1/12. Middle ear inflation for diagnosis and treatment of otitis media with effusion.An adult (18 years), healthy, male subject with persistent bilateral middle ear (ME) underpressure and a history of recurrent otitis media into his teen years was identified. The response of his MEs to air inflation was evaluated and showed an immediate pressure increase after a valsalva maneuver followed by a rapid pressure drop to approach the pre-inflation levels. That response is consistent with the presence of ME effusion, which was not diagnosed by otoendoscopy or tympanometry, but was visualized bilaterally within the mastoid regions using magnetic resonance imaging (MRI). The patient was treated for 25 days with ME inflation (3/day) and then re-examined. On each treatment day, he recorded his ME pressure using tympanometry before and after one inflation maneuver. The patient's compliance with the treatment protocol was high, and successful gas transfers were documented on most days. Over the course of treatment, pre-inflation ME pressure became more normal bilaterally. When compared to the pre-treatment test, the post-treatment inflation test showed a similar rate of ME pressure decrease, but significantly higher terminal pressures. On follow-up but not during the pre-treatment period, discrete changes in ME pressure attributable to ET openings were noted during test sessions. MRI documented lesser amounts of effusion in the mastoid, but not complete disease resolution. The significance of these observations to the design of a well controlled clinical trail of ME inflation as a treatment for otitis media is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/12. 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 = 0.5keywords = pressure (Clic here for more details about this article) |
3/12. Venous air embolism during home infusion therapy.Venous air embolism (VAE) is a potential complication of surgical procedures as well as central venous access. There are several reports in the literature of VAE during the in-hospital use and placement of central venous access. However, we are unaware of previous cases of VAE in children who received home infusion therapy via central venous access. We report the occurrence of a VAE in a 2-year-old with a Broviac catheter for home intravenous antibiotic therapy. VAE occurred when a bolus of air was unintentionally administered as the mother removed the cassette from the pump when it was alarming air in line. The cassette and tubing had been placed into the pump without a fluid flush. After the tubing and cassette were removed from the pump, the air in the line was allowed to flow by gravity into the patient, resulting in the immediate onset of respiratory and neurologic symptoms. The mother administered 2 rescue breaths, and the child's color and breathing returned to normal over the next 2 minutes. After the child arrived in the emergency department, the child's mental status returned to normal and the remainder of her physical examination was unremarkable. She had an uneventful recovery and was discharged from the hospital the following day. Additional antibiotic administration was accomplished in the emergency department of a local hospital. VAE can occur spontaneously when there is an open venous structure 5 cm or more above the heart or if air is delivered under pressure into the venous system, such as during a laparoscopy or mishaps with infusion bags. The morbidity and mortality of VAE are related to the volume of air, rate of entrainment, the patient's underlying cardiorespiratory status, and the patient's position. morbidity and mortality occur as a consequence of right ventricular outflow obstruction or end-organ dysfunction from left-sided obstruction of coronary or cerebral vasculature as air passes across a patent foramen ovale or through the pulmonary circulation. Of all the literature pertaining to VAE with central lines, there are no previous reports of VAE occurring during home infusion therapy in children. With managed care requiring shorter hospitalizations and more children being discharged from the hospital on home infusion therapy, parents and lay caregivers are being asked to administer medications and perform routine maintenance on central venous devices. In our case, despite the fact that the mother had been educated regarding the appropriate technique for medication administration, she forgot to purge the air from the line before connecting the tubing and administering the antibiotic. Although the infusion pump will alarm when there is air in the line, it detects air only in a small part of the line and this safety feature is not in play if the device is removed from the infusion pump and administered via gravity. If such safety precautions are not adhered to, then the volume of air that fills the intravenous tubing from the drip chamber to the patient (25-30 mL in the pediatric infusion pump tubing used in our patient) can be infused by gravity into the patient's venous system. Because the consequences of VAE are so severe, the focus should be on prevention. Pumps used for home infusion therapy should have appropriate alarms to alert caregivers to the presence of air in the line. Obviously, this will not totally prevent this complication as this type of pump was used in our patient. It is crucial to educate caregivers of patients with central venous access regarding the hazards of VAE and safety measures to prevent it. With the increased use of home infusion therapy, ongoing evaluations of complications related to this form of therapy are mandatory so that there is continued evaluation of practices and appropriate changes made when necessary to increase further the safety of these techniques.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
