摘要:

ObjectiveThis study aimed to examine word recognition score (WRS) changes after stapedectomy for far-advanced otosclerosis (FAO). The WRS changes were examined to determine whether they were consistent with acclimatization or recovery from auditory deprivation changes that have been seen after the restoration of sound by amplification.Study DesignRetrospective.SettingPrivate otology practice.PatientsA total of 24 patients were selected by including all the case in which a stapedectomy was performed within the past 10 years to improve the hearing of a severe or profoundly hearing-impaired patient with otosclerosis.InterventionDiagnostic.Main Outcome MeasureChanges in WRSs.ResultsOne month after surgery, the mean WRS had improved 16.5%. The WRSs continued to improve an additional 12% or more for 17 (71%) of 24 patients within 2 years after their initial postoperative hearing test. The mean WRS improvement within 2 years of the initial postoperative test was 16.2%.ConclusionsInitial WRS changes were attributed to hearing thresholds no longer being at or beyond audiometric limits. Additional WRS changes were consistent with reports of acclimatization or recovery from auditory deprivation that have been seen after hearing aid use. The authors believe these additional WRS changes illustrate that at least some improvement in WRSs from acclimatization or auditory recovery may be fairly common after the restoration of sound. Finally, the authors believe the overall WRS improvement (32.7%) should be taken into account when considering stapedectomy for patients with FAO.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to examine the reliability of the 512-Hz Rinne tuning fork test to detect conductive hearing losses. The effects of tester experience, the use of masking, and the interpretation of equivocal (+/-) Rinne results on test reliability also were examined.Study DesignRetrospective.SettingPrivate otology practice.Patients1,000 adult patients (2,000 ears) seen for their initial otologic evaluation.InterventionsDiagnostic.Main Outcome MeasureSensitivity of the 512-Hz Rinne tuning fork test was assessed by comparing tuning fork results with the pure-tone average air-bone gap.ResultsResults showed the 512-Hz Rinne tuning fork test could be very effective at detecting conductive hearing losses when performed by an experienced tester and when masking was used. Sensitivity was lower when masking was not used and lowest when the Rinne was performed by a less-experienced tester. Sensitivity for all groups was improved by interpreting equivocal results as indicating a conductive loss.ConclusionsDespite reports of poor reliability, the 512-Hz Rinne tuning fork test can be an important tool in an otology practice for the detection of conductive hearing losses and for confirming audiometric findings. In primary care settings, the Rinne would be most effective as part of a screening program for conductive hearing losses, but not as the sole indicator for referral.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

