Hans Ramsay

Long-term hearing results after stapes surgery: a 20-year follow-up.

Objective The aim of this study was to evaluate the results of stapes surgery after 20 years of follow-up and to compare the results between large fenestra versus small fenestra stapedotomy. Study Design Retrospective clinical study. Setting Tertiary referral center (university hospital). Patients One hundred forty-two patients with otosclerosis treated by surgery. Intervention Eighty patients had a total stapedectomy with House-wire prosthesis and 62 patients a stapedotomy with Teflon-piston prosthesis. Main Outcome Measures Preoperative, postoperative, and long-term hearing thresholds were compared. Patients filled in a questionnaire about the impact of surgery on the quality of life and postoperative symptoms. Results The long-term pure tone average improvement did not differ significantly between the techniques compared with the preoperative values. The air-bone gap tended to enlarge as a function of time. The change in the pure tone average was 0.9 dB per year for both techniques. In the questionnaire, some patients reported vertigo, tinnitus, loud noise intolerance, and taste disturbances. Loud noise intolerance seemed to persist in the long term. Surgery had no effect on preoperative tinnitus. Conclusions There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.

Concentration of free hCGβ subunit in serum as a prognostic marker for squamous-cell carcinoma of the oral cavity and oropharynx

This study was conducted to evaluate the clinical usefulness of serum hCGβ in the diagnosis and prognosis of patients (n = 59) with cancers of the oral cavity and oropharynx. As a reference marker we used squamous‐cell carcinoma antigen (SCCAg). A blood sample was obtained from all patients before primary surgery. Serum hCGβ was determined by a time‐resolved immunofluorometric assay (IFMA) and SCCAg by a solid phase immunoenzymometric assay. Elevated preoperative hCGβ levels were observed in 8 (14%) and elevated SCCAg in 12 (20%) out of 59 patients. Patients with preoperatively elevated hCGβ had a shorter recurrence‐free survival when compared with those with normal hCGβ levels (log‐rank Chi‐squared = 6.83, p =.009), and the risk‐ratio for recurrence during follow‐up for those was 3.6 (95% CI = 1.29–9.94). In a Cox multivariate model hCGβ (p = 0.039) and stage (p = 0.044) were independent prognostic factors. SCCAg showed no correlation with recurrence‐free survival. We conclude that determination of hCGβ in serum is a potential marker in the prognostic evaluation of patients with SCC of the oral cavity and oropharynx. Int. J. Cancer (Pred. Oncol.) 84:525–528, 1999.

Effect of Epidermal Growth Factor on Tympanic Membranes with Chronic Perforations: A Clinical Trial

Epidermal growth factor is an important modulator of cell growth, and its role in normal wound healing is well documented. Epidermal growth factor receptors have been identified in tympanic membranes of different animals. The ability of epidermal growth factor to promote healing of tympanic membrane perforations has recently been shown in experimental animals. We performed a double-blind, placebo-controlled study of the effect of epidermal growth factor applied locally on the tympanic membrane for 1 week in patients with chronic perforations. Seventeen adult patients took part in the study, eight in the epidermal growth factor group and nine in the placebo group. Three placebo-treated patients were later treated with epidermal growth factor, and five patients received repeated epidermal growth factor treatment. Perforation size was measured as a percentage of the tympanic membrane area before and at least 1 month (mean, 2.6 months) after treatment. One perforation in the placebo group healed completely, but none of the epidermal growth factor-treated perforations closed. Perforations became slightly smaller in both groups (mean decrease, 0.3% and 2.7% for epidermal growth factor and placebo, respectively), but these changes in size were not statistically significant for either group. At otomicroscopy, a proliferation reaction with thickening of the tympanic membrane and pseudomembrane formation at the perforation edge could be seen in some ears. Histologically, a sample from one epidermal growth factor-treated ear demonstrated signs of hypertrophic epithelium when compared with the morphology of a placebo-treated tympanic membrane. The only complications were two mild infections in the placebo group. Hearing remained stable after epidermal growth factor treatment.

Indium-111 bleomycin complex for radiochemotherapy of head and neck cancer — dosimetric and biokinetic aspects

1 Department of Clinical Chemistry, University Central Hospital of Helsinki, Finland 2 Department of Otorhinolaryngology, University Central Hospital of Helsinki, Finland 3 Department of Onco[ogy, University Central Hospital of Helsinki, Finland 4 Department of Pathology, University of Helsinki, Finland 5 Department of Physics, University of Helsinki, Finland 6 Department of Radiation Physics University of Lund, Sweden

Imaging of olfactory neuroblastoma—an analysis of 17 cases

A total of 17 histologically confirmed olfactory neuroblastomas treated at Helsinki University Central Hospital between 1962 and 1996 were reviewed retrospectively. The tumors displayed a variety of imaging characteristics and aggressiveness. Imaging evolved from plain X-rays at the beginning of the study period to CT and MRI during the latter part of the study. CT provided the best information about the tumor and its local invasion especially into surrounding bony structures. MRI allowed an estimate of tumor spread into surrounding soft-tissue areas, such as the anterior cranial fossa and the retromaxillary space. However, signal intensity characteristics were not specific for olfactory neuroblastomas. Bone scintigraphy and MIBG scan allowed us to detect distant metastases. Olfactory neuroblastoma is an aggressive malignancy and the prognosis is poor in most cases, as shown by the short survival rates (average 45.3 months) in our study group. The tumor can be detected, delineated and its characteristics suspected by modern radiology. Definite diagnosis is based on histopathology. This study proposes general imaging strategies for detecting this disease.

