Middle ear surgery tinnitus,18 gauge arrow earring,in ear noise cancelling headphones for iphone,ear cuff left or right vine - Tips For You

Author: admin, 05.03.2015. Category: Is There A Cure For Tinnitus

Disclosed are viscoelastic compositions and methods of their use in surgical and non-surgical packing and in effecting drug delivery, especially in conjunction with trauma to of disorders of the ear. Kelly et al., “In Vitro Release Kinetics of Gentamycin from a Sodium Hyaluronate Gel Delivery System Suitable for the Treatment of Peripheral Vestibular Disease,” Drug Dev.
Laurent et al., “Hyaluronic Acid Reduces Connective Tissue Formation in Middle Ears Filled With Absorbable Gelatin Sponge,” Am. Poyer et al., “Quantitative Method to Determine the Cohesion of Viscoelastic Agents by Dynamic Aspiration,” J. The black arrow indicates the previously placed cartilage graft, which is directly underneath the eardrum and recreates the ear canal wall that was eroded by cholesteatoma and drilled for adequate visualization of the disease process during the original ear surgery. Common surgical approaches to the vestibular nerve (middle fossa approach is not shown here). Hearing is usually slightly impaired on the operated side, because there are some hearing fibers that go through the vestibular nerve. Given that there was vestibular function prior to the surgery (which is usually the case, as otherwise why bother), there should be substantial vertigo for several months post surgery.
As mentioned above, there is an expectation of acute vertigo following surgery as well as a modest decline of hearing on the operated side.
Failure of procedure: Thedinger and Thedinger (1998) found that 20% of 142 VNS failed to relieve vertigo. Head impulse testing in persons with failed VNS often reveal residual function in the posterior canal (Lehnen et al, 2004), which is innervated by the inferior vestibular nerve, which runs with the saccule fibers. The information on this website is provided only as an introduction to the subject but should not be used as specific advice which should always be obtained by your treating doctor.
The Vibrant Soundbridge Middle Ear Implant System is an innovative alternative to conventional hearing devices.
The technology of the Vibrant Soundbridge bypasses the outer ear in order to directly stimulate middle ear structures. The implant (VORP) is placed underneath the skin and contains a magnet to hold the audio processor over the implant.
The Vibrant Soundbridge Middle Ear Implant System directly causes the middle ear structures to vibrate.
Hearing aids, which are worn in the ear canal, amplify sound acoustically in order to increase the movement of the eardrum and indirectly vibrate the middle ear structures. Cochlear implants are designed for individuals who are affected by severe to profound hearing loss. While the Vibrant Soundbridge does not impose restrictions on most daily activities, certain activities are not advisable. Extensive clinical studies conducted in the United States and Europe* have confirmed that the Vibrant Soundbridge is a safe and effective treatment option for individuals with mild to severe sensorineural hearing loss or conductive and mixed hearing losses who are seeking an alternative to acoustic hearing aids. The method of claim 2, wherein the administration of viscoelastic is made during a surgical procedure.
The method of claim 3, wherein the surgical procedure is selected from the group consisting of: tympanoplasty, mastoidectomy, and ossiculoplasty. The method of claim 4, wherein the viscosity of the agent is greater than 50 Pa.s and the CDI of said agent is greater than zero and less than 10. The method of claim 1, wherein the viscoelastic agent is optionally combined with one or more mucoadhesive polymers selected from the group consisting of polyglycols (hydrogels), chitosan, polycarbophil, hydroxyethyl cellulose, and poloxamer.
The method of claim 6, wherein viscosity of the viscoelastic agent or the viscoelastic agent optionally combined with the mucoadhesive polymer is from about 100 Pas to about 8000 Pa.s and wherein the CDI of said viscoelastic agent or the viscoelastic agent optionally combined with the mucoadhesive polymer is from about 2 to about 7. The composition of claim 9, wherein the therapeutic agent is selected from the group consisting of: antibiotics, anti-inflammatories, anesthetics, anti-fibrotics, and combinations thereof. The composition of claim 9, wherein the optional mucoadhesive agent is selected from the group consisting of: polyglycols (hydrogels), chitosan, polycarbophil, hydroxyethyl cellulose, and poloxamer. The method of claim 1, wherein the viscoelastic agent comprises sodium hyaluronate and chondroitin sulfate. The composition of claim 8, wherein the viscoelastic agent comprises sodium hyaluronate and chondroitin sulfate. The composition of claim 9, wherein the viscoelastic agent comprises sodium hyaluronate and chondroitin sulfate. The method of claim 5, wherein the viscosity of the agent is greater than 100 Pa.s, the CDI of the agent is from about 2 to about 7, and the retention factor is from about 600 to about 15,000. The methods of the present invention are particularly useful in the field of otic therapy, and especially in therapies associated with the treatment of middle ear conditions which arise as a consequence of disease, injury, surgery and the like.
