摘要:

Purpose:Nimodipine is a highly lipophilic, centrally acting calcium channel blocker. It is similar in action to flunarizine, which has been studied for use in the medical treatment of Meniere's disease.Methods:Nimodipine was offered to patients with Meniere's disease for whom first-line medical management failed (dietary restrictions and diuretics or vestibular suppressants).Results:Our preliminary clinical experience using nimodipine in 12 patients with Meniere's disease from December 1992 until March 1995 resulted in successful control of vertigo and hearing improvement or stabilization in seven (58%) of 12 patients. When hearing stabilization was not considered, eight (67%) patients had vertigo satisfactorily controlled (AAOO class A, B, or C). The four (33%) patients whose vertigo symptoms persisted despite treatment with nimodipine (AAOO class D) were surgically treated with successful vertigo control. Nimodipine was discontinued in one class D patient because of gastrointestinal intolerance.Conclusions:Nimodipine provides an alternative successful means for medical management of Meniere's disease.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:A goal of vestibular rehabilitation is to improve the functional status of patients with balance disorders. Despite the focus of vestibular rehabilitation on function, few objective data describe the outcome of vestibular rehabilitation in terms of balance function. In this prospective observational study, we tested a well-defined patient cohort (n=67) with abnormal pretreatment sensory-organization testing who were undergoing vestibular rehabilitation. Patient outcomes were determined by using objective and subjective measures of function before and after rehabilitation. Overall, 60% of patients showed objective improvement of balance function; 25% of patients improved to normal. Analysis of success and failure of vestibular rehabilitation is important as an aid to appropriate patient counseling and efficient use of rehabilitation resources.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Patients attending an outpatient clinic with the complaint of dizziness were given a set of five items to rank the magnitude of the frequency and severity of their dizziness and the impact of dizziness on their quality of life. They were given instruments to evaluate their degree of anxiety and depression. The impact of frequency and severity on the patients' daily activities, on the quality of life, and on the fear of becoming dizzy was self-rated by the patient. The score on quality of life was compared with that provided by the physician in a blind questionnaire. The items that were developed addressed the physical, functional, and emotional impact of dizziness and can be considered promising for the evaluation of the patients' degree of overall impairment.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Twelve patients with auditory and/or vestibular symptoms were examined with a gadolinium magnetic resonance imaging (Gd-MRI) study. They all were found to have enhancement of only the endolymphatic duct/sac structures of the inner ear. Most of these findings were unilateral, but a few were bilateral. The patients underwent auditory, vestibular, and blood tests in an attempt to clarify the reason for this abnormal enhancement. Several specific etiologies were identified, but several cases had unknown causes. In this article we review the concept of inflammation of the inner ear structures with particular attention to the role of the endolymphatic duct/sac in the immune response of the inner ear. The idea of an inflammatory response of the inner ear leading to endolymphatic hydrops (Meniere's disease) is discussed, but these patients did not follow a clear path from inflammation of the endolymphatic duct/sac to endolymphatic hydrops. However, the longest follow-up was only 4 years, and our observations remain preliminary. Finally, the authors have found that Gd-MRI study of the inner ear provides valuable information in the investigation of patients with new auditory and/or vestibular symptoms.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Electrocochleography (ECoG), an objective electrophysiologic test, is useful in the clinical diagnosis of endolymphatic hydrops. The purpose of this study was further to define the role of ECoG in the diagnosis of this disease. A retrospective chart review of 100 patients undergoing tympanic ECoG was undertaken comparing symptoms, degree of hearing loss, duration of disease, and diagnosis with ECoG results. The apparent sensitivity and specificity of ECoG in the diagnosis of endolymphatic hydrops were determined to be 57% and 94%, respectively. Three of 30 positive ECoG results were falsely positive. Fluctuating hearing loss and the degree of hearing loss (<40 dB) and duration of disease (<48 months) were statistically significant in predicting positive ECoG results. We conclude that a positive ECoG result is helpful in objectively confirming the disease. However, a negative result does not rule out hydrops.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Approximately 10% of all intracranial meningiomas occur in the cerebellopontine angle (CPA). Although their clinical presentation depends on their site of origin, most are first seen with nonspecific otologic symptoms like those of acoustic neuroma. We present two cases of CPA meningioma that were intimately involved with the endolymphatic sac and had symptoms and signs suggestive of endolymphatic hydrops.