bluuebunny/crossref_metadata_2025 huggingface dataset:
Eye Discomfort and Air Pollution
Authors: Versura Piera , Profazio Vincenzo , Cellini Mauro , Torreggiani Alberto , Caramazza Roberto
Published: April 2003

Discomfort eye syndrome (DES) comprises a series of ‘minor’ subjective symptoms in patients where no relevant clinical signs are observed suggesting ocular disease. Our study includes 100 DES patients, excluding video terminal users, selected from the First Aid Service of our Department over two peak periods in both winter and summer time. The Schirmer test I, ferning test, breakup time and conjunctival cytology (scraping and imprint) were performed and data were related to sex, age and air pollution indexes, recorded in the patients’ living zones. Our results demonstrate that: (i) the ocular surface cytology and the analysis of tear film changes provide significant information in those patients where no other clinical signs are evident; (ii) DES symptoms are more frequent in women than in men (ratio about 2:1), both with ages over 51 years; (iii) DES is significantly associated with ocular surface inflammation, as detected by cytological methods, and (iv) ocular surface subclinical inflammation and ocular dryness are related to high concentrations of atmospheric polluters, in both sexes.
Usefulness of Fluorescein Angiographyin Predicting the Size of the Atrophic Areaafter Surgical Excision of Choroidal Neovascularization
Authors: Giovannini Alfonso , Mariotti Cesare , Scassellati-Sforzolini Baldo , D’Altobrando Edmondo
Published: April 2003

Twenty consecutive patients affected by age-related macular degeneration (AMD) complicated by subfoveal and juxtafoveal choroidal neovascularization (CNV) underwent a surgical removal of the membrane. The patients were divided into two groups: group A = CNVs ≤2 months; group B = CNVs >2 months. The surgical excision of the CNV was also performed in 10 cases of multifocal choroidopathies and idiopathic CNV. The atrophic area after surgery was larger in AMD than in multifocal choroidopathies or idiopathic CNV (p < 0.001). In AMD the atrophic area after surgical excision of the CNV was larger in group B than in group A (p < 0.05). The area of the CNV + the hyperfluorescent halo observed in the late phase of fluorescein angiography before surgery was 84.6% of the atrophic area after surgery. Our observations could be helpful to the surgeon for a more accurate evaluation of the expected size of the atrophic area after surgical removal of a CNV, thus allowing a better selection of the patients for whom surgery could be of some benefit.
Blindness Incidence in Germany
Authors: Krumpaszky H.G. , Lüdtke R. , Mickler A. , Klauss V. , Selbmann H.K.
Published: April 2003

Few data on the incidence of blindness in Germany are available. We analysed causes of legal blindness for the region Württemberg-Hohenzollern (population 5.5 million) in order to help fill in this gap. Material and Methods: Population-based investigation on the incidence of legal blindness (visual acuity <1/50) based on materials from the social servies. Age-dependent blindness incidences were modelled via logistic regression models. Results: 647 blind persons were newly registered in 1994 (blindness incidence 11.6/100,000). The blindness incidence is moderate in infants (4.5/100,000) and decreases further during childhood. At the age of 20 years, the incidence again rises to the former level and remains relatively constant. After the age of 60 years, the incidence increases sharply: 5-year odds ratios are 1.76 (CI: 1.68–1.85) in women and 1.72 (CI: 1.60–1.84) in men. The blindness incidence is higher in women, 15.6/100,000, compared to 12.2/100,000 in men. The major causes of blindness are: macular degeneration, 3.92/100,000; diabetic retinopathy, 2.01/100,000; glaucoma, 1.6/100,000; high myopia, 0.77/100,000; optic atrophy, 0.68/100,000; central nervous system-triggered blindness; 0.56/100,000, and tapetoretinal degenerations, 0.52/100,000. Discussion: Due to monetary incentives for the blind persons, social service files offer accurate and complete data. Besides macular degeneration, glaucoma and diabetic retinopathy are major causes of blindness. Thus, this study suggests further blindness prevention activities for diabetic retinopathy and glaucoma.
Refractive Errors and Ocular Motility Disorders in Preterm Babies with and without Retinopathy of Prematurity
Authors: Ricci Benedetto
Published: April 2003

Ocular motility, refraction and visual acuity (VA) were evaluated at the age of 4 years in 136 preterm infants with gestational ages (GAs) at birth of less than 32 weeks. Group 1 (non-retinopathy of prematurity, ROP) included 87 children that had never developed ROP. Group 2 contained 19 children whose ROP had regressed spontaneously. Group 3 (cryo-ROP) was composed of 30 patients who had undergone cryotherapy for severe ROP. Strabismus was found in 13.9% of the total population. χ2 analysis revealed that strabismus was significantly (p < 0.01) associated with prematurity (i.e. GA <29 weeks), ROP and cryotherapy. Myopia of more than 3 dpt was significantly (p < 0.001) more common in the cryo-ROP infants than in the regressed-ROP and non-ROP groups. The distribution of hypermetropia was similar in all three groups. VA was measured with the E chart. Of the 272 eyes examined, 251 (92.3%) displayed VA of more than 20/25. The majority of these eyes were from the non-ROP group (65.4%), 15.3% had regressed ROP and 21.1% belonged to the cryo-ROP group. Fifteen eyes (8 non-ROP, 3 regressed ROP and 4 cryo-ROP) presented VAs between 20/25 and 20/60. VA of less then 20/60 was found in 6 eyes (2 non-ROP, 1 regressed ROP, 3 cryo-ROP). Cryotherapy did not appear to preclude the development of good VA.
Secondary Glaucoma in Patients with Uveitis
Authors: Merayo-Lloves Jesús , Power William J. , Rodriguez Alejandro , Pedroza-Seres Miguel , Foster C. Stephen
Published: April 2003

