Congenital bony fixation of the malleus.

Bony fixation of the malleus seems to be one of the most controversial clinical entities among various congenital disorders of the auditory ossicles. According to various theories, it could be caused by trauma, chronic infection of the ear, otosclerosis or even development failures in the tympanic cavity itself. Histological analysis of 1,108 temporal bones showing a normal middle ear structure was performed. All bones were cut in serial sections of 20 microns. Audiograms and the data on ear trauma or chronic infection were analysed from case histories belonging to each bony specimen. Bony fixation of the malleus was found in 14 cases. It was almost always unilateral. The most frequent site of the fixation was the lateral epitympanal wall. The forms of fixation differed from a thin bony lamella to a solid bony bridge. The mallear ligaments were not involved in any case. No relationship to chronic ear infection, ear trauma or otosclerosis was found. Only a slight conductive hearing impairment up to 20 dB was recorded in 6 out of 14 cases. The most probable predisposing anatomical factors for the onset of the bony fixation of the malleus and the most recent preoperative diagnostic possibilities are discussed.

Morphological changes of stria vascularis in congenital hearing impairment due to membranous labyrinth underdevelopment.

Congenital malformations of the inner ear may involve either the bone and membranous labyrinth or the membranous labyrinth alone. The same labyrinth structures can be affected with an acquired disease, toxaemia or viral labyrinthitis, for instance, with the same or very similar histologic findings. So far, there have been no studies examining the possible morphological changes of stria vascularis in different diseases with sensorineural anomalies. We examined the temporal bones of 16 patients, from whom audiograms and history data on hearing impairments present at birth or later were obtained previously. When malformation of the membranous labyrinth was caused by a congenital anomaly, three groups of typical changes of stria vascularis were observed: i) pseudocystic formation which replaced the strial tissue, with dark-stained deposits: ii) accumulation of endothelial cells or irregularly shaped cells in the basal coil of the cochlea: and iii) atrophy of the stria vascularis tissue in all coils. These findings may prove important for accurate diagnostic procedures.

Hearing levels in Pierre Robin syndrome.

Hearing was tested in 18 patients with Pierre Robin syndrome (PRS). These results were compared with those obtained for 243 patients with either cleft lip or cleft palate, or both. None of the PRS group patients had middle ear or inner ear malformations, or sensorineural hearing loss in speech frequencies. Hearing loss in PRS is usually conductive, bilateral, and more frequent in PRS patients (30 ears or 83.33%) than in patients who do not have PRS (290 ears or 59.67%). A significantly higher (p < .01) mean of hearing loss for air conduction in speech frequencies (MHLSF = 24.5 dB) was found in PRS patients than in patients without PRS (MHLSF = 17.8 dB). The ears of the PRS patients with hearing loss were examined, revealing middle ear effusion. In all cases, hearing was restored to a normal level through suction and the use of ventilation tubes.

[The cochlear implant in patients with sensorineural hearing defects]. / Primjena kohlearnog implantata u bolesnika sa senzoneuralnim ostecenjem sluha.

Cochlear implants are at the present time the only possibility for rehabilitation of totally deaf people. In this article the pathophysiology of sensoneural hearing impairments, the way of functioning of cochlear implants and indication for their use are presented. The results as well as the differences in rehabilitation effect in prelingual and postlingual deaf are pointed out. The reasons of sometime unexpected good and sometime unexpected poor results are discussed. On the end some unsolved problems in rehabilitation of deaf children with this method are presented.

Histological changes of incus with cholesteatoma in the attic.

In 160 cases of chronic otitis media with cholesteatoma in the epitympanum and intact ossicular chain, histological analysis of the incus was performed. The ossicles were cut in serial sections and every five cuts analysed. The findings were normal in 10.7%, a fibrous thickening of the periost was found in 13% of the cases. In 8% of the cases there was fibrosis of the periost with foci of active inflammation. Ostitis or osteomyelitis in the bone itself was present in 67.5%. In conclusion, removal of the ossicle during tympanoplasty was deemed necessary in 67.5% of the cases since otherwise relapse of the inflammatory process could sooner or later be expected.

[Hearing disorders in patients with cleft lip and palate]. / Ostecenje sluha u bolesnika s rascjepom usne i nepca.

