M. Tos

Density of Mucous Glands in a Biopsy Material of Chronic Secretory Otitis Media

Biopsies were taken from the anterior part of the promontory in the course of tubulation through a paracentesis opening in 85 ears affected with chronic secretory otitis media in the secretory stage from 54 patients, mostly children. The specimens were stained by the PAS-alcian blue whole-mount method, and on each biopsy the number of glands was counted, their area measured directly, and their density calculated. Glands were found in all ears but two from which the specimens were very small. The density varied within wide limits, from 1 to 31 glands per mm2. In most ears the density was 3–10 glands per mm2. The mean density in the entire material was 6.7 glands per mm2, gland count per biopsy 7.5. In all, 743 glands and 105 mm2 mucosa were investigated. 92.7% of the glands were active, 5.7% were transitional types, and only 1.6% were degenerated. In cases with large quantities of mucus and thickened mucosa the density as well as the number of glands per biopsy were greatest. There was a relationship betwe...

Bony Fixation of the Malleus and Incus

A material of 12 patients with bony fixations of the malleus and incus in the attic is presented. Of these patients 9 had intact, 3 interrupted ossicular chain. Various types of bony fixation of the attic were found: isolated fixation of the incus, isolated fixation of the malleus, bony fixation of the malleus as well as the incus and ossification of the ligaments. Treatment consisted in removal of the new-formed bone with mobilisation of the ossicular chain which was preserved intact. The results were good. Among the tympanoplasties in which the ossicular chain was intact, it was fixed in the attic in 10% of the cases, and among those in which the ossicular chain was interrupted in only 1.2%. In most cases the cause was chronic otitis, in one case a congenital anomaly. The aetiology and pathogenesis are discussed. It is concluded that post-infectious bony fixation presumably arises during the healing of localized osteitis. Other aetiological possibilities—such as increased pneumatization in the attic, hi...

The Mucous Glands in Chronic Secretory Otitis Media

From a patient with mild chronic secretory otitis media the mucous membrane of the osseous part of the Eustachian tube and the middle ear were removed in toto and stained by the PAS-alcian blue whole-mount method whereby the mucous glands and goblet cells stain selectively. This revealed a surprisingly large number of mucous glands as well as increased density and extent of goblet cells. The shape, structure, size, and distribution of the glands are described. In the osseous part of the Eustachian tube 135 glands were found, in the tympanic cavity 223, in the epitympanon 60, in the antrum 20, and in the mastoid process 50 glands, average density 0.9, 1.9, 1.4, 0.3, and 2.4 glands per square mm respectively. The glands were found to be in different secretory stages, 188 in an active, 102 in a transitional, and 198 in a degenerated stage, each showing its characteristics. All the glands are abnormal and responsible for the viscous mucous secretion which may be present in chronic secretory otitis media. The ...

Nasotracheal Intubation in Acute Epiglottitis

Pointing out the serious course, with rapidly progressing airway obstruction, of acute epiglottitis in children, the authors submit a material of eight patients, seven of whom were children. Treatment was by antibiotics and prolonged nasotracheal intubation using tubes of polyvinyl chloride. The intubation proved easy to establish. Complications during and after the intubation were few and negligible, and most of the children could be extubated within the first 48 hours. The critical period in acute epiglottitis is the first 24 hours. Thereafter, the oedema rapidly subsides, the epiglottis having returned to an entirely normal state on the 5th-8th day. Since all the patients could be discharged as cured within 2 weeks, we feel that in future nasotracheal intubation should be preferred to tracheotomy in the treatment of acute epiglottitis.

Obliteration of the Cavity in Mastoidectomy

A modification of Rambos teniporal-musculoplasty for obliterating tlie cavity following mastoidectomy is described and the early and late operative results in 110 cases of active, chronic otitis are presented. The use of retro-auricular tissue together with the temporal muscle gives a long, cranially pedicled flap, one end of which is placed into the antruni and tlie other towards the tip of the mastoid process. To avoid stenosis, tlie skin of the auditory canal and of tlie external meatus is incised longitudinally. By this method more than 90% of tlie ears dried, and there were only a few postoperative coniplications. The late results showed tliat tlie ears remained dry and that there was no recurrence cliolesteatonia or of infection. The results in respect to hearing are briefly mentioned.

