RESUMEN
AIMS: Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative conduction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guidelines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation. METHODS: This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients' demographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed. RESULTS: There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4-7] days vs. 2 [1-5] days; P<0.001). The incidence of myringosclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194-3.058; P=0.01). CONCLUSION: Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB.
Asunto(s)
Bloqueo Atrioventricular , Miringoesclerosis , Marcapaso Artificial , Humanos , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/terapia , Estudios Prospectivos , Miringoesclerosis/complicaciones , Factores de Riesgo , Resultado del Tratamiento , Marcapaso Artificial/efectos adversos , InflamaciónRESUMEN
OBJECTIVE: The main aim is to discuss the effect of nasal septal deviation on the postoperative hearing results of patients with tympanosclerosis. MATERIAL AND METHODS: We analyzed the hearing results of patients with tympanosclerosis who were operated on in a tertiary center. Pure tone audiometric results were compared according to the existence of nasal septal deviation. RESULTS: This study included 48 patients with unilateral tympanosclerosis disease. Moderate or severe septal deviation had no significant effect on postoperative hearing results. CONCLUSION: The nasal septal deviation as the only pathologic factor in patients with tympanosclerosis did not have a deteriorating effect after surgery.
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Audición , Mastoidectomía/efectos adversos , Miringoesclerosis/fisiopatología , Deformidades Adquiridas Nasales/fisiopatología , Timpanoplastia/efectos adversos , Adulto , Audiometría de Tonos Puros , Femenino , Pérdida Auditiva/epidemiología , Pérdida Auditiva/etiología , Humanos , Masculino , Miringoesclerosis/complicaciones , Miringoesclerosis/cirugía , Tabique Nasal/anomalías , Deformidades Adquiridas Nasales/complicaciones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
OBJECTIVE: Mesna is a thiol compound effective in the connective tissue, which is used for its chemical dissector, mucolytic, mucosal damage preventive and antioxidant effects. The aim of this study was to investigate Mesna's effects in easy dissection in type 4 tympanosclerosis cases and in the prevention of formation of new sclerotic plaques. METHODS: 11 patients were included in the study. All patients were in the Wielinga Kerr type 4 class of tympanosclerosis. All patients were administered a 100% concentration of Mesna in the middle ear during tympanosclerosis surgery. All patients underwent audiological evaluation before and 20 months after the operation. Air-conduction thresholds, bone-conduction thresholds and air-bone difference were statistically compared. RESULTS: The patients were followed-up for a mean 20.48 ± 2.37 months. The mean preoperative air-conduction threshold of the patients was 58.09 ± 9.73 dB and the mean postoperative air-conduction threshold was 34.63 ± 15.46 dB and there was a significant difference. The mean preoperative bone-conduction threshold of the patients was 16.27 ± 5.47 dB and the mean postoperative bone-conduction threshold was 14.72 ± 6.11 dB and there was a significant difference. The mean preoperative air-bone gap of the patients was 41.81 ± 10.51, and the mean postoperative air-bone gap was 19.90 ± 12.48, and the difference was statistically significant. CONCLUSION: Mesna prevented hearing loss related to type 4 tympanosclerosis and prevented the formation of new sclerotic structures in our follow-up period. We believe that this effect is due to the chemical dissector and antioxidant effects of Mesna.
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Mesna/administración & dosificación , Miringoesclerosis/cirugía , Adolescente , Adulto , Conducción Ósea , Femenino , Estudios de Seguimiento , Pérdida Auditiva/etiología , Pérdida Auditiva/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Miringoesclerosis/complicaciones , Miringoesclerosis/fisiopatología , Periodo Perioperatorio , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Conductive hearing loss (CHL) commonly results from middle ear fluid and inflammation (otitis media). Less commonly in patients with CHL, the middle ear cleft is well aerated or 'dry' with absence of soft tissue or fluid clinically and on imaging. There are numerous causes for this but they can be clinically challenging to diagnose. This pictorial review aims to illustrate and discuss the CT features of both common and less common causes of CHL in patients with a "dry middle ear cavity".
