The Yung percutaneous mastoid vent: results of a multicenter trial.

OBJECTIVE: The primary goal of the study was to find out whether the Yung vent would remain patent long-term. The secondary goal was to find out whether mastoid ventilation could overcome permanent ventilation disorder within the middle ear. STUDY DESIGN: The study was an open prospective investigation. SETTING: The study was a multicenter study involving three tertiary referral centers. PATIENTS: Twenty-three subjects older than 12 years were included. The inclusion criteria were complete atelectasis, failed tympanoplasty because of persistent eustachian tube dysfunction, and persistent otitis media with effusion in spite of repeated ventilation tube insertion. INTERVENTION: Tympanoplasty with insertion of the Yung percutaneous mastoid vent. MAIN OUTCOME MEASURES: Patency of the vent, adverse effects, patient acceptance, hearing results, and appearance of the tympanic membrane were assessed every 3 months up to 18 months postoperatively. RESULTS:: At 18 months, 20 of 23 vents were still patent. Overall, there had been no unacceptable adverse effect on any patient. Eighteen of 23 ears had improved hearing. The tympanic membrane had returned from a collapsed state to near normal in 13 of 17 completely atelectatic ears. There were five patients who had no benefit from the vent because of blockage within the epitympanum or middle ear effusion. CONCLUSION: The Yung percutaneous mastoid vent can maintain long-term patency. It is effective in the treatment of complete atelectasis as an adjunct to tympanoplasty.     

Permanent mastoid vent: a new treatment for persistent eustachian tube obstruction

To date, there is no satisfactory treatment for persistent eustachian tube blockage or negative pressure in the middle ear. Conventional ventilation tubes are usually either occluded or extruded with time. A new treatment of percutaneous mastoid vent provides permanent ventilation to the middle ear cleft without putting a tube through the eardrum. A titanium tube is inserted through the skin into the mastoid antrum using the established technique of osseo-integration and hence becomes truly permanent. It can also be connected to a CPAP machine to re-inflate a collapsed eardrum. Initial trials consist of six vents inserted and followed up for 6–16 months. There was no sign of extrusion or a foreign body reaction. However, an inner Teflon tube is essential to keep the vent patent for permanent ventilation to the middle ear cleft.     

The fate of mastoid obliteration tissue: a histopathological study

OBJECTIVES: To demonstrate the histopathological fate of tissues used for mastoid obliteration over a period of 30 years. STUDY DESIGN: Retrospective histopathological analysis of archival temporal bone microscopic sections. METHODS: From the database of the laboratory, the 17 temporal bones from subjects who had undergone mastoid obliteration procedures were identified. The microscopic appearance of the obliteration tissue was described, and microphotographs made of significant findings. RESULTS: Fat and bone chips, or paté, retained their bulk in the obliterated space, whereas subcutaneous tissue and muscle lost bulk but seemed to promote healing. Some substances, such as bone wax, used for hemostasis and buried under obliteration tissue, were found to produce a subclinical inflammatory reaction, but other materials, such as Surgicel and Gelfoam, did not. CONCLUSIONS: Fat and bone chips, or paté, used as mastoid obliteration tissue, retained their bulk and identity, whereas subcutaneous tissue and muscle did not.     

SerenoCem -glass ionomeric granules: a 3-year follow-up assessment of their effectiveness in mastoid obliteration.

A chronically discharging cavity is a complication of canal-wall down mastoidectomy procedures. Mastoid obliteration can reduce this otorrhoea, with many techniques and materials for obliteration described. This study assesses the effectiveness of SerenoCem granules in providing successful obliteration, by recording the need for subsequent aural care and patient satisfaction using the Glasgow Benefit Inventory. All ears were made dry by the procedure (three after revision). Aural care visits reduced [down 9.2 (95% CI 4.7-13.8) over 2 years] and quality of life benefited [total postoperative Glasgow Benefit Inventory score 21.8 (95% CI 10.1-33.6)] significantly, suggesting that SerenoCem granules are a useful biomaterial to consider in mastoid obliteration. Postoperative infection can prevent osseointegration of the SerenoCem.     