Purpose: To evaluate the prevalence of secondary glaucoma (SG), clinical forms of uveitis more frequently associated with glaucoma, and describe the treatment and complications encountered in a cohort of patients with glaucoma and uveitis during a 10-year period. Methods: The hospital records of patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. Results: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs’ iridocyclitis (19%), juvenile rheumatoid arthritis-associated iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leading types of uveitis associated with SG. Despite aggressive medical and surgical therapy, SG was associated with progressive visual field loss and optic nerve damage in 39 patients (33%). Conclusion: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigilance for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of glaucoma as an additional vision-robbing complication of uveitis.
The Effect of Hydroxyurea on Rabbit Subconjunctival Fibroblast Culture and Use of Hydroxyurea in Rabbits after Glaucoma Filtration Surgery
Authors: Yücel İclal , Bagci Gülseren , Duranoglu Yaşar , Öztürk Arzu , Aksu Güler , Lüleci Güven
Published: April 2003

In an in vitro study, rabbit subconjunctival fibroblasts were cultured and the effects of an antineoplastic drug, hydroxyurea (HU), on fibroblast proliferation and fibroblast attachment was investigated. The effects of HU were compared with those of mitomycin C (MMC). Different concentrations of HU and MMC were added to culture medium. The HU doses which led to 50% of inhibition (ID50) and the dose which led to about 90% of inhibition (subtoxic high dose, STHD) were determined to be 8 and 1,000 μg/ml, respectively. ID50 of MMC and its STHD which led to about 100% inhibition were found to be 0.01 and 1 μg/ml, respectively. Reversibility studies revealed that inhibition disappeared depending on the dose and incubation period of both HU and MMC. In an in vivo study, glaucoma filtration surgery (GFS) was performed in rabbits which were treated with HU (treatment group) and distilled water (control group). Tissue samples were taken from the subconjunctival area treated at 1 h, 1 day, 5 days and 30 days postoperatively. The biopsy specimens were then placed in tissue culture media. Fibroblast outgrowth rates detected in the HU group were found to be significantly lower than those in the control group in the specimens taken at the end of the first hour. The difference was significant on culture days 9–15 in the biopsy specimens taken on day 1 while it was not significant in those taken on days 5 and 30.
Effects of 0.005% Latanoprost on Optic Nerve Head and Peripapillary Retinal Blood Flow
Authors: Seong Gong Je , Lee Hyung Keun , Hong Young Jae
Published: April 2003

Fifty-two eyes of 26 healthy volunteers were recruited for evaluating the effects of 0.005% latanoprost on optic nerve head (ONH) and peripapillary retinal blood flow. In a randomized double-blind design, one eye received one drop of 0.005% latanoprost and its fellow eye received one drop of a placebo eyedrop. Intraocular pressure (IOP), ONH and peripapillary retinal blood flow were measured with Heidelberg retinal flowmetry (HRF) before, 2 and 24 h after administration of eyedrops. IOP was decreased significantly in latanoprost-treated eyes at 2 and 24 h after administration (p < 0.05). In the volume, flow or velocity of ONH and peripapillary retina, there were no significant changes from the baseline values at 2 and 24 h after latanoprost administration in either latanoprost-treated eyes or their fellow eyes (p > 0.05). No significant differences were found in the measured quantities between latanoprost-treated eyes and their fellow eyes at each time point (p > 0.05). This result may suggest that 0.005% latanoprost in healthy subjects does not have any adverse effect on ONH and peripapillary retinal blood flow.
Corneal Endothelial Changes and Aqueous Flare Intensity in Pseudoexfoliation Syndrome
Authors: Wang Lulu , Yamasita Ryoko , Hommura Sachiko
Published: April 2003

Purpose: To determine the changes of corneal endothelium in pseudoexfoliation (PEX) syndrome and the relations between their changes and aqueous flare intensity. Methods: 26 eyes with PEX syndrome, 17 clinically unaffected fellow eyes and 27 normal age-matched eyes were studied. The corneal endothelium of the eyes was examined using a specular microscope, and the aqueous flare intensity of the eyes was measured using a laser flare cell meter. Results: The corneal endothelial density significantly decreased both in the eyes with PEX and in the clinically unaffected fellow eyes compared to the normal control eyes (p < 0.001, p < 0.01). The acqueous flare intensity significantly increased in PEX syndrome (p < 0.01). There was a significantly inverse correlation between the corneal endothelial cell density and the aqueous flare intensity in PEX. Conclusion: A decrease in corneal endothelial cells was quantitatively identified in PEX syndrome. This change might have a relationship with a disorder of the blood-aqueous barrier in this syndrome.
Lipoid Proteinosis (Urbach-Wiethe Disease)
Authors: Costagliola C. , Verolino M. , Landolfo P. , Winkler N.R. , Mastropasqua L. , Landolfo V.
Published: April 2003

