The impact of malleus processing in ossicular chain reconstruction on the therapeutic effect in patients with tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of different malleus treatments on the postoperative efficacy in the tympanosclerosis patients receiving ossicular chain reconstruction.@*METHOD@#Fifty-nine patients (62 ears) with tympanosclerosis were treated by ossicular chain reconstruction. All the patients were divided into three groups, including malleus removal group (A, 24 ears), retaining only the malleus handle group (B, 18 ears) and the intact malleus group (C, 20 ears). All the patients were followed up 3 months pre-operation, 3 months and 1 year post-operation by audiometric measurement (the average hearing threshold at 0.5, 1.0, 2.0 kHz HI). Tympanic membrane was examined by ear endoscope.@*RESULT@#The pre-operation mean air bone gap (ABG) in these groups were 40.07 +/- 77.56 dB, 37.31 +/- 76.45 dB, and 36.75 +/- 76.72 dB, among which the difference had no statistical significance (P > 0.05). At 3 months after operation, the ABG in all cases was improved at 0.5, 1 and 2 kHz. The difference of ABG improvement among these three groups had no statistical significance (P > 0.05). One year after surgery, the ABG of the three groups were decreased by 17.92 +/- 9.28 dB, 16.76 +/- 5.19 dB and 10.58 +/- 7.38 dB respectively. The hearing improvement in group C is less than the other two groups (P = 0.03, P = 0.016). The difference of hearing improvement between group A and group B had no statistical significance(P > 0.05). Group A and group B each have one case of tympanic membrane perforation and artificial ossicle falling off.@*CONCLUSION@#The operating processes of malleus in ossicular chain reconstruction of patients with tympanosclerosis were introduced. In terms of short-term efficacy, the three groups showed no significant difference. However, the long-term efficacy of the patients in the group A and group B were better compared with the group C.

Applied anatomy of facial recess and posterior tympanum related to cochlear implantation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the related parameters of temporal bone structure in the surgery of cochlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization.@*METHOD@#In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope.@*RESULT@#Distance between suprameatal spine and short process of incus was (12.44 +/- 0.51) mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was (2.67 +/- 0.51) mm. Distance between short process of incus and crotch of chorda tympani nerve was (15.22 +/- 0.83) mm. The location of maximal width of the facial recess into short process of incus, crotch of chorda tympani nerve were (6.28 +/- 0.41) mm, (9.81 +/- 0.71) mm, respectively. The maximal width of the facial recess was (2.73 +/- 0.20) mm. The value at level of stapes and round window were (2.48 +/- 0.20 mm) and (2.24 +/- 0.18) mm, respectively. Distance between pyramidalis eminence and anterior round window was (2.22 +/- 0.21) mm. Width from stapes to underneath round window was (2.16 +/- 0.14) mm.@*CONCLUSION@#These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.

Applied anatomy of scala tympani inlet related to cochlear implantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the related parameters of the temporal bone structure for determining the position of implanting electrode into the scala tympani in cochlear implantation surgery through the facial recess and epitympanum approach.</p><p><b>METHODS</b>In a surgical simulation experiment, 20 human temporal bones were studied and measured to determine the related parameters of the temporal bone structure.</p><p><b>RESULTS</b>The distance 5.91∓0.29 mm between the short process of the incus and the round window niche, 2.11∓0.18 mm between the stapes and the round window niche, 6.70∓0.19 mm between the facial nerve in the perpendicular paragraph and the round window niche, 2.22∓0.21 mm from the pyramidal eminence to the round window, and 2.16∓0.14 mm between the stapes and the round window. The minimal distance between the implanting electrode and the vestibular window was 2.12∓0.19 mm. The distance between the cochleariform process and the round window niche was 3.79∓0.17 mm. The position of the cochlear electrode array insertion into the second cochlear turn was 2.25∓0.13 mm under the stapes. The location of the cochlear electrode array insertion into the second cochlear turn was 2.28∓0.20 mm inferior to the pyramidal eminence.</p><p><b>CONCLUSION</b>These parameters provide a reference value to determine the different positions of cochlear electrode array insertion into the scale tympani in different patients.</p>