The exenterated mastoid: a problem of ear surgery

The exenterated mastoid behind an intact posterior ear canal wall is one of the preconditions for the development of hidden cholesteatoma recurrences. Retraction pockets can develop into the cavity owing to persisting malfunction of the eustachian tube. Matrix inadvertently left in the tympanic space or in the mastoid process can grow into or in the cavity unnoticed. The way to avoid this nesting site is permanent obliteration of the mastoid process immediately after the eradication of the disease. Furthermore, the disadvantages of old radical operation cavities can be eliminated by secondary obliteration, connected with a revision and repair of the sound pressure transfer mechanism if necessary. It is important to use a nonresorbable obliteration material. We use methacrylate (Sulfix-6) for this purpose, so far without any negative consequences in the ears.     

Vestibular neuritis: a follow-up study

Seven to eight years after a disease period of vestibular neuritis 19 patients previously examined at our department were given a questionnaire about whether they had experienced any audiovestibular symptoms since they first fell ill. All 19 patients responded and 18 consented to participate in the long-term follow-up study. The patients were subjected to a clinical evaluation, a bithermal caloric test and audiological examinations with stapedius reflex measurements with use of the same technique as at the first examinations. Ten of the 18 patients had experienced recurrent vestibular symptoms with sensation of dysequilibrium and vertigo. Six of these 10 patients also had periods of positional vertigo. The remaining nine patients were free of symptoms. None of the patients had noticed any change in their hearing ability. The mean caloric side difference at the 7- or 8-year follow-up was not significantly higher in the group of patients with symptoms than in the group without symptoms. Neither did the group of patients with pathologically elevated stapedius reflex thresholds at onset display a larger mean caloric side difference than the group of patients with normal thresholds. However, a small caloric side difference at onset of the disease served as a predictor for residual vestibular symptoms. It is speculated whether the group of patients with residual symptoms had a different pathophysiological localization of their disease within the vestibular system than the group of patients with no symptoms at follow-up.     

Prominent ears: a follow-up study

Following a minimum observation time of 14 months, 74 patients having undergone surgical correction of prominent ears were re-examined. The applied surgical technique was modified from Stenstr?m and Warrer utilizing the scoring technique and subcutaneous mattress chrome catgut sutures for fixation. Satisfactory results were achieved in more than 95 per cent of the patients, when assessed by both the patient and the surgeon. Only few complications were revealed.     

Development of mastoid air cell system in children treated with ventilation tubes for early-onset otitis media: a prospective radiographic 5-year follow-up study

OBJECTIVES/HYPOTHESIS: Although most studies have agreed that small mastoid air cell systems correlate with long-standing otitis media, the extent to which the environmental factors affect the development of MACS remains undetermined. We investigated the radiographic development of mastoid air cell systems in children with recurrent acute otitis media or otitis media with effusion who were treated with ventilation tubes early in life. STUDY DESIGN: Prospective follow-up. METHODS: Of 305 consecutive patients aged less than 17 months with recurrent acute otitis media or otitis media with effusion who received primary tympanostomy in the Central Hospital of Central Finland, 281 (92.1%) were followed for 5 years. Mastoid radiographic films were obtained preoperatively and at the 5-year end-point examination. Mastoid air cell system size was planimetrically measured. RESULTS: Small baseline mastoid air cell system size was associated with young age at the time of first diagnosis of otitis media and small size of the child. Slow growth and small final size of mastoid air cell system related significantly with female gender and with slow overall growth of the child. Slow mastoid air cell system growth was observed in children who required several ventilation tubes during the follow-up period. Small final mastoid air cell system size correlated significantly with unfavorable otological outcome. CONCLUSION: The genetically determined development of mastoid air cell system is arrested in varying degree by environmental factors, particularly by an early onset of otitis media, a long-standing disease, and an unfavorable otological outcome. On the other hand, poor pneumatization seems to be a risk factor for chronic and recurrent infections and, ultimately, for a deficient otological outcome. However, in a vast majority of patients, this untoward development may be reversed by an early and, if needed, repeated tympanostomy.     

