Tensor veli palatini electromyography for monitoring Eustachian tube rehabilitation in otitis media.

BACKGROUND: The pathogenesis of otitis media is related to Eustachian tube dysfunction. The tensor veli palatini muscle actively opens the Eustachian tube and promotes middle-ear ventilation. This study describes a technique for paratubal electromyography that uses a surface, non-invasive electrode able to record tensor veli palatini muscle activity during swallowing. METHODS: Twenty otitis media patients and 10 healthy patients underwent tensor veli palatini electromyography. Activity of this muscle before and after Eustachian tube rehabilitation was also assessed. RESULTS: In 78.5 per cent of patients, the electromyography duration phase and/or amplitude were reduced in the affected side. The muscle action potential was impaired in all patients who underwent Eustachian tube rehabilitation. CONCLUSION: This study confirmed that Eustachian tube muscle dysfunction has a role in otitis media pathogenesis and showed that muscle activity increases after Eustachian tube rehabilitation therapy.

[On the necessity of standardization of objective methods for the study of hearing function in children presenting with acute inflammatory diseases of the middle ear at the level of outpatient treatment].

The objective of the present study was to standardize the frequency of objective evaluation of the hearing function in the children presenting with acute inflammatory diseases of the middle ear at the level of the outpatient treatment. The studies carried out to this effect with the use of modern and readily available audiological method revealed functional disorders in the middle ear of more than 50% of the children suffering from acute non-perforative otitis even after the elimination of the clinical signs of inflammation. The complete restoration of the functional state of the middle ear was documented in all the patients following the rehabilitative treatment. The authors proposed the algorithm for the examination of the children presenting with acute inflammatory diseases of the middle ear with special reference to the optimal frequency of diagnostic studies.

Clip vibroplasty: experimental evaluation and first clinical results.

OBJECTIVE: To describe an active auditory rehabilitation method (clip vibroplasty) for conductive or mixed hearing loss in cases of a preserved stapes superstructure. PATIENTS: After temporal bone experiments, the new clip vibroplasty was clinically used in 4 patients with chronic otitis media. INTERVENTIONS: A new titanium double clip device (clip vibroplasty) was developed for a standardized and effective coupling of the floating mass transducer of the Vibrant Soundbridge to the intact stapes. Temporal bone experiments using laser Doppler vibrometry were performed to evaluate the device's acoustic efficiency. The audiologic outcomes of the first 4 patients were analyzed. The subjective benefits and satisfaction were assessed using the standardized International Outcome Inventory for Hearing Aids in all patients. MAIN OUTCOME MEASURES: Transfer characteristics of laser Doppler vibrometry experiments; audiologic outcomes of the 4 patients. RESULTS: In the temporal bone experiment, coupling of the FMT using the titanium double clip support produced transfer characteristics across all tested frequencies comparable to our former total ossicular reconstruction prosthesis or an optimal round window application. The intraoperative application of the clip vibroplasty was uneventful in all cases. No signs of prosthesis dislocation were noted within the follow-up period of approximately 12 months. The audiologic outcome of the first patients showed good hearing gain in pure-tone and speech audiometry, with results that are unobtainable using a conventional air conduction hearing aid. CONCLUSION: The concept of a partial ossicular reconstruction prosthesis vibroplasty using a titanium clip support entails a straightforward procedure similar to a classic partial ossicular reconstruction prosthesis tympanoplasty. The unoccluded ear canal and the superior auditory performance offer an advantageous application of this "power clip" in cases of chronic middle ear dysfunction.

[First experience with the application of the implantable prostheses of osseous conduction BAHA].

The first experience with the application of the implantable prostheses of osseous conduction (BAHA) is described. The results of the present study suggest high efficacy of the method in question for the rehabilitative treatment of children with bilateral chronic otitis and/or congenital malformations of the ear.

Results, hearing rehabilitation, and follow-up with magnetic resonance imaging after tympanomastoid exenteration, obliteration, and external canal overclosure for severe chronic otitis media.