The aim of this study has been to assess the clinical presentation and biochemical profile of lipoid proteinosis within a defined pedigree. Glycoprotein analysis was compared to normal values in an attempt to define a biochemical phenotype. Six affected family members were identified with variable degrees of disease expression. The most likely mode of inheritance is autosomal recessive due to consanguinity. Routine laboratory investigations were normal in all family members tested. The total content of mucopolysaccharides, sialic acid and hexosamine in biopsed tissue was significantly lower than normal. Our findings demonstrate that a defect in glycoprotein synthesis, possibly enzymatic, may be the cause of lipid proteinosis and its protean clinical manifestations.
Cataract Induced by Short-Term Administration of Large Doses of Busulfan: A Case Report
Authors: Kaida Tomoko , Ogawa Tsukihiko , Amemiya Tsugio
Published: April 2003

Busulfan is a carcinostatic which is used for myelocytic leukemia. A 42-year-old Japanese woman given high doses of busulfan for a short time was referred to us because of decreased visual acuity and blurred vision in both eyes. She received 212 mg/day of busulfan for only 4 days. Ophthalmoscopic examination demonstrated a posterior polar subcapsular opacity of the lens in both eyes. Although the occurrence of cataract due to busulfan has been reported after long-term administration of busulfan, this is the first clinical case of cataract caused by high doses of busulfan for a short period. It is necessary to pay more attention to busulfan cataract.
Ultrastructure of Retinal Cells Transplanted to the Rabbit Choroid
Authors: Lütjen-Drecoll Elke , Bergström Anders , Ehinger Berndt
Published: April 2003

Purpose: Allogenic rabbit-to-rabbit retinal cell transplants survive in the choroid, which is not as expected because it has not been shown that this is an immune-privileged site. We have therefore examined the ultrastructure of such transplants, looking for features that might explain the phenomenon. Methods: Rabbit retinal tissue fragment transplants were produced with previously described methods. The donor age was 15 days and the transplants were examined by standard electron microscopy when the transplants were 1–2 months (3 transplants) or 3–4 months old, of postconception age (3 transplants). Results: The transplants survived and developed as expected from previous observations. Rosettes were seen, but they were not as common as in transplants produced with the same technique in the subretinal space of rabbits. Photoreceptor outer segments were not seen in the transplants. At 1 month, there was an incomplete sheath of Müller cells around the transplants, and a complete one at 3–4 months. There was also a well-developed basement membrane around the transplant at 3–4 months, but less so at 1 month. Blood vessels did not enter the transplant. The fenestrations in the choriocapillaris were not affected as long as the pigment epithelium was normal. Conclusions: The enclosure of the transplants by Müller cells might help to insulate them from the immune system of the host, but it is a late phenomenon and it is not likely to have much effect for the first few weeks after the transplantation. We suspect that either the rabbit choroid is an immune-privileged site, even though there is no previous direct evidence for this, or that the retinal tissue itself is responsible for the prolonged survival at this site.
The Ageing Lens
Authors: Bron A.J. , Vrensen G.F.J.M. , Koretz J. , Maraini G. , Harding J.J.
Published: April 2003

The human lens grows by a process of epithelial cell division at its equator and the formation of generations of differentiated fibre cells. Despite the process of continuous remodelling necessary to achieve growth within a closed system, the lens can retain a high level of light transmission throughout the lifetime of the individual, with the ability to form sharp images on the retina. Continuous growth of the lens solves the problem imposed by terminal differentiation within a closed, avascular system, from which cells cannot be shed. The lens fibre tips arch over the equator to meet anteriorly and posteriorly and form branching sutures of increasing complexity. The stages of branching may create the optical zones of discontinuity seen on biomicroscopy. The lens is exposed to the cumulative effects of radiation, oxidation and postranslational modification. These later proteins and other lens molecules in such a way as to impair membrane functions and perturb protein (particularly crystallin) organisation, so that light transmission and image formation may be compromised. Damage is minimised by the presence of powerful scavenger and chaperone molecules. Progressive insolublisation of the crystallins of the lens nucleus in the first five decades of life, and the formation of higher molecular weight aggregates, may account for the decreased deformability of the lens nucleus which characterises presbyopia. Additional factors include: the progressive increase in lens mass with age, changes in the point of insertion of the lens zonules, and a shortening of the radius of curvature of the anterior surface of the lens. Also with age, there is a fall in light transmission by the lens, associated with increased light scatter, increased spectral absorption, particularly at the blue end of the spectrum, and increased lens fluorescence. A major factor responsible for the increased yellowing of the lens is the accumulation of a novel fluorogen, glutathione-3-hydroxy kynurenine glycoside, which makes a major contribution to the increasing fluorescence of the lens nucleus which occurs with age. Since this compound may also cross-link with the lens crystallins, it may contribute to the formation of high-molecular-weight aggregates and the increases in light scattering which occur with age. Focal changes of microscopic size are observed in apparently transparent, aged lenses and may be regarded as precursors of cortical cataract formation.
Pigment Epithelium Defects after Submacular Surgery for Choroidal Neovascularization: First Results
Authors: Hörle Steffen , Pöstgens Harald , Schmidt Jörg , Kroll Peter
Published: April 2003

It was the aim of this study to compare postoperative pigment epithelium defects after submacular surgery for well-defined choroidal neovascularization (CNV) with preoperative fluorescein angiogram (FAG), indocyanine green angiogram (ICG), and intraoperative findings of the excised neovacularization. Surgical removal of the CNV was videotaped. By means of a gauge the absolute size of an anatomic structure was determined which was visible on video, FAG, and ICG as well. Postoperatively another FAG was performed to further examine the funduscopically visible pigment epithelium defect. By comparison with the above-mentioned anatomic structure it was thus possible to determine the exact size of CNV and pigment epithelium defect. The extent of the pigment epithelium defect as determined on postoperative FAG after submacular surgery surpasses the size of CNV as measured in FAG, ICG, and anatomical preparation.
Using Conjunctival Swab with Polymerase Chain Reaction to Aid Diagnosis of Cytomegalovirus Retinitis in AIDS Patients
Authors: Liu Jorn-Hon , Hsu Wen-Ming , Wong Wing-Wai , Wang Jaang-Jiun , Liu Wu-Tse , Liu Cheng-Yi , Chiou Shih-Hwa
Published: April 2003

