Clinical findings of 10 patients complicated with inner ear damage due to acute otitis media are presented Patients' age ranged from 16 to 65 years-old (average age: 48.5 years-old). All patients complained of typical symptoms of acute otitis media such as otalgia, otorrhea, and hearing loss. And three of them had a vertigo attack. Pure tone audiometry revealed mixed hearing loss in 9 ears and pure sensorineural hearing loss in 2 ears. The patients underwent the administration of antibiotics, steroids and vitamines. Myringotomy or tympanostomy tube insertion was performed in most cases. After all, hearing function recovered in 9 (81.8%) of the 11 ears after the treatment.
Background: Although many papers were reporting the severe otitis media, there are few papers focusing on the pediatric patients at private clinic. Methods: In this paper, the clinical course of pediatric patients with otitis media at private clinic was studied. Types of otitis media, ages, treatment methods and outcomes are described. Results: From 1998 to 2002, 3715 patients, who were younger than 18 years old, visited Teramoto Ear Nose Throat clinic. Among them, 1812 patients had acute otitis media (AOM) or otitis media with effusion (OME). According to their clinical course, these 1812 patients were classified to following four groups; 1) AOM with single episode: 963 (53%), 2) recurrent AOM: 382 (21%), 3) OME with recurrent AOM: 150 (8.3%), 4) OME without episode of AOM: 317 (17%). In the 70 to 80% of the patients with OME with or without recurrent AOM, the middle ear effusion resolved within three to six months. On the other hand, treatment longer than one year was required in about five percent of the patients with OME. Conclusions: Present study revealed that the prevalence of the persistent OME and/or OMA was lower than it has been reported. These results should be considered to develop the effective strategy for the treatment of OME and OMA.
We tried a new interlay myringoplasty, inserting a fascia graft into interlay of the tympanic membrane from the edge of perforation in 16 ears (15 patients). Successful closure of perforation was achieved in all cases. This method needs only a few days hospitalization. Only high skilled surgeon can perform this method, but we hope that the interlay method would be the third common myringoplasty like sandwich inlay method and Yuasa's underlay method using brin glue.
This b-FGF (basic fibroblast growth factor) preparation is a spray-type medicament externally applied for treatment of bedsore, cutaneous ulcer and others. Its pharmacological effects show vascularization, acceleration of granulation and epithelization. Recently it has been used in various fields including head and neck surgery, plastic surgery as a remedy for treatment of wound. A trial use was studied on its effect for ear diseases referring to various repairs of epithelial defects, including perforation of the tympanic membrane, postoperative external auditory meatus and that after mastoidectomy. As a result healing of the wound was accelerated with a much-shortened time. Thus, practically the short stay in hospital after the otic surgery can be expected. It would also be effective for treatment of the diabetic wounds, known to cause delayed healing frequently. The b-FGF preparation is considered highly useful as one of the conservative treatments of the wound in the otic field. Optimal applications to cope with the situation in otic surgery should have resulted in the further meaningful treatment.
The lateralized tympanic membrane is a complication of otologyic surgery. Eight ears with the lateralaized tympanic membrane were reviewed. All of the ears were operated by a single surgeon and followed up more than one year. The mean follow-up periods were 37.6 months. Cholesteatoma was found in one ear and ossicular chain discontinuity in one ear during the operation. Postoperative air-bone gap within 15 dB was achieved in 5 ears (62.5%), hearing gain more than 15 dB in 5 ears (62.5%) and postoperative hearing level within 30dB in 2 ears (25.0%). Either of the three criteria was achieved in 7 ears (87.5%). The reestablishment of the normal tympanic membrane was found in 6 ears (75.0%). Perforation of the tympanic membrane on the normal position was found in one ear and miringoplasty was performed. Anterior blunting was found in one ear. To enlarge the ear canal, especially to remove the bone of the prominent anterior ear canal is important to avoid the lateralized tympanic membrane. The surgical results, the postoperative hearing results and the re-establishments of the normal tympamic membrane were fairly good. The lateralized tympanic membrane is a good candidate for surgical treatment, but much longer follow-up periods are necessary.
In 5 years between January 1998 and December 2002, 7 patients (8 ears) underwent the revision stapes surgery. Two patients (3 ears) were male and 5 patients (5 ears) were female. We investigated the diagnosis and the surgical methods at the first operation, hearing improvement after the operation, and the operative findings in the second operation in these cases. The poor results in the first operation were caused by technical factors (excessively loose or tight fitting of the piston) or the pathogenesis itself. All but one patient reported hearing improvement by small fenestra stapedectomy (SFS) with a Teflon piston. In stapes surgery, correct diagnosis, fine technique and selection of an appropriate piston are very important.
Silverstein reported a new surgical technique, laser stapedotomy minus prosthesis (laser STAMP), for otosclerotic lesions in 1998. We studied the effectiveness of this technique in two consecutive Japanese patients, using a KTP laser instead of an argon laser. Silverstein stated that a crucial feature of this procedure is vaporizing the anterior crus, and mentioned the effectiveness of using a bended laser probe under endoscopic visualization. We applied a Rosen suction tube to hold the quartz fiber of a KTP laser and bend it so that the laser beam vaporized the anterior crus. The postoperative courses were uneventful and hearing level was improved, with a negligible air-bone conduction gap in both cases. Although the follow-up period was relatively short, our results confirmed that the laser STAMP could be a new alternative for the treatment of otosclerosis, especially whose otosclerotic lesions are isolated to around the fissula ante fenestram.
