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| 2. |
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| 3. |
- Atturo, Francesca, et al.
(författare)
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Is the Human Round Window Really Round? : An Anatomic Study With Surgical Implications
- 2014
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 35:8, s. 1354-1360
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: Human round window (RW) presents anatomic variations that may influence surgical approach. Background: The true shape of the human RW has been divisive since its first description in 1772 by Antonio Scarpa. Introduction of novel surgical strategies in recent years have raised its significance. Here, the human RW size and shape variations were documented in microdissected human temporal bones. Methods: An archival collection of human microdissected temporal bones was analyzed. RW rim could be delineated and photographed from the labyrinthine aspect and its topography assessed. Results: Human RW is seldom round but ovoid or orthogonal, skewed, and nonplanar (saddlelike). Membrane is fan shaped or conical with an anteroinferior and a posterosuperior part. The mean longest diameter was 1.90 mm, and the smallest one is 1.54 mm. The mean diameter from the crista fenestra was 1.31 mm. The mean area of the RW was 2.08 mm(2), which varied between 0.99 and 3.20 mm(2). The crista fenestrae of the anterior component form a "doorstep" that may limit the entry to the scala tympani from the RW niche. Conclusion: The alternate anatomic features of the human RW may influence its surgical access and designs of implants aimed at targeting this region.
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| 4. |
- Atturo, Francesca, et al.
(författare)
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The Human Cochlear Aqueduct and Accessory Canals : a Micro-CT Analysis Using a 3D Reconstruction Paradigm
- 2018
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 39:6, s. e429-e435
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We sought to study the anatomic variations of the cochlear aqueduct and its accessory canals in human temporal bones using micro-CT and a 3D reconstruction paradigm. More knowledge about the anatomic variations of these structures, particularly at the basal turn of the cochlea and round window niche, may be important to better preserve residual hearing as well as the neural supply during cochlear implant surgery.Methods: An archival collection of 30 human temporal bones underwent micro-CT and 3D reconstruction. A surface enhancement paradigm was applied. The application displays reconstructed slices as a 3D object with realistic 3D visualization of scanned objects. Virtual sectioning or cropping of the petrous bone presented subsequent areas. Thereby, the bony canals could be followed from inside the basal turn of cochlea and middle ear to the jugular foramen.Results: The cochlear aqueduct was always paralleled by an accessory canal containing the inferior cochlear vein. It ran from the basal turn of the cochlea and exited laterally in the jugular foramen. In 70% of the cases, a secondary accessory canal was observed and it derived mostly from a depression or infundibulum located in the floor of the round window niche. This canal also exited in the jugular foramen. The secondary accessory canal occasionally anastomosed with the primary accessory canal suggesting that it contains a vein that drains middle ear blood to the cranial sinus.Conclusion: Micro-CT with 3D surface reconstruction paradigm offers new possibilities to study the topographic anatomy of minor details in the human inner ear. The technique creates simulated transparent castings of the labyrinth with a coinciding surface view through enhancement of contrast between boundaries. Accessory canals that drain blood from the cochlea, spiral ganglion, and middle ear could be characterized three-dimensionally.
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| 5. |
- Axelsson, Sara, et al.
(författare)
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Prednisolone in Bell's Palsy Related to Treatment Start and Age
- 2011
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 32:1, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate if treatment start and age are related to the outcome in Bell's palsy patients treated with prednisolone. Study Design: Prospective, randomized, double-blind, placebo-controlled, multicenter trial. Setting: Sixteen otorhinolaryngologic centers in Sweden and 1 in Finland. Patients: Data were collected from the Scandinavian Bell's palsy study. A total of 829 patients were treated within 72 hours of onset of palsy. Follow-up was 12 months. Intervention: Patients were randomly assigned to treatment with placebo plus placebo (n = 206), prednisolone plus placebo (n = 210), valacyclovir plus placebo (n = 207), or prednisolone plus valacyclovir (n = 206). Main Outcome Measures: Facial function was assessed with the Sunnybrook grading system, and complete recovery was defined as Sunnybrook = 100. Time from onset of palsy to treatment start was registered. Results: Patients treated with prednisolone within 24 hours and 25 to 48 hours had significantly higher complete recovery rates, 66% (103/156) and 76% (128/168), than patients given no prednisolone, 51% (77/152) and 58% (102/177) (p = 0.008 and p = 0.0003, respectively). For patients treated within 49 to 72 hours of palsy onset, there were no significant differences. Patients aged 40 years or older had significantly higher complete recovery rates if treated with prednisolone, whereas patients aged younger than 40 years did not differ with respect to prednisolone treatment. However, synkinesis was significantly less in patients younger than 40 years given prednisolone (p = 0.002). Conclusion: Treatment with prednisolone within 48 hours of onset of palsy resulted in significantly higher complete recovery rates and less synkinesis compared with no prednisolone.
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| 6. |
- Berg, Thomas, et al.
(författare)
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Agreement between the Sunnybrook, House-Brackmann, and Yanagihara facial nerve grading systems in Bell´s Palsy
- 2004
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 25:6, s. 1020-1026
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the agreement between the Sunnybrook facial nerve grading system and the House-Brackmann and Yanagihara systems. STUDY DESIGN: Prospective clinical facial nerve grading. SETTING: Tertiary referral center. PATIENTS: One-hundred assessments, 94 in patients with Bell's palsy and 6 with herpes zoster. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Evaluation according to the weighted regional Sunnybrook system, the gross House-Brackmann system, and the unweighted regional Yanagihara system. Weighted kappa statistics was used to measure agreement between the grading systems. RESULTS: The average weighted kappa value between the Sunny-brook, House-Brackmann, and Yanagihara grading systems was 0.65; kappa values increased temporally (but not statistically significantly) up to day 180. The highest agreement value, 0.72, was found between the Sunnybrook and Yanagihara grading systems. The weighted kappa value between the Sunnybrook and House-Brackmann systems was 0.59. In Sunnybrook gradings less than 63, there was an overlap between House-Brackmann scores of III to VI. Reliable conversion tables between the gross House-Brackmann system and the regional Sunnybrook and Yanagihara systems could not be established. CONCLUSION: The Sunnybrook system scores at the same agreement level as the House-Brackmann and Yanagihara grading systems. There is an evaluative difference between the weighted regional Sunnybrook and the gross House-Brackmann systems. Substantial agreement was found between the regional Sunnybrook and Yanagihara scales. Sunnybrook grading is easy and quick. By adding objective measurements and additional secondary defects, the Sunnybrook system can be an alternative to the other predominating grading systems.
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| 7. |
- Berg, Thomas, et al.
