Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears / Avaliação endoscópica das variações anatômicas da orelha média em uma série de autópsias: análise de 204 orelhas

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.

Influência da retroalimentação auditiva nos parâmetros acústicos vocais de indivíduos sem queixas vocais / Influence of auditory feedback in the vocal acoustic parameters of individuals without vocal complaints

RESUMO Introdução: A qualidade da emissão vocal é dependente da integridade do mecanismo de retroalimentação auditiva. A presença de eventuais falhas nesse mecanismo está relacionada à indução do abuso e/ ou mau uso vocal e, por conseguinte, do surgimento de quadros de disfonia. Objetivo: Avaliar a influência da retroalimentação auditiva na intensidade e na frequência da voz, em indivíduos sem queixas vocais. Métodos: Participaram da pesquisa 40 sujeitos do gênero feminino, sem queixas vocais e com limiares auditivos dentro dos padrões de normalidade. As participantes foram submetidas a uma avaliação auditiva, composta por audiometria tonal liminar, imitanciometria e por uma avaliação acústica vocal dos parâmetros de intensidade e frequência, realizada em três momentos: antes, durante e após a exposição ao ruído branco. Resultados: Houve diferença significativa na relação das médias obtidas na intensidade e entre o limiar dos reflexos acústicos contralaterais e as frequências vocais, nos três momentos da avaliação acústica. Conclusão: Os achados sugerem que a retroalimentação auditiva interfere no controle da intensidade e frequência vocal.

ABSTRACT Introduction: The quality of the vocal emission is dependent on the integrity of the auditory feedback mechanism of the presence of eventual failures is related to the induction of abuse and / or vocal misuse, and therefore of the surgeon of dysphonia. Purpose: To evaluate the influence of auditory feedback in voice intensity and frequency in individuals with no vocal complaints. Methods: Participants were 40 female subjects without vocal and auditory thresholds within normal standards complaints. Participants underwent an auditory evaluation composed of pure tone audiometry, tympanometry and a vocal acoustic assessment of intensity and frequency parameters, carried out in three stages: before, during and after exposure to white noise. Results: There was significant difference in the average of the ratio obtained in intensity and between the threshold of contralateral acoustic reflexes and vocal frequencies in the three moments of acoustic evaluation. Conclusion: Thus, the findings suggest that auditory feedback interferes with the control of the intensity and vocal frequency.

Phylogenic Oto-stomatognathic Connection of the Mammalian Jaw: A Novel Hypothesis for Tensor Tympani Muscle and TMD-related Otologic Symptoms / 체질인류학회지

Otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss, are known to be related to temporomandibular disorders (TMDs). There have been several hypotheses regarding the clinical correlation between otologic complaints and TMDs, based on clinical phenomena with corresponding symptoms, the close neurological relationship between otic and masticatory structures, and anatomical features of the tympanic cavity and jaw joint. Function of the tensor tympani muscle seems to be crucial to understanding TMD-related otologic symptoms. The tensor tympani inserts into the handle of the malleus and it modulates sound transduction in situations of excessive noise. This muscle is innervated by the trigeminal nerve, like the masticatory muscles. Voluntary eardrum movement by pathological tensor tympani contraction results in various otologic symptoms. Thus, co-contraction of the tensor tympani with the masticatory muscle could be a possible cause of TMD-related otologic symptoms. The tensor tympani is rather unrelated to the acoustic reflex, in which the stapedius is strongly involved. The tensor tympani seem to be controlled by proprioceptive information from the trigeminal sensory nucleus. The peripheral innervation pattern of the tensor tympani and masticatory muscles is also supposed to be interconnected. The middle ear structure, including the malleus, incus, and tensor tympani, of mammals had been adapted for acoustic function and lacks the masticatory role seen in non-mammalian jawed vertebrates. The tensor tympani in non-mammals is one of the masticatory muscles and plays a role in the modulation of sound transduction and mastication. After the functional differentiation of the mammalian middle ear, the nervous connection of the tensor tympani with other masticatory apparatus still remains. Through this oto-stomatognathic vestige, the tensor tympani seems to contract unnecessarily in some pathological conditions of the TMD in which the masticatory muscles contract excessively. We hypothesized that the phylogenic relationship between the tensor tympani and masticatory apparatus is a significant and logical reason for TMD-related otologic complaints.

