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Sökning: L773:1537 4505 OR L773:1531 7129

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1.
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2.
  • Atturo, Francesca, et al. (författare)
  • Is the Human Round Window Really Round? : An Anatomic Study With Surgical Implications
  • 2014
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 35:8, s. 1354-1360
  • 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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3.
  • Atturo, Francesca, et al. (författare)
  • The Human Cochlear Aqueduct and Accessory Canals : a Micro-CT Analysis Using a 3D Reconstruction Paradigm
  • 2018
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 39:6, s. e429-e435
  • 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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4.
  • Axelsson, Sara, et al. (författare)
  • Prednisolone in Bell's Palsy Related to Treatment Start and Age
  • 2011
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 32:1, s. 141-146
  • 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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5.
  • Berg, Thomas, et al. (författare)
  • Agreement between the Sunnybrook, House-Brackmann, and Yanagihara facial nerve grading systems in Bell´s Palsy
  • 2004
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 25:6, s. 1020-1026
  • 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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6.
  • Berg, Thomas, et al. (författare)
  • The Course of Pain in Bell's Palsy : Treatment With Prednisolone and Valacyclovir
  • 2009
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:6, s. 842-846
  • 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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7.
  • Berglin, Cecilia Engmér, et al. (författare)
  • Magnetic Resonance Imaging of the Middle and Inner Ear After Intratympanic Injection of a Gadolinium-Containing Gel
  • 2014
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 35:3, s. 526-532
  • 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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8.
  • Berling Holm, Katarina, et al. (författare)
  • Surgery for chronic otitis media causes greater taste disturbance than surgery for otosclerosis
  • 2019
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 40:1, s. e32-e39
  • 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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9.
  • Boisvert, Isabelle, et al. (författare)
  • Choice of Ear for Cochlear Implantation in Adults With Monaural Sound-Deprivation and Unilateral Hearing Aid
  • 2012
  • Ingår i: Otology and Neurotology. - : Lippincott, Williams and Wilkins. - 1531-7129 .- 1537-4505. ; 33:4, s. 572-579
  • 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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10.
  • Boström, Marja, et al. (författare)
  • Neural network and "Ganglion" formations in vitro : a video microscopy and scanning electron microscopy study on adult cultured spiral ganglion cells.
  • 2007
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 28:8, s. 1109-1119
  • 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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11.
  • Calon, T. G. A., et al. (författare)
  • Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial
  • 2018
  • Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 39:7, s. 882-893
  • 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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12.
  • Counter, S. Allen, et al. (författare)
  • 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
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 38:7, s. 1052-1059
  • 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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13.
  • Eeg-Olofsson, Måns, 1967, et al. (författare)
  • Implications for contralateral bone-conducted transmission as measured by cochlear vibrations.
  • 2011
  • 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
  • Tidskriftsartikel (refereegranskat)abstract
    • The velocity response at the contralateral cochlea from bone-conducted (BC) stimulation depends on the stimulation position.
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14.
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15.
  • Enghag, Sara, et al. (författare)
  • Incus Necrosis and Blood Supply : A Micro-CT and Synchrotron Imaging Study
  • 2019
  • Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 40:7, s. E713-E722
  • 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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16.
  • Erixon, Elsa, et al. (författare)
  • Variational anatomy of the human cochlea : implications for cochlear implantation
  • 2009
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:1, s. 14-22
  • 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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17.
  • Fogels, Jonas, et al. (författare)
  • Single-Sided Deafness-Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial
  • 2020
  • Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 41:6, s. 736-744
  • 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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18.
  • Frodlund, Jonas, et al. (författare)
  • Vestibular Function After Cochlear Implantation: A Comparison of Three Types of Electrodes
  • 2016
  • Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 37:10, s. 1535-1540
  • 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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19.
  • Frykholm, Carina, et al. (författare)
  • Familial Meniere's disease in five generations
  • 2006
  • Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 27:5, s. 681-686
  • 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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20.
  • Giese, Dina, et al. (författare)
  • Carotid Artery Compression Caused by the Cochlea
  • 2015
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 36:7, s. 1275-1278
  • 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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21.
  • Gladine, Kilian, et al. (författare)
  • Evaluation of Artificial Fixation of the Incus and Malleus With Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) in a Temporal Bone Model
  • 2020
  • Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:1, s. 45-51
  • 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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22.
