摘要:

Auditory brainstem response (ABR) audiometry is said to be 90% sensitive in the diagnosis of acoustic neuromas. Since gadolinium-DTPA was introduced, magnetic resonance imaging (MRI) is capable of detecting acoustic neuromas as small as 3 mm. Early diagnosis is important, because hearing can frequently be preserved with resection of tumors smaller than 2 cm. At the same time, cost-containment has become a pressing issue in medicine. Auditory brainstem response, although considerably less expensive than MRI, may not be as sensitive as previously thought, particularly for small tumors. Of 753 acoustic neuromas treated at the House Ear Clinic from January 1988 through March 1993, 197 had ABR data available. The 98 males and 99 females ranged in age from 13 to 78 years with a mean of 48 years. The overall sensitivity of ABR was 92.3% using an interaural latency difference for wave V of more than 0.2 ms, and was 81.6% using waveform morphology. There was a statistically significant difference in sensitivity with respect to tumor size. Auditory brainstem response interaural latency difference sensitivity ranged from 100% in tumors larger than 3.0 cm to 83.1% in tumors 1.0 cm or smaller. Waveform morphology was abnormal in 100% of tumors larger than 2.0 cm but in only 76.5% of tumors 1.0 cm or smaller.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Seven cases of intratemporal facial schwannoma were assessed by preoperative magnetic resonance imaging (MRI) and intraoperative frozen sections to determine tumor boundaries. These results were then analyzed with respect to gross tumor appearance, under the operating microscope, and final histopathologic diagnosis, with immunostains. Gadolinium-enhanced MRI was helpful in planning the surgical approach and in defining the extent of tumor involvement relative to the facial nerve. Frozen sections on the other hand were often unreliable in confirming the completeness of resection, frequently overestimating tumor infiltration. Ultimately, tumor-nerve interface, especially in the proximal facial segments, is best judged by its gross intraoperative appearance under high magnification, with the aid of MRI. The difficulty in establishing tumor infiltration in the presence of organized neural fibers and artifacts is emphasized. Immunohistochemical assays are essential in this regard. Complete tumor removal was achieved in all seven cases, with acceptable functional outcome in those with sufficiently long follow-up.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was undertaken to determine quantitative histologic changes after a single episode of acute suppurative otitis media in the rat middle ear mucosa, with special reference to goblet cell density, and to determine the persistency of these changes. Drum vascularization, purulent effusion, mucosal thickness, bone, and subepithelial gland formation were assessed. Twenty-five rats were inoculated with viable pneumococci type 3 through the right, bony middle ear bulla. The left bulla served as control. At days 4, 8,16, 90, and 180 after inoculation, five rats were sacrificed on each occasion; the bullae were removed, opened, and divided in two halves, which were stained according to the periodic acid-Schiff (PAS)-alcian blue method. The stained mucosa was dissected from the bone and placed in an anise oil-colophonium chamber, for determination of interindividual median density and range of goblet cells by light microscopy. Counting was performed in 24 well-defined localities, covering the entire bulla mucosa and the drum. Areas normally containing goblet cells were extended. Goblet cell density was significantly (Mann-Whitney,p< .05) increased in almost all localities, reaching a maximum at day 16, whereafter the mucosa normalized. All changes quantitated, except drum vascularization and purulent effusion, were persisting at day 180. Cobblestone appearance of the epithelial surface and polypous mucosal prominences were found. Mucosal thickening was prominent in areas covered with flat epithelium, less so in other areas. Local differences in the degree of increased mucosal thickness were preventing intrinsic tubal occlusion. Enhanced secretory ability of the middle ear mucosa was persisting 6 months after a single episode of acute suppurative otitis media, perhaps predisposing secretory otitis media.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The temporal bone often falls within the field of radiation for head and neck tumors. Whereas osteoradionecrosis is well recognized as the end-stage complication of radiation to the temporal bone, serious non-osteitic complications can also occur, and these are important because the ear is an organ of special sense. Radiation causes changes in the specialized tissues of the ear that can impair function and influence therapeutic decisions. The purpose of this article is to review the non-osteitic effects of radiation on the ear. A series of cases is presented that illustrate the spectrum of non-osteitic complications of radiation therapy. External canal stenosis, otitis media with effusion, chronic suppurative otitis media with or without cholesteatoma, sensorineural hearing loss, vestibular impairment, and facial nerve paralysis are described. Management should be guided by an understanding of the pathogenesis of these complications. The authors believe that non-osteitic complications of therapeutic radiation to the temporal bone are relatively common and warrant increased recognition.