The clinical application of objective hearing monitoring technology in cochlear implants / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Compare the clinical characteristics and application value between elcetrically evoked stapedius responses and neural response telemetry.@*METHOD@#Select number 1, 7, 11, 17, 22 electrodes from 21 cochlear implanting nucleus 24R cochlear implants, using NRT3.0 software provided by Cochlear corporation to test the threshold of elcetrically evoked stapedius responses and neural response telemetry during operation and subjective psychological physical test after operation repectively named elcetrically evoked stapedius responses threshold, electrically evokded compound aciton potentials threshold, and T-levels. Respectively study the correlations of ESRT, ECAP threshold, and T-levels.@*RESULT@#The detection rates of ESRT, NRT, and T-levels were 96.19%, 93.33%, 100%. The mean thresholds of ESRT were 206.61 +/- 10. 74, 208.48 +/- 13.64, 205.52 +/- 14. 63, 203.76 +/- 12.97, 199.50 +/- 11.19; The mean thresholds of NRT were 184.11 +/- 6.35, 188.55 +/- 11.70, 187.00 +/- 12.29, 181.85 +/- 13.22, 179.00 +/- 10.50; The mean thresholds of T levels were 145.48 +/- 18.66, 148.62 +/- 8.22, 146.62 +/- 18.08, 142.52 +/- 13.11, 140.33 +/- 13.68. The mean thresholds of ESRT in each electrode were rather greater than that of T-levels. There is a high degree of consistency in the mean thresholds of ES RT, NRT and T-levels. The test time, test means, unilaterally detection rate during operation, ESR is better than NRT. All the electrodes were set as observation objects, the correlation of ESRT and NRT is 0.69, the correlation of NRT and T is 0.62, and the correlation of ESRT and T is 0.39.@*CONCLUSION@#The application of elcetrically evoked stapedius responses and neural response telemetry during operation can rapidly estimate wether the implant is in good condition and the pathway is normal. Rather than neural response telemetry, elcetrically evoked stapedi us responses is more flexible, convienient, accurate and visual, while it is more objective superiority after operation especially for young children for the former detector.

Distribution of elastic fibers in the head and neck: a histological study using late-stage human fetuses / 대한해부학회지

There is little or no information about the distribution of elastic fibers in the human fetal head. We examined this issue in 15 late-stage fetuses (crown-rump length, 220-320 mm) using aldehyde-fuchsin and elastica-Masson staining, and we used the arterial wall elastic laminae and external ear cartilages as positive staining controls. The posterior pharyngeal wall, as well as the ligaments connecting the laryngeal cartilages, contained abundant elastic fibers. In contrast with the sphenomandibular ligament and the temporomandibular joint disk, in which elastic fibers were partly present, the discomalleolar ligament and the fascial structures around the pterygoid muscles did not have any elastic fibers. In addition, the posterior marginal fascia of the prestyloid space did contain such fibers. Notably, in the middle ear, elastic fibers accumulated along the tendons of the tensor tympani and stapedius muscles and in the joint capsules of the ear ossicle articulations. Elastic fibers were not seen in any other muscle tendons or vertebral facet capsules in the head and neck. Despite being composed of smooth muscle, the orbitalis muscle did not contain any elastic fibers. The elastic fibers in the sphenomandibular ligament seemed to correspond to an intermediate step of development between Meckel's cartilage and the final ligament. Overall, there seemed to be a mini-version of elastic fiber distribution compared to that in adults and a different specific developmental pattern of connective tissues. The latter morphology might be a result of an adaptation to hypoxic conditions during development.