Asunto(s)
Oído Medio/diagnóstico por imagen , Pérdida Auditiva Conductiva/etiología , Adolescente , Adulto , Anciano , Osículos del Oído/anomalías , Osículos del Oído/diagnóstico por imagen , Osículos del Oído/lesiones , Femenino , Pérdida Auditiva Conductiva/diagnóstico por imagen , Humanos , Yunque/anomalías , Yunque/diagnóstico por imagen , Laberintitis/complicaciones , Laberintitis/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Miringoesclerosis/complicaciones , Miringoesclerosis/diagnóstico por imagen , Otosclerosis/complicaciones , Otosclerosis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Cirugía del Estribo/efectos adversos , Tomografía Computarizada por Rayos X , Membrana Timpánica/anomalíasRESUMEN
OBJECTIVE: We evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus. STUDY DESIGN: A prospective, randomized, controlled clinical study. SETTING: A university-affiliated teaching hospital. SUBJECTS AND METHODS: We prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only. RESULTS: We analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group. CONCLUSIONS: FGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.
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Factor 2 de Crecimiento de Fibroblastos/administración & dosificación , Esponja de Gelatina Absorbible , Miringoesclerosis/patología , Miringoesclerosis/terapia , Perforación de la Membrana Timpánica/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Martillo , Persona de Mediana Edad , Miringoesclerosis/complicaciones , Estudios Prospectivos , Regeneración , Resultado del Tratamiento , Perforación de la Membrana Timpánica/etiología , Perforación de la Membrana Timpánica/patología , Cicatrización de Heridas , Adulto JovenRESUMEN
OBJECTIVE: This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis. METHODS: A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air-bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air-bone gap were the main outcome measures. RESULTS: Mean post-operative air-bone gap was 5.25 dB. Four patients had an air-bone gap of less than 10 dB; the remaining patient had an air-bone of 12.50 dB. CONCLUSION: Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.
Asunto(s)
Pérdida Auditiva Conductiva/cirugía , Yunque/cirugía , Martillo/cirugía , Miringoesclerosis/cirugía , Prótesis Osicular , Reemplazo Osicular/métodos , Timpanoplastia/métodos , Adolescente , Adulto , Audiometría de Tonos Puros , Oído Medio/cirugía , Femenino , Audición/fisiología , Pérdida Auditiva Conductiva/diagnóstico , Pérdida Auditiva Conductiva/etiología , Humanos , Masculino , Miringoesclerosis/complicaciones , Miringoesclerosis/diagnóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
The objective was to assess audiological results after total ossicular reconstruction for stapes fixation. The study is a retrospective evaluation conducted in a tertiary referral centre. The patients were 16 adults with conductive or mixed hearing loss and stapes fixation due to tympanosclerosis or otosclerosis. A total or partial stapedectomy with perichondrium interposition on the oval window and ossicular reconstruction with titanium total prosthesis were done. To assess pre- and post-operative (1 and 4 years) air and bone-conduction thresholds (frequencies 0.5, 1, 2, 3 kHz), pure-tone average air and bone conduction, and air-bone gaps were measured and the number of decibels of closure of the air-bone gap at 1 year and at 4 years were compared. One year after surgery, air conduction thresholds and pure-tone average air conduction were improved for all frequencies, and there were no significant differences in bone conduction thresholds or in pure-tone average bone conduction. There were no differences in air and bone conduction thresholds, pure-tone average air or bone conduction between 1 and 4 years. The air-bone gap was significantly reduced 1 year after surgery and remained so at 4 years. (Preoperative air-bone gap, 34.04 dB; at 1 year, 16.40 dB; at 4 years, 17.3 dB. Decibels of closure of the air-bone gap at 1 year, 17.64 dB; at 4 years, 16.74 dB.) No differences were found between otosclerosis subjects and all other cases combined. Total ossicular reconstruction in stapes fixation due to tympanosclerosis or otosclerosis produces satisfactory short- and long-term auditory results.