(författare)
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The Course of Pain in Bell's Palsy : Treatment With Prednisolone and Valacyclovir
- 2009
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:6, s. 842-846
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effect of prednisolone and valacyclovir on ipsilateral pain around the ear and in the face or neck in Bell's palsy. The incidence and intensity of pain during the first 2 months of palsy and its prognostic value were also assessed. Study Design: Prospective, randomized, double-blind, placebo-controlled, multicenter trial. Setting: Sixteen tertiary referral centers in Sweden and 1 in Finland. Patients: Data are part of the Scandinavian Bell's palsy study; 829 patients aged 18 to 75 years with onset of palsy within 72 hours were included. Follow-up time was 12 months. Intervention: Patients were assigned to 1 of 4 treatment arms in a factorial fashion: placebo plus placebo; prednisolone 60 mg daily for 5 days, then tapering for 5 days, plus placebo; valacyclovir 1,000 mg 3 times daily for 7 days plus placebo; or prednisolone plus valacyclovir. Main Outcome Measures: Pain was registered on a visual analog scale within 72 hours, at Days 11 to 17, 1 month, and 2 months. Facial function was assessed with the Sunnybrook and House-Brackmann systems. Results: Prednisolone and/or valacyclovir did not significantly affect the incidence or intensity of pain during the first 2 months. Pain was registered in 542 (65%) of 829 patients. At 2 months, 53 (8%) of 637 patients still reported pain. Subjects with pain at Days 11 to 17 had lower facial recovery rates at 12 months than those with no pain (p < 0.0001). Conclusion: Prednisolone and/or valacyclovir did not affect the incidence or intensity of ipsilateral pain in Bell's palsy. The incidence of pain was similar during the first 2 weeks and then decreased. Presence of pain at Days 11 to 17 indicated a worse prognosis for facial recovery.
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| 8. |
- Bergius, Elin, et al.
(författare)
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Benefit of Higher Maximum Force Output in Bone Anchored Hearing Systems: A Crossover Study.
- 2021
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - 1537-4505. ; 42:10, s. 1451-1459
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Tidskriftsartikel (refereegranskat)abstract
- To investigate how higher maximum force output (MFO) in bone anchored hearing systems (BAHS) affects perceived benefit and the subjective experience of sound as well as hearing outcomes in subjects with mixed hearing loss.Prospective single-center, randomized crossover design (A-B-A) with within-subject control design.The study included 19 experienced BAHS users with mixed hearing loss in the fitting range of a standard BAHS.The study evaluated two sound processors with differing MFOs and sizes-Device A: standard sound processor with a lower MFO and Device B: superpower sound processor with a higher MFO.Speech recognition in noise at different signal to noise ratios, aided thresholds, and questionnaires.Speech recognition test showed significant improvements using Device B compared with Device A at both 78dB SPL (mean difference: 9%) and 75dB SPL (mean difference: 12%) (p<0.05). Moreover, speech, spatial and qualities of hearing scale (SSQ12-C) showed a significantly greater perceived benefit with Device B concerning spatial abilities (mean: 0.5-0.6) (p<0.05). At the conclusion of the study, 58% of participants chose to keep Device A for further use. The main reasons for this were the size of the sound processor and a more comfortable sound experience.A BAHS sound processor with a higher MFO leads to improved speech-in-noise performance in loud/noisy listening situations and is perceived as significantly better to process spatial information in daily listening situations. However, the relation between cosmetics and performance is not straightforward, and several factors seem to affect the selection process of BAHS.
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| 9. |
- Berglin, Cecilia Engmér, et al.
(författare)
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Magnetic Resonance Imaging of the Middle and Inner Ear After Intratympanic Injection of a Gadolinium-Containing Gel
- 2014
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 35:3, s. 526-532
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To investigate the distribution and elimination of a gadolinium containing high viscosity formulation of sodium hyaluronan (HYA gel) after injection to the middle ear.MATERIALS AND METHODS:The T1 contrast agent gadolinium-diethylenetriamine pentaacetic acid-bis methylamine (Gd-DTPA-BMA) was added to HYA gel and delivered to the middle ear of 13 albino guinea pigs by 3 different ways of injection. Magnetic resonance imaging was performed with a 4.7 T MRI system using a T1-weighted 3-dimentional rapid acquisition with relaxation enhancement sequence.RESULTS:An injection technique where the Gd-DTPA-BMA-containing HYA gel was delivered to the middle ear through a percutaneous injection through the auditory bulla after a small incision had been made in the tympanic membrane gave the best filling of the middle ear, covering the cochlea and the region of the round window niche for 24 hours in a majority of the ears studied. Ears injected without an incision in the tympanic membrane showed an immediate uptake of Gd-DTPA-BMA in the inner ear as a sign of rupture of the round window membrane.CONCLUSION:A percutaneous injection of a HYA gel into the tympanic bulla is distributed in a predictable way and gives a good filling of the middle ear cavity. The HYA gel remains in close vicinity to the RWM for more than 24 hours. Injection should be performed after an incision of the tympanic membrane has been made to prevent rupture of the round window membrane.
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| 10. |
- Berling Holm, Katarina, et al.
(författare)
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Surgery for chronic otitis media causes greater taste disturbance than surgery for otosclerosis
- 2019
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 40:1, s. e32-e39
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Patients with otosclerosis more often complain about postoperative taste disturbance than patients with chronic otitis media, which seems paradoxical. We aim to investigate if and potentially why this seems to be the case, since the chorda tympani nerve (CTN) is thought to be severely traumatized less frequently during surgery in the former than in the latter.Study Design: Prospective cohort study.Setting: Department of Otorhinolaryngology at Hospital of Vastmanland, Vasteras, Sweden.Patients: Sixty-five adults undergoing primary middle ear surgery were included. Thirty-seven were operated on for chronic suppurative otitis media with or without cholesteatoma (CSOM) and 28 for otosclerosis.Interventions: Middle ear surgery due to otosclerosis or CSOM. Subjective and objective taste measurements and quality of life (QoL) questionnaire.Main Outcome Measures: Taste was assessed using electrogustometry (EGM) and the filter paper disc (FPD) method before and up to 1 year after surgery. Questionnaires on taste disturbance, including a visual analogue scale (VAS), and QoL were completed before and up to 1 year after surgery.Results: Subjective taste disturbance anytime during the 1-year follow-up were reported by 62 and 46%, respectively. The difference in EGM 1 week after surgery compared with preoperative EGM was significantly greater among CSOM patients than otosclerosis. One year postoperatively, the difference is non-significant.Conclusion: Surgery for CSOM causes greater initial and more long-lasting taste disturbances as compared with surgery for otosclerosis. One-year postoperative taste normalizes for both CSOM and otosclerosis patients according to VAS and EGM measurements. No real change in QoL was seen 1-year postoperatively.
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| 11. |
- Boisvert, Isabelle, et al.
