ABSTRACT
PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.
Subject(s)
Facial Nerve Diseases/etiology , Facial Nerve Diseases/surgery , Facial Paralysis/etiology , Facial Paralysis/surgery , Otitis Media/complications , Adult , Aged , Chronic Disease , Facial Nerve/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Much controversy surrounds the etiology and management of Bell's palsy, and the pathogenetic mechanisms underlying Bell's palsy remain obscure despite the extensive body of relevant research. The pathological condition of Bell's palsy is almost an inflammatory reaction compressing the facial nerve in the fallopian canal, particularly in the narrowest labyrinthine segment, followed by demyelinating neural change. As one of the best method for the visualization of the inflamed facial nerve in the intratemporal segment, temporal bone CT enable us not only to measure the exact length and thickness of individual segments of the facial nerve canal but also to view variable anatomic variations in the intratemporal facial canal. Some suggest that anatomical variation may predispose the nerve to inflammatory processes and also there can be peculiar structures of the temporal bone that are vulnerable to inflammation or neural compression injury.
Subject(s)
Bell Palsy/etiology , Facial Nerve/pathology , Temporal Bone/pathology , Bell Palsy/pathology , Humans , Inflammation/pathology , Models, TheoreticalABSTRACT
AIM: The objective of this study was to assess whether Nd:YAG laser myringotomy has a negative effect on the cochlea. MATERIALS AND METHODS: Ten adult guinea pigs with a normal Preyer's reflex were treated by myringotomy with an Nd:YAG laser (power output 8-10W) under surgical microscopic guidance. Preoperative and immediately postoperative hearing tests were performed using auditory brainstem response. The cochlear hair cells were investigated by scanning electron microscope (SEM). RESULTS: The mean postoperative hearing threshold of the auditory brainstem response showed an insignificant elevation. SEM findings revealed normal outer and inner hair cells after laser myringotomy. CONCLUSION: No negative effect of Nd:YAG laser myringotomy on the cochlea was found. From these results, it can be concluded that the Nd:YAG laser is safe and effective for myringotomy.
Subject(s)
Cochlea/surgery , Laser Therapy , Lasers, Solid-State/adverse effects , Myringoplasty , Animals , Guinea Pigs , Laser Therapy/adverse effects , Male , Microscopy, Electron, Scanning , Myringoplasty/adverse effectsABSTRACT
UNLABELLED: Sensorineural hearing loss, which is limited to the cochlear basal turn, due to acute or chronic otitis media has been reported in clinical and experimental studies. In the present study, the effect of intratympanic dexamethasone on endotoxin-induced cochlear damage was investigated by measuring the cochlear blood flow and hearing. MATERIALS AND METHODS: Ten male Sprague-Dawley rats were inoculated with lipopolysaccharide (LPS), and divided into 2 groups of five rats each. One hour after intratympanic inoculation, the group A received 40 microl of phosphate-buffered saline (PBS) in the right middle ear cavity, group B received 40 microl of dexamethasone. The treated animals were examined 24 h after inoculation using auditory brainstem response (ABR) and cochlear blood flow (CBF). RESULTS: The elevated threshold decreased significantly after intratympanic dexamethasone administration compared to the PBS-treated group. Intratympanic dexamethasone administration to the round window of rats led to a statistically significant increase in CBF compared to the PBS-treated group (p <0.05). The response to round window application of prostaglandin E1 (PGE1) in the dexamethasone-treated group was better than in the PBS-treated group. CONCLUSION: Our results showed that intratympanic dexamethasone treatment was effective in protecting the function of the cochlea against endotoxin-induced otitis media.
Subject(s)
Dexamethasone/therapeutic use , Endotoxins/toxicity , Hearing Loss/chemically induced , Otitis Media/chemically induced , Administration, Topical , Animals , Dexamethasone/administration & dosage , Male , Rats , Rats, Sprague-DawleyABSTRACT
Widespread use of antimicrobial drugs in the management of otitis media has significantly reduced the incidence of labyrinthitis nowadays. Cases of tympanogenic labyrinthitis following acute otitis media have rarely been reported in recent literature on otolaryngology. We report an unusual case of tympanogenic labyrinthitis that presented with sudden sensorineural hearing loss (SNHL) following acute otitis media in an adult who had no previous otological complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the left ear. MRI was helpful to identify the inflammatory change of the membranous labyrinth. The patient's hearing returned to normal after treatment. The definite diagnosis of serous labyrinthitis was established retrospectively.
Subject(s)
Hearing Loss, Sensorineural/etiology , Labyrinthitis/complications , Otitis Media, Suppurative/complications , Acute Disease , Adult , Audiometry, Pure-Tone , Female , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/therapy , Humans , Labyrinthitis/therapy , Otitis Media, Suppurative/therapy , Tympanic MembraneABSTRACT
BACKGROUND: Because of chronic otitis media with effusion (COME) demonstrates pathogenic bacteria, treatment with appropriate antibiotic is reasonable. OBJECTIVE: We determined the penetration of cefprozil into the middle ear effusion (MEE) in children with COME. MATERIALS AND METHODS: 25 patients 2-13 years of age with COME were eligible for study. After the single dose of 15 mg/kg patients were assigned to have MEE, and serum samples were obtained during ventilation tube insertion at 0.5, 2, 3, 5, or 6 h after administration of the dose. The concentration of cefprozil was measured using validated high performance liquid chromatography method. RESULTS: The mean concentrations of cefprozil in the MEE ranged from 0.4 to 4.4 microg/ml. The penetration into MEE was rapid and effective. Cefprozil in the MEE was maintained at a greater level than MIC 90 in S. pneumoniae for at least 6 h after administration of 15 mg/kg. CONCLUSION: Cefprozil penetrated well into the MEE in children with COME.
Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Cephalosporins/pharmacokinetics , Ear, Middle/metabolism , Otitis Media with Effusion/drug therapy , Otitis Media with Effusion/metabolism , Administration, Oral , Adolescent , Anti-Bacterial Agents/administration & dosage , Cephalosporins/administration & dosage , Child , Child, Preschool , Chromatography, High Pressure Liquid , Chronic Disease , Dose-Response Relationship, Drug , Ear, Middle/drug effects , Female , Humans , Male , Otitis Media with Effusion/blood , CefprozilABSTRACT
OBJECTIVE: The widespread use of fluoroquinolone otic drops has resulted in the emergence and subsequent increase of fluoroquinolone resistance, at rates greater than anticipated. To evaluate the patients with recurrent otorrhea that were unresponsive to topical ciprofloxacin. METHODS: Seventeen pediatric patients who were treated with refractory otorrhea between 2000 and 2001 were reviewed retrospectively. RESULTS: All patients had ciprofloxacin-resistant pseudomonas on culture and sensitivity test. Ciprofloxacin-resistant pseudomonas from these patients were multidrug resistant. Imipenem was the most sensitive antibiotic agent, followed by amikacin. Most patients were treated with intramuscular amikacin and two patients were treated with intravenous imipenem. CONCLUSION: In our series, resistance to cirpfloxacin in patients with otitis media is increasing recently. Culture and antibiotic sensitivity test may help guide management. Continuous surveillance is necessary to monitor antibiotic resistance and to guide antibacterial therapy.
