RESUMO
Objective: Our objective was to evaluate the surgical restrictions, audiologic benefits and satisfaction from using an active transcutaneous bone conduction device (BCD), Bonebridge® (BB) in patients with mixed/conductive hearing loss (MCHL) or single-sided deafness (SSD).Design: A retrospective review from all patients who underwent BB surgery at the Pusan National University Hospital from 2015 to 2017 for SSD or MCHL was performed.Study sample: Twenty-two patients with SSD and five with MCHL had a BB implanted and analysed.Results: Complete transmastoid implantation of the device was possible for all patients with an intact canal wall (ICW), using lifts if necessary. The overall functional hearing gain (FHG) in SSD and MCHL was 31.4 and 37.6 dB, respectively. The mean percentage of speech recognition in a quiet was 81% (vs. 11% unaided) for MCHL group and 82% (vs. 29% unaided) for SSD group. Mean speech recognition scores in noise improved significantly under various signal-to-noise ratio (SNR) for both groups. Questionnaires showed overall improvement, and there was no significant difference between the two groups.Conclusions: The BB provides improved functional gain, and there were no limitations during surgery despite the large device. Both MCHL and SSD group had benefit and improved quality of life with BB.
Assuntos
Condução Óssea , Auxiliares de Audição/estatística & dados numéricos , Perda Auditiva Condutiva/cirurgia , Implantação de Prótese/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos RetrospectivosRESUMO
OBJECTIVES: This study aimed to investigate the efficacy of simultaneous steroid and hyperbaric oxygen therapy (HBOT) in patients with severe to profound idiopathic sudden sensorineural hearing loss (ISSNHL), which has a poor prognosis. METHODS: Sixty patients diagnosed with severe to profound ISSNHL (≥70 dB HL) were randomly divided into two groups in a prospective controlled trial: an oral steroid + intratympanic steroid injection (ITSI) group (control group) and an oral steroid + ITSI + HBOT group (study group). Pure-tone audiometry (PTA) results and word discrimination scores (WDS) were compared between the two groups before treatment and 10 days and 1, 2, and 3 months after treatment. Hearing improvement was assessed using the modified American Academy of Otolaryngology-Head and Neck Surgery criteria. Analyses were by both intention to treat and per protocol. RESULTS: A total of 58 patients completed the 3-month follow-up, and 2 patients in the study group were excluded due to follow-up loss in the per-protocol analysis. In the intention-to-treat and per-protocol analyses, the study group showed significantly better hearing levels than did the control group at 500 Hz (p < 0.05) 1 month after treatment and at 1 kHz (p < 0.05) 3 months after treatment. However, the average PTA values and PTA at 2, 4, and 8 kHz showed no significant difference. WDS improvement was significantly higher in the study group compared to the control group 3 months after treatment by both per-protocol (66.4 ± 13.3 and 56.7 ± 19.1%, respectively; p = 0.029) and intention-to-treat analyses (65.9 ± 14.1 and 56.7 ± 19.1%, respectively; p = 0.035). The sum of complete and partial hearing recovery for the study group was significantly higher than that for the control group by per-protocol analysis (60.7 vs. 33.3%; p = 0.037) and intention-to-treat analysis (60.0 vs. 33.3%; p = 0.038). CONCLUSION: These results demonstrate that the addition of HBOT to steroid combination therapy does not improve the average PTA values in severe to profound ISSNHL; however, it was associated with a better outcome at 500 Hz 1 month after treatment and, at 1 kHz, WDS 3 months after treatment. The sum of complete and partial hearing recovery was significantly higher for the study group than for the control group.