(författare)
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Choice of Ear for Cochlear Implantation in Adults With Monaural Sound-Deprivation and Unilateral Hearing Aid
- 2012
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Ingår i: Otology and Neurotology. - : Lippincott, Williams and Wilkins. - 1531-7129 .- 1537-4505. ; 33:4, s. 572-579
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To identify whether speech recognition outcomes are influenced by the choice of ear for cochlear implantation in adults with bilateral hearing loss who use a hearing aid in 1 ear but have long-term auditory deprivation in the other. less thanbrgreater than less thanbrgreater thanStudy Design: Retrospective matched cohort study. Speech recognition results were examined in 30 adults with monaural sound deprivation. Fifteen received the implant in the sound-deprived ear and 15 in the aided ear. less thanbrgreater than less thanbrgreater thanSetting: Tertiary referral centers with active cochlear implant programs. less thanbrgreater than less thanbrgreater thanPatients: Adults with bilateral hearing loss and a minimum of 15 years of monaural sound deprivation who received a cochlear implant after meeting the traditional implantation criteria of the referral centers. less thanbrgreater than less thanbrgreater thanIntervention: Cochlear implantation with devices approved by the U.S. Food and Drug Administration. less thanbrgreater than less thanbrgreater thanMain Outcome Measure(s): Paired comparisons of postoperative monosyllabic word recognition scores obtained with the implant alone and in the usual listening condition (CI alone or bimodal). less thanbrgreater than less thanbrgreater thanResults: With the cochlear implant alone, individuals who received the implant in a sound-deprived ear obtained poorer scores than individuals who received the implant in the aided ear. There was no significant difference, however, in speech recognition results for the 2 groups when tested in their usual listening condition. In particular, poorer speech recognition scores were obtained with the cochlear implant alone by individuals using bimodal hearing. less thanbrgreater than less thanbrgreater thanConclusion: Similar clinical outcomes of cochlear implantation can be achieved by adults with a long-term monaural sound deprivation when comparing the usual listening condition, irrespective of whether the implant is in the sound-deprived or in the aided ear.
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| 12. |
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| 13. |
- Boström, Marja, et al.
(författare)
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Neural network and "Ganglion" formations in vitro : a video microscopy and scanning electron microscopy study on adult cultured spiral ganglion cells.
- 2007
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 28:8, s. 1109-1119
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: To analyze if adult-dissociated spiral ganglion cells may be propagated in vitro for later use in transplantation models to form integrated neural networks. Background: Hearing loss is often associated with primary or secondary spiral ganglion cell degeneration. New strategies for cell repair and tissue engineering warrants further elucidation of the regenerative capacity of the auditory nerve. Methods: We used in vitro/in video microscopy in combination with immunocytochemistry and field emission scanning electron microscopy to analyze neural development and network formation from dissociated adult guinea pig spiral ganglion cells. Cells were cultured in serum-free medium and in the presence of brain-derived neurotrophic factor, neurotrophin 3, and glia cell line-derived neurotrophic factor for up to 8 weeks. Results: Time-lapse video microscopy and scanning electron microscopy exposed the propagation of auditory neurons and the role of neural growth cones in axon locomotion, fasciculation, and nuclear migration, often ensuing in cell congregation (ganglion-like formations) during network formation. Axons were sometimes ensheathed by adjoining S-100/glia fibrillary acidic protein-expressing cells. A few expanding neurons were nestin positive and sometimes incorporated the markers of proliferating cells Ki67 and 5'-bromo-2-deoxyuridine. Neurons expressed the markers and transcription factors for neural development neurogenin 1, neurogenic differentiation factor 1, Brn3a, and GATA binding protein 3, as well as the neural markers beta-III tubulin, NeuN, and neurofilament 160 during this process. Conclusion: This method of culturing and expanding spiral ganglion neurons in vitro may be useful in further studies of cell transplantation models aiming to restore the injured inner ear.
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| 14. |
- Calon, T. G. A., et al.
(författare)
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Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial
- 2018
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 39:7, s. 882-893
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To compare the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with those of the linear incision technique with soft-tissue preservation for bone-anchored hearing systems (BAHS).Design:Sponsor-initiated multicenter, open, randomized, controlled clinical trial.Setting:Maastricht University Medical Centre, Ziekenhuisgroep Twente and Medisch Centrum Leeuwarden, all situated in The Netherlands.Participants:Sixty-four adult patients eligible for unilateral BAHS surgery.Interventions Single-stage BAHS surgery with 1:1 randomization to the linear incision technique with soft-tissue preservation (control) or the MIPS (test) group.Primary and Secondary Outcome Measurements:Primary objective: compare the incidence of inflammation (Holgers Index 2) during 12 weeks' follow-up after surgery. Secondary objectives: skin dehiscence, pain scores, loss of sensibility around the implant, soft-tissue overgrowth, skin sagging, implant extrusion, cosmetic results, surgical time, wound healing and Implant Stability Quotient measurements.Results:Sixty-three subjects were analyzed in the intention-to-treat population. No significant difference was found for the incidence of inflammation between groups. Loss of skin sensibility, cosmetic outcomes, skin sagging, and surgical time were significantly better in the test group. No statistically significant differences were found for dehiscence, pain, and soft-tissue overgrowth. A nonsignificant difference in extrusion was found for the test group. The Implant Stability Quotient was statistically influenced by the surgical technique, abutment length, and time.Conclusion:No significant differences between the MIPS and the linear incision techniques were observed regarding skin inflammation. MIPS results in a statistically significant reduction in the loss of skin sensibility, less skin sagging, improved cosmetic results, and reduced surgical time. Although nonsignificant, the implant extrusion rate warrants further research.
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| 15. |
- Counter, S. Allen, et al.
(författare)
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Ultra-high-field (9.4 T) MRI Analysis of Contrast Agent Transport Across the Blood-Perilymph Barrier and Intrastrial Fluid-Blood Barrier in the Mouse Inner Ear
- 2017
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 38:7, s. 1052-1059
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: Effective paramagnetic contrast agent for the penetration of the perilymphatic spaces of the scala tympani, scala vestibuli, and scala media of the mouse inner ear can be determined using intravenous injection of various gadolinium (Gd) complexes and ultra-high-field magnetic resonance imaging (MRI) at 9.4 Tesla.Background: A number of contrast agents have been explored in experimental high-field MRI to determine the most effective Gd complex for ideal signal-to-noise ratio and maximal visualization of the in vivo mammalian inner ear in analyzing the temporal and spatial parameters involved in drug penetration of the blood-perilymph barrier and intrastrial fluid-blood barrier in the mouse model using MRI.Methods: Gadoteric acid (Dotarem), Gadobutrol (Gadovist), Gadodiamide (Omniscan), Gadopent acid (Magnevist), and Mangafodipir (Teslascan) were administered intravenously using the tail vein of 60 Balb/C mice. High-resolution T1 images of drug penetration were acquired with a horizontal 9.4 T Agilent magnet after intravenously injection. Signal intensity was used as a metric of temporal and spatial parameters of drug delivery and penetration of the perilymphatic and endolymphatic spaces.Results: ANOVA analysis of the area under the curve of intensity enhancement in perilymph revealed a significant difference (p < 0.05) in the scalae uptake using different contrast agents (F (3,25) = 3.54, p = 0.029). The Gadoteric acid complex Dotarem was found to be the most effective Gd compound in terms of rapid, morphological enhancement for analysis of the temporal, and spatial distribution in the perilymphatic space of the inner ear.Conclusion: Gadoteric acid (Dotarem) demonstrated efficacy as a contrast agent for enhanced visualization of the perilymphatic spaces of the inner ear labyrinthine in the mouse, including the scala tympani and scala vestibuli of the cochlea, and the semicircular canals of the vestibular apparatus. These findings may inform the clinical application of Gd compounds in patients with inner ear fluid disorders and vertigo.