HypothesisThis study aimed to show whether sensorineural hearing loss in diabetes mellitus is secondary to changes in the organ of Corti and stria vascularis.BackgroundThe high rate of sensorineural hearing loss in diabetes mellitus has led to much speculation as to whether there is an association between the two.MethodsA well-established diabetic animal model was used to examine the inner ear histopathologically.ResultsNo statistical difference in the inner and outer hair cells or in the stria vascularis was shown between the geneticdiabetic rats and control subjects.ConclusionsIf there is hearing loss with diabetes, its pathogenesis does not involve damage to the hair cells or stria vascularis.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to review a single institution's experience with Clarion Multi-Strategy Cochlear Implant with respect to surgical technique, surgical complications, and rehabilitative outcome.Study DesignThis study was a review of patients implanted with the Clarion Multi-Strategy Cochlear Implant.SettingThe setting was a tertiary referral center with care delivered in the inpatient and outpatient environment.PatientsThe first 37 patients were implanted under an Investigational Device Exemption as part of the Food and Drug Administration (FDA) clinical trial of the Clarion implant. Subsequent patients were implanted after the device received FDA approval. Patients met the following criteria for implantation: 18 years of age or older, psychological and emotional stability, profound postlingual deafness without evidence of middle ear disease, one cochlea at least partially patent, and marginal or no benefit from conventional hearing aids.InterventionPatients received implantation with the Clarion Multi-Strategy Cochlear Implant.Main Outcome MeasuresMeasured were presence or absence of surgical complications and auditory performance with open- and closed-set word and sentence recognition testing.ResultsA total of 47 patients have been implanted. Three patients have suffered complications: two cases of delayed-onset facial palsy both resolved with steroid therapy and one case of internal cochlear stimulator migration required refixation. Significant improvement in speech understanding has been seen in the majority of patients who were implanted within the first 6 months of device use. Specifically, at 6 months, scores on CID (Central Institute for the Deaf) sentences (implant alone) improved from a preoperative mean of 9% to a mean of 72%, and scores on the NU-6 (Northwestern University) monosyllabic word test increased from a preoperative mean of 3% (range, 0-20%) to a mean of 32% (range, 0-70%). More than two thirds (68%) of the adults were able to understand at least 50% of sentences over the telephone, and half were able to understand at least 75% of the sentence material.ConclusionsThe authors' institutional experience with the Clarion Multi-Strategy Cochlear Implant shows minimal surgical morbidity and significant improvement on all open-set test measures of sentence and word recognition.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to clarify the pathoanatomic characteristics of the endolymphatic sac in Meniere's disease by surgical observations.Study DesignThe study design was a retrospective case study conducted in the setting of University Hospital at Shiga University of Medical Science.PatientsStudied were 101 patients with Meniere's disease who underwent endolymphatic sac drainage surgery at the university hospital by the same surgical team between 1984 and 1995. Control group consisted of 23 patients with non- Meniere's disease.Main Outcome MeasuresPhotographs were taken of the sac in 101 patients with Meniere's disease during endolymphatic sac drainage surgery, and the pathoanatomic findings of the sacs were classified into three grades regarding position (types I, II, III), size (large, intermediate, small), color (red, intermediate, white), and vascularity (fair, intermediate, poor). Statistical difference was studied between Meniere's group and non-Meniere's group by chi-square test.ResultsThe patients with Meniere's disease were found to have endolymphatic sacs located inferiorly to the posterior semicircular canal, very close to the jugular bulb (type III) (p < 0.001). The sacs also were smaller in size (p = 0.068), whiter in surface color (p = 0.0036, 0.01), and of less vascularity (p = 0.051) than those of the patients with non-Meniere's disease. The comparisons showed significant differences only in position and color.ConclusionThe patients with Meniere's disease were found to have endolymphatic sacs located inferiorly to the posterior semicircular canal, very close to the jugular bulb. The sacs also were whiter in surface color.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to determine how the smooth pursuit neck torsion (SPNT) test is affected by various diseases associated with disturbances in balance and arising in the neck, in the posterior intracranial fossa, and in the labyrinth in patients having such conditions, and to compare the findings with those in healthy subjects.Study DesignThis study was a consecutive, prospective, double-blind clinical studySettingThis study was conducted with ambulatory patients in a tertiary referral center (i.e., a county hospital).PatientsStudied were 75 patients with whiplash-associated disorders (WAD) of at least grade II, according to the Quebec classification, all of whom had been injured in car accidents. Of these, 50 patients reported dizziness and 25 did not.Control SubjectsTwenty patients had vertigo of central origin with positive central nervous system findings, 20 patients had Meniere's disease, and 30 subjects were healthy.InterventionThe SPNT test is a smooth pursuit eye movement test. The subjects are placed in a neutral position, and then they turn 45° to the right and to the left. The difference between the average gain in neutral and torsion positions is the test parameter. In addition to the SPNT test, the authors performed saccade tests, auditory brain stem response, and the caloric test.Main Outcome MeasuresIn the two WAD groups, neck torsion reduced the SP gain (p < 0.001), but in control patients with central and peripheral vertigo and in the healthy control subjects, it did not. Results: The sensitivity of the SPNT test in the WAD group with dizziness was 90% and the specificity was 91%. The sensitivity in the WAD group without dizziness was 56%.ConclusionThe SPNT test seems to be useful for diagnosing cervical dizziness, at least in patients with WAD having symptoms of dizziness, because it has a high sensitivity and specificity.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors.Study DesignThis study was a retrospective case review of 473 patients with vestibular schwannoma.SettingThe surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center.PatientsA total of 473 patients with a unilateral sporadic vestibular schwannoma were studied.Main Outcome MeasuresMeasured were the principal presenting symptoms and the criteria for audiologic management.ResultsOf this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney U test; tied p value=0.0002), shorter length of history (tied p value < 0.0001), and better preserved hearing (tied p value < 0.001) than the typical otologic presentation group. These clinical correlates are related to tumor morphology, and it is hypothesized that the site of the neurilemmal-glial junction (medial or lateral) has an effect here. If the U.S. criteria for the treatment of a patient by an audiologist are applied to this series of patients, then 7 patients (1.5%) would not have had the diagnosis of vestibular schwannoma. If the U.K. criteria are applied, this number of missed tumors is 17 (3.6%). The addition of unilateral tinnitus as an indicator of the need for otologic investigation reduced the number of patients who might be missed to 2 (0.42%) for the U.S. cases and 5 (1.1%) for the U.K. cases.ConclusionsOf patients with vestibular schwannoma, 10.7% have an atypical principal presenting symptom, and this group of patients has significantly larger tumors than those patients who present typically. This finding is of particular relevance to the entry point of such cases to the healthcare system. A number of patients with vestibular schwannoma appear to pass the criteria for treatment by an audiologist without reference to an otologic opinion. These patients may not be investigated from an early stage with potential implications for increased morbidity

