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1/154. Sensorineural hearing loss associated with otitis media with effusion in children.

    Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME. ( info)

2/154. Spontaneous cerebrospinal fluid otorrhea from a tegmen defect: transmastoid repair with minicraniotomy.

    Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare condition that presents in 2 clinical categories. In congenital labyrinthine malformations, it leads to bouts of meningitis in a hearing-impaired child. In the adult age group, a spontaneous CSF leak almost always results from a dural and bony defect in the tegmen area. Possible pathogenic mechanisms include progressive sagging and rupture of dura through a congenital tegmen dehiscence and progressive bone erosion by aberrant arachnoid granulations. These patients usually present with a middle ear effusion, resulting in clear discharge after myringotomy with tube insertion. Based on 4 patients with a CSF leak from a tegmen defect, this report reviews the clinical findings and diagnostic approach. The surgical management by a 5-layer closure using a transmastoid approach with minicraniotomy is outlined. This procedure offers a relatively simple and reliable method for repair without the inherent risks of a middle fossa craniotomy. ( info)

3/154. Middle ear inflation for diagnosis and treatment of otitis media with effusion.

    An adult (18 years), healthy, male subject with persistent bilateral middle ear (ME) underpressure and a history of recurrent otitis media into his teen years was identified. The response of his MEs to air inflation was evaluated and showed an immediate pressure increase after a valsalva maneuver followed by a rapid pressure drop to approach the pre-inflation levels. That response is consistent with the presence of ME effusion, which was not diagnosed by otoendoscopy or tympanometry, but was visualized bilaterally within the mastoid regions using magnetic resonance imaging (MRI). The patient was treated for 25 days with ME inflation (3/day) and then re-examined. On each treatment day, he recorded his ME pressure using tympanometry before and after one inflation maneuver. The patient's compliance with the treatment protocol was high, and successful gas transfers were documented on most days. Over the course of treatment, pre-inflation ME pressure became more normal bilaterally. When compared to the pre-treatment test, the post-treatment inflation test showed a similar rate of ME pressure decrease, but significantly higher terminal pressures. On follow-up but not during the pre-treatment period, discrete changes in ME pressure attributable to ET openings were noted during test sessions. MRI documented lesser amounts of effusion in the mastoid, but not complete disease resolution. The significance of these observations to the design of a well controlled clinical trail of ME inflation as a treatment for otitis media is discussed. ( info)

4/154. eustachian tube function in children.

    eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-eustachian tube pathology potentially contributing to eustachian tube dysfunction were excluded from the study. eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal eustachian tube function. This is extremely effective palliation, and should be recognized as such. ( info)

5/154. Nontuberculous mycobacterial otomastoiditis in children: four cases and a literature review.

    Otomastoiditis due to nontuberculous mycobacteria (NTM) is rare but increasingly being recognised. We present four cases and discuss the clinical presentation, pathogenesis, diagnosis, and treatment, with a review of previous case reports in the literature. ( info)

6/154. lateral sinus thrombosis after untreated otitis media. A clinical problem--again?

    Antimicrobial agents have greatly reduced the incidence of intracranial complications of infections of the middle ear and mastoid. Too many prescriptions and overconsumption of antibiotics when otitis media is suspected has caused resistance to many antibiotics, leading to a pronounced and justifiable desire to reduce the widespread excessive use of antibiotics. The possible untoward consequences of a too restricted antibiotic policy, however, is illustrated by the following case of a 14-year-old boy who, after non-treatment of an ear infection, fell ill with one-sided headache and vomiting caused by a lateral sinus thrombosis. After intravenous treatment with antibiotics, anticoagulants and ventilation of the middle ear, the infection was cured without complications. This case calls attention to the symptoms of otitic complications arising outside the temporal bone. The physician must always bear in mind the possibility of an unusual event. The general treatment of endocranial complications is outlined, giving details of the treatment given in this special case. We stress that one should not be too cautious in prescribing antibiotics in otitis media. ( info)

7/154. CT findings in tuberculous otomastoiditis. A case report.

    PURPOSE: Otomastoiditis is a rare but important manifestation of tuberculosis and is well recognizable when information on its clinical course is considered in connection with the radiographic changes. MATERIAL AND METHOD: A patient with a clinical history of chronic otorrhea, resistant to conventional therapy but without dramatic symptoms, was referred for CT examination. RESULTS: CT revealed widespread soft tissue densities in the tympanic cavity and in the mastoid process, with bone erosions in the latter. Surgery and bacteriology confirmed the diagnosis of mycobacterium tuberculosis infection. CONCLUSION: CT evidence of widespread bone destruction without clinical signs of aggressive infection should suggest the diagnosis of a mycobacterial process. Early treatment is essential in order to avoid propagation of the disease and lasting loss of function. ( info)

8/154. Pseudoaneurysm of a lateral internal carotid artery in the middle ear.

    We report a case where a 7-year-old girl suffered significant aural bleeding following myringotomy of the tympanic membrane. Investigations by computed tomography scan, carotid angiography, and magnetic resonance angiography showed a lateral aberrant internal carotid artery (LACI) with a little pseudoaneurysm in the middle ear. The anomaly of the internal carotid artery was supposed to be congenital, and the pseudoaneurysm was supposed to be traumatic, formed after incision into the wall of the artery. Considerations about diagnosis, symptoms, and treatment are discussed. The patient was treated by balloon embolization in the internal carotid artery without sequelae. ( info)

9/154. Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction.

    To try to solve the pathogenesis of severe attic retraction viewed from mastoid condition, we examined the residual soft tissue density (RSTD) in the mastoid by computed tomography (CT) in 85 patients (107 ears) with otitis media with effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in children (24.1%). Ears with severe attic retraction had RSTD significantly more frequently (80%) than those with no or mild attic retraction, and many of the mastoids with severe attic retraction were occupied totally by RSTD. The area of the mastoid (mastoid pneumatization) was significantly smaller, and CT density of the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than in those without. RSTD after tympanostomy tube insertion in the mastoid indicating organic change of effusion was considered one of the important factors relating to the pathogenesis of severe attic retraction. ( info)

10/154. abscess formation in the temporomandibular joint as a complication of otitis media.

    A case of an eight-month-old girl with an abscess in the temporomandibular joint as a complication of acute otitis media is described. The complications of acute otitis media in general and the probable explanation for the development of this complication are discussed. ( info)
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