The growth rate and size of the mastoid air cell system and mastoid bone: a review and reference

This review suggests a reference to the postnatal growth of mastoid air cells and bone. Information was retrieved from studies having large consecutive age groups, in order to reveal a development pattern. Data regarding origin, gender, and antibiotic treatment was investigated as well. Most measurements were obtained by planimetry. Assessment of the various data sources suggested the antrum to be well developed at birth (1–1.5 cm²), the mastoid cells to be about 3.5–4 cm² at 1 year, followed by a linear growth till the age of 6 (1–1.2 cm²/year), having a slower increment up to adult size at puberty (~12 cm²). The mastoid bone expansion is about 0.6–0.9 cm/year in length and width and 0.4 cm/year in depth in the first year, followed by half that rate until the age of 6–7. At puberty there was a slower sprout reaching adult size. Different ethnic groups share similar mastoid aeration and bone growth patterns. There were no differences between mastoid aeration measured at the pre-antibiotic era and after its widespread use. In conclusion, there are three distinguishable phases of mastoid pneumatization from birth till reaching final size. Bone and air cell compartments share a similar growth pattern; bone expansion lags behind aeration. Antibiotic treatment for otitis may have no impact upon mastoid aeration.     

Recovery after tonsillectomy in adults: a three-week follow-up study.

OBJECTIVE: To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN: A prospective, longitudinal study of 102 patients undergoing tonsillectomy. METHODS: All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3-mg/kg continuous infusion over 24 hours, and oxycodone for rescue analgesia. Twenty-five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities. RESULTS: No pre-emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3-24 days) and the median of analgesic treatment was 12 days (range, 5-25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2-24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred. CONCLUSIONS: The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol-codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.     

The influence of pneumatization of mastoid bone on caloric nystagmus response. A clinical study and a mathematical model.

Pursuing the problem whether and why the pneumatization of mastoid bone has any influence on caloric nystagmus, we examined 15 large or extensively (L.P.) and 15 poorly (P.P.) pneumatized subjects. Following water irrigation (44 degrees and 30 degrees C, 30 sec) we checked the parameters maximum SPV, max. frequency, latency, duration and time of max. response by ENG recordings. Both groups differed significantly for all parameters except duration (p less than 0.001). On comparing these findings with an earlier proposed model (Bock & Bromm, 1977) we could show a good correspondence for the P.P. group by doubling the parameter 'thermal diffusivity of mastoid bone'. An even better correspondence could be found by diminishing the parameter 'coefficient of temperature changes by perfusion'. The theoretical and practical implications and conclusions of our findings are discussed.     

The hearing of the patients treated with hemodialysis: a long term follow-up study.

Sensorineural hearing loss is frequently found in the patients under the treatment with hemodialysis, but the responsible etiological factor(s) still remains controversial. The purpose of the present study was to determine by a long term follow-up study whether hemodialysis per se or other factors induce sensorineural hearing loss. Thirty-seven patients with the observation periods of 4 years or longer were selected for the analysis. Hearing tests were performed soon after the initiation of hemodialysis and every 3 to 12 months thereafter. Significant hearing loss was found in 16 cases (31 ears) at the first test. Although 3 cases (5 ears) of the initially normal group and one case (2 ears) of the group with already existing hearing loss exhibited significant hearing loss, the change in the hearing level was quite minimal in remaining 67 ears during the observation period. Although the cochlea in patients under the treatment with hemodialysis is susceptible to various insults, we conclude that hemodialysis per se does no harm to the cochlea and the hearing can be maintained at the pre-hemodialysis level in the majority of the cases.     

Defects in the bony wall of the mastoid bowl: a study based on staged intact canal-wall tympanoplasty.

The incidence and outcome of bony wall defects in the mastoid bowl were studied in 175 ears of 167 patients who underwent staged tympanoplasty by the intact canal-wall technique. In the first stage, the middle fossa dura was exposed iatrogenically in 38 ears and pathologically in eight ears through a defect at the tegmen. In the second stage, the bone defect was cured in 27 ears of the former group and in 3 ears of the latter group. The overall cure rate of the defect in the tegmen during these stages was 65.2 percent (30/46). Exposure of the sigmoid sinus or posterior fossa dura, which had occurred iatrogenically in 12 ears in the first stage, was cured in 11 ears (91.7%) in the second stage. Defects of the anterior wall of the mastoid bowl, i.e., the posterior wall of the external auditory canal, were recognized in 105 ears in the first stage, 91 of which involved pathologic defects of the tympanic scutum caused by cholesteatoma. In the second stage, these defects remained unhealed with cures occurring in only two ears (1.9%), in which a small hole had been created iatrogenically in the middle of the canal wall. Defects in the canal wall due to bone resorption following the first stage operation were noted in the second stage in 26 of 175 ears (14.9%).     