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis study aimed to update the authors' experience with the modified transcochlear approach for the management of lesions of the central skull base. The surgical technique, classification, indications, and results also are presented.Study DesignA retrospective review of the charts of 66 consecutive patients treated in our centers by the modified transcochlear approach was conducted.SettingThe study was performed in two tertiary referral centers.PatientsAll patients treated by the modified transcochlear approach were included. Thirty-five patients had extradural lesions, whereas 31 lesions were intradural.InterventionAll patients were treated surgically using the modified transcochlear approach either in its basic form (type A) or with its extensions (types B, C, and D).Main Outcome MeasuresThe outcome of surgery is evaluated with particular emphasis on the incidence of morbidity, mortality, and the degree of total tumor removal.ResultsTotal tumor removal was accomplished in 58 cases either in single or staged procedures. A second-stage procedure for total tumor removal is planned in five other patients. Subtotal tumor removal was performed in three patients. Mortality occurred in two cases. Ipsilateral hearing loss and immediate facial nerve palsy constituted the major drawbacks of this approach. However, 67.5% recovered to grade III facial function or better 1 year after surgery.ConclusionsThe modified transcochlear approach provides a relatively safe, wide, and versatile access to large lesions of the central skull base.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe study aimed to present clinical, radiographic, and operative findings in cases of recurrent facial neuromas and discuss changes in demographics of primary facial neuromas since 1986.Data SourcesMEDLINE search of English language literature since 1966 and bibliographies of collected articles were the data sources.Study SelectionAll available reports of recurrent facial neuromas (N = 8) and case reports of primary facial neuromas since 1986 (N = 238) were selected. Data Extraction: Cases of facial neuromas confirmed by histologic and/or clinical and radiographic criteria are included.Data SynthesisCompilation of reported anatomic and clinical data is included.ConclusionsImproved imaging techniques have documented an increased incidence of primary facial neuromas medial to the geniculate ganglion. Clinical suspicion, histologic confirmation of tumor-free margins, interspecialty cooperation in tumor resection, and routine follow-up imaging with magnetic resonance imaging are suggested to minimize recurrent facial neuromas.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:This study aimed to evaluate the recovery of balance function after acoustic neuroma resection.Study Design:This study was a retrospective case review with patient survey.Setting:The surgery was conducted at a tertiary referral center.Patients:Patients who underwent surgical resection of acoustic neuroma and had preoperative vestibular function testing were eligible for entering the study.Interventions:All patients received surgical resection of acoustic neuroma. Patients treated since 1990 received postoperative vestibular habituation exercises.Main Outcome Measures:These included postoperative symptom and disability scores, dizziness handicap inventory (DHI) total and subset scores, time after surgery at which patients were able to walk independently, whether patients returned to their usual professional responsibility, and time to return to full activities at work.Results:Significant correlation was found between several preoperative symptoms and vestibular testing results and the resulting postoperative disability from dizziness.ConclusionsThis information may be helpful in counseling patients before surgery with respect to the degree of postoperative dysequilibrium and may suggest that the clinician should initiate more aggressive vestibular rehabilitation exercises in patients who may be at greater risk of having persistent dysequilibrium develop after surgery.

ISSN:0192-9763    

出版商:OVID    

年代:1998

数据来源: OVID