Conjunctival swabs were used in combination with polymerase chain reactions (PCR) or virus culture to aid to confirm the diagnosis of cytomegalovirus (CMV) retinitis in AIDS patients. Based on ophthalmoscopic findings, 13 AIDS patients were diagnosed as having CMV retinitis and treated with systemic ganciclovir from January 1997 to December 1998. Nine of 13 AIDS patients with CMV retinitis were found to be positive for CMV DNA by using a conjunctival swab with PCR (CS-PCR). CMV was also isolated from the conjunctival swab culture in 2 AIDS patients with CMV retinitis. Following 1 month of systemic ganciclovir treatment, except for 1 patient who had disease progression and remained positive for CMV DNA by using CS-PCR, 12 patients were negative for CMV with a concordant lesion regression. Results of this study also indicate that this CS-PCR method is valuable for confirming the diagnosis of CMV retinitis and monitoring the ganciclovir effect on the treatment of CMV retinitis in AIDS patients.
The Cutler-Beard Bridge Flap Technique with Use of Donor Sclera for Upper Eyelid Reconstruction
Authors: Kadoi Chiharu , Hayasaka Seiji , Kato Tsuyoshi , Nagaki Yasunori , Matsumoto Masayuki , Hayasaka Yoriko
Published: April 2003

We evaluated the Cutler-Beard bridge flap technique with the use of donor sclera for upper eyelid reconstruction. The right upper eyelid of a 22-year-old man (case 1) was bitten by a dog. A mass in the left upper eyelid of an 85-year-old man (case 2) was excised. Major full-thickness defects of the eyelid with small loss of tarsus were reconstructed with the use of donor sclera. Good cosmetic results were obtained. Major full-thickness defects of the upper eyelid with small loss of tarsus may be effectively reconstructed by the Cutler-Beard technique with use of donor sclera.
Indocyanine Green Angiography in Fundus flavimaculatus
Authors: Schwoerer Joan , Secrétan Michel , Zografos Leonidas , Piguet Bertrand
Published: April 2003

Purpose: To describe the characteristic findings of fundus flavimaculatus (Stargardt disease) as seen on indocyanine green angiography. Methods: Twelve eyes of 6 consecutive patients with fundus flavimaculatus were studied by fundus color photographs, fluorescein angiography and indocyanine green angiography. Results: Indocyanine green angiography allowed visualization of small, clearly demarcated areas in which hypofluorescence increased over time, leading eventually to a large reticular pattern with small areas of normal-appearing choroid encircled by a well-defined network of hypofluorescent curvilinear lesions. These hypofluorescent flecks were present in all 12 eyes but corresponded only partially to the yellow flecks visible on biomicroscopy of the fundus. The peripapillary area was well preserved on indocyanine green angiography and the periphery did not show any visible abnormalities. Conclusions: The hypofluorescent curvilinear areas visualized on indocyanine green angiography form a reticular pattern that is similar to the polygonal shape of the watershed zones between terminal choroidal arterioles, which supply the choriocapillaris. These dark areas may reflect choriocapillaris defects secondary to lysis of lipofuscin-engorged retinal pigment epithelial cells. The typical lesions of fundus flavimaculatus thus seem to be situated in areas of least vascular supply. Their absence in the peripapillary area, which benefits from anastomotic vascular connections, would support this hypothesis.
Ultrasound Biomicroscopic Analysis of the Human Ciliary Body after 1 and 2% Pilocarpine Instillation
Authors: Arakawa Akira , Tamai Makoto
Published: April 2003

We examined ciliary body thickness (CBT) of 11 human eyes after 1% followed by 2% pilocarpine instillation using ultrasound biomicroscopy. The examination revealed that CBT decreased in 2 eyes after 1% pilocarpine treatment but increased after 2% pilocarpine. In the eyes with decreased CBT by 1% pilocarpine, the pretreatment ciliary bodies were thicker and the changing rate of CBT induced by 2% pilocarpine, although not decreased, was also smaller than that in CBT-increased eyes. These findings showed that the ciliary body was under relatively strong stimulus of endogenous acetylcholine and has subsensitivity to both 1 and 2% pilocarpine in CBT-decreased eyes. Configurative changes in CBT-decreased eyes may be explained by the localization of different muscarinic receptor subtypes in different portions of the ciliary muscle.
Unusual Visual Evoked Potentials in Patients with Age-Related Macular Degeneration
Authors: Walter Peter , Königsfeld Pia , Soudavar Ferrial , Brunner Richard
Published: April 2003

Among a series of patients with age-related macular degeneration (ARMD), a few individuals could be identified showing larger amplitudes of pattern reversal visual evoked potentials (prVEP) after stimulation of a central 3° field compared to stimulation of a 13° field although in the majority of ARMD patients and in normals, VEP amplitudes increased with increasing field size. An analysis of prVEPs recorded after stimulation of different macular zones showed that the 3° central area and the perifoveal zone contributed differently to the 13° response or macular response. Perifoveal activity in this subgroup of ARMD patients seemed to mask the foveal contribution to the macular prVEP. The cortical magnification factor in ARMD may be higher than in normal controls. Small-field stimulation techniques are therefore also recommended in patients with central retinal pathology.
Hypothyroidism and Primary Open-Angle Glaucoma
Authors: Muñoz-Negrete Francisco J. , Rebolleda Gema , Almodóvar Francisca , Díaz Belen , Varela César
Published: April 2003

