Mastoid volume and eustachian tube function in ears with cholesteatoma

Eustachian tube function, as measured by the pressure equalizing technique, and the mastoid air cell area were compared among ears with traumatic eardrum perforations, ears with chronic otitis media, and cholesteatomatous ears. A statistically significant difference among the three groups was found regarding the residual positive pressure after swallowing, with the poorest function found in the cholesteatoma group. Also, the ability to reduce a negative pressure was found to be inferior in the cholesteatoma group compared with the others. The mean mastoid air cell area measured on the x-ray film was smallest among ears with cholesteatoma and differed significantly among the groups. These disturbances in the active eustachian tube function as well as the volume of the middle ear cleft, including the mastoid air cell system, were found to be characteristic among ears with acquired cholesteatomas.

Repair of traumatically ruptured tympanic membrane using hyaluronan

Three large tympanic membrane (TM) perforations (occupying more than one quadrant) were treated with hyaluronan (1% hyaluronic acid) without delay after the accident. Using the highly viscous hyaluronan as an aid, the margins of the perforations could be noticeably restored. The size of the perforation could be immediately reduced to roughly half of its original size. Immediate restoration and covering of a traumatically ruptured TM wound improve the healing potential of the drum and counteract middle ear infection.

Metal spark perforation of the tympanic membrane with deafness and facial paralysis

An extremely rare case of traumatic thermal injury of the middle and inner ear with deafness and irreversible peripheral facial palsy is presented. The accident was caused by a metal spark perforating the tympanic membrane during welding.

Traumatic lesions of the middle ear: aetiology and results of treatment

A retrospective investigation of the aetiology and results of treatment for traumatic, conductive hearing loss was performed in 122 patients treated from 1979 to 1983. The mean age at the time of the trauma was 25 years. The average treatment delay was 7 years. The patients were grouped according to the nature of the injury. The group with head injury (40 patients) was characterized by a frequent combination of young men and traffic accidents. Among direct trauma (16 patients) lesions to the tympanic membrane and/or the middle ear were caused by ear syringing or by the introduction of swabs or other instruments into the auditory canal. In the group exposed to indirect trauma (57 patients) the dominant single cause of the trauma in the present material consisted of a blow to the ear and was most often seen among young women. A subgroup exposed to blasts contained more young men. The dominant operative findings were rupture of the tympanic membrane, luxation of the incus, partial bone necrosis and fracture of the auditory ossicles. Ear surgery consisted of closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Normal hearing was restored in 78%, and hearing improved in another 10%. The hearing remained unchanged or deteriorated in 9% of the patients, a group often characterized by a long treatment delay and/or the development of chronic otitis.

The migration theory of cholesteatoma formation. Some experimental observations

The migration theory of cholesteatoma formation considers that stratified squamous epithelium from the external auditory meatus migrates into the middle ear, giving rise to cholesteatoma. To test the ability of squamous epithelium to migrate in this manner, 73 stains were placed in relation to 23 chronic perforations. In no instance did epithelium migrate into the middle ear cleft. The limitations of the migration theory are discussed.

An ink impregnation study of the migratory skin in the external auditory canal of the guinea-pig

If the tympanic membrane or attic skin is wounded with a fine needle dipped in ink, ink particles are introduced into the epidermis and underlying tissue. These particles are subsequently taken up by cells in the epidermis and dermis. In this experiment the distribution of ink within the skin of ear canal was studied in nineteen guinea-pigs, one to ten days after wounding. Examination of the intact canal reveals that ink becomes distributed along a precise line from the wound to the point of desquamation. On sectioned tissue, the ink in this line is found to be mainly intracellular, initially in the epidermis, and subsequently in the upper dermis. When considered with other evidence, these results indicate that migration probably occurs in the deeper layers of the epidermis, and that it stops at the junction of the deep and superficial parts of the ear canal.

