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6 results

  • Ossicular chain mobilisation versus reconstruction in surgery for isolated malleus and/or incus fixation: systematic review and meta-analysis

  • W L Crutcher, P Tassone, S Pelosi
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 10 / October 2018
    Published online by Cambridge University Press:
    05 October 2018, pp. 858-865
    Print publication:
    October 2018
  • Objective

    To compare post-operative audiometric outcomes for the two prevailing surgical approaches for isolated malleus and/or incus fixation: ossicular mobilisation with preservation of the ossicular chain, and disruption and reconstruction of the ossicular chain.

    Methods

    A search was conducted, in December 2016, of PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature articles written in English. Papers presenting original data regarding post-operative audiometric outcomes in patients who underwent surgical treatment for malleus and/or incus fixation with a mobile and intact stapes were included. A risk of bias assessment was performed on the 14 selected papers and a tier system was developed. Meta-analysis was accomplished by comparing pooled rates of surgical success by chi-square test and calculating odds ratios by logistical regression. Analysis was performed using Revman5 and R software.

    Results and conclusion

    Analysis of the literature revealed no differences in audiometric outcomes between ossicular chain mobilisation and ossicular chain reconstruction in patients with isolated malleus and/or incus fixation. A large, prospective study comparing both short- and long-term hearing results for ossicular chain mobilisation and ossicular chain reconstruction in this population may identify whether a difference in outcomes exists between the two approaches.

  • 11 - Surgical management of spasticity

    • By Patrick Mertens, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France, Marc Sindou, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book:
    Upper Motor Neurone Syndrome and Spasticity
    Published online:
    22 August 2009
    Print publication:
    24 April 2008, pp 193-213

  • Summary

    Spasticity is one of the commonest sequelae of neurological diseases. In most patients spasticity is useful in compensating for lost motor strength. Nevertheless, in a significant number of patients it may become excessive and harmful, leading to further functional losses. Stimulation of spinal cord was developed in the 1970s on the basis of the 'gate-control theory' of Melzach and Wall for the treatment of neurogenic pain. This method has been found to be partially effective in the treatment of spastic syndromes, such as those encountered in multiple sclerosis or spinal cord degenerative diseases, such as Strumpell-Lorrain syndrome. Orthopaedic procedures can reduce spasticity by means of muscle relaxation that results from tendon lengthening and may help in restoring articular function when deformities have become irreducible. Current techniques for correcting excessive shortness of the muscle tendon assembly are muscular desinsertion, myotomy, tenotomy and lengthening tenotomy.

  • 10 - Intrathecal baclofen for the control of spinal and supraspinal spasticity

    • By David N. Rushton, Consultant in Neurological Rehabilitation Frank Cooksey Rehabilitation Unit, Kings College Hospital, London, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book:
    Upper Motor Neurone Syndrome and Spasticity
    Published online:
    22 August 2009
    Print publication:
    24 April 2008, pp 181-192

  • Summary

    Penn and Kroin first described the benefits reporting the treatment of six patients with severe continuing spasticity and spasms resulting from spinal injury or multiple sclerosis. Baclofen is hydrophilic and crosses the blood-brain barrier poorly. Spinal intrathecal administration bypasses the blood-brain barrier, allowing effective treatment of spasticity with a dose range that is 100 to 1000 times smaller than that required for oral treatment. The plasma levels of baclofen in patients undergoing intrathecal infusion have been found to be vanishingly low. Intrathecal baclofen (ITB) reduces spasticity, as clinically assessed using the Ashworth scale. Flexion or extension spasms, more common in the lower limbs, may occur spontaneously or in response to cutaneous stimuli in association with spasticity. The threshold of the electrically induced flexion reflex in the lower limb has been found to be reduced in spinal spasticity and the response amplitude to be increased.

  • Tympanosclerosis: review of literature and incidence among patients with middle-ear infection

  • Saad Asiri, Alaa Hasham, Fatma Al Anazy, Siraj Zakzouk, Adel Banjar
  • Journal:
    The Journal of Laryngology & Otology / Volume 113 / Issue 12 / December 1999
    Published online by Cambridge University Press:
    29 June 2007, pp. 1076-1080
    Print publication:
    December 1999

  • The aim of the study was to review the literature of tympanoscierosis especially its pathogenesis, to study the general incidence of tympanoscierosis among patients with chronic suppurative otitis media (CSOM), its association with cholesteatoma and also the type of hearing loss as well as its relation to the degree and site of tympanosclerosis.

    Seven hundred and seventy-five patients with CSOM were studied retrospectively. A full history was taken and thorough ENT examinations were carried out. Pure tone audiograms (PTA) of all patients were done and analysed. The operative finding of tympanosclerosis as well as middle-ear status were inspected.

    The incidence of tympanosclerosis was found to be 11.6 per cent (90 patients out of 775 CSOM cases). Most tympanosclerosis cases had dry ear, (85.6 per cent). Of the 57.8 per cent who had myringosclerosis, their PTA showed an AB gap 20–40 dB. When sclerosis affect both the tympanic membrane and middle ear, 61 per cent of patients had an AB gap >40 dB. The association of cholesteatoma and tympanosclerosis may be regarded as uncommon, 2.2 per cent.

    The exact aetiology and pathogenesis of tympanosclerosis is as yet not well known. Our study concentrated on the clinical picture of tympanosclerosis among patients with CSOM. The majority of hearing loss associated with tympanosclerosis was of the conductive type.

  • Surgery of tympanosclerosis

  • Syed Akhtar Kamal
  • Journal:
    The Journal of Laryngology & Otology / Volume 111 / Issue 10 / October 1997
    Published online by Cambridge University Press:
    29 June 2007, pp. 917-923
    Print publication:
    October 1997

  • Eighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (x2) and also plotted in the Glasgow Benefit Plot.