Objective: To test if there is an association between hypothyroidism and primary open-angle glaucoma (POAG) and the utility of routine study of thyroid function in these patients. Methods: The study was conducted in a case-control fashion. Seventy-five consecutive patients with a previous diagnosis of POAG and 75 control patients were prospectively evaluated for hypothyroidism. The levels of thyroid-stimulating hormone and free thyroxin were measured. Results: Hypothyroidism was revealed in only 2 patients with previous diagnosis of POAG (2.67%) and 3 patients of the control group (4%). Conclusions: As we have not been able to demonstrate the previously reported relationship between hypothyroidism and POAG, we cannot recommend the systematic screening for hypothyroidism in patients with POAG.
Palatal Mucoperiosteal Free Graft: Another Reconstruction Option for Oral Defects
Authors: Dulguerov Pavel , Kerner Marc M. , Marchal Francis , Lehmann Willy
Published: April 2003

Traditional methods of repair for medium-size (3–5 cm) oral defects include allowing granulation, primary closure, skin grafts, and buccal mucosal grafts. Each of these methods has several disadvantages, and all tend to result in significant scar contracture and often lack sufficient bulk. In 10 patients, the defect left by resection of cancer lesions was reconstructed with a free palatal mucoperiosteal graft. In all patients, the grafts survived with little contracture, allowing for adequate tongue mobility. Because of the thickness of the palatal mucoperiosteum, local depressions typically associated with floor of the mouth defects could be avoided. The palatal donor site was left to granulate and recovered in 2–3 weeks with little residual deformity. In 4 patients a through-and-through resection of a floor of the mouth cancer was performed in continuity with a neck dissection. A palatal mucoperiosteal free graft was utilized exclusively in the reconstruction, without the development of salivary fistula.
External Acoustic Meatus Cholesteatoma
Authors: Aymat A. , Morgan D.W. , Henderson J.
Published: April 2003

Cholesteatoma is a condition usually affecting the middle ear and mastoid, but in certain cases it can be found in the external ear canal. It usually affects elderly people and presents with chronic otorrhoea and dull otalgia. The disease can progress to extensive mastoid destruction. Small lesions can be treated with regular microscopic debridement in out-patients while larger lesions require surgery to eradicate the cholesteatoma sac. We present 2 cases of external ear cholesteatoma to add to the less than 50 cases reported to date.
Confirmation of G. von Békésy’s Theory of Paradoxical Wave Propagation along the Cochlear Partition by Means of Bone-Conducted Auditory Brainstem Responses
Authors: Schratzenstaller Bruno , Janssen Thomas , Alexiou Christoph , Arnold Wolfgang
Published: April 2003

In order to investigate the propagation time of the traveling wave in the cochlea after boneconduction stimulation of the inner ear, bone-conducted auditory brainstem responses (ABRs) were recorded in 6 normally hearing subjects after masking the basal cochlear region using high-pass filtered noise. As in air-conducted ABRs, Jewett V wave latency is delayed corresponding to the propagation time of the traveling wave front traversing the desynchronized hair cell region. These results support the theory of paradoxical wave propagation proposed by von Békésy in 1952, who postulated that wave motion always starts from the stiffest part of the basilar membrane, independent of the location of the vibrating force. In addition, we also found a latency delay of the Jewett V wave of bone-conducted ABRs in 8 patients with high-frequency hearing loss which corresponded to the severity of their hearing impairment.
Trigeminal Neuralgia Associated with Sinusitis
Authors: Sawaya Raja A.
Published: April 2003

When a patient presents with trigeminal neuralgia, one usually thinks of a vascular loop at the root entry zone of the nerve and consequently of vascular decompression. An image of sinusitis on the MRI may be considered an incidental finding. We present a case of an elderly woman who experienced severe neuralgic pain in the distribution of the trigeminal nerve on the left side following a mild upper respiratory tract infection. Routine MRI revealed severe sinusitis with no pathology in the brain. Following antibiotic treatment for the sinusitis, the symptoms of the neuralgia resolved completely and no other therapy was necessary. A review of the literature reveals a wide variety of etiologies for trigeminal neuralgia. A vascular loop compressing the nerve may be the most frequent cause of trigeminal neuralgia. Nevertheless, other etiologies must be considered prior to decompressive surgery since some can be treated medically.
Scala vestibuli Insertion in Cochlear Implantation: A Valuable Alternative for Cases with Obstructed Scala tympani
Authors: Kiefer Jan , Weber Alexander , Pfennigdorff Thomas , von Ilberg Christoph
Published: April 2003

Insertion of a sufficient number of electrodes is important for a successful use of cochlear implants. We investigated the results of scala vestibuli insertion for cochlear implantation in cases of obstructed scala tympani. In a series of 200 cochlear implantations, scala vestibuli insertion was successfully performed in 4 cases with obstruction of the scala tympani. Etiologies included a temporal bone fracture, severe otosclerosis and malformations of the cochlea. The maximum insertion depth obtained via the scala vestibuli was 30 mm. Postoperative results were comparable to patients in whom conventional scala tympani insertion was performed. No adverse effects related to the site of insertion were observed. Scala vestibuli insertion offers a valuable alternative in cases of obstructed scala tympani that can be employed for a variety of etiologies.
Pneumococcal Toxins Reversibly Affect Cochlear Electrophysiology
Authors: Kubo Takeshi , Anniko Matti , Hsu Wey-Jim , Lundholm Monica
Published: April 2003

