Michelangelo Lacilla

Tympanic Reperforation in Myringoplasty: Evaluation of Prognostic Factors

Objectives: The most frequent failure in myringoplasty is reperforation. This complication appears at a rate of 7% to 27%. The aim of this study was to evaluate the importance of the principal prognostic factors to the risk of reperforation. Methods: This is a study of prognosis based on an inception cohort. The prognostic factors considered in the study refer to clinical and surgical aspects; follow-up ranged from 5 to 7 years (mean, 68 months). The study was performed on 212 patients with or without otorrhea who underwent operation for tympanic perforation. All subjects underwent myringoplasty by means of an underlay or overlay technique depending on the size and site of the perforation. Results: Healing of the tympanic perforation was obtained in 182 cases (86%). Age, otorrhea, status of the contralateral ear, and conductive hearing loss did not significantly affect the outcome of surgery. On the other hand, time from surgery, the site of perforation, the type of anesthesia, the approach, the surgical technique, and the type of graft were significantly related to the outcome. Conclusions: In the analysis of our results, the surgical approach proved to be the principal prognostic factor in the anatomic outcome of myringoplasty. The results obtained suggest that the principal factors influencing the outcome of myringoplasty are technical and not clinical.

Hearing Loss and Desferrioxamine in Homozygous Beta-Thalassemia

The authors present the results obtained during an audiometric screening of 153 children aged 5-18 years, affected by beta-thalassemia and treated with regular blood transfusions and iron overload chelation by means of desferrioxamine. Thirty-eight percent of the patients showed a significant sensorineural hearing loss at high frequencies with recruitment. Younger patients had a greater hearing loss, indicating that cochlear damage was not due to the disease itself. Furthermore, hearing loss appeared to be correlated with the mean and peak desferrioxamine doses administered and was higher in subjects with lower iron load. Thus, the ototoxic effect seems to have been higher when a good iron chelation had been obtained. Among our patients, conductive hearing loss was not more frequent than in patients without beta thalassemia.

Delayed Vertigo after Stapes Surgery

Objectives: Stapes surgery restores partial or total hearing in almost 95% of cases, and in case of failure, revision surgery may often resolve the problem. Delayed vertigo is commonly related to perilymphatic fistula. The aim of this study is to report experience gained in revision stapes surgery in cases of delayed vertigo.

Impedance Measurement as a Noninvasive Technique for the Monitoring of Intracranial Pressure Variations

In previous reports it has been demonstrated that jugular compression causes a modification of middle ear acoustic impedance; this phenomenon has been named the jugulotympanic reflex (JTR). The aim of the present study was to contribute to the understanding of the origin of this reflex. We have analyzed the middle-ear impedance modifications induced by unilateral and bilateral jugular compression in 12 normal subjects, in 12 patients afflicted with otosclerosis, in 3 patients with Menières disease and in 6 patients demonstrating intracranial hypertension. In the latter group, the cerebrospinal fluid (CSF) pressure was simultaneously recorded. The JTR was elicited in each normal subject and in each patient affected by Menières disease and intracranial hypertension, while it was usually absent or modified in otosclerotic patients. The absence of the JTR in otosclerotic patients and, above all, the correspondence between CSF pressure and the middle-ear impedance modification induced by jugular compression suggest that it is due to the transmission of pressure changes from the CSF to the perilymph through the cochlear aqueduct.

Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications

Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration.

Condition of the anterior part of the middle ear cleft in acquired cholesteatoma.

Conclusion: The high rate of flogistic suffering of the controlateral ear seems to suggest a correlation between tubal dysfunction and acquired cholesteatoma but the low rate of pathological reports regarding the anterior mesotympanic region exclude a eustachian tube dysfunction (EDT) at the time of surgery. These observations support the hypothesis that ETD is not a factor that may influence the evolution of the cholesteatoma. Objectives: To evaluate the role of eustachian tube function in the middle ear secondary acquired cholesteatoma. Patients and methods: This was a case series study. The study group consisted of 72 patients submitted to tympanoplasty for middle ear secondary acquired cholesteatoma. Results: The contralateral ear was normal in 37 subjects (51%) and affected by chronic otitis media in 35 (49%); the anterior part of middle ear cleft was normal in 53 patients (74%). There was no significant relationship between the contralateral ear condition and the status of the anterior region of middle ear (p>0.05). The site of retraction or the presence of tympanic perforation with skin migration was not related to the condition of the protympanum. Otorrhea, cholesteatoma extension, and ossicular chain lesions were not significantly related to the status of the anterior part of the middle ear cleft (p>0.05).