In situ localization of F-actin in the normal and injured guinea-pig tympanic membrane

Although cell migration is an important function of the epithelial cells of the tympanic membrane (TM), little is known about the distribution of the F-actin cytoskeleton, a contractile protein important in cell motility. The purpose of this experiment was to study the in situ localization of F-actin in the epithelial cells of the TM. F-actin, localized using Rhodamine-phalloidin, was present as a thin cortical band at the margin of both the mucosal cells on the inner side of the drum, and the suprabasal cells of the epidermis. The basal cells showed diffuse circumferential F-actin staining sometimes appearing as short microfilaments. Following a full thickness injury, changes in the distribution of F-actin could be observed with in situ localization. While the diffuse F-actin staining of the basal cells was reduced, both long F-actin microfilament bundles extending parallel to the long axis of the cell and focal aggregates of F-actin were prominent. The suprabasal cells became elongated, and while the F-actin remained localized to the cell margin, faint central F-actin microfilaments were observed. The staining of the mucosal cells remained unchanged. This study showed that the guinea pig TM is a useful model to study the distribution of epithelial F-actin in situ under normal and repair conditions, and that the basal cell layer may be important in regulating migration in the epidermis.

Water polo injuries

This article covers the commonly occurring injuries and conditions in water polo athletes with suggested treatments by the team physician. It addresses the uniqueness of the throwing/swimming combination inherent in this sport with the resultant difference in the treatment of water polo athletes compared to swimmers only, particularly the differences in knee injuries and conditions between the two types of athletes.

Medical problems of the swimmer

A swimmer is often faced with medical problems such as asthma, epilepsy, skin disease, and external otitis. Adequate management of these conditions is extremely important for optimal performance by the athlete.

Further studies on the application of the compartmentalization/airlock concept to aircraft and spacecraft

The effect of the application of the compartmentalization/airlock on accidental decompression was studied in conscious rats, mice, and guinea pigs. It was observed that in unprotected rats and mice, 78 of 102 middle ears (76.5%) exhibited hemorrhages with their eardrums intact; and in unprotected guinea pigs, 37 of 50 eardrums (74%) revealed rupture associated with hemorrhages of all middle ears (100%). Seven cases of malleus fractures (14%) were also found in unprotected guinea pigs. On the other hand, none of the protected animals showed signs of middle ear barotrauma. The protective effect on the tolerance of middle ears in the present study showed the same tendency as that on the tolerance of lungs in our previous study. These findings indicate that the application of the compartmentalization/airlock would be of great value in protection against accidental rapid decompression of pressurized aircraft and spacecraft.

Histology of the tympanic perforation and the replacement membrane

This study shows that the mucocutaneous junction of a perforation of the tympanic membrane may be located at the margin, in the middle ear, or in the ear canal. It is incumbent upon the surgeon performing myringoplasty to identify this junction in order to optimize the success of surgery. About one-third of the healed area following perforation has an intermediate fibrous layer. The membranes in 2 cases of myringoplasty evidenced thicker-than-normal intermediate layers.

Recognition of malleus handle fracture in the differential diagnosis of otologic trauma

We have had the opportunity to care for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well as possible perilymph fistulae. In each of these cases there was a small conductive hearing loss which fluctuated and a high compliance tympanogram. Careful otoscopy with the aid of pneumomassage revealed an isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula and the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperatively in these three other patients made exploration unnecessary. While injuries to the ossicular chain have been well-described in the literature, isolated malleus handle fracture has not been previously reported.

Hydrogen sulfide and the probabilities of 'inhalation' through a tympanic membrane defect

We conclude that workers with tympanic membrane defects (perforated eardrums) should not be excluded from working in atmospheres containing concentrations of hydrogen sulfide (H2S). Several existing requirements and recommendations exclude workers with perforated eardrums from working in or around H2S. Such protective measures stem from the belief that H2S can enter the body through the perforation in sufficient measure to compromise the wearer's respiratory protection. However, based on calculations of anticipated leakage of H2S for a variety of eustachian tube conditions and in the absence of either medical literature or personal reports documenting H2S poisoning due to eardrum perforation, the recommendation for excluding workers with such a condition from working in or around H2S is not supported. The anatomy, physiology, and pathology of the eustachian tube are discussed, including the effects such devices as tympanomaxillary shunts might have on contaminant leakage. The National Institute for Occupational Safety and Health (NIOSH) criteria for respirator tests and sources of respirator leakage are examined and NIOSH recommendations for respiratory protection against H2S are outlined.

