ABSTRACT
Abstract Introduction Observing the obliquity of stapes by closely scrutinizing the HRCT temporal bone in otosclerosis revealed a reliable and consistent finding. This finding can add to the existing radiological criteria in diagnosis of otosclerosis. Objective The objective of this study is to establish the obliquity of stapes in otosclerosis by radiological measurements using HRCT temporal bone by comparing: (a) the distance between the horizontal (tympanic) segment of facial nerve and stapes head in otosclerotic ears (study group) with non-otosclerotic ears (control group); and (b) the angle subtended by stapes with promontory in the study and control groups. Methods This is a prospective study performed after the institutional Ethics Committee clearance (IEC 3/2013). Results An increased mean distance between the horizontal segment of facial nerve and stapes head in otosclerotic patients (i.e., 2.49mm +/ 0.24mm SD), when compared with the non-otosclerotic patients (i.e., 1.46mm +/ 0.16mm SD) is noted. There is a change in angle (i.e., 64.550 +/ 7.190 SD) subtended by the stapes toward the promontory in otosclerotic ears when compared with that of controls (i.e., 99.700 +/ 40 SD). We applied the Mann-Whitney U non-parametric test and considered p value of < 0.0001 highly significant. Conclusions Obliquity of stapes in otosclerosis referred to as a "Pisa" sign by the senior author has diagnostic value as a new radiological sign in imaging of otosclerosis. This obliquity explains the torsional effect of otosclerosis on the ossicular chain. The findings correlate with late complications and failures in stapes surgery.
Subject(s)
Humans , Hearing Loss , Otosclerosis/diagnosis , Ear/anatomy & histology , Tomography, X-Ray ComputedABSTRACT
O objetivo deste trabalho foi analisar as medidas de reflectância em uma paciente com otosclerose. A paciente, do gênero feminino, 51 anos, apresentava queixa de hipoacusia bilateral e a hipótese diagnóstica de otosclerose. Foram realizados os seguintes testes de avaliação audiológica: imitanciometria, audiometria tonal, vocal e medidas de reflectância acústica, em ambas as orelhas. Por meio da análise dos resultados da reflectância acústica de banda larga, foi possível observar aumento na reflectância, característico de otosclerose, entre as frequências de 500 e 1500 Hz, e diferenciar a orelha esquerda e a orelha direita. As medidas de reflectância permitiram a obtenção de resultados detalhados por frequência que, em conjunto, possibilitaram a diferenciação entre as duas orelhas. O uso da reflectância de banda larga é sugerido para complementar o diagnóstico da otosclerose.
This research aimed to analyze the reflectance measurements in a patient with otosclerosis. The patient, female, 51 years old; she complained of bilateral hearing loss and had a diagnosis hypothesis of otosclerosis. The following audiological tests were performed in both ears: tympanometry, pure-tone audiometry, and speech audiometry tests and acoustic reflectance measurements. Through acoustic wideband reflectance analysis, it was possible to observe an increase in reflectance, such as is seen in otosclerotic ears, between the frequencies of 500 Hz and 1500 Hz and to differentiate the left and right ear. Acoustic reflectance measurements have the potential to yield results that allow the differentiation between the two ears; thus, the use of the wideband acoustic reflectance is suggested as a part of the otosclerosis diagnostic procedure.
Subject(s)
Humans , Female , Acoustic Impedance Tests/methods , Audiometry , Hearing Loss, Bilateral/diagnosis , Hearing Loss/diagnosis , Otosclerosis/diagnosis , Hearing Tests/methodsABSTRACT
Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.
Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.
