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Lawrence Z Meiteles - One of the best experts on this subject based on the ideXlab platform.
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Bone conduction impairment in Chronic Ear Disease.
Annals of Otology Rhinology & Laryngology, 2001Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:The preoperative and postoperative bone conduction (BC) thresholds were prospectively investigated in 24 patients with Chronic Ear Disease in the form of cholesteatoma, Chronic suppurative otitis media, or adhesive otitis media. All underwent tympanoplasty with mastoidectomy. Ossicular reconstruction was performed in 14, and the remaining 10 were still awaiting second-stage ossicular reconstruction at the time of this investigation. In each group, the postoperative results were compared with the preoperative results by the paired-samples t-test. In the ossicular reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds, as compared with the preoperative BC thresholds, at 250, 1,000, and 2,000 Hz, with the largest mean improvement observed at 2,000 Hz. No significant improvement was observed at any frequency for the group without ossicular reconstruction. Postoperative improvement of at least 10 dB at 2 or more frequencies was observed in 71% of the ossicular reconstruction group, as compared with 0% of the group that did not undergo ossicular reconstruction. The results support the theory that the elevated BC thresholds of patients with Chronic Ear Disease result from the elimination, due to Disease, of the middle Ear contribution (from the inertial ossicular component and ossicular resonance) to the BC response. The results also suggest that the middle Ear contribution to the BC response is restored with ossicular reconstruction.
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eustachian tube endoscopy in patients with Chronic Ear Disease
Laryngoscope, 2000Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:Objectives/Hypothesis A paucity of resEarch exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in Chronic Ear Disease is needed, particularly because the eustachian tube has been implicated in the Chronicity and pathogenesis of Chronic Ear Disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy. Study Design Twenty-two adult patients with Chronic Ear Disease gave informed consent to participate in a prospective, trans–eustachian tube endoscopic investigation. Methods Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for Chronic Ear Disease. The endoscope was passed from the middle Ear (transtympanic approach) to the nasopharynx. Results The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing Disease (≥20 y) than for persons without long-standing Disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. Conclusions The findings of trans–eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with Chronic Ear Disease and have implications for the timing of surgical intervention (ossicular reconstruction).
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Eustachian tube endoscopy in patients with Chronic Ear Disease.
Laryngoscope, 2000Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:Objectives/Hypothesis A paucity of resEarch exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in Chronic Ear Disease is needed, particularly because the eustachian tube has been implicated in the Chronicity and pathogenesis of Chronic Ear Disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy. Study Design Twenty-two adult patients with Chronic Ear Disease gave informed consent to participate in a prospective, trans–eustachian tube endoscopic investigation. Methods Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for Chronic Ear Disease. The endoscope was passed from the middle Ear (transtympanic approach) to the nasopharynx. Results The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing Disease (≥20 y) than for persons without long-standing Disease (
Christopher J Linstrom - One of the best experts on this subject based on the ideXlab platform.
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Bone conduction impairment in Chronic Ear Disease.
Annals of Otology Rhinology & Laryngology, 2001Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:The preoperative and postoperative bone conduction (BC) thresholds were prospectively investigated in 24 patients with Chronic Ear Disease in the form of cholesteatoma, Chronic suppurative otitis media, or adhesive otitis media. All underwent tympanoplasty with mastoidectomy. Ossicular reconstruction was performed in 14, and the remaining 10 were still awaiting second-stage ossicular reconstruction at the time of this investigation. In each group, the postoperative results were compared with the preoperative results by the paired-samples t-test. In the ossicular reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds, as compared with the preoperative BC thresholds, at 250, 1,000, and 2,000 Hz, with the largest mean improvement observed at 2,000 Hz. No significant improvement was observed at any frequency for the group without ossicular reconstruction. Postoperative improvement of at least 10 dB at 2 or more frequencies was observed in 71% of the ossicular reconstruction group, as compared with 0% of the group that did not undergo ossicular reconstruction. The results support the theory that the elevated BC thresholds of patients with Chronic Ear Disease result from the elimination, due to Disease, of the middle Ear contribution (from the inertial ossicular component and ossicular resonance) to the BC response. The results also suggest that the middle Ear contribution to the BC response is restored with ossicular reconstruction.
