Impression-material foreign bodies of the middle ear and external auditory canal

Twenty-nine evaluable patients with endometrial cancer were treated with amonafide 300 mg/m2 for 5 consecutive days every 3 weeks. Two partial responses (8%) were seen. Hematologic toxicity was severe or life-threatening in 13 patients occurring as follows: leukopenia in 13 patients (45%); thrombocytopenia in 10 patients (34%); granulocytopenia in 13 patients (45%); and anemia in four patients (14%). In view of the low response rate and high toxicity, this dose schedule of amonafide does not warrant further investigation in endometrial cancer.     

Exostosis of the external auditory meatus or ear canal nodes. A study of etiology and therapeutic results

In this study we evaluated the relation between exposure of the ear canal to cold water and development of exostosis. Furthermore we wanted to evaluate the clinical outcome of surgical removal of the exostosis. The material consisted of a group of 15 winter bathers who had been exposed to cold water over a period varying from three to 45 years. All but one subject who had exposed the ear canal to cold water had developed exostoses of the ear canals. Follow-up examinations of nine patients after surgical removal of the exostosis revealed normal, well calibrated ear canals. Three winter bathers who continued the exposure to cold water developed a new exostosis.     

Twenty-one cases of malignant tumor of the external auditory canal or middle ear

We have assessed the effects of intraplantar local anaesthetics (bupivacaine and lignocaine) on carrageenan-induced oedema, mechanical allodynia and spinal c-fos protein expression. Mechanical allodynia was evaluated using the vocalization threshold to paw pressure (VTPP) every 30 min until 60, 180 or 240 min after administration of carrageenan. Peripheral oedema, mechanical allodynia and spinal c-fos protein expression were maximal 180 min after carrageenan. Lignocaine did not influence either oedema or VTPP, but reduced spinal c-fos expression at 60 min after carrageenan without later effects. Bupivacaine induced an increase in VTPP at 30 and 60 min, limitation of oedema at 60 min and a reduction in spinal c-fos expression at 60 and 180 min, but these effects were not present 240 min after carrageenan. Intraplantar infiltration with lignocaine and bupivacaine before carrageenan transiently limited signs of inflammatory pain but did not prevent them.     

Radiation therapy in the management of carcinoma of the external auditory canal, middle ear, or mastoid

Twenty-three patients with squamous-cell carcinoma of the external auditory canal, middle ear, or mastoid were treated with combined surgery and irradiation, giving a 5-year NED rate of 48% (11/23). Except in extremely early lesions without bone involvement, treatment by radiation therapy alone was rarely successful and is not recommended. The most serious complication was osteoradionecrosis of the temporal bone; this occurred in 5 patients, all of whom received more than 2,100 rets due to faulty radiotherapeutic technique.     

Congenital deformities of the middle and external ear

Congenital deformities of the external and middle ears were shown by tomography in 246 patients. Surgical exploration has been undertaken at some time in many of these ears. The appearance of the tomograms and their significance were reviewed in the light of the operative findings and the authors' experience of congenital ear lesions. In nearly every case a middle ear cavity could be demonstrated although this varied from a normally aerated middle ear and mastoid in association with an isolated unilateral atresia of the external auditory meatus to a small slit-like hypotympanum in patients with craniofacial abnormalities. The ossicles were nearly always present but deformed. The typical appearances of the ossicles and the frequently aberrant pathways of the facial nerve are described.     

Guanylate cyclase activity in the inner ear and auditory nerve of the rat

Novel molecular mediation in the sound transductional process is implicitly suggested. We investigated the presence of the cGMP-synthesis enzyme, guanylate cyclase, in Corti's organ and auditory nerve of the rat. The soluble guanylate cyclase activity found was sensitive to changes of sound intensity in the different acoustic media used, suggesting a potential role for the system that involves this enzyme. The guanylate cyclase activity appeared to be inversely related (in the inner ear) with the sound intensity to which the animals were exposed; different behavior was observed for the auditory nerve. The enzymatic activity found in Corti's organ, a direct bio-receptor of sound, represents the first reported enzymatic activity of this type in this tissue, which apparently could be influenced by the intensity of a physical stimulus such as sound. Finally, an adequate ionic environment appears to play a potential role in the expression of the changes observed, indicating that it may function according to the requirements of the biological sensor.     