The effect of ketoprofen on recovery after tonsillectomy in children: a 3-week follow-up study.

OBJECTIVE: To evaluate recovery after tonsillectomy in children, and to determine the safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN: A prospective, longitudinal study in 102 children undergoing tonsillectomy. METHODS: All children underwent tonsillectomy under a same general anesthesia. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3-5 mg(-1) kg(-1) per 24 h for postoperative pain control at home, with paracetamol or paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, and all adverse events during recovery and return to normal daily activities. RESULTS: The median of pain cessation was 9 days (range 1-20 days) and the median duration of analgesic treatment was 10 days (4-19 days). More than 50% of the patients needed rescue analgesic daily during the first week after tonsillectomy. Ketoprofen combined with paracetamol or paracetamol-codeine provided sufficient analgesia for most children. However, the analgesic action of drugs was too short to achieve pain relief, which allow undisturbed sleep during the first postoperative nights. A return back to normal daily activities took place after 9 days (2-26 days). The influence of age for pain pattern was negligible. Five patients needed electrocautery to stop postoperative bleeding. No other serious adverse-events occurred. CONCLUSIONS: The main problem after tonsillectomy is significant pain that may last 9 days or longer after surgery. Ketoprofen combined with paracetamol-codeine seems to provide a sufficient analgesia, but before ketoprofen may be recommended for children during tonsillectomy a larger study is needed to show whether or not ketoprofen increases the hemorrhage rate.     

Laser management of oral leukoplakias: a follow-up study of 70 patients.

OBJECTIVES/HYPOTHESIS: To assess the efficacy of laser therapy for the management of premalignant oral lesions. STUDY DESIGN: The study group consisted of seventy consecutive laser-treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of all grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty-nine patients had some degree of microscopic dysplasia and six demonstrated high-risk proliferative verrucous leukoplakia. The clinical appearances of the lesions were white (homogeneous leukoplakia) in 48, red and white (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31-90 y). METHODS: Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used. RESULTS: There was no postoperative infection, hemorrhage, or paresthesia Two patients developed pyogenic granulomas in their surgical sites. Fifty-five of 70 patients were followed for more than 6 months; follow-up averaged 32 months (range 6-178 mo). Twenty-nine patients had complete control of their lesions; 19 patients had small recurrences removed with subsequent laser surgeries, leading to control; 2 patients had complete recurrences; and 5 patients developed squamous cell carcinoma at the lesion site. Verrucous lesions had an especially high rate of recurrence (83%), with 9 of 12 ultimately controlled with subsequent surgeries. CONCLUSIONS: Laser surgery of oral leukoplakia is an effective tool in a complete management strategy that includes careful clinical follow-up, patient education to eliminate risk factors and report suspicious lesions, and biopsy of suspicious lesions when appropriate. However, recurrence and progression to cancer remain a risk.     

乳突骨膜在鼓室成形术中的应用(附314例报告)

目的研究乳突骨膜在鼓室成形术中的应用.方法用乳突骨膜为314耳慢性化脓性中耳炎行鼓室成形术,术后随访2月～1年.结果治疗后2月内262耳愈合,30耳好转,22耳失败.结论乳突骨膜为良好的鼓室成形材料.     

Pneumocephalus secondary to mastoid surgery: a case report

Pneumocephalus secondary to mastoid surgery is uncommon. Serious sequelae and central nervous system infection may result from inadequate management. It is diagnosed by careful history, physical examination and imaging studies. Treatments of pneumocephalus secondary to mastoid surgery are conservative treatment or surgery. The aim of surgery is to detect communication between mastoid cavity and brain, and to correct it. We present a case of pneumocephalus secondary to mastoid surgery in 22-year-old man, which was treated with surgery.