Abstract Otology 2000 A16-1

Myroslav B. Krouk MD, PhD, MDSc, Myroslav M. Krouk MD

ENT Department Medical University UKR-Lviv

Various factors cause the development of the middle ear deseases (MED): upper respiratory infection, paranasal sinusitis with allergy, Disfunction of the Eustachian Tube (DET), et other. We had investigated 200 patients with paranasal sinusitis and allergy without otical symptoms. For diagnostic function State of the Eustachian Tube (FSET) we used: Tympanometry in dynamic, sonotubometry, optical nasopharyngoscopie, planumetry of the pneumatisation of air cells of Mastoid by M.Tos (PACM). In 86% cases we had revealed DET, which correlated with lower degree PACM. We considered that group patients as a the risk-group for development of MED. Simultaneously with treatment of the sinusitis and for prevention of MED we used: topical corticoid Beconase (aqueous suspension of Beclomethasone Dipropionate BP 0,05% w/w), nasal spray antihistaminic drug Histimet (levocabastin 0,5 mg/ml), oral antihistaminic Semprex (acrivastin) during 1,5 month; vibromassage pharyngeal orifice of ET, Kinesitherapy of the muscle of ET with acupuncture, phytoimmunostymulate drugs (Imod Zubitsky). After treatment functional State of the Eustachian Tube had improved in 58% cases.

Abstract Otology 2000 A16-2

Murray N.H. Waldron Prof.Dr., I.J.M. Johnson Prof.Dr.

Dept. of Otolaryngology Freeman Hospital GB-Newcastle-upon-Tyne

Introduction The effect otitis media with effusion (OME) has on the balance system of children has long been debated. Studies using force platforms have suggested OME caused limited effects. Sway magnetometry (SM) has been validated as a reliable and reproducible (<5% error) device in this field and has been shown to be more sensitive than force platforms (1).Sway results are reported as pathlength per unit time which is the most accurate method of measurement (2). Objective To establish wether OME has any effect on balance as assessed by sway magnetometry. Method Phase I: Data was collected from normal children (with OME and no other otological problems), age range 5-15 years. SM was undertaken in 4 states with eyes open and closed (to reduce optic fixation) whilst standing off and on foam (to reduce propiocetion). Adult normal range data has already been established. Phase II: Children with clinically, audiometrically and surgically proven bilateral OME, age range 6-10 years, underwent SM using the same protocol. SM was performed immediately prior to the insertion of grommets and also post-operatively (3-10 days). The delay allowed the anaesthetic to clear. Each child therefore acted as their own control. Results Phase I: Results from 18 children standing off foam showed an average pathlength of 198 (range 115-324) with eyes open and 258 (range 172-400) with eyes closed. This compares with the adult results of 140 and 200 respectively. Phase II: Children with bilateral OME showed increased pathlenghts. Insertion of gommets and resolution of the effusions almost universally reduces the pathlength to the normal range. The average pathlengths in 10 children whilst standing off foam reduced from 255 (range 134-414) to 199 (129-336) with the eyes open, and from 336 (range 187-441) to 265 (range 158-378) with the eyes closed. Conclusion OME does have an effect on balance in children and this can be demonstrated with sway magnetometry. References 1. Johnson, IJM; Clifford, E.; Hughes, R. & Birchall, J. 1998. Sway Magnetometry: evidence for the timing of vestibular recovery following stimulation. Clin. Oto. 23: 282-283. 2. Fitzgerald, J.; Murray, A.; Elliot,C. & Birchall, J. 1994. Comparision of body sway analysis techniques. Acta. Otolaryngol. (Stockh.) 114: 115-119. Conflict of Interest None.

