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Background: A new method for the stimulation of the organ of equilibrium by means of a broad-scale and monochromatic near infrared emission was developed. This method should be examined within the framework of a pilot study, evaluated and its clinical possible applications examined. Patients and Methods: Healthy probands (n = 15), patients with a radical cave of the ear (n = 5), patients with a defect of the tympanic membrane (n = 5) and spontaneous nystagmus (n = 5) were examined. In healthy probands an irritation with broad-scale as well as monochromatic near infrared (NIR) was performed and compared with a water irrigation (44 degrees, 50 ml in 30 seconds). The subjective, local feelings during the application and the appearance of giddiness according to irritation were corded and the nystagmus was registered by means of videonystagmography. In patients with radical cave of the ear and tympanic membrane defects, a broad-scale NIR-irritation before a comparative irritation with warm air (44 degrees) was performed exclusively. Results: In all healthy probands, a nystagmus reaction could be seen with broad-scale and monochromatic NIR. Compared to the hot water irritation slow phase velocity (SPV) was decreased however registrable by means of Frenzel glasses and elektronystagmography during the culmination stage. In patients with radical cave (n = 4) and tympanic membrane defects (n = 3) showing paradoxical nystagmus reaction during hot air irritation, a nystagmus to the site of stimulation resulted by means of light calorisation. In patients with a spontaneous nystagmus an attenuation (n = 1) or inversion (n = 2) could be achieved by NIR-radiation. Conclusions: The method of the NIR-radiation is suitable in clinical practice for the caloric test proofing warm reaction. Vaporization cold does not occur. The application of heat charm is better proportionable and steerable than during air irritation. The procedure is sterile, noiseless and non-contact. Difficulties in interpretation of results of vestibular tests because of evaporation coldness do not occur.

BACKGROUND: Among other materials it is also possible to use autologous fat tissue for closing tympanic membrane perforations. In this study we have evaluated 44 consecutive myringoplasties with adipose tissue performed between 1999 and 2001. MATERIAL AND METHOD: The indications were residual microperforations following tympanoplasty with temporalis fascia or tympanic membrane perforations due to trauma or chronic otitis media simplex. Myringoplasty with fat tissue was performed as an outpatient procedure and took about 15 minutes. The adipose tissue was harvested from the posterior side of the ear lobe in local anaesthesia. After refreshing the borders of the tympanic membrane perforation with a micro hook, the adipose tissue was positioned into the perforation by using a handheld or fixed ear speculum. The graft was covered with a silk strip soaked with Garamycine ointment. In bigger perforations a bed of gelfoam was put into the tympanic cavity in order to avoid adhesions between the graft and the promontorium. RESULTS: A permanent healing of the tympanic membrane was achieved in 40 (91 %) out of the 44 patients. In 21 patients hearing improved between 5 -10 dB. Surgical complications did not occur. CONCLUSIONS: Our results indicate that transcanal myringoplasty with adipose tissue is a simple and minimally invasive method for closing small to medium sized tympanic membrane perforations.

BACKGROUND, APPLICATION OF STATIC PRESSURE AT THE TYMPANIC MEMBRANE: Cleland in London (1741) presumed that the pressure of a strong sound wave would push the tympanic membrane inward, thereby causing deafness. He recommended correcting this situation by applying suction to the auditory canal, and he demonstrated a small tube suitable for this purpose. Toynbee in London (about 1860) realized that, following a malfunction of the Eustachian tube, a negative pressure would develop in the middle ear and draw the tympanic membrane inward, thus causing hearing loss. This concept resulted in efforts to actively support the aeration of the middle ear via the Eustachian tube. In addition to these measures, Politzer in Vienna (1867) suggested blocking the external auditory canal tightly so that resorption of the air would produce negative pressure, counteracting the low pressure in the middle ear. Lucae in Berlin (1874) proposed the theory that the two small muscles in the drum would act as antagonists on the tympanic membrane and accommodate the ear for high and low-pitched sounds respectively. He tried to correct malpositions of the tympanic membrane due to a misbalance of the two muscles by applying static positive or negative pressure in the auditory canal. APPLICATION OF ALTERNATING PRESSURE AT THE TYMPANIC MEMBRANE: Siegle in Stuttgart (1864) put forward the idea that repeated strong movements driven by the pneumatic ear speculum that he had invented would be able to loosen adhesions in the middle ear. Lucae (1884) later devised an elastic probe to be placed on the short process of the malleus for massage of the ossicular chain. Delstanche in Brussels (1885) presented two instruments called "rarefacteur" and "masseur du tympan et des osselets" which in the auditory canal would produce negative pressure or alternating pressure respectively. The next step were suggestions and devices enabling the patient to treat himself for reduced mobility of the tympanic membrane or the ossicular chain, such as alternating pressure on the tragus, or tubes to conduct pressure from the mouth or a rubber bag to the ear. With the aim of speeding up the frequency of the pressure impulses, mechanic pumps were constructed, which were first driven by hand, later on by electric power. CRITICAL EVALUATION: At the turn of the century numerous attempts were made to evaluate the effectiveness of the pneumatic massage of the middle ear and to specify the indication for this kind of treatment. Although no convincing and predictable results could be demonstrated and even harmful effects had been observed in animal experiments, the massage of the tympanic membrane continued its triumphant march for half a century. The reason for this seems to be the suggestive and plausible therapeutic approach to a well known pathology of the middle ear. Since the middle of this century it has been regarded as obsolete and is no longer mentioned in text books. The history of this episode is presented in detail.

