Albert Mudry

Cholesteatoma in children: techniques and results☆

A retrospective analysis of the medical records of all cases of cholesteatoma in children treated between 1981 and 1996 was performed. The charts of 59 children with cholesteatoma were reviewed. A total of 62 ears received surgery over 15 years. The median follow-up period was 5 years. There were 132 operations. An intact canal wall (ICW) procedure was performed in 29% of the ears in the first stage, a canal wall down (CWD) procedure in 37%, a transmeatal atticotomy (TA) in 21%, a tympanoplasty (T) in 6.5% and a myringoplasty (M) in 6.5% of the ears. The ICW procedure had a higher rate of residual/recurrent cholesteatoma than did CWD (P=0.8), TA (P=0.4), T (P=0.5), and M (P=0.05). The CWD procedure had a lower rate than TA (P=0.7), but a higher rate than T (P=0.6) and M (P=0.09). Lastly, TA had a higher rate than T (P=0.7) and M (P=0.1). Auditory results were similar for type II and type III reconstructions (P=0.5). An air-bone gap of less than 20 dB was achieved in 51% of the ears, and 80% had a gap of less than 40 dB. We found a clear difference, although not statistically significant, in the personal rate of recurrent cholesteatoma. It was 26% for surgeons who had performed more than 350 otological surgeries and fell to 15% for the most-experienced surgeon (1715 operations). It rose to 34% for the less experienced surgeons (P=0.8). We recommend that surgery for children with cholesteatoma be reserved for experienced surgeons.

Historical Background of Bone Conduction Hearing Devices and Bone Conduction Hearing Aids

During the last 20 years, bone-anchored hearing aids (Baha(®)) became a familiar solution in the treatment of some types of hearing loss. The aim of this chapter is to present the different historical steps which have permitted the production of this new bone conduction hearing device. The recognition of bone conduction hearing is old and was known at least in Antiquity. During the Renaissance, Girolamo Cardano demonstrated a method by which sound may be transmitted to the ear by means of a rod or the shaft of a spear held between ones teeth: this was the beginning of teeth stimulators to improve hearing, firstly in connection with a musical instrument and then, in the second part of the 19th century, with the speaker. The development of the carbon microphone at the beginning of the 20th century allowed the construction of the bone conduction vibrator placed on the mastoid area, notably supported by eyeglasses since the 1950s. Confronted by various problems, and notably the loss of part of sound in the soft tissue of the external mastoid, the idea to implant the vibrator into the mastoid bone was developed in Göteborg, and the first Baha was implanted in 1977 by Anders Tjellström. From that date, various improvements allowed the development of the actual Baha. These different steps are presented in this study, supported by original documentation.

Necrotizing otitis externa caused by Staphylococcus epidermidis

Abstract We present a case of malignant necrotizing otitis externa (MNOE) caused by Staphylococcus epidermidis, which is usually a non-pathogenic microorganism. The patient is an otherwise healthy, nondiabetic 58-year-old white man. Contributory history began in 1994 after surgery for bilateral exostoses of the external auditory canals. Between April 1994 and May 1998 persistent otalgia occurred, with progressive mixed hearing losses, purulent discharge from both ears, spontaneous perforations of the tympanic membranes and ulceration of canal wall skin. From the beginning, Staph. epidermidis was isolated in all but one culture, but was not recognized as the pathological agent because of the presence of other more frequently involved bacteria and fungi. After multiple intravenous and oral antibiotics and antifungal treatments failed, further management involved frequent debridement of both external auditory canals and tympanic membranes, right tympanoplasty, bilateral mastoidectomy, revision tympanomastoidectomies and left modified radical mastoidectomy. Antistaphylococcal therapy including ceftazidime, vancomycin, teicoplanin, clindamycin and rifampicin was tried. Following the modified radical radical mastoidectomy, normalization of the status of his ears took approximately 2 months and has since remained stable to date. His left ear is deaf because of vancomycin administration, while magnetic resonance imaging and gallium scintigraphy have shown persistent inflammation of the skull base.

Auricular hematoma and cauliflower deformation of the ear: from art to medicine.

Abstract Auricular hematoma and cauliflower deformation of the ear are unique in several respects. Knowledge about it began, in antiquity, through artists, particularly Greek and Roman, and then Japanese in the 18th century with their representation of cauliflower deformation of the ear on sculptures and paintings of pugilists and wrestlers. It is only in the 19th century that physicians began to make substantive progress in understanding this abnormality. It was first thought to be associated with mental disease, but by the beginning of the 20th century, its etiology was recognized as being caused by trauma and was then named auricular hematoma. The second step in the understanding of this affliction was the observation that auricular hematoma progresses toward cauliflower deformation of the ear, which was named cauliflower ear. Recognition of this evolution led to the development of therapies. During the second half of the 20th century, different treatments were developed. They included various hematoma drainage techniques with special bandages to prevent hematoma recurrence and ensuing progression to cauliflower ear. In summary, cauliflower deformation of the ear is an old artistic affliction that has only recently received medical attention.

