Abstract Otology 2000 A14-1

Gábor Katona MD, István Lellei MD

ENT Department Heim Pál Hospital for Sick Children H-Budapest

Authors administered oral corticosteroid (methylprednisolon) in a daily dose of 1 mg/kg for 33 consecutive children suffered from otitis media with effusion. The duration of the therapy was 1 week. Aim of the study was to assess corticosteroid effect on hearing and tympanic pressure of chronic OME children. Previous adenoidectomy without tympanostomy tube and age range of 2-10 years were inclusion criteria. No antibiotics, not any other treatment was recommended. Exclusion criteria were: varicella infection or incubation, hypertension, diabetes mellitus. Children with sensorineural hearing loss were also excluded. Hearing assessment (audiometry) and tympanometry was carried out before treatment, at the end of treatment (one week) and 1 month after treatment. 10 age-matched OME children without any treatment served as a control group. A total of 29 children's hearing improved at on week control, at least 10 dB on at least 2 frequencies on al least one ear. On the follow up (1 month ) the improvement of hearing could be detected on 18 children. Effusion recurred on 11 children (17 ears). In the control group 3 improvement ( 5 ears) have been measured 1 month after the first observation. (difference is significant p<0.05). Conclusion: Oral corticosteroid treatment could be a useful alternative treatment for children with OME. With short-term therapy side effects can be avoided. Further data collection is necessary to determine its role among other treatment regimen (antibiotics, tube, etc).

Abstract Otology 2000 A14-2

Norihiko Murai MD (1), Etsuo Yamamoto MD (2)

(1) Department of Otolaryngology Matsue City Hospital J-Matsue, Shimane
(2) Department of Otolaryngology Kobe City General Hospital J-Chuo-Ku Kobe

Allergic otitis media (ALOM) is caused by entry of antigens into the middle ear via the Eustachian tube or a perforation of the tympanic membrane. We report two patients with ALOM whose clinical features differed according to the route of entry of antigens. The first case was a 64-year-old woman with a past history of bronchial asthma who complained of hearing loss. Her tympanic membranes were retracted bilaterally. Myringotomy revealed gummy secretions. After closure of the myringostoma, her right tympanic membrane bulged and became pale and hypertrophic. A ventilation tube was inserted. However, frequent relapses of otorrhea occurred simultaneously with attacks of asthma. Microscopic examination of the gelatinous material obtained from her middle ear disclosed numerous eosinophils. Since the clinical course and findings were compatible with those of ALOM of tubotympanic type, anti-allergic drugs were given orally. This treatment was successful. The other case was a 44-year-old man with a past history of asthma and allergic rhinitis who visited our hospital because of otorrhea and hearing loss. Otoscopy revealed a large aural polyp. He underwent tympanoplasty. Removal of the polyp disclosed a perforation of the tympanic membrane, through which the polyp exhibited continuity with granulation tissue in the middle ear. Histologic examination of the polyp revealed infiltration of eosinophils. RAST revealed positive scores for house dust, mites, silk, and other antigens. Since he exhibited neither otorrhea nor relapses of the aural polyp once the perforation was closed, we surmised that the antigen had entered his middle ear via the perforation.

Abstract Otology 2000 A14-3

Mila Bojanovic MD, MA, Milan Stankovic MD, PhD, Miodrag Dinic MD, MA, Ljiljana Milisavljevic MD, PhD, Emilija Zivkovic MD, MA, Ankica Stefanov MD

ORL Clinic University of Nis YU-Nis

Secretory otitis media (SOM) is a common condition among children and is characterized by non-purulent fluid in the middle ear and fluctuacting conductive hearing loss. Most children will spontaneously regain normal air-filled middle ears, but a certain number will have persistant problems. This study was performed to investigate the course of recovery from SOM in children treated in various ways. A total of 53 children, 29 boys and 24 girls, 3-11 years of age, with SOM were enrolled in randomised, controlled studies: one trial evaluating the efficacy of antihistamine/mucolytic combination for SOM and one trial evaluating efficacy of antibiotic (Amoxicillin and clavulanic acid) therapy for SOM. The patients were followed for 3 monts. During the follow-up period, clinical examination and impedancemetry were performed in all patients. Statistical significance was determined by use of x2 test. No side effects of therapy were noted. A significant difference (p<0.01) was found in the group treated with antihistamine/ mucolytic combination after 2 months. Antibiotic therapy had effect on recovery of SOM, but not significant.