Functional surgery of ceruminoma of the external and/or middle ear

We made a prospective study of 58 patients with suspected internal derangement of the knee. They were examined by magnetic resonance imaging using 3-D gradient echo intermediate-weighted studies before having an arthroscopy. The preoperative clinical assessment was found to have a diagnostic sensitivity of 77% and a specificity of 43%, compared with 100% and 63% respectively for magnetic resonance imaging. Comparison of magnetic resonance imaging and arthroscopy confirmed the accuracy of magnetic resonance imaging in the diagnosis of internal derangement but the results for articular cartilage lesions were much less good, with a sensitivity of only 18% but a specificity of 100%. Acceptance of the magnetic resonance imaging findings could have resulted in a 29% reduction in the number of arthroscopies without missing any significant meniscal lesion.     

Surgery of inner ear diseases (author's transl)

In the treatment of Menière's disease, surgical procedures are available when conservative measures have failed. The most distressing symptom of vertigo can frequently be arrested, tinnitus reduced and hearing improved. Sudden deafness due to round window rupture is treatable. The most important disorder with labyrinthe symptoms is the acoustic neuroma, the smaller ones of which can be operated on by otologists in collaboration with neurosurgeons using the transtemporal or translabyrinthine approach with preservation of the facial nerve.     

Influence of hyperoxia on in vitro growth of rabbit middle ear epithelium and auditory meatal epithelium

As stated in the conclusion, "life is a thing of macromolecular cohesion in salty water." This brief historical overview shows that "compensatory" organic osmolytes take an essential place in this cohesion. It reviews the major steps of the study of these compounds over more than 100 years, from the early beginnings of 1885 until now, showing some of its fascinating developments and ending on the idea that the most fascinating is still to come. This study can be taken as an example of the richness of the comparative approach.     

Study on the etiology of cholesterin granuloma of the middle ear (author''s transl)

The radiological features of 20 surgically proven thoracic disc protrusions are reviewed. In 15 (75%), characteristic plain film changes were found to be very helpful in making the correct diagnosis. Calcified disc material in the spinal canal was clearly demonstrated in 11 (55%) cases, and this, in association with linear calcification in the adjacent disc space, has been shown to be diagnostic of the condition. At myelography, central protrusions (55%) were found to be predominant, while lateral protrusions were uncommon. The differential diagnosis of a calcified lesion in the spinal canal includes thoracic disc protrusion, osteochondroma and meningioma.     

Experimental demonstration of an identic antigenicity of the inner ear and kidney (author's transl)

An allergic glomerunephritis was produced in rats by injection of an anti-basement-membrane-serum (IgG-fraction), taken from rabbits which were sensitized against a basement membrane fraction of rat-glomerula. Tissues from heart, liver, brain, lung and inner ear were compared with the well known alterations of the glomerula. Exclusively in stria vascularis and renal glomerula heavy changements of the basement membranes and endothelial cells could be shown by electronmicroscopic examination and by immunohistological methods.     

Influence of the gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases

To investigate the influence of gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases, the authors examined the mastoid pneumatization among patients with sniffing habit using computed tomography, and also examined the change of negative middle ear pressure induced by sniffing using tympanogram. In 20 ears with cholesteatoma or adhesive otitis media, the areas of mastoid cavity measured at the level of the lateral semicircular canal were significantly smaller than those in 26 ears with otitis media with effusion (OME) or attic retraction and in eight normal ears with sniffing habit (P < .01 and P < .0001, respectively). In 26 ears with OME or attic retraction, the areas of mastoid cavity were significantly smaller than those in eight normal ears with sniffing habit (P < .0001). By contrast, in the four ears with sniff-induced middle ear disease, the recovery of negative middle ear pressure in 5 minutes without swallowing was less than 10 mm H2O, whereas in all seven ears with normal eardrum, negative middle ear pressure recovered by more than 20 mm H2O in 5 minutes. These findings suggested that impairment of gas exchange function through the middle ear mucosa, as well as eustachian tube dysfunction, might be closely related to the development of sniff-induced middle ear diseases.     

