The Impact of Postmeningitic Labyrinthitis Ossificans on Speech Performance After Pediatric Cochlear Implantation.

OBJECTIVE: 1) To characterize pediatric cochlear implant performance in patients with hearing loss secondary to bacterial meningitis. 2) To evaluate performance differences in patients with and without labyrinthitis ossificans (LO). STUDY DESIGN: Retrospective case review. SETTING: A large university-based multidisciplinary cochlear implant program. PATIENTS: Forty-nine patients with hearing loss from bacterial meningitis who received cochlear implants from 1991 to 2011. Thirty-nine patients had adequate data for analysis. INTERVENTION: Cochlear implantation with postoperative performance evaluation. MAIN OUTCOME MEASURE(S): Speech perception category (SPC). RESULTS: Nineteen (48.7%) patients had intraoperative evidence of LO. Fourteen patients (70.0%) without LO compared with seven (36.8%) with LO developed open-set speech after implantation. There was a trend toward better postimplant SPC outcomes in patients without LO that did not reach statistical significance (p = 0.17). The presence of LO negatively correlated with classroom placement (p < 0.05). Analysis of each group individually demonstrated statistically significant improvement in pre- versus postimplant SPC outcomes (p < 0.001). CONCLUSION: The presence of LO may negatively affect performance in pediatric patients receiving a cochlear implant for hearing loss secondary to bacterial meningitis.

The incidence of tympanogenic labyrinthitis ossificans.

OBJECTIVE: To estimate the incidence of tympanogenic labyrinthitis ossificans. METHODS: The records of patients treated with mastoidectomy for various tympanogenic aetiologies from January 2007 to December 2011 were retrospectively reviewed. Patients whose high-resolution computed tomography scans showed evidence of labyrinthine calcification of the temporal bone were enrolled. Patients with a history of head and neck cancer, meningitis, and otosclerosis, and patients with cochlear implants, were excluded from this study. RESULTS: A total of 195 patients were enrolled in this study; 4 of the patients presented with calcification in the inner ear. Therefore, the incidence of tympanogenic labyrinthitis ossification was 2 per cent. The computed tomography findings revealed: (1) cochlear calcifications of the basal and middle turn in two patients; and (2) vestibular, superior semicircular canal, posterior semicircular canal and lateral semicircular canal calcification in one, four, three and two patients, respectively. CONCLUSION: The incidence of tympanogenic labyrinthitis ossification in patients who had undergone a mastoidectomy was 2 per cent.

Semicircular canal dehiscence: frequency and distribution on temporal bone CT and its relationship with the clinical outcomes.

PURPOSE: In this study, we aimed to investigate the frequency of SCD and its distribution and relationship with clinical outcomes on thin-section CT of the temporal bone. MATERIALS AND METHODS: Digital temporal bone CT images of 850 consecutive patients (1700 temporal bone CTs, 5100 SCs) who presented with a range of complaints such as vertigo, deafness, ear pain, fullness, and discharge between January 2008 and December 2011 were re-evaluated. Axial and oblique coronal reconstruction images of the temporal bone were made with a reconstruction thickness of 0.5mm. Additionally, superior SC was evaluated in two perpendicular planes. RESULTS: Out of 850 patients, 70 had completely normal temporal bone CT. Ninety-three patients had at least one SCD. In the temporal bone-based evaluation, 119 (26 bilateral, 67 unilateral) of 1700 temporal bones (7%) showed dehiscence. The SC-based evaluation revealed 125 SCD (2.5%) in 5100 SCs. The total number and rates of SCD were as follows: superior 103 (82.4%), posterior 13 (10.4%), and lateral nine (7.2%). Twenty of the 93 patients with SCD (21.5%) revealed no other findings on their temporal bone CTs. We determined a significant correlation between vestibular complaints, conductive hearing loss and SCD but there was no correlation between mixed, sensorineural hearing loss and SCD. CONCLUSION: We determined the frequency of SCD in 11% of patients and 7% of temporal bones. With regards to the distribution, the superior SC showed the highest dehiscence rate (82.4%). We found a significant correlation between vestibular symptoms, conductive hearing loss and SCD.

Otitis media in five cats associated with soft palate abnormalities.