Assuntos
Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Oxigenoterapia Hiperbárica/métodos , Administração Oral , Adulto , Idoso , Audiometria de Tons Puros , Protocolos Clínicos , Terapia Combinada , Feminino , Audição , Humanos , Injeção Intratimpânica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study is to estimate the entire population-based prevalence and incidence of Patulous Eustachian tube (PET) using the Korean National Health Insurance (NHI) claims database. The annual trends of prevalence and incidence of PET were also investigated. METHODS: Retrospective analysis of PET patients was performed between 2010 and 2016, from the NHI claims database. PET patients were defined as those who had at least one service claim with a primary diagnosis under an ICD-10-based PET code (H69.0). RESULTS: During the study period, there were 20,533 new PET patients in Korea. In 2016 there were 4482 incident cases, and the standardized annual incidence rate was 8.8 per 100,000 persons. The standardized annual prevalence rate increased significantly from 7.2 per 100,000 persons in 2010 to 10.3 per 100,000 persons in 2016. The prevalence increased significantly on annual basis, whereas the incidence rate fluctuated over time. Interestingly, the incidence and prevalence of PET in women was almost twice as high as that in men, and peaked in their 20s. CONCLUSIONS: This study demonstrated the substantial annual increase of the NHI claims with PET code (H69.0) in Korea from 2010 to 2016. Statistical results based on the NHI claims, we confirmed the high prevalence and incidence rates of clinically significant PET in women than in men. This study only covered patient using the medical service for PET and missed PET sufferers not seeking medical service. However, this study can provide basic epidemiological information on clinically significant PET.
Assuntos
Otopatias/epidemiologia , Tuba Auditiva , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: Despite the worldwide availability of endoscope in otology, it still has not replaced the microscopic surgery as it has for nose surgery. In 2008, we administered a questionnaire on the preference of using otoscopes in Korea. In light of the worldwide availability of endoscopic ear surgery, we have now conducted a more detailed survey to determine if this preference has changed over 8years. SUBJECTS AND METHODS: A questionnaire consisting of 10 questions was used to survey members of the Korean Otological Society who were actively performing middle ear surgery. The responses to this questionnaire were compared to those from 2008. The study also determined the preference for endoscope use based on the surgeon's experience. RESULTS: The mean surgical experience of the otologists was 12.7years. Endoscopy for tympanoplasty and tympanomastoidectomy increased over a period of 8years. In the outpatient clinic, the use of endoscopy also increased; over 8-year period, it surpassed the microscope as the most preferred diagnostic tool in the outpatient clinic. Greater than half of the operating rooms were equipped with endoscopic sets; however, only 4.5% of otologists acknowledged having endoscopic instruments. CONCLUSION: Endoscopy for surgery and in outpatient clinic assessment increased in otology in Korea; however, endoscopes have consistently been used as an adjuvant to the microscope to improve visualization of the tympanic cavity rather than as a tool for totally endoscopic ear surgery.
Assuntos
Endoscópios/tendências , Endoscopia/tendências , Otolaringologia , Procedimentos Cirúrgicos Otológicos/métodos , Sociedades Médicas , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , República da Coreia , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de TempoRESUMO
Patulous eustachian tube (PET) can have a significant negative impact on a patient's quality of life. Several methods of surgical management can be an option to treat PET, and our objective is to evaluate the safety and efficacy of autologous cartilage injection in patients with PET. Thirty-three ears of twenty-five patients with chronic PET refractory to conservative treatment were enrolled to this study. Autologous tragal cartilage was harvested, and chopped into fine pieces to allow its injection using a 1 cc Bruening syringe. Endoscopic cartilage injection was performed submucosally into the anterior (0.5 mL) and posterior aspects (0.5 mL) of the nasopharyngeal ET under local anesthesia in an operating room. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. The only complication that occurred was temporary otitis media with effusion in one ear. Inferior turbinate reduction was performed in three ears with accompanying nasal septal deviation or turbinate hypertrophy to allow better nasopharyngeal ET visualization. After autologous cartilage injection, the successful treatment rate, as determined by subjective autophony symptoms, was 69.7% (23/33). The average follow-up period was 25.2 months. Autologous cartilage injection is a minimally invasive technique that has been used by the authors to successfully treat patulous eustachian tube. The described procedure was found to provide a good overall success rate without long-term complications.