Equine versus Bovine Pericardium in Transmeatal Underlay Myringoplasty

Objectives: Many different grafting materials have been proposed in myringoplasty. The aim of this study was to evaluate the results obtained in transmeatal underlay myringoplasty using bovine and equine pericardium. The results were compared with those obtained by using autologous temporalis fascia. Methods: The study group consisted of 52 patients with tympanic perforation. Twenty-nine patients were randomly selected for treatment with bovine pericardium and 23 for equine pericardium. A group of 14 patients was treated with autologous temporalis fascia. Results: Closure of the perforation was achieved in 19 of 29 patients (66%) treated with bovine pericardium, in 19 of 23 (83%) treated with equine pericardium, and in 13 of 14 (93%) treated with autologous fascia. The best functional results in patients who gained closure of the perforation were obtained by means of equine pericardium. Conclusions: The overall long-term tympanic closure rate demonstrates that equine pericardium has a greater take rate than bovine pericardium. The results obtained are inferior to those obtained with autologous fascia, but this technique is less aggressive. The higher success rate with equine pericardium may be due to the fact that it is thinner and easier to handle and model than bovine pericardium.

Monitored anesthesia care with target-controlled infusion in vibroplasty.

Objectives: Correct positioning of a floating mass transducer during middle ear implant surgery is often problematic. With the use of monitored anesthesia care (MAC), however, deep sedation is maintained during surgery, followed by conscious sedation in which the patient can respond to test questions that investigate correct device position and function. The main aim of this study was to determine whether intraoperative audiometric assessment was feasible with MAC with target-controlled infusion in vibroplasty. An additional aim was to determine whether MAC was sufficiently comfortable for patients during the procedure. Methods: The study group comprised 8 patients who underwent vibroplasty under sedation. Before suturing, audiometric assessment was done by stimulating the external auditory processor with pure tones at 0.5, 1, 2, and 4 kHz. Blood pressure, arterial oxygen saturation level, heart rate, and end tidal carbon dioxide level were monitored during the procedure and at awakening. Results: Audiometric assessment was successfully completed in all 8 patients. The selected parameters indicated that no patient experienced pain or discomfort during surgery; the absence of discomfort was confirmed 1 to 2 hours after the operation by simple questioning. Conclusions: We found MAC to be an efficient and relatively safe technique for verifying the correct coupling of the floating mass transducer with the middle ear during vibroplasty. The patients were able to respond appropriately to questions and commands; moreover, none reported having experienced pain or discomfort during the operation.

Dynamic aspects of stapedial reflex in myasthenia gravis.

The modifications of stapedial reflex have been studied in 30 subjects affected by myasthenia gravis. The test was performed in basal conditions (i.e. at least 6 h after the last administration of an anticholinesterase drug), after the injection of Tensilon and again in basal conditions, 1 week after thymectomy. The reflex was elicited in 27 patients but in 1 case it appeared only after therapy. Among the various parameters analyzed, only rise velocity, decay velocity and amplitude have shown lower values in patients than in the normal group. These parameters increased significantly after the pharmacological test and 1 week after thymectomy in 60% of the cases. The data suggest that patients with more evident muscular damage are more likely to present a rise of stapedial strength after therapy. The efficiency of thymectomy has also been demonstrated.

Monaural or binaural sound deprivation in postlingual hearing loss: Cochlear implant in the worse ear.

To determine whether speech recognition scores (SRS) differ between adults with long‐term auditory deprivation in the implanted ear and adults who received cochlear implant (CI) in the nonsound‐deprived ear, either for hearing aid–assisted or due to rapidly deteriorating hearing loss.