Otologic Complications Research Articles

Effect of Rimantadine Treatment on Clinical Manifestations and Otologic Complications in Adults Experimentally Infected with Influenza A (H1N1) Virus

Susceptible adults (n = 105) were enrolled into a randomized double-blind study of rimantadine treatment of experimental influenza A infection. Subjects were cloistered for 8 days and challenged with a rimantadine-sensitive strain of influenza A H1N1 virus at the end of the first day. Forty-eight hours after challenge and for 8 days, 54 subjects received placebo and 51 received rimantadine (100 mg orally, twice a day). Symptoms, signs, and pathophysiologies were monitored. Nine subjects were not infected. Seventeen subjects (38%) in the rimantadine and 26 (53%) in the placebo group became ill. A beneficial effect of rimantadine was documented for virus shedding, symptom load, and sinus pain. Rimantadine had no effect on nasal patency, mucociliary clearance, nasal signs, or on symptoms and signs of otologic complications. These results do not support a preventive effect of rimantadine on the development of otologic manifestations of influenza A infection in adults.

Variant petrotympanic fissure as possible cause of an otologic complication during TMJ arthroscopy: A case report

In this reported case, a variant petrotympanic fissure — opening at the height of the orifice of the Eustachian tube into the hypotympanon — was identified by high resolution computed tomography (CT) as the possible cause of a tympanic membrane perforation. Inner ear function was preserved by an otosclerotic stapes which prevented destruction of the labyrinth. The perforation was closed by a myringoplasty and was to be followed by a stapedectomy after six months to restore normal hearing. Surgeons performing temporomandibular joint arthroscopy should be aware that in a small percentage of patients a variant anatomy of the tympanic plate exists and, therefore, great care must be exercised in the manipulation of instruments near this structure. A preoperative high resolution CT with thin slices of the temporal bone might allow identification of these high risk patients.

Otological complications of hyperbaric oxygen therapy.

Otological complications of hyperbaric oxygen therapy.

Eustachian tube in atrophic rhinitis.

Atropic Rhinitis is a chronic non-specific disease characterised by atrophy of mucosa and turbinate bones. Maxillary antrum may sometimes be involved as result of primary disease or at time secondary to mucosal pathology or crusting. Extension of disease involving the eustachian tube is uncertain. In the present study, endoscopy of the nasopharynx was performed in 20 patients with atrophic rhinitis to find out the type, nature and site of lesion at the orifice of the eustachian tube. The lesion was found in seven cases (35%) involving the eustachian tube. The lesion occurs in form of atrophic changes with crusting granuloma and thick mucoid area. Endoscopy is also found to be therepeutic value in removing the thick discharge crust etc. at the orifice of eustachian tube to prevent the otological complications.

Use of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Diagnosis of Sigmoid Sinus Thrombosis

Magnetic resonance angiography is an established radiologic technique which is rapidly becoming useful in imaging the head and neck. Currently, this imaging modality is important in the diagnosis of sigmoid sinus thrombosis caused by otologic disease. Since the introduction of antibiotic therapy, the percentage of deaths attributed to intracranial complications from otitic disease has decreased from 2.5 to approximately 0.25% of documented deaths. Also, the incidence of sinus thrombosis within this group has decreased, but it is still a serious and potentially lethal condition. Sinus thrombosis is suspected clinically when mastoid disease progresses, with picket fence fever pattern, chills, headaches and signs of papilledema. Definitive diagnosis is necessary before surgical treatment. The Queckenstedt test is unreliable, computed tomography is better suited for demonstrating thrombosis of the sagittal sinus rather than the sigmoid sinus, and conventional angiography (although it provides excellent visualization) has the hazard of ionizing radiation and requires vessel puncture and the use of intraarterial contrast agents. We present two cases of thrombosis of the sigmoid sinus as an intracranial otologic complication which were diagnosed definitively with magnetic resonance imaging and magnetic resonance angiography. The combination of magnetic resonance imaging, which showed the thrombosis displaying abnormal signal intensity, and magnetic resonance angiography, which demonstrated the absence of flow in the sinus, was an ideal diagnostic tool. For both patients, treatment consisted of mastoidectomy, sigmoid sinus decompression and antibiotics.

Prechallenge antibodies: moderators of infection rate, signs, and symptoms in adults experimentally challenged with rhinovirus type 39.

