Treatment of nasal polyposis in Byzantine times

The goal of this study was to describe the therapeutic methods and surgical techniques used during Byzantine times (AD 324-1453) for a disease that has occupied physicians since antiquity: nasal polyps. The original Greek-language texts of the Byzantine medical writers, most of which were published after the 17th century, were studied in order to identify the early knowledge of the definition, symptoms, conservative treatments, and surgical intervention in cases of this disease. A considerable number of conservative treatments, etiologic and local (with inunctions or blowing of caustic substances), with evident influence from Roman medicine, were identified even in the early Byzantine medical texts (4th century). Further, some surgical techniques were described that seem to constitute evolution of the Hippocratic tradition. From the study of the original texts of Byzantine medical writers, their interest in the rhinological diseases is evident; in the case of nasal polyps, new techniques were mentioned. The first meticulous intranasal surgical removal of polyps was described. These techniques, obviously developed during the Hellenistic period, initially influenced European medicine and later the rest of the world.     

From the roots of rhinology: the reconstruction of nasal injuries by Hippocrates

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine.     

Surgical management of complications after hearing aid fitting

OBJECTIVES: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management. METHODS: Four otologists at a major university center with a combined 65 years of experience performed a retrospective analysis of their surgical practice. Six patients were identified that had encountered severe complications from improper earmold fitting that required surgical intervention. RESULTS: One patient had a perforation of the tympanic membrane with earmold material found to have migrated into the middle ear cleft. The tympanic membrane healed spontaneously, resulting in persistent otalgia and a maximum air-bone gap. The earmold cast was successfully removed by means of a tympanomastoidectomy. Two patients with presbycusis and normal ear canals developed eardrum perforations and conductive hearing deficits. In both patients, earmold material was found partially occupying the middle ear cleft and removed by way of a transcanal approach. Three patients with prior canal wall down mastoidectomy defects and narrow external ear canals required microtoscopy under general anesthesia or canaloplasty for removal of impacted material. CONCLUSION: Proper fitting of hearing aids performed by well-trained medical professionals results in a very low incidence of significant complications. Perforation of the tympanic membrane with impaction of earmold material in the middle ear or mastoid bowl may occur and can be successfully managed by standard otologic surgical techniques.     

Surgery on the only hearing ear

Modern otosurgical tools and techniques have greatly improved the outlook for hearing improvement in otologic surgery, while decreasing the risk of severe and irreversible hearing loss complicating the surgical procedure. Nevertheless, even a minimal risk operation must be weighed differently in an only hearing ear situation. This paper reviews the author's experience and philosophy regarding only hearing ear surgery for chronic otitis media, endolymphatic hydrops, perilymph fistulas and acoustic neuromas.     

Pediatric fluctuating sensorineural hearing loss: problems in medical management

OBJECTIVES: To discuss the diagnosis and management of children with fluctuating sensorineural hearing loss, especially focusing on those problems dealing with autoimmune inner ear disease. STUDY DESIGN: A retrospective chart review of a large pediatric otolaryngology practice. A series of 40 children with progressive hearing losses was identified. Of that group, 22 children, aged 1.5 to 12.2 years at first audiogram, were considered to have fluctuating sensorineural hearing loss (FSNHL). Criteria for inclusion in the FSNHL group were threshold variations of 15 dB or more in at least one ear at two or more of the standard audiometric frequencies on at least 2 testing days. METHODS: Charts were reviewed for age, sex, otologic history, laboratory evaluations, medical or surgical treatments, significant medical history, and family medical history. RESULTS: Twenty-two children met the criteria for fluctuating sensorineural hearing loss. Of those with fluctuating hearing loss, 15 were idiopathic, 3 had positive lymphocyte transformation tests (LTT) suggestive of autoimmune inner ear disease (AIED), and 4 had fistula on middle ear exploration. Average fluctuation for all groups was 29.1 dB. Average duration of fluctuations was 4.95 years. CONCLUSIONS: The majority of pediatric FSNHL cases (15 of 22) were idiopathic in nature. Of those FSNHL children with positive LTTs, only one was treated with steroid therapy. In the other patients with positive LTTs, parents or other physicians were often reluctant to treat, or the patient was lost to follow-up. Mean fluctuations varied substantially across all standard audiometric frequencies for all groups.     

Complications and their management in tympanomastoid surgery.