Reflexo estapédico em portadores de paralisia facial periférica antes e após intervenção fonoaudiológica / Stapedial reflex in patients with facial paralysis before and after phonoaudiological intervention

Objetivo: Comparar as características do reflexo estapédico em portadores de paralisia facial periférica (PFP) após o diagnóstico bucomaxilofacial e após fonoterapia. Material e Métodos: Cinco sujeitos com diagnóstico de PFP participaram da pesquisa. Os participantes foram submetidos a audiometria e, após confirmada a normalidade auditiva, imitanciometria (timpanometria e reflexo estapédico). Os sujeitos foram submetidos a fonoterapia (por, no máximo, três meses) e,posteriormente, realizaram nova imitanciometria, a fim de se comparar os resultados do reflexo estapédico com o primeiro exame. Resultados: Anteriormente à fonoterapia, foi verificada ausência de reflexo estapédico nas frequências de 500, 1.000, 2.000 e 4.000Hz em todos os participantes.Após a fonoterapia, foi verificado retorno do reflexo em umaou mais frequências em quatro pacientes. Conclusões:Possivelmente, a fonoterapia promoveu o retorno da presençade reflexos estapédicos, inicialmente, na frequência de 500Hze se estendendo à frequência de 1.000Hz. A imitanciometria,ao revelar o retorno da função do músculo estapédio, pode fornecer dados ao fonoaudiólogo com relação ao planejamento terapêutico do paciente com PFP.

Objective: To compare the stapedial reflex characteristics inpatients with facial paralysis after bucomaxilofacial diagnosisand phonoaudiological therapy. Material Method: Five peopleparticipated in the study. They were submitted to anaudiometry exam, and after normal hearing confirmation, toan imitanciometry (timpanometry and stapedial reflex).Subsequently to the exams, the subjects were submitted tophonoaudiological therapy, and then submitted to a newimitanciometry to be compared with the first exam results.Results: Previously to the phonoaudiological therapy, it wasverified absence of stapedial reflex in the frequencies 500;1,000; 2,000 and 4,000Hz in all subjects. After thephonoaudiological therapy, it was verified a stapedial reflexreturn in four people. Conclusions: The phonoaudiologicaltherapy possibly promoted the return of normal stapedialreflex physiology, initially in 500Hz frequency, extending to1,000Hz. The imitanciometry, revealing that return, mayprovide important information to the phonoaudiologist relatedto the therapeutic planning of people with facial paralysis.

Human oscicular chain articulations: asymmetric sound transmission / Articulaciones de la cadena oscicular humana: transmisión asimétrica del sonido

The mechanism for conducting acoustic energy via middle ear oscicles is still a controversial topic and will remain so until consensus is reached regarding whether it amplifies or reduces sound transmission. 22 paired human temporal bone blocks and 1 left block were studied. Digital measurements were taken of the tympanic membrane, oscicular articulations and the oval window; the results were then correlated. A relationship of non-lineal areas was found amongst the structures being studied, suggesting a sound transmission relationship combining both sound reduction and amplification. A complex relationship of levers could be observed originating in an oscicular and articular asymmetric relationship suggesting an amplifying function in initial sound transmission and also a final reducer destination for such conduction.

El mecanismo para conducir la energía acústica a través de oscículos del oído medio es todavía un tema controvertido y lo seguirá siendo hasta alcanzar un consenso con respecto a si se amplía o reduce la transmisión del sonido. Fueron estudiados 22 pares de bloques de hueso temporal izquierdo y uno derecho hmanos. Mediciones digitales fueron tomadas de la membrana timpánica, articulaciones osciculares y de la ventana oval, siendo estos resultados correlacionados. Una relación de las áreas no-lineal se encontró entre las estructuras, lo que sugiere una relación de transmisión de sonido que incluye tanto la reducción de sonido y amplificación. Una compleja relación de las palancas se pudo observar originando una relación oscicular y articular asimétrica, lo que sugiere una función de amplificación de la transmisión del sonido inicial y también un destino reductor final para su conducción.

Fístula perilinfática traumática: entidad otorrinolaringológica poco frecuente / Traumatic perilymphatic fistula: a rare otorhinolaryngological entity

La fístula perilinfática corresponde a una patología infrecuente en la práctica otorrinolaringológica diaria. Esta puede tener un origen congénito, de aparición espontánea o más frecuentemente postraumática, presentando habitualmente la triada clínica de hipoacusia, tinnitus y vértigo. A continuación se presenta el caso clínico de una paciente de 50 años atendida en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile, ingresada por un cuadro con clínica compatible, de inicio súbito luego de una perforación timpánica traumática autoinferida.