Electron-Microscopic Studies in Guinea Pig with Tympanosclerosis / 听力学及言语疾病杂志

Objective To study the middle ear mucosa of guinea pigs with tympanosclerosis by electron microscope and try to obtain some insights into the feature and pathogenesis of tympanosclerosis.Methods Eight healthy variegated guinea pigs were devided into 2 groups.Six(8 ears) guinea pigs were subjected to inoculation of 1×10~8/L of staphylococcus aureus solution 100 μl into the middle ear cavities under the microscope.All the guinea pigs were observed for more than 6 months with no farther treatment.For electron-microscopic studies,the mucosa tissues were taken from the tympanic mucosa in 6 guinea pigs (8 ears) with tympanosclerosis from various sites,while the middle ear mucosa of two healthy guinea pigs (4 ears) were taken as a control.Results Uhrastructural examination of the normal middle ear mucosa revealed a few collagen fibers,normal morphous of fibrocyte,rough endoplasmic reticulum and mitochondria,and there was no lysosome.However,the tympanosclerosis specimens showed that irregular deformation,elongation,and degeneration of fibrocytes and oval nucleus were darkly stained,lots of mitochondria and lysosomes gathered into the cytoplasm around the nuclear and cystic expansion of the endoplasmic reticulum.In the submucosa extracellular matrix,there were a large number of collagen fibers containing lots of amorphous high-density electron-rich body.Conclusion Electron-microscopic studies of the middle ear mucosa of guinea pigs with tympanosclerosis revealed evident proliferation of collagen fibers,and calcifications were seen in the structures such as extracellular matrix vesicle,lysosomes,myelin structures within lipid granules,which mainly in extracellular matrix vesicles.

Long-term results of endolymphatic sac decompression and endolymphatic-mastoid shunting for Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy of endolymphatic sac surgery for Meniere's disease, and compare the effects of endolymphatic sac decompression with endolymphatic-mastoid shunting.@*METHOD@#Twelve patients(13 ears) undergoing endolymphatic-mastoid shunting and eleven patients (11 ears) undergoing endolymphatic sac decompression were retrospectively compared for hearing results and vertigo controlled rates. All of them have been followed up for more than two years after surgery.@*RESULT@#According to Chinese Meniere's disease diagnosis and curative effect standard evaluation criteria published in 2006, for vertigo symptom of endolymphatic mastoid shunting group, 9 cases (69.2%) achieved grade A(completely controlled), 4 cases (30.8%) achieved grade B (fundamentally controlled). There were 8 cases (72.7%) with grade A, 2 cases (18.2%) with grade B and one case (9%) with grade C among 11 patients who received endolymphatic sac decompression. There was not statistically significant differences in postoperative speech pure tone average and vertigo controlled rate between the two groups.@*CONCLUSION@#Endolymphatic sac decompression and endolymphatic-mastoid shunting are effective management with less complication for intractable Meniere's disease. Particularly, the vertigo symptoms were controlled significantly. Patients with Meniere's disease in advanced clinical stages may also be relieved.

Experience of 76 cases of large vestibular aqueduct syndrome, clinical diagnosis and treatment / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the disease incidence, clinical symptoms, prevention and treatment measures of the large vestibular aqueduct syndrome (LVAS).@*METHOD@#Retrospective analyse the medical history, hearing, vestibular function examination and treatment of 76 LVAS patients who were diagnosed in our department of Otolaryngology from 2002 to 2008.@*RESULT@#Most patients (93.4%) showed sensorineural hearing loss. Part of patients (61.8%) showed air-bone conduction gap in low frequency. The hearing loss of 43 ears is > 40-60 dB HL, > 60 -80 dB HL 47 ears, > 80 dB HL 62 ears. Decline curve is the characteristic of the Audiogram. The decline in high-frequency 112 ears, flat curve in 29 ears, island hearing in 11 ears. Forty-six patients were conducted the vestibular function examination, which showed low vestibular function. Tympanogram showed that 141 ears are type A, 11 ears are type C. High-resolution CT scan revealed that vestibular aqueduct minimum diameter is 2.2 mm and the largest is 6.2 mm, with a wide opening and deep narrower, and showed the "triangle" or "flared". Forty-two cases of this group were simple dilatation of the vestibular aqueduct, and no large vestibular semicircular canal malformation or cochlear malformation. There was no intellectual and other development disorders. In accordance with the degree of hearing loss, 20 cases of patients restored hearing after drug treatment. Eleven were cases fit a suitable hearing aid and carried out the language rehabilitation training. Forty-five very severe patients were implanted the cochlear and mapping one month later.@*CONCLUSION@#Fluctuative and progressive hearing loss is the main clinical symptoms of large vestibular aqueduct syndrome. The patients should be examined by high resolution CT scan of the temporal bone. There is no precise and effective treatment for the disease. It is very important for the deaf children who have residual hearing to fit hearing aids and carry out the language rehabilitation training as soon as possible. As for the patients who suffer from hearing loss severely and the hearing aid cannot achieve effective compensation, the cochlear implant should be considered.

