Objective: Otosclerosis is an underlying disease of the bony labyrinth. This disorder, occurring only within the area of a person’s temporal bone, is characterized by a progressive hearing loss and tinnitus. Material and Methods: The study looked for the answer to the question of whether the presence or absence of Carhart notch in the presurgical tonal audiogram affects the final outcome of the otosclerosis surgery. Results: The analysis included 140 patients operated on for the first time due to otosclerosis between 2010 and 2016. The study group consisted of 107 women aged from 19 to 62 (average age: 40.33) and 33 men aged 27 to 59 (average age: 38.23). Analysis showed a statistically better result of stapedotomy in patients without the notch than in the same procedure in patients with the notch present. The opposite situation occurred in the case of stapedectomy. Conclusion: (1) The presence of a refraction of the bone conduction curve with a depth of 10 to 20 dB at a frequency of 2000 Hz (the so-called Carhart notch) in the presurgical tonal audiogram is an unfavorable prognostic factor in relation to closing the cochlear reserve and improving bone conduction after the stapedotomy. (2) Regardless of the presence or absence of Carhart notch in the presurgical tonal audiogram, stapedotomy is the procedure with the highest efficiency in the treatment of otosclerosis.
Unchanged mucous lining middle ear spaces and intact ossicular chain are crucial for bone conduction improvement after otosurgery. Scars, especially in round window, are poor prognostic factor for hearing improvement. Cleaning of the middle ear from granulation has an positive influence for bone conduction threasholds changes.
Introduction: Septal perforations are among the most common craniofacial defects. The causes of septal perforations are varied. Objectives: The purpose of the study was to develop a septal cartilage implant biomaterial for use in the reconstruction of nasal septal perforations and prepare personalized implants for each patient individually using 3D printing technology. Methods: Fragments of septal nasal cartilage from 16 patients undergoing surgery for a deviated nasal septum were analyzed to establish microfeatures in individual samples. A scanning electron microscope was used to estimate the microstructure of the removed septal cartilage. 3D models of porous scaffolds were prepared, and a biomaterial was fabricated in the shape of the collected tissue using a 3D printer. Results: Of the various materials used in the Fused Deposition Modeling (FDM) technology of 3D printing, PLLA was indicated as the most useful to achieve the expected implant features. The implant was designed using the indicated pre-designed shape of the scaffold, and appropriate topography, geometry and pore size were included in the design. Conclusions: The implant’s structure allows the use of this device as a framework to carry nanoparticles (antibiotics or bacteriophages). It is possible to create a porous scaffold with an appropriately matched shape and a pre-designed geometry and pore size to close nasal septal perforations even in cases of large septal cartilage defects.
BackgroundMiddle ear surgery aims to eliminate pathology from the middle ear, improve drainage and ventilation of the postoperative cavity, and reconstruct the tympanic membrane and ossicles.The aim of this work is to define the factors that affect ABG (air-bone gap) and bone conduction in the patients operated on due to chronic otitis media.Material/MethodsA prospective analysis of patients operated on due to diseases of the middle ear during 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were analyzed.The analysis encompassed patients who had undergone middle ear surgery. The patients were divided into several groups taking into account the abnormalities of the middle ear mucous and damage of the ossicular chain observed during otosurgery.ResultsA significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a PORP was used in the reconstruction. Granulation tissue was an unfavorable factor of hearing improvement following tympanoplasty.A significant improvement of bone conduction was observed in the patients with dry perforation without other lesions in the middle ear.The elimination of granulation lesions was a positive factor for the future improvement of the function of the inner ear.ConclusionsThe presence of granuloma-related lesions in the middle ear spaces is likely to impede hearing improvement.Damage to the ossicular chain rules out the possibility of bone conduction improvement after surgery.The prognosis on tube-related simple chronic otitis media after myringoplasty, with the preserved continuity of the ossicular chain, consists of closing the ABG and leads to significant improvement of bone conduction.
Background Otosclerosis is a primary disease of the bony labyrinth. In the course of otosclerosis, abnormal resorption and recalcification of the endochondral layer of the temporal bone is observed. The otosclerotic process most commonly develops in the anterior part of the oval window. Material/Methods We analyzed stapes superstructures from 4 patients undergoing surgery for otosclerosis. The first step involved tissue assessment under a scanning electron microscope. The resulting images were analyzed in terms of morphological changes. The stapes superstructure was then divided into small “ossicles”, including fragments from the closest vicinity of the stapes footplate and a fragment of the head of the stapes. This material was examined using a scanning electron microscope with a unit for chemical analysis in microareas. Results Chemical analysis confirms the appearance of considerable quantities of the following elements: carbon, oxygen, potassium, and calcium, and the appearance of small quantities of sodium and magnesium. Based on a detailed analysis of the chemical composition, these fragments could represent a calcium phosphate compound from the following system: CaO-P 2 O 5 -H 2 O. Fragments of the superstructure from the region closest to the base of the stapes demonstrated a considerably larger presence of carbon, oxygen, and nitrogen, which most likely suggests an increased metabolic process in this region. Conclusions Our analysis revealed an increased metabolic activity in the closest vicinity of the otosclerotic focus, the fissula ante fenestram. The increased metabolism correlated with the bone tissue changes seen on scanning electron microscopy.
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