Perilymphatic fistula is an infrequent pathology in standard otorhinolaryngological practice. Fistulas of this sort may be of congenital, spontaneous or, more frequently post traumatic origin, normally presenting with the clinical triad of hearing loss, tinnitus and vertigo. The case of a 50 year old patient presenting with clinically compatible symptoms of sudden appearance after a self-infringed traumatic tympanic perforation is discussed.

Achados audiológicos em indivíduos com distrofia miotônica de Steinert / Audiologic findings in individuals with Steinert's myotonic dystrophy

Objetivo: Identificar as principais alterações audiológicas em indivíduos portadores de distrofia miotônica de Steinert. Métodos: Cinco indivíduos foram submetidos à audiometria tonal e vocal, imitanciometria, teste de função tubária, pesquisa do reflexo estapediano, declínio do reflexo acústico e aplicação de dois questionários: a) Desempenho da função auditiva; b) Investigação psico-acústica-social. Resultados: O estudo demonstrou que 60 por cento da amostra apresentaram limiares auditivos dentro dos padrões de normalidade, 10 por cento perda condutiva e 30 por cento perda auditiva nas freqüências altas. Em relação aos reflexos estapedianos, observou-se o percentual de alteração de 30 por cento nas freqüências de 0,5 e 1 kHz e de 40 por cento em 2 e 4 kHz. Observou-se declínio do reflexo acústico em 10 por cento da amostra nas freqüências de 0,5 e 1 kHz. Conclusão: O estudo mostrou que o padrão audiológico típico de perda auditiva em freqüências altas foi observado em 30 por cento da amostra.

Purpose: To identify the main hearing disorders in individuals with Steinert's myotonic dystrophy. Methods: Five individuals were submitted to tonal and vocal audiometry, acoustic impedance tests, examination of Eustaquian tube function, acoustic reflex investigation,and acoustic reflex decay. They also answered two questionnaires: a) Performance of auditory function; b) Psycho-acoustic-social investigation. Results: The study showed that 60 percent of the sample presented normal hearing thresholds, 10 percent had conductive hearing loss and 30 percent had hearing loss in high frequencies. Concerning acoustic reflexes, it was observed that 30 percent of the subjects presented deficits at 0.5 and 1 kHz and 40 percent at 2 and 4 kHz. Acoustic reflex decay was observed in 10 percent of the sample at 0,5 and 1 kHz. Conclusion: The study showed that the typical auditory profile of high-frequencies hearing loss was observed in 30 percent of the sample.

Propofol has minimal or no effect on the threshold of the acoustically evoked stapedius reflex

Today cochlear implantation is a widely used therapeutic approach for the treatment of deafness and severe hearing disorders. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. Intraoperatively measured stapedius reflex [SR] threshold values are routinely used for programming the speech processor. However, anaesthetic agents can increase the SR threshold up to total blockade. Unlike previous studies, which used various anaesthetic combinations, the aim of the present study was to evaluate substance-specific effects of propofol on the threshold of the acoustically evoked SR in normal hearing. Subjects Twenty patients undergoing elective ENT surgical procedures participated in this study. On the day before surgery, pure tone audiogram and immitance metry were done to help proper selection of patients. None of the patients received any premedication. Anaesthesia was induced with i.v. propofol in a dose of 1.5-2.5mg/kg BW. After induction of anaesthesia and loss of eyelid reflex, tympanometry and ipsilateral and contralateral SR measurement were performed. Statistical analysis included the arithmetic mean, standard deviation, standard error and hypothesis Student's [t] test, p-values <0.05 were considered significant. After i.v. injection of propofol, 17 out of 20 patients showed either no change or a slight, but statistically non-significant elevation of the SR threshold both ipsilaterally and contralaterally at all stimulus frequencies [p>0.05]. Paradoxically, three patients showed variable, yet statistically non-significant reductions in SR threshold at 500, 1000 and 4000 Hz. The results presented in this study show that propofol in a dose of 1.5-2.5mg/kg BW appears to influence the acoustically evoked SR threshold only very slightly, if at all provided it is administered as a sole anaesthetic. Thus. propofol can be especially suitable for anaesthesia in audio-logical diagnostic procedures. We recommed conducting a similar study on a larger group of patients combined with monitoring of the degree of hyponsis

