Virtual endoscopy imaging of the middle ear cavity and ossicles.

Ten cadaver temporal bone blocks were studied with high-resolution computed tomography (HRCT) in order to produce topographic images, which are more informative than ordinary CT slices. Virtual endoscopic images were produced with separate, commercially available software, paying attention to the middle ear cavity and ossicles. Four major viewing locations for virtual endoscopy (the ear canal, hypotympanum, attic and eustachian tube) developed images acceptably. The malleus and incus were visualized properly. Small structures such as the lenticular process and the stapes sometimes failed to have good imaging. The eustachian tube and attic virtual views, which are usually not receptive to ordinary endoscopy, gave proper visualization of middle ear structures. Even the smallest structure, the stapes, can produce a virtual image.Virtual endoscopic images, or topographic images, of the middle ear and ossicles contribute to the understanding of the anatomy of the middle ear, thus enhancing the chances for successful surgery.

Comparison of CT and fiberoptic video-endoscopy findings in congenital dysplasia of the external and middle ear.

Twenty-six ears (of 25 patients) with congenital dysplasia of the external and middle ear were studied with two different types of imaging technologies in order to find out if it is possible to improve the anatomical overview of the dysplastic middle ears by combining the imaging methods. All the 26 ears were studied with computed tomography (CT), which gave cross-sectional images of the tympanic cavity. A fiberoptic video-endoscope (FVE) was introduced through the nose and via the Eustachian tube into the middle ear so that the topographic view of the anatomical structures of the middle ear could be visualized. Some structures were visualized better with FVE than with CT and vice versa. We concluded that the combined information obtained from these two imaging technologies provided a better understanding of the structural anatomy of a congenital dysplastic middle ear.

Endoscope-guided round window fistula repair.

OBJECTIVE: Endoscope-guided round window membrane repair was performed to evaluate whether the approach is feasible in the treatment of a round window fistula. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care academic center. PATIENT: A 27-year-old man had been scuba diving 6 days previously in the Australian Great Barrier Reefs. He had poor hearing with tinnitus in the left ear and a vertiginous sensation. INTERVENTION: A myringotomy was incised, and a tympanoscope was introduced into the middle ear cavity. With the patient under general anesthesia, the middle ear and the oval and round window areas were examined with a tympanoscope. In endoscopic visualization, a round perforation could be seen in the round window membrane. After detection of the round window perforation, a small piece of temporal fascia was obtained to seal the membrane perforation. RESULTS: One month after the operation, the patient's hearing was significantly better. The myringotomy had healed. CONCLUSION: A transmyringeal endoscopic procedure for round window fistula repair is feasible and combines the best features of minimally invasive surgery and aural endoscopy.

Tympanoscope-assisted myringoplasty.

Thirty ears of 29 patients with different sized perforation of the tympanic membrane were operated on with the aid of rigid otoendoscopes. The technique has a significant novel feature: endoscopy of the tympanic cavity through a perforation with small tympanoscopes 1.7 mm in diameter with a 0%. The postoperative air-bone gap was less than 10 dB in 90% of the ears. It was concluded that tympanoscope-assisted myringoplasty is a reliable and simple procedure with the benefit of minimal trauma in healthy tissue and that it is a feasible approach for day-case surgery with an ordinary success rate of tympanic membrane closure and hearing results.

Epidemiology and aetiology of middle ear cholesteatoma.

A total of 500 patients with cholesteatoma diagnosed and operated during 1982-91 in the region of Tampere University Hospital and Mikkeli Central Hospital in Finland were analysed retrospectively. The mean annual incidence was 9.2 per 100,000 inhabitants (range 3.7-13.9) and during the study period the annual incidence decreased significantly. The incidence was higher among males under the age of 50 years. There was no accumulation of cholesteatoma diseases in lower social groups. The majority (72.4%) of cholesteatoma patients had suffered from otitis media episodes. Tympanostomy was carried out in 10.2% and adenoidectomy or adenotonsillectomy in 15.9% of all cholesteatoma ears prior to cholesteatoma surgery. Cholesteatoma behind an intact tympanic membrane with no history of otitis media was verified in 0.6% of patients and in cleft palate patients in 8%. In this study, 13.2% of patients had ear trauma or ear operation in anamnes.

Visualization of the middle ear with high resolution computed tomography and superfine fiberoptic videomicroendoscopy.