History of myringoplasty and tympanoplasty type I

The history of myringoplasty and tympanoplasty type I is a delightful chapter in the development of otologic surgery. The aim of this commentary is to sketch the great lines of the history of myringoplasty and tympanoplasty type I. From its first controversial description in 1878 to its actual foundation in 1952, different otologists, mostly German, participated in its development.

Adam Politzer (1835-1920) and the description of otosclerosis.

In 1893, Adam Politzer was the first to describe otosclerosis as a specific disease fixating the stapes. The aim of this study is to follow Politzers research to understand how he finally explained the mechanism responsible for the fixation of the stapes. Politzer conducted his preliminary research from 1862 to 1893. From the concept of a dry catarrh of the middle ear, the fixation of the stapes became progressively associated with a specific ossification in and around the footplate. Politzer presented his first results in 1893. He completed his research by concluding in 1901 that otosclerosis had become an independent disease and should have the right to its own chapter in otologic books. He selected the word otosclerosis to describe this new pathologic entity.

Risk of transmission of human immunodeficiency virus infection during tympano-ossicular homograft : An experimental study

It is generally agreed that middle ear reconstructive surgery performed with tympano‐ossicular homografts produces superior functional results compared with prosthetic material, especially with respect to extrusion rate. The use of homografts, though, has been seriously hampered recently by the fear of transmission of human immunodeficiency virus (HIV) infection. In HIV‐infected patients, the virus is primarily found in the cells of the lymphoid and monocytic lineage. The nature of the tissues in the eardrum and ossicles, mostly fibrous tissue and compact bone without marrow, suggests that little virus load should be found in homografts. Indeed, culturing minced homograft tissue from two HIV‐infected donors with acquired immune deficiency syndrome(AIDS) in a sensitive culture system with PHA‐stimulated lymphoblasts produced no virus. Before use, homografts undergo a fixation procedure in 5% formaldehyde and then are kept in a solution containing Cialit as a preservative. The authors therefore examined the capacity of formaldehyde and Cialit to reduce the infectivity of HIV in models of infected tissue as measured in vitro. The reduction of in vitro infectivity due to these treatments was at least 105‐fold and 102‐fold, respectively. Coupled with the low virus burden in tympano‐ossicular tissue, our data suggests that the fixation procedure affords such a reduction in infectivity that the risk of HIV transmission, even from an HIV‐infected donor, is vanishingly low.

History of instruments used for mastoidectomy

AIM To present the historical development of specific instruments used for mastoidectomy and their resulting implications for this surgery. METHOD Compilation of original written documents, trade catalogues and collections of instruments used in mastoid surgery, with a review of the secondary literature on the subject. RESULTS The first surgical opening of the mastoid was performed by Petit in 1736 with a trepanation system. More than one and a half centuries later, in 1873, Schwartze codified the operation using chisels and gouges. At the end of the nineteenth century, Macewen introduced the electrical dental burr for mastoid surgery, but it remained largely unrecognised. At the beginning of the 1950s, the systematic use of the microscope in ear surgery allowed generalised use of the drill and improvement of the suction-irrigation system. CONCLUSION Three instrumental periods are recognisable in the history of mastoidectomy: the trepan period, the chisel and gouge period, and the electrical drill period.

The history of middle cranial fossa approach to the cerebellopontine angle.

Objectives: To investigate the historical origins of the current middle fossa (MF) approach to the cerebellopontine angle (CPA). Methods: A review of more than 30 original articles from the 1880s to the early 1960s that document the evolution of the MF approach. Historically important journal articles and book chapters in various languages were supplemented by interviews with surgeons instrumental in the adaptation of this method to modern microsurgical neurotology. Results: The inspiration for the current MF approach could be traced back to the late 19th century extradural subtemporal surgeries for the trigeminal neuralgia performed by Krause and Hartley and the contemporary surgeries performed by Ernst von Bergmenn for treatment of otogenic temporal bone infections. The first case of MF approach to CPA for vestibular nerve section was reported by RH Parry in 1904. In the mid-20th century, otologists found numerous applications for this approach, which gained popularity at the hands of William House. Although his initial MF operations aimed to decompress the internal auditory canal for cochlear otosclerosis, House soon realized the versatility of this approach and performed his first MF acoustic neuroma surgery in 1961. Conclusion: The current MF approach has its roots in operations for trigeminal neuralgia and otologic surgeries for palliation of temporal bone infections performed in the late 19th century. The earliest reported MF approach to the CPA dates back to 1904 and its application to microsurgical exposure of the internal auditory canal to the late 1950s.

History of the technological development of air conduction hearing aids

This was a study of the history of the technological development of air conduction hearing aids, and a review of international literature on the subject. The technological evolution of amplification devices, from their origin to the present day, can be divided into seven distinct periods: the period of sound collectors, the period of hearing devices constructed from carbon, the period of vacuum tubes, the transistor period, the period of integrated circuits, the microprocessor period and the period of digital hearing instruments. Throughout these different stages, hearing instruments have progressively developed reaching their present state. The current era is itself undergoing constant development and change. With the introduction of new technologies, we expect that the rate of change will increase rapidly in the future.