OBJECTIVES: We sought to evaluate the results, auditory rehabilitation, and follow-up with magnetic resonance imaging (MRI) after tympanomastoid exenteration with obliteration of the mastoid cavity and overclosure of the external ear canal in patients with severe chronic otitis media that was resistant to medical therapy and conventional surgery and was associated with a profound sensorineural or severe conductive hearing loss. METHODS: Twenty-nine patients were analyzed and underwent this surgical technique. Twelve patients had, during the same or later stage, either cochlear implantation, fixture implantation for a bone-anchored hearing aid, or middle ear implantation. For follow-up control of the obliterated cavity, delayed gadolinium-enhanced, T1-weighted MRI in combination with non-echo planar imaging diffusion weighted sequences were used. RESULTS: No patient had recurrent otorrhea after an average follow-up period of 4.75 years. One patient had a residual cholesteatoma as shown by new MRI techniques, and this was successfully resected. One patient developed complications 6 months after 1-stage tympanomastoid exenteration and cochlear implantation. CONCLUSIONS: This technique is very useful in selected patients with severe chronic otitis media that is resistant to medical therapy and surgery and is associated with a profound sensorineural or severe conductive hearing loss. New sequences in MRI are used for postoperative follow-up of these obliterated cavities and seem reliable for the detection of residual or recurrent cholesteatoma. Middle ear implantation and cochlear implantation can be relatively safely performed in these patients in a second stage.

Craniofacial titanium implants and chronic pain: histologic findings.

OBJECTIVE: To determine whether histologic features or histomorphometric outcomes of retrieved craniofacial percutaneous titanium implants could be found that could be related to chronic pain at the implant site in the temporal bone. STUDY DESIGN: Histologic investigation and histomorphometric measurements of seven retrieved titanium implants with surrounding bone tissue. SETTING: Tertiairy referral center. PATIENTS AND METHODS: Four patients who had previously received percutaneous titanium implants for auricular prostheses (1 patient) and a bone anchored hearing aid (three patients) had chronic pain at the implant site despite conservative treatment. The implants were retrieved, sectioned, and ground for qualitative light microscopic inspection and quantitative measurement of the bone-to-metal contact and bone area. RESULTS: Qualitative inspection of the sections of the implants demonstrated soft tissue zones at the interface, especially under the flange. Inflammatory cells were seen in the interface in all seven implants. In the implants with good bone-to-metal contact, the percentage of bone-to-metal contact rose with time. In the two implants with poor bone-to-metal contact, the soft tissue zones were more extensive, and slightly more skin reactions were observed than in the other implants while still in situ. CONCLUSION: A clear explanation for the chronic pain is not at hand. The only common histologic findings were the inflammatory cells present in the interface, but with varying density, and the presence of soft tissue zones. A variety of bone-to-metal was found among the retrieved implants.

[Bone-anchored hearing aids BAHA: 10 years' experience]. / La prothèse auditive à ancrage osseux BAHA: 10 ans d'expérience.

Bone anchored hearing aid (BAHA), based on the concept of osseointegration, offers the possibility of restoring hearing in case of conduction or mixed deafness. We report our experience with 87 in 74 patients implanted from 1989 to 1999. The patients were divided into two major groups, with bilateral agenesia (22 cases) or chronic otitis media (52 cases). Anatomical results are very good. We got 3 extrusions with no osseointegration, 10% local infections and 3 traumas. Functional outcome was excellent, with 73 patients being fitted with 81 HC200, HC300 or HC360 prostheses. One patient had a functional failure. We stress the importance of rigorous audiometric criteria and the determinant factors of osseointegration, essentially the surgical technique. In patients with chronic otitis, BAHA offers a functional solution for those with no benefit from an air conduction hearing aid and who are not operable or decline a new operation for tympano-ossicular reconstruction. For cases of ear malformation, BAHA can be a temporary solution that does not damage the inner ear. Indeed, rehabilitation with a BAHA does not exclude the possibility of functional tympano-ossicular surgery when the child is older and if the anatomic conditions are favorable.

Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory.

OBJECTIVE/HYPOTHESIS: The bone-anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life. STUDY DESIGN: Retrospective questionnaire study. METHODS: Sixty consecutive patients receiving treatment with BAHA were enrolled in the study. The male/female ratio was 1.26 to 1; mean patient age was 45 years. The most common indication was hearing loss secondary to mastoid disease and surgery followed by congenital atresia and chronic discharge from the ear. RESULTS: The response rate was 85%, which is high and adds weight to the results. The general benefit score was +34 (range, +27-+48), which is comparable to middle ear surgery but just below benefit from cochlear implantation. The social benefit was +21 (range, +12-+37) with only +10 (range, +2-+26) for the physical score. This pattern mirrors that reported for other ear interventions. Maximum benefit was noted in patients with congenital atresias followed by discharging mastoid cavities. CONCLUSION: This study is the first to demonstrate significant quality of life benefit from BAHA surgical intervention as measured by the Glasgow Benefit Inventory.

[The rehabilitation of children with the initial forms of conductive hypoacusis due to recurrent acute otitis media]. / Reabilitatsiia detei s nachal'nymi formami konduktivnoi tugoukhosti, obuslovlennoi retsidivami ostrogo srednego otita.

The aim of the trial was study and rehabilitation of sound conduction functional disorders in 3-10-year-olds after recurrent acute otitis media. Tympanometry findings allowed to differentiate various alterations in the auditory tube and scarring in the middle ear. Treatment of the children was decided depending on the process in the middle ear. It is concluded that early diagnosis of adhesive phenomena is achieved with active search for latent auditory and tubular dysfunctions in children who previously had recurrences of acute otitis media. Children with sound conduction system dysfunction are recommended to be on the follow-up with control study of the auditory and tubular function once in 6 months and have repeat courses of corrective therapy up to stable effect.

[The way of nutrition and frequency of otitis media in hospitalized infants and 3-year-old children]. / Zmiana modelu zywienia a czestosc wystepowania zapalenia ucha srodkowego u niemowlat i dzieci do trzech lat leczonych szpitalnie.

It was made a comparison frequency of diagnosis of otitis media in hospitalized in the I Clinic of Children Diseases of Medical University of Lódz in 1975 and in 1995 infants and children under 2 depending on way of nutrition. It was shown and evident decreasing of frequency of otitis media from 22.6% in 1975 to 4.2% hospitalized in 1995. It was caused mainly by the change of a way of nutrition from artificial to natural and easy accessibility diets. It shows an allergic process as a probable source of otitis media in children.

[The treatment of hypoacusis in children by using a pulsed low-frequency electromagnetic field]. / Lechenie tugoukhosti u detei s pomoshch'iu impul'snogo nizkochastotnogo élektromagnitnogo polia.

The authors provide specifications of the unit INFITA supplied with ELEMAGS attachment of their own design; the technique of treating hypoacusis in children with utilization of impulse low-frequency electromagnetic field; the results of this treatment in 105 hypoacusis children. The method was found highly effective and valuable for wide practice.

[Permanent grommets: easy and quick detection]. / DTT permanentes: colocación fácil y rápida.

In some conditions, insertion of a transtympanic T-tube is not easy. We report a practical insertion method.

Fascioperiosteal flap and neoosteogenesis in radical mastoidectomy.

A surgical method, consisting of IRM and inferiorly based fascioperiosteal flap was utilized on twenty-five patients who had chronic otitis media with cholesteatoma and the long term results of the method are presented. At most, two months postoperatively, none of the patients were obligated to have any otologic care. Ear discharge, debris formation within the mastoid cavity, recurrence of cholesteatoma and/or osteitis were not encountered in the group. On the seventh year postoperatively, all of the mastoid cavities were healthy and reduced in volume. In seven years, the average volume became progressively reduced to 39% of the average volume measured one month postoperatively. This was considered to be due to the neoosteogenetic activity of the fascioperiosteal flap. This flap also provided a viable bed for a healthy epithelial layer.