochlear damage.
         
    To prevent this damage ability of a lipoic acid, a free radical scavenging agent has been found. The possible protective effect of a lipoic acid administered topically is evaluated in 16 guinea pigs.
         
    This interesting study may not have ultimate application in humans. The cochleotoxic effect can be counteracted by a lipoic acid a free radical scavenging agent in patients who are administered amino glycoside antibiotics systematically remains to be seen in humans.
          

  • Hone SW, Nedzelski J, Chen J (Univ of Toronto)
    Does Intratympanic Gentamicin Treatment for Meniere’s Disease Cause Complete Vestibular Ablation?
    J Otolaryngology 29: 83-87, 2000
          
    Intratympanic gentamicin (ITG) ablation and vestibular system used as treatment in intractable cases of Meniere’s. The vertigo control is reported from 83% to 100% and causes hearing loss in 15% to 50% of patients.
          
    Caloric testing to assess changes in vestibular system was done. The changes were prospectively correlated with the need for further treatment. 103 patients were studied before and after treatment. 
         
    It was concluded that patients who did not have ice cold caloric response were unlikely to need any further treatment. 
         
    Note of Warning : As the basal turn of cochlea occupies substantial portion of damaged cochlea, high frequency hearing loss may not be demonstrated until later in patients life.
         

  • Alzamil KS, Linthicum FH Jr (House Ear Inst, Los Angeles)
    Extraneous Round Window Membranes and Plugs: Possible Effect on Intratympanic Therapy
    Ann Otol Rhinol Laryngol 109: 30-32, 2000
            
    To assess the therapeutic effects of intratympanic perfusion of drugs through round window, the conditions of round windows of 202 sequential pairs of temporal bones from 117 patients were studied by postmortem studies. 
           
    The presence of fibrous or fatty plugs or extraneous round windows was determined. 
          
    Overall 33.2% prevalence was noted, 1.5% fatty plugs, 10.4% fibrous plugs and 21.3% extraneous round windows were noted.
           
    Conclusion was anatomical differences in round windows may explain variations in dosage of medication, was needed to produce desirable clinical effects. 
            
    This thus creates another problem when one tries to perfuse, e.g. ototoxic drugs through the round window and into the vestibular labyrinth.
          

  • Kawano H, Paparella MM, Ho SB, et al (Univ of Minnesota, Minneapolis)
    Identification of MUC5B Mucin Gene in Human Middle Ear With Chronic Otitis Media 
    Laryngoscope 110: 668-673, 2000
            
    Of the 9 or more mucin genes that have been identified MUC5B in major mucin expressed in rat and human middle ear and has not been well studied. It was identified and the correlation between infiltration cells in the submucosa and expression of the mucin gene was established.
          
    Specimens from inferior tympanic promontory were studied from 19 patients with chronic otitia media. 
         
    Conclusion- The MUC5B mucin gene and MUC5B mucin were extensively expressed and were significantly correlated with the degree of inflammatory cell infiltration in the submucosa of the middle ear cleft.
          
    The MUC5B mucin gene was identified in secretory cells. Such studies will lead to better understanding of the pathogenesis and ultimately the treatment and prevention of this common ear problem.
         

  • Moyse E, Lyon M, Cordier G, et al (Universite Claude Bernard, Villeurbanne, France; Hopital E Herriot, Lyon, France)
    Viral RNA in Middle Ear Mucosa and Exudates in Patients With Chronic Otitis Media With Effusion 
    Arch Otolaryngol Head Neck Surg 126: 1105-1110, 2000
         
    Chronic otitis media (OME) is believed to be the result of a blockage and infection of eustachian tube, which results in a persistent inflammatory process in the middle ear that may appear after either bacterial or viral acute otitis media. 
         
    Viruses are those which commonly affect rhinopharynx viz. adenoviruses, human respiratory syncytial virus and human parainfluenza viruses 1, 2, and 3. These are found at moderate to high frequencies in OME. 
          
    Mucosal biopsies, samples of fluid and exudates from 26 children with middle ears were subjected to reverse transcriptase – polymerase chain reaction analysis.
          
    RNA was extracted. The evidence of viruses in effusions, inflammatory excludates but not any of cells of biopsy samples.
          