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| 16. |
- Eeg-Olofsson, Måns, 1967, et al.
(författare)
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Implications for contralateral bone-conducted transmission as measured by cochlear vibrations.
- 2011
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - : LWW. - 1537-4505 .- 1531-7129. ; 32:2, s. 192-8
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Tidskriftsartikel (refereegranskat)abstract
- The velocity response at the contralateral cochlea from bone-conducted (BC) stimulation depends on the stimulation position.
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| 17. |
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| 18. |
- Enghag, Sara, et al.
(författare)
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Incus Necrosis and Blood Supply : A Micro-CT and Synchrotron Imaging Study
- 2019
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 40:7, s. E713-E722
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incus necrosis is a common complication following stapes surgery and is associated with impaired microcirculation. The objective of this study was to investigate the vascular anatomy of the human incus by using light microscopy, micro-computed tomography (micro-CT), and synchrotron phase-contrast imaging (SR-PCI) for a novel three-dimensional (3D) analysis of the middle ear, mucosal folds, major vascular pathways, and intraosseous vascular bone channels. Methods: One-hundred-and-fifty temporal bones from the Uppsala collection were analyzed under light microscopy. Twenty temporal bones underwent high-resolution micro-CT scanning, and an additional seven specimens underwent SR-PCI at the Canadian Lightsource in Saskatoon, Canada. One of these specimens was from an individual who had undergone stapes surgery. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping for bone transparency, cropping, and soft tissue analyses. Results: Micro-CT and SR-PCI with 3D rendering revealed the extensive vascular plexus within the un-decalcified incus bone communicating with the exterior surface. The relationship between the vessels, lenticular process, and incudostape-dial joint were clearly observed. SR-PCI allowed for histologic-level detail while preserving the specimen and its 3D relationships. Conclusion: SR-PCI with 3D reconstructions confirmed the main vascular supply to the lenticular process along the intraosseous lenticular vessels. This is the first synchrotron analysis of a patient having undergone stapes surgery, and it suggests that incus necrosis associated with stapes surgery may be caused by a disruption of the lenticular blood flow induced by the prosthesis loop, and not by strangulation of mucosal vessels as has been previously described.
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| 19. |
- Erixon, Elsa, et al.
(författare)
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Variational anatomy of the human cochlea : implications for cochlear implantation
- 2009
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:1, s. 14-22
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: To study variations in human cochlea anatomy with potential implications for cochlear implantation surgery. BACKGROUND: A comprehension of the anatomic variations of the human cochlea is essential for understanding the degree of surgical trauma induced by inserting various electrode arrays in cochlear implantation surgery. Variations in anatomy may also limit the potential for performing hearing preservation. METHODS: We studied 73 archival, nonselected, adult, corrosion casts of human inner ears. Anatomic reference points were constructed from photographic reproductions taken at different angles, and various dimensions were assessed using planimetry. Anatomic variants with particular clinical/surgical interests were pinpointed. RESULTS: Results showed that the human cochlea is individually shaped, varying greatly in dimensions ("fingerprint"). The outer cochlear wall length ranged from 38.6 to 45.6 mm with a mean length of 42.0 mm. The first turn represented 53% of the total length and ranged from 20.3 to 24.3 mm. The number of quadrants varied from slightly more than 8 to 12. The facial nerve canal ran in close proximity to the upper first turn explaining facial nerve excitement during stimulation of electrodes in this region in some instances. The internal diameter (height) of the cochlear tube in the first turn varied broadly (1.6-2.6 mm), occasionally with limited space for conventional implants. CONCLUSION: The human cochlea exhibits extensive anatomic variations. These variations will influence the location of cochlear implant arrays and affect the potential of hearing preservation surgery. Our results may explain the surgeon's difficulties sometimes to insert electrode arrays even in so-called "normal" cochleae.
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| 20. |
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| 21. |
- Fogels, Jonas, et al.
(författare)
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Single-Sided Deafness-Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial
- 2020
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 41:6, s. 736-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective:A comparison of three interventions for profound unilateral sensorineural hearing loss.Study Design:Prospective, crossover randomized clinical trial.Participants:Fifteen participants with profound unilateral sensorineural hearing loss.Interventions:Three potential technical interventions were compared: Bone Conduction Device on softband, Contralateral Routing of Signal (CROS), and Remote Microphone . Each intervention was randomly trialed for a period of 3 weeks, separated by a 1 week washout period.Outcome Measures:Speech in noise recognition test performed under four conditions (lateral noise poorer ear, lateral noise better ear, speech poorer ear, speech better ear). Standardized questionnaires (Abbreviated Profile of Hearing Aid Benefit, Bern Benefit in Single Sided Deafness Questionnaire, and Speech, Spatial, and Other Qualities 12) were used to evaluate amplification benefit at baseline and following each intervention.Results:The use of remote microphone provided the best results in the speech recognition in noise test. A benefit in some signal-to-noise ratios was presented of the CROS over bone conduction device on softband in the Speech Poor Ear condition. On questionnaires of benefit, participants did not rate a particular intervention as significantly better than any other. Following the study, CROS was the intervention preferred by the 8 of 15 participants (53%). The majority of participants (80%) chose to continue with an intervention rather than no treatment.Conclusion:The use of all interventions resulted in increased performance in speech recognition in noise and rated higher on subjective benefits in comparison with baseline. People with SSD are a heterogeneous population when considering perceived difficulties. Future research should focus on segmenting the population of SSD depending on factors such as etiology, high frequency loss in the better ear, and age of acquired loss for the poorer ear. This stratification may possibly increase the benefit for the patient in terms of more individual-based clinical routines.
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| 22. |
- Frodlund, Jonas, et al.
(författare)
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Vestibular Function After Cochlear Implantation: A Comparison of Three Types of Electrodes
- 2016
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 37:10, s. 1535-1540
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the vestibular function after cochlear implantation with different types of electrode arrays. Study Design: Retrospective cohort study. Setting: Academic tertiary referral center. Materials and Methods: Forty three adults underwent first cochlear implantation. Three consecutive series of patients: Group 1 (n = 13) implanted with a precurved electrode, Group 2 (n = 15) implanted with a straight electrode, Group 3 (n = 15) implanted with a flexible electrode. Patients vestibular functions were assessed with pre-and postoperative caloric testing using videonystagmography (VNG). The postoperative reduction of the maximum slow phase velocity (MSPV) in the implanted ear was evaluated. Medical charts were reviewed to evaluate the occurrence of late onset of postoperative vestibular symptoms. Results: Mean reduction of MSPV was 7.6/s (standard deviation [SD] 8.0) in Group 1, 23.1/s (SD 16.6) in Group 2, and 0.1/s (SD 18.5) in Group 3. Significant difference was found between Group 1 and 2 (p amp;lt; 0.030) and between Group 2 and 3 (p amp;lt; 0.001). Group 2 showed a higher prevalence of late onset of clinical vertigo (28.6%) than Group 1 (7.7%) and 3 (6.7%). Conclusion: In this prospective study, significantly larger reductions of caloric responses were found in subjects implanted with a straight electrode compared with subjects implanted with a precurved or flexible electrode. These findings seem to correlate to a higher prevalence of postoperative vertigo.
