ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

It is ironic that, while the term “Meniere's disease” is becoming more and more well known today, published accounts of a biographic nature are scarce for the man for whom the eponym was devised: Prosper Ménière. As we are obliged to turn to only a few avenues for this sort of information, we are fortunate to discover new sources of original materials to augment the published account of the life and character of Ménière the man. One such unpublished source that has recently come to light is a cache of letters from the pen of Ménière that was preserved for the period extending from the early 1850s up to the time shortly preceding the author's death a decade later; and it is these letters that form the basis of this inquiry into the mind and character of Ménière, the brilliant otologist and man of letters. This particular body of letters, while being for the most part of an admittedly social nature, is of particular interest not only for the occasional references Ménière makes to the ear or to his deaf-mute patients, but also because of Ménière's epistolary style, and because of their content in general. For this reason the letters have been analyzed primarily with an eye to three categories of interest. The first category is the professional life of Ménière, which for the purpose of this paper will be understood to comprise his professional work as a physician, his mention of his patients, of deaf-mutes and their treatment, of his writings in general, and of other pertinent aspects of his medical involvement. The second category represents what might be regarded as Ménière's philosophic outlook as represented by occasional passages in the letters that provide this particular sort of insight into the mind of the man. The third category serves to reveal a glimpse into the glittering social life of Ménière (who was a man of not only high professional standing, but of high social standing as well), and reveals the names of a number of important persons with whom he associated socially in some manner or other, whether intimately or casually. Ménière was devoted not only to medicine, but to literature and literary productions as well. Not surprisingly, he was a prolific writer. One of his closest friends was Jules Janin, the critic, whom he frequently mentions in the letters. It is also known that Ménière was acquainted with Honore Balzac, as well as he might be, as Ménière was a well known intellectual figure in the Paris of his day. It is hoped that, through the presentation of particulars from the letters of Ménière that form the basis of this inquiry, a deeper insight may be gained into the brilliant mind of this man who, because of Ménière's disease,will notbe forgotten, but who, because he was in a number of ways a truly great man,should notbe forgotten.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Preoperative counseling of patients, regarding facial nerve function following cerebellopontine angle (CPA) surgery, has remained a difficult task. Facial nerve electroneurography (ENoG) or evoked electromyography can detect subclinical neural degeneration. This test was used in 44 patients undergoing CPA surgery, and facial nerve function was followed postoperatively. A normal preoperative ENoG study appeared to predict an 81 percent and 84 percent chance of good (House grade I–II) early and late postoperative facial function, respectively. An abnormal test is not as reliable. The relation of preoperative ENoG results with tumor size and tumor adherence to the facial nerve is investigated. Electroneurography appears to be a useful preoperative test when counseling patients regarding facial function following CPA surgery.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Intraoperative stimulation of the facial nerve during surgery of the cerebellopontine angle greatly aids the surgeon in identification of the nerve. The preservation of the ability to stimulate the facial nerve, at the brain stem following tumor removal, has been shown to correlate with good postoperative facial outcome. Thresholds of facial nerve stimulation recorded in our series, using constant voltage stimulation, showed statistically significant relevance to facial nerve outcome. When the difference between thresholds before and after tumor removal was 0.2 V or less or when the threshold after tumor removal was less than or equal to 0.2 V, a good postoperative facial outcome could be expected. This paper discusses the relevance of stimulation threshold prior to tumor removal to the size of tumor.