    Conclusion : Viral contributes to OME. It is suggested that inflammatory cytokines are derived from cells of inflammatory exudates and not from cells of the middle ear mucosa.
          
    This study suggests a strong evidence of viral contribution involved in pathogenesis of OME. Genetic factors may predispose to eustachian tube dysfunction. Virus inflammatory process also may play a role as not suprising because middle ear cleft is part of respiratory system, which is commonly involved, in viral inflammation.
           

  • Ikui A, Sando I, Haginomori S-I, et al (Univ of Pittsburgh, Pa)
    Postnatal Development of the Tympanic Cavity: A Computer-Aided Reconstruction and Measurement Study 
    Acta Otolaryngol (Stockh) 120: 375-379, 2000
          
    Knowledge of the tympanic cavity is important in all surgical procedures on it. This study was conducted on 14 temporal bones, 6 of infant (£ 1 year old) and 8 adults (18-76).
          
    Results : The volumes of cavities between infants and adults differed considerably and increased in various regions with age. It was 1.5 times larger in adults. 
          
    This is an important contribution especially when cochlear implant is done in young children. M. M. Paparella also believes that there is hypoplasia of the middle ear and the mastoid air cell system that leads to otitis media in childhood or adulthood. 
          
    This study if applied to study of otitis media, will be of immense help.
          

  • Booth TN, Vezina LG, Karcher G, et al (Children’s Med Ctr of Dallas; Children’s Natl Med Ctr, Washington DC)
    Imaging and Clinical Evaluation of Isolated Atresia of the Oval Window 
    AJNR 21: 171-174, 2000
          
    Hearing loss in children is commonly congenital. CT is done in cases of unknown cause. The clinical and high-resolution CT (HRCT) findings in children with oral window atresia, not associated external auditory canal (EAC) anomalies are presented. Nine children were studied.
         
    HRCT revealed a well-defined bony plate in the oral window, between the middle ear cavity and the vestibule. There were associated anomalies of incus, stapes and the facial nerve.
         
    Such CT findings are useful in assessing anomalies in the middle ear of children with congenital hearing loss and useful while doing exploratory tympanotomy. 
         
    A word of caution – If stapes is fixed, central hole to mobilize stapes should be done. Stapedectomy can be hazardous as it may cause perilymph gusher.
          

  • Ohishi Y, Komiyama S, Shiba Y (Hiroshima Univ, Japan; Kyushu Univ, Fukuoka, Japan)
    Predominant Role of the Chorda Tympani Nerve in the Maintenance of the Taste Pores: The Influence of Gustatory Denervation in Ear Surgery 
    J Laryngol Otol 114: 576-580, 2000
         
    Disturbance in taste in patients following surgery of the middle ear resulting from denervation of the chorda tympani nerve. The effect and the actin filaments of taste pores was studied histologically.
         
    Chorda tympani nerve and a lingual nerve section were carried out in rats. The study of specimens was by scanning electron microscopy.
         
    Conclusion: Actin filaments were more quickly disrupted after chorda tympani section than after lingual nerve section. Thus it is clear that chorda tympani is required for taste pore maintenance and should be preserved.
         
    Though this demonstrates the importance of maintenance function of chorda tympani, in vast majority of cases have no difficulty, probably because the lingual nerve takes over to avoid permanent disability. No doubt there will be temporary aberration in taste following chorda tympani section.
           

  • Tekin M, Mutlu C, Paparella MM, et al (Univ of Minnesota, Minneapolis; Internatl Hearing Found, Minneapolis; Minnesota Ear, Head and Neck Clinic, Minneapolis)
    Tympanic Membrane and Middle Ear Pathologic Correlates in Mucoid Otitis Media 
    Otolaryngol Head Neck Surg123: 258-262, 2000
         
    A retrospective study of tympanic membrane and middle ear pathologies was done in 40 patients with mucoid otitis media and 56 control ears.
          
    Results: The thickness of tympanic membrane increased in all quadrants except at umbo.
         
    Conclusion: Changes in the tympanic membrane are likely to occur in patients with MOM. The changes should be taken as evidence of middle ear pathologic process.
         