Ten temporal bone blocks were dissected from fresh postmortem specimens from patients succumbing to diseases unrelated to the ears. A superfine fiberoptic videomicroendoscope (SFV) was introduced through the eustachian tube into the middle ear, and middle ear structures were visualized. The cadaver temporal bone blocks were also studied with high-resolution computed tomography (HRCT). When HRCT gave good results SFV did not succeed well and vice versa. However, SFV provided topographic anatomical information of the middle ear structures while HRCT gave cross-sectional images of the anatomy of the tympanic cavity. The different types of information obtained by the two imaging technologies supplement each other and were found to improve diagnosis in such cases as external ear canal atresia.

Tympanoscopy to increase the accuracy of diagnosis in conductive hearing loss.

The diagnosis of conductive hearing loss is usually based on audiological methods and radiology. The aim of our study was to show that there is a useful additive method to clarify the findings of diseases with conductive hearing loss. Patients (151 ears) with conductive hearing loss were examined using several methods: otomicroscopy, air- and bone-conduction threshold,pure tone average, speech threshold, speech discrimination, tympanometry and stapedial reflex and tympanoscopy. The management of the patients changed in 17 per cent of cases due to tympanoscopy. In a group with normal tympanic membrane the movement of the stapes during endoscopy was compared to stapedial reflex. Stiff stapes were found more often than an abnormal stapedial reflex. Middle ear endoscopy can increase the accuracy of diagnosis of conductive hearing loss thus enhancing decision making in the case of the patient.

Salivary antimicrobial proteins and mutans streptococci in tonsillectomized children.

Whole saliva from 53 children who had been tonsillectomized when they were younger than 4 years old was analyzed for selected antimicrobial proteins and oral mutans streptococci 3-4 years after the operation. The results were compared with those from age- and gender-matched control children with no history of tonsillectomy. The salivary analyses comprised both immune (total IgA, IgG and IgM) and selected nonimmune (lactoferrin, myeloperoxidase, salivary peroxidase) antimicrobial proteins. Specific IgA and IgG antibodies against viral antigens (adeno-, cytomegalo-, respiratory syncytial- and Epstein-Barr-viruses) and against Streptococcus mutans cells were quantitated in both groups. The tonsillectomized children had statistically significantly higher concentrations of all immunoglobulin isotypes (P 0.001) as well as of lactoferrin (P less than 0.005), and myeloperoxidase (P less than 0.001) in saliva. However, no differences were found in the numbers of cariogenic mutans streptococci or in the total oral aerobic flora. In line with the streptococcal counts, no differences existed in anti-S. mutans IgA or IgG titers between the groups. Most antibodies against viruses, especially of IgG isotype, were significantly (P less than 0.001) higher in saliva of tonsillectomized children than in that of the controls. The results suggest that, within a long run, the humoral immune status of human saliva is not weakened by tonsillectomy. Also, mainly serum-derived antimicrobial proteins (myeloperoxidase, lactoferrin, IgG) exist in high concentrations in whole saliva after tonsillectomy.

Indispensability of mediastinoscopy in intrathoracic tuberculosis.

An analysis of 33 patients with histologically confirmed intrathoracic tuberculous lymphadenopathy was made. Tuberculosis could have been diagnosed without mediastinoscopy only in 3 patients: 2 had positive bronchial cultures and 1 simultaneous cervical lymph node tuberculosis. Bacteriological confirmation is conclusive, but seldom possible. Mediastinoscopy provides the best method to obtain tissue samples, and consequently, it is still necessary in the diagnosis of intrathoracic tuberculous lymphadenitis.

Mediastinoscopy in relation to clinical evaluation.

The aim of the study was to evaluate the entire spectrum of mediastinoscopy, from common to rare conditions, in relation to clinical judgement. The 2021 consecutive patients comprised 992 with 'open' clinical diagnoses at mediastinoscopy and 1,029 with verified or presumptive diagnoses. In the first group the most common indications for mediastinoscopy were pulmonary infiltrate (73%) and mediastinal shadow (17%), and in the second group they were bronchogenic carcinoma (57%) and sarcoidosis (38%). Mediastinoscopy was classified as positive in 43% of the first, and 60% of the second group. Of the total series, 51% had positive mediastinoscopy findings, the most common being malignant disease (24%) and sarcoidosis (21%). Mediastinoscopy was useful especially for evaluating malignant mediastinal involvement, but also for differentiation of lymphadenopathies and in diagnosis of rare diseases.

Complications of mediastinoscopy.

