Made available in DSpace on 2016-04-27T18:12:15Z (GMT). No. of bitstreams: 1 ClaudiaLapertosa.pdf: 415369 bytes, checksum: 617b0c9c60175a389d041b32304c0047 (MD5) Previous issue date: 2006-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: otitis media is an inflammatory disease of middle ear that has greater occurrence on pediatric population, being considered a helth public problem all around the world. Peripheral ans fluctuanting hearing loss may be observed and this may cause a disturbance on the complex auditory stimuli perception, including speech. This altered auditory perception may cause difficulties on sound acoustics representation and on the auditory abilities related to speech in noise recognition, auditory memory, binaural interaction and temporal processing. Objective: to investigate the temporal auditory processing throug random gap detection test in a group of children with recurrent otitis media history on the early year of life. Method: 26 children, aged from 7 of 8 years old, according to one these criteria: otological history of 3 to 4 episodes of otitis media/year on the early years of life; 3 to 4 episodes of otitis media on their first moment life; type B ou C tympanometry at the moment of audiological evaluation. All the children were submited to the following procedures pure tone audiometry, speech audiometry, acoustic immitance measurement and to randm gap detection test (RGDT). Results: data showed RGDT hreshold longer for the frequency of 1000 Hz on the group of children with a type B timpanometry; the same happens with the group that showed abnormal acoustc reflex for 1000 Hz. Averange values for RGDT threshold ere 10 ms, sd of 2,7 ms, median of 10 ms, mode of 10 ms, minimum value was 5 ms an maximum was 15 ms. Compared to Dias (2004) values, the otitis media group showed longer threshold values. Conclusion: recurrent otitis media on early life years may produce a enlargement on the detection of silent intervals threshold / Introdução: A otite média é um processo inflamatório da orelha média de grande ocorrência na população infantil, sendo considerada um problema de saúde de caráter mundial. A presença de perda auditiva periférica e flutuante observada em alguns casos de otite média pode ocasionar alteração da percepção dos estímulos auditivos complexos, inclusive a fala. Esta alteração na percepção do sinal acústico pode causar prejuízo na representação de sons e nas habilidades auditivas que envolvem o reconhecimento da fala em ambientes ruidosos, memória auditiva, interação binaural e processos temporais. Objetivo: investigar o processamento auditivo temporal através do teste de detecção de intervalos de silêncio em crianças que tiveram otite média recorrente nos primeiros anos de vida. Método: Foram selecionadas 26 crianças com idade entre 7 e 8 anos que obedeciam aos seguintes critérios: ter histórico de 3 a 4 episódios de otite média/ano nos primeiros anos de vida, ter histórico de 3 a 4 episódios no primeiro anos de vida, ou ter timpanometria do tipo B ou C no momento da avaliação. As crianças foram submetidas à audiometria tonal, logoaudiometria, medida da imitância acústica e à pesquisa do limiar de intervalo de silêncio - RGDT (Random gap detection test). Resultado: Foi observado um aumento dos limiares do RGDT na freqüência de 1000 Hz nas crianças que tinham curva tipo B na timpanometria, assim como em relação ao reflexo do músculo estapédio contralateral alterado na mesma freqüência. Não houve correlação entre os valores do limiar do RGDT e o número de episódios de otite média. Os valores de média encontrados foram de 10 ms, desvio-padrão (dp)=2,7 ms, mediana=10 ms, moda=10ms, e valor mínimo encontrado igual a 5 ms e máximo igual a 15 ms. Comparados estes resultados com os de Dias (2004) estes valores foram maiores que os encontrados em crianças sem histórico de problema de ouvido ou de aprendizagem. Conclusão: a otite média recorrente nos primeiros anos de vida pode acarretar aumento na detecção de intervalos de silêncio o que pode explicar algumas das dificuldades de discriminação de ponto e modo articulatório encontradas nestas crianças

Objetivo: Avaliar o controle da supuração de cavidades mastoideas após cirurgia revisional e obliteração de mastoide com aloenxerto ósseo particulado congelado (AOPC). Desenho do estudo: Exploratório, prospectivo, tipo série de casos. Pacientes: Dez adultos selecionados entre pacientes já submetidos à cirurgia de mastoidectomia cavidade aberta ou fechada para tratamento de otite média crônica colesteatomatosa e que tinham indicação de cirurgia revisional. Intervenção: Revisão de mastoidectomia e obliteração da cavidade com AOPC, material de preenchimento de baixo custo obtido de um banco de tecidos. Desfecho(s): Desfecho primário: controle da supuração. Desfechos secundários incluem: integração do AOPC na cavidade mastoidea, presença de colesteatoma residual ou recorrente, resultados audiológicos, complicações