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Objective: To compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed. Patients and Study Design: This study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties. Setting: The study was carried out partly at a private practice and partly in an academic tertiary referral center. Main Outcome Measures: This study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology - Head and Neck Surgery (1995). Results: When success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency. Conclusion: Cumulative data from several authors show that ∼50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB. Key Words: Ossiculoplasty—Tympanoplasty—Myringoplasty. Otol Neurotol 22:140–144, 2001.

Cholesteatoma and cholesterol granuloma of the ear are two different pathologic conditions that have often been confused in the past, and even in the present, in the literature. The features differentiating the two lesions are presented.

It is current opinion that the intercellular spaces of the stria vascularis represent a closed compartment isolated from the endolymph by the tight junctions of the marginal cells and from the perilymph by the junctional complexes of the basel cells. However, it has not yet been investigated whether these two barriers meet at the stria margins toward Reissner's membrane and the spiral prominence. Possible candidates for this sealing could be junctions between the spindle-shaped cells. In the present study freeze-fracture replicas of guinea pig specimens fixed in the presence of filipin were used in order to investigate the junctions of the spindle-shaped cells and to localize the cholesterol in their plasma membrane. Replicas reveal that, below the belt-like apical zonula occludens, the basolateral plasma membranes of the spindle-shaped cells adjacent to each other and to the basal cells are joined over their entire extension by a large number of junctional strands intermingled with numerous filipin-cholesterol-complexes. Gap junctions are present in the meshes formed by these junctional strands. Thus, the plasma membrane of the spindle-shaped cells shows morphological and cytochemical characteristics which indicate that they are the anatomical components completing the barrier isolating the intrastrial compartment from the surrounding fluids.

Owing to its position, shape and prominence, the auricle is at risk of sharp and blunt trauma, lacerations, bite wounds, burns and damage from extreme cold.

Aerotitis media, barotraumatic otitis media, otitic barotrauma, inner ear decompression illness.

A multicentre study of the inner ears of an 88-year-old patient with vertiginous spells and severe hearing loss in the left ear was performed, employing regular and block surface preparations, light and electron microscopy with qualitative and quantitative evaluation of the cochlear and vestibular nerves. There was severe hydrops of the left cochlea and saccule. Reissner's membrane extended into the vestibule and herniated into the perilymphatic space of the non-ampullated end of the horizontal canal. Furthermore, the short canal connecting the posterior ampulla with the utricle had a small, exceedingly thin balloon-like expansion. Only slight hydrops limited to the cochlea was found in the right ear. Sensorineural degeneration was much more pronounced in the left cochlea than in the right. The number of cochlear and vestibular nerve fibres was greatly reduced in the left ear where more fibres with degenerative changes were present. In both specimens the number of myelinated nerve fibres in osseous spiral lamina was smaller than that in the cochlear nerve in the internal auditory canal. Changes occurred in the endolymphatic sacs but were considered non-specific. In this case severe, apparently progressive hydrops and sensorineural degeneration, characteristic of Menière's disease, were associated with atypical onset of clinical symptoms at a late age.

Thirty-eight patients aged 70 years and older submitted to stapedectomy by the same surgeon were identified and their clinical records retrospectively reviewed. The comparison group consisted of 38

Middle ear ossicles removed during ear surgery in 40 patients were examined in order to compare the histopathologic changes in children with those observed in adults. Bone resorption, mainly localized at the level of the periosteum and haversian canals in adults, was much more extensive in children. Replacement of bone by fibrous granulation tissue was observed in 60% of children's ossicles and in 27% of those belonging to adults. In children, extensive active resorptive osteitis of the ossicles was frequently associated with intensive round cell infiltration, which seems to play an important role in bone absorption and in the aggressiveness of cholesteatoma.

Meningoencephalic herniations into the middle ear and mastoid are rare and histologic information has been supplied only in few reports. Sections from two idiopathic encephaloceles were compared with those from encephaloceles associated with previous trauma, infection or surgery described in the literature. In the idiopathic encephaloceles, the herniated tissue consisted of cortical neural tissue with degenerative changes and gliosis like that described in cases with a history of chronic infection, previous surgery or trauma, but no inflammatory cells were present.

Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases.Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture.The study was performed partly at a private practice and partly in an academic tertiary referral center.At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied.The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal.This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.

This study aimed to compare the hearing changes in the long term after vestibular neurectomy, endolymphatic mastoid shunt, and medical treatment in classic Meniere's disease.A retrospective case review was conducted based on audiologic follow-up between 5 and 21 years.The study was performed at two centers in Bari University Hospital, one performing vestibular neurectomy as the first surgical procedure for Meinere's disease and the other, endolymphatic mastoid shunt.Of 68 patients with intractable idiopathic Meniere's disease, 29 underwent middle fossa vestibular neurectomy, and 17 had endolymphatic mastoid shunt; 22 were offered surgery but declined.Outcome measures were puretone average (PTA), speech reception threshold, and speech discrimination score before and after treatment.PTA declined by an average of 9.3 dB in neurectomy patients, 13.3 dB in patients undergoing endolymphatic mastoid shunt, and 18.1 dB in patients who were offered surgery but declined. Patients were subdivided into two cohorts based on their preoperative or initial PTA. In the patients who had PTA scores worse than 50 dB initially, the PTA declined an average of 4.3 dB in the vestibular neurectomy group, 11.5 dB in the endolymphatic sac group, and 4 dB in the nonsurgical group. In the patients with PTAor = 50 dB initially, the PTA declined an average of of 25.3 dB in the vestibular neurectomy group, 16.1 in the endolymphatic sac group, and 26.2 dB in the nonsurgical group. Although shunt patients with good hearing initially deteriorated less than neurectomy patients and less than patients who declined surgery, the difference was not significant.These results indicate that patients with poor hearing stabilized, while patients with good hearing continued to deteriorate. The same conditions were observed in the patients who had surgery and those who were offered surgery but declined.

Thirty-seven patients operated on by total vestibular neurectomy for Ménière's disease underwent follow-up examination for at least 5 years. Vertigo has been controlled in all the patients excepting one who developed Ménière's disease in the opposite ear. Three patients had a total hearing loss. Overall results in this study are comparable to those of other series in the literature. Vestibular neurectomy has been confirmed to be an effective procedure for relieving vertigo in intractable Ménière's disease with a success rate of 90-100% while preserving hearing in most of the patients. The results of vestibular neurectomy are far better than those obtainable with endolymphatic sac surgery.

The term very far-advanced otosclerosis is proposed to indicate otosclerotic patients with both bone and air conduction thresholds nonmeasurable on a standard clinical audiometer (blank audiogram). Three of these patients have undergone stapedotomy with satisfactory results. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients at least with implants available today. Some of the patients with a blank audiogram are better off with exploratory tympanotomy and stapedotomy.

The efficacy and tolerability of nimesulide in a new pharmaceutical suppository form were assessed in a double blind study versus flurbiprofen in pain-inflammatory pathologies of obstetrico-gynecological nature. One hundred patients with pelvic inflammatory disease were randomly assigned to treatment with nimesulide or flurbiprofen. Both drugs, administered in a dose of 2 suppositories a day for 7 days, evidenced speedy, effective analgesic and anti-inflammatory activity combined with good tolerability. Specifically, as regards the pain component, nimesulide demonstrated a significantly more marked analgesic effect than flurbiprofen in the first two hours of treatment.

The present paper describes the setting-up of a new project, sponsored by the Commission of the European Communities, to promote the study of functional histopathology of the human audio-vestibular organ. The project has the purpose of co-ordinating in Europe morphological research on the hearing and equilibrium organ and promoting the comparison of data from clinical, physiological and morphological studies in the field of hearing and equilibrium impairment. A manual (Iurato et al., 1982) has been prepared with the objectives of (1) stimulating clinicians to participate in the project, (2) encouraging the collection of audiological data for comparison with pathology, and (3) supplying clinicians with the necessary information about the technique of fixation and preparation of the specimens. The fixation procedures for the two major techniques of studying ear pathology: (1) microdissection and electron microscopy, and (2) embedding of the whole block for serial sectioning and light microscopy, are described in detail. Special paragraphs deal with the technique of fixation of the brain and with the technique of removal of the temporal bones and brain at autopsy. The instructions for delivery of the specimens and the publication rules are enclosed in the main body of the manual. Appendix 1 contains a list of the participating laboratories. Appendix 2 deals with autopsy legislation in the different European countries. Appendix 3 contains the sender's data sheet which supplies the instructions for collecting the clinical history of the patient and the audiological and vestibular data.