From 1968 to 1987, mediastinoscopy was performed on 2021 consecutive patients. The procedure was carried out in 35.7 per cent on patients with a pulmonary infiltrate and in 28.8 per cent with bronchogenic carcinoma. Mediastinoscopy was positive in 54 per cent of the cases. The total number of complications was 2.3 per cent (47/2021). There were four cases with major haemorrhage, three tracheal ruptures and three wound infections. Recurrent nerve paralysis was verified in three patients and pericardial rupture in two patients. The total of major complications was 0.5 per cent (10/2021). There was no deaths in this series. In the authors' opinion, mediastinoscopy can be regarded as an effective and safe procedure in the hands of an experienced surgeon.

Repeat mediastinoscopy.

The author reports 18 cases with repeated mediastinoscopy. The surgical procedure was performed twice on 16 patients and three times on 2 patients. Mediastinal shadow was the indication in 6 patients and bronchogenic carcinoma in 3 patients. Average time lag between the procedures was 35 months. In 56% of the cases, repeated mediastinoscopy was regarded as positive. Strong peritracheal fibrosis disturbing the procedure was verified in 16 patients. No complications were observed.

Oesophageal carcinoma: endoscopic and clinical findings in 258 patients.

During the 10-year period 1971-1980, oesophagoscopy was carried out on a total of 3235 patients in the Department of Otolaryngology, Turku University Central Hospital, Finland. Oesophageal carcinoma was diagnosed in 258 patients, 113 (44 per cent) men and 145 (56 per cent) women. The diagnosis was verified in 228 cases (88.4 per cent) by using an optical rigid oesophagoscope and in 30 cases (11.6 per cent) by a fibreoptic endoscope. The most common and earliest symptom was difficulty in swallowing in 50 per cent of cases. In 44 per cent of patients the symptoms persisted over six months before diagnosis. Upper and middle thoracic portions of the oesophagus were the sites of origin of the carcinoma in 57 per cent of the patients. The macroscopic picture obtained by oesophagoscopy was regarded as malignant in 83 per cent of patients and extraoesophageal spread of the tumour was estimated to be present in 48 per cent of patients by the time of diagnosis. Histological studies showed the tumour to be squamous cell carcinoma in 62 per cent of patients and in 24 per cent well differentiated. Squamous cell carcinoma was seen more often in men than in women. In patients with carcinoma in situ, alcohol and tobacco were regarded as aetiological factors in 53 per cent of cases. The need for repeated oesophagoscopy in patients with symptoms related to swallowing is stressed.

Esophageal ulceration due to oral medications.

From 1975 through 1984 at the Department of Otolaryngology, Turku University Central Hospital, a total of 88 patients with esophageal ulceration due to oral medications were diagnosed endoscopically. The frequency of ulcerations increased until 1980 (14 cases) and was then followed by a decline. There were 24 patients (27.3%) under 20 years of age and 67 patients (76.1%) under 40 years of age, the mean age being 30 years 5 months. Emepronium bromide was the cause of esophageal injury in 24 patients (28.9%), doxycycline in 22 patients (26.5%) and analgetics in 11 patients (13.3%). There were three serious complications in the present series: an esophageal perforation due to doxycycline, an acute mediastinitis and a pericarditis due to emepronium bromide. In this material there was only 1 patient needing dilatation because of stricture formation.

Local IgA-class antibodies against respiratory viruses in middle ear and nasopharyngeal secretions of children with secretory otitis media.

The presence of antibodies against some important respiratory viruses in the middle ear and nasopharyngeal secretions of 52 children with secretory otitis media (SOM) was investigated in order to find out about the role of these viruses in the development of SOM. The method employed was a sensitive radioimmunoassay test. Antibodies to adeno, syncytial, and parainfluenza 3 viruses were detected in about 50%, 50% and 20% of the patients, respectively. In eight patients the middle ear secretion/nasopharyngeal secretion titer ratio of antibodies to one virus was selectively increased in comparison with the other viruses tested, indicating an active local production of specific antibodies in the middle ear. Further studies are required to determine the cause of such an active antibody synthesis and its possible role in the etiopathogenesis of SOM.

Innominate artery compression syndrome. Presentation of 16 cases.

A series of 16 patients with tracheal compression by the innominate artery is presented. In more than half of the patients the symptoms began during the first few days of life with stridor varying severity, recurrent tracheobronchitis and apneic spells. In six cases requiring surgical treatment the immediate result was good. In ten mild cases treatment consisted of medical management and follow-up. The present study confirms that the great arteries can exert compression on the trachea, which can always be relieved by means of an operation which moves the arteries forward. Bronchoscopy is considered to be the only reliable means of diagnosis. This entity should be considered more often in the differential diagnosis in children less than 3 years of age with stridor, breathing difficulties, recurrent infections, apneic spells, and asthma.