Density of Goblet Cells in the Human Eustachian Tube: Relationship between Goblet-cell Density in the Tube and Number of Mucous Glands in the Middle Ear

In 14 temporal bones the mucosa from the Eustachian tube and middle ear was removed and stained by the PAS-alcian blue whole-mount method. The goblet-cell density in various parts of the tube was determined on the basis of 4 140 counts of 0.01768 mm counting fields. The number and density of glands in the entire middle ear and in its various parts were determined. In the normal series this revealed up to 50 glands (mean, 13 glands) with a mean density of 0.04 gland per mm2. In the slightly abnormal series there were 50-440 glands (mean 193) with a mean density of 0.85 gland per mm3. The goblet-cell density in the osseous part of the tube and in the tubal orifice was found to be considerably lower in the normal than in the slightly abnormal series. The density pattern of the goblet cells exhibited in the normal series a very marked and regular decrease into the tympanic direction and a very low density in the tympanic orifice. In the slightly abnormal series there was a moderate decrease of density into th...

New Aspects In The Pathogenesis Of Chronic Secretory Otitis Media

On the basis of quantitative studies of the mucous elements in the Eustachian tube and middle ear mucosa of normal and abnormal temporal bones as well as of biopsies from secretory and adhesive otitis the secretory pathogenesis is described. Secretory otitis is divided into a stage of development, during which the mucous glands form, a stage of secretion, during which they produce mucus, and a stage of degeneration, during which they degenerate, become inactive, and mucus production decreases. The relationship between the ability of the mucosa to produce mucus and the ability of the Eustachian tube to transport the mucus to the rhinopharynx is the essential factor in the secretory pathogenesis.

Tympanoplasty in Chronic Adhesive Otitis Media

The results of tympanoplasty on 56 patients with chronic adhesive otitis media are presented. the principle of the method was radical removal of the diseased parts of the drum, preservation of the mucosa, inspection and opening of the tubal orifice with bougienage of the tube, mobilization of the ossicles, ossiculoplasties increasing the height of the tympanic cavity, insertion of silastic film around the stapes, and tubulation. the mean hearing gain in the frequency range 500-2 000 cps 3-9 months after the operation was 23.5 dB, postoperative hearing 35 dB and air-bone gap 15.6 dB. in 80% of the cases the tympanoplasty proved successful, and 86% of the patients obtained a hearing gain exceeding 10 dB. the most favourable results were observed in cases tubulated at the time of the tympanoplasty. the results are analysed in relation to tubal passage, assessed by the Valsalva manoeuvre before and after the operation. the best results were obtained when the tube was passable before and after the operation in...

Results of Tympanoplasty with Modified Radical Mastoidectomy

The results of tympanoplasty combined with modified radical mastoidectomy in the same stage on 266 discharging ears was assessed by various criteria. Prior to the operation 9% of the cases had social hearing, 3-9 months after 47%. The air-bone gap closed to within 0-15 dB in 37% of the cases, within 0-30 dB in 77%. A hearing gain exceeding 10 dB was obtained in 66%. Perforation recurred in 14% of the cases, and 8 ears could not be rendered dry. The results in cholesteatoma were found to be the same as in chronic granulating otitis. The results were identical in cases where the bridge was preserved and in cases where it was removed. There was no major difference between the various types of tympanoplasty with respect to the magnitude of the hearing gain, but the mean postoperative hearing was considerably better after type I—III than after type IV tympanoplasty. The most successful ossiculoplasty proved to be interposition of bone and incus, least successful with interposition of polyethylene. The results ...

Laryngeal Complications of Percutaneous Cerebral Angiography Continued Observations

Through a systematic laryngological examination of 54 patients undergoing percutaneous carotid angiography, 5 patients presented laryngeal oedemas of varied size and spread on the same side. In another 5 patients both oedema and suggilations of the larynx were found, extending in the cranial direction to the pharynx and the rhinopharynx. The cause and pathogenesis of the laryngeal oedema are discussed and it is concluded that the oedema is produced by the development and dissection of deep neck haematomas which give rise to localized congestion. Furthermore factors which might influence the formation of haematomas during and after puncture have been studied. Hereby it was found that the number of attempts to puncture might exert an influence, however, this is not the sole explanation of the development of the haematoma.From a study of 20 patients undergoing vertebral or coronary angiography via a catheter inserted from the axillary or the femoral arteries, no laryngeal complications were disclosed.