Chronic diseases of the ear and their surgical treatment can endanger the delicate structures of the temporal bone in close relationship with the middle ear. The experience and expertise of the otologic surgeon, based on perfect knowledge of the complex anatomy of the whole temporal bone, are unfortunately built up partly through the management of complications encountered in tympanomastoid surgery and may require knowledge of basic neuro-otologic procedures. Paralysis and paresis of the facial nerve and labyrinthine, and dural and vascular injuries may have consequences not only in the final result of surgery but also in endangering the patient's life. All major complications are discussed and some possible treatments are proposed. Minor complications affecting the temporomandibular joint, the dura, the external auditory canal, and the bony canal wall are also covered, along with some suggestions on how to keep these consequences within reasonable percentages.     

Hearing loss in children with congenital heart disease: a preliminary report

Life expectancy for children with serious congenital heart defects has dramatically increased in recent years due to advances in medical and surgical care. Anatomic studies of temporal bones in patients with non-syndromic congenital heart disease have demonstrated a high incidence of middle and inner ear anomalies. Systematic study of auditory function in these patients has not been reported. Fifty children with serious congenital heart disease have been evaluated with otologic examination and auditory brainstem-evoked response (ABR) testing. The patients ranged in age from 3 days to 17 years-8 months. Eight patients had hearing loss and normal otologic examinations, 14 patients had hearing loss and associated otitis media with effusion, and 28 patients had normal hearing by ABR testing. These results show a high incidence (16%) of hearing loss not associated with otitis media with effusion in the study population. We suggest that children with serious congenital heart disease are at high risk for hearing loss. This patient group will benefit from early identification, and appropriate medical and audiologic management.     

Hearing and otopathology in Crouzon syndrome.

OBJECTIVES: To better establish the incidence and types of otologic and auditory abnormalities in patients with Crouzon syndrome. STUDY DESIGN: Retrospective chart review of the otologic and auditory findings of patients diagnosed with Crouzon syndrome who were seen at our institution between 1978 and 1994. METHODS: Charts were reviewed and data recorded on patient sex, family history, appearance, auricular abnormalities, auditory findings, history of otologic disease, and follow-up. RESULTS: Nineteen patients were identified with the diagnosis of Crouzon syndrome: 12 males and 7 females. Twelve cases represented spontaneous mutations. Eight patients had abnormalities involving the external ear: from malalignment of the pinna (6 patients) to external auditory canal atresia (1 patient). Ten patients had documented hearing loss: 4 with conductive hearing loss, 2 with a mixed hearing loss, and 4 with a sensorineural hearing loss, the etiologies of which ranged from ossicular fixation and serous otitis media to unknown sensorineural deficits. CONCLUSIONS: Patients with Crouzon syndrome can exhibit various pathological features of the ear. Although external malformations are unusual, middle ear disease and hearing loss are common. We advocate close otologic and audiologic follow-up in these patients and note a higher frequency of sensorineural hearing loss than previously reported. Recent genetic advances may allow more accurate and earlier diagnosis of this syndrome.     

Sudden hearing loss in the contralateral ear in postoperative acoustic tumor: Three case reports

Careful presurgical otologic assessment of the contralateral ear in acoustic tumor patients is essential, not only to establish baseline data but more importantly to resolve the intense patient anxiety that arises almost immediately when the diagnosis is presented. Any subsequent reduction in hearing acuity in the contralateral ear after the tumor ear has been deafened, poses serious psychological, socio-economic and medical problems. Three detailed case reports of sudden hearing loss in the contralateral ear of postoperative acoustic tumor patients are presented. The lesion sites include: the middle ear, cochlear, and retrocochlear. In each case, hearing returned to its previous or near-previous levels. Allergic factors were implicated in two cases.     

Otologic manifestations of Langerhans' cell histiocytosis

Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.     

Contralateral hearing loss following inner ear injury: sympathetic cochleolabyrinthitis?

