Ervin Ostfeld

Acquired irreversible sensorineural hearing loss associated with otitis media with effusion

The development of irreversible sensorineural hearing loss (SNHL) in three patients having chronic otitis media with effusion of the serous or mucoid type is described. Anamnestic, clinical, and laboratory investigations revealed no evidence of known etiologic factors, diseases, or conditions that could have induced inner ear damage. It seems that the pathogenetic mechanism of this complication of chronic otitis media with effusion is penetration of infectious agents or their toxic products from the middle ear to the inner ear through the round window membrane. The SNHL may be of different types and degrees, from a high-tone hearing loss to complete anacusis. The development of SNHL was not prevented or influenced by the insertion of tympanostomy tubes.

Peripheral Blood T and B Lymphocyte Subpopulations in Bell's Palsy

A prospective clinical, virological and immunological study was performed on 25 consecutive Bells palsy (BP) patients. Multiple cranial nerve involvement was found in 15 patients. A significant decrease in the peripheral blood T lymphocyte percentage as well as an increase in B lymphocyte percentage (p<0.001) were found in 13 of the BP patients during the first 24 days from the clinical onset of the paralysis. No correlation was found between the peripheral blood lymphocyte subpopulations and the patients age, sex, degree of paralysis or recovery rate. No changes were detected in the levels of immunoglobulins (IgG, IgM), complement (C3, C4) and antiviral antibodies to herpes simplex and zoster, EBV, cytomegalic virus, adenovirus, influenza and mumps. The clinical and immunological data of BP show a similar pattern to those of Guillain-Barre syndrome suggesting that BP may be an antoimmune demyelinating cranial polyneuritis which may be caused by a preceding viral infection.

Malignant external otitis: The diagnostic value of bone scintigraphy

Technetium00m Methylene Diphosphate bone scintigraphy (BS) of the skull was performed in three patients with malignant external otitis (MEO). Pathological uptake of the radioisotope in the mastoid region was found during the early stages of MEO updating radiologic findings. The extent of the radioisotope accumulation during the early stages of MEO indicates that the actual tissue damage exceeds the clinical estimation. The follow‐up BS findings correlate well with the clinical course of MEO indicating either healing or extension to the base of skull.

Fourth pharyngeal pouch sinus

This is the first description and documentation of an extremely rare developmental anomaly of the pharyngeal apparatus in a 15‐year‐old female. The clinical, radiological, histological, and anatomical findings indicated that the anomaly originated in the pharyngeal fourth pouch. It presented as a recurrent lateral neck abscess which was due to a paratracheal sinus. This sinus penetrated the larynx and after a translaryngeal course ended in the pyriform sinus. It was caudad to the superior laryngeal nerve nnd external to the recurrent laryngeal nerve. Its penetration into the larynx at the cricothyroid joint region could serve as a useful surgical landmark.

Malignant external otitis: early histopathologic changes and pathogenic mechanism.

The histopathologic changes during the early stage of malignant external otitis (MEO) were studied in two patients, one a non‐diabetic. The specimens were obtained by an en bloc excision of the diseased tissue of the external ear canal through a retroauricular approach. The most prominent histologic features of the early stage of MEO consist of a thick layer of almost acellular, partly degenerated, collagen extending from the cartilage into the dermis, which most likely existed prior to the penetration of the microorganism. This finding supports our concept that MEO is a disease which develops as a result of invasion of opportunistic organisms into tissues previously devitalized, probably due to vascular compromise and that these latter features constitute the basic mechanism of the entire disease process.