Assuntos
Cartilagem/transplante , Endoscopia/métodos , Audição/fisiologia , Otite Média com Derrame/cirurgia , Tuba Auditiva , Feminino , Seguimentos , Humanos , Injeções , Masculino , Otite Média com Derrame/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Resultado do TratamentoRESUMO
Steroids are currently the most frequently accepted agents for idiopathic sudden sensorineural hearing loss (ISSNHL). However, the therapeutic effect of steroids is not always satisfactory. In this pilot study, we evaluated whether systemic treatment with Ginkgo biloba extract (EGb761) has an additive therapeutic effect in patients receiving a systemic steroid due to ISSNHL. A multicenter, randomized, double-blind clinical trial was performed. Fifty-six patients with ISSNHL were allocated to either EGb761 or placebo. In both groups, methylprednisolone was administered for 14 days. EGb761 was infused intravenously for 5 days in the EGb761 group, while the same amount of normal saline was infused in the placebo group. For the efficacy evaluation, pure-tone audiometry, speech audiometry, tinnitus handicap inventory (THI) and short form-36 health (SF-36) survey outcomes were obtained before administration and on days 3, 5, 14 and 28 of administration. Twenty-four patients in each group completed the study protocol. There was no difference in hearing loss between the two groups before treatment. At day 28, air conduction threshold values in the placebo and EGb761 groups were 34.63 ± 28.90 and 23.84 ± 25.42 dB, respectively (p = 0.082). Speech discrimination scores in the placebo and EGb761 groups were 69.17 ± 40.89 and 87.48 ± 28.65 %, respectively (p = 0.050). THI and SF-36 scores in the placebo and EGb761 groups were similar. Although a combination of steroid and EGb761 for initial treatment did not show better pure tone threshold, compared with steroid alone, speech discrimination was significantly improved in combination therapy. Further studies will be needed to know if addition of EGb761 actually improves the outcome of ISSNHL treatment.
Assuntos
Dexametasona/administração & dosagem , Ginkgo biloba , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Metilprednisolona/administração & dosagem , Extratos Vegetais/administração & dosagem , Administração Intravenosa , Adulto , Idoso , Audiometria/métodos , Fármacos Cardiovasculares/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Glucocorticoides/administração & dosagem , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Percepção da Fala/efeitos dos fármacos , Zumbido/tratamento farmacológico , Zumbido/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the safety and therapeutic efficacy of trans-tympanic catheter insertion (TCI) in patients with refractory patulous eustachian tube (PET). METHODS: TCI was attempted in thirty-six ears of twenty-nine patients with chronic PET refractory to conservative treatment. The catheter was inserted under local anesthesia in an operating room through the bony orifice of the eustachian tube (ET) to occlude the isthmus of the tube via a myringotomy site on the tympanic membrane. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. Patients had no concurrent disease and did not undergo any additional surgical procedure. RESULTS: TCI was performed in all except one ear, in which it failed because of an abnormally narrow tympanic ET orifice. Follow-up durations ranged from 6 to 37 months, with an average of 19.3 months. Successful treatment of subjective autophony was achieved in twenty-nine (82.4%) of the thirty-five ears. Ventilation tube (VT) placement was performed in the two ears because of otitis media with effusion (OME) after TCI. In one ear, the inserted catheter was finally removed due to additional unilateral mastoiditis after VT extrusion. CONCLUSION: TCI seems to be a minimally invasive and was used successfully to treat PET. The procedure had a good overall success rate and complications were rare in the long-term.
Assuntos
Cateterismo/métodos , Cateteres de Demora , Tuba Auditiva/cirurgia , Transtornos da Audição/cirurgia , Anestesia Local , Doença Crônica , Endoscopia , Tuba Auditiva/fisiopatologia , Feminino , Seguimentos , Transtornos da Audição/fisiopatologia , Humanos , Masculino , Estudos RetrospectivosRESUMO
Cochlear implants (CI) have now become a standard method of treating severe to profound hearing loss. Recently, the number of patients with CI has been rapidly increasing as the big benefits of CI become more widely known. Magnetic resonance imaging (MRI) has also become a routine diagnostic imaging modality, used in the diagnosis of common conditions, including stroke, back pain, and headache. We report our recent experience with a case in which internal magnet of the cochlear implant was reversed after 1.5-T lumbar spine MRI. This complication is managed successfully by reversing the orientation of the external magnet in the head coil.
Assuntos
Implantes Cocleares , Surdez/reabilitação , Imageamento por Ressonância Magnética/efeitos adversos , Imãs , Idoso , Surdez/diagnóstico , Feminino , Humanos , Falha de PróteseRESUMO
The function of the E-tube is to adjust the balance of both sides of the ear drum. The patulous Eustachian tube (PET) is a rare disease and a benign condition. So, most of the doctors ignored this disease. But, patients with PET suffer from ear fullness, autophony, hearing their own breathing, and etc. Many treatment methods have been introduced and injection is also one way of treating the disease. We introduce an injection technique for the treatment of PET using calcium hydroxylapatitie (Radiesse®).