Abstract Otology 2000 A14-4

V. Ivanovska MD, Marina Cakar MD, Elena Bogeska MD, Lidija Dubrovska MD

ENT Department University Hospital MAZ-Skopje

The authors of this study tried to evaluate the applicability of tympanoemtry in the younger age groups and to make an epidemiological study of the distribution of tympanogram types in group of preschool children. In a period of one month we examined 240 children between two and three years age in limited geographic area. 456 ears in 23o children (95,8 of those invited) were completely investigated with tympanometry and otoscopy. 54,5% of the ears showed type A tympanometric curves, 32.1% type B and 12,4% type C. In 112 (46,6%) children we found bilateral type A tympanograms. The prevalence of abnormal tympanometry proved to be unexpectedly high in both sexes. These findings will be subject of further discussion.

Abstract Otology 2000 A14-5

Hamad Al Muhaimeed Prof., Siraj M. Zakzouk Prof.

Department of ORL King Abdul Aziz Univ. Hospital SA-Riyadh

A survey to identify the aetiology of hearing impairment among Saudi children was carried out. Children were divided into two groups according to presence or absence of laboratory evidence of toxoplasmosis 'at risk' and 'at not risk'. Serological tests for toxoplasmosis were done to 1054 children. We found positive IgM antibody against Toxoplasma gondii in the blood of 70 of the 1054 children (6.6%) (age ranged between 12 months and 14 years). Forty nine of the seventy infected children (70%) were found to have bilateral sensorineural hearing loss (11 of 19 children of the 'at risk group' and 38 of 51 from the 'not at risk' group). Hearing impairment was bilateral in all cases, profound in 9, moderate to severe in 29 and mild in 11. Known causes of hearing impairment were excluded. The high prevalence of hearing impairment among children due to toxoplasmosis is presented.

Abstract Otology 2000 A14-6

Giovanni Carlo Modugno MD, Domenico Saggese MD, Giorgio Magnani MD, Antonio Pirodda MD, Alberto Rinaldi Ceroni MD

ENT Department University of Bologna I-Bologna

Despite a wide international experience on the treatment of chronic ears, the problem of obtaining a satisfying, long-lasting functional recovery still remains largely unsolved. For this reason, an attempt to find out some predictive factors depending on both the anatomic conditions and the surgical procedures was made: a multivariate analysis was carried out on a group of 120 patients who underwent a tympanoplasty between 1987 and 1993. All the cases had a follow- up of 5 years at least. The great majority of cases had a cholesteatoma (90.8%) and was operated on by a closed technique (89.1%). The ossicular reconstruction was mostly made with plastipore prostheses (93.3%), under unfavorable conditions: only a mobile footplate in 49.1% of cases, while a mobile intact stapes in absence of the other ossicles was found in 34.2% of cases. In 42.4% of cases a satisfactory result (air-bone gap <20dB) was achieved; an initial extrusion of the prosthesis was observed in 12.5% of cases. The multivariate analysis (logistic regression) demonstrated that age, staged surgery, tubal function, mesotympanic extent of the cholesteatoma, surgical management of the fenestral areas, procedures in order to keep a correct tympanic ventilation, interposition of inert materials between tympanic membrane and prosthesis had no influence on the functional results; the only factors which proved to be significantly and independently related to a satisfactory functional result were the good late postoperative anatomic condition of the tympanic membrane, the eradication of cholesteatoma, the preoperative condition of the ossicular chain (intact malleus and stapes), the surgical technique (closed tympanoplasty).

Abstract Otology 2000 A14-7

Walter Livi MD, N. Zuccarini MD, D. Limoni MD, Desiderio Passàli MD

ENT Dept University Hospital I-Siena

Elective material for ossicular chain reconstruction is autologous ossicle, but it is not always available because the ossicles are often damaged (erosion!). For several years the authors (A.A.) took advantage of plastipore and cartilaginous prostheses for the ossiculoplasty, instead of autologous ossicles. Plastipore prostheses showed good functional results, but they are not excellent for extrusion problem. The results about biocompatibility and functionality were better when A.A. performed ossiculoplasty with cartilaginous prostheses. In E.N.T. Dept of University of Siena, from January 1978 through December 1998, 1045 patients (698 males, 347 females; age range 12-68 years) were operated for middle ear pathologies. 327 of these patients underwent an ossiculoplasty using biocompatible materials (plastipore, hydroxiapatite and homologous cartilage. The records of 168 timpanoplasty patients who underwent an ossicular reconstruction with plastipore and cartilaginous prostheses were reviewed. Our data showed the extrusion of the prosthesis in 15 % of the cases, while this complication was absent using rib cartilaginous prostheses. The A.A. advice cartilaginous prostheses to reconstruct ossicular chain when ossicles are not available.

Abstract Otology 2000 A14-8

Gürol Gültekin MD, Levent Olgun MD, Ibrahim Cukurova MD, Erdal Gül MD, Ilker Nalbant MD, Sezaver Alper MD

SSK Izmir Educational HDSP TR-Izmir

In this study early results of Titanium-gold TORP were invastigated. The study was done on 12 chronic cholesteatoma cases. The operation was wall down tympanoplasty in all cases. A titanium-gold total ossicular replacement prosthesis covered with a otograft cartilage plate used as a columella. Graft take was excellent at 6-10 months. There were not any extrusion and hearing results were comparable with historic controls of clinic. Titanium-gold TORP found to be satisfactory at least in short term.