The Clinicopathologic and Electron-microccopic Characteristics of Patients with Tympanosclerosis / 听力学及言语疾病杂志

Objective The light and electron-microscopic examination was utilized to study the tissue from middle ears diagnosed as having tympanosclerosis. The main purpose of this article is to understand the clinicopathologic and electron-microscopic characteristics of 68 patients with tympanosclerosis. Methods The material for histopathologic and electron-microscopic studies were taken from the tympanic mucosa in various localities, especially from the whitish sclerotic masses in the tympanum of the patients with tympanosclerosis, during middle ear surgeries between 2006 and 2008. Specimens were divided into two groups: one group of 68 specimens was fixed and stained for light microscopic study with hematoxylin-eosin; the second group of 12 specimens was viewed in the electron microscope. Results The specimens from tympanic mucosa showed granulation tissue with infiltration of chronic inflammatory cells, and slight fibrosis in the submucosal layer. The histopathology of the plaques after haemaoxylin and eosin staining revealed dense bundles of collagen with hyaline degeneration and scattered areas of calcification. An ultrastructural examination of these specimens revealed fibrocytes that were irregularly shaped, elongated, and degenerating. The osmiophilic cytoplasm contained vesicles and collagen bundles. There were clusters of mitochondria in perinuclear cytoplasm and lots of electron dense calcareous deposits within lysosomes and degenerated mitochondria in fibrocyte cells. Conclusion The histopathologic examinations of tympanosclerosis revealed dense fibrous and collagenous connective tissues, poor in cell, with hyaline degeneration and occasional calcification in the tympanic mucosa. Electron-microscopic studies further revealed marked proliferation of collagen fibers and electron dense calcareous deposits within lysosomes and degenerated mitochondria in fibrocyte cells.

Long-term results of endolymphatic sac decompression and endolymphatic-mastoid shunting for Meniere's disease / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the efficacy of endolymphatic sac surgery for Meniere's disease,and compare the effects of endolymphatic sac decompression with endolymphatic-mastoid shunting.Method:Twelve patients(13 ears)undergoing endolymphatic-mastoid shunting and eleven patients (11 ears) undergoing endolymphatic sac decompression were retrospectively compared for hearing results and vertigo controlled rates.All of them have been followed up for more than two years after surgery.Result:According to Chinese Meniere's disease diagnosis and curative effect standard evaluation criteria pubilished in 2006,for vertigo symptom of endolymphaticmastoid shunting group,9 cases(69.2%) achieved grade A(eompletely controlled),4 cases (30. 8%) achieved grade B(fundamentally controlled).There were 8 cases(72.7%)with grade A, 2 cases (18.2%)with grade B and one case(90% ) with grade C among 11 patients who received endolymphatic sac decompression.There was not statistically significant differences in postoperative speech pure tone average and vertigo controlled rate between the two groups.Conslnsion:Endolymphatic sac decompression and endolymphatic-mastoid shunting are effective management with less complication for intractable Meniere's disease. Particularly,the vertigo symptoms were controlled signifisantly. Patients with Meniere's disease in advanced clinical stages may also be relieved.