Kauko Ojala

Late results of tympanoplasty using ossicle or cortical bone.

Hearing results are presented for 164 ears with chronic otitis media which were operated on radically and obliterated with a musculo-periosteal flap (Palva flap), and in which tympanoplasty was performed. The ears were followed-up annually for 5-13 years (mean 6.8 years). Results are compared with the method of ossiculoplasty and with the condition of the stapes superstructure at operation. Ossiculoplasty using autogenous cortical bone columellas resulted in a somewhat greater improvement in the post-operative air-bone gap than ossiculoplasty with auto- or homo-graft ossicles, when compared with the pre-operative gap. Similarly, the post-operative gap improved more in ears with an intact stapes superstructure than in ears in which the stapes superstructure was absent. The use of an autogenous cortical bone columella can be recommended in cases in which the patients own ossicles are affected by disease and cannot be used.

Comparative Trial of Flunisolide and Beclomethasone Dipropionate Nasal Sprays in Patients with Seasonal Allergic Rhinitis

In order to evaluate the effects of flunisolide and beclomethasone dipropionate nasal sprays on seasonal allergic rhinitis, 45 patients were included in an open parallel comparative trial. The study design was open because of the different dosage schedules for the two preparations. Strict criteria were set up for patient selection, and all patients were carefully examined and assessed before and after the 4‐week trial period. Throughout the whole treatment each patient kept a detailed daily record. A substantial or complete control of symptoms was achieved in 18 of the 21 patients on flunisolide and in 20 of the 22 on beclomethasone dipropionate. No serious side effects were observed. Thus it can be concluded that both test drugs are effective and well tolerated in the treatment of seasonal allergic rhinitis.

Comparison of pre- and post-operative bacteriology of chronic ears

The over-all distribution of the pre-operative bacteria of 806 ears and the post-operative bacteria of 109 post-operatively moist or discharging ears correlated very well, the only clear difference being the detection of diphtheroid bacilli more often post-operatively than pre-operatively. When comparing the pre- and post-operative bacteriology of 109 post-operatively infected chronic ears which had undergone radical surgery and obliteration with Palva flaps (and which were drawn from a group of 806 ears originally operated on and followed yearly for 5-14 years) it was noticed that Pseudomonas aeruginosa and Proteus sp were cultured more often post-operatively than pre-operatively in the same ears. Statistically, other bacteria were not found to be significantly present in the same ears.

Late post-operative hearing results correlated with the severity of tissue changes in ears with chronic otitis media.

Late hearing results in 627 ears (574 patients) operated on radically for chronic otitis media are presented. Clinically, the ears were followed-up annually for 5-14 years. The results are correlated with the severity of histopathological changes in the tympanic cavity and in the mastoid air-cell system and also with the management of the tympanic mucosa and ossicular chain at operation. The mean post-operative air-bone gap was significantly better in ears with mild histopathological changes than in ears with severe histopathological changes in the middle ear (17.0 db./33.1 db.; p less than 0.001) or mastoid (29.0 db./34.2 db.; p less than 0.01) at operation. The difference in hearing results in favour of the former group was more significant in ears in which the tympanic mucosa had been saved at operation (p less than 0.01/p less than 0.001) than in ears in which the mucosa had been removed (p less than 0.05).

Bacteriology in chronic otitis media correlated with the clinical state of ears

ZusammenfassungBei 702 Patienten mit chronischer Otitis media wurden die bakteriologischen Befunde zum klinischen Zustand des Ohres in Beziehung gesetzt. Eine statistisch signifikante Korrelation zur Heftigkeit der Infektion ergab sich bei Pseudomonas aeruginosa, St. aureus und E. coli. Die Funktion der Ohrtrompete war von den bakteriologischen Befunden unabhängig. Pseudomonas aeruginosa war häufiger bei Ohren ohne als bei solchen Cholesteatom nachzuweisen.SummaryBacteriologic findings in 702 cases of chronic otitis media were correlated with the clinical conditions of the ears. Statistically significant correlations with the severity of the clinical infection were noticed concerning Pseudomonas aeruginosa, St. aureus and E. coli. The bacteriological findings did not correlate with the results of Valsalva test. Pseudomonas aeruginosa was statistically more often present in ears without than in ears with cholesteatoma.

External, asymptomatic laryngocele without known predisposing factors in a middle-aged man

A laryngocele is an air-filled swelling of the upper pouch (the sacculus) of the laryngeal ventricle of Morgagni, which may herniate through the thyro-hyoid membrane to form a mass which is palpable subcutaneously in the neck. The condition is rare, but is found at times in individuals with laryngeal malignancy and in individuals who have been pre-disposed to it by increased internal laryngeal pressure. When the condition is discovered it is always an indication for a thorough examination of the larynx, with follow-up, bearing in mind the possibility of malignancy.

