E. De Seta

Cavernous haemangioma of external ear canal

OBJECTIVES The aim of this study was to document the occurrence of a cavernous haemangioma of the external auditory canal, and to review the literature on this pathology. METHODS We report the clinical presentation, imaging studies, surgical procedure and histological findings for a cavernous haemangioma of the external auditory canal. RESULTS This patient represents the fourth reported case of cavernous haemangioma affecting only the external auditory canal. A cavernous haemangioma of the external auditory canal, not affecting the tympanic membrane, was surgically removed, without post-operative complications. CONCLUSIONS Cavernous haemangioma of the external auditory canal is a rare otological pathology. Computed tomography imaging is important in order to precisely define and localise the site and size of the lesion. Histological examination is necessary for the correct diagnosis of the pathology.

High-frequency audiometry above 8 kHz. Comparative results of normative thresholds obtained with a headphone system and a quasi-free-field system

Since a standard method for high-frequency audiometry does not yet exist, the authors, using 20 young subjects, compare the results obtained with a quasi-free-field system devised by Osterhammel et al. [Scand. Audiol. 6:91-95, 1977] and those obtained by a headphone system. The headphone system is considered to be better, because it offers many practical advantages.

High-Frequency Audiometry in Children

On the grounds of recent literature and of their own previous studies, the authors have examined a group of 25 normal-hearing children, ranging from 7 to 10 years of age, with high-frequency audiometry. The results were compared with those obtained in a group of young adults. On the basis of these findings, average threshold values were derived for this age group; such data have not yet been published for this simple headset technique. Furthermore, the comparison between the two age groups enabled the authors to determine a deterioration of the high-frequency hearing threshold which takes place at a fairly early age. Reliability of the equipment, in which headphones were used as transducers, was checked and the reproducibility for this test was shown to be adequate, as seen from the low test-retest variability.

Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique?

OBJECTIVE This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft. SUBJECTS AND METHODS The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time. RESULTS Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group. CONCLUSION Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.

Cartilage tympanoplasty: how to reduce surgery time

In the last few years, cartilage has been the preferred material for reconstruction of the tympanic membrane, particularly in the case of allergy, re-perforation, or total or subtotal perforation. The mechanical characteristics of cartilage offer the advantage of high resistance to retraction and re-perforation. This paper describes two original techniques which reduce cartilage tympanoplasty surgery time, involving a 0.3 mm thick cartilage-perichondrium composite graft to repair the tympanic membrane.

Distortion product otoacoustic emissions in otosclerosis: Intraoperative findings

The aim of the study was to investigate changes in middle ear dynamic characteristics caused by both otosclerosis and stapes surgery (platinotomy, prosthesis positioning, ossicular chain maneuver) and to evaluate distortion product otoacoustic emissions (DPOAEs) before and following surgery. The study included 15 patients (12 women, 3 men; mean age 51 years; range 32-69 years) with advanced otosclerosis. All the patients were evaluated with the use of pure-tone audiograms (preoperatively, 5 and 30 days after surgery), stapedial reflexes (preoperatively), and DPOAE recordings (preoperatively, at the end of surgery, and 5 and 30 days after surgery). Changes in the hearing thresholds and in the DPOAE amplitudes were compared. Preoperative tests showed conductive hearing loss, with a mean air-bone gap of 36.6 dB HL ranging from 0.25 to 1 kHz, and no stapedial reflexes were detected. DPOAEs were not measurable preoperatively, and they were detected only in 2 patients at the end of surgery, with low amplitudes in a narrow frequency range. No significant changes occurred in DPOAEs 5 days postoperatively. A month after surgery, improvement in conductive hearing loss was observed; the mean air-bone gap from 0.25 to 1 kHz was 12.9 dB HL, whereas the higher frequencies were still affected by the disease. DPOAEs increased in amplitude in 4 patients, but this was not significant. It remains unclear why DPOAEs are not detected despite a subjective hearing improvement and a sufficiently closed air-bone gap at least in middle and low frequencies. The results of our study show that DPOAEs cannot replace behavioral threshold tests; they may only be included in a battery of tests for a complete clinical follow-up for efficiency monitoring after stapes surgery.

Sound localization in bilaterally implanted children.

It is well known that the use of binaural hearing devices gives considerable advantages for bilateral deafness in comparison with monaural. These advantages consist mainly of the summation of loudness effect, better localization of sound source and in improving the performances of speech discrimination especially in noise (Karsten and Turner, 2000). The characteristics of binaural hearing are mainly based on: (a) head shadow effect, due to ITD (interaural time delay) and IID (interaural intensity difference), that leads to a directional hearing; (b) squelch effect that consists of the ability to suppress background noise and to attend selectively to a specific stimulus (central function). The recent application of binaural cochlear implants has once again stressed the usefulness of tests conceived with the aim of quantifying the specific advantages deriving from binaural amplification (Van Hoesel and Clark, 1997). Moreover, the advent of bilateral cochlear implantation in children has led to some further problems, mainly linked to the destructive effect on inner-ear structures with consequent preclusion for future treatments, to length of anaesthesia and to cost/benefit. For these reasons it is of fundamental importance to assess whether these advantages, present in all age groups, can lead particularly in children to an increase in the rate or in a qualitative improvement in the acquisition of language skills, when compared to those that can be reached with monaural implants. Proceedings of the 4th International Symposium on Electronic Implants in Otology 47