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eustachian tube endoscopy in patients with Chronic Ear Disease
Laryngoscope, 2000Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:Objectives/Hypothesis A paucity of resEarch exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in Chronic Ear Disease is needed, particularly because the eustachian tube has been implicated in the Chronicity and pathogenesis of Chronic Ear Disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy. Study Design Twenty-two adult patients with Chronic Ear Disease gave informed consent to participate in a prospective, trans–eustachian tube endoscopic investigation. Methods Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for Chronic Ear Disease. The endoscope was passed from the middle Ear (transtympanic approach) to the nasopharynx. Results The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing Disease (≥20 y) than for persons without long-standing Disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. Conclusions The findings of trans–eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with Chronic Ear Disease and have implications for the timing of surgical intervention (ossicular reconstruction).
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Eustachian tube endoscopy in patients with Chronic Ear Disease.
Laryngoscope, 2000Co-Authors: Christopher J Linstrom, Arie Rosen, Carol A. Silverman, Lawrence Z MeitelesAbstract:Objectives/Hypothesis A paucity of resEarch exists on trans–eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in Chronic Ear Disease is needed, particularly because the eustachian tube has been implicated in the Chronicity and pathogenesis of Chronic Ear Disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans–eustachian tube endoscopy. Study Design Twenty-two adult patients with Chronic Ear Disease gave informed consent to participate in a prospective, trans–eustachian tube endoscopic investigation. Methods Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for Chronic Ear Disease. The endoscope was passed from the middle Ear (transtympanic approach) to the nasopharynx. Results The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing Disease (≥20 y) than for persons without long-standing Disease (
C. Gary Jackson - One of the best experts on this subject based on the ideXlab platform.
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Chronic Ear surgery in patients with syndromes and multiple congenital malformations
The Laryngoscope, 2007Co-Authors: Matthew R O'malley, David M. Kaylie, Daniel J. Van Himbergen, Marc L. Bennett, C. Gary JacksonAbstract:Objectives/Hypothesis: The propensity for the development of Chronic Ear Disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of Chronic Ear Disease in patients with congenital syndromes or multiple major malformations associated with high rates of Ear Disease. Study Design: Retrospective chart review. Methods: Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of Chronic Ear Disease who underwent Ear surgery for Chronic Ear Disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported. Results: Forty-three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 Ears. Seventy-nine percent of patients had undergone an Ear procedure prior to presentation. Disease eradication was achieved in 64% of Ears with a single procedure, and 89% of Ears were controlled with two surgeries or less. Thirty-two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air-bone gap, resulting in hEaring improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered. Conclusions: Syndromic patients and those with a major congenital malformation may present with significant Chronic Ear Disease. Appropriate surgical management can yield successful eradication of Disease with low complication rates.
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Chronic Ear Disease: Surgical decisions and techniques
Otolaryngology–Head and Neck Surgery, 1995Co-Authors: Michael E. Glasscock, C. Gary JacksonAbstract:Educational objectives: To apply the basic principles of tympanoplasty and to integrate a spectrum of canal wall-up and canal wall-down formats into a system of surgical procedures for COM.
Daniel J Lee - One of the best experts on this subject based on the ideXlab platform.
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Pediatric Endoscopic Ossiculoplasty Following Surgery for Chronic Ear Disease
The Laryngoscope, 2020Co-Authors: Christen Caloway, Daniel J Lee, Evette A. Ronner, Razan A. Basonbul, Anthony M. Tolisano, Angela W. Zhu, Harini Suresh, Brandon Isaacson, Michael S. CohenAbstract:Objective Rigid endoscopes can improve visualization of the tympanic space compared to traditional microscopic techniques. This study investigates whether use of transcanal endoscopic ossiculoplasty influences audiologic outcomes compared to microscopic ossiculoplasty following Chronic Ear surgery in children. Study design Comparative cohort study at two tertiary care centers. Methods Retrospective review of pediatric Chronic Ear cases where ossiculoplasty was performed from February 2009 to March 2018. Results We identified 100 Ears that underwent endoscopic ossiculoplasty and 100 Ears that underwent microscopic ossiculoplasty. The mean age was 11 yEars (range, 4-18 yEars) with 63% males. There were no significant differences in these parameters between the two groups. Subjects underwent either primary ossiculoplasty or ossiculoplasty during second-look procedures. There was no significant difference in air conduction pure tone average (PTA) after microscopic cases compared to endoscopic cases (-12.5 dB vs. -10.5 dB, P = .40). These results were independent of prosthesis type. Microscopic ossiculoplasty was significantly more likely to use a post-auricular approach (P = .0001). There was no difference in complication rate between the two groups. The malleus was more likely to be absent or removed prior to endoscopic ossiculoplasty (P = .0004) with no significant difference in the change in PTA between groups. Conclusions Transcanal endoscopic ossiculoplasty was found to have equivalent audiometric outcomes with significantly fewer post-auricular approaches and no increase in complications compared to microscopic ossiculoplasty. While the malleus was more likely to be absent in endoscopic cases, this did not appEar to influence the change in PTA. Level of evidence 4 Laryngoscope, 2020.
