Archives of oto-rhino-laryngology最新文献

Free grafts, regional or myocutaneous flaps, microvascular tissue transfer and prosthetic rehabilitation are essential techniques required for modern reconstruction of defects in the head and neck. The myocutaneous flaps and the microvascular grafts especially offer a wide variety of tissues useful for reconstruction. It is our belief that a microsurgical team should be organized in every major ENT department for interdisciplinary cooperation depending on the local situation.

For partial reconstruction of the nose we use an original forehead compound-island flap and the frontotemporal flap of Schmid-Meyer. In repairing the lower two-thirds of the nose we apply our fronto-parieto-auricular flap, which was modified by Orticochea and by Washio. For total reconstruction of the nose, we have abandoned the scalp flap of Converse and substitute in its place the fronto-parieto-occipital flap of Galvao.

In 1987, at the Congress of Implants in Otology in Venice, Italy, we first presented our experiences with stored lyophilized bone allografts for reconstruction of the tympano-ossicular chain. Since then, we have extended our experiences to include reconstruction of the external bony ear canal, the filling of defects in the mastoid bone, reconstructive nasal surgery and rehabilitation of major bony defects of the face. Additionally, we have tried to improve the preparation of the bony implants used clinically and have started a multicenter collaboration with other European universities.

In our previous histological studies of the tympanic membrane, we reported the presence of encapsulated nerve corpuscles that are capable of detecting middle ear pressure. Based on these findings, the relation between sensory receptors in the tympanic membrane and tubal function was examined in a clinical study. Tubal function was tested during Valsalva maneuvers and its active equilibration. Function was recorded as a change of the static compliance of the tympanic membrane on an otoadmittance meter. To paralyze the sensory receptors in the tympanic membrane, iontophoresis was used to induce anesthesia of the drum. Forty ears of 20 subjects were tested. All ears were able to equalize positive middle ear pressure without or with a single swallowing. After anesthesia, 13 ears needed more than two swallows and 4 ears failed to equalize middle ear pressure in spite of repeated swallowings. As eustachian tube function changed following anesthesia of the tympanic membranes, a neural connection between sensory receptors in the tympanic membrane and tubal muscles is suggested.

Radiopaque concretions in the maxillary sinus in cases of sinusitis are often observed in infections with aspergillosis. For several authors, such features are considered to be typical of these infections. For us this foreign body in most cases is believed to be related to overfilling of the teeth. We have previously drawn attention to this fact. We report 85 cases of aspergillosis of the maxillary sinus. Cases involving immunosuppressed patients were excluded because of very different clinical conditions. A radiopaque foreign body was seen in 94% of the cases. Of this group, 85% were believed to be related to overfilling of maxillary teeth with dental paste, particularly since evidence for endodontic treatment was found in the premolar/molar region. An image of intrasinus dental paste was demonstrated in 12% of the cases as a direct extension of filling paste from affected teeth. The nature of the dental paste is important because the zinc contained can stimulate the growth of Aspergillus fumigatus. In vitro studies in our laboratory also showed that the growth of A. fumigatus was stimulated with a low concentration of zinc.

Natural antibodies against laminin (ALA) have been detected recently in some acute and chronic infectious disorders. In our present study sera of a large number of patients with inner ear disorders of unknown etiology (n = 413) were tested for ALA. Control sera were taken from patients with diseases of known infectious etiology and patients with diseases of unknown etiology in which an infectious etiology was suggested. Patients with classical autoimmune diseases as well as healthy blood donors were also included in this study. The highest frequency of ALA was found in patients with sensorineural hearing loss (SNHL) (68%), whereas the incidence of ALA was comparatively uncommon in patients with Menière's disease (14%). In patients with chronic infectious diseases ALA were detected with almost the same frequency as in patients with SNHL. The elevation of the erythrocyte sedimentation rate and the association of ALA-positive SNHL with other chronic inflammatory disorders suggest that ALA might be stimulated by a persisting infectious process. These findings suggest that certain forms of inner ear disorders might have a chronic infectious etiology.

We report our methods for using the surgical microscope to decompress the optic nerve intranasally and our results in five cases with optic nerve trauma, including a 7-year-old girl. Decompression seemed necessary in cases without canal fractures (four cases in the present report), since circular disturbances from edema may play a role in producing reversible visual impairments. The intranasal approach not only solved cosmetic problems associated with other techniques, but also provided better, less distorted views when compared with extranasal or transantral approaches. Microsurgery using a self-retaining retractor speculum resulted in improved visualization and reliable procedures during surgery. Since the operation does not impose a cosmetic or physical burden on patients, it can be done early when indicated to accelerate visual improvement following trauma.

In normal guinea pig ears, hydrostatic perilymphatic pressure is equal to endolymphatic pressure. Alterations of perilymphatic pressure induced, for example, by laceration of the round window membrane are transmitted immediately to the endolymphatic compartment, probably via Reissner's membrane. In guinea pigs with experimental endolymphatic hydrops, however, pressure gradients between the endolymph and perilymph remained preserved after rupture of the round window membrane. This is considered as further evidence that after long-standing distention of Reissner's membrane the membranous labyrinth loses its ability to equalize endolymphatic and perilymphatic pressure.

Encapsulated nerve endings were found in both the subepidermal connective tissue and the lamina propria of a human tympanic membrane. The structure of the corpuscles was round or oval and contained a number of axon terminals with mitochondria and Schwann cell processes. Amorphous materials were present in the intercellular space. These features appear to be advantageous in transmitting mechanical forces on the capsule to the axon terminals and are comparable to the function of a mechanoreceptor. Resultant changes in the shape and stiffness of the tympanic membrane as the result of its dislocation indicate similar changes in the pressure on the corpuscle. The arrangement of the sensory corpuscles suggests that they may play a role in detecting pressure changes in the middle ear cavity.