  • Gunther, Mattias, et al. (författare)
  • Surgical Treatment of Patients With Facial Neuromas : A Report of 26 Consecutive Operations
  • 2010
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 31:9, s. 1493-1497
  • 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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23.
  • Hellström, Sten, et al. (författare)
  • Tympanic membrane vessel revisited : a study in an animal model
  • 2003
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 24:3, s. 494-499
  • 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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24.
  • Helpard, Luke, et al. (författare)
  • Three-Dimensional Modeling and Measurement of the Human Cochlear Hook Region : Considerations for Tonotopic Mapping
  • 2021
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:6, s. E658-E665
  • 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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25.
  • Hendrickx, Jan-Jaap, et al. (författare)
  • Familial aggregation of pure tone hearing thresholds in an aging European population
  • 2013
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 34:5, s. 838-844
  • 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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26.
  • Hu, Zhengqing, et al. (författare)
  • Functional Evaluation of a Cell Replacement Therapy in the Inner Ear
  • 2009
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 30:4, s. 551-558
  • 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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27.
  • Håkansson, Bo, 1953, et al. (författare)
  • Percutaneous Versus Transcutaneous Bone Conduction Implant System : A Feasibility Study on a Cadaver Head
  • 2008
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 29:8, s. 1132-1139
  • 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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28.
  • Knutsson, Johan, et al. (författare)
  • Collagen type distribution in the healthy human tympanic membrane
  • 2009
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:8, s. 1225-1229
  • 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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29.
  • Knutsson, Johan, et al. (författare)
  • Distribution of different collagen types in the rat's tympanic membrane and its suspending structures
  • 2007
  • Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 28:4, s. 486-491
  • 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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30.
  • Knutsson, Johan, et al. (författare)
  • Structural Tympanic Membrane Changes in Secretory Otitis Media and Cholesteatoma
  • 2011
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 32:4, s. 596-601
  • 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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31.
  • Koro, Eleonor, et al. (författare)
  • Long-term follow-up in active transcutaneous bone conduction implants
  • 2023
  • Ingår i: Otology and Neurotology. - : Wolters Kluwer. - 1531-7129 .- 1537-4505. ; 45:1, s. 58-64
  • 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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32.
  • Kämpfe Nordström, Charlotta, et al. (författare)
  • The Human Vestibular Aqueduct : Anatomical Characteristics and Enlargement Criteria
  • 2016
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 37:10, s. 1637-1645
  • 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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33.
  • Li, Hao, 1984-, et al. (författare)
  • Aeration of the Human Prussak's Space : A 3D Synchrotron Imaging Study
  • 2021
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:7, s. E894-E904
  • 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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34.
  • Lindell, Ellen, 1979, et al. (författare)
  • Dizziness Symptoms, Balance Confidence, and Vestibular Function in Older Women Reporting Dizziness and Unsteadiness
  • 2022
  • Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 43:4
  • 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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35.
  • Linder, Birgitta, et al. (författare)
  • In vitro growth of human endolymphatic sac cells : a transmission electron microscopic and immunohistochemical study in patients with vestibular schwannoma and Ménière's Disease
  • 2001
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 22:6, s. 938-943
  • Tidskriftsartikel (refereegranskat)abstract
    • HYPOTHESIS:Human endolymphatic sac cells have been notoriously difficult to maintain in culture. It was hypothesized that an in vitro environment intended for growth of keratinocytes would also be suitable for human endolymph sac cells.BACKGROUND:Studies on cell physiology of human endolymphatic sac cells have been hampered by difficulties in maintaining them in culture.METHODS:Human endolymphatic sac cells were taken from 10 patients during translabyrinthine skull base surgery for vestibular schwannoma, one of whom also had Ménière's disease. Cell lines of proliferating epithelial cells were obtained after trypsinization and growth in a 3:1 mixture of Dulbecco's modified Eagle medium and Ham's F12 medium supplemented with 10% fetal calf serum. Fibroblast overgrowth was counteracted by the use of so-called cloning rings. During various stages, cells were investigated with transmission electron microscopy and/or immunohistochemistry.RESULTS:Proliferation took place after 2 to 3 days of primary cell culture. The cells were cytokeratin-positive and pleomorphic, and they had abundant polarized microvillus-like projections, numerous coated cytoplasmic pits and vesicles, and a well-developed rough endoplasmic reticulum.CONCLUSION:Cell lines of proliferating human endolymphatic sac cells can be produced with the technique described here and may be a valid tool in studies of human endolymph sac physiology.