Abstract Otology 2000 A16-3

Nikolas H. Blevins MD, Collin S. Karmody MD

Department of Otolaryngology-HNS Tufts University School of Medicine New England Medical Center USA-Boston MA

Chronic myringitis (myringitis chronica granulosa, tympanic membrane epithelitis) is an often-overlooked condition characterized by the loss of surface epithelium of the lateral tympanic membrane. The incidence and etiology of chronic myringitis (CM) are poorly defined, with the literature paying relatively little attention considering the condition+s apparent frequency. CM is often asymptomatic, although it may be associated with malodorous drainage, pruritis, or otalgia. CM may affect any portion of the tympanic membrane, and may extend to involve adjacent canal skin. The lines of demarcation are usually well defined, with variable amounts of granulation tissue seen in affected areas. Tympanic membrane thickening may result in conductive hearing loss. Although the clinical course is often indolent, CM can result in tympanic membrane perforation and chronic suppuration. Resulting scar formation may contribute to an acquired aural atresia. CM may be confused with chronic suppurative otitis media, and such misdiagnosis may result in needless tympanomastoid surgery. We review our experience with CM over the last 5 years. A retrospective chart review of patients seen in one academic otology practice revealed a prevalence of CM of approximately 1% (about 1/10th as frequent as the diagnosis of chronic otitis media). We discuss etiologic factors (otitis externa, otitis media, previous otologic surgery), clinical presentation, radiology, audiometric findings, and clinical course. Pathology specimens from a number of cases are reviewed. Definitive treatment of CM has yet to be defined, although prolonged topical therapy can be effective. Surgical intervention is used only in a small minority of refractory cases.

Abstract Otology 2000 A16-4

Duc M. Bui MD, Tam M. Bui MD

Westminster Ear Nose Throat Clinic USA-Westminster, MD

In chronic ear disease, a thorough evaluation of the middle ear is very important. The microscope with its straigth light beam is unable to reach the deep recesses of the middle ear. Using small telescopes, endoscopy might preferably be used in the out patient clinic to evaluate the mesotympanum. Sixty-five patients with perforation of the tympanic membrane due to chronic otitis media underwent endoscopy of the middle ear in the out patient clinic. The procedure was performed without anesthesia. Under direct television monitoring, the 2.4mm diameter telescope is introduced carefully through the perforation without touching the rim or the ossicles. The areas to be observed are the posterosuperior aspect of the mesotympanum, the attic floor, the Eustachian tube orifice and the supratubal recess. The evaluation is adequate with moderate size perforations. Central perforations are most indicated for this procedure. Two cases were aborted dure to bleeding at the rim of the perforation and one case was interrupted due to pain. No iatrogenic complication was encountered in our series. The hidden areas are much better visualized with this technique than with the microscope. Endoscopy of the middle ear could be performed safely without anesthesia in ambulatory setting with excellent results.

Abstract Otology 2000 A16-5

A.B.R. Desai MD, Ashim A. Desai MD

Laud Mansion IND-Bombai

The restoration of hearing in tympanosclerosis is dependent upon many factors: the ossicular fixation (single, double or triple ossicular fixation), the sensoneural component and the function of the other ear. Triple ossicular fixation by tympanosclerosis in cases of CSOM is very common in India possibly because of persistent low-grade infection due to improper primary level management. When the stapes is fixed a two-stage operation is required, therefore a gelfoam patch (not paper patch) test can help us to predict to the patient the possibility of a second stage surgery. Tympanosclerosis beeing sub-endothelial, mere peeling off the plaques during surgery always leaves bare bone, so mobilisation is often followed by refixation. At the first stage, a cortical mastoidectomy extending into the anterior attic is performed. The Incus is removed and the malleus head is rotated out of the attic on the axis of the tensor tympani. Tympanosclerosis deep to the ossicles is then removed and the malleus and incus replaced back in their position on a bed of silastic and gelfoam. The perforation is closed using temporalis fascia using the interlay technique. At the second stage the stapes superstructure is removed with a laser and a small-fenestra stapedotomy and teflon piston with vein interposition is performed. In those cases where a discrete hole in the footplate is not possible, stapedotomy with cartilage on vein technique is performed. The results are presented.