Objectives: Streptococcus pneumoniae (pneumococcus) produces various toxic proteins such as pneumolysin, autolysin, neuraminidase, hyaluronidase and pneumococcal surface protein A. To evaluate effects on the sensorineural component of hearing of such an infection in the middle ear a sterile suspension of pneumococcus containing all these toxins was instilled into the round window niche. Material and Methods: Inner ear function was evaluated by a frequency-specific auditory brainstem response (ABR) technique using the rat as experimental animal. Both ABR threshold curves and intensity-latency (I-L) curves were investigated. Results: The electrophysiological effects of pneumococcal toxin on the middle and the inner ear were moderate. Sensorineural hearing loss appeared from 1 day after instillation especially at high frequencies (31.5-20 kHz) and gradually extended into the frequencies 16, 14 and 12 kHz. The threshold impairment was reversible and improved within 2 weeks after exposure. The mean threshold change ranged from 5 to 10 dB at high frequencies. Conclusions: Our experimental results are compatible with previously reported clinical findings. The I-L curve investigation was useful to distinguish the changes due to conductive or sensorineural or mixed type of hearing loss. The I-L curve is more accurate than ABR threshold diagrams to identify minor electrophysiological changes of the cochlea.
A Venous Malformation of the Neck
Authors: Küppers G.L.E. , Eichhorn E. , Hoeve L.J. , Verwoerd C.D.A.
Published: April 2003

The most common cause of a mass in the neck, which appears only during the Valsalva manoeuvre, is a laryngocele. Less common are venous malformations in the neck, especially in children. We report a 5-year-old boy with a progressively enlarging tumour in the neck that proved to be a malformation between the common facial vein and external jugular vein. Comparable ultrasonography and computerized tomography are the diagnostic methods to distinguish the pathology. Surgical excision was carried out successfully.
Analyse der Ultraschallbildsequenzen von Zungenbewegungen peripher und zentral verursachter Schluckstörungen
Authors: Wein Berthold B. , Neuschaefer-Rube Christiane , Fischer-Wein Gerlinde , Angerstein Wolfgang , Klajman Stanislav , Günther Rolf W.
Published: April 2003

Fragestellung: Ziel dieses Beitrages war die Untersuchung, ob sich bei peripher und zentral bedingten Schluckstörungen im oralen Bereich typische Ablaufmuster der Zungenbewegung differenzieren lassen. Patienten: In dieser Arbeit wurden 86 Videosequenzen von 66 Patienten mit Schluckbeschwerden untersucht. Die Krankheitsbilder wurden in peripher (n = 27) und zentral (n = 39) verursachte Störungen eingeteilt. Methode: Digitalisierte Videoaufzeichnungen von Zungenbewegungen beim Schlucken bildeten das Ausgangsmaterial für die nachfolgende computergestützte Analyse. Diese erfolgte in Form einer interaktiven Konturierung des Zungenrückens, wobei die erhaltenen Konturen im Zeitverlauf der Bildfolge zusammengestellt eine Pseudo-3D-Darstellung ergaben. Auf der Grundlage der so erhaltenen Abbildungen erfolgten eine Zungenbewegungsanalyse einzelner Schluckphasen sowie eine klinische Differenzierung unterschiedlicher Schluckablaufvarianten. Ergebnisse: Bei Patienten mit oralen Schluckstörungen konnten folgende Schluckablaufvarianten ermittelt werden: Doppelschluckakt, Schluckakt mit geordneter Zusatzbewegung, mit geringem Bewegungsumfang und mit ungeordneten Zusatzbewegungen. Während in der Patientengruppe mit peripher bedingten Bewegungsstörungen hauptsächlich Schluckakte mit geringem Bewegungsumfang vorkamen, überwogen bei zentral bedingten Schluckstörungen Schluckakte mit ungeordneten Zusatzbewegungen. Die Dauer der Bolusverdrängungsphase war bei Patienten mit zentralen Schluckstörungen in Relation zu anderen Schluckphasen verlängert. Schlussfolgerung: Für eine sichere Differenzierung peripher und zentral bedingter Schluckstörungen sind zwar neben der sonographischen Bildanalyse zusätzliche klinische Informationen erforderlich. Innerhalb der Erkrankungsgruppen von Patienten mit peripher und zentral bedingten oralen Schluckstörungen treten jedoch unterschiedliche Schluckablaufvarianten gehäuft auf.
Diagnostic Criteria for Otitis media in Children
Authors: Alho Olli-Pekka , Koivunen Petri , Luotonen Jukka
Published: April 2003

