1/27. cholesteatoma extending into the internal auditory meatus.We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semi-circular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation.- - - - - - - - - - ranking = 1keywords = labyrinthitis (Clic here for more details about this article) |
2/27. Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management.OBJECTIVES: The objective of this study was to identify factors correlated with the CT outcome and to examine the contribution of the CT scan in the aetiological diagnosis and management of unilateral sensorineural hearing loss in childhood. methods: The records of 35 consecutively investigated patients by the audiology Department of Great Ormond Street Hospital between January 1996 and June 1998 were reviewed. The CT results, population sample characteristics, initiation of further investigations after the CT results and management decisions based on the CT results were tabulated and analysed. RESULTS: In a series of 35 consecutively investigated children with unilateral sensorineural hearing loss, 11 CT scans were identified as abnormal. The CT findings were: labyrinthitis ossificans (3), unilaterally dilated vestibular aqueduct (2), bilaterally dilated vestibular aqueduct (2), unilateral deformity of the cochlea ('Mondini') (1), unilateral severe labyrinthine dysplasia (1), unilateral markedly narrow internal acoustic meatus (1), bilaterally dilated lateral semicircular canals (1). The presence of progressive hearing loss was a significant predictor of abnormal CT outcome, while the severity of hearing loss was not. The CT scans offered valuable information regarding the aetiological diagnosis in all cases and, in addition, prompted the appropriate vestibular rehabilitation in three cases, further investigations in four (with dilated vestibular aqueduct) and hearing preservation counselling in two (bilateral DVA) (seven out of 35 = 20%). CONCLUSION: All children with unilateral sensorineural hearing loss should have a CT scan of the petrous pyramids/IAMs performed at some stage, as not only aetiology but also prognosis and management of these cases may be significantly influenced by the CT outcome.- - - - - - - - - - ranking = 1keywords = labyrinthitis (Clic here for more details about this article) |
3/27. Histopathological findings in the inner ear caused by measles.An otopathological analysis of three cases of viral labyrinthitis was performed. Six temporal bones cut in serial sections were available for this study. According to the degree of degenerative changes in various parts of the inner ear two types of morphologically distinct labyrinthitis after measles are presented: the first one with the port of entrance through the internal auditory meatus and characterized by, first and most significantly, changes in the spiral ganglion cells; and the second, as described previously by Lindsay, with the port of entrance of the virus in the inner ear through the stria vascularis, with degenerative changes in various structures within the endolymphatic duct.- - - - - - - - - - ranking = 2keywords = labyrinthitis (Clic here for more details about this article) |
4/27. Radiologic diagnosis of labyrinthitis ossificans.labyrinthitis ossificans is the pathological ossification of the membranous labyrinthine spaces in response to processes which are destructive of the membranous labyrinth or the endosteum of the otic capsule. It has been primarily a histopathologic diagnosis. Complex motion tomography however, allows a detailed view of the osseous labyrinth and permits the diagnosis in the living state. Radiologic documentation of labyrinthitis ossificans is objective evidence of a process destructive of the membranous labyrinth. It supports the likelihood of an absence of cochlear and vestibular function. It alerts the surgeon to the possible obliteration of key inner ear anatomical landmarks.- - - - - - - - - - ranking = 5keywords = labyrinthitis (Clic here for more details about this article) |
5/27. Labyrinthine fistula detection: the predictive value of vestibular symptoms and computerized tomography.A retrospective case record study of 20 patients in Oslo operated on for chronic otitis media with labyrinthine fistula between 1986 and 1999 was performed in order to estimate the incidence of, and identify predictors for, labyrinthine fistulas. The incidence of fistula was 0.3 per 100 000, with a median age at diagnosis of 37 years. The median duration of chronic otitis media prior to labyrinthine fistula detection was significantly correlated with age at surgery. Subjective hearing loss (90%), otorrhoea (65%) and dizziness (50%) were presenting symptoms. Modified canal-wall-down mastoidectomy was performed in all patients. Preoperative hearing levels could not predict postoperative hearing outcome. Positive signs of fistula were found in only 4 patients (20%). Correspondingly, computerized tomography (CT) diagnosed the fistula in 11 patients (55%). The seven patients presenting without dizziness and with a negative CT scan and fistula test were characterized by lower age, absence of previous middle ear surgery, lower preoperative pure-tone thresholds for bone conduction and better hearing outcome after surgery. In conclusion, the identification of a younger group of patients presenting with fewer symptoms indicates that fistulas should be suspected in all patients undergoing surgery for chronic middle ear and mastoid disease.- - - - - - - - - - ranking = 0.001364970291802keywords = otitis (Clic here for more details about this article) |
