Ove Söderberg

Myringotomy Made by CO2 Laser An Alternative to the Ventilation Tube?:An Experimental Study

In order to examine whether a myringotomy made with a CO2-laser might be alternative to a ventilation tube, a perforation was made in the upper rear quadrant bilaterally, of 22 rats. The laser-made perforations showed a delayed healing pattern, about twice the closing time of a similar-sized perforation made with a myringotomy lancet. Serous effusion was constantly observed in the attic space during the first 9 days but only in one ear was there actual discharge through the perforation. The size of the perforation started to diminish when the hyperplastic keratinizing squamous epithelium reached the perforation border.

Repair of Chronic Tympanic Membrane Perforations Using Applications of Hyaluronan or Rice Paper Prostheses

A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1% hyaluronan (Healon; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with puretone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15%) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases.

Exogenous Hyaluronic Acid (Healon®) Accelerates the Healing of Experimental Myringotomies

Topical application of hyaluronic acid (Healon) onto the borders of rat tympanic membrane perforations accelerated the rate of wound healing. The closure time was roughly 60% of that of the untreated perforations. Epithelial cells fused with opposing cells slightly in advance of supporting connective tissue and thus bridged the remaining gap. It seems as if hyaluronic acid, topically applied, can serve as a supporting and orienting matrix for the proliferating squamous epithelium.

Appearance of effusion material in the attic space correlated to an impaired Eustachian tube function

In adult Sprague-Dawley rats a dysfunction or a total blockade of the Eustachian tube was established by various experimental procedures. The appearance of effusion material in the attic was subsequently considered to be evidence of incomplete ventilation of the middle ear cavity. Though the salpingopharyngeus muscle (SPM) seemed to be the muscle which could open the Eustachian tube maximally, splitting of the soft palate and consequent interference with the tensor veli palatini muscle (TVPM) and the levator veli palatini muscle (LVPM)--but obviously not with the salpingopharyngeus muscle (SPM)--caused the effusion material to be produced in the middle ear cavity. Neither blockade by about 80% of the tympanal orifice nor severing of the tendon of the tensor tympani muscle (TTM) close to the malleus produced any signs of effusion material whatsoever. Our findings strongly suggest that the most important part of the Eustachian tube, as regards ventilation, is the nasopharyngeal portion, as a normally functioning TVPM and LVPM seems to be an absolute prerequisite to prevent effusion material from developing in the attic.

Tele-otolaryngology consultations between two rural primary-care centres in southern Lapland and the University Hospital of Umeå.

In 1996 a telemedicine link was established between two primary-care centres of Västerbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultations. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.

Structural Changes in the Tympanic Membrane after Repeated Tympanostomy Tube Insertion

In an animal model (rat) a polyethylene tympanostomy tube was repeatedly inserted (four periods lasting 2 weeks) into the upper rear quadrant of the right tympanic membrane (TM). The intervals between the different tubulation periods (TPs) lasted 3 weeks. The corresponding quadrant of the left TM was subjected to repeated myringotomies (four times). The structural changes in the TMs were evaluated otomicroscopically and by histological techniques 3 weeks and 3 months after the final TP. Repeated tympanostomy tube insertion caused a dramatically thickened pars tensa. The thickened areas were characterized by a scar tissue exhibiting sclerotic plaques and a dense connective tissue with bone-like formations. Occasionally, islands of keratinizing stratified squamous epithelium were noted within the thickened pars tensa as well as interrupting the epithelial lining facing the tympanic cavity. Similar structural changes occurred after myringotomy without tube insertion, but they were not so pronounced as after repeated tympanostomy tube insertion. The changes were not restricted to the manipulated quadrants, but also affected the untouched anterior quadrants. Throughout the observation period the anterior quadrants improved, while the rear quadrants remained severely affected.

A case of a double tongue : case report

A baby boy presented with a double tongue combined with a median cleft palate. He was otherwise normally developed. The double tongue was reconstructed to form one tongue 40 days after birth. At follow-up examination when he was 6 months old the tongue was well formed with normal function.

A Subfrontal Meningioma with Primary Origin from the Nasal Cavity

A case report concerning a meningioma located in the subfrontal region and nasal cavities is presented, with clinical, radiological and pathological findings. The literature concerning meningiomas in this location is reviewed. Some possibilities of differential diagnoses are discussed. Indications of a primary origin in the nasal cavities are given.

Tympanostomy tubes for prevention of purulent otitis media.

A recently developed animal model was used to study the effect of tympanostomy tubes (TTs) on the spontaneous development of purulent otitis media. in 35 rats with soft-palate clefts a TT was inserted into the right tympanic membrane. The left ear was left intact. Serous effusion occurred in the attic space within 2 days after surgery, whether or not the middle ear cavity (MEC) was artificially ventilated. Between days 7 and 21 the intact-ear MEC was gradually filled with effusion material that turned purulent. Effusion material did not develop in the mesotympanum and hypotympanum of the intubated ears. Microbiologic examination of the effusion material showed a microflora similar to that in the nasopharynx. Ventilation through a TT reduced the number of colonized MECs (4 vs. 10) on day 21. In the individual culture-positive MEC with a TT there were fewer colonies than in the corresponding ear without a TT. These results support the contention that a TT may prevent the development of purulent otitis media.

Experimental background for the use of tympanostomy tubes

Already within 24 h, splitting of the soft palate in rats caused production of effusion in the attic space. During the next couple of days the effusion material filled the meso- and hypotympanon. The production of a serous fluid in the attic space appeared concomitant with an elevated histamine content in the middle ear cavity, irrespective of whether the ears were ventilated or not. In the artificially ventilated middle ears no effusion appeared in the meso- and hypotympanon and the hypotympanal mucosal lining remained normal. The serous effusion filling the middle ear cavities with the intact tympanic membranes was replaced at about 7 days by a purulent effusion material containing mainly Gram-negative enteric rods. Thus it seems that a serous otitis media and a purulent otitis media occur in a continuum. The change to a purulent infection could be prevented by artificial ventilation, but as soon as the myringotomies were healed or the tympanostomy tubes got clogged a flocculent, pus-like effusion also appeared in these middle ear cavities.