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Purpose:The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients.Methods:Operation logs from 1988 through 1993 were reviewed to identify patients who underwent lateral suboccipital craniotomy or craniectomy. The nature of the operation, preoperative and postoperative complaints of headache, treatment for postoperative headache, and the use of primary cranioplasty were recorded from the medical records.Results:Fifty-six suboccipital approaches were performed by the senior authors between 1988 and 1990. Seven patients had debilitating postoperative headaches. None responded to conservative management, and all underwent secondary cranioplasty. All seven patients showed significant improvement in their pain, with four of seven requiring no other treatment (follow-up from 15 to 38 months). Fifty patients underwent cranioplasty at the time of their initial operation, from 1991 to 1993. No case of debilitating headache was identified postoperatively in these patients.Conclusions:Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Prolonged headache subsequent to excision of acoustic neuromas via a suboccipital approach has been cited as a significant complication of this procedure. However, few studies have sought to compare the incidence of postoperative headaches in patients undergoing either translabyrinthine or suboccipital approaches with surgical techniques designed to minimize this complication. We performed a retrospective survey of 52 patients having undergone either a suboccipital or translabyrinthine resection of acoustic neuromas. Cranioplasties were performed on all patients having undergone resections via a suboccipital approach. The survey asked patients to categorize headache severity based on a numeric scale at 1 month, 6 months, and 1 year after surgery. Medications required to control headaches were also recorded. At 1 and 6 months after surgery, headache severity was significantly less in patients having undergone a translabyrinthine resection (p<0.05). However, by 1 year after surgery, headache severity in the two groups of patients was essentially equivalent (p=0.6). Data concerning the strength of analgesics required to control postoperative headaches paralleled these results. These results indicate that within the first postoperative year, patients undergoing suboccipital craniotomies have significantly more postoperative pain than do those patients having undergone translabyrinthine resections, despite the performance of a cranioplasty. However, by 1 year after surgery, these differences are no longer significant. Thus the complication of long-term postoperative headache is no more prevalent in patients undergoing a suboccipital resection than in those having undergone translabyrinthine surgery. These results are important to both the surgeon and the patient during preoperative counseling regarding the choice of surgical approach for acoustic neuroma excision.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Purpose:Delayed facial palsy after acoustic neuroma resection may occur in up to 15% of cases. Prognosis is generally good if the palsy does not progress to total paralysis. However, delayed palsy with subsequent total paralysis has a more variable final outcome, which ranges from normal function to permanent total paralysis. This delayed paralysis has been attributed to edema from surgical manipulation of the facial nerve. Steroids and intraoperative decompression of the meatal foramen have been used with some success, but some cases remain refractory to these measures. Herpes simplex virus and varicella-zoster virus are ubiquitous in the population and remain in a latent state in neural ganglia. These viruses are reactivated during times of stress. Trigeminal nerve surgery (partial sensory rhizotomy and microvascular decompression) stimulates reactivation of herpes simplex with manifestations the sensory distribution of the trigeminal nerve in 38-94% procedures. Prevention of this reactivation has been demonstrated in placebo-controlled trials by using prophylactic acyclovir. We present a patient who underwent translabyrinthine resection of an intracanalicular acoustic neuroma and in whom developed otalgia, vesicles on the ear canal and the ipsilateral buccal mucosa, and progressive facial palsy the week after surgery. Serologic evaluation confirmed the diagnosis of herpes zoster oticus. Reactivation of latent virus apparently occurred as a result of surgical manipulation of the facial nerve. This parallels viral reactivation seen in trigeminal nerve surgery. We propose a new theory for an additional cause of delayed facial palsy after acoustic neuroma resection—reactivation of latent herpesvirus resulting from surgical trauma. Acyclovir should be evaluated in clinical trials for a prophylactic role in patients undergoing acoustic neuroma resection or a therapeutic role in patients in whom a delayed postoperative facial palsy develops.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Patients with satisfactory facial nerve function [House—Brackmann (HB) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve preservation were identified. Delayed facial paralysis occurred in 62 (24.3%) patients; 90% ultimately recovered to their initial postoperative HB grade, and 98.3% recovered to within one grade of their initial HB level. Paralysis occurred at an average of 3.65 postoperative days (range, 1-16 days). The average time to maximal recovery for those with changes of 1,2,3, and 4 HB grades was 5.6,21.5,39.8, and 50.5 weeks, respectively. The early onset of paralysis (<48 h after surgery) resulted in shorter average recovery times. Of patients who demonstrated nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the overwhelming majority of patients with delayed facial paralysis after acoustic neuroma surgery do eventually recover to their postoperative HB grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.

ISSN:0192-9763    

出版商:OVID    

年代:1996

数据来源: OVID