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Ear Surgery (ear + surgery)
Kinds of Ear Surgery Selected AbstractsHearing Results After Primary Cartilage Tympanoplasty,THE LARYNGOSCOPE, Issue 12 2000Matthew J. Gerber MD Abstract Objectives/Hypothesis Cartilage,perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia. Study Design A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. Methods Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma. Pre- and postoperative speech reception thresholds and air,bone gaps at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared. Results Eleven patients comprised the cartilage study group, and there were 11 age- and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air,bone gap closures between the two groups. Conclusions These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage,perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing. [source] Taste deficits after middle ear surgery for otosclerosis: taste somatosensory interactionsEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 5 2008Marie-Violaine Berteretche The aim of this study was to evaluate the postoperative consequences of chorda tympani reclining during middle ear surgery for otosclerosis. Electrogustometric taste thresholds were measured at 11 loci on the tongue and the soft palate in 14 patients before surgery, and 8 d, 1 month and (in some cases) 6 months after surgery. A significant increase in thresholds was observed on the ipsilateral side of the tongue after surgery. The extent of the deficit and the recovery time course depended on tongue locus. The tip of the tongue displayed a limited deficit, suggesting bilateral chorda tympani innervation. The edge of the tongue was less impaired than the dorsal or the lateral tip loci; it may be dually innervated by both chorda tympani and glossopharyngeal nerves in humans, as already shown in rats. Likewise for the fungiform papillae located just anterior to the circumvallate papillae. Somatosensory early complaints suggest a derepression of chorda tympani on lingual nerve signals. In a second stage, relief of complaints before electrogustometric threshold recovery suggested trigeminal compensation of the chorda tympani deficit. Relief of complaints seems to involve central integrative processes, whereas the evolution of electrogustometric threshold represents the actual recovery time course of chorda tympani peripheral sensitivity. [source] Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2005G. M. Koksal Background:, This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response. Methods:, Sixty ASA I,II patients, scheduled for tympanoplasty, were randomly allocated to be anaesthetized with either sevoflurane or desflurane at maintenance inspiratory concentrations of 1,1.5 MAC of either agent. Blood samples were taken for plasma tumour necrosis factor , (TNF,), interleukin 1, and interleukin-6 assay before induction of anaesthesia, before surgery, and at the end of surgery. Alveolar cells were obtained after induction of anaesthesia and at the end of surgery. Results:, Plasma TNF, was greater with desflurane than sevoflurane both before surgery (45.1 ± 3.5 pg ml,1 for desflurane vs. 23.2 ± 2.5 pg ml,1 for sevoflurane, P < 0.01) and (62.0 ± 5.3 pg ml,1 vs. 35.5 ± 4.6 pg ml,1, P < 0.001). Interleukin 1, was similarly greater with desflurane than sevoflurane before (39.3 ± 4.0 pg ml,1 vs. 17.4 ± 3.0 pg ml,1; P < 0.01) and after surgery (46.0 ± 3.4 pg ml,1 vs. 23.3 ± 3.2 pg ml,1, P < 0.001). There were similar results for interleukin 6 before (42.3 ± 3.5 pg mls,1. 29.0 ± 2.6 pg ml,1, P < 0.001) and after surgery (86.0 ± 4.5 pg ml,1 vs. 45.9 ± 6.3 pg ml,1, P < 0.001). Alveolar cell TNF, concentrations after surgery were also greater with desflurane than sevoflurane (96.3 ± 12.4 pg ml,1 vs. 64.8 ± 10.1 pg ml,1, P < 0.001), as were interleukin 1, (75.4 ± 6.2 pg ml,1 vs. 32.0 ± 8.3 pg ml,1, P < 0.001) and interleukin 6 concentrations (540.1 ± 65.3 pg ml,1 vs. 363.6 ± 29.2 pg ml,1, P < 0.001). Conclusion:, Desflurane appears to cause a greater systemic and intrapulmonary pro-inflammatory response than sevoflurane during anaesthesia for ear surgery. [source] The Role of Extraesophageal Reflux in Otitis Media in Infants and Children,THE LARYNGOSCOPE, Issue S116 2008Robert C. O'Reilly MD Abstract Objectives/Hypothesis: Gastroesophageal reflux disease (GERD) is common in children, and extraesophageal reflux disease (EORD) has been implicated in the pathophysiology of otitis media (OM). We sought to 1) determine the incidence of pepsin/pepsinogen presence in the middle ear cleft of a large sample of pediatric patients undergoing myringotomy with tube placement for OM; 2) compare this with a control population of pediatric patients undergoing middle ear surgery (cochlear implantation) with no documented history of OM; 3) analyze potential risk factors for OM in children with EORD demonstrated by the presence of pepsin in the middle ear cleft; and 4) determine if pepsin positivity at the time of myringotomy with tube placement predisposes to posttympanostomy tube otorrhea. Study Design and Methods: Study Group: prospective samples of 509 pediatric patients (n = 893 ear samples) undergoing myringotomy with tube placement for recurrent acute OM and/or otitis media with effusion in a tertiary care pediatric hospital with longitudinal follow-up of posttympanostomy tube otorrhea. Control Group: prospective samples of 64 pediatric patients (n = 74 ears) with negative history of OM undergoing cochlear implantation at one of the three tertiary care pediatric hospitals. A previously validated, highly sensitive and specific modified enzymatic assay was used to detect the presence of pepsin in the middle ear aspirates of study and control patients. Risk factors for OM and potentially associated conditions, including GERD, allergy, and asthma were analyzed for the study group through review of the electronic medical record and correlated topresence of pepsin in the middle ear space. Study patients were followed longitudinally postoperatively to determine the incidence of posttympanostomy tube otorrhea. Results: The incidence of pepsin in the middle ear cleft