Nevertheless, they are still useful in individuals in whom gentamicin fails, or in whom the site of lesion is between the inner ear and brainstem (i.e. Considering the relative safety and efficacy of gentamicin treatment, this indication is very weak for VNS in Meniere's. Any disorder that can be treated medically, should be so treated, before an irreversible procedure such as VNS is undertaken.
This would be an irrational procedure however if the site of lesion were known to be in the vestibular nerve itself (such as in vestibular neuritis). The middle fossa approach is somewhat more dangerous and requires more expensive equipment (e.g.
However, these results could be caused by use of a high dose gentamicin protocol, which presently seems imprudent.
These are not really complications -- which implies that they are unusual, but rather are expected consequences. Reasons included incomplete section, poor compensation, new vestibular disease in the opposite ear, and various other causes. However, we are somewhat dubious that HIT testing can be trusted about any axis than horizontal. Auditory results after vestibular nerve section and intratympanic gentamicin for Meniere's disease. Head impulse test reveals residual semicircular canal function after vestibular neurectomy. It is designed for individuals who have been diagnosed with mild to severe sensorineural hearing loss or conductive and mixed hearing losses.
In contrast, the Vibrant Soundbridge provides an enhanced signal to the inner ear by directly vibrating the middle ear structures while leaving the ear canal open and the eardrum undisturbed.
They are implanted directly in the inner ear, or cochlea, where they electrically stimulate the nerves through a series of electrodes. A typical patient who uses their Vibrant Soundbridge 12-16 hours a day may need to change the battery about once a week.


For example, contact sports in which a blow to the side of the head is possible should be avoided due to the potential damage to the internal part of the Soundbridge.
Once the ear canal returns to its normal size, a hearing aid can be used for assistance until the audio processor is activated eight weeks after surgery. Implant patients are exposed to the normal risks of middle ear surgery and general anaesthesia. The compositions and methods of the present invention are particularly useful in mastoidectomy and tympanoplasty surgeries. In our practice, we have seen two cases of refractory perilymph fistula (PLF) improve dramatically and go back to work after vestibular nerve sections.
As it seems likely that hair cell regeneration technology will eventually be available, another reason NOT to do a VNS is to preserve the connection between the inner ear and brain. This suggests that if one starts with a moderate hearing loss, it is little changed by surgery. Thus, we presently are dubious that VNS has better hearing results than low-dose gentamicin. Over the long term, following VNS one should expect a permanent modest reduction in balance. It consists of the battery, a microphone and electronics responsible for digital signal processing. This a€?direct drivea€? stimulation enables excellent sound quality without blocking the ear canal.
In contrast, the Vibrant Soundbridge is designed for hearing-impaired people with mild to severe hearing loss.
The tiny FMT, the part of the implant that is attached to a vibratory structure in the middle ear, is about a quarter of the size of a standard grain of rice. Each night the audio processor should be removed from the head, and the battery compartment opened.
After the activation of the audio processor, there is no further need for a hearing aid in the implanted ear. We disagree with them, because we think that TTG has been refined and is superior because of low risk and high efficacy.
In theory, as one has suddenly lost 50% of one's vestibular system, persons with VNS may become less steady at an accelerated rate as they age.
It provides an enhanced signal to the inner ear by directly vibrating the middle ear structures.
Other sports such as tennis, golf, skiing and running may necessitate the need to support the audio processor with a headband, or to remove the processor during these activities. It is sometimes used in people who fail the retrolabyrinthine approach, as it provides better visualization (Green et al, 1992).
The external ear, which consists of the cartilaginous outer ear and the external canal are designed to gather sound and protect the tympanic membrane, which marks the beginning of the middle ear. The tympanic membrane and ossicular chain function to convert sound waves passing through the external cannel into mechanical vibrations which can then be processed by the inner ear. The eustachian tube functions as a pressure equalizer to avoid undue strain on the tympanic membrane. The “snail shell” shaped cochlea contains sound receptor cells, which respond to the sound vibrations and send signals to the brain. One reason for this is that the tympanic membrane and the ossicular chain are extremely delicate. Any trauma which impedes or alters the motility of the respective components will necessarily impact the transducer function they serve. The three tiny bones of the ossicular chain and reconstructions thereof are particularly susceptible to impaired function if the ossicular chain is permitted to collapse before it is sufficiently healed. Such collapse can result in undesirable adhesions and fibrosis that can severely limit the motility of the ossicular chain members and hence their ability to serve the transducer function. In order to stabilize the tympanic membrane and the ossicular chain, at the end of middle ear surgery, the middle ear compartment is typically “packed” with some type of gel product.Several such products are known. One drawback to the use of these products is the relatively difficult “cut to fit” technique that must be employed by the surgeon to effect the packing. Also, although used extensively in middle ear surgery, AGS has been implicated as a possible factor in the development of unexpected adhesions and new bone formation. Other attempts have been made to improve the supportive properties of these packing materials.