Subject(s)
Humans , Male , Female , Diagnostic Techniques, Otological , Tympanic Membrane/anatomy & histology , Tympanic Membrane/pathology , Ear, External/physiopathology , Ear, Middle/physiopathology , Otoscopy/methods , Otoscopy , Otitis Externa/diagnosis , Otitis Media/diagnosis , Otosclerosis/diagnosis , OtoscopesABSTRACT
Introduction: Otosclerosis is a disease that produces a conductive hearing loss. It consists of an abnormal bone growth called otospongiosis that develops a stapes fixation. It is a hereditary disease but the specific cause is unknown. Its surgical management has shown good audiometric results and low complication rates. Aim: To describe the clinical experience in our Unit, with bilateral and unilateral surgeries in patients with Otosclerosis. Methods: A retrospective study on clinical charts revision. Results: 415 patients underwent surgery for Otosclerosis. 359 patients had a unilateral procedure and 56 patients had a bilateral surgery (13,5 percent). Mostly women (67,9 percent). There was no difference between the results of both ears. The Average air-conductive hearing improvement in the first surgery was 29,9 +/- 3,4 dB, and in the second surgery was 30,6 +/- 3,4 dB. The most frequent complication was the section of the chorda tympani (2 percent). Discussion: The surgical treatment for Otosclerosis is a safe procedure with excellent audiometrical results and low complication rates. Our results are similar to those in literature. The number of this procedure has increased every year in our institution and we have demonstrated that surgery in both ears is safe with good results.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Otosclerosis/surgery , Otosclerosis/diagnosis , Otosclerosis/epidemiology , Stapes SurgeryABSTRACT
Objetivo: Caracterización de la experiencia quirúrgica reciente en el tratamiento de la otoesclerosis.Materiales y método: Revisión sistemática de la historia clínica de pacientes operados por el autordurante el período enero 2005 a diciembre 2009. Resultados: Desde enero de 2005 a diciembre de 2009 se realizaron 246 cirugías de estribo en 201pacientes con diagnóstico de otoesclerosis en la Clínica Rivas de Bogotá, Colombia. 230 fueronprocedimientos de primera intervención y 16 de revisión. Se realizaron 213 estapedotomías y 19 estapedectomías. Se reportan en 50 intervenciones (20,3%) complicación perioperatoria siendo en su mayor proporción las relacionadas con desgarro de la membrana timpánica o piel del conductoauditivo externo (CAE) (56%), luxación de la platina (26%) y otras causas 18%.Conclusiones: Se corrobora la tendencia de incidencia de otosclerosis en la población de mujeres y es aún mayor en los casos operados bilateralmente. La estapedotomía es el procedimiento de elección para la cirugía de la otosclerosis en nuestros pacientes. La estapedectomía total o parcial se realizasólo en casos excepcionales. Importancia clínica: Consideraciones sobre la técnica quirúrgica. Accesibilidad a base de datos internacional de otología.
Objective: To characterize the recent surgical experience to treat otosclerosis.Materials and methods: systematic review of the surgical record of patients that have been operated on by the author during the period of January, 2005 to December, 2009. Results: From January, 2005 to December, 2009; 246 stapes surgeries were performed in 201 patients who had been diagnosed with otosclerosis at Clínica Rivas from Bogotá, Colombia. 230 of these werefirst time interventions and 16 of them were revisions. 213 stapedotomies were performed and 19 stapedectomies. Perioperatory complications were reported in 50 of the surgeries (20.3%). Out of those 50 surgeries the ones with the highest proportion were the ones related to tears of the tympanicmembrane or of the skin of the external auditory canal (EAC), (56%), dislocation of the foot plate (26%) and other causes 18%. Conclusions: A tendency for the incidence of otosclerosis is corroborated in the women populationand is even higher in those cases that have been bilaterally operated on. Stapedotomy is the procedure of choice to surgically treat our patients suffering from otosclerosis. Total or partial stapedectomy is performed under in exceptional cases. Clinical interest: Considerations on the surgical technique. Accessibility to an International Databaseof Otology.