    This underlying process may be silent or subclinical.
         

  • Horn KL (Presbyterian Ear Inst, Albuquerque, NM)
    Intracranial Extension of Acquired Aural Cholesteatoma 
    Laryngoscope 110: 761-772, 2000
          
    It is either congenital or acquired. Records of 6 patients and of 477 patients with cranial extension of aural petrosal cholesteatoma treated between 1985 to 1999 were reviewed. Patients were followed up with CT and MRI at 2 years interval.
         
    CT was done to demonstrate extension of the tumor and MRI was done to help differentiate petrous cholesteatoma from other petrous bone tumors.
          
    Intracranial acquired cholesteatoma most commonly spread through anterior epitympanic air cells or supratubal recess.
         

  • Tos M, frntoft S, Stangerup S-E (Gentofte Univ, Hellerup, Denmark)
    Results of Tympanoplasty in Children After 15 to 27 Years 
    Ann Otol Rhinol Laryngol 109: 17-23, 2000
          
    A total of 124 ears from 116 children from 2.5 years to 14 years, 26 ears from children age 2.5 to 7 years and 98 ears from children aged 8 to 14 years.
           
    Surgery was performed between 1968 and 1980. Perforations were anterior (22%), posterior (21%) and total (38%). All dry ears were operated by transcanal tympanoplasty and only temoralis fascia was used.
          
    Results- The perforation rate was 4% at 2 to 15 years and 6% at 16 to 27 years. Hearing was good and stable.
          
    M. M. Paparella agrees that results in children can be long-standing and comparable to long-term results in adults.
         

  • Ruhl CM, Pensak ML (Univ of Otolaryngology, Providence, RI; Univ of Cincinnati, Ohio)
    Role of Aerating Mastoidectomy in Noncholesteatomatous Chronic Otitis Media
    Laryngoscope 109: 1924-1927, 2000
          
    Objective was to improve tympanoplasty results in noncholesteatomatous otitis in revision cases by doing aerated mastoidectomy. In these cases previous tympanoplasty had failed.
          
    135 patients between 1986 to 1996 were revised with cortical mastoidectomy with regrafting of tympanic membrane. CT scanning was performed on all patients 90.4% success rate was achieved.
          
    It was concluded in otitis with poorly pneumatized mastoids with failure of surgery were benefited by doing mastoidectomy. Those who had normal looking mastoids did not benefit from revision surgery by doing cortical mastoidectomy.
          
    The other ways of aerating middle ear is to increase depth and width of middle ear. The mastoidectomy aeration may not be needed, when it is observed that those with normal hearing and tympanogram have poor mastoid areation.
          

  • Darrouzet V, Duclos J-Y, Portmann D, et al (Univ Hospital of Bordeaux, France; Clinique Saint-Augustin, Bordeaux, France)
    Preference for the Closed Technique in the Management of Cholesteatoma of the Middle Ear in Children: A Retrospective Study of 215 Consecutive Patients Treated Over 10 Years
    Ann J Otol 21: 474-481, 2000
           
    The controversy of closed vs. open technique in cases of cholesteatoma in children continues to be debated.
         
    A retrospective analysis of 215 cholesteatoma in 199 children with mean age of 9.6 year and follow-up of 70 months has been presented. Initial treatment was closed technique in 88%, while 10% had open technique. 
        
    Multiple surgical procedures were needed as follows: 
         
    61% 2, 3 in 21%, 4 in 4.5%.
         
    Results- The rate of residual lesions was 23.8% in open technique vs. 20.5% in closed. The rate of was recurrence was 19% vs. 8.9% in open vs. closed. 
         
    For most children closed treatment is preferable. The primary goal was to achieve socially acceptable hearing. The role of second stage surgery to improve results is emphasized.
          
    M. M. Paparella found it more useful to custom make procedure to adapt pathologic tissues and anatomical pathologic conditions found. It is useful to be as conservative as possible and therefore closed technique in children is used.
          
    By endaural approach the cholesteatoma can be followed to remove it up to the anatomical involvement and leave the rest as it is.
          

 

 

By |2022-07-20T16:43:53+00:00July 20, 2022|Uncategorized|Comments Off on Ear

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