Age as a factor in the success of tympanoplasty: a comparison of outcomes in the young and old.

In order to determine if age is a factor in healing after tympanic membrane grafting, the author compared the results of 163 consecutive type I tympanoplasties performed on patients aged 20 to 40 with those of 97 consecutive type I tympanoplasties performed on patients aged 65 and older. The tympanoplasties were performed over a 5-year period. The postoperative followup period ranged from 6 to 10 years. The author found no difference in the success or failure of the graft-take rates between the two groups. Therefore, it would appear that in general, age is not a factor in the success or failure of healing following tympanoplasty surgery.

Plasti-pore implants in middle ear surgery.

Plasti-pore, a high-density polyethylene sponge, was one of the earliest biocompatible materials developed specifically for implantation in the middle ear. It is one of the most nonreactive materials known when tested in simulated biochemical exposure to pseudoextracellular fluid. The two basic prosthetic designs are the total ossicular replacement prosthesis and the partial ossicular replacement prosthesis. Plasti-pore implants have now been used for 20 years and are widely accepted by otologic surgeons. The basic properties of the material, implant design, and surgical techniques involved using these prostheses are reviewed in this article.

Simultaneous idiopathic sudden sensorineural hearing loss in identical twins.

Two sisters, who are identical twins, had a simultaneous idiopathic sudden hearing loss (ISHL) while listening to loud music at a rock concert. The possibility that their hearing losses, along with the sudden hearing losses related to cordless telephone injuries, are attributable to intracochlear membrane ruptures is discussed.

Physical examination and clinical evaluation of the patient with otosclerosis.

A detailed history, otoscopic examination, and testing with tuning forks are essential to the diagnosis of otosclerosis. These steps, including a differential diagnosis to rule out those middle ear conditions that can masquerade as otosclerosis, can help the examining physician make the presumptive diagnosis of otosclerosis.

Biocompatible implants in tympanoplasty.

The history of implants in otology is reviewed. Currently available biocompatible ossicular implants are described, and a survey of their use by members of the American Otological Society and the American Neurotology Society is reported.

Streptomycin treatment in Menière's disease.

Streptomycin treatment in Menière's disease has traditionally been used for control of vertigo in patients with severe bilateral involvement or unilateral involvement in the only hearing ear. Guidelines for use that have worked at the Shea Clinic are presented. In addition, a special case is discussed in which this form of therapy has been used for treatment of fluctuant hearing loss in a patient with Menière's disease.

Sensorineural hearing loss in cordless telephone injury.

Audiometric data from 19 cases of cordless telephone injury are reviewed, including three cases with pre-insult and post-insult audiograms. In addition, data are presented from analyses of intensity and frequency for the ring signal of three telephones involved in injury cases. The most severe hearing loss was found at 500 Hz and 1000 Hz, where the mean threshold difference in the injured ear was 20 dB and 29 dB, respectively. The three cases for which pre-insult and post-insult data were available exhibited similar audiometric patterns, although the degree of threshold shift varied. Spectral analysis of the ring signal indicated sound-pressure levels of approximately 140 dB, with a fundamental frequency near 750 Hz.

Low-frequency harmonic acceleration in the evaluation of patients with intracanalicular and cerebellopontine angle tumors.

The application of low-frequency harmonic acceleration (HA) with the rotary chair is becoming more widespread in the clinical evaluation of the vestibular system. In the last 2 years, 18 patients with surgically or radiologically confirmed intracanalicular or cerebellopontine angle tumors have been evaluated with this clinical modality. In all cases (100%)--which included seven small tumors--vestibular evaluation with HA was abnormal. Slow harmonic acceleration, as is the case with other methods of vestibular evaluation, is not specific for acoustic tumors. Its great sensitivity in detecting peripheral vestibular abnormalities, however, may make it a useful addition to the test battery in the evaluation of patients with suspected intracanalicular or cerebellopontine angle tumors.