Treatment of acoustic tumours in elderly patients: is surgery warranted?

Controversy regarding the best and safest treatment of acoustic tumours in elderly patients still exists. These patients may therefore end up having either microsurgical tumour removal, stereotactic radiosurgery or no treatment at all, depending on where the treatment decision is made. We evaluated the results of microsurgery for acoustic tumour removal in 65 patients who were 70 years of age or older. Surgery was performed between 1982 and 1989, using the translabyrinthine approach. Total tumour removal was achieved in 61 patients (94 per cent). No deaths due to surgery occurred. Other than one case of meningitis, there were no serious complications. Seven cases had post-operative CSF leaks, and three required surgery for correction of the problem. Facial nerve function pre-operatively, at the time of discharge and at one year or more post-operatively was compared to that in a younger age group. No differences between the groups were found. Nor was there any significant difference in mean operative time, blood loss, or hospital stay between the older and younger patients. We believe that total microsurgical tumour removal is the treatment of choice in patients who are in good health, regardless of age. Partial removal is acceptable only if the tumour is adherent to the facial nerve or if vital-sign changes occur during surgery. Other forms of treatment are reserved for cases where surgery is contraindicated or refused by the patient.

Fate of the mesenchyme in the process of pneumatization.

Hypothesis This studys aim was to find histologic data that would indicate the mode of disappearance of the embryonal mesenchyme. Background The basic studies made during the first half of the 20th century concluded that mesenchyme disappears by regression and resorption. Recently, it was suggested that mesenchyme disappears by receding, spreading, and thinning to match the enlarging bony spaces. Methods We studied 11 serially sectioned temporal bones from newborns to adults and describe detailed findings in a 9-day-old newborn and in a 1.5-year-old infant. The temporal bones were sectioned to 20 &mgr;m and stained by hematoxylin and eosin. Results Histologic evidence of regression was found in the form of degenerating mesenchymal cells and fibers, in areas free of cells, and with empty spaces of varying size between the fibers. Vacuoles differing much in size appeared, and phagocytic cells were frequent. A rich capillary network allowed resorption of hemopoietic cells dispersed from the marrow spaces into the mesenchyme. From the lower lateral attic, from Prussaks space, and from the mastoid air cells, mesenchyme can disappear only by regression—there is no space where it could recede. Conclusion Pneumatization of the middle ear spaces occurs by regression and resorption with an individual speed under genetic guidance. The osteoclastic activity of the periosteum, intertwined with the nearest mesenchyme, is decisive in the mastoid air cell formation. Dispersion and reabsorption of hemopoietic cells is a normal phenomenon in this process. Underpressure in the middle ear spaces, caused either by a meconium-related foreign body otitis media in infancy or by chronic otitis media in childhood, are factors that may lead to a partial or full arrest of pneumatization.

Revision Surgery for Otosclerosis

The outcome of surgery was analyzed in 76 otosclerosis patients (82 operations) undergoing revisions during the period 1986–89. The ears were divided into 3 groups based on preoperative A–B gaps 1) larger than 25 dB, 2) between 10 to 25 dB, and 3) less than 10 dB. A final hearing gain of more than 11 dB was recorded in 76%, 40% and 10% of the ears in groups 1, 2 and 3, respectively. In the groups with conductive component none of the ears deteriorated. In the sensorineural group 2 patients suffered further loss of 10 and 29 dB, respectively, and one ear became deaf. At revision the most common causes of conductive impairment were found to be dislocation of the prosthesis, remnants of footplate or new bone growth. Fistula was suspected in 10 ears and verified in 5. Several reconstruction methods must be mastered.

Somatostatin receptor imaging of olfactory neuroblastoma.

Neural-crest tumours, including neuroblastomas, express somatostatin receptors. This can be shown by radionuclide labelling of octreotide, a somatostatin analogue. Studies on imaging with this substance have dealt with childhood neuroblastomas. Olfactory neuroblastoma (aesthesioneuroblastoma) is a rare tumour in which somatostatin receptor content has not been analysed, nor have radionuclide methods for diagnostic purposes been described. We report a case of olfactory neuroblastoma, in which scanning with 111In-labelled octreotide was performed. A strong uptake was seen at the base of the skull. This was confirmed as a recurrent tumour by magnetic resonance (MR) imaging. Uptake was also observed in the neck and chest, indicating extensive spread of the disease. Somatostatin receptor expression has been shown to correlate with prognosis in childhood neuroblastoma. The accuracy of labelled octreotide in the diagnosis of olfactory neuroblastoma indicates that it might be useful in radionuclide therapy of patients with advanced disease, when no other treatment modalities are available.

MODIFICATION OF AUDITORY PATHWAY FUNCTIONS IN PATIENTS WITH HEARING IMPROVEMENT AFTER MIDDLE EAR SURGERY

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)