ABSTRACT
BACKGROUND AND OBJECTIVES: Delayed facial nerve palsy (DFNP) following a middle ear surgery is an uncommon event, and is defined to develop 48 or 72 hours after surgery. The pathogenesis of DFNP is not known clearly, but it is presumed to inflammation, neuronal edema or reactivation of herpes virus. The purposes of this study were to provide the clinical aspect of DFNP after middle ear surgery and to discuss the prognostic factors and treatment plan. MATERIAL AND METHOD: From January 1985 to August 1999, in the course of over 5,670 middle ear surgeries, we experienced 12 ipsilateral delayed facial nerve palsies. We analyzed the course of DFNP according to several clinical factors retrospectively. Degree of facial palsy was evaluated with the House-Brackmann grade (HBG). RESULTS: DFNP was developed from 3 day to 14 day after middle ear surgery. The initial degree of facial palsy was HouseBrackmann grade (HBG) II in 6, HBG III in 4, and HBG IV in 2 patients. All patients were treated with steroid and volume expander. The final recovery were HBG I in 11 of the twelve patients. Remaining one patient was found to be HBG Il after a 5-year follow up. In the group who recovered within 1 month, the initial HBG were II or III. CONCLUSION: We obtained satisfactory results with steroid therapy in most patients. The courses of DFNP after middle ear surgery are favorable. The better initial HRG and HBG at 2 weeks are, the earlier recovery can be expected.
Subject(s)
Humans , Ear, Middle , Edema , Facial Nerve , Facial Paralysis , Follow-Up Studies , Inflammation , Neurons , Paralysis , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVES: The aim of this study is to analyze ciliary beat frequency (CBF)and ciliary morphology of the middle ear bulla and the upper respiratory tract in mice. MATERIALS AND METHODS: Fifteen mice with 37-42 gram weight were dissected and specimens were taken from the middle ear bulla, the eustachian tube, the inferior turbinate, the nasopharynx, and the upper trachea. The CBF of each specimen was measured using a video-computerized analysis system and the morphology of cilia was also studied using scanning electron microscopy (SEM). RESULTS: The measured CBF ranged from 9.38 Hz to 13.59 Hz, and there were no significant differences in the CBF values among the middle ear bulla, the eustachian tube, the inferior turbinate and the nasopharynx, except for the upper trachea. The mean CBF value of the upper trachea was 11.6 Hz, which was significantly lower than those of other parts. SEM showed that the cilia of the upper tracheal region were shorter than those of other parts. CONCLUSION: The CBF value of the middle ear bulla is similar to those of other parts in the upper respiratory tract except for the upper trachea. In the upper trachea, the CBF is lower and ciliary lenghth of epithelium is shorter than those of other parts.
Subject(s)
Animals , Mice , Cilia , Ear, Middle , Epithelium , Eustachian Tube , Microscopy, Electron, Scanning , Nasopharynx , Respiratory System , Trachea , TurbinatesABSTRACT
BACKGROUND AND OBJECTIVES: Facial nerve paralysis is a visible complication following acoustic neuroma surgery. The pro-gnostic factors which predict postoperative facial nerve function after acoustic neuroma surgery were investigated. MATERIALS AND METHODS:Fifty one patients with acoustic neuroma operated with neurotological approaches from March, 1987 to May, 1997 at Seoul national university hospital were studied by retrospective medical record review. Patient groups were divided according to surgical approach which were selected on the basis of tumor location and size as well as the need for hearing preservation. They were also divided according to the extent of tumor, preoperative facial nerve function, and tumor size. Under the House-Brackmann grading system, preservation of facial nerve function for each of the groups was analyzed before the operation, immediately after the operation (7th day), and at the time of last follow up (>12 month). The mean age of patients was 49.3 years, ranging from 29 to 72 years. Spearman Correlation analysis was used for statistical evaluation. RESULTS: The extent of tumor or different surgical approaches of tumor removal, such as translabyrinthine, transotic, middle fossa, and the combined approach, did not influence on facial nerve preservation. Pre-operative and immediate postoperative facial nerve functions as well as tumor size were important prognostic factors in the long term facial nerve function. As the size of tumor increased, the long term postoperative facial nerve function became poor. CONCLUSION: Early diagnosis and surgery are required for small size tumors in order to have good facial nerve function following acoustic neuroma surgery.