Electrically evoked stapedius reflex threshold and its clinical contribution of cochlear implantations / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate and measure the electrically evoked stapedius reflex threshold (ESRT) and the maximum comfortable level (MCL), the feasibility of using objective index of the fitting of speech processor was evaluated.</p><p><b>METHODS</b>The relationship of ESRT and MCL was conducted by measuring the ESRT and MCL of 28 Medel Combi 40 + cochlear implant users from August 2003 to April 2006.</p><p><b>RESULTS</b>The incidence of ESRT of 10 patient during operation was 78.3% (94/120), and the incidence 3 months after the operation was 82.5% (99/120). The incidence of ESRT in 3 patients with Large vestibular aqueduct syndrome was 47.2% (17/36). The ESRT and MCL of each electrode of those 28 patients after operation were compared, the result was shown as following: (1) 247 electrodes' MCL were greater than ESRT; (2) 14 electrodes' MCL were equal to ESRT; (3) 46 electrodes' MCL were smaller than ESRT. The average of ESRT after operation was (677.1 +/- 109.8) cu, the average of MCL was (732.3 +/- 114.8) cu. ESRT was smaller than MCL (t = 11.37, P < 0.05).</p><p><b>CONCLUSIONS</b>The cochlear implantations must be in normal working condition when ESR was positive. ESRT is a useful method to map the fitting of speech processor.</p>

Resultados auditivos de estapedostomías en platinas complicadas / Hearing results on stapedostomies in complicated platens

La estapedostomía es una alternativa de tratamiento quirúrgico de la otoesclerosis altamente eficaz y con resultados estables a largo plazo. Uno de los factores que puede condicionar una peor ganancia auditiva postoperatoria es la presencia de alteraciones significativas en la platina del estribo. Se incluyen en este estudio pacientes con otoesclerosis que fueron sometidos a estapedostomía entre los años 2000 a 2005 y en los cuales se constató la presencia de platina obliterada o flotante. Se compararon los valores auditivos pre y postoperatorios con un grupo de referencia constituido por pacientes sometidos a estapedostomía en el mismo período con platina azul. Se incluyeron 14 pacientes, sin diferencias en edad y género con respecto a los controles. No existieron diferencias estadísticamente significativas entre los grupos en cuanto a umbrales de vía ósea, aérea ni diferencia óseo-aérea. No se presentaron complicaciones en esta serie. Estos resultados demuestran que una técnica quirúrgica apropiada, junto a la experiencia del equipo quirúrgico hacen de la estapedostomía una alternativa exitosa en este tipo de pacientes.

Estudo comparativo entre nível de desconforto e reflexo acústico em trabalhadores / Comparative study between the level of discomfort and the acoustic reflex in workers

TEMA: estudo comparativo do nível do desconforto e do limiar do reflexo acústico em trabalhadores. OBJETIVO: observar o comportamento auditivo por meio da avaliação da atividade da contração do músculo estapédio e do nível de desconforto em pessoas expostas e não expostas a ruído ocupacional, com intuito de identificar alguma influencia do ruído no comportamento da contração do músculo estapédio e na sensibilidade auditiva. MÉTODO: o estudo foi desenvolvido no Serviço Social da Indústria - SESI Ceará. Foram selecionados 103 adultos com audição normal, de ambos os sexos, na faixa etária de 18 a 45 anos distribuídos em três grupos: G1 com 41 adultos expostos a ruído que utilizavam EPIA, G2 com 32 adultos expostos a ruído que não utilizavam EPIA e G3 composto por 30 adultos não expostos. Os indivíduos foram submetidos à avaliação audiológica, tendo sido analisado o LRA e ND nas freqüências de 500Hz, 1000Hz, 2000Hz, 3000Hz, 4000Hz e WN. A análise estatística foi realizada por meio dos testes de Mann Whitney, Wilcoxon e Kruskal com nível de significância em 5 por cento. RESULTADOS: não houve diferença estatística significante entre os LRA obtidos nos três grupos, com valores médios de 93 a 103dBNA; o LRA foi significantemente menor que o ND, tendo valores médios para ND variando de 111 a 119dBNA no G1, de 113 a 120dBNA no G2 e 106 a 114dBNA no G3; o ND é maior nos indivíduos do grupo G1 seguidos pelos grupos G2 e G3. CONCLUSÕES: o ruído não determina alterações no comportamento do LRA; o ND é aumentado pela exposição ao ruído ocupacional; o ND é maior que o LRA de 10 a 25dB.