The medical records of five cats that were diagnosed with otitis media and soft palate abnormalities, three of which had concurrent otitis interna, were reviewed retrospectively. The animals presented with unilateral or bilateral otitis media or otitis interna associated with soft palate hypoplasia (four cases) or unilateral soft palate cleft (one case). Otitis media was confirmed by radiography, CT or MRI. The soft palate abnormalities present were discovered on oropharyngeal examination at induction of anaesthesia. These five cases provide additional support of a link between otitis media and soft palate abnormalities in cats, as reported in humans and dogs.

[The diagnostics and treatment of subclinical forms of labyrinthitis in the patients presenting with inflammation of the middle ear].

The current concepts of diagnostics and treatment of labyrinthitis in the patients presenting with acute and chronic forms of otitis are considered. It is emphasized that early recognition of the pathological process underlying the evolvement of tympanogenic labyrinthitis is of paramount importance for the efficacious treatment of this disease. This inference implies the necessity to improve diagnostics of its subclinical forms and develop a universal strategy for the management of the patients with the pathology being considered.

Diecisiete casos de complicaciones intratemporales de otitis media aguda en niños en dos años / Intratemporal complications from acute otitis media in children: 17 cases in two years

Introducción: Para describir las características clínicas de los niños con complicaciones intratemporales de otitis media aguda (OMA), se realizó un trabajo retrospectivo y descriptivo durante dos años. Métodos: Se consideró mastoiditis al eritema y edema retroauricular, protrusión del pabellón auricular y caída de la pared posterior del conducto auditivo externo; laberintitis, al vértigo con o sin náuseas, vómitos y nistagmus, y parálisis facial periférica, a la ausencia o disminución de la movilidad en hemicara. Previa otomicroscopía para diagnóstico de enfermedad otológica aguda coexistente, se tomó material para estudio bacteriológico de oído medio, de absceso subperióstico o de cavidad mastoidea. Resultados: Edad media: 54,23 meses; 30% menores de 12 meses; 12/17 masculinos y 5/17 femeninos; 8/17 recibían antibioticoterapia; 7/17 presentaban fiebre; 9/17 (52,9%) con mastoiditis aguda; 7/17 (41,2%) con laberintitis y 1/17 (5,9%) con parálisis facial periférica. El 17,6% presentó complicaciones endocraneales. Todos requirieron antibioticoterapia parenteral. Se realizó miringotomía en 16/17 (94,1%); drenaje de absceso subperióstico en 3/17 (17,6%) y antromastoidectomía en 2/17 (11,8%). La bacteriología fue positiva en 9/17, aislándose Streptococcus pyogenes (S. pyogenes) en el 44% de los casos. Secuelas: una hipoacusia neurosensorial. Entre enero de 2008 y diciembre de 2009 fueron asistidos 17 pacientes con complicaciones intratemporales de OMA. Conclusión: La mastoiditis aguda es la complicación intratemporal más frecuente. S. pyogenes es prevalente en estas infecciones invasivas en nuestro medio. La resolución de la OMA complicada requiere procedimientos quirúrgicos en todos los casos (miringotomía, drenaje de absceso subperióstico o antromastoidectomía) y tratamiento antimicrobiano parenteral(AU)

Background: To describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for two years. Methods: We considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface. All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess or from granulation tissue during tympanomastoidectomy. Results: From January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than twelve months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17 and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. Conclusions: Acute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess or tympanomastoidectomy) (AU)

A retrospective study of 29 cases of otitis media/interna in dairy calves.

