高频率探测音鼓室压测试结合同侧声反射诊断中耳积液初探

通过临床流行病学的方法对７６例耳镜检查疑有ＭＥＥ的１０２耳的鼓室区测试结果的准确性进行评价。鼓室压图分别用２２６Ｈｚ和６７８Ｈｚ的探测音测试其声导和声纳，并同时测试同侧声反射阈，将测试结果与鼓膜穿刺结果进行比较：发现用６７８Ｈｚ探测音的声纳测试为诊断ＭＥＥ较好的测试方法：Ｂ６７８的Ｉ型图，无论声反射存在与否，均可视为无ＭＥＥ的批征，Ｂ６７８Ⅲ型图结合声反射〉１１５ｄＢ，则可作为有ＭＥＥ标志，而Ⅱ，     

Impedance audiometry in infants with a cleft palate: The standard 226-Hz probe tone has no predictive value for the middle ear condition

Objective

Infants with a cleft palate and microscopical evidence for middle ear effusion attracted our attention because of normal tympanometry results and negative otoacoustic emissions. These contradictory findings initiated us to study to what extent high frequency tampynometry is able to supply us with more reliable results.

Methods

Eighty-three ears of 46 cleft palate babies aged between 2 and 7 months were examined within the pedaudiological screening procedure via tympanometry before their surgical cleft closure. We applied probe tone frequencies of 226 Hz and 678 Hz. A control cohort of 69 ears of 36 babies without cleft palate was established. Results were later compared to the intraoperative findings.

Results

By tympanometry with a 226-Hz probe tone, the examiners predicted the intraoperative findings correctly in only 29 cases of 83 examined ears (34.9%). However, their interpretation of tympanometry results by means of a 678-Hz probe tone correlated to the intraoperative findings in 96.3% cases.

Conclusions

In cleft palate babies tympanometry with a 678-Hz probe tone yields clear evidence of middle ear effusion and should therefore serve as an essential instrument before the first surgical step of palate closure. In case of applying the 226-Hz probe tone, we were often confronted with normal function of the Eustachian tube despite of proved existence of middle ear effusion.     

Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review

We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18 months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.     

An immunological study of otitis media with effusion. Antibodies directed against coagulase-negative staphylococci in the effusion fluid

Summary From 14 chronic middle ear effusions (MEEs), 17 strains of coagulase-negative staphylococci (CS) were isolated. We then used an ELISA method to determine the antibody titers against these microorganisms in the corresponding effusion fluids and the blood sera of the patients and compared them to the antibody titers against a group of standard CS. In most cases, no specific immune response could be detected against the infecting CS in either the effusion fluids or in the sera. Our results can be explained by the inability of most CS strains to provoke a specific immune response in chronically inflamed middle ears due to their inhibition by non-specific antibodies, which reach the middle ear cavity by plasma leakage. The non-specific antibody titer against Staphylococcus hominis, however, seems to be much lower than against the other CS species. We found a high specific antibody titer against the infecting CS in the effusion fluid of a single case, but not in the serum. This finding supports the hypothesis that the middle ear mucosa has the ability to produce autonomous, local antibodies which are independent of a systemic immune response.     

How to improve the accuracy of diagnosing otitis media with effusion in a pediatric population

Objective

To determine the accuracy of pneumatic otoscopy, a tympanogram and otomicroscopy for diagnosing otitis media with effusion (OME) in a pediatric population.

Study design

Prospective blinded clinical and IRB-approved study at a secondary referral hospital.

Subjective and methods

Eighty-one children (155 ears) were recruited for this study, who were referred to my secondary referral hospital after OME was diagnosed at other primary clinics. The examiner was blinded for the findings of the diagnostic tools. Myringotomy under local anesthesia was used as the diagnostic reference standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the three diagnostic tools were calculated.

Results

Otomicroscopy was the most sensitive and specific tool among the three diagnostic tools. Otomicroscopy showed the best agreement with myringotomy (kappa = 0.784).