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36.
  • Maier, Hannes, et al. (författare)
  • Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss
  • 2022
  • Ingår i: Otology and Neurotology. - : Lippincott, Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 43:5, s. 513-529
  • Tidskriftsartikel (refereegranskat)abstract
    • Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
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37.
  • Marsk, Elin, et al. (författare)
  • Early Deterioration in Bell's Palsy : Prognosis and Effect of Prednisolone
  • 2010
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 31:9, s. 1503-1507
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To assess if early deterioration is a negative prognostic factor in Bell's palsy and if prednisolone treatment reduces early progression and enhances recovery. Study Design: Data extracted from the randomized, double-blind, placebo-controlled multicenter, Scandinavian Bell's palsy study. Setting: Sixteen tertiary referral centers in Sweden and one in Finland. Patients: A total of 829 patients aged 18 to 75 years with Bell's palsy. Intervention: The study design was factorial; 416 patients were given prednisolone, whereas 413 did not receive the drug. Data were analyzed with a modified intention-to-treat principle and the last-observation-carried-forward method. Main Outcome Measures: Facial function was assessed within 72 hours before treatment start, at Days 11 to 17, and at 12 months. Sunnybrook was used as the main facial grading system with complete recovery defined as Sunnybrook 100. Results: In 236 (28%) of 829 patients, the palsy deteriorated from baseline to the first follow-up at Days 11 to 17. Complete recovery at 12 months was 45% among subjects with early deterioration compared with 73% in patients with no initial deterioration (p < 0.0001). In the early deterioration group, complete recovery at 12 months was 62% in patients treated with prednisolone and 31% in those not treated (p G 0.0001). Conclusion: Early deterioration in Bell's palsy is a negative prognostic factor for complete recovery at 12 months. Prednisolone given within 72 hours may reduce early progression and improve the outcome of palsy.
  •  
38.
  • Niklasson, Anders, et al. (författare)
  • An Optimal Partial Ossicular Prosthesis Should Connect Both to the Tympanic Membrane and Malleus : A Temporal Bone Study Using Laser Doppler Vibrometry
  • 2018
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 39:3, s. 333-339
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:To compare stapes vibrations in different partial ossicular replacement prosthesis (PORP) applications.Methods: Stapedial vibrations were measured on fresh frozen human temporal bones with laser Doppler vibrometry. Eight different types of common ossiculoplasty methods were compared regarding recovery of stapes vibrations in relation with the normal ossicular chain. The PORPs were divided into three groups: 1) PORPs with the lateral contact only with the tympanic membrane, 2) PORPs with lateral contact only to the malleus handle, and 3) PORPs with lateral contact with both the malleus handle and the tympanic membrane.Results: The PORPs with lateral contact only to the malleus handle performed better than the PORPs with lateral contact to the tympanic membrane only at 2 kHZ, but the best recovery was found in the group with contact both to the malleus handle and the tympanic membrane.Conclusion: The best sound transmission might be achieved by placing a PORP in contact with both the tympanic membrane and the handle of the malleus.
  •  
39.
  • Niklasson, Anders, et al. (författare)
  • Ossiculoplasty on Isolated Malleus Fractures : A Human Temporal Bone Study Using Laser Doppler Vibrometry
  • 2016
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 37:7, s. 895-901
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis: In the literature several surgical methods have been reported that aim to improve hearing in patients with isolated malleus fractures; however, it is still not clear which method gives the best results.Background: In this study, laser Doppler vibrometry (LDV) was used to compare the outcome of different surgical methods on malleus fractures in fresh frozen human temporal bones.Methods: Fractured malleus shafts of defrosted human temporal bones were repaired with bone cement, with a malleus prosthesis from cortical bone, or with a partial ossicular replacement prosthesis (PORP) from cortical bone, and LDV measurements were obtained for analysis.Results: The best result was achieved with the bone cement only, applied directly at the site of the fracture. The malleus prosthesis and the PORP gave similar results.Conclusion: All three surgical methods gave good results, but when the distal end of the fractured malleus can be attached close to the proximal end, the technique using only cement tends to be the best option. If the parts are too far apart, a malleus prosthesis or a PORP would be good options.