6/27. hearing loss of acquired syphilis: diagnosis confirmed by incudectomy.syphilis, both congenital and acquired, may cause sensori-neural hearing loss. Congenital syphilis presents in two forms: early (infantile), and late (tardive). Acquired syphilis, both secondary and tertiary, may cause deafness. The clinical course of the acquired and congenital forms are similar. Sensori-neural hearing loss with low discrimination scores may affect both ears simultaneously or sequentially, and vestibular complaints are common. A clinical diagnosis can be made on the basis of history, the presence of other stigmata of syphilis, and serological tests, including the FTA-ABS. The histopathology of acquired and congenital forms is indistinguishable and is essentially twofold: first, syphilis may cause a miningo-neurolabyrinthitis with round cell infiltration of the labyrinth and VIIIth nerve as the predominant lesion in early congenital syphilis and the acute meningitides of secondary and tertiary acquired syphilis. Second, syphilis may cause a perivascular round cell osteitis of the temporal bone with secondary involvement of the membranous labyrinth in both late congenital and acquired late latent or tertiary syphilis. endolymphatic hydrops may be seen in both the congenital and acquired forms. A case of bilateral sequential sudden deafness due to acquired syphilis is presented. A histological diagnosis of syphilitic involvement of the temporal bone was made by incudectomy. Treatment with prednisone and penicillin over a three-month period resulted in return of good cochlear function in one ear.- - - - - - - - - - ranking = 1keywords = labyrinthitis (Clic here for more details about this article) |
7/27. cytomegalovirus endolabyrinthitis.A premature male infant, who died 22 days after birth with hyaline membrane disease, was found to have had cytomegalic inclusion disease at autopsy. Histopathologic examination of the temporal bones showed cytomegalovirus (CMV) infection of the entire endolabyrinth without involvement of the neural and sensory structures. These findings support the thesis that late gestational or perinatal fetal CMV infection results in an endolymphatic labyrinthitis. We hypothesize that blood-borne virus passes from the stria vascularis into the endolymphatic spaces and infects the nonneurosensory epithelium. This pattern of infection differs from the perilabyrinthitis of human varicellazoster and experimentally produced mouse CMV.- - - - - - - - - - ranking = 6keywords = labyrinthitis (Clic here for more details about this article) |
8/27. The hypotympanum and infralabyrinthine cells in chronic otitis media.Despite the localization implied by the term "chronic otitis media," little attention has been paid to the role of the hypotympanum in chronic active otitis media. Most authors have emphasized the role of recurrent cholesteatoma or unexenterated cells in the mastoid cell system as causes of recurrent disease. Seven cases are reported in which clinical evidence indicated that recurrent chronic otitis media was limited to the hypotympanum and infralabyrinthine cell system. In the five cases in which revision surgery was done, exenteration of this area resulted in an asymptomatic ear. The anatomy, radiographic evaluation, and surgical approach to the hypotympanum are reviewed. Careful inspection of the hypotympanum in primary surgery for chronic ear disease and exenteration of the hypotympanic and proximal infralabyrinthine cell tract are advocated when these regions contain cholesteatoma or extensive granulomatous disease.- - - - - - - - - - ranking = 0.0047773960213071keywords = otitis (Clic here for more details about this article) |
9/27. Perilymphatic fistulas in children: rationale for therapy.We report 26 consecutive patients (32 ears) who were identified in a 2 year period (July 1, 1985-June 30, 1987) with unexplained sudden, fluctuating, or progressive sensorineural hearing loss (SNHL). All patients underwent an exploratory tympanotomy and a perilymphatic fistula was identified in 13 patients (14 ears). The mean change of 14 /- 27 dB in speech reception threshold before and after surgery was significant at p = 0.08 among children with fistula and ranged from -30 to 80 dB. In children with sudden, progressive or fluctuating SNHL and multiple sensory deficits, including blindness or contralateral SNHL, or prior head trauma, prompt surgical exploration is mandatory. Additionally, the aggressive management of otitis media with effusion is essential in such patients to minimize fluctuations in hearing caused by superimposed conductive hearing loss. Caution must be exercised to separate fluctuating hearing loss from fluctuations in audiologic testing.- - - - - - - - - - ranking = 0.00068248514590101keywords = otitis (Clic here for more details about this article) |
10/27. Labyrinthine fistulae caused by cholesteatoma. Improved bone conduction by treatment.In five cases of labyrinthine fistulae caused by extensive cholesteatoma, more than 30-dB improvement in bone conduction was observed in four postoperative cases and in one case after preoperative administration of antibiotics. In each case, a fistula of more than 2 mm in length was present at the lateral semicircular canal, and membranous labyrinthine wall was exposed when the cholesteatoma membrane was removed. These five cases were considered to be in the stage of serous labyrinthitis. The experience with these cases shows that emergent antibiotic treatment and surgery are appropriate for cases with reduced bone conduction in which labyrinthine fistula caused by cholesteatoma is suspected. In addition, as the reduction of bone conduction does not necessarily preclude the possibility of good postoperative hearing, tympanoplasty may be appropriate even for cases with markedly reduced bone conduction due to labyrinthine fistulae.- - - - - - - - - - ranking = 1keywords = labyrinthitis (Clic here for more details about this article) |
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