pós-operatórias, tais como infecção e extrusão do enxerto, e qualidade de vida após o procedimento medida com a escala de resultados de Glasgow (ERG). Resultados: O tempo médio de seguimento foi de 28 meses. Sete pacientes apresentaram o ouvido seco, em média, 8 semanas após a cirurgia. Três pacientes desenvolveram exposição do enxerto ósseo seguido de infecção e extrusão do material de preenchimento. A densidade média do enxerto ósseo no local da obliteração foi de 755.35 unidades Hounsfield medida na tomografia realizada após um tempo médio pós-operatório de 31 meses. A porcentagem do volume mastoideo obliterado foi de 75 a 100% em 6 casos e de 50 a 75% em 1 caso. Nos 7 pacientes, houve um aumento na densidade óssea durante o período de seguimento. Um paciente apresentou colesteatoma epitimpânico recorrente (0,5cm) identificado na ressonância magnética 1 ano após a cirurgia, embora este não estivesse na área de obliteração. A audição foi preservada em 80% dos pacientes 12 meses após o procedimento. A qualidade de vida melhorou em todos os pacientes, com média do escore ERG de 52, em escala que varia de -100 a +100. Conclusões: Este estudo demonstrou que o AOPC pode ser usado como material de preenchimento na obliteração mastoidea para se obter um ouvido seco, apresentando boa integração na mastoide e manutenção da densidade óssea / Objective: Assess the control of suppuration after revision surgery with mastoid obliteration for chronic otitis media (COM) with cholesteatoma using particulated frozen allograft bone (PFAB). Study Design: Exploratory, prospective, case series. Patients: Ten adults were selected from among patients who had undergone canal wall down or canal wall up mastoidectomy for COM with cholesteatoma, and had an indication for revision surgery. Intervention(s): Revision mastoidectomy with obliteration of the open cavity was performed with PFAB, a low-cost filler material obtained from a tissue bank. Main Outcome Measure(s): The main outcome measure was the control of suppuration. Secondary outcome measures included PFAB integration in the mastoid cavity, presence of recurrent or residual cholesteatoma, hearing outcomes, postoperative complications as infection and bone graft extrusion and quality of life after the procedure using the Glasgow benefit inventory (GBI) survey. Results: Mean follow-up was 28 months. Seven patients achieved a dry ear at a mean of 8 weeks postoperatively. Three patients developed bone graft exposure followed by infection and extrusion of the filler material. Mean bone density was 755.35 Hounsfield units at the obliteration site measured at computed tomography performed after a mean of 31 months postoperatively. Percentage of mastoid volume obliterated was between 75% and 100% in 6 cases and between 50% and 75% in 1 case. In all 7 patients, there was an increase in bone density postoperatively. One patient presented with recurrent epitympanic cholesteatoma (0.5 cm) at 1 year postoperatively, but it was not in the obliteration area. At 12 months postoperatively, 80% of patients had preserved hearing. All patients had an improvement of quality of life after mastoid obliteration, the average score on the GBI was 52 in a scale from -100 to +100. Conclusions: This study demonstrated that PFAB may be used to achieve a dry mastoid cavity with good bone graft osteointegration and density maintenance

Children frequently experience fluctuating conductive hearing loss during and following episodes of otitis media with effusion. With the prevalence of the disease increasing in the non-Aboriginal population in Australia, many children may be at risk of long-term learning and behavioural problems. There are conflicting findings in the research literature regarding the effects of this type of hearing loss. Although it is expected that the insertion of tympanostomy tubes (grommets) will reduce the duration and prevalence of both the disease and the conductive hearing loss, this does not always happen. For some primary school aged children it appears that experience with otitis media with effusion with or without grommet insertion is associated with various education problems including poor academic achievement and inappropriate behaviour. A current concern is whether or not these possible effects would continue to influence the learning and behaviour of children as they continue into their high school years. A review of the literature suggests that multiple factors including interrelationships between experience of otitis media with effusion, family and childcare environments may be involved in explaining why some students do not achieve as expected at school (Roberts et al., 2000). The literature further suggests there may be a cumulative effect in these factors, which introduces both quantitative and qualitative aspects to the discussion. A study was undertaken to identify the impact of otitis media with effusion and its associated sequelae on the learning