BACKGROUND The cochlear aqueduct is a route for direct pressure transfer between intracranial and intracochlear fluids. In patients with Meniere's disease, intracochlear pressure is presumably disturbed. The "Tympanic Membrane Displacement Analyser (TDA)" is a new system which provides a useful noninvasive method of detecting intracranial and intracochlear pressure changes. PATIENTS In this study TDA measurements in combination with a glycerol test were performed in nine patients with Meniere's disease and in seven normal persons. RESULTS Before ingestion of glycerol, no significant difference in pressure was found between the two groups. After ingestion of glycerol a temporary decrease in intracochlear pressure was detected in both groups without any significant difference between the two groups. CONCLUSION These results show that the combination of glycerol testing and TDA measurements does not seem to be helpful for the differential diagnosis of Meniere's disease.

BACKGROUND The human temporal bone preparation is a common model for research of physical processes of the ear canal and middle ear. In the past decade only a few reports were published discussing changes of the vibration behaviour of the tympanic membrane, as well as the ear canal resonance, during the time between death and preparation of the temporal bone. The aim of our study is to verify whether measurements at the temporal bone of dead humans can be really applied to the in vivo situation. METHODS We investigated whether changes of the ear canal resonance and the vibration of the tympanic membrane depend on temperature and time after death. In a female human body we defined the resonance of the outer ear and the impedance of the tympanic membrane using a tympanometer and a real ear measurement system during nine hours post mortem. RESULTS We were able to prove that before the preparation of the temporal bone none of the parameters changed significantly. CONCLUSIONS In conclusion, the method of preserving the bone after its preparation is decisive for the validity of measurements at the isolated (post mortem) human temporal bone.

The tympanic membrane displacement technique (TMD) is aimed at evaluating intracochlear and intracranial pressure changes non-invasively. Therefore, the present paper describes the findings in patients with Meniere's disease where an increase in volume of the endolymphatic spaces is discussed. It should be investigated to which extent a change in the intracochlear pressure corresponds to different stages of the disease. It could be described that the intracochlear pressure does change over a certain period of persisting Meniere's, but that there is no extensive increase in intracochlear pressure between the attacks. The glycerol test as well as the acute attack (case report on one patient) are, however, characterised by distinct patterns. The same holds true for the late-stage Meniere's. It could be demonstrated that the functional patency of the cochlear aquaeduct in patients with long-term Meniere's history is reduced. This finding is surprising and should be investigated further. In essence, the TMD technique enables to better characterise Meniere patients, but it should not be a tool of routine diagnosis of the disease. In some audiological patients, it can also be beneficially applied (10).

The influence of topical anaesthesia of the tympanic membrane on Eustachian tube function was investigated using the pressure chamber impedance method, thus obtaining quantitative data. Anaesthesia was performed by application to the tympanic membrane of small cotton balls containing lidocaine and dimethylsulfoxide. We did not observe significant alterations of tubal parameters after unilateral or bilateral anaesthesia. Our observations are in contrast to investigations published by Nagai. We suppose that differences in methods of topical anaesthesia are responsible for this discrepancy. Our technique of topical anaesthesia of the tympanic membrane excludes any effect on the Eustachian tube, thereby avoiding negative consequences of middle ear pressure on wound healing.

