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We analyzed the results of 604 cases of primary stapes surgery performed between 1974 and 1997 with replacement of the stapes by a 0.6- or 0.8-mm Schuknecht Teflon-wire piston. At long-term follow-up (1 to 21 years; mean, 7 years), the residual air-bone gap was 10 dB or less in 79% of the cases. The hearing results and postoperative complications were comparable to those reported by authors who used the same evaluation criteria. Although the aim of the surgery was to perform a small stapedotomy with a narrow footplate perforation (0.8 mm), a large stapedotomy or a stapedectomy was performed in 134 cases (22.2%) because of surgical or anatomic conditions. Our results show that the larger footplate perforations allowed a better correction of the air-bone gap at the lower frequencies. The ears with larger perforations did not show a higher incidence of sensorineural hearing loss.

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Extensive ossification of the cochlea is a common finding in patients with total deafness caused by meningitis, labyrinthitis, or otosclerosis. When the cochlea is totally ossified, the prognosis for achieving free-running speech without lip reading is poor. However, subtotal ossification with residual cochlear patency in the upper basal turn, the middle turn, or the apical turn can be maximally exploited by selective insertion of electrodes. Results can be surprisingly adequate in spite of the poor anatomic conditions. Computed tomography and exploratory cochleotomy, in which electrically evoked auditory brainstem responses are elicited and recorded by intracochlear stimulation are good diagnostic indicators of ossification and residual auditory nerve excitability. "Apical cochleostomy" is an adequate procedure to help penetrate the basal turn in retrograde insertion of the cochlear implant electrode array. Results of this study indicate that the surgical technique and placement of the Ineraid electrode array play a major role in the ability of the patient to achieve understanding of free-running speech.

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Between 1980 and 1990, 9,176 patients suffering from otoneurological disorders were investigated in our clinic. Sixty-six (0.72%) internal auditory canal or other cerebellopontine angle tumors (CPAT) were diagnosed. Brainstem auditory evoked potentials (BAEP), interaural time discrimination, and magnetic resonance imaging (MRI) revealed to be the most sensitive and efficient tests for the detection of CPAT. However, the investigation of otoneurological symptoms cannot be limited to BAEP and MRI on the a priori of a hypothetical CPAT. Electrophysiologic tests such as impedancemetry, and electronystagmographic testing are also needed to elucidate the many causes of otoneurological symptoms.

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Cochleosacculotomy was performed on 25 patients with Meniere's syndrome. Long-term relief of vertigo was obtained in 19 out of 23 (82%). Postoperatively dead ears occurred in three cases. The same operation was performed on 12 guinea pigs in which hydrops had been surgically induced by blockage of the endolymphatic duct and sac. All fistulas were healed and cochleosacculotomy did not decrease or prevent the induced endolymphatic hydrops in these animals. Although histologic confirmation of persistent fistulas in human ears is lacking, the relief of vertigo in patients may not be caused by "drainage" but, rather, by a nonspecific effect on the inner ear. Cochleosacculotomy gives results comparable with other nondestructive surgical procedures performed to suppress vertigo in Meniere's syndrome.

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Dizziness is a common symptom in disorders of the brain and the ear. In a retrospective study of 1,000 cases, dizziness is attributed to a peripheral disorder in 25%, to a CNS disorder in 46%, and to undetermined causes in 29% of the cases. Peripheral disorders can be defined in terms of histopathological changes; the most frequent is cupulolithiasis, followed by endolymphatic hydrops and vestibular neuritis. These vestibular disorders are reviewed and discussed in connection with accepted facts and current hypotheses.

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The practicability of recording auditory nerve and brainstem responses during early childhood is demonstrated. This paper reports our experience with two different electrode locations: ear-canal/ear-lobe and ear-lobe/vertex. The test is performed with a light portable stimulus-generating and response-recording system that can easily be brought into wards and nurseries. In most instances, the presence of responses can be assessed using ear-lobe/vertex recordings. There is seldom any need for sedation or general anaesthesia. Testing personnel can be limited to one trained technician. If responses are not detected, ear-canal/ear-lobe recording may be used to clarify the results. General anaesthesia may then be necessary and the presence of a physician will be required for the placement of the canal electrode.

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A new and rapid method of quantitative salivary gland scintigraphy has been developed. The uptake of pertechnetate in the glandular tissue and in a reference area in the neck are measured. The ratio between these measurements gives an index of salivary gland activity. By using this activity index, quantitative information on the functional state of the parotid and submandibular glands can be obtained. In cases of xerostomia such measurements may be particularly helpful in differentiating Sjögren's syndrome and sialosis and hence in the choice of appropriate treatment.

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The practicality of recording auditory nerve responses in the routine practice of an otologist is demonstrated. Such recordings are particularly useful when the course of treatment requires a distinction between central or peripheral disorders. They are also helpful when it is difficult to obtain a valid audiogram. The electrical recordings from the auditory nerve can, in combination with standard audiological, otological and neurological examinations, present a more accurate picture of the patient's condition.

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Summary--The feasibility of making rountine measurements of human auditory-nerve potentials in an office environment is demonstrated. Using a portable device for stimulus generating and response recording, auditory-nerve potentials are recorded from subjects with normal and abnormal hearing by means of an electrode placed on the skin of the ear canal. The results can be compared with those of others obtained under laboratory conditions. Preliminary results indicate that in many instances, the nature of the hearing deficit is related to the latency and size of the click-evoked auditory-nerve potentials. The precise relationships between nerve responses and specific disease conditions are still difficult to formulate.

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Recording auditory-nerve potentials from human subjects is already a routine procedure in the laboratory. In order to bring such recording capabilities into the office of practicing otologists, a number of difficulties had to be overcome. First, a small signal averager was built and incorporated into a stimulus generating and response recording system. The entire system was made portable and self-sufficient. The effects of electrical interference and background acoustic noise were shown to be tolerable. After studies of how responses vary with electrode location, electrodes were designed to be placed on the ear canal so that no invasive procedures were necessary. Methods were found to simplify the procedure so that recordings can be made in a matter of minutes by one person working alone.

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