An environmental and demographic analysis of otitis media in rural Australian aborigines

Otitis media (OM) and tympanic scarring prevalence among rural Australian Aboriginal children is examined in relation to age, sex, community size and 34 environmental variables pertaining to living conditions and climate. The environmental variables are reduced to a smaller set of underlying factors via Principal Components Analysis. With age and sex standardized, a multivariate analysis is performed. OM prevalence is profoundly age-dependent, and is related negatively to community socioeconomic status and the presence of swimming facilities. Scarring prevalence is shown to be subject to substantial inter-observer variation, and with the appropriate adjustment manifests an inverse relationship with winter warmth. The data were collected under the National Trachoma and Eye Health Program.

Ear disease and hearing loss among Navajo children--a mass survey

A team of trained technicians in a specially equipped mobile van conducted a mass screening effort on the Navajo Reservation from 1978 to 1980 to detect and refer individuals with ear disease and hearing loss; 15,890 school children were examined. The prevalence data and correlations of hearing level with ear disease are presented: 4.0% of the children had TM perforations, 2.3% middle ear effusions, 1.9% TM atelectasis, and 0.4% had sensorineural hearing loss. Microtia was found in 1:935, with a cluster on the Western one-fourth of the reservation. Cholesteatoma was rare. The patterns of ear disease are contrasted with other groups.

Photography in treatment of tympanic membrane perforations

A photographic method which gives a large image on the film is used for recording perforations of the tympanic membrane and it may be valuable for comparing different methods of closure. A method for the treatment of minor perforations is also briefly mentioned.

Diving injuries

This is a collective review about the pathophysiology, diagnosis, and management of SCUBA and diving injuries by the emergency physician. These injuries can be classified into those resulting from the toxic effects of the inhaled gas, from the pressure changes in the water and gas mixture while diving, and from decompression sickness. With the increasing popularity of SCUBA diving, it is hoped that this discussion will enable a recognition of these injuries and therefore minimize the morbidity and mortality from them.

Tympanic membrane cholesteatoma (keratoma)

Four cases of tympanic membrane cholesteatoma are presented and the characteristics of this lesion are discussed. Failure to recognize and remove all the squamous epithelium medial to the tympanic membrane at the time of grafting eventually will result in graft breakdown due to continued production and desquamation of squamous epithelium into the middle ear.

Tympanic membrane perforations from water sports: treatment and outcome

A study of 15 patients with 17 tympanic membrane perforations resulting from water sports was carried out. Most small perforations healed spontaneously. Perforations that persisted after 8 weeks were treated surgically, usually with the office paper patch procedure. A frequent history of middle ear problems in these patients suggests that middle ear dysfunction may play a role in the occurrence and delayed healing of traumatic perforations.

Epithelial migration on the guinea-pig tympanic membrane: the influence of perforation and ventilating tube insertion

The guinea-pig tympanic membrane was used to study epithelial migration by using an ink-dot staining technique. The normal tympanic membrane exhibited clear-cut migratory pathways, mainly in a superior direction. Tympanic membranes were acutely perforated and others had ventilating tubes inserted in them to determine their influence on the migratory process. The overall pattern of migration was found to be unaltered; only those cells were affected whose normal pathways had been disrupted by these procedures. The possible relationship of epithelial migration to ventilating tube extrusion is discussed.

Measurement of mucociliary function of the eustachian tube

Mucociliary function of the eustachian tube was measured with a radioisotopic method; 0.01 mL of a human serum albumin labeled with technetium 99m was instilled into the anterior part of the middle ear cavity either through a perforation or by puncturing the tympanic membrane, and its course was followed by a gamma-camera. In the normal eustachian tube, the velocity of the mucociliary transport was 0.7 to 1.1 mm/min. The mucociliary function was totally absent in chronic otitis media, in untreated secretory otitis media, and in the ear with a moist perforation of the tympanic membrane. The mucociliary transport returned to normal when the ear was clinically healed. It is assumed that the impairment of the mucociliary function of the eustachian tube and middle ear plays an important role in the pathogenesis of secretory otitis media and chronic ear discharge.

Incisions in tympanoplasty: anatomic considerations and indications

The endaural, postauricular and transmeatal incisions are the most commonly used surgical approaches for tympanoplasty. Each incision used in tympanoplasty has its own advantages and limitations so that no single approach is the best approach for all tympanic membrane perforations. The incision selected for tympanoplasty should be determined by the location and extent of disease. Forty adult temporal bones were studied to understand the limiting factors for each surgical approach used in tympanoplasty. The external endaural incision has been modified to permit easier visualization of the crescentic endomeatal canal incisions. The anterior external endaural incision allows direct exposure of temporalis fascia, the external meatus, bony canal and perforation involving the posterior tympanic membrane and ossicular chain. The postauricular incision gives direct exposure of the anterior tympanic membrane with preservation of the anterior canal wall skin. The transmeatal approach should be reserved for smaller central perforations with limited risk for squamous ingrowth into the middle ear. In the transmeatal tympanoplasty, the ear canal should permit the use of a speculum large enough to expose the entire perforation.

Trauma of the ear from infrasound

Twenty-eight chinchillas received continuous or intermittent infrasound (1, 10, 20 Hz) at 150, 160, or 170 dB SPL; there were 7 controls. Serial sections of the temporal bones were examined using light microscopy. Pathologies noted were tympanic membrane perforation, stapes subluxation, bleeding from the middle ear mucosa and tensor tympani, strial pathology, Reissner's membrane rupture, endolymphatic hydrops, saccular wall rupture, hair cell damage, and blood in the cochlear scalae. Continuous infrasound was more damaging than intermittent. Only continuous infrasound produced saccular pathology and perforations of the tympanic membrane. Of the other pathologies observed, continuous infrasound exposures produced 67% of the hair cell damage, 73% of the bleeding in the cochlear scalae, 83% of the strial pathology, and 78% of the cases of cochlear hydrops. 170-dB infrasound exposures produced the highest percentage of ears with pathologies of the three exposure intensities. As frequency increased the percentage of ears with pathologies decreased.

Volume measurement of middle ear and mastoid air cell system with impedance audiometry on patients with eardrum perforations

The usefulness of the electroacoustic impedance bridge with a probe tone frequency of 0.22 kHz in the determination of the middle ear and mastoid volumes was evaluated in patients with dry eardrum perforations. The values obtained were compared with the volumes determined by an aspiration technique utilizing the gas laws. Also, a comparison was made between the impedance volumes and the size of the mastoid air cell system as measured on x-ray film in a lateral projection. A significant agreement between the two methods of direct volume determination was found. A good relationship was found between the impedance volume and the mastoid air cell area. The impedance audiometry enables a rapid and valuable estimation of the air reservoir in the middle ear in patients with eardrum perforations.