and behaviour of high school students. Information from parents of high school students in Years 8 and 9 was used to identify students for inclusion in the study and to provide information on their medical and educational history as well as the parents' perceptions of various aspects of the students' learning and behaviour (including social skills). Three groups were formed: a Non-OME/Non-Grommet Group (n = 28), an OME/Grommet Group (n = 17) and an OME/Non-Grommet Group (n = 32). The TORCH, WRAT 3 and the Test of Syntactic Abilities (Screening Test) were administered to the students who also provided their own perceptions of specific aspects of their own learning and behaviour on a survey form. Teachers' perceptions on these areas were also collected. School academic records as well as data from school behavioural records were used. Analysis of the results revealed a range of mild effects. These included poorer academic results particularly for girls with a history of grommets, who also exhibited a lack of confidence in their social skills. An increase in behaviour problems for boys with a history of the disease (with or without grommets) was also found. The study identifies a number of associated teaching and learning issues including noise levels in childcare environments and school classrooms, current teaching and learning methodology and the training of new teachers. It recommends a number of areas for future research including more in-depth questioning of parents regarding their awareness of hearing problems in their children, the use of more fine-grained measures to assess learning outcomes and the identification of possible gender differences associated with the disease and experiences with grommets.

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM). Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Présentement, le diagnostic d’otite moyenne-interne chez le veau est basé sur la présence de signes cliniques appropriés ainsi que les tests diagnostiques tels que la radiographie et la tomodensitométrie. L’objectif de cette étude prospective était d’évaluer les valeurs prédictives de l’examen neurologique, l’examen otoscopique et le test des potentiels auditifs évoqués (PAE) dans le diagnostic d’otite moyenne-interne chez le veau, en utilisant la tomodensitométrie comme test standard. Le deuxième objectif était de définir les valeurs de référence pour le PAE chez le veau normal et d’en décrire les anomalies chez des veaux atteints d’otite moyenne-interne. Dix-sept veaux de race Holstein entre 5-7 semaines d’âge ont été inclus. Tous les veaux ont eu un examen neurologique, un examen otoscopique et une évaluation des PAEs. Les veaux ont été tranquillisés avec de la xylazine intraveineuse (0,05-0,15mg/kg) pour la tomodensitométrie des bulles tympaniques afin d’évaluer pour la présence d’otite moyenne-interne. Selon les résultats de la tomodensitométrie, 11 des 17 veaux étaient atteints avec otite moyenne, 4 de façon unilatérale et 7 bilatéralement. Cinq ondes ont été identifiées de façon constante sur les tracés des PAEs des 6 veaux normaux. Les valeurs positives prédictives pour le PAE, l’examen neurologique et l’examen otoscopique étaient 94,7%, 91,7% et 66,7% respectivement. D’un point de vue clinique, le test le plus fiable dans le diagnostic d’otite moyenne-interne chez le veau est le PAE. Les anomalies ont été observées au PAE avant le développement des signes neurologiques chez certains veaux. / Currently, the antemortem diagnosis of otitis media-interna is based upon the presence of appropriate clinical signs and adjunctive diagnostic imaging including radiography and computed tomography. The purpose of this prospective study was to evaluate predictive values of neurological examination, otoscopic examination and BAER in calves for the diagnosis of otitis media-interna using computed tomography as the gold standard. The second objective was to define BAER reference values in normal calves and to describe BAER abnormalities in calves affected with otitis media-interna. Seventeen Holstein calves between 5 and 7 weeks of age were included. All calves had a neurological examination, otoscopic examination and BAER. Calves were sedated with intravenous xylazine (0.05-0.15 mg/kg [0.02-0.07 mg/lb]) for computed tomography of the tympanic bullae to evaluate for the presence of otitis media-interna. Based upon computed tomographic results, 11 of 17 calves were affected with otitis media, 4 unilaterally and 7 bilaterally. Five waveforms were consistently identified on BAER traces from 6 normal calves. The positive predictive value of BAER, neurological examination and otoscopic examination were 94.7%, 91.7% and 66.7% respectively. Clinically, the most reliable non-invasive diagnostic test to diagnose otitis media-interna in the calf is the BAER. Abnormalities were observed on BAER before the development of neurological deficits in approximately 40% of calves allowing earlier diagnosis.

