1/22. eustachian tube function in children.eustachian tube function of children with bilateral serous otitis media was studied in 14 ears following myringotomy and pressure equalizing tube insertion. Cases with non-eustachian tube pathology potentially contributing to eustachian tube dysfunction were excluded from the study. eustachian tube function was evaluated utilizing an impedance audiometer to document neutralization of positive and negative middle ear pressures. All cases showed persistent tubal dysfunction for up to six months. Partial incomplete neutralization of positive pressure occurred in 64 per cent, but in no case could negative pressure be partially neutralized even when "locking" was relieved with valsalva. Continuous ventilation of the middle ear for up to six months did not allow a return to normal eustachian tube function. This is extremely effective palliation, and should be recognized as such.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/22. Influence of otitis media on hearing and development.otitis media affects nearly every child at some time; many children have mild-to-moderate hearing losses for prolonged periods. The effects of these losses on language and educational development may be significant; possible mechanisms are discussed. Especially in suboptimal listening situations, speech perception may be impaired by even a mild hearing loss. Patterns of imperception are predicted by comparison of composite audiometric data from children with middle ear effusions with speech power data, and by analysis of sound pressure waveforms of speech filtered to simulate the typical hearing loss of these patients. A new method of analysis of brain stem evoked responses, yielding response components attributable to binaural interaction, is reported. This and other evoked response techniques may be able to identify objective changes in auditory nervous system function attributable to relative sensory deprivation during development. Finally, directions for further research in this area are discussed.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
3/22. 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 = 0.25keywords = pressure (Clic here for more details about this article) |
4/22. meningitis due to fusobacterium necrophorum in an adult.BACKGROUND: fusobacterium necrophorum may cause a number of clinical syndromes, collectively known as necrobacillosis. meningitis is a significant cause of mortality, rarely reported in the adult population. CASE PRESENTATION: We report a fatal case of meningitis, caused by fusobacterium necrophorum, secondary to otitis media in an alcoholic male. Diagnosis was delayed due to the typical slow growth of the organism. The clinical course was complicated by encephalitis and by hydrocephalus. The patient failed to respond to metronidazole and penicillin. The patient died on day 12 from increased intracranial pressure and brain stem infarction. CONCLUSIONS: This case emphasizes the need for a high index of clinical suspicion to make the diagnosis of fusobacterium necrophorum meningitis. We recommend the use of appropriate anaerobic culture techniques and antimicrobial coverage for anaerobic organisms when the gram stain shows gram negative bacilli.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
5/22. Lethal otogenic Candida meningitis.history revealed a chronic obstructive pulmonary condition which had been treated with prednisolone for a long time. There was a raised temperature with further signs of an acute inflammatory underlying disease and internal hydrocephalus. After performing trepanation, the symptoms of raised intercerebral pressure ceased. candida albicans could be detected microbiologically in the cerebrospinal fluid. There was no pneumonia at the time of admission. Despite instituting immediate intensive care with administration of antibiotics and antimycotics, the patient died 11 days after inpatient admission. autopsy revealed a C. albicans mycosis originating from the right middle ear with extensive suppurative meningitis, which was the immediate cause of death. Confluent bronchopneumonia had developed in both lower lung lobes at the time of death, but did not show any signs of mycosis and had contributed indirectly to the death of the patient.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
6/22. Failure of a 5-day course of intramuscular ceftriaxone to eradicate streptococcus pneumoniae from the middle ear.A 10-kg 9-month-old infant with recurrent, unresponsive otitis media presented with bilateral acute otitis media caused by streptococcus pneumoniae type 19A, resistant to all oral agents and intermediately susceptible to ceftriaxone. Treatment with myringotomies and intramuscular ceftriaxone, 50 mg/kg/d for 5 days, was unsuccessful. The patient responded to pressure equalization tubes and local ciprofloxacin with dexamethasone drops.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
7/22. Surgical management of acute mastoiditis with epidural abscess.The prevalence of intracranial complications of acute coalescent mastoiditis in children has decreased significantly; however, this clinical problem persists, with a relatively high mortality. The common practice for management of acute mastoiditis with epidural abscess is mastoidectomy, drainage and placement of a ventilation tube, which means that the main pathology is confined to the mastoid cavity. We suggest that tympanic exploration is mandatory in certain cases, an example of which we present here. We report one case of acute mastoiditis with epidural abscess, in which mastoidectomy with tympanic exploration was needed to ensure drainage throughout the cavities and to prevent pressure rebuilding in the mastoid and tympanic cavities. We stress that if the tympanic membrane is thickened and no fluid is drained when placing a pressure equalization tube, there could be granulation tissue in the tympanum and tympanic exploration is mandatory, especially in a case of acute mastoiditis with intracranial complications accompanied by prolonged symptoms.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/22. pneumocephalus at the cerebellopontine angle secondary to chronic otitis media.Intracranial air is usually asymptomatic but carries a potential risk of increased intracranial pressure or meningitis which require immediate therapy. Although pneumocephalus is quite common following trauma, especially with a fracture involving paranasal sinuses it is a rare manifestation of chronic otitis media. In this report, a case with a tension pneumocephalus at the cerebellopontine angle following a chronic mastoid infection is presented and the possible mechanism, diagnostic measures and the surgical management is discussed.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
9/22. Aerotitis: cause, prevention, and treatment.Aerotitis, an acute inflammation of the middle ear caused by the difference in air pressure between the airplane cabin and the middle-ear space, is becoming more common in the united states as our society becomes increasingly mobile. We describe a case in which a 33-year-old woman with a resolving upper respiratory tract infection and mildly blocked eustachian tubes flew on a business trip. During ascent, her ears became blocked. This blockage was partially alleviated by a Valsalva's maneuver. On descent, however, her ears became severely blocked, she experienced intense pain, and her tympanic membranes ruptured. She became nauseated and vomited. Her hearing became significantly diminished and she experienced vertigo. On landing, she was taken to a local emergency room and treated with penicillin and antivertiginous medication. Subsequent otologic evaluation revealed severe permanent sensorineural hearing loss. The vestibular symptoms lasted several months. She now requires hearing aids on a permanent basis. Suggestions are presented for prevention and treatment of aerotitis.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
10/22. From the aerospace medicine Residents' teaching File. Case #36.A designated naval aviator was evaluated after several episodes of vertigo related to a zoom climb flight profile. Workup led to the diagnosis of alternobaric vertigo. Contributing factors were concurrent upper respiratory infection and functioning left pressure equilibration (PE) tube for chronic otitis media.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
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