Subject(s)
Otosclerosis/diagnosis , Otosclerosis/history , Otosclerosis/rehabilitation , Otosclerosis/therapyABSTRACT
A miringoesclerose é uma alteração cicatricial da lâmina própria da membrana timpânica caracterizada por proliferação de fibras colágenas, seguida de hialinização, deposição de cálcio e fósforo, seguindo uma seqüência semelhante ao que ocorre em outros tipos de calcificação patológica comuns em pacientes com doença renal crônica. OBJETIVO: Verificar a influencia da insuficiência renal crônica (IRC) na prevalência da miringoesclerose. MÉTODO: Foi realizada otoscopia em 341 pacientes com IRC em hemodiálise e em 356 indivíduos de um grupo controle. Foi comparada a freqüência de otoscopia positiva entre os dois grupos, procurando-se relacionar com variáveis pessoais e relacionadas a IRC. RESULTADOS: O grupo de pacientes apresentou 11,7 por cento de otoscopia positiva contra 5,1 por cento do grupo controle. Não houve influência do sexo ou cor na freqüência da miringoesclerose. Porém, os grupos foram heterogêneos em relação à faixa etária. Também não houve diferença importante no tempo de diálise nem nos níveis séricos de minerais e do PTH entre os pacientes do grupo de estudo que apresentavam otoscopia positiva ou negativa. CONCLUSÃO: Os achados, embora apontem para uma maior ocorrência da miringoesclerose nos pacientes renais crônicos, não nos permitem concluir com certeza que exista alguma relação entre a IRC e as alterações timpânicas.
Myringosclerosis is a scar of the tympanic membrane lamina propria, resulting from trauma or inflammation, characterized by proliferation of collagen, hyalinization, calcium and phosphate deposits and cartilaginous or osseous metaplasia of the middle ear mucosa, a sequence that is similar to that taking place in other types of pathologic calcification, common in chronic renal failure (CRF). AIM: To verify the influence of chronic renal failure on the prevalence of myringosclerosis. METHOD: The otoscopic examination was done in 341 chronic renal failure patients and in 356 normal control individuals. The frequency of positive otoscopies was compared between the two groups, based on individual variables and those pertaining to CRF. RESULTS: 11.7 percent of the patients had a positive otoscopy in the CRF group, compared to 5.1 percent in the control group. There was no statistical diference in the frequency of myringosclerosis acording to gender, ethnic group, time of dialysis or serum minerals. The groups had a wide age range. CONCLUSION: Although the findings of this study suggest a higher ocurrence of myringosclerosis in patients with renal disease, they do not provide a basis for stating that there is any relation between renal failure and tympanic alterations.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Kidney Failure, Chronic/complications , Otosclerosis/etiology , Tympanic Membrane/pathology , Case-Control Studies , Cross-Sectional Studies , Otoscopy , Otosclerosis/diagnosis , Sclerosis , Young AdultABSTRACT
A otospongiose é uma osteodistrofia do osso temporal caracterizada pela reabsorção e neoformação óssea desordenada. Clinicamente, caracteriza-se por disacusia condutiva, neurossensorial, e/ou mista, progressiva e zumbidos. O início dos sintomas ocorre entre 30 e 40 anos de idade sendo rara sua manifestação na infância. Descrevemos o caso de um paciente de 11 anos de idade, com quadro de hipoacusia unilateral progressiva há 5 anos. O exame otorrinolaringológico revelou mancha rubra de Schwartze em orelha esquerda. A audiometria, imitanciometria e a tomografia computadorizada demonstraram características sugestivas de otospongiose. Realizamos uma revisão dos aspectos clínicos, diagnósticos e da conduta terapêutica da otospongiose na infância.
Otospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartz's sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children.