Rapid elimination of conventional HA solutions through the Eustachian tube may limit its capability to provide adequate graft support, leading to adhesion formation. Laurent et al., Hyaluronic acid reduces connective tissue formation in middle ears filled with absorbable gelatin sponge, Am. Many different materials have been placed in the middle ear in an attempt to prevent formation of adhesions and fibrous tissue. Silastic and Teflon, Gelfoam elicits a host inflammatory response leading to its resorption [citations omitted].
In some cases, this inflammatory response results in adhesions, especially when the middle ear mucosa is deficient. Further, gelfoam is resorbed within 2 weeks, which is probably insufficient time for mucosal regeneration to occur. Hyaluronic acid is somewhat more difficult to handle than gelfoam [citation omitted] and is also absorbed before mucosal regeneration is likely to be completed. Silastic and Teflon sheeting are relatively inert [citations omitted] but they are not resorbed and can extrude on occasion. In some cases, Silastic and Teflon become engulfed by fibrous tissue leading to a nonaerated ear [citation omitted].
What is needed is a material that will remain in place for several weeks to allow sufficient time for mucosal regeneration and will then undergo degradation and resorption so that the ear can become aerated without fibrosis.Surgical grade viscoelastics are known in the art. Kelly et al., In vitro release kinetics of gentamycin from a sodium hyaluronate gel delivery system suitable for the treatment of peripheral vestibular disease, Drug Dev. 25(1):15-20 (1999), disclose in vitro testing of a delivery system comprising gentamycin in a sodium hyaluronate gel for the treatment of peripheral vestibular disease. The ocular surgical use of viscoelastic agents having different cohesive properties is disclosed in U.S. Prior art viscoelastics, however, are not known to be particularly well-suited for use as a middle ear packing material, for the aforementioned reasons.BRIEF DESCRIPTION OF THE DRAWINGSFIG. The packing materials of the present invention provide adequate support for otologic repair until adequate healing can take place.


These materials are less susceptible to premature bioabsorption or degradation than those previously used in the art, are therefore suitable for enhanced drug delivery, if desired, and will promote healing with minimal tissue fibrosis. It has further been discovered that viscoelastics suitable for such purposes will have certain physical characteristics, including high viscosity and a suitable cohesion-dispersion index. These same physical characteristics are desirable in viscoelastics being employed for packing the external ear canal. Any physiologically acceptable viscoelastic formulated to meet the inventive physical characteristic requirements will be suitable for purposes of the present invention.DETAILED DESCRIPTION OF THE INVENTIONThe middle ear is part of a continuous pathway that runs from the nose and throat through the eustachian tubes to the middle ear, and then to the surrounding mastoid air cells in the bone and cartilage surrounding the ear. Infection can easily travel along this pathway to the middle ear and to the mastoid air cells when infected, the chambers in the middle ear and mastoid air cells fill with fluid. If such infections are not resolved, the middle ear structures can become permanently damaged. Ear pathologies associated with perforation or a conductive deficit include but are not limited to: otitis media, otitis externa, granulation tissue, and trauma (including without limitation myringotomy). Key characteristics of the suitable viscoelastic material are viscosity and cohesion-dispersion index (CDI).
The zero shear viscosities of many viscoelastics are known in the literature and may, in any event, be determined by means well known in the art.
For present purposes, zero shear viscosity was determined using a Bohlin CS Rheometer as more particularly described in the following examples.Surgical grade viscoelastic agents are known in the art, especially as adjuncts in ophthalmic surgeries. 4,141,973 and 5,422,376, and 6,051,560, all of which are by this reference incorporated herein. It is also known that viscoelastic agents may be used as carriers for pharmacologically active agents.
In addition, mucoadhesive polymers (for example, polyglycols (hydrogels), chitosan, polycarbophil, hydroxyethyl cellulose, and poloxamer) may be added to the foregoing viscoelastics to enhance dispersivity and thereby prolong retention time at the desired site, for example, in the middle ear cavity or in the external canal.Viscoelastics exhibit a degree of cohesion, which is the result of intermolecular entanglement. While not dependent on any particular theory, the present invention recognizes that the relative cohesion of a viscoelastic agent may affect the degree to which it is prematurely evacuated from the desired site, and particularly from the middle ear cavity through the eustachian tube. Surprisingly, it has been discovered that these viscoelastics are remarkably effective at preventing undesirable tissue-tissue adhesions and fibrosis. Specifically, the viscoelastics of the present invention may be used as a delivery vehicle for therapeutic agents useful in treating a variety of otic conditions, including those enumerated above.