Asunto(s)
Pérdida Auditiva/cirugía , Miringoesclerosis/cirugía , Prótesis Osicular , Reemplazo Osicular , Otosclerosis/cirugía , Cirugía del Estribo , Adulto , Conducción Ósea/fisiología , Femenino , Pérdida Auditiva/etiología , Humanos , Masculino , Persona de Mediana Edad , Miringoesclerosis/complicaciones , Otosclerosis/complicaciones , Estudios Retrospectivos , Titanio , Resultado del Tratamiento , Adulto JovenRESUMEN
SUMMARY: Tympanosclerosis is the middle ear tissue hyalinization and calcification caused by chronic middle ear inflammation, which mainly results in conductive deafness with unobvious clinical symptom. Etiology is unclear. The treatment is given priority to surgical treatment at present, while long-term effect reported mostly poor. This article analyzed etiology and treatment of the tympanic cavity sclerosis.
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Miringoesclerosis/etiología , Miringoesclerosis/terapia , Calcinosis , Enfermedad Crónica , Oído Medio , Pérdida Auditiva Conductiva/etiología , Humanos , Miringoesclerosis/complicaciones , Otitis Media , EsclerosisRESUMEN
The ear is a complex organ that can be affected by various pathologies that are still fairly misunderstood. This work tests the possibilities of studying the ear and its pathologies using a virtual environment and thus bypassing expensive and time-consuming clinical trial. A previous validated finite element model of the middle ear was employed to study two pathological states of the middle ear. It was shown that the model obtained results very close to the clinical evaluation thus proving of being a proper tool for further investigations of middle ear pathologies.
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Enfermedades del Oído/diagnóstico , Oído Medio/patología , Análisis de Elementos Finitos , Modelos Biológicos , Humanos , Miringoesclerosis/complicaciones , Miringoesclerosis/diagnóstico , Perforación de la Membrana Timpánica/complicaciones , Perforación de la Membrana Timpánica/diagnósticoRESUMEN
OBJECTIVE: The purposes of this study were to determine the factors involved in the spontaneous healing and to profile the various etiologies of traumatic tympanic membrane (TM) perforation. METHODS: A retrospective review was performed on 729 cases of traumatic TM perforation diagnosed in the emergency department and outpatient clinic from January 2007 to March 2011. RESULTS: A total 641 patients with traumatic TM perforations were enrolled in the study. The group consisted of 320 male and 321 female patients with a mean age of 33.6 years (3-79 years). The types of trauma included compression injury (554 patients), blast injury (55 patients), and instrumental injury (32 patients). The causes of conflict by a slap or a fist were spouse or lover (52%), parents and sibling (3%), school teachers (4%), schoolmate (12%), state police and prisoner (7%), and blow against the ear during street fight (22%). Of the 641, 137 were lost during follow-up; of the remaining 504, perforations closed spontaneously in 451 (89%), within a mean of 27.4 days. Wet perforations with bloody or watery discharge significantly improved the healing rate (P < .01) and shortened the average perforation closure time (P < .01), as compared with dry perforations. Although the perforation that involved malleus or umbo damage did not significantly affect the healing rate (P > .05), a significantly prolonged closure time (41.6 vs 23.8 days) was observed as compared with no damage. However, the curled edges did not also affect the outcome of spontaneous healing; the healing rate was 91% and 88% (P > .05), and the average closure time was 28.1 and 26.7 days (P > .05), respectively, for with and without curler edges. By perforation size, the overall healing rate was 92% and 54% (P < .01), and the average closure time was 22.8 and 47.3 days (P < .01), respectively, for small and larger perforations. Moreover, 7 patients had neomembrane formation on follow-up, 2 developed cholesteatoma, 1 developed tympanosclerosis, and 1 developed facial paralysis. CONCLUSION: In our experience, domestic violence and street fight were the most common causes of the traumatic TM perforation. Traumatic TM perforations have excellent prognosis. However, preexisting tympanosclerosis and the perforation that involved malleus or umbo damage could lengthen the healing time of perforation, Wet perforations with bloody or watery discharge accelerate the healing, but the curled edges did not affect the outcome of spontaneous healing.