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Twenty-seven patients with mild multiple sclerosis were tested with the dynamic posturography protocol used in the NeuroCom Equitest procedure. The purpose of this study was to determine if the standard test procedure elicited a pattern of responses that would suggest the possibility of multiple sclerosis during differential diagnosis of a patient with dysequilibrium. In addition, the patients' ability to align a light bar to vertical and horizontal was tested with the head erect and with the head tilted 45 degrees to the right and left shoulder. There was a pattern of abnormality in the Equitest motor coordination tests. Only one patient produced normal scores in both the latency and adaptation tests. No pattern of error was noted in the sensory organization tests. In the visual alignment tests, only 3 of the 27 patients tested produced values that were within normal limits for the three different head positions. Visual alignment and the motor coordination tests are not specific for multiple sclerosis, but poor performance probably indicates a disruption of the integration of visual, vestibular, and somatosensory information. Although patients with early multiple sclerosis and patients with purely vestibular disorders often have similar complaints, they have quite different profiles of abnormalities in posturography testing.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pulsatile tinnitus, hearing loss, lower cranial nerve deficits, and radiographic evidence of a vascular lesion of the jugular foramen have been considered diagnostic of a glomus jugulare tumor. Angiographic evidence of a blood supply from the external carotid artery system, including the ascending pharyngeal artery, further substantiates this diagnosis. This diagnostic algorithm for tumors of the jugular fossa is usually followed by either a surgical exenteration of a presumed glomus jugulare tumor via an infratemporal fossa approach or radiation therapy in selected patients. Pre-treatment biopsy of such lesions is typically not done, nor is it recommended widely in the literature. As demonstrated in this report, a number of lesions, including hemangioperi-cytoma and extramedullary plasmacytoma presenting in the jugular foramen can mimic glomus jugulare tumors in all aspects of their clinical and radiographic presentation. Omission of a pre-treatment biopsy can lead to a treatment plan appropriate for glomus tumors but suboptimal for these rare pathologic entities. A pre-treatment biopsy of lesions of the jugular foramen by exploratory tympanotomy or postauricular mastoidotomy provides a pathologic diagnosis on which to base treatment of lesions of the jugular foramen, without adding substantial morbidity or decreasing the chances of cure.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The anatomic results of mastoid obliteration surgery on 54 ears during the past 10 years were analyzed, and the comparative utility of several materials for obliteration was evaluated. Thirty-three ears had primary chronic otitis media with or without cholesteatoma (group 1), and 21 ears had old open mastoid with intractable chronic discharge due to incomplete epithelialization (group 2). The materials used for obliteration were biologic (pedicled muscle flap, autogenous bone chips, tragal cartilage with perichondrium, allograft dura), nonbiologic (hydroxyapatite), or a combination of two of these materials. Evaluation at 2 months postoperatively showed that 42 ears were anatomically complete, whereas the other 12 ears were incomplete: three cases in group 1 and nine cases in group 2. The main causes of these unsatisfactory results were exposure of transplanted artificial material or partial loss of the pedicled muscle flap. In the long-term follow-up results, four ears were evaluated as unsatisfactory in group 1, and six ears in group 2, owing to shrinkage of obliterated tissue. The major causes of failure were anatomic incompleteness following surgery for old open mastoid cavity, in which the use of biologic materials for obliteration was much safer than nonbiologic material, and from the protrusion of artificial materials used.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Among 24,321 patients with otitis media treated at the Otolaryngology Department of Chiang Mai University Hospital from 1978 through 1990, 87 patients had 140 central nervous system complications (0.36%). Multiple complications existed simultaneously in almost 45% of the patients. The group developing the complications were mainly in their second decade of life. Meningitis occurred in 43 patients, brain abscess in 29, perisinus abscess in 23, lateral sinus thrombosis in 16, and extradural abscess in 12 patients. The most striking symptoms and signs were increasing otorrhea, visible cholesteatoma and/or granulations, fever, headache and otalgia, and vestibular symptoms.Proteus mirabilis, Pseudomonas aeruginosa, and staphylococcal organisms were found in almost 80% of patients. Overall mortality was 18.4% with brain abscess being the main cause (31%). Epidemiologic presentation, clinical features, and results of treatment for each disease are compared and contrasted to those of previous studies.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study involved elderly patients with Meniere's disease with incapacitating vertigo. Several of these patients underwent surgery for relief of symptoms that was tailored to the individual's general health and degree of physical activity. Factors that might affect postoperative rehabilitation and recovery were considered, including vision, vertebrobasilar ischemia, proprioception (such as neuropathy resulting from diabetes), and basal ganglia disease. The postoperative results of this tailored approach have been completely satisfactory.

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1995

数据来源: OVID