Hearing threshold in cleft lip/or palate was assessed in 316 ears by pure tone audiometry. Normal hearing threshold was found in almost a half (164/51,9%) of the ears examined. Hearing defects were most frequently observed in cases of complete unilateral cleft palate (48/60%), whereas they were least frequently recorded in cases of cleft lip (15/19,2%). Complete bilateral cleft lip and palate was associated with conduction deafness in 29 (42,9%) ears examined, thus occupying the last but one place according to the frequency of association between deafness and cleft defects. A hearing conduction gap or more than 40 dB was most frequently present in complete cleft lip and palate (7/5,6%), followed by cleft palate (4/5%). Submucous cleft palate was observed to be less frequently accompanied by conduction deafness (9/56,2%) as compared to complete cleft palate, despite a common feature of bone and muscle support discontinuity. Cleft lip was least frequently accompanied by conduction deafness, but it was still present to a relatively high percentage when compared to the cleft-free population.

[Radiological study of the permeability of the eustachian tube. Personal procedure]. / Examen radiologique de la perméabilité de la trompe d'Eustache. Procédé personnel.

An original method for visualizing the Eustachian tube using micropulverized barium sulfate is described. The contrast substance must be insufflated under air pressure into the Eustachian tube by means of a catheter. Radiologic images as axial projections of base of skull allow detailed analysis of anteriorly insufflated tubes. Analysis of findings using this method on 306 tubes showed that filling with contrast was total in 83.8%, partial in 11.1% and absent in 5.1%.

Histological structure of vocal fold lamina propria in foetal larynx.

Previous investigations of vocal fold lamina propria in adult human larynx have revealed a highly specific organization and distribution of the connective fibres. The authors tried to elicit the developmental characteristics of that process using a material of foetal larynxes, ranging in foetal age from 13 to 23 weeks. The specimens were embedded in paraffin and then serially sectioned in both horizontal and vertical plane. The specific technique of differentiating elastic fibres from collagen fibres was utilized. The distribution and organization of connective tissue in foetal vocal fold lamina propria differed from that in adults and no straight elastic fibres were demonstrated as the first sign of later differentiation.

The high position of the jugular bulb.

The relationship between the bottom of the hypotympanon and the jugular bulb has been investigated on the basis of a histological analysis of 815 temporal bones. A high position of the jugular bulb has been found in 3.5% of the temporal bones examined. Only exceptionally does it occur bilaterally and is more often found on the right than left side. We distinguish two localizations of the high position of the bulb in the hypotympanon: the lateral and the medial. In either case the bulb may be damaged during myringotomy or during the removal of granulation tissue in middle ear surgery. Injury at myringotomy can be avoided only if there is a reinforcement of the bony wall. In the lateral position, the jugular bulb may be damaged when the tympanomeatal flap is being elevated. The bulb can occasionally be mistaken for a jugular glomus tumour. There is hardly any difference between cases where the bone between the bulb and the middle ear space is dehiscent or only very thin. The thickness of the bony shell is only 0.1-0.3 mm--thus there is no real protection against instrumental injuries.

Simultaneous histological, audiological and radiological findings in congenital anomalies of the inner ear.

Twenty-eight cases of children with deafness or severe perceptive impairment of hearing are discussed. They are selected into two groups for the symmetrical longitudinal planigraphy of the ear, the findings of which enable us to prove a labyrinthine aplasia and to compare them with audiometric findings. Accordingly we are able to draw a definite conclusion in small children. Histological findings about congenital anomalies of the inner ear with changes in the cochlea may also be divided into two groups: 1. Complete absence of development of inner ear with labyrinth aplasia. 2. Greater or lesser aplasia in the bony part of the cochlea Subgroups: (a) classic type after Mondini; (b) partial type after Mondini.

[Our way in the treatment of middle ear carcinoma (author's transl)]. / Unsere Art, das Mittelohrkarzinom zu behandeln.

The treatment of middle ear carcinoma is in first place surgical, completed electrocoagulation and post-operative irradiation. The first intervention should be as radical as possible. But we do not consider that a total resection of the temporal bone should be routinely performed in each case. The range of the operation should be adapted to the size and localisation of the tumours process. It is impossible and unnecessary to preserve the labyrinth with a radical operation. The facial nerve can be preserved only in singled out cases. The retroauricular incision should be left open whenever possible because it helps to discover a relapse in due time and to apply radium, i.e., radioactive isotopes. A radical neck-resection should be performed only in case of a clinically obvious metastasis.