Traumatic perforations of the tympanic membrane: early closure with paper tape patching

There is a difference of opinion about treating traumatic perforations of the tympanic membrane expectantly or with early surgery. Those who treat expectantly argue that most of the perforations will heal, given enough time. Those who argue for early closure note the occasional finding of middle ear damage, high closure rates, and faster healing. We present 50 consecutive traumatic perforations seen over a 3-year period and initially treated with paper tape patches (3M Micropore) applied in the office under local anesthesia. The success rate was 92%. Three of the four patients whose treatments failed, presented with a draining ear the night of patch placement, suggesting prior infection. All four failures were successfully treated with myringoplasties. Surprisingly, meticulous attention to aligning the perforation margins did not appear to affect the outcome. Healing usually occurred within 2 to 3 weeks. We contend that this method of treatment is quick, inexpensive, highly successful, identifies potential complications, is accepted by most patients, and promotes early healing.

Iatrogenic ossicular injury in an autistic child

A 5-year-old autistic child inserted a grain of oiled popcorn into his right ear canal. Forcible removal of the foreign body in an emergency room while the child was held down resulted in severe ossicular injury. This case well illustrates the danger in removing foreign bodies from the ear of a child without anesthesia. The danger becomes greater when the child is autistic. Ossicular injury, when it happens in such a case, may become quite severe. Treatment of an autistic child presents another difficult problem.

Auditory brainstem evoked potentials in blast injury

Blast injury typically consists of a mixed conductive and sensorineural hearing loss. The sensorineural component includes temporary as well as permanent threshold elevations. Auditory brainstem evoked potentials (ABEP) are sensitive to functional changes in various levels along the auditory pathway. ABEP were recorded from 37 survivors of blasts and latency measures were correlated with clinical findings. Prolongation of peak latencies was correlated with the conductive component of blast-induced hearing loss, as well as with the TTS component of the sensorineural impairment. No central effects of blast on the auditory system were detected. In addition to their objectivity, ABEP hold the promise of differentiating between the permanent and temporary effects of blast on hearing.

Blast injury of the lungs due to lightning

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[Bilateral tympanic membrane perforation caused by a lightning accident]

Electrical damage of the ear can be caused by lightning or by electricity. A 41 year old woman hit by lightning causing burns and rupture of both tympanic membranes is reported and analysed.

New perspectives in myringoplasty

Until 1950 the treatment of a perforated eardrum consisted of covering the drum permanently with artificial material. Since then a surgical technique to establish a functional reconstruction of the eardrum was developed (myringoplasty). A survey of the biological grafting materials used in this technique is given. Biodegradable and non-degradable synthetic materials may prove to be a valuable supplement of the existing biological grafting materials. Artificial eardrums made from several biodegradable poly(alpha-hydroxy acids) and poly(alpha-amino acids) and made from a number of microporous poly(tetrafluorethylene) membranes and from a microporous bisphenol-A poly(carbonate) membrane were implanted into the ears of rats and dogs and as a reference subcutaneously. The implants were histologically examined for periods up to one year. From the biodegradable polymers studied poly(beta-benzyl-L-aspartate-co-L-leucine) 50/50 evoked the least tissue reaction and the newly formed eardrums were the best in terms of thickness and overall integrity. The formation of a reinforced eardrum may be accomplished by the support of an inert, very thin, highly porous poly(tetrafluoroethylene membrane) preferably implanted as a composite graft with a biodegradable polymer.