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| 23. |
- Frykholm, Carina, et al.
(författare)
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Familial Meniere's disease in five generations
- 2006
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Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 27:5, s. 681-686
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Clinical characterization of a Swedish family followed for five generations. Several members of each generation had Meniere's disease (MD). Possible modes of genetic transmission were assessed. Study Design: Retrospective family survey. Setting: University hospital. Tertiary referral center. Patients: Members of a large family in which several members in each generation were affected by MD. Interventions: Hearing levels were assessed, and the patients were asked to complete a questionnaire regarding age at onset, hearing loss, tinnitus, aural fullness, vertigo, and if MD was unilateral or bilateral. Glycerol tests were performed in a few cases. For deceased relatives, information was obtained from patient charts and interviews with relatives. Genetic studies with linkage analysis was performed for the loci DFNA 1, DFNA6/14, DFNA9, and DFNA 15. Results: One member of Generation I and, according to patient charts, two members of Generation 11 could have suffered from MD. In Generations III to V, 9 of 25 members developed inner ear dysfunction. Six of these individuals developed MD that was strictly in accordance with American Academy of Otolaryngology and Head and Neck Surgery, 1995 guidelines criteria, whereas three individuals had unilateral or bilateral hearing impairment, one in combination with benign paroxysmal positioning vertigo, which could represent an incomplete expression of the disease. ne mean age at disease onset was 64.5 years in Generation 111, 43 years in Generation W, and 25 years in Generation V. In the genetic studies, none of the regions investigated showed linkage to the disease gene with a significant calculated log of odds ratio (LOD) score above three. Conclusion: The pattern of inheritance suggested that familial MD was autosomal dominant and exhibited incomplete expression of inner ear symptoms in some affected members. The decreasing age at onset of disease with succeeding generations could indicate anticipation. None of the hitherto-known DFNA loci, which has phenotypes hearing some resemblance to MD, had haplotypes in common with this large family affected by MD.
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| 24. |
- Giese, Dina, et al.
(författare)
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Carotid Artery Compression Caused by the Cochlea
- 2015
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 36:7, s. 1275-1278
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis We investigated the possible interference between the human internal carotid artery and the cochlea. Background The cochlea and the internal carotid artery (ICA) are anatomically closely related in the human temporal bone. The intimacy may even result in functional interferences. Methods Here, we analyzed 324 human plastic inner ear corrosion casts including the ICA canal and jugular bulb. Results Results showed that in 23% (14 cases), the cochlea caused physical impression in the carotid canal (CA) with luminal restriction. In one case, there was no separation between the CC and the basal turn of the cochlea. The distance between the CC and the cochlea varied between 0 and 1 mm among these 14 specimens. The lumen restriction of the CC in the pyramid-axial projection varied between 39% and 79%. Conclusion We speculate that the reduction in ICA canal lumen size caused by the cochlea may form a predilection site for intratemporal ICA plaque formation and therefore be clinically relevant.
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| 25. |
- Gladine, Kilian, et al.
(författare)
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Evaluation of Artificial Fixation of the Incus and Malleus With Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) in a Temporal Bone Model
- 2020
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Background: A significant number of adults suffer from conductive hearing loss due to chronic otitis media, otosclerosis, or other pathologies. An objective measurement of ossicular mobility is needed to avoid unnecessarily invasive middle ear surgery and to improve hearing outcomes.Methods: Minimally invasive intraoperative laser vibrometry provides a method that is compatible with middle ear surgery, where the tympanic membrane is elevated. The ossicles were driven by a floating mass transducer and their mobility was measured using a laser Doppler vibrometer. Utilising this method, we assessed both the absolute velocities of the umbo and incus long process as well as the incus-to-umbo velocity ratio during artificial fixation of the incus alone or incus and malleus together.Results: The reduction of absolute velocities was 8 dB greater at the umbo and 17 dB at the incus long process for incus-malleus fixations when compared with incus fixation alone. Incus fixation alone resulted in no change to the incus-to-umbo velocity ratio where incus-malleus fixations reduced this ratio (-11 dB). The change in incus velocity was shown to be the most suitable parameter to distinguish between incus fixation and incus-malleus fixation. When the whole frequency range was analyzed, one could also differentiate these two fixations from previously published stapes fixation, where the higher frequencies were less affected.Conclusion: Minimally invasive intraoperative laser vibrometry provides a promising objective analysis of ossicular mobility that would be useful intraoperatively.
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| 26. |
- Gottlow, Jan, 1951, et al.
(författare)
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An experimental evaluation of a new craniofacial implant using the rabbit tibia model: part I. Histologic findings.
- 2010
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - 1537-4505. ; 31:5, s. 832-9
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: This experimental study was undertaken to test the hypothesis that a new design of craniofacial implant shows a stronger tissue response than the currently used implant. MATERIALS AND METHODS: A total of 60 newly designed Cochlear Baha BI300 titanium implants (test) and 60 of the current design (control) were placed in the tibiae of 30 adult loop-eared rabbits. The new implant had the surface modified by blasting with TiO2 particles to give a moderately rough surface topography. The control implant had an as-machined surface. The animals were euthanized after 5, 14, or 28 days. The implants with surrounding bone tissue were retrieved for descriptive histology and morphometric measurements of bone-implant contacts (BICs). RESULTS: The test implants showed integration through bone formation direct on the surface and ingrowth from the vicinity. Conversely, the control implants showed increased BICs because of ingrowth of bone from the adjacent bone surfaces only. The test implant showed significantly more BICs at all time points. CONCLUSION: It is concluded that the new craniofacial implant with a moderately rough surface showed integration through a contact-osteogenesis pathway, whereas the smoother control surface was integrated by distance osteogenesis. More bone contacts were seen for test implants and, thus, a stronger bone tissue response compared with control implants. Biomechanical tests are needed to also evaluate the impact of the different histologic responses on implant stability.
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| 27. |
- Granström, Gösta, 1950, et al.
(författare)
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Imaging of osseointegrated implants in the temporal bone by accuitomo 3-dimensional cone beam computed tomography.
- 2011
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - 1537-4505. ; 32:2, s. 199-203
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Tidskriftsartikel (refereegranskat)abstract
- Follow-ups of osseointegrated implants in the temporal bone have been limited to clinical stability and resonance frequency measurements. Standard computed tomographic scanning is restricted because of the high radiation doses to the brain and the presence of disturbing metal artifacts. The present study was undertaken to evaluate the use of cone beam computed tomography preoperatively and postoperatively.
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| 28. |
- Gunther, Mattias, et al.