Results of implant in otology [cochlear implantation, tympanoplasty, stapedoplasty] bilateral implantation of med-el cochlear implants system in adults

Study include 28 adults patients underwent bilateral cochlear implantation using Med-El implant system [C40C / C40+ / Pulsar CI100] over a period of ten years [1995-2005], in the Clinic of Otolaryngology-l lead and Neck Surgery at Uni. Wuerzburg-Germany [Director Prof. Dr. med. J. Helms], and Tympanoplasty or Stapedoplasty using titanium Ossicular prosthesis. 28 patients files were taken from outpatients and data of audiological investigations from CI center of the clinic after Bi1CI with both implants. Average of age 45 years. Female:%53.5, Male:%46.5. Etiology of profound deafness was Congenital:%50, Meniere:%7.1, Trauma:%7. 1, Meningitis:%10.7, Otosclerosis:%14.3. Sudden Hearing loss:%3.5, Osteogenesis Imperfecta [OI] [Otospongiosis]:%3.5, Ototoxic Drugs + Mumps:%3.5. Period of Deafness [from date of onset of deafness until 1st CI by years]. ranged from less than one year to over than fifty years.%107 underwent bilateral CI in one session and%89.3 in separate sessions. Total number of Cochlear Implant operations were: 65, Re-Implantation: 7 patients [%25] and 9 operations [%16 of implantations]. Tympanoplasty underwent before CI was [%l 3.3], and Stapedoplasty [%13.3]. Type of last Implants was C40+:%76.8, C40C [8 channel]:%l2.5] and Pulsar [CI] 100:% 10.7. Electrode type was Standard:%96.4, and S [Compressed]:%3.6. length of Inserted Electrode was 31.8 [Maximum]: [Standard-.%50], 30-31.6: Standard [%37.5], 30 > : Standard [C4OC]:%5.3 - [C40+ 5]%36, [unknown]:% 3.6. Re-Implantation was 7patients [25%], 9 implantations [16%] because of Manufacturing Filer [%44.5], Trauma [%22.2], Upgrade [%22.2], Medical reason [Pain] [%l1.1] of replacements devices. Complications were Necrosis of flap in one case [%1.5]. Investigation of Speech Understanding in both implants together performed FW [Friburger] and HSM [Hochmeier, Schultz, Moser] in 22 patients. The result was very good% 63.6, good in%l8.2, and mild in 2% 9.1, moderate in% 9.1 patients. In this study the outcomes of 56 bilateral implantations of Me- El devices [C40C, C40+, Pulsar [CI] 100] for 28 adults' patients have been reviewed over a period of ten years [1995-2005]. Average of age 45 years. Females[%53.5], Male [%46.5]. The main reason of profound deafness was Congenital [%50]. Majority of patients underwent CI in separate session% 89.3 and%l0.7 in one session.%87.5 devices inserted successfully deep [over 30 mm] to the tip of cochlea. Electrode type was Standard%96.4, and S [Compressed]%3.6.%16 of implants Re-Implanted, the main reasons was Manufacturing Filer%7.2. Complications were Necrosis flap only in one implantation [%1.5]. 22 patients had speech understanding tests in both implants together, good and very good results was in 18 patients [%81.8]. Tympanoplasty [%1 3.3] and Stapedoplasty [%1 3.3] performed before CI using Titanium Prosthesis dos not offer satisfaction hearing improvement. It is apparent from this study that patients with bilateral CI's using Me-El devices [C40C, C40+, Pulsar [CI] 100] commonly report that their total hearing experience is enriched by bilateral implants, and The deep insertion of the electrode provides users a maximum of acoustic information across the whole cochlea

