Preservation of vestibular evoked myogenic potentials with modified translabyrinthine approach

Vestibular evoked myogenic potentials (VEMPs) represent a relatively recent subject of investigation in regard to diagnosing specific vestibular disorders. Numerous experimental animal models(1-3) and clinical studies(4-9) suggest that VEMPs are a vestibular-colic reflex, the afferent branch of which originates in the acoustic cells of the saccule, conducting signals through the inferior vestibular nerve. These studies have proposed hypotheses based on the possibility of VEMPs originating in the saccule but have provided no definitive proof to that effect

Surgical Management of the Labyrinthine Fistula Complicating Chronic Otitis Media with or without Cholesteatoma

Objectives: To present our most recent experience on the diagnosis and treatment of the labyrinthine fistula. The relative data are compared with those of our past experiences adopting the same modality of presenting the results. Methods: The clinical and surgical records of 334 patients affected with chronic otitis media with or without cholesteatoma were analyzed to evaluate the frequency, site, and size of the labyrinthine fistulae. In this study, a more agressive strategy was adopted that comprised immediate total removal of the cholesteatoma matrix and the surrounding inflammatory tissues even when they involved the membranous labyrinth. Results: Sixteen labyrinthine fistulae were found, only one of which was in a patient with chronic otitis media without cholesteatoma. Only one patient suffered from postoperative hearing deterioration of the bone conduction above 10 dB. The fistulae were smaller in size than in the previous survey, although the total incidence was slightly higher. Conclusions: Imaging techniques have demonstrated a favourable clinical impact on the diagnosis regarding the size and involvement of one or more anatomic structures of the otic capsule, not on the frequency percentage of fistulae. Total removal of the cholesteatoma matrix in one step, also combined with partial labyrinthectomy, yields satisfactory hearing results. To obtain successful outcomes, it is essential to respect certain fundamental precautions

Malleostapedotomy in tympanosclerosis patients.

Objectives: To present our personal experience of a series of 10 patients suffering from tympanosclerosis with functional blocking of the stapes or footplate, who underwent malleostapedotomy surgery. The criteria for patient selection for this type of operation, and its results and complications, are discussed.Methods: Prospective study.Results: Incus and malleus dysfunction was observed in 70 per cent of cases, either alone or combined with fixation of the stapes. The post-operative hearing results were considered to be satisfactory (i.e. within 20 dB) in 80 per cent of cases. Only one patient had sensorineural hearing loss over 10 dB.Conclusions: Malleostapedotomy has proved its practicability in the treatment of patients with fixed footplate or stapes complicated by ankylosis of the ineudomalleolar joint. This procedure can be considered a further, valid technique within the otologist's surgical armamentarium