Assuntos
Durapatita/administração & dosagem , Otopatias/tratamento farmacológico , Tuba Auditiva/patologia , Adulto , Humanos , Injeções/métodos , MasculinoRESUMO
Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries as well as draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. Potential mortality and morbidity associated with therapeutic procedures must be considered with these patients. Improper treatment often aggravates the condition, potentially rendering therapy more complex. A multidisciplinary approach, including an endovascular approach, surgical excision, and flap reconstruction, is considered to completely eradicate an AVM. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.
Assuntos
Malformações Arteriovenosas/cirurgia , Meato Acústico Externo/patologia , Otopatias/cirurgia , Hemorragia/cirurgia , Glândula Parótida/irrigação sanguínea , Equipe de Assistência ao Paciente , Adulto , Malformações Arteriovenosas/terapia , Transfusão de Sangue Autóloga/métodos , Artéria Carótida Externa/anormalidades , Otopatias/terapia , Embolização Terapêutica/métodos , Feminino , Seguimentos , Retalhos de Tecido Biológico/transplante , Hemorragia/terapia , Humanos , Veias Jugulares/anormalidades , Veias Jugulares/cirurgia , Artérias Meníngeas/cirurgia , Retalho Miocutâneo/transplante , Planejamento de Assistência ao Paciente , Procedimentos de Cirurgia Plástica/métodos , Artérias Temporais/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
Lightning strike can produce an array of clinical symptoms and injuries. It may damage multiple organs and cause auditory injuries ranging from transient hearing loss and vertigo to complete disruption of the auditory system. Tympanic-membrane rupture is relatively common in patients with lightning injury. The exact pathogenetic mechanisms of auditory lesions in lightning survivors have not been fully elucidated. We report the case of a 45-year-old woman with bilateral profound sensorineural hearing loss caused by a lightning strike, who was successfully rehabilitated after a cochlear implantation.
Assuntos
Implante Coclear , Perda Auditiva Neurossensorial/cirurgia , Lesões Provocadas por Raio/complicações , Raio , Audiometria de Tons Puros , Feminino , Audição , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Lesões Provocadas por Raio/diagnóstico , Lesões Provocadas por Raio/cirurgia , Pessoa de Meia-IdadeRESUMO
The eustachian tube (ET) is normally closed, but it opens temporarily during swallowing. Patients with a patulous ET (PET) have various aural symptoms such as aural fullness, autophony, and hearing their own breathing. These symptoms are caused by abnormal transmission of sound from the pharynx to the middle ear via an open ET with little attenuation. We introduce a novel injection technique for the treatment of PET using autologous cartilage. This procedure is minimally invasive and has been successfully used to treat PET in 2 patients.
Assuntos
Cartilagem/transplante , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Otopatias/diagnóstico , Seguimentos , Humanos , Injeções , Masculino , Pessoa de Meia-IdadeRESUMO
Petrous apicitis has traditionally been treated with aggressive surgical methods. However, recent reports describe good results with more conservative medical treatment and minimal surgical intervention. We report a case of petrous apicitis presenting as the Gradenigo syndrome treated by ventilation tube insertion. We recommend aggressive surgical intervention for patients who failed to respond to conservative therapy including ventilation tube insertion.
Assuntos
Ventilação da Orelha Média/métodos , Otite Média/complicações , Petrosite/etiologia , Osso Petroso/cirurgia , Doença Aguda , Criança , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Otite Média/diagnóstico , Petrosite/diagnóstico , Petrosite/cirurgia , Osso Petroso/patologiaRESUMO
Cochlear implants are used worldwide for the treatment of severe to profound bilateral sensorineural hearing loss in both adults and children. A number of implantees are likely to be treated with radiosurgery later in life, but very little is known about the effects of radiosurgery on cochlear implants. We report a cochlear-implanted patient who underwent radiosurgery due to a recurrent meningioma. After radiosurgery, the impedance of the implant maintained a normal range, and auditory performance tests were unchanged as compared to before radiosurgery. This is the first report addressing the effects of radiosurgery in a patient with a cochlear implant.