Identificação de sentenças sintéticas (SSI) e reflexo acústico contralateral / Synthetic sentence identification (SSI) and contralateral acoustic stapedius reflex

TEMA: estudo da relação do reflexo acústico contralateral na habilidade auditiva de fechamento auditivo. OBJETIVO: analisar a identificação do sinal de fala em presença de sons competitivos em sujeitos com ausência do reflexo acústico contralateral. MÉTODO: aplicação do teste de identificação de sentenças sintéticas (SSI) nas condições mensagem competitiva contralateral (SSI-MCC), na relação sinal-ruído de 0 e -40dB e mensagem competitiva ipsilateral (SSI-ICM), na relação sinal-ruído de 0, -10, -15 e -20dB, em 43 adultos-jovens (grupo A = 21 sujeitos com presença do reflexo acústico contralateral em todas as freqüências pesquisadas e grupo B = 22 sujeitos com ausência do reflexo na freqüência de 500Hz, em todas as freqüências pesquisadas ou ainda em algumas das freqüências pesquisadas, mas que incluísse 500Hz), de ambos os sexos sem queixas auditivas, otológicas ou de aprendizagem. RESULTADOS: o limiar do reflexo acústico esteve acima de 100dB NA em 59 por cento dos indivíduos do grupo B e em 14 por cento dos indivíduos do grupo A, todos os indivíduos apresentaram desempenho de acordo com o padrão de normalidade sugerido pela literatura especializada para o teste SSI, o desempenho do grupo B no teste SSI-ICM foi inferior ao grupo A em todas as relações sinal-ruído utilizadas, embora a diferença não tenha sido estatisticamente significante, o grupo B que apresentou limiar do reflexo acústico superior a 100dB NA ou ausência do reflexo acústico também foi o que apresentou pior desempenho no teste SSI. CONCLUSAO: a ausência do reflexo acústico contralateral parece interferir na identificação do sinal de fala na presença de ruídos competitivos.

effect of propofol versus sevoflurane based anaesthesia on the electrically evoked stapedius reflex during cochlear implant surgery in paediatrics [comparative study]

Cochlear implantation is a widely used mean of treatment in deafness and severe hearing disorders in adults, children, and infants. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. In young children, this fitting process can be difficult because of limited communication capabilities. Investigators have used electrically evoked stapedius reflex threshold [ESRT] to predict maximum comfortable loudness [MCL]. During surgery the drugs used for general anaesthesia influence the values of the stapedius reflex. This study aims to compare two anesthetic regimens that can be used during cochlear implant surgery with the least effect on the evoked stapedius reflex threshold. This prospective r and om controlled study was done on 20 patients [n=20] ASA physical status I-II, scheduled for cochlear implant surgery. According to the maintenance agent patients were allocated randomly into two equal groups, each group is 10 patients. The propofol group [group Prop.], in which patients were maintained using propofol infusion [6mg.kg[1] hr[-1]]. The other group was maintained using sevoflurane [group Sevo.] at a concentration of 2%. Intra operative stapedius reflex testing was performed after implantation of prosthesis. The stimuli were generated by the nucleus diagnostic programming interface and reflex threshold was determined by observing the contraction of stapedius muscle. Two months later the MCL value was determined The mean amplitude of electric current [in mAm] used for induction of ESRT was significantly lower in the group Prop, than that required to induce the reflex in group Sevo. Regarding the ability of the electrically elicited stapedius reflex thresholds obtained under anaesthesia to predict the MCL in the post-operative setting. It was found that this was achievable in the propofol group and not sevoflurane. Compared to sevoflurane propofol has less inhibitory effect on the ESRT. The reflex threshold obtained under the effect of propofol can serve as a guide for postoperative MCL. This was not the case while using sevoflurane.