From a total of 720 patients with acute deafness, 85 patients suffered from unilateral deafness with a hearing loss of at least 80 dB in the speech frequency range. Under conservative therapy in 58 patients, there was an improvement in hearing in 19 cases and a return to normal in 6 patients. In 27 patients, the clinical history was suggestive of a possible tympanic membrane rupture, which was confirmed by tympanoscopy in 5 cases. On 5 other occasions, the intraoperative findings were highly suggestive of tympanic membrane rupture. In each case, a membranoplasty was performed. The results of operative therapy tended to give better results than conservative therapy. The presence of concomitant vestibular disorders did not influence the results of treatment in either group. The results of the study show, that apart from tympanoscopy, there are no other diagnostic criteria to recognize a membrane rupture. Typical case histories demonstrate that tympanoscopy can be useful diagnostic and therapeutic measure in cases of therapy-resistant deafness.

25 cases of tympanic welding spark injuries of the years 1959-1989 are reported. Early results and late sequelae after conservative therapy, immediate and interval operation are described and discussed. Regarding the tendency of tympanic defects to enlarge after thermal injuries despite conservative and early operative therapy, secondary seal by tympanoplasty is recommended. Even then, however, the rate of residual and recurring perforations must be reckoned as being higher than after tympanoplasty in comparable defects of other origin, due to the inferior nutritive supply owing to the extended scar caused by burning. On the other hand, the rate of inner ear traumatisation with 12% directly after welding injury and with 4% remaining impairment of hearing, is low.

In a clinical study 27 adults with cleft lip and palate (mean age 21.9 years) were examined to look for long-term results of hearing and pathology of the tympanic membrane. 69.2% of the ears showed normal hearing; the threshold of mean hearing loss never exceeded the 20 dB-level. Slight changes of the tympanic membrane could be seen in 48.2%, severe changes in 16.7%.

5 patients suffering from high-grade sound conduction deafness due to extensive adhesion process on both ears underwent tympanoplasty on one of the ears. The missing tympanic mucosa was replaced by an autologous cell suspension prepared from mucosa of the maxillary sinus. 6-12 months after re-epithelialisation of the tympanic cavity, reconstruction of the ossicular chain was performed using glasionomer cement prostheses (IONOS). 3 patients showed an improvement of hearing after transplantation of the isolated mucosal cells and following replacement of auditory ossicles. One patient had good improvement of hearing already after reconstruction of the tympanic cavity. In one case reobliteration of the tympanic cavity occurred. The clinical results confirm that using mucosal cell suspensions for reepithelisation of an obliterated tympanic cavity is yet another successful step forward in reconstructive surgery of the middle ear.

In 1983, 45 out of 63 clinically treated patients with sudden hearing loss underwent an exploratory tympanotomy. In 27 cases (60%) a perforation of the round window membrane was found, whereas in 18 cases (40%) the round window membrane was intact and there was no perilymph fistula. From 1982 to the end of 1983 30 perforations of the round window membrane were found which are reported here, most of them being spontaneous perforations without any preceding trauma. Audiometrically, hearing losses were found ranging from medium to high degree. These included all types of hard hearing, such as loss of high or low tones and losses over all frequency ranges to total deafness. All patients complained of tinnitus. One-third of the patients with perforated membrane had dizziness or vertigo combined with disturbances of balance. Treatment consisted of sealing the round window membrane with a plug of fascia or periostium. When the patients were discharged, or shortly after their discharge, audiometry revealed normal hearing in three patients, improved hearing in 8 patients, no change in 14 patients, and further deterioration in 3 patients. In 8 patients with perforated membrane, the sudden hearing loss had occurred 1 to 12 months back and in 6 patients only 8 to 30 days ago. The study will continue, but we can already see from the present results that every sudden hearing loss should be examined for a possible spontaneous perforation of the round window membrane. For this reason, exploration of the round window should be done within the first few days. The study yields new knowledge of the pathogenesis of the sudden hearing loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Reaction de corps etranger temporaire mais importante. Ne favorise pas la regeneration du tympan. Ces meches ne sont pas satisfaisantes