Abstract Otology 2000 A14-9

Pingling Kwok MD, Jürgen Strutz Prof.Dr.med.

HNO-Klinik Universität Regensburg D-Regensburg

The surface condition of a stapes prosthesis is an essential factor for the mobility of the prosthesis in the stapedotomy opening. Thus, it is a determinant for the success in surgical hearing improvement. A rough surface structure of the prosthesis results in increased friction and resistance during movement of the prosthesis piston and leads to conducting hearing impairment. Gold-, teflon-, and titanium pistons were examined for their surface structure with the electron microscope. The overall results show that gold pistons have the smoothest surface, followed by titanium pistons which have a scaly appearance. The teflon pistons are provided with horizontal parallel grooves showing a clear fibrous texture at a high magnification.

Abstract Otology 2000 A14-10

Pingling Kwok MD, Annette Waldeck MD, Jürgen Strutz Prof.Dr.med.

HNO-Klinik Universität Regensburg D-Regensburg

As magnetic resonance imaging (MRI) has become one of the most important investigations in the medical field, it is necessary to know whether patients with metallic middle ear implants may undergo this examination. We studied four different stapes prosthesis (gold, titanium, teflon-platinium and teflon-steel), a titanium TORP, and two kinds of grommets (titanium and silver-goldplated) for their MRI-suitability. The objects were put in front of the MRI-scanner opening a) laid in a petri-dish and b) hung up on a thin thread. c) The light objects (teflon and titanium prostheses) were also put afloat in a petri dish filled with water to detect also small forces that might act upon the implants. d) All objects were placed in a petri dish filled with Gadolinium to find out what kind of artefacts they might produce on the final image. None of the implants moved when placed in a petri dish or when they were hung up on a thin thread. The teflon-platinum and teflon-steel stapes prostheses adjusted their direction and floated towards the MRI-scanner when put close enough to the Scanner opening. All implants showed as little artefacts that would still make the evaluation of the surrounding tissue possible.

Abstract Otology 2000 A14-11

Deborah A. Arthur M.A.

Vice-President, Clinical Affairs Symphonix USA-San Jose, CA

The Vibrant P soundbridge began clinical trials in the United States in mid-1998 with subject enrollment completed by early 1999 Test results indicate no changes in residual hearing and functional gain measures obtained at 250 Hz through 8KHz indicate mean improvements (over acoustic hearing aid) <10dB above 1KHz with individual improvements as much as 25 dB.

Abstract Otology 2000 A14-12

Akihide Ichimura MD, Mamoru Suzuki MD

ENT Department Tokyo Medical University Hospital J-Tokyo

The effects of surgical manipulation to the vestibular system have not fully been elucidated. This study was designed to investigate the effects of tympanoplasty on positional nystagmus. Materials and methods: The study was conducted on a total of 36 cases of tympanoplasty. There were 23 cases of cholesteatoma and 13 cases of chronic otitis media. The cases with vertigo and labyrinthine fistula were excluded. Types of tympanoplasty were type I (7 cases), type III (24 cases) and type IV (5 cases). The cases which underwent intensive manipulation around the stapes or the round window niche were excluded. The positional nystagmus was monitored and video-recorded using an infrared CCD camera before surgery, one day and every several days after surgery until it disappeared. Results: Postoperative nystagmus was observed in 13 out of 30 cases which showed no nystagmus prior to surgery. Direction and type of the nystagmus varied. It was toward the surgical side in 8 cases, downbeat nystagmus in 3 and apogeotropic direction-changing positional nystagmus in 2. In the sitting position, no nystagmus was observed. Most of the nystagmus was present even after the canal packing was removed. Conclusion: Tympanoplasty has a significant effect on the vestibular system. Mechanical vibration by drilling to the inner ear, especially to the otolithic organs possibly plays a major role in emergence of the positional nystagmus.

Abstract Otology 2000 A14-13

Chul-Ho Jang MD, Jin O. Kim MD, Seung T. Park MD

Dept. of ENT Wonkwang Medical School ROK-ChunBuk

After traumatic perforation of the tympanic membrane(TM), healing occurs spontaneously in most cases, but sometimes the perforation fails to heal and myringoplasty is required. We carried out a study of transforming growth factor-a(TGF-a) distribution to clarify the reason for the accelerated epidermal cell proliferation occuring after traumatic tympanic membrane perforation of rat. Comparative findings were noted between normal and perforated tympanic membrane. TGF-a was not found in the normal TM , but its expression was observed over the whole TM. Most of perforations had closed by 10 days. In the healed perforation, prominent reduction of expression was observed.