L'otite moyenne est une condition fréquente chez le veau et peut parfois être subclinique, rendant difficile son diagnostic à la ferme. L'objectif de cette étude est d’estimer la sensibilité et la spécificité de l'échographie des bulles tympaniques pour le diagnostic d'otite moyenne clinique et subclinique et de déterminer sa répétabilité. Quarante veaux âgés entre 19 et 50 jours ont été sélectionnés dans une ferme de veaux de grain, en fonction des résultats de l'échographie réalisée à la ferme (A). L'échographie a été réalisée une seconde fois par le même échographiste (A') et par un second échographiste (B), et le diagnostic noté pour chaque bulle tympanique comme étant négatif, suspect ou positif. Les images ont été enregistrées pour relecture et le diagnostic noté. Les veaux ont été euthanasiés, soumis en nécropsie et l'histologie a été utilisée comme méthode de référence. À l'histologie, 45 bulles tympaniques étaient atteintes d'otite moyenne et 35 bulles tympaniques étaient saines. Selon l'échographiste et la classification des bulles tympaniques suspectes, la sensibilité de l'échographie variait de 32% à 63% et la spécificité variait de 84% à 100%. La répétabilité était modérée, avec des valeurs de kappa de 0,53 entre A' et B, de 0,48 entre A et A', et de 0,58 et 0,75 pour la relecture de leurs images par A' et B respectivement. / Otitis media is a common disease in calves but can remain subclinical, making diagnosis challenging on the farm. The objective of this study is to estimate the sensitivity and specificity of the ultrasound imaging technique of tympanic bulla for the diagnosis of clinical and subclinical otitis media, and to determine its repeatability. Forty calves 19-50 days of age were selected from a veal calf farm, on the basis of results of ultrasound examination performed on the farm (A). Ultrasound examination was performed a second time by the same ultrasonographer (A') and by another ultrasonographer (B), and diagnosis was recorded for both tympanic bulla as negative, suspicious or positive. Images were recorded for further re-reading. Calves were euthanized and submitted for necropsy, and histopathologic diagnosis was used as gold standard. Based upon histology, 45 bullae were affected with otitis media and 35 bullae were unaffected. Depending on ultrasonographer and on classification of suspicious bullae, sensitivity varies from 32% to 63% and specificity varies from 84% to 100%. Repeatability is moderate, with kappa values of 0.53 for A'-B, 0.48 for A-A', and 0.58 and 0.75 for re-reading of A' and B, respectively.

A otite média, afecção comum na infância, acarreta uma perda auditiva condutiva flutuante, pois uma vez tratada os limiares auditivos voltam aos valores normais. Preocupação ocorre quando estes episódios tornam-se recorrentes levando a criança a receber uma estimulação sonora inconsistente do sistema nervoso auditivo central, dificultando a percepção dos sons da fala. O objetivo do presente estudo foi investigar se crianças com episódios recorrentes e comprovados de otite média com efusão apresentam alterações das habilidades auditivas que compõe o processamento auditivo. Foram avaliadas 59 crianças com idade entre 6 e 10 anos, divididas em dois grupos: grupo experimental composto por 29 crianças de ambos os gêneros com histórico documentado de otite media com efusão, perda auditiva condutiva nos primeiros anos de vida e com e sem história de cirurgia para colocação de tubo de ventilação na idade pré-escolar e escolar; e grupo controle, composto por 30 crianças, pareadas em idade e gênero com o grupo experimental, mas sem história da afecção. Na avaliação das habilidades auditivas que compõe o processamento auditivo foram utilizados o teste fala com ruído (TFR), teste dicótico de dígitos (TDD) e teste Gaps-in-noise (GIN). Todas as crianças no momento da avaliação estavam livres de perda auditiva condutiva. Os resultados mostraram que: os dois grupos não apresentavam diferenças dos limiares tonais, no momento da avaliação; o grupo experimental apresentou resultados inferiores no TFR e GIN, tanto na análise quantitativa quanto na qualitativa; o TDD apenas na análise qualitativa diferenciou os dois grupos. Pode-se concluir, no presente estudo, , que crianças com história de otite média com efusão recorrente e persistente, nas fases pré-escolar e escolar, apresentaram transtorno do processamento auditivo. / Otitis media, a common affection in childhood, causes a fluctuating conductive hearing loss, because once treated the hearing thresholds back to normal values. Concern occurs when these episodes become recurring leading