A simple autologous fibrinogen glue for otologic surgery.

A simple method of concentrating a patient's own fibrinogen for use with a thrombin/calcium solution--to produce a coagulum-type tissue glue for otologic surgery--is presented. The principal advantages of this system include a simple modification of the cryoprecipitate technique, which can be easily performed in any hospital laboratory using a minimal amount of the patient's blood, and the use of autologous fibrinogen, which completely rules out the possibility of transmission of hepatitis or AIDS viruses. Useful tips on preparation and use of this autologous tissue glue, based on experience over the past 2 years, will be presented.

Long-term experience with biocompatible ossicular implants.

The senior author's 8-year personal experience with biocompatible ossicular implants is reviewed. Four hundred sixty-one consecutive operations, in which high-density polyethylene sponge ossicular replacement prostheses were used, are grouped according to the Bellucci classification of chronic otitis media. The prostheses used were the drum-to-footplate prosthesis (TORP, total) and the drum-to-stapes prosthesis (PORP, partial). Each group's short- and long-term hearing results are compared. Prosthesis extrusion and persistent or recurrent conductive hearing loss are the most common causes of operation failure. Failures within each group are analyzed, and techniques to prevent these complications are outlined.

The large vestibular aqueduct syndrome.

The hypocycloidal polytomographic temporal bone studies performed on 2683 patients were reviewed, and the radiographic appearance of the vestibular aqueduct was evaluated. Within this group of 5366 ears, forty-seven ears (1%) in twenty-six patients demonstrated a large vestibular aqueduct (diameter greater than 1.5 mm). A review of the relevant embryology, anatomy, and physiology is reported. A discussion of hypocycloidal polytomography and computed tomography of the temporal bone as well as a discussion of the Mondini dysplasia is also presented. The twenty-six patients underwent a battery of audiometric and vestibular function tests. These data were compiled and correlations made, allowing for a more complete characterization of the large vestibular aqueduct syndrome.

The medical treatment of tinnitus.

Currently there are three methods of treating patients with intractable tinnitus, a physical one using masking (Vernon, 1977), a psychosomatic method using biofeedback (House et al., 1977), and a chemical treatment using intravenous lidocaine and the oral anticonvulsants--carbamazepine, primidone and lidocaine amine. The latter seems to be the most promising, being easier to use, less time-consuming, more accurate to assess, and relying less on the patient's active participation and intelligence. The only disadvantages of the chemical method are the serious side-effects of the drugs in use. This can be managed by careful administration of these drugs and monitoring of the patient. In the future, new anticonvulsants with fewer side-effects will certainly be produced. It may be that chemical treatment can be combined with the masking and/or the biofeedback methods with a synergistic result. Another possible use of carbamazepine is in the treatment of palatal myoclonus and other similar disorders. Further clinical studies are needed to corroborate this application of the treatment.

Treatment of tinnitus with tocainide hydrochloride.

Intravenous (IV) injection of lidocaine was used in patients with tinnitus for combined treatment with oral anticonvulsants carbamazepine (Tegretol) and primidone (Mysoline). In most cases, the high complication rate with these drugs precluded their long-term use. Tocainide hydrochloride (HCl), a primary amine analog of lidocaine, can be taken orally and was evaluated for the use in the treatment of tinnitus. A double-blind study in which one group received 200 mg tocainide HCl four times a day and one group received a placebo revealed no significant differences in tinnitus relief between the two groups. A single-blind study in which 600 mg tocainide HCl four times a day was administered showed 80% to 98% tinnitus relief in five of the six patients who tolerated the drug. Tocainide HCl treatment of tinnitus is promising.

Recent advances in pediatric otology.

An overview of the clinical applications of electroencephalic response audiometry, electrocochleography, and hypocycloidal polytomography are presented. Biocompatible ossicular implants provide a new and superior method of ossicular chain reconstruction. A case in which all of these newer modalities of diagnosis and treatment were used is presented.