  •  
40.
  • Nordang, Leif, et al. (författare)
  • Morphological changes in round window membrane following topical hydrocortisone and dexamethasone treatment
  • 2003
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 24:2, s. 339-43
  • Tidskriftsartikel (refereegranskat)abstract
    • HYPOTHESIS: Are all glucocorticoids supposed to have the same effect on the round window membrane? BACKGROUND: Interest in glucocorticoids for topical treatment of inner ear diseases is increasing. The safety of such treatment should therefore be an important consideration before clinical use. METHODS: In this study the authors investigated the morphology of the round window membrane after topical instillation of dexamethasone or hydrocortisone into the middle ear. Twenty Sprague-Dawley rats were used. Five rats received 5 doses, and five rats 10 doses, of 1 microg (20 microl) dexamethasone in the right ear, and five others were given 5 doses, and five rats 10 doses, of 2% (20 microl) hydrocortisone solution, also in the right ear. Membrane morphology was studied in both light microscopy and transmission electron microscopy. The thickness of exposed membranes was measured and compared with that of control membranes. RESULTS: Thickening and microscopically signs of inflammation were observed in hydrocortisone-exposed membranes but not in dexamethasone-exposed membranes, which did not differ morphologically from those in control ears. CONCLUSION: Although hydrocortisone has anti-inflammatory properties, it seems to provoke inflammation in the round window membrane after topical instillation. Dexamethasone had no such effects, however.
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41.
  • Ohm, Rebecka, et al. (författare)
  • Sequelae treatment needs following peripheral facial palsy : retrospective analysis of 525 patients
  • 2024
  • Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 45:5, s. E450-E456
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention.Study Design: Retrospective case review.Setting: Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions.Patients: All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022.Interventions: Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae.Main Outcome: Measures Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading.Results: Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients (p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6.Conclusions: Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.
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42.
  • Osborne, M. S., et al. (författare)
  • Clinical Evaluation of a Novel Laser-Ablated Titanium Implant System for Bone Anchored Hearing Systems in a Pediatric Population and the Relationship of Resonance Frequency Analysis With Implant Survival
  • 2022
  • Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 43:2, s. 219-226
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate the clinical outcomes of pediatric patients implanted a novel 4.5 mm wide laser ablated titanium bone anchored implant system and to evaluate the implant stability over the first 12-month period. Study Design: A prospective, single-subject, repeated measure, cohort study. Participants served as their own controls. Setting: Community and tertiary referral hospital pediatric assessment center. Patients: A total of 115 consecutive pediatric patients aged 4 to 15 years were implanted with 176 laser ablated titanium bone anchored implants from January 2016 to January 2019. Main Outcome Measure: Clinical outcomes, implant failure rates, and post implantation implant stability quotient (ISQ) scores were studied over the first 12-month period. Data were analyzed for statistical significance through mixed effect modeling, with the significance level p = 0.01. Results: A median 12-month survival of 96.6% was observed. Six implants (3.5%) were lost in total, one of these (0.6%) was lost due to trauma. Adverse skin reactions (Holgers grade 2-4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). Neither the ISQ high (ISQH) nor ISQ low (ISQL) values increased significantly between the stage 1 and 2 surgeries. In contrast, the ISQ results, irrespective of abutment size, demonstrated an increasing trend from 49.1 to 57 over the 12 months review period. A statistically significant change was only demonstrated from the 3 months follow up onwards. Conclusion: The use of 4.5 mm wide laser-ablated titanium bone anchored hearing implants resulted in superior survival rates and excellent clinical outcomes compared with previous implant systems.
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43.