the child to receive an inconsistent sound stimulation auditory central nervous system, it difficult for the perception of speech sounds. The aim of this study was to investigate whether children with recurrent episodes of proven otitis media with effusion present alterations of auditory skills that composes the auditory processing. We evaluated 59 children with ages between 6 and 10 years, divided into two groups: the experimental group comprised of 29 children of both genders with documented history of otitis media with effusion, conductive hearing loss in the early years of life and with and without history of surgery for ventilation tube placement in preschool and school age; and the control group, consisting of 30 children, paired in age and gender with the experimental group, but no history of the disease. In the assessment of auditory skills that make up the auditory processing was used Speech in Noise Test (SNT), Dichotic Digits Test (DDT) and Gaps in Noise test (GIN). All children had at the time of assessment were free of conductive hearing loss. The results showed that: the two groups showed no differences in tonal thresholds, at the time of the assessment; the experimental group showed results below the SNT and GIN, both in qualitative and in quantitative analysis; DDT only in qualitative analysis differentiated the two groups. It can be concluded, with the results of the work, that children with a history of otitis media with effusion recurrent and persistent, pre-school and school phases, may have auditory processing disorder.

A avaliação da integridade do sistema tímpano-ossicular é um pré-requisito para que o processo de diagnóstico audiológico infantil possa ser concluído com precisão, assim, muito têm se discutido em relação aos procedimentos utilizados na prática clínica para definir a presença ou ausência de problema condutivo. Nesse sentido, as medidas de imitância acústica de banda larga mostram-se como uma opção para o avanço na área. Diante disso, surgiu o interesse em ampliar os conhecimentos e trazer as características das medidas de imitância acústica de banda larga nas diferentes condições de orelha média. O objetivo do estudo foi caracterizar as medidas de imitância acústica de banda larga com os estímulos tom puro e chirp em crianças com perda auditiva sensorial de grau severo e profundo e diferentes padrões timpanométricos. Foram avaliadas 187 orelhas de 98 crianças na faixa etária de seis a 60 meses de idade, subdivididas em grupos de acordo com a pressão e compliância obtidas na timpanometria com sonda de 226 Hz. As medidas de imitância acústica de banda larga foram realizadas por meio do sistema de medidas do Acoustics\' Middle-Ear Power Analyzer - MEPA, versão 5.0, utilizando os estímulos tom puro e chirp, com faixa de frequência de 211 a 6000 Hz. Os valores de compliância e pressão obtidos na timpanometria convencional foram correlacionados às medidas de imitância acústica de banda larga, adotando-se testes estatísticos apropriados, com nível de significância de 0,05. Os resultados obtidos evidenciaram o efeito das faixas de frequência (grave, média e aguda) em todas as medidas analisadas, com exceção do delay da reflectância. Foi constatada influência de pressões correspondentes a -100 daPa ou mais negativas e também para pressões positivas acima de 25 daPa, e compliâncias menores que 0,2 ml nas medidas de imitância acústica de banda larga. Além disso, houve diferença significante entre os estímulos tom puro e chirp para frequências baixas para a absorvância e magnitude da impedância, com maior reflexo da variação dos valores de compliância e pressão nos resultados obtidos com estímulo chirp. Conclui-se que as características das medidas de imitância acústica de banda larga estão relacionadas à condição de orelha média e a frequência do estímulo teste. Para o delay da reflectância observou-se uma ampla variabilidade entre frequências ao analisar os grupos subdivididos pela pressão e também na frequência de 258 Hz ao analisar os grupos subdivididos pela compliância. / The evaluation of the integrity of the tympanic-ossicular system is a prerequisite for the child audiology diagnostic process to be completed accurately, thus, much has been discussed in relation to the procedures used in clinical practice to define the presence or absence of conductive problems. Hence, the wideband acoustic immittance measurements show to be an option to the advance in the field. As a result, the interest in expanding the knowledge and bringing the characteristics of wideband acoustic immittance measurements in the different conditions of middle ear, emerged. This study aimed at characterizing the wideband acoustic immittance measurements using pure and chirp stimuli in children presented with severe and profound sensorineural hearing loss and different tympanometric standards. 