The viscoelastics, containing one or more therapeutic agents, may be instilled during or upon completion of a surgical procedure, and especially in conjunction with middle ear surgery where antibiotics and anti-inflammatory agents are preferred therapeutic agents.
The external canal may be treated by packing it with the viscoelastic containing the therapeutic agent(s). The middle ear can similarly be treated by i) applying such viscoelastic to the tympanic membrane where the therapeutic agent will cross the membrane into the middle ear, or, ii) in a more aggressive regimen, injecting it through the tympanic membrane into the middle ear. Even treatment of the inner ear, which is not readily accessible by conventional surgical procedures, may also be effected using the viscoelastics of the present invention for drug delivery. Contacting the membrane of the oval window separating the middle and inner ear with such viscoelastics will effect delivery of the drug across the membrane and into the inner ear. Such contact may be effected by packing the middle ear, for example in conjunction with surgery, or by the targeted application of the viscoelastic to the oval window, for example by spraying a coating of the viscoelastic on the target site. Among anti-inflammatory agents, particularly well-suited for such trans-membrane applications are the compounds described in U.S.
In most instances, the extended retention of the viscoelastics on the target tissue, which is attributable to their viscosity and CDI characteristics, will permit more drug to reach the target tissue over a longer period of time and with a lower dose than would be possible using conventional approaches.Several physical parameters of viscoelastic materials have been measured and are well-documented including viscosity, pseudoplasticity (shear-thinning), and molecular weight.
A method to measure their cohesion is described by Poyer et al., Quantitative method to determine the cohesion of viscoelastic agents, by dynamic aspiration, J. 2 and using the following materials and methods.MATERIALS AND METHODSMaterials and EquipmentPolypropylene test tubes (found bottom, 14 mL) were obtained from Becton Dickinson Labware and polypropylene pipette tips (model RT-20), from Rainin Instrument Co. A Sartorius model 1612 balance was used for the gravimetric determinations and a positive displacement pipette (Rainin model M1000), for viscoelastic sample transfer.
Vacuum was applied with a Gast vacuum pump.Aspiration of Viscoelastic SamplePolypropylene well inserts were cut from the bottom of 14 mL test tubes, weighted (W0), and inserted into the well of a 24-well cell culture cluster for secure holding (FIG.
Polypropylene provides a non-adsorptive surface to minimize interference with aspiration by potential adsorptive forces from the container. Vacuum was applied at various levels indicated by a gauge (5, 10, 15, 20, 24, and 28 inches Hg, equivalent to 127, 254, 381, 508, 610, and 711 mm Hg) to the viscoelastic samples, using a new sample (in duplicate) for each vacuum level. The tip's position was fixed at an angle of 80 degrees from the horizontal surface of the sample, preventing obstruction of the tip by the bottom of the insert. Bolus removal (for the purpose of break point) is defined as having more than 25% of the sample removed by a single vacuum level. More specifically, the invention is directed to viscoelastic agents optionally combined with one or more mucoadhesive polymers (hereinafter “viscoelastic compositions”), for which the Retention Factor is at least 600 and preferably greater than 600 (i.e. Animals for the fibrosis study underwent bilateral surgeries with product in one ear and none in the other.
The cohesion-dispersion index (“CDI”) was determined in accordance with the methodology of Poyer et al., “Quantitative method to determine the cohesion of viscoelastic agents by dynamic aspiration”, J. 17627)), equipped with Bohlin Software 5.4, an HP Color DeskJet 1600C printer, and VWR Programmable water bath Model 1147 (Alcon Asset No. As indicated above, formulation 2 (1.6% HMW HA+4% CS) was found to be superior in terms of retention to the other evaluated formulations.
The present invention offers sustained, long-duration drug delivery and is particularly well suited for delivery of anti-fibrotics, antibiotics, steroidal and non-steroidal antiinflammatories, anesthetics, analgesics and other medicaments or gene therapies to the middle and inner ear. They will be particularly useful in nasal, spinal cord, cardiovascular, orthopoedic and orthodontic surgical procedures that would otherwise be prone to such complications. Skilled practitioners will recognize that the preferred retention characteristics of the viscoelastic agent will depend upon the type of procedure for which it is being employed. Using the present teaching, retention characteristics can be optimized for a specific function or type of procedure. As used herein, the term “pharmaceutically acceptable vehicle” means any vehicle that would be suitable for therapeutic administration of a viscoelastic agent or a therapeutic agent to a patient by any conventional means without significant deleterious health consequences.
The embodiments described above are therefore considered to be illustrative in all respects and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description.




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