A Case of Oculostapedial Synkinesis Following Bell's Palsy / 대한이비인후과학회지

Oculostapedial synkinesis following Bell's palsy, Ramsay Hunt syndrome and traumatic facial nerve paralysis is a rarely reported phenomenon. Oculostapedial synkinesis accompanying with hemifacial spasm also has been reported. We experienced a 51-year-old woman with persistent loud rumbling noise from her left ear related with voluntary left eye closure compatible with oculostapedial synkinesis after Bell's palsy. We objectively proved this oculostapedial synkinesis with impedance audiometry. The patient was successfully treated by transmeatal tenotomy of the left stapedius muscle tendon under local anesthesia.

Tratamento clínico da paralisia de Bell: estudo comparativo com o uso de valaciclovir mais deflazacort versus deflazacort versus placebo / Clinical treatment of Bell's palsy: comparative study with the use of valaciclouir more deflazacort versus deflazacort versus placebo

A paralisia de Bell é uma doença de causa ainda desconhecida que pode deixar seqüelas estéticas e funcionais, algumas vezes irreversíveis. Estudamos o tratamento clínico em 46 pacientes com paralisia de Bell na fase aguda, dividindo-os em grupo placebo, grupo deflazacort e grupo valaciclovir mais deflazacort. Encontramos uma idade média geral de 30 anos completos e pacientes com grau II à V na escala de House-Brackmann. Houve maior porcentagem de casos suprageniculados e com ausência de reflexo estapediano nos graus IV e V. Em relação às alterações no teste elétrico com o estimulador de Hilger, ao tempo de recuperação do reflexo estapediano, ao tempo de recuperação da paralisia facial e à presença ou ausência de seqüelas, houve resultados mais satisfatórios no grupo que utilizou valaciclovir mais deflazacort, embora estes resultados não foram estatisticamente significantes. Concluímos que o prognóstico da paralisia não se alterou de acordo com o tratamento clínico instituído.

Electrically Evoked Stapedial Reflex in Cochlear Implantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An essential part of the successful application of a cochlear implant is to adjust the stimulation levels to the patient's dynamic range. To test the subjective behavioral threshold (T-level) and the most comfortable loudness level (C-level), however, it may be troublesome or even impossible in very young children who are not able to perform such tasks appropriately. Therefore, utilization of objective measurements is important in children to estimate T- and C-levels. One of the objective measurements is the electrically evoked stapedial reflex (ESR) test. It has also been suggested that ESR may have applicability in confirming and quantifying electrical stimulation through a cochlear implant. The purpose of this study is to examine the feasibility of utilizing ESR to test device function during cochlear implant surgery and to predict ultimate behavioral T- & C-levels. MATERIALS AND METHODS: The ESR measurements were performed in 18 subjects during a cochlear implant surgery. Eight subjects received the Nucleus 22 multichannel cochlear implant (CI 22M) and 10 subjects received Nucleus 24 multichannel cochlear implant system (CI 24M). To test the ESRs, three electrodes, namely, apical electrode (E20), medial electrode (E12) and basal electrode (E5), were stimulated in each case. ESR thresholds were measured by visual observation of the stapedius muscle contraction in response to electrical stimulation delivered to the auditory nerve via a cochlear implant system. And the ESR thresholds were compared with the behavioral T- and C-levels in each electrode. RESULTS: ESRs were presented in 19/23 electrodes (82.6%) in subjects who received the CI 22M and 26/30 electrodes (86.7%) in subjects with CI 24M. The mean ESR threshold was the lowest in apical electrodes (E20) in both groups. In subjects with CI 22M, ESR thresholds were significantly correlated with behavioral T- and C-levels in apical electrodes (E20). In subjects with CI 24M, ESR thresholds were highly correlated with the C-levels in E5, E12, and E20. CONCLUSION: ESR provides an objective, accurate and rapid method to evaluate the device function during cochlear implant surgeries and in estimating T-/C- levels, which may be useful in the initial programming of younger children and the difficult-to-tests.

Latência do reflexo estapediano em indivíduos com audiçäo normal / Timpamometry and acoustic reflex measures in normal subjects

Foram testados 35 indivíduos com audiçäo normal e medidas de latências do reflexo estapediano. Estas medidas mostraram ser muito variáveis, sendo os valores finais tomados pela média de três medidas de latências em cada frequência testada. As médias nä mostraram dependência de sexo, intensidade ou orelha testada, mas sim houve aumento de latência com o aumento da frequência de teste