Post-Operative cholesteateatomas and retraction pockets after obliterative surgery in ears without cholesteatoma

The frequency of post-operative cholesteatomas, epidermizations and retraction pockets in a series of 343 chronically infected ears (315 patients) without cholesteatoma at primary surgery was evaluated. The ears were operated on radically, exclusively by the Palva method, with removal of the bridge in 248 ears and preservation of it in 95 ears. Musculo-periosteal obliteration and seclusion of the aditus were performed in every case with a Palva flap and with a temporalis muscle-fascia graft. The primary operations took place over the period 1964-1972, and all the ears without cholesteatoma at primary surgery were included; they were followed up annually. The evaluation of this material was carried out in 1976-1979 and the follow-up time was on an average of 8.5 years (5-15 years). Cholesteatoma was found in six (6/343; 1.7 per cent), epidermization of the tympanum in four (4/343; 1.2 per cent), and retraction pockets without cholesteatoma in six (6/343; 1.7 per cent) of the ears. Preservation or removal of the bridge at operation did not cause any significant difference in the frequency of the post-operative complications mentioned (p greater than 0.05). Most of the complications were discovered after the first postoperative year.

The preoperative state of infection in chronic otitis media correlated with postoperative hearing results

ZusammenfassungUnter besonderer Berücksichtigung des Schleimhautzustandes bei der Operation wurden die postoperativen Hörergebnisse bei 627 Ohren in einem Zeitraum von 5 bis 14 Jahren jährlich kontrolliert. Durchgeführt war eine Radikaloperation mit Obliteration der Höhle nach der Technik von Palva, ein Trommelfellersatz mit Temporalfaszie sowie ein Aufbau der Ossicula in bekannter Weise. Der postoperative Hörgewinn war besser, wenn die Schleimhaut im Mittelohr erhalten werden konnte. Dies war auch der Fall, wenn die Ohren bei der Operation trocken waren.SummaryThe postoperative long-term hearing results, with special reference to the state and management of the tympanic mucosa at operation, in 627 ears (574 patients) after an annual clinical follow-up period of 5–14 years are presented. The ears were operated on radically due to chronic otitis media, using the obliterative radical operation technique developed by T. Palva. The air-bone gap improved from the preoperative level significantly more in ears where the tympanic mucosa had been preserved than in ears where it had been removed at operation (p < 0.001). The improvement was also significantly better in dry ears than in ears which were moist or discharging at operation (p < 0.05). The mean late deterioration in the air-bone gap after the first follow-up year was significant in all the groups of ears (p < 0.05), and the mean long-term change in air-bone gap from pre- to late postoperative examination was the improvement of 3.0 dB in ears with, and a deterioration of 2.0 dB in ears without ossicular reconstruction.

Late hearing results after paraffinplasty or silastic sheeting

ZusammenfassungLangzeitbeobachtung des Hörgewinns bei 135 radikal operierten Ohren. Bei 59 Patienten wurde Paraffin in die Pauke gegeben und nach 6 Monaten die Ossikuloplastik durchgeführt. Sechsundsiebzig Ohren wurden einseitig mit Einlage von Silastikfolie operiert. Die Kontrolluntersuchung zeigte, daß sich mit beiden Verfahren ein guter Hörgewinn erzielen läßt, wobei die Paraffinplastik ein besseres Spätresultat erbrachte.SummaryThe long-term hearing results are presented for 135 ears operated on radically. In 59 of the ears temporary paraffin filling of the tympanic cavity was employed after the removal of the typanic mucosa at operation. The filling material was removed, and the ossiculoplasty was performed about 6 months later. In 76 ears a one-stage operation with tympanoplasty and Silastic sheeting was employed.There were no statistical differences between the groups of ears mentioned according to hearing results early (1 year) or late (5–14 years) postoperatively or in the deterioration of the air-bone gaps after the first postoperative year (P>0.05). The late change in the air-bone gap was significant in both groups (paraffin group: 6.1 dB; Silastic sheeting group: 5.7 dB; P<0.05). The total improvement of hearing late after surgery (as compared to the preoperative hearing) was significantly better in the paraffin group than in ears with Silastic sheeting (P<0.05). Paraffinplasty seems to be a suitable way to avoid tympanic adhesions.

Post-operative roentgenological findings and changes after mastoid obliteration

This study consisted of the evaluation of the plain X-ray findings of films taken at early follow-up (mean 1.5 months after surgery) and at late follow-up (4-14 years after the early films) of 211 ears which had been operated on radically and obliterated. Residual cells which were detected on the basis of the early films were associated with a more frequent occurrence of post-operative infection and were thus hallmarks of a poorer prognosis. Changes in the bone surrounding the surgical cavity and the radiological quality of the walls of the surgical cavity, the presence of new bone formation in the cavity and other radiological features did not yield useful information about post-operative complications. New bone formation was associated with a smaller amount of post-operative cavitation. Post-operative X-ray examination of the obliterated ear is a prognostically useful examination, but it does not significantly contribute further to the information available by clinical and otomicroscopic examination in regards to the complications of infection and cholesteatoma.