of the study group was 20% of patients and 14% of ears, which is significantly higher than 1.4% of control patients and 1.5% of control ears (P < .05). Study patients younger than 1 year had a higher rate of purulent effusions and pepsin in the middle ear cleft (P < .05). Patients with pepsin in the middle ear cleft were more likely to have an effusion at the time of surgery than patients without pepsin in the middle ear cleft (P < .05). There was no statistical association found between the presence of pepsin and clinical history of GERD, allergy, asthma, or posttympanostomy tube otorrhea. Conclusions: Pepsin is detectable in the middle ear cleft of 20% of pediatric patients with OM undergoing tympanostomy tube placement, compared with 1.4% of controls; recovery of pepsin in the middle ear space of pediatric patients with OM is an independent risk factor for OM. Patients under 1 year of age have a higher incidence of purulent effusions and pepsin-positive effusions. Clinical history of GERD, allergy, and asthma do not seem to correlate with evidence of EORD reaching the middle ear cleft. The presence of pepsin in the middle ear space at the time of tube placement does not seem to predispose to posttympanostomy tube otorrhea. [source] Vestibular and Cochlear Ototoxicity of Topical Antiseptics Assessed by Evoked Potentials ,THE LARYNGOSCOPE, Issue 9 2000Ronen Perez MD Abstract Objectives/Hypothesis To evaluate and compare the effect of chlorhexidine gluconate, povidone-iodine, and alcohol,three antiseptics used before ear surgery,on the function of the vestibular and cochlear parts of the sand rat's inner ear. The assessment of damage is based on the recording of vestibular evoked potentials (VsEPs) and auditory brainstem response (ABR). Study Design Prospective controlled animal study. Methods Fat sand rats were randomly assigned to five different groups, each receiving topical application of a different agent: saline (control), gentamicin (ototoxic control), chlorhexidine, povidone-iodine, and alcohol. Right-side total labyrinthectomy was performed, and a polyethylene tube was inserted into the left (contralateral) middle ear. After baseline recordings were taken of VsEPs and ABR, each animal received five consecutive daily applications of the specific agent into the left middle ear. Three days after the fifth application, evoked potential recordings (VsEPs and ABRs) were repeated and compared with baseline measurements. Results Administration of saline affected neither VsEPs nor ABR. In contrast, as expected, neither of these responses could be recorded after gentamicin application. After application of chlorhexidine all waves disappeared in all sand rats. Alcohol caused the waves to disappear in some of the animals only. Povidone-iodine did not affect VsEP recordings and had only a small effect on ABR. Conclusions Chlorhexidine and alcohol had a clear toxic effect on the vestibular and cochlear function of the inner ear of the sand rat, whereas povidone-iodine did not. Thus, taking into consideration that this is an animal study, it appears that povidone-iodine might be preferable to the other agents tested in disinfecting ears with a perforated tympanic membrane. [source] Identification of MUC5B Mucin Gene in Human Middle Ear With Chronic Otitis Media,THE LARYNGOSCOPE, Issue 4 2000Hirokazu Kawano MD Objectives To identify the mucin gene and its expressing cells in the middle ear mucosa with chronic otitis media (COM), and to study the correlation between infiltration of inflammatory cells in the submucosa and expression of the mucin gene in the mucosal epithelium with COM. Study Design Middle ear mucosal specimens removed from the inferior promontory area of 19 patients undergoing middle ear surgery for COM were studied. Methods Sections were stained with H&E, Alcian blue-periodic acid Schiff (AB-PAS), polyclonal MUC5B antibody, and specific MUC5B riboprobe for histological, histochemical, immunohistochemical, and mucin mRNA analyses. Results H&E staining revealed pseudostratified epithelia in 18 of the middle ear specimens with COM and cuboidal secretory epithelia in one. AB-PAS staining of epithelia revealed abundant secretory cells and their products (glycoconjugates). In situ hybridization and immunohistochemistry studies demonstrated that the secretory cells of the middle ear mucosa with COM expressed MUC5B mucin mRNA and its product MUC5B mucin. Conclusions The MUC5B mucin gene and its product were identified in the middle ear secretory cells of patients with COM. Its e-pression was e-tensive in pseudostratified mucosal epithelia and related to infiltration of inflammatory cells in the submucosa of the middle ear cleft with COM, suggestive that inflammatory cell products are involved in the production of MUC5B. [source] Hearing thresholds in patients affected by rheumatoid arthritisCLINICAL OTOLARYNGOLOGY, Issue 1 2004F. Salvinelli Hearing thresholds in patients affected by rheumatoid arthritis The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air,bone (a,b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis. [source] Endaural or postaural incision for myringoplasty: does it make a difference to the patient?CLINICAL OTOLARYNGOLOGY, Issue 5 2003J.L. Inwood The aim of this study was to find out from patients who had undergone a myringoplasty via either an endaural or postaural approach whether or not they had experienced problems or symptoms relating to their scar, and if these differed depending on which incision had been used. A questionnaire was sent to 91 patients who had undergone myringoplasty between 18 and 62 months earlier. Thirty-four patients who had undergone previous or subsequent ear surgery were excluded. The only statistically significant difference found between groups having either a postauricular or endaural incision was in how likely others were to comment on their scar. There seem to be few long-term sequealae relating to the scar from myringoplasty. From a patient perspective, between 18 and 62 months postoperatively, there was very little difference in symptoms or problems whether or not an endaural or a postaural incision had been used for the surgery. [source] | ||||||||||