Subject(s)
Humans , Acoustics , Early Diagnosis , Facial Nerve , Follow-Up Studies , Hearing , Medical Records , Neuroma, Acoustic , Paralysis , Retrospective Studies , SeoulABSTRACT
BACKGROUND AND OBJECTIVES: Several studies have attempted to show the reasons for ototoxicity induced by cisplatin, but the cochlear ototoxicity remained poorly understood. Recently, it is considered that free radicals play an important role in cisplatin ototoxicity. Heat shock proteins (HSP) are consistently present at some level in normal tissues and increased synthesis following stress. They have been implicated in the role of cellular protection during sub-lethal stressors. Many studies have demonstrated the increased synthesis of HSP following hyperthermia, ischemia, surgical injury and noise exposure. Free radicals are also considered as important inducer of HSP. The purpose of this study was to demonstrate the increase of HSP after cisplatin injection. MATERIALS AND METHOD: Thirty six Albano guinea pigs were used in this study. The animals were injected with a dose of 8 mg/kg cisplatin intraperitoneally. Cochleae are harvested 1, 3, 5 or 6, 12, 24 hours after injection. Immunocytochemistry and surface preparation method were used to detect the expression of HSP 72 in the cochlear tissues. RESULTS: The level of HSP 72 immunoreactivity began increasing by 3 hours after injection and continued to increase thereafter to reach maximal levels at 6 hours. Twelve hours after injection, the level of HSP 72 seemed to decrease to its normal levels. The increase of HSP 72 was mainly detected in Deiters' cells. CONCLUSION: Cisplatin induces a HSP in the guinea pig cochlea, particularly in the organ of Corti. However, further studies including quantitative analysis should be followed.
Subject(s)
Animals , Cisplatin , Cochlea , Fever , Free Radicals , Guinea Pigs , Heat-Shock Proteins , Hot Temperature , HSP72 Heat-Shock Proteins , Immunohistochemistry , Intraoperative Complications , Ischemia , Noise , Organ of CortiABSTRACT
BACKGROUND AND OBJECTIVES: Successful management of malignant tumors involving temporal bone depends on the early identification and the localization of the primary tumor, and adequate management of the tumor. However, a large proportion of the cases are complicated with long standing chronic middle ear disease, early diagnosis and initiation of appropriate management are delayed in such cases. Based on the reviews of the literature and on our experiences from a small series of cases, treatment results following surgery with radiation and the basic principles of the management of malignant tumor involving the temporal bone are described. MATERIALS AND METHODS: Nine patients with malignancies of the middle ear and mastoid operated between 1984 and 1996 in Seoul National University Hospital were reviewed retrospectively. The follow up period was from 3 months to 9 years and median follow up was 1 year. RESULTS: Subtotal temporal bone resection was performed in all cases and subsequent radiation therapy was followed in 7 cases. The most frequent pathologic type was squamous cell carcinoma in 7 cases. Recurrence was detected in 3 cases, one case died postoperatively without recovery and one case died of CO poisoning 3 month postoperatively. Remaining 4 cases were followed without recurrence from 1 year to 8.5 years postoperatively. Three year disease-free survival rate was 42%. CONCLUSION: En-bloc subtotal temporal bone resection and subsequent radiation therapy are recommended treatment modalities of malignancies of the temporal bone in the absence of petrous apex involvement.