Abstract Otology 2000 A14-14

Yoshiro Yazawa MD, Mikio Suzuki MD, Hiroya Kitano MD, Kazutomo Kitajima MD

Dept Otolaryngology Shiga University of Med. Science J-Otsu

A number of techniques have been designed to avoid the problem associated with an exteriorized mastoid cavity. We performed a simple method of posterior canal wall reconstruction using only remnant external canal skin and temporalis fascia (Smith et al, 1986) after canal wall down tympanoplasty in 45 ears with cholesteatoma as a one-stage procedure. They include 41ears of primary surgery and 4 ears of revision surgery. The age of patients ranged between 9 and 71 years. The postoperative period to attain dry ear ranged from 7 to 31 days (mean, 13.2 days). During the follow-up period between 15 and 54 months (mean, 32.3 months), we had a case of residual cholesteatoma, a case of recurrent cholesteatoma and a case of perforation of the reconstructed canal wall. All these 3 failure cases (7%) were observed in children. The postoperative air-bone gap of < 30 dB was reached in 36 cases (80%) at 1 year after surgery. The mean number of dB of closure of the air-bone gap was 12.7 dB. The positive values (less gap) of this number were obtained in 35 cases (78%), the negative values (worse gap after surgery) were in 6 case (13%) and 0 values (no change) were in 4 cases (9%). Slight to moderate retraction of the reconstructed posterior canal wall were observed in 42 cases (96%) and the aeration of the mastoid cavity were confirmed in 9 cases (20%) by CT. The results seem to be much better than the other reconstruction methods.

Abstract Otology 2000 A14-15

Navin L. Hiranandani MD

Oto Rhino Laryngology Nair Hospital Inmedical College IND-Bombay

The hearing process in tympanoplasty is a complex depending on several factors. This depends on the type of ossicular reconstruction which is done in a particular operation. The other factor is the presence of disease process. Cholesteatoma often erodes the ossicular chain and depending on the amount of destruction of ossicles, reconstruction has to be made. Even small cholesteatomas may require removal of parts of the ossicular chain. Since the deconstruction in cholesteatoma can be also extensive, the reconstruction becomes more elaborate. There may be widespread destruction of bone in cholesteatoma requiring bony reconstructive procedures. The removal of the ossicles also depends on the extent of cholesteatoma. Mere destruction of the ossicles is not sufficient to remove the ossicles. If cholesteatoma is extending to accessible places like the attic, the removal of even normal or partially abnormal bones becomes necessary to remove the disease process.

Abstract Otology 2000 A14-16

Domenico Saggese MD, Giovanni Carlo Modugno MD, Francesco Soprani MD, Antonio Pirodda MD, Alberto Rinaldi Ceroni MD

ENT Department University of Bologna I-Bologna

The unanswered problems related to the treatment of children cholesteatoma can raise additive difficulties in obtaining a stable satisfactory result from a functional point of view. This is the reason why this particular topic deserves in our opinion to be separately analyzed: in order to give a cognitive contribution a retrospective study was made concerning 64 ears operated on between 1975 and 1992 and followed up for 5 years at least. Despite the frequent unfavorable anatomical preoperative conditions (absence of malleus and incus in 32.9 % of cases; absence of malleus , incus and crura in 40.6 % of cases), a good result (air-bone gap <20dB) was achieved in 60.9 % of cases. A multivariate analysis, carried on according to the logistic regression method, showed the importance of number of operations for recurrence, conditions of the ossicular chain, allergy, late postoperative conditions of the tympanic membrane, and myringostapedopexy in influencing long-term functional results.

Abstract Otology 2000 A14-17

Emilija Zivkovic MD, MA, Milan Stankovic MD, PhD, Ljiljana Milisavljevic MD, PhD, Mila Bojanovic MD, MA, Ankica Stefanov MD

ORL Clinic University of Nis YU-Nis

The degree of ossicular destruction in chronic suppurative otitis media (CSOM) depends not only on the nature of the pathological process (cholesteatoma or granulation tissue) but also on the intensity of the pathological process. This paper presents the results of a review of 39 patients suffering from CSOM with granulation tissue. All the patients were treated both medically and surgically. We compared the number of the inflammatory cells and the number of the blood vessels in cholesteatoma and granulation tissue, depending on their localization and intensity. We established that the activity of the pathological process was far more significant than its type and localization. Due to antibiotic treatment the number of the inflammatory cells was reduced in the granulation tissue from 1406.33 ± 36.41 to 858.67 ± 306.90 in granulations localized in the posterior part of the cavum, from 2606.5 ± 573.5 to 2059.33 ± 511.20 in granulations localized in the cavum and from 3022.67 ± 364.46 to 2298.33 ± 620.03 in extensive granulations. The administration of adequate antibiotics based on the antibiogram significantly reduces the intensity of the infection, making the surgical procedure more successful.