Cet article decrit l'organisation d'un nouveau projet, commandite par la Commission des Communautes Europeennes, concernant l'etude fonctionnelle et histopathologique de l'organe audio-vestibulaire humain. Le but de ce projet est de coordonner en Europe la recherche anatomique sur l'organe de l'audition et de l'equilibre et aussi de promouvoir la comparaison de donnees cliniques, physiologiques et morphologiques dans le domaine de la pathologie. Un manuel [Iurato, S.; Bredberg, G.; Bock, G.: Functional histopathology of the human audio-vestibular organ. European Data - Hearing Project, catalogue Nr. CD-NJ-82-003-EN-C 1982, Office of Official Publications of the European Communities, Luxembourg 1982] a ete redige dans le but de: (1) stimuler les cliniciens a participer au projet; (2) encourager la collecte de donnees audiologiques pour comparaison avec la pathologie et (3) fournir aux cliniciens les informations techniques necessaires pour la fixation et la preparation des specimens. On decrit en detail de...

This is a summary of a report which was the result of an epidemiological investigation, carried out under the sponsorship of the Commission for the European Communities (CEC) and its Committee on Medical and Public Health Research (CRM) in the nine countries of the European Community, in order to determine the prevalence of childhood deafness. The design of the study specified that all children born during the year 1969 would be included if their hearing loss averaged 50 dB or worse in the better ear. Most of the children were enumerated in 1977 when they were eight years old.The prevalence of the degree of deafness in the CEC was 0.9/1000 live births in 1969. There were more deaf children born in the winter than in the summer months. Perceptive hearing loss accounts for 92% of all the cases of deafness and Rubella was the largest single cause of the deafness where the aetiology was known. If perceptive deafness is considered as a whole, in 42% of the children no cause was reported. 29% of the children we...

The Commission of the European Communities funds a 'concerted action' programme in the area of hearing impairment. The programme does not fund research directly, but is intended to provide funds for coordination of research in different countries. Previous projects funded by the programme include a comprehensive study of the prevalence of childhood deafness in the European Community, and meetings on cochlear implants, human temporal bone histopathology, diagnostic techniques and hearing impairment in children. The programme is currently concerned with new technologies for communication in the hearing impaired and activities in 1988 will include workshops on signal processing hearing aids and early diagnosis in children.

The maculae sacculi and utriculi of the chinchilla vestibular labyrinth have been studied by freeze-fracture method. In the replicas extensive zonulae oc-cludentes have been found between sensory and supporting cells at the endolymphatic surface. Gap junctions are located between the supporting cells. Some intramem-branous specializations of the synoptic regions are described in both types of the sensory cells.

Cochlear hair cell counts from individuals who had clinically normal hearing prior to their death have been plotted for various age bands as a function of the number of hair cells per millimetre against their position in the cochlea. Position has been expressed as the distance of that observation of hair cell density from the base of the cochlea, divided by the total length of the cochlea, thereby giving a proportional representation of the cochlea in the range of 0.0 to 1.0 with 20 subdivisions of 0.05. There is an age-related decrease in the number of hair cells in the normal population, and this is more marked for the outer hair cells.

The junctional complexes in the reticular membrane of the organ of Corti have been investigated in chinchilla inner ear by the freeze-fracture method. Extremely developed zonulae occludentes were observed where the supporting cells contact each other and the sensory cells. These junctions can be considered “very tight” and completely seal off the tunnel of Corti, Nuel's space and the outer tunnel from the endolymph, as observed by investigations carried out by using tracers. The zonulae occludentes between Hensen's cells are always uninterrupted but considerably lower than among supporting and sensory cells.