187 ears of 98 children in the age range six-sixty months, subdivided into groups according to pressure and compliance achieved through tympanometry with a 226 Hz probe, were assessed. Wideband acoustic immittance measurements were performed by the measuring system of the Acoustics\' Middle-Ear Power Analyzer - MEPA, version 5.0, using pure and chirp tone stimuli, in a frequency ranging from 211 to 6000 Hz. The values of compliance and pressure obtained through conventional tympanometry were correlated with wideband acoustic immittance measures, by applying suitable statistical tests, with a 0.05 significance level. The results achieved evidenced the effect of frequency bands (low, medium and high) in all measures examined, with the exception of the reflectance delay. The Influence of pressures -100 daPa or more negative ones and also in positive pressures above 25 Pa, and compliance lower than 0.2 ml in the wideband acoustic immittance measurements, was verified. In addition, there was a significant difference between pure tone and chirp stimuli at low frequencies for impedance absorbance and magnitude, with a greater reflex of the variation of compliance and pressure values in the results obtained with the chirp stimulus. It is concluded that the characteristics of broadband acoustic immittance measures are related to the condition of middle ear condition and the frequency of the test stimulus. For Reflectance delay, a wide variability between frequencies was observed when analyzing the groups subdivided by pressure and also in the frequency of 258 Hz, when analyzing the groups subdivided by compliance.

Objetivo: Avaliar o controle da supuração de cavidades mastoideas após cirurgia revisional e obliteração de mastoide com aloenxerto ósseo particulado congelado (AOPC). Desenho do estudo: Exploratório, prospectivo, tipo série de casos. Pacientes: Dez adultos selecionados entre pacientes já submetidos à cirurgia de mastoidectomia cavidade aberta ou fechada para tratamento de otite média crônica colesteatomatosa e que tinham indicação de cirurgia revisional. Intervenção: Revisão de mastoidectomia e obliteração da cavidade com AOPC, material de preenchimento de baixo custo obtido de um banco de tecidos. Desfecho(s): Desfecho primário: controle da supuração. Desfechos secundários incluem: integração do AOPC na cavidade mastoidea, presença de colesteatoma residual ou recorrente, resultados audiológicos, complicações pós-operatórias, tais como infecção e extrusão do enxerto, e qualidade de vida após o procedimento medida com a escala de resultados de Glasgow (ERG). Resultados: O tempo médio de seguimento foi de 28 meses. Sete pacientes apresentaram o ouvido seco, em média, 8 semanas após a cirurgia. Três pacientes desenvolveram exposição do enxerto ósseo seguido de infecção e extrusão do material de preenchimento. A densidade média do enxerto ósseo no local da obliteração foi de 755.35 unidades Hounsfield medida na tomografia realizada após um tempo médio pós-operatório de 31 meses. A porcentagem do volume mastoideo obliterado foi de 75 a 100% em 6 casos e de 50 a 75% em 1 caso. Nos 7 pacientes, houve um aumento na densidade óssea durante o período de seguimento. Um paciente apresentou colesteatoma epitimpânico recorrente (0,5cm) identificado na ressonância magnética 1 ano após a cirurgia, embora este não estivesse na área de obliteração. A audição foi preservada em 80% dos pacientes 12 meses após o procedimento. A qualidade de vida melhorou em todos os pacientes, com média do escore ERG de 52, em escala que varia de -100 a +100. Conclusões: Este estudo demonstrou que o AOPC pode ser usado como material de preenchimento na obliteração mastoidea para se obter um ouvido seco, apresentando boa integração na mastoide e manutenção da densidade óssea / Objective: Assess the control of suppuration after revision surgery with mastoid obliteration for chronic otitis media (COM) with cholesteatoma using particulated frozen allograft bone (PFAB). Study Design: Exploratory, prospective, case series. Patients: Ten adults were selected from among patients who had undergone canal wall down or canal wall up mastoidectomy for COM with cholesteatoma, and had an indication for revision surgery. Intervention(s): Revision mastoidectomy with obliteration of the open cavity was performed with PFAB, a low-cost filler material obtained from a