Conclusion

Otomicroscopy can make a more accurate diagnosis even for children who are seen at an outpatient clinic. The much higher specificity of otomicroscopy makes it the best confirmative test and its much higher positive predictive value can prevent a late diagnosis of OME, which can result in severe sequelae.     

Contribution of magnetic resonance imaging to the diagnosis of middle ear cholesteatoma: Analysis of a series of 97 cases

ObjectivesTo evaluate the reliability of magnetic resonance imaging (MRI) for the diagnosis of middle ear cholesteatoma and to determine the contribution of each MRI sequence.Patients and methodsA series of 97 cases was reviewed, corresponding to 89 patients (43 women, 46 men). Each patient was assessed by the following MRI protocol: T1-weighted, T2-weighted, early contrast-enhanced T1-weighted, delayed contrast-enhanced T1-weighted, and diffusion-weighted sequences. All patients were operated, for the first time in 16 cases and for second-look surgery in 81 cases. Radiological findings were compared to surgical and histological findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each sequence.ResultsSeventy-four cholesteatomas were diagnosed at surgery. These lesions had a mean diameter of 8.29 ± 5.46 mm. The smallest cholesteatoma in this series was 2 mm in diameter. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences had a sensitivity of 84.9% and 90.4%, a specificity of 87.5% and 75%, a positive predictive value of 95.4% and 91.7%, and a negative predictive value of 65.6% and 72%, respectively. T1-weighted, T2-weighted, and early contrast-enhanced T1-weighted sequences had a low specificity.ConclusionsMRI is a reliable imaging modality for the diagnosis of middle ear cholesteatoma. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences were discriminant. In the context of postoperative follow-up of cholesteatoma, these sequences allow better selection of cases requiring second-look surgery.     

An initial investigation into the validity of a computer-based auditory processing assessment (Feather Squadron)

Objective: This research investigates a novel method for identifying and measuring school-aged children with poor auditory processing through a tablet computer. Design: Feasibility and test-retest reliability are investigated by examining the percentage of Group 1 participants able to complete the tasks and developmental effects on performance. Concurrent validity was investigated against traditional tests of auditory processing using Group 2. Study sample: There were 847 students aged 5 to 13 years in group 1, and 46 aged 5 to 14 years in group 2. Results: Some tasks could not be completed by the youngest participants. Significant correlations were found between results of most auditory processing areas assessed by the Feather Squadron test and traditional auditory processing tests. Test-retest comparisons indicated good reliability for most of the Feather Squadron assessments and some of the traditional tests. Conclusions: The results indicate the Feather Squadron assessment is a time-efficient, feasible, concurrently valid, and reliable approach for measuring auditory processing in school-aged children. Clinically, this may be a useful option for audiologists when performing auditory processing assessments as it is a relatively fast, engaging, and easy way to assess auditory processing abilities. Research is needed to investigate further the construct validity of this new assessment by examining the association between performance on Feather Squadron and objective evoked potential, lesion studies, and/or functional imaging measures of auditory function.     

Thyroplasty type I under general anaesthesia with the use of the laryngeal mask and a waking period to assess voice

Objective

To evaluate a modified technique of type I thyroplasty using general anaesthetic with a laryngeal mask and then local anaesthetic.

Methods

General anaesthesia with a laryngeal mask is used while the delicate marking and windowing of the thyroid cartilage occurs. The patient is then woken, so that vocalisation can be associated to direct visualization with flexible scope to determine the size of prosthesis used to optimise vocal outcome.

Results

This modified technique was used in three patients where sedation would be unacceptable. All patients exhibited an improved voice post operatively. The mean maximum phonation time rose to 9.6, 10.6 and 9.3 s from 4.3, 4.6 and 5.3 s.

Conclusion

Using sedation for type I thyroplasty is not safe or acceptable in some patient groups. Using general anaesthetic with a laryngeal mask and then a shorter local anaesthetic provides a safe and effective alternative.