This study determined the influence of serum neutralizing antibody titers on infection rate, symptom manifestations, and provoked signs and pathophysiologies in adults experimentally exposed to rhinovirus type 39 (RV-39). Antibody status was determined for 151 healthy volunteers who were then cloistered in a hotel for 6 days. At the end of the first cloister day, the volunteers were challenged with RV-39 in a median tissue culture infective dose of 100. On each of the 6 days, a nasal examination was performed, symptoms were scored, and objective tests of nasal mucociliary function, nasal airway patency, secretion production, and middle ear pressures were completed. Both subjects and investigators were blinded to the prechallenge serum homotypic antibody titers of the subjects. Four subjects presented with a wild virus and were excluded from the analysis. Of the 147 included subjects, prechallenge serum antibody titers to RV-39 were low (under 2) in 56 subjects, intermediate (2 to 8) in 51 subjects, and high (above 16) in 40 subjects. The high-titer group was significantly different from the low-titer group with respect to viral shedding, symptom load, subjective extent of illness, and secretion production, as well as in the frequency of subjects with abnormal nasal mucociliary clearance and positive middle ear pressures. The study results document that for experimental RV-39 exposure, high levels of homotypic serum neutralizing antibody titers are associated with protection from infection and a lessened degree of disease expression, but not with a reduction of otologic complications.

Otologic and systemic manifestations of experimental influenza A virus infection in the ferret

In an effort to further validate an animal model and to better define the mechanisms relating viral upper respiratory tract infections and acute otitis media, we infected 10 ferrets intranasally with influenza A virus. Infection was monitored by cultures and antibody titers, illness was monitored by signs and temperatures, and otologic complications were monitored by otoscopy, tympanometry, and eustachian tube function testing. All animals became infected. Forced-response test results showed progressive increases in the passive function variables after inoculation. Inflation-deflation test results documented progressive impairment of active tubal function, which was accompanied by the development of middle ear underpressures. No otitis media was seen. The results suggest that influenza A virus infection results in progressive, subtotal occlusion of the eustachian tube lumen, which compromises the ventilatory function of the tube, thereby promoting the development of middle ear underpressures. These findings support the hypothesized pathophysiologic relationship between viral upper respiratory tract infections, eustachian tube dysfunction, middle ear underpressures, and acute otitis media. Given these pathophysiologic changes and previously documented physiologic similarities to the eustachian tube-middle ear system of human beings, we conclude that the ferret represents an appropriate animal model for studying the pathogenic processes related to viral upper respiratory tract infections, eustachian tube dysfunction, and otitis media and for testing of potential prophylactic and therapeutic regimens. (OTOLARYNGOL HEAD NECK SURG 1995;112:572-8.)

Otologic and systemic manifestations of experimental influenza a virus infection in the ferret

In an effort to further validate an animal model and to better define the mechanisms relating viral upper respiratory tract infections and acute otitis media, we infected 10 ferrets intranasally with influenza A virus. Infection was monitored by cultures and antibody titers, illness was monitored by signs and temperatures, and otologic complications were monitored by otoscopy, tympanometry, and eustachian tube function testing. All animals became infected. Forced-response test results showed progressive increases in the passive function variables after inoculation. Inflation-deflation test results documented progressive impairment of active tubal function, which was accompanied by the development of middle ear underpressures. No otitis media was seen. The results suggest that influenza A virus infection results in progressive, subtotal occlusion of the eustachian tube lumen, which compromises the ventilatory function of the tube, thereby promoting the development of middle ear underpressures. These findings support the hypothesized pathophysiologic relationship between viral upper respiratory tract infections, eustachian tube dysfunction, middle ear underpressures, and acute otitis media. Given these pathophysiologic changes and previously documented physiologic similarities to the eustachian tube-middle ear system of human beings, we conclude that the ferret represents an appropriate animal model for studying the pathogenic processes related to viral upper respiratory tract infections, eustachian tube dysfunction, and otitis media and for testing of potential prophylactic and therapeutic regimens.

Presentation and diagnosis of small acoustic tumors.