A review is given of the methods employed in human temporal bone pathology, from the camera lucida drawings of the last century to the sophisticated techniques of today.

The Reissner membrane of the chinchilla inner ear was studied with the freeze-fracture method. Zonulae occludentes, composed of 2 to 8 strands, seal the intercellular space close to the endolymphatic surface. They are morphologically simialr to those seen between the marginal cells of the stri vascularis, but much less developed than those between the basal strial cells.

This paper studies the changes in speech discrimination following stapes surgery in patients with advanced otosclerosis. Two thirds of these patients showed a postoperative improvement in the discrimination score with obvious correlation with closure of bone-air gap. The results were slightly worse in comparison to those obtained on otosclerotic patients with good bone conduction. In advanced otosclerosis even a minimal impairment in bone conduction and/or an incomplete closure of the gap interfere with discrimination.

The junctional complexes in the vascular stria and spiral ligament of the chinchilla inner ear have been studied using the electron microscope with freeze-fracture technique. The intercellular spaces of the vascular stria are sealed towards the endolymph by the zonulae occludentes “intermediate to tight” of the marginal cells and towards the perilymph by the zonulae occludentes “very tight” of the basal cells. All the cells of the vascular stria and spiral ligament have their cytoplasms in direct communication, which is mediated by numerous gap junctions. The significance of the junctional complexes of the vascular stria probably is connected with the unique ionic composition of the cochlear endolymph and with the maintenance of steep solute gradients by active transport in the stria.

The junctions between the cells of the organ of Corti have been investigated with the freeze-fracture method in the chinchilla inner ear. Numerous gap junctions have been found among all the supporting cells, particularly at the level of their basal part. This means that the supporting cells have their cytoplasm electro-tonically and metabolically coupled. Gap junctions were not observed between supporting and sensory cells nor between sensory cells and nerve endings. At this level the transmission should be chemically mediated.

Two different tissues have been observed in specimens of tympanosclerotic material studied under light and electron microscopy. The first. devoid of cells and blood vessels, is a dense fibrous tissue similar to that already described in fibrous tympanosclerosis. The sec ond resembles a bone tissue, containing osteocytes and vascular channels: it is laid down by metaplasic fibro-blasts following the invasion of the first tissue by osteo-clasts and blood vessels after its calcification.

The alterations of the connective tissue components in the middle ear during tympanosclerosis have been analyzed at ultrastructural level. The final steps of this pathological condition are characterized by the disappearance of the blood vessels, cellular degeneration, hyalin degeneration, and calcification. The different features of the inorganic deposits and the cellular origin of the organic structures involved in the calcification process are described.

The structure of the bone tissue ectopically formed during tympanosclerosis has been analyzed with the aid of light and electron microscopy. Methaplasic fibroblasts appear to be involved in the deposition of calcifying matrix, while completely normal osteoclasts resorb the tissue already formed. Signs of several deposition-resorption phases are present.

A technique combining microdissection with cytocochleogram and TEM is described as a tool for studying human cochlear pathology. It is recommended in cases well studied from a clinical point of view and with a short time interval between death and fixation.

Microslices 3 mm thick from undecalcified human temporal bones were prepared with a special cutting machine and then processed for SEM and TEM in order to evaluate advantages and disadvantages of the microslicing technique for the study of the temporal bone pathology. In the examined microslices there was some mechanical distortion of the membranous labyrinth, detachment of soft tissues from bone and a considerable amount of contamination by bone dust and debris which are circulated during sectioning. For SEM the method therefore has limited value. For TEM a relatively contamination free area can be found some distance from the cutting surface of each microslice.

The relation between organ of Corti degeneration and radial nerve fibre degeneration in the osseous spiral lamina was studied in two human cochleas.

The structure of a human tympanic membrane has been studied with the electron microscope 12 months after implantation. The lamina propria of the epidermis and the connective submucosal layer were thicker in the homograft than in the normal tympanic membrane. Creeping substitution in the fibers of the outer radial and inner circular layers was not observed but cannot be excluded. The protective role of the skin of the external meatus and of the epithelial cells of the mucosal layer has been noted.