Subject(s)
Child , Humans , Male , Otosclerosis/diagnosis , Diagnosis, Differential , Disease Progression , Hearing Tests , Hearing Loss, Sensorineural/etiology , Otitis Media/diagnosis , Otosclerosis/complications , Tomography, X-Ray Computed , Temporal BoneSubject(s)
Humans , Male , Adult , Ear Ossicles , Bone Neoplasms/complications , Ear Neoplasms/complications , Osteoma/complications , Otosclerosis/diagnosis , Hearing Loss, Conductive/etiology , Diagnosis, Differential , Bone Neoplasms/diagnosis , Ear Neoplasms/diagnosis , Osteoma/diagnosis , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Female , Otosclerosis/surgery , Otosclerosis/diagnosis , Audiometry , Prospective StudiesABSTRACT
La salida de líquido perilinfático y cefalorraquídeo a través de la platinotomía durante la cirugía del estribo ha recibido los nombres en inglés de "gusher" cuando es abundante y "oozer" cuando es escasa. Hemos conservando estos nombres por conocidos internacionalmente. Esto depende, al parecer, de la presencia de una comunicación anormal entre el vestíbulo y el espacio subaracnoideo, y de su sitio. Se presentan cinco casos con este tipo de fístula prelinfática, en pacientes con otosclerosis sometidos a estapedectomía. Se analiza la fisiopatogenia, los hallazgos transoperatorios, el manejo y los resultados audiométricos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Audiometry/statistics & numerical data , Audiometry/statistics & numerical data , Stapes Surgery , Fistula/physiopathology , Otosclerosis/diagnosis , PerilymphABSTRACT
El diagnóstico radiológico de la otoesclerosis de la otoespongiosis se hace necesario cuando la enfermedad ocasiona solamente hipoacusia sensorineural, ya que solo así se justifica el tratamiento con fluoruro de sodio. Para evaluar la utilidad de la tomografía computada con densitometría de la cápsula laberíntica, se estudiaron siete huesos temporales de cuatro pacientes que en vida habían sido diagnosticados como otoescleròsos, inclusive con estudios de politomografía. Los huesos fueron estudiados con CT y densitometría y posteriormente fueron montados en celoidina y seccionados para su estudio histopatológico. Las lesiones encontradas fueron correlacionada con las imágenes tomográficas. Las imágenes con densidad mayor que 2000 U.H. correspondieron con focos de otoesclerosis, excepto cuando se encontraban en la zona entre el conductor auditivo interno y la vuelta basal de la cóclea, en donde normalmente el hueso es muy denso. En un hueso temporal se encontró una imagen de baja densidad en la pared externa de la cóclea que correspondío a hueso medular hematopoiético. Las lesiones grandes de otoespongiosis muestran densidades menores que 800 U.H. y habitualmente están rodeadas de hueso denso.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Histology , Otosclerosis/diagnosis , Tomography, X-Ray Computed , Deafness/etiology , Deafness/physiopathology , Otosclerosis , Temporal Bone , Temporal Bone/physiopathologyABSTRACT
Os autores fazem estudo do estado atual de conhecimentos sobre a doença de Ménière. Tecem considerações sobre o exame do aparelho vestibular, o que quer dizer, o estudo dos sistemas vestíbulo-espinhal e vestíbulo-oculomotor. Fazem referência a doença de Ménière não idiopática e apreciação sobre as causas, exames subsidiários e diagnóstico diferencial. Foram estudados 83 casos
Subject(s)
Humans , Diagnosis, Differential , Meniere Disease/diagnosis , Meniere Disease/etiology , Endolymphatic Hydrops/diagnosis , Endolymphatic Hydrops/etiology , Hypersensitivity/complications , Neuritis/diagnosis , Otosclerosis/diagnosis , Syphilis, Congenital/diagnosis , Vestibule, Labyrinth/physiopathologyABSTRACT
Dermatoglyphic analysis was performed on a total of 142 children, 50 normal, 30 mentally retarded, 38 with impaired vision and 24 with impaired hearing. The purpose of this study is to investigate whether the dermatoglyphic deviation is characteristic enough to be applied for a diagnostic purposes. The results of the data show some differences between these groups but the significance of these differences is not clear