  • Pamulova, Lucia, et al. (författare)
  • Innervation of the apical turn of the human cochlea : a light microscopic and transmission electron microscopic investigation
  • 2006
  • Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 27:2, s. 270-5
  • Tidskriftsartikel (refereegranskat)abstract
    • HYPOTHESIS: A light and transmission electron microscopic investigation of the apical turn of a freshly fixed human cochlea. BACKGROUND: Our knowledge about the human cochlea rests to a large extent on animal species research. An opportunity to obtain tissue from normal-hearing persons occurs during surgery for life-threatening petroclival meningioma. This study presents detail on the morphology and innervation of the apical part of the human cochlea using light microscopic and transmission electron microscopic level sectioning. METHODS: The tissue was histologically processed after removal during petroclival meningioma surgery. The cochlea was serially sectioned perpendicularly to its long axis, and at regular distances semithin sections were reembedded and prepared for transmission electron microscopy. Nerve fibers/fascicles were traced from the area of the spiral ganglion to the level of the inner hair cells, and a cochleotopic "map" of the cochlear nerve supplying the apical portion was constructed. RESULTS: The apical turn was found to be innervated by 3,694 myelinated nerve fibers representing approximately 10% of the total number of fibers innervating the cochlea. The total number of unmyelinated nerve fibers was 513. The majority belonged to the efferent olivocochlear system and the intraganglionic spiral bundle or represented Type II afferent neurons innervating outer hair cells. CONCLUSION: The significance of the anatomic findings in relation to cochlear implantation is discussed.
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44.
  • Persson, Pekka, et al. (författare)
  • Speech recognition in background noise : Monaural versus binaural listening conditions in normal-hearing patients
  • 2001
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 22:5, s. 625-630
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis: Patients with unilateral conductive hearing impairment often experience a great advantage in improved hearing thresholds after reconstructive ear surgery because the binaural hearing leads to increased speech recognition in competing noise. The aim of this study was to develop a clinical audiometric test to quantify the ability of speech recognition in background noise preoperatively and postoperatively. Methods: A model consisting of phonetically balanced (PB) monosyllabic words and/or a just-follow-conversation test (JFC) was used in 16 normal-hearing listeners. In 8 of the participants, JFC at two levels of background noise (60 and 40 dB sound pressure level) was used as the only method. The tasks were performed in an anechoic chamber with varying spatial separations of speech and noise sources under free field conditions. The tests were made binaurally and monaurally, the latter condition was achieved by occluding one ear with a hearing protector. In PB word tests, the percent of correctly repeated words was scored. In the JFC task, the speech signal was adjusted by the listener to a level where he or she could just understand what was being said. This was expressed as a signal-to-noise (S/N) ratio. Results: In both types of tests, the subjects achieved significantly better speech recognition scores in the binaural situations. In summary, compared with monaural conditions, the subjects achieved 17% to 18% better speech recognition in PB tests, and in JFC tests a 2-to 3-dB lower S/N ratio in binaural conditions. Conclusion: These free field tests can be developed further as a clinical tool preoperatively and postoperatively to evaluate the effect of binaural hearing after ear surgery.
  •  
45.
  • Persson, Pekka, et al. (författare)
  • Using the glasgow benefit plot as a prognostic instrument and for preoperative counseling in patients with otosclerosis
  • 2007
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 28:6, s. 739-744
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The Glasgow Benefit Plot (GBP) is a graph showing the pure-tone thresholds preoperatively and postoperatively, and is meant to visualize the possible outcome of binaural hearing for individual patients. We used our database comprising a large number of patient data to test the usefulness of the GBP. STUDY DESIGN: Evaluation based on retrospective clinical data. SETTING: Tertiary referral center, University clinic. MAIN OUTCOME MEASURES: Audiometric assessment included bilateral preoperative and postoperative evaluation using conventional audiometry. Three preoperative groups (unilateral, asymmetric, and symmetric hearing impairment) were split into 6 postoperative categories in the GBP diagram. RESULTS: Considering the 509 operations, including 34 bilateral operations, the total outcome was distributed as follows: 34% resulted in bilateral normal hearing, 24% unilateral normal hearing (in operated ear), 14% still unilateral hearing impairment (in operated ear), 13% symmetric hearing impairment, 10% asymmetric hearing impairment (operated ear best), 5% still asymmetric hearing impairment (nonoperated ear best). The distribution of outcomes depended in part on the bone conduction level in the operated ear and in part on the hearing status in the contralateral ear. CONCLUSION: The GBP is a useful instrument that provides a means for judging the binaural hearing status. However, the outcome of stapes surgery for individual persons and for a group depends critically on the preoperative audiometric criteria for patients who are chosen for surgery. In cases of depressed bone conductions, the method does not indicate the upper limit for possible hearing improvement. A number of patients with combined hearing impairments were included in the present study population. In preoperative counseling, the GBP must be complemented with information with regard to the limitation of possible hearing improvement owing to the individual bone conduction level.
