Sten Harris

Report on a Long-term Study of Maternal and Congenital Cytomegalovirus Infection in Sweden. Review of Prospective Studies Available in the Literature

This report summarizes knowledge accumulated in a long-term study of congenital and maternal cytomegalovirus (CMV) infection in Sweden. Some new findings are included. We considered diagnostic methods, sources of maternal infection (including occupational risks), roles of primary and secondary maternal infections, transmission to foetuses, incidence, symptoms and prognosis of established congenital infection and relative importance of such infection in infantile sensorineural deafness, microcephaly and type 1 diabetes mellitus. Virus isolation testing was done 1977-1985 on 16,474 newborns. 76 (0.5%) congenitally infected infants were found, 22/76 (29%) with transient neonatal symptoms and 11/60 (18%) with neurological symptoms by the age of 7 y. Type of maternal CMV infection was serologically determined in 62/76 cases (30 primary, 32 secondary). CNS disturbances in the infants occurred after both primary (all trimesters) and secondary maternal infections. The negative potential of secondary maternal infections might be an obstacle to preventive vaccination.

Congenital Cytomegalovirus Infection and Sensorineural Hearing Loss

In a prospective study still in progress, infants with congenital cytomegalovirus (CMV) infection were followed with audiological, ophthalmological, neurological, and psychological tests; 10,328 infants were investigated within a 5-year period (1977-1982) by virus isolation in urine within the first week of life. Fifty (0.5%) had a congenital CMV infection. In this group four children turned out to have total deafness and a fifth possibly a mild hearing disorder. In one case the deafness was associated with severe mental retardation and spastic tetraplegia. The mother of the child had a primary CMV infection in the first trimester. In one of the other cases of severe deafness it could be proven that the mother had had a secondary CMV infection and in further two cases, presumed secondary infections. Prospective serological tests of the mothers would not have revealed more than one of the high risk pregnancies. The value of vaccination against congenital CMV infection is questioned. Screening of newborn infants for congenital CMV infection is recommended in order to reveal infants at high risk for deafness and make an early habilitation possible.

Lung Function Before and After Laryngectomy

Five patients were examined with respect to pulmonary mechanics before and after laryngectomy. Methods were used, the results of which were not influenced by the laryngeal stenosis before and by any stenosis of the tracheostoma after the operation. It was shown that the pulmonary resistance from trachea to pleura was normal before operation. Postoperatively pulmonary resistance increased and reached a maximum after six months, when it was about ten times as high as preoperatively. One year after operation it was not more than about twice the original value. At that time lung function was normal as concerns working capacity and arterial blood gases. A great adaptability of the airways was thus shown. The dangers and problems during the period of adaption are discussed.

Middle Ear Mechanics and Eustachian Tube Function in Tympanoplasty

In 100 patients with chronic otitis media, tubal function and volume was tested before operation. In a postoperative study on hearing and healing there was no positive correlation between these findings and the preoperative results. In 50 patients with healed ear drums, tubal function was retested in a pressure chamber with a flow volume technique. An improvement in Eustachian tube function could be demonstrated. These findings indicate that poor tubal function in chronic otitis media might be secondary to other factors responsible for the disease.

Translabyrinthine Acoustic Neuroma Surgery as Performed by the Otoneurosurgical Group at Lund University Hospital

The Lund otoneurosurgical group has operated 97 out of 118 pontine angle tumours using the translabyrinthine approach originally described by House. The pre- and postoperative evaluation of these 97 patients is described. The traditional classification of acoustic neuromas, the results of the reported surgery and complications are discussed.

Postural Control and Vestibular Function in Patients Selected for Cochlear Implantation

Postural control and vestibular and eye motor function were evaluated in 7 postlingually deaf patients before cochlear implantation as vibration toward the calf muscles or galvanic electrical stimulation of the vestibular nerves perturbed stance. The patients were compared with 21 control subjects. Vibration-induced bodysway was increased in the patients compared to the normals. Galvanic stimulation induced a bodysway that was not significantly different from that of the control group suggesting that the patients selected for cochlear implantation, and with otherwise reduced postural control, are sensitive to electrical stimulation of the vestibular nerve. This finding may contribute with a complementary hypothesis to the causes of dizziness among cochlear implant patients.

Pulsatile Tinnitus and Therapeutic Embolization

Fifteen patients with disabling pulse-synchronous tinnitus were investigated with super-selective angiography demonstrating an arteriovenous malformation in 8 cases, chemodectoma of the jugular bulb in 3, and a local arterial stenosis in one case. In 12 of these cases the murmur could be registered objectively, while in the 3 cases with a negative angiographic finding no such murmur could be heard, an observation which may be of importance when selecting patients for further angiographic examination. The cases with a tumour and those with an arteriovenous malformation were all treated with gelatin sponge embolizatioected cases embolization is recommended alone or in combination with surgery.

The MED-EL SONATATI100 cochlear implant: An evaluation of its safety in adults and children

Abstract Conclusions: Data from 50 patients suggest that the SONATATI100 cochlear implant (CI) is a safe and effective device. Objective: MED-EL has developed and tested a CI with titanium housing (the SONATATI100), which has the same internal components as the PULSARCI100. Implant surgery should be less traumatic, as with these CIs smaller incisions and less drilling are involved. The study aimed to assess surgical issues pertaining to the implantation of the device, patient compatibility with the titanium of the implant housing, and other patient-related issues. Methods: Fifty patients were recruited into this multicenter study. In phase 1, 30 adults and in phase 2, 20 children received a SONATATI100 cochlear implant. An intraoperative survey was completed by the surgeons for all patients. A postoperative survey was completed by the audiologists/fitting engineers at first fitting and 3 and 6 months after the first fitting to evaluate the safety and the efficacy of the device. Results: The device was proven to be effective in that it was stable in the implant bed and that minimally invasive surgery could be carried out. The device was proven to be safe after medium-term use and no unexpected adverse events were reported.

Three-Dimensional Laser Doppler Interferometric Display of Human Tympanic Membrane Vibrations at two Different Frequencies and Sound Pressure Levels

The vibrational movements of the tympanic membrane of human in vitro specimens were studied by computerized laser Doppler interferometry. The entire surface of the vibrating tympanic membrane was scanned with the laser beam and all information was stored digitally making it possible to recreate the movements as in slow motion on the oscilloscope. Single phases of interest from the vibrational cycle were plotted as shown. The resonance patterns at 0.58 kHz and 3.11 kHz are compared and the effect of different sound pressure levels on the vibrational movement of the tympanic membrane demonstrated.

Tubal Function and Surgery in Chronic Otitis Media. a Study on the Predictive Value of Testing Tubal Function, Valsalva's Manoeuvre and Volume of Ear Spaces

In 141 ears with central tympanic membrane (TM) perforation preoperative tubal studies as well as volume determination of the air-filled ear spaces was performed. Tubal patency was checked with Valsalvas manoeuvre and pressure equilibration function with Toynbees test and aspiration-deflation tests respectively. At postoperative control 74.5% of the ears had intact movable TM (healed), 5.7% had intact but immovable or retracted TM and 19.8% had perforation (defect). There was no difference between the healed and defect ears regarding results in aspiration-deflation tests. A positive Valsalvas manoeuvre was significantly more frequent in the healed ears. Ears with a small air-filled volume and negative Valsalvas manoeuvre showed significantly lower healing rate than ears with positive Valsalvas manoeuvre and a large air-filled volume.