(författare)
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Surgical Treatment of Patients With Facial Neuromas : A Report of 26 Consecutive Operations
- 2010
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 31:9, s. 1493-1497
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze surgical treatment and outcome in patients with facial neuromas at a tertiary referral hospital. Study Design: A chart review of 26 patients treated between 1971 and 2006, with questionnaire follow-up ranging from 2 to 19 years. All patients except one were operated with radical tumor removal approaches. Results: Approximately 54% of the patients presented with symptoms related to the VIIth cranial nerve (facial palsy and facial spasm), 58% with symptoms related to the VIIIth cranial nerve (hearing deficit, tinnitus, and vertigo), and 8% related to the Vth cranial nerve (facial pain and facial sensory deficit). Approximately 39% presented with no facial symptoms. Twenty-one patients received a facial nerve graft from the greater auricular nerve or the sural nerve; 1 patient had an accessory-facial anastomosis. One patient had a subtotal tumor removal preserving the facial nerve. Three patients were not grafted. Most tumors (88%) affect the geniculate ganglion. Approximately 82% of the grafted patients regained a House-Brackmann facial nerve function (HB) grade III; 14% regained HB grades IV to V. No serious morbidity or mortality was reported. No recurrences have been reported where a total tumor removal was performed. Conclusion: Surgical removal of facial neuroma is a safe procedure with a low complication rate and a low recurrence rate. First symptoms are diverse and are predominantly derived from the facial and vestibulocochlear nerve. Facial nerve grafting is reliable, giving the patient an acceptable facial nerve function (HB III).
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| 29. |
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| 30. |
- Hellström, Sten, et al.
(författare)
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Tympanic membrane vessel revisited : a study in an animal model
- 2003
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 24:3, s. 494-499
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: The present study aimed at elucidating whether there are blood vessels in the semitransparent portion of the tympanic membrane. BACKGROUND: The normal semitransparent portions of pars tensa show strikingly few, small-caliber vessels under the otomicroscope. The major portion of a pars tensa seems to be devoid of blood vessels. In inflammatory conditions of the middle ear, the vascular pattern of the tympanic membrane is dramatically altered, and blood vessels traversing the pars tensa can be discernable. METHODS: The study was performed in rats with healthy tympanic membranes and in tympanic membranes obtained from animals with purulent otitis media evoked by inoculation of Str. pneumoniae. The tympanic membrane vessels were dilated by injection of adenosin, and directly afterwards the animal was perfused with china ink. Vessels were also revealed by immunohistochemistry with antibodies for Thy-1 and the von Willebrand factor as well as by detection of carbon particles at an ultrastructural level. RESULTS: Adenosin caused a marked dilation of the mallear and annular vessels. However, no preexisting vasculature was revealed in the normally transparent portions of the pars tensa except single vessels in the posterior quadrant and in the lower quadrants. In Str. pneumoniae-induced acute otitis media, the tympanic membrane thickened, bulged, and discolored. Even then, at 12 hours after inoculation, no vessels could be distinguished in the normally transparent portions of the tympanic membrane. However, at 4 and 7 days of acute purulent otitis media, vessels developed in those areas, most probably through ingrowth of newly formed vessels. CONCLUSION: The results support the view that the semitransparent portions of the pars tensa lack vascularity. In inflammation, new vessels are formed in pars tensa to meet the demand for an increased blood supply.
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| 31. |
- Helpard, Luke, et al.
(författare)
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Three-Dimensional Modeling and Measurement of the Human Cochlear Hook Region : Considerations for Tonotopic Mapping
- 2021
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:6, s. E658-E665
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: Measuring the length of the basilar membrane (BM) in the cochlear hook region will result in improved accuracy of cochlear duct length (CDL) measurements.Background: Cochlear implant pitch mapping is generally performed in a patient independent approach, which has been shown to result in place-pitch mismatches. In order to customize cochlear implant pitch maps, accurate CDL measurements must be obtained. CDL measurements generally begin at the center of the round window (RW) and ignore the basal-most portion of the BM in the hook region. Measuring the size and morphology of the BM in the hook region can improve CDL measurements and our understanding of cochlear tonotopy.Methods: Ten cadaveric human cochleae underwent synchrotron radiation phase-contrast imaging. The length of the BM through the hook region and CDL were measured. Two different CDL measurements were obtained for each sample, with starting points at the center of the RW (CDLRW) and the basal-most tip of the BM (CDLHR). Regression analysis was performed to relate CDLRW to CDLHR. A three-dimensional polynomial model was determined to describe the average BM hook region morphology.Results: The mean CDLRW value was 33.03 ± 1.62 mm, and the mean CDLHR value was 34.68 ± 1.72 mm. The following relationship was determined between CDLRW and CDLHR: CDLHR = 1.06(CDLRW)-0.26 (R2 = 0.99).Conclusion: The length and morphology of the hook region was determined. Current measurements underestimate CDL in the hook region and can be corrected using the results herein.
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| 32. |
- Hendrickx, Jan-Jaap, et al.
(författare)
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Familial aggregation of pure tone hearing thresholds in an aging European population
- 2013
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 34:5, s. 838-844
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the familial correlations and intraclass correlation of age-related hearing impairment (ARHI) in specific frequencies. In addition, heritability estimates were calculated.STUDY DESIGN: Multicenter survey in 8 European centers.SUBJECTS: One hundred ninety-eight families consisting of 952 family members, screened by otologic examination and structured interviews. Subjects with general conditions, known to affect hearing thresholds or known otologic cause were excluded from the study.RESULTS: We detected familial correlation coefficients of 0.36, 0.37, 0.36, and 0.30 for 0.25, 0.5, 1, and 2 kHz, respectively, and correlation coefficients of 0.20 and 0.18 for 4 and 8 kHz, respectively. Variance components analyses showed that the proportion of the total variance attributable to family differences was between 0.32 and 0.40 for 0.25, 0.5, 1, and 2 kHz and below 0.20 for 4 and 8 kHz. When testing for homogeneity between sib pair types, we observed a larger familial correlation between female than male subjects. Heritability estimates ranged between 0.79 and 0.36 across the frequencies.DISCUSSION: Our results indicate that there is a substantial shared familial effect in ARHI. We found that familial aggregation of ARHI is markedly higher in the low frequencies and that there is a trend toward higher familial aggregation in female compared with male subjects.
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| 33. |
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| 34. |
- Hu, Zhengqing, et al.
(författare)
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Functional Evaluation of a Cell Replacement Therapy in the Inner Ear
- 2009
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 30:4, s. 551-558
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS:Cell replacement therapy in the inner ear will contribute to the functional recovery of hearing loss.BACKGROUND:Cell replacement therapy is a potentially powerful approach to replace degenerated or severely damaged spiral ganglion neurons. This study aimed at stimulating the neurite outgrowth of the implanted neurons and enhancing the potential therapeutic of inner ear cell implants.METHODS:Chronic electrical stimulation (CES) and exogenous neurotrophic growth factor (NGF) were applied to 46 guinea pigs transplanted with embryonic dorsal root ganglion (DRG) neurons 4 days postdeafening. The animals were evaluated with the electrically evoked auditory brainstem responses (EABRs) at experimental Days 7, 11, 17, 24, and 31. The animals were euthanized at Day 31, and the inner ears were dissected for immunohistochemistry investigation.RESULTS:Implanted DRG cells, identified by enhanced green fluorescent protein fluorescence and a neuronal marker, were found close to Rosenthal canal in the adult inner ear for up to 4 weeks after transplantation. Extensive neurite projections clearly, greater than in nontreated animals, were observed to penetrate the bony modiolus and reach the spiral ganglion region in animals supplied with CES and/or NGF. There was, however, no significant difference in the thresholds of EABRs between DRG-transplanted animals supplied with CES and/or NGF and DRG-transplanted animals without CES or NGF supplement.CONCLUSION:The results suggest that CES and/or NGF can stimulate neurite outgrowth from implanted neurons, although based on EABR measurement, these interventions did not induce functional connections to the central auditory pathway. Additional time or novel approaches may enhance functional responsiveness of implanted cells in the adult cochlea
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| 35. |
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| 36. |
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| 37. |
- Håkansson, Bo, 1953, et al.