Assuntos
Implantes Cocleares , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Radiocirurgia/efeitos adversos , Feminino , Perda Auditiva Neurossensorial/cirurgia , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: This study aimed to investigate whether optical coherence tomography (OCT) provides useful information about the microstructures of the middle and inner ear via extratympanic approach and thereby could be utilized as an alternative diagnostic technology in ear imaging. METHODS: Five rats and mice were included, and the swept-source OCT system was applied to confirm the extent of visibility of the middle and inner ear and measure the length or thickness of the microstructures in the ear. The cochlea was subsequently dissected following OCT and histologically evaluated to compare with the OCT images. RESULTS: The middle ear microstructures such as ossicles, stapedial artery and oval window through the tympanic membrane with the OCT could be confirmed in both rats and mice. It was also possible to obtain the inner ear images such as each compartment of the cochlea in the mice, but the bone covering bulla needed to be removed to visualize the inner ear structures in the rats which had thicker bulla. The bony thickness covering the cochlea could be measured, which showed no significant differences between OCT and histologic image at all turns of cochlea. CONCLUSION: OCT has been shown a promising technology to assess real-time middle and inner ear microstructures noninvasively with a high-resolution in the animal model. Therefore, OCT could be utilized to provide additional diagnostic information about the diseases of the middle and inner ear.
RESUMO
PURPOSE: The aim of the study was to investigate the effect of cigarette smoke on the auditory tube and middle ear mucosa after long-term exposure (4 and 6 months). MATERIALS AND METHODS: Fifteen rats were divided into 3 groups. The experimental groups were exposed to cigarette in a smoking chamber for 4 and 6 months (n = 5 each). A control group (n = 5) was placed in the same chamber without exposure to cigarette smoke. Histologic changes of the auditory tube mucosa were observed through light and electron microscopes. Histologic changes of the middle ear mucosa were also observed through light microscopes. RESULTS: The histologic changes consisted of a proliferation of goblet cells and an increase of mucus secretion in auditory tube. Squamous metaplasia was paradoxically decreased according to the duration of exposure in auditory tube. The number of goblet cell was gradually increased according to the duration of exposure in the auditory tube and middle ear. CONCLUSIONS: Long-term passive smoke directly affects the auditory tube and middle ear mucosa. Histologic changes of auditory tube mucosa consisted of goblet cell proliferation and excessive mucus secretion.
Assuntos
Tuba Auditiva/patologia , Células Caliciformes/fisiologia , Muco/metabolismo , Poluição por Fumaça de Tabaco/efeitos adversos , Animais , Proliferação de Células , Exposição Ambiental/efeitos adversos , Tuba Auditiva/ultraestrutura , Células Caliciformes/metabolismo , Células Caliciformes/patologia , Células Caliciformes/ultraestrutura , Masculino , Metaplasia , Mucosa/metabolismo , Mucosa/patologia , Mucosa/ultraestrutura , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de TempoRESUMO
OBJECTIVES: This study aimed to evaluate the safety and efficacy of transvenous stent-assisted coil embolization for dehiscent high jugular bulb (HJB) with tinnitus and contralateral hypoplastic venous sinus. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. METHODS: From September 2008 to October 2018, a series of patients with dehiscent HJB presenting with intractable pulsatile tinnitus abated only by ipsilateral jugular vein compression were included. Patients underwent transvenous stent-assisted coil embolization for selective obstruction to the dome of the HJB due to hypoplastic contralateral transverse or sigmoid venous sinus. Technical safety and clinical efficacy were retrospectively analyzed. Clinical outcome measurements included pure-tone audiogram, tinnitus character, and tinnitus handicap inventory and evaluated based on the change during the first 6 months after the procedure. RESULTS: Subjects included five patients with dehiscent HJB and troublesome pulsatile tinnitus who refused surgery (nâ=â4), or who experienced recurrence after surgical covering and reinforcement using autologous cartilage (nâ=â1). The mean age of the five patients (only female) was 45 years. Transvenous stent-assisted coil embolization was technically successful in all patients with symptomatic dehiscent HJB, with no procedure-related complications. Temporary postprocedural headache was observed in two patients, but resolved within 3 days. Symptoms were completely resolved in all cases. There was no recurrence or aggravation of tinnitus during follow-up period. CONCLUSIONS: Transvenous stent-assisted coil embolization for dehiscent HJB with tinnitus and contralateral hypoplastic transverse or sigmoid venous sinus could be a technically safe and clinically effective treatment strategy while preserving cranial venous drainage.