tissue bank. Main Outcome Measure(s): The main outcome measure was the control of suppuration. Secondary outcome measures included PFAB integration in the mastoid cavity, presence of recurrent or residual cholesteatoma, hearing outcomes, postoperative complications as infection and bone graft extrusion and quality of life after the procedure using the Glasgow benefit inventory (GBI) survey. Results: Mean follow-up was 28 months. Seven patients achieved a dry ear at a mean of 8 weeks postoperatively. Three patients developed bone graft exposure followed by infection and extrusion of the filler material. Mean bone density was 755.35 Hounsfield units at the obliteration site measured at computed tomography performed after a mean of 31 months postoperatively. Percentage of mastoid volume obliterated was between 75% and 100% in 6 cases and between 50% and 75% in 1 case. In all 7 patients, there was an increase in bone density postoperatively. One patient presented with recurrent epitympanic cholesteatoma (0.5 cm) at 1 year postoperatively, but it was not in the obliteration area. At 12 months postoperatively, 80% of patients had preserved hearing. All patients had an improvement of quality of life after mastoid obliteration, the average score on the GBI was 52 in a scale from -100 to +100. Conclusions: This study demonstrated that PFAB may be used to achieve a dry mastoid cavity with good bone graft osteointegration and density maintenance

The present study was undertaken to evaluate the rat as a model for middle ear re­search. The rat was chosen primarily because the gross structure of its middle ear shows several similarities to that of man. It was considered of great importance to make a thorough structural study of the rat middle ear and to compare the results with those reported for the human middle ear. The thesis therefore includes indepen­dent studies on various aspects of rat middle ear structure and function as well as a review of the literature. The most pertinent findings in the experimental part of this study were the following. The rat Eustachian tube consists of a nasopharyngeal, and a cartilaginous and bony portion. The orifice of the nasopharyngeal portion is composed of two soft tissue lips, which appear to be opened mainly by the action of the salpingopharyngeal mus­cle, but also by the levator and tensor veli palatini muscles. The cartilaginous por­tion appears to be opened solely by the tensor veli palatini muscle. The tensor tympani muscle seems to have no effect on the tube. A ciliated and secretory epithelium lines the inferomedial walls of the tube throughout its length. In the tympanic cavity these thelial cell types extend as two tracts - one anterior and the other inferoposterior to  the promontory - which communicate with the epitympanic/attic compartments. The remaining parts of the tube and the tympanic cavity are covered by a squamous/cuboidal, non-ciliated epithelium. The subepithelial loose connective tissue contains vessels, nerves, and connective tissue cells, among these mast cells. The mast cells are confined to areas covered by the ciliated epithelium, and in the floor of the bulla, in the pars flaccida, and along the manubrial vessels. Glands are restricted to the Eustachian tube. In the clearance/transport of serum-like material, from the epitympanum towards the tube, hydrostatic forces appear to be important. The tympanic membrane is vascularized from meatal and tympanal vessels. Meatal ves­sels branch in the pars flaccida and along the handle of the malleus, where they are localized directly beneath the outer, keratinizing, stratified, squamous epithelium. Furthermore, meatal vessels form a vascular network at the junction between the fi­brocartilaginous annulus and the tympanic sulcus. Tympanal vessels send branches to the periphery of the pars tensa, where they run immediately beneath the tympanal, simple, squamous epithelium. In the major portion of the pars tensa, no blood vessels were found. The rat stapedial artery is a thin-walled vessel with a wide lumen. Without branch­ing, it runs through the tympanic cavity to the extratympanal regions it supplies. In contrast to the corresponding artery in man, the rat stapedial artery persists throughout life. The artery does not seem to be affected by the fluid produced during experimentally induced otitis media with effusion. The middle ear structure in the rat and in man show both similarities and differ­ences. If the differences are kept in mind and considered, it would seem that the rat is indeed a suitable model for experimental middle ear research. / digitalisering@umu