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development of a temporal bone model for transcanal endoscopic Ear surgery
Otolaryngology-Head and Neck Surgery, 2015Co-Authors: Matthew M Dedmon, Elliott D Kozin, Daniel J LeeAbstract:Transcanal endoscopic Ear surgery (TEES) is being increasingly used in Chronic Ear Disease for cholesteatoma removal and middle Ear reconstruction, reducing the need for a postauricular incision an...
David M. Kaylie - One of the best experts on this subject based on the ideXlab platform.
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Chronic Ear Disease
Medical Clinics of North America, 2018Co-Authors: Susan D Emmett, John Kokesh, David M. KaylieAbstract:: Chronic Ear Disease is composed of a spectrum of otologic disorders intrinsically tied to Eustachian tube dysfunction. Presentation can range from asymptomatic findings on physical examination to critically ill patients with intracranial complications. Internists represent the first line in diagnosis of these conditions, making awareness of the common signs and symptoms essential. With surgical management often required, partnership between internal medicine and otolaryngology is fundamental in the management of patients with Chronic Ear Disease.
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Chronic Ear surgery in patients with syndromes and multiple congenital malformations
The Laryngoscope, 2007Co-Authors: Matthew R O'malley, David M. Kaylie, Daniel J. Van Himbergen, Marc L. Bennett, C. Gary JacksonAbstract:Objectives/Hypothesis: The propensity for the development of Chronic Ear Disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of Chronic Ear Disease in patients with congenital syndromes or multiple major malformations associated with high rates of Ear Disease. Study Design: Retrospective chart review. Methods: Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of Chronic Ear Disease who underwent Ear surgery for Chronic Ear Disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported. Results: Forty-three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 Ears. Seventy-nine percent of patients had undergone an Ear procedure prior to presentation. Disease eradication was achieved in 64% of Ears with a single procedure, and 89% of Ears were controlled with two surgeries or less. Thirty-two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air-bone gap, resulting in hEaring improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered. Conclusions: Syndromic patients and those with a major congenital malformation may present with significant Chronic Ear Disease. Appropriate surgical management can yield successful eradication of Disease with low complication rates.
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management of brain herniation and cerebrospinal fluid leak in revision Chronic Ear surgery
Laryngoscope, 2005Co-Authors: Christopher T Wootten, David M. Kaylie, Frank Warren, Gary C JacksonAbstract:OBJECTIVES/HYPOTHESIS: Brain herniation and cerebrospinal fluid (CSF) leakage into the middle Ear and mastoid are rare but described complications of Chronic Ear Disease. This paper will discuss the presentation and management of brain herniation and/or CSF leak encountered in revision Chronic Ear surgery. STUDY DESIGN: Retrospective chart review. METHODS: Twelve of 1,130 cases of revision Chronic Ear surgery in which brain herniation or CSF leak was diagnosed were identified and analyzed. RESULTS: Ten (83%) patients' initial diagnosis was tympanic membrane (TM) perforation with cholesteatoma and two (17%) with TM perforation without cholesteatoma. Initial revision procedures included one (8.3%) tympanoplasty with canal-wall-up mastoidectomy maintaining ossicular continuity, two (17%) tympanoplasties with canal-wall-down (CWD) mastoidectomies with ossicular chain reconstruction (OCR), and nine (75%) tympanoplasties with CWD mastoidectomies without OCR. Three (25%) required a second procedure, two (17%) a third, and one (8.3%) a fourth, finally resulting in four (33%) with an ossicular reconstruction and eight (67%) without. Brain herniation and/or CSF leak were repaired by way of transmastoid and middle fossa approaches. Preoperative and postoperative pure-tone average air-bone gaps were statistically similar (33.1 and 28.1 dbHL, respectively; P = .464). CONCLUSIONS: Brain herniation and/or CSF leak appEar to be rare complications of surgery for revision Chronic Ear Disease. Their management require adherence to the principles of establishing a safe Ear with hEaring restoration as a secondary goal.