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46.
  • Pierre, Pernilla Videhult, et al. (författare)
  • High-Dose Furosemide Enhances the Magnetic Resonance Signal of Systemic Gadolinium in the Mammalian Cochlea
  • 2020
  • Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:4, s. 545-553
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis:Furosemide alters the permeability of the intrastrial fluid-blood barrier.Background:The cochlear sensory cells are protected by the blood-perilymph and intrastrial fluid-blood barriers, which hinder substances, including gadolinium-based contrast agents (GdCAs), to enter the endolymphatic space. High-dose furosemide causes transient shift of hearing thresholds and morphological changes in stria vascularis. Furosemide is also known to enhance drug-induced ototoxicity.Methods:Furosemide (400mg/kg b.w.) was injected i.v. in Balb/C mice (n=20). Twenty minutes later, the GdCA gadobutrol, gadopentetic acid, or gadoteric acid was injected i.v. The distribution of GdCA to the perilymphatic and endolymphatic spaces was studied with MRI (9.4T) for 250minutes.Results:The perilymphatic and endolymphatic spaces were signal-enhanced in all animals. Gadopentetic acid and gadoteric acid yielded similar signal enhancement in all three scalae, while gadobutrol yielded significantly higher enhancement in scala tympani than scala media (p=0.043) and scala vestibuli (p=0.043). The signal enhancement reached a plateau but did not decrease during the time of observation.Conclusion:Treatment with a high dose of furosemide before injection of a GdCA resulted in enhancement of the MRI signal in the endolymphatic space as well as the perilymphatic space, which supports our hypothesis that furosemide alters the permeability of the intrastrial fluid-blood barrier.
  •  
47.
  • Prodanovic, Srdan, et al. (författare)
  • Consequences of Mastoidectomy on Bone Conducted Sound Based on Simulations in a Whole Human Head
  • 2020
  • Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:9, s. E1158-E1166
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis: The aim of this study is to investigate how a mastoidectomy surgery affects bone conduction (BC) sound transmission using a whole head finite element model. Background: Air conduction (AC) and BC hearing thresholds are normally used to evaluate the effect of an ear surgery. It is then assumed that the BC hearing thresholds are unaffected by the surgery. Moreover, BC hearing aids are used in cases of unilateral or conductive hearing loss in heads that have undergone a mastoidectomy surgery. Given the invasiveness of the surgery, the BC hearing sensitivity may be altered by the surgery itself. Methods: Two types of mastoid surgery, canal wall up and canal wall down, with and without obliteration, were simulated in a whole head finite element model for BC stimulation, the LiUHead. The evaluations were conducted for two different methods of applying the BC sound, at the skin surface (B71 transducer) and directly at the bone (BC hearing aid). Results: The results showed that a mastoidectomy surgery increased the cochlear vibration responses with BC stimulation. The increase was less than 5 dB, except for a canal wall down surgery which gave an increase of up to 8 dB at frequencies close to 10 kHz. The increase was greater at the ipsilateral cochlea compared with the contralateral cochlea. Conclusion: A mastoidectomy surgery increases the vibration at both cochleae for BC stimulation and the increase generally improved with frequency. Obliteration of the surgical cavity does not influence BC sound transmission.
  •  
48.