Subject(s)
Humans , Carcinoma, Squamous Cell , Disease-Free Survival , Ear, Middle , Early Diagnosis , Follow-Up Studies , Mastoid , Poisoning , Recurrence , Retrospective Studies , Seoul , Temporal BoneABSTRACT
BACKGROUND: The primary goal of the treatment of the malignancies of the external auditory canal (EAC) is to remove the primary tumor without recurrence and with maximal preservation of function. En-bloc resection with sufficient safety margin will reduce the recurrence rate, and partial temporal bone resection can achieve preservation of hearing and the facial nerve function when the tumor is confined to the EAC. OBJECTIVES: Authors reviewed the results of partial temporal bone resection for the malignancies of the EAC performed during the last 15 years. MATERIALS AND METHODS: Eight patients with malignancies of the EAC operated between 1982 and 1997 in Seoul National University Hospital were reviewed retrospectively. Partial temporal bone resection was performed in all cases and subsequent radiation therapy was followed in 4 cases. The duration of mean follow-up was 3 years and 6 months with the range of 4 months to 14 years. RESULTS: Seven out of 8 patients showed no evidence of recurrence during the follow-up period. One patient with squamous cell carcinoma showed local recurrence and it was treated with surgical resection. Five year disease-free survival rate was 86%. CONCLUSION: Malignant tumors of the EAC with the minimal involvement of surrounding structures can be successfully controlled using partial temporal bone resection with preservation of facial nerve and auditory function.
Subject(s)
Humans , Carcinoma, Squamous Cell , Disease-Free Survival , Ear Canal , Facial Nerve , Follow-Up Studies , Hearing , Recurrence , Retrospective Studies , Seoul , Temporal BoneABSTRACT
BACKGROUND AND OBJECTIVES: Despite the continued research on the pathology of Meniner's disease, it still remains largely uncertain. Since endolymphatic hydrops is known to occur in Meniner's disease, this study was conducted with experimentally induced endolymphatic hydrops. We evaluated the usefulness of click evoked otoacoustic emissions (CEOAE) and electro-cochleogram (ECoG) in studying endolymphatic hydrops. MATERIALS AND METHODS: Animal endolymphatic hydrops was induced in giunea pigs by mechanically obliterating the right endolympatic sacs and their ducts. The left ears were used as controls. In twelve weeks following the induction of endolymphatic hydrops, CEOAE and ECoG were measured. RESULTS: 1) The endolymphatic hydrops induced group responded to CEOAE with 33.3% positivity, whereas the control group responded with 87.6% positivity. The echo response and reproducibility were significantly low in the endolymphatic hydrops group, for which the negative echo response was more pronounced. For the CEOAE positive endolymphatic hydrops group, the average peak frequency of the response curves was shifted significantly to a higher frequency. 2) The tone burst stimulated ECoG response showed the permanant summating potential. The tone bursts with the intensity of 95 dB and frequencies of 4 or 8 kHz were found to be suitable stimuli for the study of endolymphatic hydrops. On click stimulation, the latency of the first negative peak (AN1) in the endolymphatic hydrops group was prolonged. The ratios of the summating potential amplitude to the action potential were observed to be significantly high.
Subject(s)
Animals , Action Potentials , Ear , Endolymphatic Hydrops , Guinea Pigs , Guinea , Pathology , SwineABSTRACT
BACKGROUND AND OBJECTIVES: Otogenic cerebrospinal fluid (CSF)fistula referrs to the abnormal communication between the CSF and the middle ear space due to defects in the inner ear, and is one of the causes of recurrent meningitis. MATERIALS AND METHODS: We report on five children with congenital otogenic CSF fistula, presented by recurrent meningitis and confirmed by surgical exploration. We also propose diagnostic steps for detecting otogenic fistula in the children based on our experiences and paper review. RESULTS: We used the metrizamide CT in the diagnostic procedure for most cases, although not all. The temporal bone CT was an useful initial diagnostic step for clinically suspicious cases. CONCLUSION: No one test or combination of specific tests were found to accurately predict the presence or absence of CSF fistula. It is thought that the only way to diagnose the CSF fistula is by surgical exploration. If the CSF fistula was suspected, aggressive diagnostic evaluation was needed in order to prevent recurrence.