Although cholesteatomas are more commonly found in the middle ear and the mastoid, the disease can occur in the external ear canal. All cases of ear canal cholesteatoma treated by the author were reviewed. There were nine ears in seven patients, who had an average age of 62 years. The lesions ranged in size from a few millimeters to extensive mastoid destruction. Smaller lesions can be managed by frequent cleaning as an office procedure. Larger lesions require surgery, either canaloplasty or mastoidectomy. The otolaryngologist should suspect this disease in the elderly. Microscopic examination of the ear with meticulous cleaning of all wax, especially in elderly patients, is most useful in detecting early disease. Frequent applications of mineral oil to the canal should be used in the management of the disease and to prevent recurrence.
Noise levels of 155 tractors on 36 farms were studied. The range of noise levels at the driver's ear level with radios off and windows closed (if so equipped) was from 78 to 103 dB. Seventy-five percent of tractors without cabs had noise levels in excess of 90 dB, compared to only 18% of tractors with cabs. The use of a radio adds an average of 3.1 dB of noise. When some cab windows are open and the radio is on, an average of 4.2 dB is added to the cab noise. From the results of this study, the authors recommend hearing protection when time on a tractor with a cab approaches 3 to 4 hours and when time on a tractor without a cab approaches 1.5 to 2 hours. Limited use of the radio is also recommended.
The ponticulus is present in the majority of ears. It is best defined as a bridge of bone from the pyramidal eminence to the promontory and most commonly occurs as a thin, bony structure. This definitive study of the ponticulus will allow the otologic surgeon to better remove disease from the posterior tympanum.
This three-part study explored the difficult problem of dissecting the facial nerve through the soft tissues of the mastoid tip. The anatomic relationships of the mastoid tip tissues were measured in 20 specimens. At the stylomastoid foramen, the facial nerve lies an average of 9 mm from the digastric muscle, 11 mm from the external canal, and 21 mm from the nerve's parotid bifurcation. The histologic relationships between the nerve sheath and the mastoid tip fascial tissues were examined in 10 specimens. The tight adherence of sheath and fascial fibers prevent their easy separation. By applying this new anatomic and histologic knowledge on cadaver specimens, the author refined a technique for the safe dissection of the facial nerve through mastoid tip tissues. This technique has proven successful in the operating room.
Transseptal transsphenoidal approach to the pituitary fossa is a well-described and effective procedure. This article relates our experience with this procedure with specific emphasis on the nasal septum, both before and after surgery. It has been our experience that this surgery has minimal local complications in the nose and it would appear to improve septal alignment with subjective improvement in nasal function as reported by the patient. A total of 55 patients undergoing a sublabial transseptal transsphenoidal approach to the pituitary fossa were included in this study. All other approaches to the pituitary gland were excluded. Visual changes and headaches were the most common presenting symptoms, occurring alone or in combination in 28 (51%) patients. Twelve (22%) patients reported symptoms of nasal obstruction before surgery and only one (2%) after surgery. A moderately or severely deviated septum was noted in 30 (54%) patients before surgery and 4 (7%) patients after surgery. The septum was straight in 21 (38%) patients before the procedure and 49 (89%) patients after the surgery. Sinusitis developed in two patients, and one patient subsequently required surgery. No synechiae or septal perforations were noted.
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