Theoretic Analysis of Middle Ear Gas Composition under Conditions of Nonphysiologic Ventilation

As gas flows in and out of the nasopharynx, the pressure in that region fluctuates. It drops below or rises above atmospheric pressure, which is itself not constant but is subject to changes in altitude and weather. Such pressure changes in the nasopharynx produce a pumping of gas into and out of the middle ear. The net amount of middle ear gas transferred from or to the nasopharynx will, component for component, in steady state exactly equal the amount of middle ear gas transferred to or from the microcirculation by means of diffusional absorption by (or release from) the mucosa. In the case of a permanently patulous eustachian tube, a single parameter, characteristic of the rate of ventilation through the open eustachian tube, is found to determine the gas composition in the middle ear, whereas in the case of a middle ear ventilated by tympanostomy, two rate-of-ventilation parameters, one for gas flow through the ventilation tube and one for flow through a periodically open eustachian tube, determine the steady state gas composition. A high rate of ventilation favors absorption of oxygen and venting of carbon dioxide from the middle ear in both cases.

Bilateral tension pneumothorax during pediatric bronchoscopy (high-frequency jet injection ventilation).

Bilateral tension pneumothorax complicating high-frequency jet injection ventilation during rigid open bronchoscopy for foreign body removal in a 3-year-old child is reported. Subcutaneous emphysema, bradycardia and low voltage of the QRS complex were the presenting symptoms. Disparition of heart dullness by percussion was the most suggestive clinical sign while auscultation of the breath sounds was not conclusive. It is stressed that tension pneumothorax is a potential life-threatening complication of high-frequency injection ventilation and should be promptly considered in any case of persistent cardiac deterioration during pediatric bronchoscopy.

Bone conduction evaluation related to mastoid surgery

The bone conduction threshold changes of 97 patients (100 ears) who underwent mastoid surgery were determined by comparing the last preoperative audiogram with the 1 year postoperative audiogram. Three types of mastoid surgery were evaluated: Radical mastoidectomy, modified radical mastoidectomy, and intact wall atticomastoidectomy. The average three speech frequency preoperative bone conduction threshold was 17.4 dB (S.D. 11.5) in the radical mastoidectomy group, 10.1 dB (S.D. 9.6) in the modified radical mastoidectomy group, and 10.7 dB (S.D. 8) in the intact wall atticomastoidectomy group.

Bone conduction changes following successful tympanoplasty type I

Pre and one year postoperative bone conduction (b.c.) thresholds were compared for 50 ears of 48 patients, ranging in age from 14 to 42 years, in whom successful tympanic grafts resulted in at least an average improvement of 10 db for 500 to 4000 Hz. While pre and postoperative data are included for all ears and test frequencies, significant BC improvement is seen only at those frequencies, in each case, where the pre‐op BC thresholds were worse than 10 db. Normal pre‐op BC thresholds cannot show substantial improvement because of audiometric limitations. The amount of BC shift at each frequency for those with pre‐op BC thresholds that were subnormal averaged 6 db at 500 Hz, 13.3 db at 1000 Hz, 13.8 db at 2000 Hz and 9 db at 4000 Hz, all highly significant statistically. There were no significant postoperative BC shifts related either to duration of the disease process, length of postoperative period before final test (all were more than one year) or whether the surgical procedure was tympanoplasty type I or myringoplasty.

Gas Scavenging during Bronchoscopy under General Anesthesia

Prevention of exposure of the endoscopist to high levels of anesthetic gases during bronchoscopy was attempted experimentally in dogs by a scavenging system. Results were compared with exposure during the conventional technique of anesthetic gas administration for clinical bronchoscopy using the rigid open ventilating bronchoscope. The scavenging system consisted of a vacuum pump applied to the open ventilating rigid bronchoscope sidearm connection during intratracheal administration of nitrous oxide, oxygen, and halothane gas mixture. Gas samples were taken from the trachea, the proximal end of the bronchoscope, and the endoscopists breathing zone, and analyzed by gas chromatography. Findings indicate that halothane anesthesia for bronchoscopy administered by conventional techniques is a source of air pollution in the operating room and exposes the endoscopist to subanesthetic levels of halothane that may affect psychomotor functioning. The use of the gas scavenging system lowered the concentrations of halothane and nitrous oxide at the endoscopists breathing zone to a level at which inhalation for short periods has no clinical effects, while the concentrations of the anesthetics and oxygen in the trachea were maintained at a satisfactory level.