Epidemiological data, clinical findings, laboratory data, medical imaging, and outcomes were reviewed in 29 dairy calves with otitis media/interna. Age at admission ranged from 1 to 24 wk. The majority of calves were referred during winter. Clinical signs included drooping ear, ptosis, head tilt, abnormal nystagmus, strabismus, dysphagia, regurgitation, stiff neck, opisthotonos, facial hyperesthesia, and purulent aural discharge. Intranasal endoscopic examination of 5 animals revealed nasopharyngeal collapse in 4. Cerebrospinal fluid (CSF) was abnormal in all of 7 cases. Mycoplasma bovis was cultured from all but 1 case with external ear or tympanic bullae samples (n = 12), and Mycoplasma arginini was cultured from the remaining ear sample. Radiographs of the tympanic bullae were performed in 24 calves, tomodensitometry (CT) in 3 calves and ultrasound in 4 calves. According to medical imaging techniques or necropsy, 69% of the cases were classified as chronic. Mean duration of treatment was 23.3 d. The rate of clinical recovery was 75%.Epidemiological data, clinical findings, laboratory data, medical imaging, and outcomes were reviewed in 29 dairy calves with otitis media/interna. Age at admission ranged from 1 to 24 wk. The majority of calves were referred during winter. Clinical signs included drooping ear, ptosis, head tilt, abnormal nystagmus, strabismus, dysphagia, regurgitation, stiff neck, opisthotonos, facial hyperesthesia, and purulent aural discharge. Intranasal endoscopic examination of 5 animals revealed nasopharyngeal collapse in 4. Cerebrospinal fluid (CSF) was abnormal in all of 7 cases. Mycoplasma bovis was cultured from all but 1 case with external ear or tympanic bullae samples (n = 12), and Mycoplasma arginini was cultured from the remaining ear sample. Radiographs of the tympanic bullae were performed in 24 calves, tomodensitometry (CT) in 3 calves and ultrasound in 4 calves. According to medical imaging techniques or necropsy, 69% of the cases were classified as chronic. Mean duration of treatment was 23.3 d. The rate of clinical recovery was 75%.

RésuméÉtude rétrospective de 29 cas d'otite moyenne/interne chez les veaux laitiers. Les données épidémiologiques, les signes cliniques, les résultats de laboratoire et d'imagerie médicale et l'évolution de 29 veaux atteints d'otite moyenne/interne sont présentés. L'âge à la présentation variait de 1 à 24 semaines. La majorité des veaux ont été admis en hiver. Les signes cliniques incluaient une oreille tombante, une ptose de la paupière, une tête penchée, un nystagmus pathologique, un strabisme, de la dysphagie, des régurgitations, une raideur cervicale, de l'opisthotonos, de l'hyperesthésie faciale et une écoulements purulente de l'oreille. L'endoscopie des voies respiratoires supérieures a révélé un collapse du nasopharynx dans 4 cas sur 5. L'analyse du liquide céphalo-rachidien était anormale chez 7 veaux. Mycoplasma bovis a été isolé de tous les cas à partir d'échantillons d'oreille externe ou de bulle tympanique sauf 1 (n = 12) où Mycoplasma arginini a été isolé. La radiographie des bulles tympaniques a été réalisée sur 24 cas, la tomodensitométrie sur 3 cas et l'échographie sur 4 cas. Selon les techniques d'imagerie médicale ou la nécropsie, 69 % des cas étaient chroniques. La durée moyenne du traitement était de 23,3 jours. Le pronostic était de 75 %.(Traduit par les auteurs).

Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance.

The literature about bony defects in the semicircular canal system is highly inconsistent. Therefore, we analyzed a series of 700 high-resolution multislice CT examinations of the temporal bone for semicircular canal dehiscencies. An unselected group of ENT patients with different clinical symptoms and variable age was chosen. We found semicircular canal dehiscence in 9.6% of temporal bones, superior semicircular canal was affected mostly (8%), less common posterior semicircular canal (1.2%); only in 3 cases (0.4%), lateral semicircular canal showed dehiscence. In 60% of SSC dehiscence, we registered bilateral manifestation. The so-called "third mobile window" in semicircular canal dehiscence causes a great variety of clinical symptoms like vertigo, nystagmus, oscillopsies, hearing loss, tinnitus and autophonia. Comparison with anatomic studies shows that CT examination implies the risk of considerable overestimation; this fact emphasizes the important role of clinical and neurophysiological testing.

[Innovations in pathogenetic therapy for peripheral affection of the cranial nerves in otorhinolaryngology].

A total of 150 patients with peripheral affection of the facialnerve, 100 patients with acute neurosensory hypoacusis, 50 patients with affection of the reciprocal nerve were treated by the method using reciprocal interaction between M- and H-cholinergic mechanisms. Treatment outcomes showed that anticholinesterase therapy raises the efficacy of rehabilitation in patients with peripheral affection of the cranial nerves.

Bacterial meningitic deafness: historical development of epidemiology and cellular pathology.