With the recent advent of magnetic resonance imaging and auditory brain stem response, it is now possible to diagnose acoustic tumors while they are still quite small. As a result, it is becoming obvious that the clinical presentation of these smaller lesions can be somewhat variant to what is considered typical for an acoustic neuroma. Likewise, although the sensitivity of auditory brain stem response for larger tumors is believed to be quite good, the sensitivity for smaller tumors has recently been questioned, particularly when the patient is first seen early in the course of the disease with only mild otologic complications. To assess auditory brain stem response results as well as clinical and audiologic presentations, we conducted a retrospective study of patients treated for small acoustic tumors (less than 1 cm). Of the 70 patients included in the study, auditory brain stem response was abnormal in 65 (93%), on the basis of wave V latency prolongation and interaural latency differences. This would indicate that auditory brain stem response is a valid screening test for acoustic tumors, even in early stages of development. The clinical presentation of patients with small acoustic tumors was similar to that reported for acoustic tumors in general, but with vertigo occurring more frequently in patients with smaller tumors. Several atypical patterns of hearing loss were also noted.

Otological complications of herpes zoster.

Otological complications of varicella-zoster virus (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, hyperacusis (dysacousis), vertigo, dysgeusia, and decreased tearing. Cranial nerves V, IX, and X are often affected. Gadolinium-enhanced magnetic resonance imaging demonstrates enhancement of the geniculate ganglion and facial nerve. These manifestations are identical to Bell's palsy but are more severe and carry a graver prognosis. Eight percent of Bell's palsy patients eventually are diagnosed as "zoster sine herpete." A new case of Ramsay Hunt syndrome will occur every 52 minutes, compared to every 10 minutes for a new case of Bell's palsy.

A conservative approach to the management of otitis media with effusion in cleft palate children.

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic. There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes. A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

Facial Nerve Palsy in Acute Lymphoblastic Leukemia

Seventh nerve paralysis during the course of leukemia is rare in children. it present, it may be seen during remission as well as in relapse. Fasical palcy occur most frequently in patients with the acute forms of leukemia and spesifically in acute lymphoblastic leukemia due to perineural or endoneural infiltration, hemorrhage or infection. Unilateral peripheric type of facial palsy has been detected in a child aged 14, due the acute lymphoblastic leukemia. Facial palcy arose during leukemic relapse. Localizatıon studies showed an involvement proximal to ganglion geniculi. The patient had not experienced another otologic complication and had poor general condition and pancytopenia. He died soonly after hospitalization.

Persistent foramen of Huschke: Possible risk factor for otologic complications after arthroscopy of the temporomandibular joint

Several cases of otologic injury after arthroscopy of the TMJ have been reported. This study describes the persistent foramen of Huschke, an area of incomplete ossification of the tympanic plate of the temporal bone present in some persons. The presence of this foramen may render middle and inner ear structures vulnerable to injury during arthroscopy of the TMJ.

Otolaryngologic problems in cardiac transplant patients.

Cardiac transplantation is now a well-accepted treatment for selected patients who have end-stage heart disease. Of the 38 patients who underwent cardiac transplants at our center from August 1984 through August 1987, 27 received consultation for otolaryngologic problems. Eleven patients had sinonasal complications; 8 had laryngotracheal complications; 4 had otologic complications; 2 had oropharyngeal complications; and 2 had a combination of more than one of the above complications. Of these otolaryngologic disorders, 63% were infectious in etiology. Development of otolaryngologic infections generally did not correlate with either higher doses of maintenance immunosuppression or with treatment of an acute rejection episode, which requires increased immunosuppression. Otolaryngologists should be aware of the sinonasal, laryngotracheal, oropharyngeal, and otologic disorders that can occur in cardiac transplant patients.

Complications and Sequelae of Chronic Suppurative Otitis Media

Chronic suppurative otitis media is an infection of the ME space associated with irreversible tissue disease. This entity is generally seen clinically as ME infection associated with a nonhealing perforation of the TM. It has significant complications and sequelae. Otologic complications of C Supp OM include petrositis, facial paralysis, and labyrinthitis. Intracranial complications include lateral sinus thrombophlebitis, meningitis, and intracranial abscesses. Sequelae include osseous changes of the ME with associated hearing loss, cholesteatoma, and tympanosclerosis.