(författare)
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Percutaneous Versus Transcutaneous Bone Conduction Implant System : A Feasibility Study on a Cadaver Head
- 2008
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 29:8, s. 1132-1139
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Percutaneous bone-anchored hearing aid (BAHA) is an important rehabilitation alternative for patients who have conductive or mixed hearing loss. However, these devices use a percutaneous and bone-anchored implant that has some drawbacks reported. A transcutaneous bone conduction implant system (BCI) is proposed as an alternative to the percutaneous system because it leaves the skin intact. The BCI transmits the signal to a permanently implanted transducer with an induction loop system through the intact skin. The aim of this study was to compare the electroacoustic performance of the BAHA Classic-300 with a full-scale BCI on a cadaver head in a sound field. The BCI comprised the audio processor of the vibrant sound bridge connected to a balanced vibration transducer (balanced electromagnetic separation transducer).Methods: Implants with snap abutments were placed in the parietal bone (Classic-300) and 15-mm deep in the temporal bone (BCI). The vibration responses at the ipsilateral and contralateral cochlear promontories were measured with a laser Doppler vibrometer, with the beam aimed through the ear canal.Results: Results show that the BCI produces approximately 5 dB higher maximum output level and has a slightly lower distortion than the Classic-300 at the ipsilateral promontorium at speech frequencies. At the contralateral promontorium, the maximum output level was considerably lower for the BCI than for the Classic-300 except in the 1-2 kHz range, where it was similar.Conclusion: Present results support the proposal that a BCI system can be a realistic alternative to a BAHA.
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| 38. |
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| 39. |
- Karlberg, Mikael, et al.
(författare)
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Treatment of acute vestibular neuronitis with glucocorticoids.
- 2011
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Ingår i: Otology & Neurotology. - 1537-4505. ; 32:7, s. 1140-1143
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: : To report the effects of glucocorticoid treatment of acute vestibular neuronitis on recovery of vestibular function and length of hospital stay. STUDY DESIGN: : Prospective, consecutive case series compared with historic controls. SETTING: : Secondary referral academic hospital. PATIENTS: : Patients with acute vestibular neuronitis. One group treated with glucocorticoids within 3 days after symptom onset (n = 33) and 2 historic untreated control groups (n = 41 and n = 67). INTERVENTIONS: : Oral prednisolone 50 mg/d for 5 days with tapering of doses for the next 5 days, alternatively with intravenous betamethasone 8 mg on the first 1 to 2 days if nauseated. MAIN OUTCOME MEASURES: : Extent of unilateral vestibular paresis (%) in the caloric test at presentation and at 12 months of follow-up. Length of hospital stay (days). RESULTS: : The initial vestibular paresis value did not differ between the treatment group and the control group. At follow-up, the treatment group showed a lower value (22.8% versus 47.2%, p = 0.0003) and greater improvement (53.4% versus 35.6%, p = 0.002). At follow-up, 70% of the treatment group had a normal caloric test result compared to only 34% of the control group. The mean hospital stay of the treatment group was significantly shorter than that of the control group (1.8 versus 3.0 d, p = 0.001). CONCLUSION: : Glucocorticoids administered within 3 days after onset of vestibular neuronitis improves long-time recovery of vestibular function and reduces length of hospital stay
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| 40. |
- Knutsson, Johan, et al.
(författare)
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Collagen type distribution in the healthy human tympanic membrane
- 2009
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:8, s. 1225-1229
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Tidskriftsartikel (refereegranskat)abstract
- The differences in distribution of collagen types in the different fiber layers of the lamina propria suggest that the lattice of connective tissue supporting the tympanic membrane is not uniform. Understanding the differences in collagen type distribution and in the physical properties of the individual collagen types themselves may contribute to a comprehensive model of retraction pocket pathogenesis.
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| 41. |
- Knutsson, Johan, et al.
(författare)
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Distribution of different collagen types in the rat's tympanic membrane and its suspending structures
- 2007
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Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 28:4, s. 486-491
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: The objective of the study was to investigate the histological distribution of collagens in the healthy rat's tympanic membrane. METHODS:: Immunohistochemical analysis of collagen type I, II, III, and IV in the tympanic membranes in healthy adult female Sprague-Dawley rats. The staining was semiquantified using light microscopy in a blinded fashion, not knowing what type of collagen the slide had been stained for. RESULTS:: The pars tensa of the tympanic membrane was mainly stained for collagen type II and IV. The fibrous annulus could on immunohistochemistry be subdivided into an inner and an outer portion. The inner portion of the fibrous annulus was mainly stained for collagen type II, whereas the outer portion was most strongly stained for collagen type III and collagen type IV. The test-retest reliability of the semiquantative method was 81%. CONCLUSION:: Collagen type II and IV are the major collagen constituents of the pars tensa of the tympanic membrane. The outer portion of the fibrous annulus has collagen type III and IV as its major constituents, whereas the inner portion is made up of collagen type II.
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| 42. |
- Knutsson, Johan, et al.
(författare)
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Structural Tympanic Membrane Changes in Secretory Otitis Media and Cholesteatoma
- 2011
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 32:4, s. 596-601
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Tidskriftsartikel (refereegranskat)abstract
- Background: Otitis media may predispose for retraction pathologic abnormality later in life. A weakening of the collagen fiber bundles in the lamina propria of the tympanic membrane (TM) is a prerequisite for the formation of a retraction pocket. Various collagen types have different tensile strength. The collagen-type distribution in the TM during otitis media and cholesteatoma has not been reported before. Materials and Methods: The collagen contents of TM biopsies from child patients with longstanding secretory otitis media without retraction pockets were compared with pars tensa cholesteatomas using immunohistochemical staining for collagen Types I to IV. The histology was also investigated using transmission electron microscopy. Results: The outer epithelium was in some biopsies thickened with evidence of edema. The biopsies showed an intact lamina propria with positive immunohistochemical staining for collagen Types I to III and showed normal collagen fiber bundles on electron microscopy. The outer epithelium of the cholesteatomas showed marked thickness variations and signs of edema. There was a presence of normal collagen fiber bundles in smaller parts of all cholesteatomas, positive for collagen Types I to II. In other parts, only scattered collagen fibers were found. Conclusion: Tympanic membrane biopsies from patients with longstanding secretory otitis media may show a thickening of the outer epithelium. Collagen Types I to III are present in the lamina propria, and no ultrastructural changes of the collagen fiber bundles are observed. Collagen is found in cholesteatomas in the remnants of the lamina propria, with positive staining for collagen Types I and II, whereas Type III seems to be lacking.