Objectives: To determine the accuracy of various symptoms in predicting acute otitis media and the accuracy of pneumo-otoscopy and minitympanometry in identifying middle ear fluid in children. Patients: Symptoms were recorded and compared to pneumo-otoscopic findings in 354 children suffering from acute illness, to analyze the validity of various symptoms in predicting acute otitis media. Pneumo-otoscopic findings were recorded in 76 children and minitympanometric findings in 162 children referred for surgery due to recurrent or chronic otitis media and compared to the myringotomy finding to assess the validity of various pneumo-otoscopic signs and type B minitympanogram in identifying middle ear effusion. Results and Conclusions: The ear-related symptoms were specific, but too unsensitive, and the general symptoms too unsensitive and unspecific to be used alone as criteria for acute otitis media. The abnormal position and impaired mobility of the tympanic membrane in pneumatic otoscopy were very specific signs of middle ear effusion but only the latter had a moderately high sensitivity. When combined by an experienced otoscopist into an overall subjective judgement, however, they afforded an acceptably high sensitivity (81%) and specificity (86%). Type B minitympanogram was reasonably sensitive (79%) and had a high specificity, but only in cooperative children (93%), the specificity in uncooperative children being very low (38%). All in all, penumatic otoscopy and minitympanometry, the latter in cooperative children, are acceptably accurate methods to be used in the diagnosis of both acute otitis media and chronic otitis media with effusion.
Management of ‘Otitis-Prone’ Children: A Diagnostic and Therapeutic Challenge
Authors: Linder T.E.
Published: April 2003

Treatment guidelines for acute otitis media and otitis media with effusion have been discussed for many years. Children referred to otolaryngologists often have been treated adequately before and still continue to suffer from ear infections. They are called ‘otitis-prone’ and need to be identified and treated accordingly. Systematically evaluating the known risk factors and ranking the otoscopic findings as well as the hearing tests can help to recognize ‘high-risk’ children early on. These patients will benefit from a more offensive therapy, both medically as well as surgically, whereas ‘low-risk’ patients can be treated with a ‘watchful waiting’ policy.
Perilymph Fistula: Myth or Reality?
Authors: Legent François , Bordure Philippe
Published: April 2003

Perilymph fistula (PLF), an abnormal communication between the inner and middle ears associated with permanent or transient perilymph leakage, differs from cerebrospinal fluid fistula. PLF was first described after stapedectomy, and posttraumatic and spontaneous or idiopathic forms have since been reported. It is the source of various cochlear and vestibular symptoms. Diagnosis and surgical treatment remain controversial, especially for spontaneous PLF. Preoperative tests and imaging techniques have proved inadequate, and there is in fact no single diagnostic test for PLF. Therefore, the patient’s history and clinical picture still provide the main basis for diagnosis, which can be confirmed by careful exploratory tympanotomy (though this is not always foolproof). β2-Transferrin analysis allows objective confirmation in debatable cases. The indication for exploratory tympanotomy and surgical treatment depends on the etiology of PLF and the clinical picture. Treatment requires sealing of the fistula by connective tissue or stapedectomy. Vestibular symptoms show improvement in more than half of the cases, whereas auditory symptoms are generally less responsive to surgical repair. The diagnosis and rationale for surgical treatment are still based on clinical criteria. There is a need for multicenter studies to improve diagnostic testing and management of the disorder.
Perilymphatic Fistulae
Authors: Kohut Robert I. , Ryu Jai H. , Hinojosa Raul , Burke Alan J.C.
Published: April 2003

Objectives: To provide information regarding the challenge and refinement of our understanding of perilymphatic fistulae (PLFs) by systematic clinical observations coupled with human temporal bone histopathologic/clinical studies. Materials and Methods: (1) Traditional human temporal bone collection for histologic study (representing subjects having disorders of hearing or balance); (2) special human temporal bone collection for histologic study (from consecutive autopsies representing a cross-section of society); (3) clinical data corresponding to human temporal bone specimens of both types; (4) predictive experimental paradigm (histopathology predicts clinical signs and symptoms and vice versa); (5) clinical study parallel to human temporal bone study using the same medical and surgical variables; (6) outcome analysis of clinical study (5-year follow-up – 173 patients with diagnosis of PLF); (7) temporal bone specimens for histopathologic study of patients from the clinical study having the diagnosis of PLF. Results: (1) The accuracy of the clinical diagnosis for PLF criteria was defined: p < 0.001, sensitivity 59% and specificity 91%. (2) The histologic diagnostic criteria for PLFs were defined. (3) The prevalence of labyrinthine capsule patencies related to PLF was determined with fluid permeability/impermeability of patencies as identified variable. (4) The duration of symptoms before the diagnosis of PLF was determined and a comparison of medical versus surgical management was made (symptoms: complete resolution, improvement, persistence and recurrence). (5) Human temporal bone histopathologic findings from patients with PLF diagnosed during life were consistent with the predictive PLF studies and revealed variables related to surgical methods. Conclusions: (1) Clinical criteria for the diagnosis of PLF can be used to predict patencies of the labyrinth capsule at the fissula ante fenestram, fissure of the round window niche (and sometimes the fossula post fenestram) which are related to disorders of hearing and/or balance. (2) Current treatment methods result in less than ideal success rates – medical management should precede surgical intervention. (3) It appears that no reliable perilymph tracer is yet identified for clinical or surgical use.
The Large Vestibular Aqueduct Syndrome as a Cause for Sudden Deafness in Children
Authors: Riley L.C.M. , Stokroos R.J. , Manni J.J.
Published: April 2003

A case report and a review of the literature on the ‘large vestibular aqueduct syndrome’ are presented. This syndrome purports to be a large vestibular aqueduct with a sensorineural or combined sensorineural and conductive hearing loss. The vestibular aqueduct has retained its wide embryologic size. Although indications have been found supporting a possible genetic origin for the persistence of the large aqueduct, many questions remain on the development of the hearing loss. Once the diagnosis is suspected, an MRI or CT scan will reveal the large vestibular aqueduct. Operations proposed to stop the decline of the hearing or even to improve it, have not been successful to date. For this reason, these patients mostly rely on revalidation.
Embolisationsbehandlung der akuten Blutung bei Morbus Osler
Authors: Wörner Bertold , Richter Bernhard , Siekmann Ralf , Schumacher Martin
Published: April 2003