Sudden hearing loss: Eight years' experience and suggested prognostic table

The etiology, incidence, acute and late prognosis, and treatment of sudden hearing loss (SHL) are described variously in the literature. In an 8-year prospective study of 225 SHL patients, initiated in July 1973, overall, normal, or complete recovery occurred in 45% of patients and late otologic complications in 28%. Important prognostic indicators were severity of initial hearing loss and vertigo, time to initial audiogram, and elevated erythrocyte sedimentation rate; other indicators were age greater than 60 and less than 15 years, midfrequency audiogram configuration, and hearing status of the opposite ear. A common inflammatory cause is suggested for all degrees of severity in SHL, and a prognostic table is provided to aid the practitioner in predicting recovery. There is still no evidence that treatment achieves a result better than expected with spontaneous recovery.

Mastoid surgery in chronic granulomatous disease

A patient is reported with a severe inherited phagocytic defect, chronic granulomatous disease, in whom otological complications occurred. Successful ear surgery in this condition is described.

Pediatric otolaryngological relations of velopharyngeal insufficiency.

On the basis of his examinations, the author presents data and gives his opinion on the classification, etiopathogenesis, diagnostics, phonosurgery, and therapy of the otological complications of velopharyngeal insufficiency (VPI). VPI may be organic or functional, produced by congenital or acquired causes, due to paresis or local disorders, but most frequently occurs as a result of cleft palate. Usually, diagnosis is evident; however, the verification of the milder cases of anatomic disproportion and/or muscular dysfunction is sometimes difficult. For the examination of dubious cases the author suggests, apart from the well-known methods (auditive evaluation, function tests, nasopharyngoscopy, velopharyngometry, supersound, X-ray, manometric measurements, speech intelligibility tests, acoustic analyses, etc.), electrophysiological and enzyme-histochemical measurements. Careful examination is most important, also on account of the possible indication of phonosurgery. An operation is to be proposed when a progressive neuro-myogenic process can thus be excluded, or when logopedic treatment is hopeless. The author has done 500 flap operations (as well as 2500 cleft palate and cleft lip ones) in the course of 30 years with a 98% result of anatomical healing. According to the pathological situation he employed 10 variants of the operation. As a result, hyperrhinophony ceased or became minimal in 90% of the cases; speech intelligibility was judged good or excellent in 74%. Functional effects can be influenced by the following: the width of the flap, the functional ability of the pharyngeal muscles, the cause of VPI, the patient's age, and the state of ears and hearing. In case of VPI otological and audiological examinations are routinely required. The author considers adenoidectomy and grommet-insertion to be alternative methods. One of the most important factors in achieving good results is teamwork, which the author discusses on the basis of the model developed at the Heim Pál Hospital for Sick Children, Budapest.

Otogenic tetanus in Zaire

Sixty-seven patients with tetanus of otogenic origin were hospitalized at the Mama Yemo hospital, Kinshasa, Zaire over the two-year period from 1975 through 1976. The care of these patients was the same as that for all 620 tetanus cases admitted during this period. No otologic surgical procedures were performed on this group; nor were any special ear procedures utilized. The survival rate in the otogenic tetanus group was 83%. The survival rate in the 620 tetanus admissions was 79%. All 67 patients had evidence of chronic otitis media. None of these patients had evidence of otologic complications before, during or for one month after developing tetanus, other than uncomplicated otorrhea. Tetanus antitoxin of 10,000 or 50,000 IU did not appear to affect survival rates. Mortality rates were not increased in the 18% of patients who did not receive tetanus antitoxin. Sedation sufficient to eliminate muscle spasms and maintain the patient sleeping seems to be important in increasing survival rates in tetanus. The need for tracheotomies appeared to be reduced with the increased sedation. Mortality rates increased among the patients who had tracheotomies. Otologic surgical procedures do not appear to be indicated in the management of patients with otogenic tetanus.

Otologic complications of radiation therapy.

Radiation therapy has proved to be a valuable modality in the management of patients with nasopharyngeal tumors. Routine follow-up of patients in the tumor clinic of the University of Illinois Eye and Ear Infirmary appeared to indicate an increasing incidence of otologic pathology. For this reason, a retrospective study focusing on the otologic findings in patients whose radiation therapy for nasopharyngeal tumors included the external auditory canal, middle ear space, or eustachian tube was performed. The results of this study are discussed in relationship to total radiation dosage, time of survival after therapy, and pretreatment otologic status. The complications covered a spectrum from intermittent serous otitis media to osteoradionecrosis of the external auditory canal. Possible contributing factors are discussed, and preventive neasures are suggested.