1/20. Auricular endochondral pseudocysts: diagnosis and management.The auricle can be the site of a variety of cystic lesions, many of which involve either potential spaces between the auricular cartilage and the perichondrium or spaces within the skin and subcutaneous tissues. An auricular endochondral pseudocyst is a fluid collection located within the cartilaginous structure of the auricle. The auricular hematoma and the auricular pseudocyst may represent opposing ends of a continuum of damage and repair of traumatic insults. Whereas the hematoma represents a significant acute traumatic event resulting in cleavage between the perichondrium and the cartilage, the pseudocyst could be the outcome of chronic lower grade trauma. In this instance, the perichondrium not only separates from the cartilage but may be induced to regenerate an outer cartilaginous wall exacting the contour of the separated perichondrium, thus completing a cartilaginous auricular pseudocyst. This firm, cartilaginous outer cyst wall accounts for the increased difficulty in treating pseudocysts and clearly requires a different surgical treatment than for the hematoma. Having reviewed a substantial number of case reports, we recommend incision and drainage of the cavity followed by obliteration of the cavity by curettage, sclerosing agent, and pressure dressing. More invasive techniques should be reserved for an uncommon recurrence after adequate initial treatment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/20. rupture of the round window membrane.A perilymph leak into the middle ear through a ruptured round window membrane results in the symptoms of hearing loss, tinnitus and vertigo, either singly or in combination. The case histories of thirteen patients with such a fistula are described, these patients having in common a predisposing incident which had led to a rise of C.S.F. pressure. Symptomatology and the results of investigation are analysed and operative technique and results discussed. While it appears that vertigo uniformly responds very satisfactorily to operative treatment the improvement in hearing loss and tinnitus is more difficult to predict.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/20. Perilymphatic fistula following trans-tympanic trauma: a clinical case presentation and review of the literature.The perilymphatic fistula is constituted by an anomalous connection between the perilymphatic space and the middle ear. The principal accuses are to be sought in the intracranial pressure increasement, cranial traumas, barotraumas, congenital anomalies, trans-tympanic traumas, etc. stapes's dislocation in the vestibule and the fracture of the platina are the most frequent pathogenic mechanisms. In clinical practice, the diagnosis remains a problem rather debated, even if the clinical pattern, the laboratory investigations, the diagnostic images and the tympanic exploration, all together can confirm, in the majority of the cases, the diagnostic suspect. This article presents a clinical case of a transtympanic trauma with perilymphatic fistula caused by a foreign body. The peculiarity of this case must be set in relation with both the aetiopathogenesis of the labyrinthine lesion and the severity of the symptomatology caused by it.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/20. otitis media and CNS complications.Intracranial complications from otitis media can be quite devastating to the patient if an early diagnosis is not made. patients may develop meningitis, venous sinus thrombosis or cranial nerve palsies, as well as intracranial abscess. The presenting features in such cases may be subtle and include headache, nausea, vomiting, personality changes and signs of increased intracranial pressure as well as focal neurological deficits. A case of intracranial brain abscess is presented in a patient with a history of chronic otitis media with cholesteatoma. Delay in the diagnosis of intracranial complications of otitis media can lead to improper treatment with increased morbidity and mortality. The etiology and treatment of complications affecting the CNS is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/20. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants.Four case reports of infants with cleft palate and intractable otorrhea following the placement of pressure equalization tubes are presented. In one patient, liquids taken orally were noted to reflux through her ears. Otorrhea was refractory to medical management in all cases and was controlled only after closure of the soft palate. Persistent otorrhea may be an indication for early closure of the soft palate in these infants.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
6/20. Otologic manifestations of pseudotumor cerebri.Otologic manifestations of pseudotumor cerebri heightened awareness of pseudotumor cerebri and its varied subtle presentations will allow for a more expedient diagnosis by the otolaryngologist. pseudotumor cerebri is defined as increased intracranial pressure and papilledema without a mass lesion or obstruction of the ventricular system. Presenting symptoms most commonly are headache and visual dysfunction. However, patients may present with associated symptoms of tinnitus, dizziness and hearing loss. These patients may be seen first by the otolaryngologist. Fourteen patients with a diagnosis of pseudotumor cerebri are reviewed. Nine of the 14 patients had neurotologic symptoms during the course of their evaluation. pseudotumor cerebri is a diagnostic challenge. Keys to diagnosis are a high index of suspicion, careful history and funduscopic examination in patients with unexplained neuro-otologic symptoms.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/20. Bilateral otorrhagia associated with continuous positive airway pressure.A patient had bilateral tympanic membrane rupture and otorrhagia, an unusual complication of continuous positive airway pressure (CPAP). CPAP, applied by a bag/mask system using disposable spring valves, was used to treat acute pulmonary edema during volume resuscitation and vasopressin therapy for bleeding from esophageal varices.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/20. temporal bone histopathologic findings in drowning victims.The human temporal bones of five drowning victims, the largest such series, to our knowledge, were evaluated to determine what histopathologic changes occurred. Thickening of the periosteal epithelium, especially on the surgical dome of the otic capsule, was evident in all cases. There was also hemorrhage in the middle ear cavity in four of the cases. In the fifth case, a cholesteatoma and ruptured tympanic membrane were observed, but there was no evidence of hemorrhage. It is proposed that an intact tympanic membrane is needed to create sufficient negative pressure in the middle ear cavity to cause rupture of the blood vessels and hemorrhage. Such bleeding is indicative of drowning when the tympanic membrane is intact.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/20. Pulsion hernias of the tympanic membrane.A pulsion hernia of the tympanic membrane is an outwardly bulging, thin, atrophic area of the tympanic membrane. Those patients who develop pulsion hernias repeatedly autoinflate the middle ear and consequently maintain a positive middle ear pressure, which pushes the thin atrophic portion of the tympanic membrane laterally beyond the normal plane of the tympanic membrane. The thinness of the tympanic membrane over the pulsion hernia suggests that the herniation has developed through a pre-existing area of weakness where the fibrous middle layer has disappeared.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/20. Postsurgical acrylic ear splints for keloids.It is generally acknowledged that earlobe keloids are best surgically resected and repaired while attempting to leave a residual skeletal cartilaginous soft-tissue framework, oftentimes composed of keloidal tissue itself. Whether grafts, flaps, or primary incision and closure are performed, the success of each procedure may require the adjuvant use of pressure to the involved ear-lobes for at least a year. Where gross deformity has existed, the use of an "oyster splint" seems to act as a pressure remolding device.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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