Feedback control of the auditory periphery: anti-masking effects of middle ear muscles vs. olivocochlear efferents

Both MEM and MOC systems are sound-evoked reflexes to the auditory periphery which can be elicited by sound in either ear. Both MEM and MOC systems can increase thresholds in the auditory periphery: the MEM system acts by stiffening the ossicular chain, the MOC system by decreasing outer hair cell amplification of sound-induced motion in the inner ear. MEM-induced attenuations are largest for low frequency stimuli, MOC-induced attenuations are largest for mid- to high-frequency sounds. Both MEM and MOC systems can have anti-masking effects. The MEM reflex can decrease the masking of high-frequency signals by low-frequency noise (i.e., the upward spread of masking). The MOC reflex is complementary in that it minimizes masking of high-frequency transient signals by high-frequency continuous noise. MEM anti-masking arises by reducing suppressive masking and can improve masked thresholds at high frequencies. MOC anti-masking arises by counteracting excitatory masking. It does not improve masked thresholds, but can improve the detectability of small suprathreshold intensity increments. Anti-masking effects of both MEM and MOC systems should be reduced in cases of sensorineural hearing loss.     

Active electronic cochlear implants for middle and inner ear hearing loss--a new era in ear surgery. I: Basic principles and recommendations on nomenclature

Hearing aids have fundamental disadvantages: (1) stigmatization of the patient; (2) the sound is often found to be unsatisfactory due to the limited frequency range and undesired distortion; (3) in many patients, the ear canal fitting device generally necessary leads to an occlusion effect; (4) acoustic feedback when amplification is high. Conventional hearing aids transmit sound into the ear canal via a small microphone. Sound has the disadvantage of requiring high output sound pressure levels for its transmission. This along with the necessary miniaturization of the loudspeaker as well as the resonances and reflections in the closed ear canal contribute to the disadvantages mentioned. In contrast, implantable hearing aids do not make sound signals but micromechanical vibrations. An implantable hearing aid has an electromechanical transducer instead of the loudspeaker of a conventional hearing aid. The hearing signal does not leave the transducer as sound but as a mechanical vibration which is directly coupled to the auditory system bypassing the air. This implantable hearing aid is either coupled to the tympanic membrane, the ossicular chain, the perilymph of the inner ear, or the skull. An implantable hearing aid is expected to have: 1 Better sound fidelity than a hearing aid 2 No ear canal fitting device, free ear canal 3 No feedback 4 Invisibility Requirements on electronic hearing implants designed for patients with conductive hearing loss differ from those on implants for sensorineural hearing loss. Conductive hearing loss requires the implant to replace the impedance transformation, thus being an impedance transformation implant (ITI). In various respects, the demands on an ITI are lower than the demands on an electronic hearing aid for patients with sensorineural hearing loss. The latter are mostly patients with a failure of the cochlea amplifier (CA). A damage to the CA is clinically discernible by a positive recruitment and loss of otoacoustic emissions (OAE). Since these patients form the majority of cases with sensorineural hearing loss, an active hearing implant for such patients should partially replace the function of the CA. Therefore, the suggestion is to refer to a CAI (cochlea amplifier implant). The implant expressions ITI (for patients with conductive hearing loss) and CAI (for patients with sensorineural hearing loss) used in this context allow nomenclatural association with the CI (cochlear implant) for complete inner ear failure as well as with the BSI (brainstem implant) in the case of hearing nerve failure.     

Coevolution of the mammalian middle ear and neocortex

Phylogenetic analysis with x-ray computed tomography of fossilized and recent crania implicates differential growth of the neocortex in the evolution and development of the mammalian middle ear. In premammalian tetrapods, the middle ear evolved as a chain of bones attached to the mandible and cranium, but in adult mammals the chain is detached from the mandible and lies behind it. The neocortex evolved concurrently with detachment of the chain. In mammalian development the auditory chain arises connected to the mandible but later detaches, recapitulating the phylogenetic transformation. In modern didelphid development, the auditory chain reaches mature size by the third week after birth and is then separated from the jaw and displaced caudally as the neocortex grows for another 9 weeks.