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| 43. |
- Koro, Eleonor, et al.
(författare)
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Long-term follow-up in active transcutaneous bone conduction implants
- 2023
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Ingår i: Otology and Neurotology. - : Wolters Kluwer. - 1531-7129 .- 1537-4505. ; 45:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate long-term outcomes of active transcutaneous bone conduction implants (atBCIs) regarding safety, hearing, and quality of life.Study design: A clinical study with retrospective medical record analysis combined with prospective audiometry and quality of life questionnaires.Setting: Three secondary to tertiary care hospitals.Patients: All subjects operated with an atBCI in three regions in Sweden were asked for informed consent. Indications for atBCI were single-sided deafness (SSD) and conductive or mixed hearing loss (CMHL).Intervention: Evaluation of atBCI.Main Outcome Measures: Pure tone and speech audiometry and Glasgow Benefit Inventory (GBI).Result: Thirty-three subjects were included and 29 completed all parts. The total follow-up time was 124.1 subject-years. Nineteen subjects had CMHL and in this group, pure tone averages (PTA4) were 56.6 dB HL unaided and 29.6 dB HL aided, comparable with a functional gain of 26.0 dB. Effective gain (EG) was −12.7 dB. With bilateral hearing, Word Recognition Scores (WRS) in noise were 36.5% unaided and 59.1% aided. Fourteen subjects had SSD or asymmetric hearing loss (AHL) and in this group, PTA4 were >100 dB HL unaided and 32.1 dB HL aided with the contralateral ear blocked. EG was −9.1 dB. With bilateral hearing, WRSs were 53.2% unaided and 67.9% aided. The means of the total GBI scores were 31.7 for CMHL and 23.6 for SSD/AHL.Conclusion: Few complications occurred during the study. The atBCI is concluded to provide a safe and effective long-term hearing rehabilitation.
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| 44. |
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| 45. |
- Kämpfe Nordström, Charlotta, et al.
(författare)
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The Human Vestibular Aqueduct : Anatomical Characteristics and Enlargement Criteria
- 2016
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 37:10, s. 1637-1645
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: The human vestibular aqueduct (VA) shows great anatomical variations, and imaging can be difficult, so we need more data on the normal anatomy of the VA for better radiologic evaluation of large vestibular aqueduct syndrome (LVAS). Background: The normal anatomy of the human VA was analyzed in micro-dissected human temporal bones. Methods: The study is based on two sets of human temporal bones. One set of 32 human temporal bones was selected from a collection of 50 micro-dissected specimens. The outline of the intraosseous portion of the VA was drawn and digitized, and dimensions were assessed. The other set of 20 plastic molds were randomly selected from a collection of 324 specimens, and the VA dimensions were assessed. Results: Measurements from this study are presented in means, standard deviations, and ranges. The results from these measurements are considered normal and compared with previously published data. The variations in the normal anatomy of the VA are presented and discussed. Conclusion: The VA courses sagittal in the human skull. Therefore, we recommend the lateral projection (reformatted) to demonstrate the VA in LVAS patients. We advocate assessing: 1) the width (or height) of the external aperture (EA), 2) the width at the half distance between the EA and the common crus (CC), and if possible 3) the width of the proximal portion of the VA. Based on the measurements, our criteria for enlargement are 2.0mm or greater, 1.5mm or greater, and more than 1mm at these sites.
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| 46. |
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| 47. |
- Larsson, Anna, 1973, et al.
(författare)
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Implant Losses for the Bone-Anchored Hearing Devices Are More Frequent in Some Patients.
- 2015
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - 1537-4505. ; 36:2, s. 336-340
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Tidskriftsartikel (refereegranskat)abstract
- Our knowledge of implant losses for bone-anchored hearing devices (BAHD) is still limited. This study examined the long-term survival rate, the reasons for implant loss, and the need for implant replacement in a large cohort with a long follow-up.
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| 48. |
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| 49. |
- Li, Hao, 1984-, et al.
(författare)
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Aeration of the Human Prussak's Space : A 3D Synchrotron Imaging Study
- 2021
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:7, s. E894-E904
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Prussak's space (PS) is an intricate middle ear region which may play an essential role in the development of middle ear disease. The three-dimensional (3D) anatomy of the human PS and its drainage routes remain relatively unknown. Earlier studies have histologically analyzed PS, by micro-dissection and endoscopy. Here, we used synchrotron-radiation phase-contrast imaging (SR-PCI), 3D reconstructions, and modeling to study the framework of the human PS, including aeration pathways. It may lead to increased understanding of development of middle ear pathology.Design: Nine human temporal bone specimens underwent in-line SR-PCI at the Canadian Light Source in Saskatoon, Saskatchewan, Canada. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping and segmentations to visualize its walls in fixed, undecalcified human temporal bones.Results: The PS was found to be an irregular, variably shaped chamber with different aeration systems. Three different drainage pathways were found: 1) via the posterior malleolar pouch of von Troltsch in seven of nine ears; 2) directly posterior-inferior into the mesotympanum medial to the posterior malleolar pouch in one ear; and 3) anteriorly in another. The posterior-inferior communications depended on the anatomy of the posterior malleolar fold. In one bilateral case, the aeration differed between the ears. Earlier descriptions of upper ventilation routes between the PS and the epitympanic spaces could not be substantiated.Conclusions: The 3D anatomy of the membrane folds organizing the PS in humans was demonstrated for the first time using in-line SR-PCI. The PS was always aerated into the mesotympanum, suggesting its relative independence of attic ventilation. The impact of its various drainage routes on middle ear ventilation and disease were discussed.
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- Lindell, Ellen, 1979, et al.
(författare)
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Dizziness Symptoms, Balance Confidence, and Vestibular Function in Older Women Reporting Dizziness and Unsteadiness
- 2022
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 43:4
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this article is to evaluate older women who report dizziness on a daily or weekly basis, but not seeking medical care for their problems, for levels of patient-reported outcome measures related to dizziness, balance confidence, vestibular impairment, benign paroxysmal positional vertigo walking speed, Timed Up and Go (TUG), balance confidence, depression, and anxiety. Study Design: Cross-sectional survey. Setting: Secondary referral center. Patients: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Women reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose, and Throat clinic at Sodra alvsborg Hospital, Sweden. Main Outcome Measure: Patients completed the Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale, and Hospital Anxiety and Depression Scale and were investigated with the video Head Impulse Test, for benign paroxysmal positional vertigo, walking speed, and TUG test. Results: Fifty-two female patients were enrolled. Associations were found between high levels of DHI and high distress due to dizziness, and low levels of balance confidence and reduced walking speed and TUG test time. Participants with higher DHI levels reported higher levels of both depression and anxiety. No associations were found between levels of DHI and results on vestibular tests. Conclusion: Women reporting higher levels of distress due to dizziness had reduced walking speed and reported less balance confidence and higher levels of anxiety and depression. The findings support the theory that DHI captures aspects of overall self-rated wellbeing and function rather than structural vestibular deficits.
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