Fragestellung: Zur Behandlung der Epistaxis bei M. Osler-Weber-Rendu existiert eine Vielzahl von Therapieansätzen, wobei bezüglich der Embolisationsbehandlung bisher nur vergleichsweise wenige Berichte vorliegen. Ziel der vorliegenden Untersuchung war es, die Erfahrungen anhand unserer eigenen Patienten mit M. Osler-Weber-Rendu darzustellen, die in den letzten 10 Jahren interventionell neuroradiologisch behandelt wurden. Patienten: Wir behandelten 7 Patienten mit akuten Blutungen im HNO-Gebiet bei M. Osler-Weber-Rendu durch Embolisation. Methoden: Über einen transfemoralen Zugang wurden nach angiographischer Darstellung in allen Fällen eine endovaskuläre Embolisation mit Polyvinylalkoholpartikeln (Partikelgrösse: 150–1000 μm) und in einem Fall eine zusätzliche Spiralenembolisation durchgeführt. Ergebnisse: Bei 5 Patienten liess sich durch Embolisation mit Polyvinylalkohol die akute Blutung bereits in der ersten Sitzung stillen, in 2 Fällen musste nachembolisiert werden. Bei einer Patientin mit einem atypischen M. Osler-Weber-Rendu, bei der sich 9 Aneurysmen im Bereich der rechten Arteria facialis und eine ausgedehnte arteriolokapilläre Fehlbildung mit langsamem Fluss im Bereich des Zungengrundes zeigten, liessen sich die Aneurysmen durch Spiralenembolisation vollständig, das Zungenangiom zu überwiegenden Teilen ausschalten. Schlussfolgerungen: Die endovaskuläre Embolisation bei M. Osler-Weber-Rendu erwies sich bei unseren Patienten als eine sinnvolle Ergänzung zu den bekannten Therapieverfahren und als eine vergleichsweise wenig belastende Therapie von akuter Epistaxis und Blutungen bei Gefässmalformationen im Carotis-externa-Stromgebiet.
Untersuchungen zu einer möglichen Masernviruspersistenzin der Otosklerose
Authors: Niedermeyer Hans P. , Arnold Wolfgang , Schuster Maria , Wesemeier Kirsten , Kramer Jutta , Baumann Christa , Neubert Wolfgang J.
Published: April 2003

Morphologische und biochemische Untersuchungen von verschiedenen Autoren haben gezeigt, dass die Otosklerose eine Masernvirus-assoziierte, entzündliche Erkrankung des menschlichen Felsenbeins ist. Das Ziel unserer Untersuchungen war es, Informationen über die Auswirkungen der Masernvirusinfektion im Felsenbein auf das Immunsystem des Innenohres zu erhalten und zu überprüfen, ob sich in Präosteoblasten, die aus dem Otoskleroseherd kultiviert wurden, Masernvirusgenom befindet. Während Stapedektomien wurde neben Fussplatten und Kontrollgewebe für die Präosteoblastenkultur Perilymphe entnommen und mit Westernblot auf Antikörperexpressionsmuster hin überprüft. Aus den Präosteoblasten konnte keine Masernvirus-RNA amplifiziert werden. In der Perilymphe konnten IgG gegen Masernviren nachgewiesen werden und das Expressionsmuster wies in 2 von 10 Fällen einen Unterschied im Vergleich zum Expressionsmuster im Serum des gleichen Patienten auf. Diese Ergebnisse sind im Einklang mit der Hypothese, dass in der Otosklerose eine Masernviruspersistenz vorliegt.
Indication du training autogène de Schultz chez les patients vertigineux
Authors: Eber A.M. , Paul C.
Published: April 2003

La méthode de training autogène de Schultz (TA) est une technique de relaxation par entraînement à l’autohypnose. Dans ce travail nous l’appliquons à des patients qui présentent une pathologie vertigineuse chronique apparue au décours d’une atteinte lésionnelle vestibulaire. Une angoisse plus ou moins importante accompagne toujours les plaintes fonctionnelles de ces patients. Cette angoisse est efficacement prise en charge par le TA qui implique un travail centré sur le corps. Cette méthode peut par ailleurs faciliter dans un deuxième temps une approche psychothérapique classique.
Reconstructions otomandibulaires dans les microsomies hémifaciales
Authors: Postec F. , Disant F. , Morgon L. , Coudert J.L. , Jourlin M. , Bossard D.
Published: April 2003

Objectif: Analyse de 6 reconstructions otomandibulaires. Patients et méthodes: Une reconstruction a été réalisée dans le cadre d’un syndrome otomandibulaire dans 4 cas et d’un syndrome de Goldenhar dans 2 cas. Tous ont bénéficié d’une correction première des bases osseuses par la technique de distraction mandibulaire suivie d’une otopoïèse par greffons costaux sculptés en deux temps. Résultats: Si les résultats esthétiques de l’ostéodistraction ont été satisfaisants, les résultats fonctionnels occlusaux et mécaniques sont plus inconstants avec les types d’appareils distracteurs actuels. Conclusion: Les résultats esthétiques de l’otopoïèse effectuée sur des bases osseuses symétrisées sont améliorés, car cette chronologie permet de positionner l’oreille reconstruite sur une hémiface symétrisée.