Acoustic tumor surgery provided an ideal model in which to study possible contralateral hearing loss following a destructive surgical procedure on the inner ear. Follow-up audiometric studies were performed on patients with unilateral acoustic tumors who had undergone resection of their tumors. Patients who had obvious causes for contralateral hearing loss, such as chronic otitis media, unrelated otologic surgery, and noise-induced hearing loss, were excluded from this patient population. A total of 380 patients had available pre- and postoperative audiograms. A mean air-conduction threshold (500, 1000, 2000 Hz) of greater than or equal to 20 dB was considered a significant hearing loss. After adjusting these losses for presbycusis, 1.3% of these patients still had a significant contralateral hearing loss. We discuss the possible causes for the development of contralateral hearing loss and examine the possibility that, following surgical manipulation and injury to the inner ear, immunocompetent cells become sensitized to previously unseen inner ear antigens, setting the stage for contralateral inner ear dysfunction. The similarities of this condition to sympathetic ophthalmia are discussed.     

Lightning and its effects on the auditory system

Patients struck by lightning can present with a wide variety of unusual otologic problems including burns to the external auditory canal, tympanic membrane rupture, middle ear injury, and sensorineural hearing loss. Four patients who incurred various otologic problems, including one patient with previously unreported bilateral oval window fistulas following lightning injury, are presented. Audiologic, otologic, and surgical findings are reviewed as well as patient follow-up and outcome.     

耳显微外科手术立体图谱的制作及应用

目的研究立体视图镜在耳外科学临床和教学中的应用。方法对典型耳科病例术中的重要解剖结构进行拍照,经Adobe Photoshop软件将其制作成立体图片,由50名具有不同程度耳科临床经验的评估人员观察平面图和利用立体视图镜观察立体图并进行比较。结果制作的100张立体手术图片均能产生清晰的立体视觉,并且立体图的层次感优于平面图。结论将立体视图技术应用于耳科手术,制作的立体手术图谱可以提供更多的解剖信息．有利于年轻医师的培养。     

Intralabyrinthine schwannomas: symptoms and managements

OBJECTIVE: To describe the characteristic presentations, radiologic findings and managements of the intralabyrinthine schwannomas. METHOD: Retrospective review of patient records, their managements, and review of the literature. RESULT: Four patients with a variety of otologic symptoms including hearing loss, vertigo, and tinnitus were found to have a schwannomas involving the labyrinth. In all cases, the inner ear lesions were preoperatively identified on magnetic resonance imaging, and the surgical removals were performed in all patients without serviceable hearing. The patients experienced improvement in their vertigo and tinnitus after surgery. Two patients were implanted the Bone-Anchored Hearing Aid (BAHA) to reconstruct the pseudo-stereophonic hearing. CONCLUSION: Intralabyrinthine schwannomas are the rare tumours in the otology. The tumour can be removed by surgical approach, but we do not propose surgical excision for the patients with serviceable hearing. BAHA can give patients a post-operative monaural pseudo-stereophonic hearing.     

Otologic history,audiometry and tympanometry as a case finding procedure for school screening

An algorithm for identification of hearing loss and middle ear effusion based on otologic history, audiometry and tympanometry was designed and tested on 771 first grade school children. Each ear was profiled as being normal, at risk, at high risk, or in need of otologic referral based on test-retest screening. In addition, each child was categorized on the basis of the worse ear. Results showed 57 percent of the children as being normal; otologic referral was indicated in 14 percent. The remaining children (29 percent) were at risk or at high risk. The combination of medical history, audiometry and tympanometry constitutes an excellent case finding procedure for screening the otologic status of young school children. Through the utilization of specific criteria, optimal referrals can be made, thereby providing better health care.     

a report of who ear and hearing disorders survey in guizhou province

Objective To report a population-based survey on the prevalence, pathogenic factors and medical needs of ear diseases and hearing loss. Methods Using the probability proportion to size (PPS) method, 6626 residents were investigated in 30 clusters in accordance with the WHO protocol. Results The prevalence of hearing loss was 17.1%(compatible with the natioanal standardized rate of 17.6%), including mild (11.0%), moderate (4.2%), severe (1.4%), and profound (0.5%)impairment. Of the 1131 individuals with hearing loss, 663 (20.2%) were male and 468 (14.0%) were female. The prevalence of hearing disability was 6.1%(again compatible with the national standardized rate of 6.5%). The causes of hearing loss were ear diseases (31.4%), non-infectious ear disorders (42.5%), genetic disorders (6.7%), infectious disease (0.4%) and undetermined causes (29.3%). Of the hearing impaired people, 13.8% needed otologic and/or audiologic interventions and 9.1% needed hearing aids. Conclusion The prevalence of hearing loss and hearing disability have increased in the past twenty years. The data pro-vide important information for authorities in formulating policies for prevention and management of deafness.