Fourteen patients underwent translabyrynthine approach for unilateral acoustic tumor (AT) resection with the auditory nerve preservation. Electrical stimulation test (EST) and electrically evoked auditory brainstem response (EABR) were performed to evaluate the postoperative auditory nerve function. Four (29%) of 14 patients retained the functional integrity of the auditory nerve after translabyrinthine AT removal. The average tumor size in maximum was significantly smaller in the group with a positive response to EST or EABR than in the group with a negative response to EST. It seems to be difficult to preserve auditory nerve function in cases with a tumor extending to the fundus of internal auditory canal. These results suggest that size of tumor and/or extension of tumor to the fundus are critically important factors to preserve the auditory nerve function using a translabyrynthine approach.
Two cases of ossicular disruption after tympaoplasty Type I were surgically treated in our department. These two cases also showed continuous conductive hearing loss after tympanoplasty Type I Exploratory tympanotomy was carried out in these two cases. In the first case, a 58-year-old male, (tympanoplasty Type I 12 years ago), sclerotic lesions existed in the M-I joint and I-S joint. We performed SFS (small fenestrate stapedotomy) and mobilization of the long process of the incus. In the second case, a 28-year-old male (tympanoplasty Type I 4 years ago), postoperative epithelial remnant was found behind the eardrum and the long process of the incus was destroyed by a soft fibrous tissue. Almost good hearing was obtained after tympanoplasty Type III-i (apaceram-P). It is difficult to confirm the existence of lesion by the conventional hearing and imaging tests, therefore the long-term follow-up of the postoperative course is necessary. The preoperative approaches to this disease are described in our cases and the relevant literatures.
A 51-year-old woman presented with mixed hearing loss, high fever and general fatigue. Treatment with systemic antibiotics was ineffective. Laboratory findings showed positive C-reactive protein, high erythrocyte sedimentation rate, negative PR3-ANCA and negative MPO-ANCA. CT and exploratory mastoidectomy findings showed a granulomatous lesion in the mastoid cavity. Histological examination revealed nonspecific granulomatous inflammation. The hearing level of the patient fluctuated according to a dose of steroid medication. Administration of oral methotrexate was effective in reduction of the steroid dose. Methotrexate may be a well tolerated and durable option for the treatment of steroid responsive hearing loss and granuloma. As the patient might have the associated systemic immune-mediated disease in the future, the careful followup will be neccesary in this case.
The Management of cholesteatomas invading the cranium either by their en bloc removal with dura mater or by staged removal of the cholesteatoma alone is still controversial. The potentially lifethreatening nature of otogenic intracranial complications makes their early diagnosis essential, but their rate is decreasing due to progress in CT and MRI examinations and antimicrobial agents, and the development of microscopic surgery. We report a 59-year-old female whose chief complaints were vertigo and left-side hearing loss who underwent at our hospital the total removal of a cholesteatoma using combined mastoidectomy and middle fossa craniotomy, which included the removal of the dura mater adhering to the cholesteatoma. In conclusion, the combined transversal middle cranial fossa and mastoid approach provides good results. Dura mater taht is markedly invaded by the cholesteatoma should be removed and repaired with fascia concurrently. A staged operation is recommended in cases of widespread invasion of the cranium by a cholesteatoma in order to reduce the likelihood of residual cholesteatoma.
In an 18-year-old male, the Eustachian tube was abnormally wide and passed through the large pterygoid cavity bilaterally. Furthermore he had bilateral cup ears, congenital aural fistula, the narrowed ear canal with the small ear drum, malformations of the ossicular chain with vestibular window anomaly, and exposed facial nerves bilaterally. His audiogram indicated severe conductive deafness with typical Carhart's notch bilaterally. Vestibular dysfunctions and mental retardation were not obseved. CT examinations revealed a broad cavity containing the tympanic cavity and the pterygoid cavity with good aeration bilaterally. In this case, the apex of the petrous part of the temporal bone and a part of the wings of the sphenoid bone might have not been developed. As an embryological consideration, developmental disorder must have taken place during the 8th week of gestation, when a constriction between the tube and the tympanic cavity would have been formed. It is also very interesting that normal dolphins have the similar large tympano-pterygoid cavity.
Meningeal carcinomatosis is diffuse infiltration of metastatic adenocarcinoma to the meninges. The manifestation is often sign of meningeal irritation, cranial nerves and peripheral nerves dysfunction. The 3rd, 5th and 7th cranial nerves are usually involved. But dysfunction of the 8th alone is rare. We describe a case of meningeal carcinomatosis that presented with first manifestation of sudden onset bilateral sensorineural hearing loss. The patient underwent the surgery for gastric carcinoma two years previously. The meningeal carcinomatosis caused infiltration of the meninges by metastatic lymph nodes of the gastric carcinoma. The cerebrospinal fluid cytology and gadolinium-enhanced MRI were useful for diagnosis. The treatment was not commenced due to his rapidly deteriorating condition. Finally, bilateral hearing level was deteriorated to a complete deafness, and he died about three months after the appearance of symptoms.