  • Rahman, Anisur, et al. (författare)
  • Structural and functional properties of the healed tympanic membrane : a long-term follow-up after laser myringotomy
  • 2007
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 28:5, s. 685-691
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis: The short-term healing scar that forms after experimental laser myringotomy will revert to a normal lamina propria in the long run. The mechanical stiffness will stay normal. Background: Recent studies have shown severe structural changes in the fibrous layer in the early course after experimental laser myringotomy, whereas the scar quickly restored the strength of the tympanic membrane (TM). A reorganization of the fiber layer is expected to occur. Methods: Potassium titanyl phosphate laser myringotomy was made on one side of the TM in Sprague-Dawley rats. The ear of the other side was untouched and used for control. After half a year of observation, the stiffness and strength of the healed TMs were measured with moiré interferometry and examined with otomicroscopy and light and electron microscopy. Results: The interferometry readings showed a slightly reduced strength in the myringotomized and healed TMs. After half a year, still there were immense structural changes including increased thickness over a wide area of the pars tensa with increased amounts of fibers. An obvious reorganization of the fiber layer was lacking. Conclusion: Laser myringotomy causes profound, long-standing, or permanent structural changes in the lamina propria of the pars tensa, whereas the strength of the TM may become slightly reduced.
  •  
49.
  • Redfors, Ylva Dahlin, et al. (författare)
  • Otosclerosis : anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT
  • 2012
  • Ingår i: Otology and Neurotology. - Philadelphia, USA : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 33:6, s. 922-927
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To assess the use of cone beam computed tomography (CBCT) compared with multi-slice computed tomography (MSCT) in otosclerosis, with special emphasis on middle-and inner-ear anatomy.Study Design: Prospective study.Patients: Twenty patients who underwent a stapedectomy 30 years ago were selected on the basis of bone conduction threshold values. Their mean age was 65 years (range, 48-76 yr).Intervention: All patients underwent CBCT and MSCT with a slice thickness of 0.5 to 0.6 mm.Main Outcome Measures: Sixteen middle-and inner-ear anatomic structures and stapedial prostheses were analyzed by visual grading analysis. To assess critical reproduction and thereby the clinical applicability of CBCT, a dichotomization was made. Assessment of otosclerotic foci was performed using a grading system dividing the lesions in; 1) sole fenestral lesions, 2) retrofenestral lesions with or without fenestral lesions and 3) severe retrofenestral lesions.Results: The 16 anatomic structures were clearly reproduced by both imaging techniques. However, there was an interobserver variation in judging the superiority of 1 method in favor of the other. Otosclerotic lesions were diagnosed in 80/95% using MSCT and 50/85% using CBCT (evaluators 1 and 2, respectively). Retrofenestral lesions were diagnosed in 5 of 10 of ears with severe-to-profound hearing loss, whereas no retrofenestral lesions were diagnosed in the 10 ears with mild-to-moderate hearing loss. The stapedial prostheses were adequately or very well reproduced by both methods.Conclusion: CBCT is a new imaging technique with a considerably lower radiation dose than conventional MSCT. Our study indicates that CBCT is suitable and, in many ways, equivalent to MSCT, for temporal bone imaging in otosclerosis.
  •  
50.
  • Reinfeldt, Sabine, 1978, et al. (författare)
  • Study of the Feasible Size of a Bone Conduction Implant Transducer in the Temporal Bone
  • 2015
  • Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 36:4, s. 631-637
  • Tidskriftsartikel (refereegranskat)abstract
    • Hypothesis: The aim was to assess the temporal bone volume to determine the suitable size and position of a bone conduction implant (BCI) transducer. Background: A BCI transducer needs to be sufficiently small to fit in the mastoid portion of the temporal bone for a majority of patients. The anatomical geometry limits both the dimension of an implanted transducer and its positions in the temporal bone to provide a safe and simple surgery. Methods: Computed tomography (CT) scans of temporal bones from 22 subjects were virtually reconstructed. With an algorithm in MATLAB, the maximum transducer diameter as function of the maximum transducer depth in the temporal bone, and the most suitable position were calculated in all subjects. Results: An implanted transducer diameter of 16 mm inserted at a depth of 4 mm statistically fitted 95% of the subjects. If changing the transducer diameter to 12 mm, a depth of 6 mm would fit in 95% of the subjects. The most suitable position was found to be around 20 mm behind the ear canal. Conclusion: The present BCI transducer casing, used in ongoing clinical trials, was designed from the results in this study, demonstrating that the present BCI transducer casing (largest diameter [diagonal]: 15.5 mm, height: 6.4 mm) will statistically fit more than 95% of the subjects. Hence, the present BCI transducer is concluded to be sufficiently small to fit most normal-sized temporal bones and should be placed approximately 20 mm behind the ear canal.
  •  
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