Meningitis resulting in labyrinthitis and its associated hearing loss was first described by several authors during 1864 and 1865 but it was not integrated into the otological cannon until H. Knapp's publications of 1871. These reports were incorporated by St John Rossa in his textbook of 1873. Politzer, in 1882, included a fuller description of the clinical symptoms. Analysis of records of the etiologies of students in 90 schools for the deaf in North America from 1817 to 1893 showed that before the mid-1870s meningitis was rarely identified as an etiology (<1%) but by the 1880s it accounted for 10-20% of all etiologies, with male preponderance. Cellular pathology of meningitic labyrinthitis from the 1860s to the 1990s examined the ways in which bacteria invaded the inner ear. Human temporal bone studies were a major source of understanding of the pathological processes. Honda, in 1927, injected guinea pigs intracranially with live bacteria, and observed the effects on the membranous labyrinth. In 1988 Lebel's observation of the effectiveness of dexamethasone in preventing much deafness from meningitis stimulated the examination of the labyrinthine immune response. Immunological mechanisms can account for some of the variable morbidity of unilateral, progressive, less-than-severe deafness.

Pseudomonas aeruginosa otitis media and interna in a chinchilla ranch.

Pseudomonas aeruginosa has been associated with conjunctivitis, enteritis, pneumonia, septicemia, sudden death, and abortion in chinchillas. This case report describes an unusual clinical presentation and diagnosis of P. aeruginosa otitis media and interna with neurologic manifestations. To our knowledge, this clinical presentation has not been reported previously in chinchillas.

[Middle ear cholesteatoma]. / Cholestéatome de l'oreille moyenne.

Cholesteatoma is a serious form of chronic otitis media. The aim of this paper is to present the state of the art of disease management, including recent data from the literature and the authors' derived from their Mentors' teaching, Professor Pierre Roulleau (Paris, France) and Professor Robert Charachon (Grenoble, France). The main recent advances concern the use of cartilage grafts to reconstruct the canal wall and/or tympanic membrane (allowing a significant reduction in residual cholesteatoma) and progress in medical imaging allowing more acute preoperative determination of extension of the cholesteatoma (in order to propose an optimally designed surgical technique) and a less invasive postoperative follow-up.

Labyrinthitis in chronic otitis media.

Labyrinthitis is the most frequent complication of chronic otitis media (COM). Retrospective analysis of 1,210 patients operated due to COM was carried out. Circumscribed labyrinthitis was found in 17.2% and deafness in 1.2% of patients. To evaluate the effect of labyrinthitis on bone conduction (BC) we measured BC threshold in a group of 140 patients with unilateral COM without labyrinthitis and in a group of 42 patients with unilateral COM with labyrinthitis. BC threshold of the healthy ear was subtracted from the BC threshold of the affected ear in the same patient to eliminate presbyacusis. There was no significant difference in bone conduction threshold between the patients with circumscribed labyrinthitis and patients with COM without labyrinthitis. The incidence of labyrinthitis was higher in patients with cholesteatoma than in patients without cholesteatoma. Management of labyrinthine fistula is presented.

The complications of chronic otitis media: report of 93 cases.

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990-1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold's abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.

Temporal bone histopathology in chronically infected ears with intact and perforated tympanic membranes.

Chronic suppurative otitis media has been clinically defined as a chronic discharge from the middle ear in the presence of a perforation of the tympanic membrane. However, irreversible tissue pathology in the middle ear or mastoid can occur behind an intact tympanic membrane. One hundred forty-four human temporal bones with chronic otitis media were divided into two groups: those with perforated (28) and those with nonperforated (116) tympanic membranes. The histopathological findings of their middle ears were compared. Granulation tissue in various degrees was the most prominent pathological feature. It was observed in 96% of temporal bones with perforation of the tympanic membrane, and in 97% of those without perforation. Also found were ossicular bony changes (96% with perforation; 90.5% without), middle ear effusion (93% with perforation; 89% without), cholesterol granuloma (21% with perforation; 12% without), cholesteatoma (36% with perforation; 4% without), and tympanosclerosis (43% with perforation; 20% without). This study shows that the histopathological changes of the middle ear are similar in temporal bones with and without perforation of the tympanic membrane. The clinician should, therefore, be aware that an intact tympanic membrane does not necessarily preclude the presence of gross pathological changes of the middle ear cleft.