Assuntos
Cavidades Cranianas/patologia , Embolização Terapêutica/métodos , Veias Jugulares/anormalidades , Veias Jugulares/cirurgia , Zumbido/etiologia , Adulto , Prótese Vascular , Embolização Terapêutica/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Zumbido/terapia , Resultado do Tratamento , Adulto JovemRESUMO
Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
RESUMO
OBJECTIVE: Intracordal injection for vocal fold augmentation is easy and simple and does not require a cervical skin incision. We reported previously on the 1-year results of injected autologous auricular cartilage for volumetric augmentation in paralyzed canine vocal cord. This study evaluates the long-term histomorphologic results of injected autologous auricular cartilage for the augmentation of the paralyzed canine vocal fold at 2 and 3 years. STUDY DESIGN AND SETTING: A prospective trial of autologous cartilage augmentation of vocal cord in animal model. Five dogs were operated on. A piece of auricular cartilage was harvested from the ear and minced into tiny chips with a scalpel. Fat was harvested from inguinal area and minced with a scalpel. The minced cartilage and fat-paste (0.2 ml) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle using direct laryngoscopy. Three animals were sacrificed at 2 years, two at 3 years. Each subject underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior vocal fold were made. RESULTS: There was no significant complications perioperatively or postoperatively. The injected cartilage that seemed to have lost viability existed in the vocalis muscles until 36 months. Fibrotic change was exhibited in the surrounding injected cartilage. There were no differences between 2 and 3 years in histomorphologic results of the injected cartilage. CONCLUSION: The autologous auricular cartilage graft is well tolerated and may be a very effective material for long-term volumetric augmentation in the paralyzed vocal cord. EBM RATING: C-4.
Assuntos
Cartilagem da Orelha/transplante , Paralisia das Pregas Vocais/patologia , Animais , Modelos Animais de Doenças , Cães , Seguimentos , Injeções , Estudos Prospectivos , Fatores de Tempo , Transplante Autólogo/métodos , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgia , Prega VocalRESUMO
OBJECTIVE AND BACKGROUND: It is generally accepted that cigarette smoke is a major risk factor for middle ear disease. However, the literature is void of articles addressing the direct relationship between cigarette smoke exposure and middle ear disease. Furthermore, there are many conflicting opinions concerning the role of cigarette smoke in the pathogenesis of middle ear disease. The purpose of this study was to evaluate the effects of cigarette smoke on the Eustachian tube mucosa. MATERIALS AND METHODS: Thirty healthy 150 to 230 g Sprague Dawley rats with normal middle ears were used. The animals were divided into six groups of five. Five experimental groups (N=5 each) were exposed to a domestic cigarette (This, tar 7.0 mg, nicotine 0.75 mg) every 30 minutes (total 2.5 hours, 5 cigarettes total) on a daily basis in a smoking chamber for 1, 2, 4, 6, or 8 weeks. A control group (N=5) was placed in the same chamber without exposure to cigarette smoke. After exposure, the animals were sacrificed and cross sections of the Eustachian tubes were prepared. Histologic changes of the Eustachian tube mucosa were observed through light and electron microscopes. RESULTS: Loss of cilia, goblet cell depletion, and squamous metaplasia of the Eustachian tube mucosa were observed following exposure to smoke. The one- and two-week exposure groups demonstrated the greatest decrease in goblet cell counts. The eight-week exposure group showed recovery from this decrease. Squamous metaplasia was observed in all experimental groups and was most prominent in the eight-week exposure group. CONCLUSION: These findings suggest that cigarette smoke directly affects Eustachian tube mucosa in the early stages of exposure. Some of the mucosal changes, however, were reversed during the latter stages of exposure. A mechanism different from that which occurs in the nasal cavity and trachea may be activated in the Eustachian tube after exposure to passive smoke. The protective function of the Eustachian tube may play some role in this mechanism.