Glial heterotopia of the middle ear.

A choristoma is the presence of histologically normal tissue in an area where it is not normally located. The most frequently reported choristoma of the middle ear is salivary choristoma. Heterotopic brain tissue is very uncommon in the middle ear and mastoid. We present a rare case of glial choristoma of the middle ear, together with a review of the literature.

A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty.

OBJECTIVES: The aim of this study was to evaluate the effects of smoking and other prognostic factors on long-term surgical outcome and hearing results in myringoplasty. DESIGN: Retrospective cohort. SETTING: Tertiary medical centre. PARTICIPANTS: Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Ataturk Training and Research Hospital, using the chi-squared test, Fisher's exact test, t-test and multiple logistic regression statistical analysis. MAIN OUTCOME MEASURES: The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients' files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day. RESULTS: The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non-smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8). CONCLUSIONS: A non-smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.

Does the stapes reflex remain the same after Bell's palsy?

OBJECTIVE: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis. STUDY DESIGN: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients. SETTING: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit. PATIENTS: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years. INTERVENTION: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion. MAIN OUTCOME MEASURES: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli. RESULTS: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between grade III and control group. CONCLUSIONS: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method.

Electroneurography in the late period of Bell's palsy.

Our purpose is to investigate the electrophysiological characteristics of Bell's palsy and to obtain clues for estimating prognosis in the late period by using electroneurography. Thirty-three patients were followed by electroneurography over a period of 12 months. They were classified according to House-Brackman system. At the end of the follow-up, 100% of grade II-III patients, and 61% of grade IV patients recovered completely. Thirty per cent of grade IV patients recovered as grade II, and one grade IV (8%) and one grade V (100%) patient had bad prognoses (grade IV). There were significant differences between each group in the time course between the first and third months of onset. We concluded that the amount of non-degenerated synchronous fibres can allow us to estimate prognosis of Bell's palsy, especially between the first and third month of onset, if we make serial tests.