4/12. diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea.OBJECTIVES/HYPOTHESIS: Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear can occur in adults without a history of temporal bone trauma or fracture, meningitis, or any obvious cause. Therefore, clues may be lacking that would alert the otolaryngologist that fluid medial to an intact eardrum, or fluid emanating from an eardrum perforation, is likely to be CSF fluid. A review of relevant medical literature reveals that herniation of the arachnoid membrane through a tegmen defect may be congenital, or CSF leak may occur when dynamic factors (i.e., brain pulsations or increases in intracranial pressure) produce a rent in the arachnoid membrane. Because tegmen defects may be multiple rather than single, identifying only one defect may not be sufficient for achieving definitive repair. Data on nine cases of spontaneous CSF leak to the ear in adult patients from four medical centers are presented and analyzed to provide collective information about a disorder that can be difficult to diagnose and manage. STUDY DESIGN: Retrospective review of nine cases of spontaneous CSF middle ear effusion/otorrhea. RESULTS: The majority of patients presented with symptoms of aural fullness and middle ear effusion. Many developed suspicious clear otorrhea only after insertion of a tympanostomy tube. Two patients had multiple defects in the tegmen and dura, and five patients had meningoencephaloceles confirmed intraoperatively. Five patients underwent combined middle cranial fossa/transmastoid repair. Materials used in repair included temporalis fascia, free muscle graft, Oxycel cotton, calvarial bone, pericranium, bone wax, and fibrin glue. CONCLUSIONS: CSF middle ear effusion/otorrhea can develop in adults without a prior history of meningitis or head trauma or any apparent proximate cause. Although presenting symptoms can be subtle, early suspicion and confirmatory imaging aid in establishing the diagnosis. Because surgical repair by way of a mastoid approach alone can be inadequate if there are multiple tegmen defects, a middle fossa approach alone, or in combination with a transmastoid approach, should be considered in most cases.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
5/12. necrosis of the incus by the chorda tympani nerve.Ossicular necrosis is often associated with chronic adhesive otitis media. An unusual abnormality discovered in an incus removed during tympanoplasty is reported. The long process appears to have been grooved by pressure from the chorda tympani. An alternative theory to explain the vulnerability of the long process of the incus is suggested.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
6/12. 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 = 0.625keywords = pressure (Clic here for more details about this article) |
7/12. Middle ear effusions and myasthenia gravis.A case of ME effusion in a patient with MG is reported. The likely pathogenesis is of TVP muscle weakness causing eustachian tube dysfunction. ME effusion should be suspected in a myasthenic complaining of sudden hearing loss. Tympanometry with measurement of the ME pressures and reflexes is a useful tool for assessing a myasthenic's response to treatment.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
8/12. Tympanograms in ears with small perforations of the tympanic membranes.It has been believed that in an ear with a perforation, the tympanogram becomes a straight line due to the lack of compliance change in response to the pressure change in the external auditory meatus. Recently, however, we found two types of tympanogram with distinctive characteristics in ears with small perforations. In the first tympanogram type, when the external auditory meatus pressure was changed in the decreasing direction, the compliance peak was formed in the positive-pressure area, whereas it was formed in the negative-pressure area when it was changed in the increasing direction. The difference of the pressure at which compliance peak was obtained was great. The second tympanogram type was unique, with multiple notches similar to those of electronystagmographic recordings of the jerky nystagmus. knowledge of these tympanograms helps in recognizing small tympanic-membrane perforations.- - - - - - - - - - ranking = 0.625keywords = pressure (Clic here for more details about this article) |
9/12. adult-onset fluid in the tympanomastoid compartment. diagnosis and management.Fluid in the tympanomastoid compartment having its onset in adulthood may be caused by three pathogenic mechanisms. Serous otitis in vacuo is the result of blockage of the eustachian tube and the most frequent cause is neoplastic disease. adult serous effusion is a disorder of unknown cause characterized by active secretion of serous fluid from the mucous membrane lining the tympanomastoid compartment. cerebrospinal fluid otorrhea is the result of a CSF fistula in the tympanomastoid compartment and may be caused by congenital anomalies, acquired diseases, and trauma. The differential diagnosis demands a systematic approach beginning with history and examination and progressing as necessary through a series of diagnostic procedures that may include pressure-equilizing tube insertion, fluorescein dye test, and surgical exploration.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
10/12. Mastoidectomy for chronic serous otitis media.The purpose of this paper is to show that satisfactory results following mastoidectomy can be obtained for the problem of chronic serous otitis. The success of the simple mastoid operation or mastoidectomy with facial recess approach and the subsequent increased aeration of the mastoid-antral-attic-middle-ear complex is to be suggested when the repeated use of myringotomy tubes alone is not the answer to chronic serous otitis. It is chronic negative pressure due to eustachian tube dysfunction that leads to irreversible mastoid disease. Seven cases of mastoidectomy for chronic serous otitis media are presented. All cases had adequate conservative medical and surgical treatment over a period of years for chronic serous otitis before mastoidectomy wa considered. The clinical history, as well as lateral mastoid X-ray, was used in diagnosing irreversible mastoid disease.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
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