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The incidence of benign paroxysmal positional vertigo (BPPV) has been documented at 17 percent of all vertiginous patients. Partitioning of the labyrinth is a laser technique for resolution of BPPV. In 1991 Anthony partitioned the posterior semicircular canal of two patients and eliminated their BPPV in 24 hours, which was much sooner than anticipated. This paper presents an animal study that was undertaken to determine why laser partitioning of the posterior semicircular canal resolved BPPV so promptly. The histologic changes 24 hours post-partitioning in the guinea pig showed bony semicircular canal fistula creation, and constriction of the membranous semicircular canal. The constriction caused decreased endolymphatic flow and led to BPPV-resolving long-term obstruction of the membranous canal described by Wilpizeski. Also, the clinical study of the application of partitioning to 14 patients with BPPV is described. The technique under investigation provided the resolution of positional vertigo within 7 days in most cases, and within 8 weeks in all uncomplicated cases. Results included some temporary postoperative motion sensitivity for 6–8 weeks, a transient sensorineural hearing loss in 6 of 14 (43%) patients, and a permanent hearing loss in one (7%) insulin-dependent diabetic patient. Location of the partition on the posterior semicircular canal did not affect the resolution of BPPV, the incidence of transient hearing loss, or the motion sensitivity. Partitioning provided prompt, permanent resolution of BPPV and did not put the hearing at risk in nondiabetic patients. This procedure challenges the current surgical techniques for management of benign paroxysmal positional vertigo.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Functional and cosmetic rehabilitation of the severely atretic auricle poses a formidable challenge. Conventional autologous grafts for auricular reconstruction may produce inconsistent results, and revision of failed grafts is often unsatisfactory. Osseointegrated implant systems to retain auricular prostheses provide an alternative approach in rehabilitating patients with severe auricular defects. Fourteen patients were implanted with 30 osseointegrating implants for rehabilitating major auricular defects and were followed for 1 to 3.5 years, yielding 143 implant observations. Symptomatic skin reactions to the percutaneous implant were noted in 3.5 percent of the observations. Implant extrusion did not occur. This evaluation of tissue-integrated prosthetic systems suggests this approach to be an extremely reliable alternative for selected patients with major auricular defects. The technique of implanting the retention unit is readily adapted to atresia repair.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The disability resulting from uni-or bilateral loss of vestibular function was assessed by exposing subjects, in darkness, to random rotational displacements on a motorized chair away from a “center” position and requiring them to rotate themselves back to center using a “joystick” control. Normal subjects were accurate within 10 to 15 percent over 180-degree rotations. Alabyrinthine subjects failed to sense their rotation to any useful extent. Subjects with unilateral loss of function as a result of surgery produced hypometric responses to ipsilateral rotation and large amplitude, but inaccurate responses to contralateral rotation. This pattern became more symmetric and normometric with adaptation to loss of function. The procedure promises to be a more useful measure of adaptation than assessing vestibulo-ocular reflexes.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Gentamicin is an extremely effective antibiotic against a wide variety of organisms. However, its use is limited by its nephrotoxic and ototoxic effects. Recent studies in rats have shown that poly-l-aspartic acid (PAA) effectively blocks the nephrotoxic effects of the aminoglycosides and does not decrease the antibiotic effectiveness of gentamicin against those organisms tested. A controlled test was undertaken to evaluate the effect of PAA on cochlear ototoxicity. Test solutions were administered to four groups of guinea pigs for 10 days. Group 1, the controls, received distilled water, group 2 received gentamicin, group 3 received PAA, and group 4 received gentamicin plus PAA. Auditory brainstem response thresholds at 20, 16, 8, and 4 kHz were obtained before therapy, after completion of the 10-day course, and 21 days following the completion of therapy. Two-dimensional diffusion assays in human serum were performed to evaluate the effect of PAA on the antimicrobial activity. Histologic evaluation of the cochleae was performed at the conclusion of the experiment. Threshold shifts following 10 days of therapy were not statistically significant in group 4 compared to controls, while the gentamicin group (group 2) was significantly different for all frequencies tested. At 21 days following therapy, group 4 (PAA + gentamicin) maintained significance in the higher frequencies studied. Antimicrobial studies demonstrated that PAA has no effect on the antimicrobial activity of gentamicin and has no antimicrobial effect againstBacillus subtiliswhen used alone. Histologic examination of the cochleae demonstrated a significant difference in hair cell loss. These results indicate that PAA has some protective effect against the cochlear ototoxicity of gentamicin without decreasing its antimicrobial activity.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The goal of cochlear implant surgery is to insert the entire electrode array into the scala tympani. Incomplete insertion is usually attributable to the presence of new bone formation as a result of meningitis. Surgical techniques for dealing with obstruction include various degrees of drilling of the cochlea or alternative placement of the electrode array. We evaluated the postoperative performance of eight such patients implanted with the Nucleus multichannel cochlear implant at NYU Medical Center as well as data from adults and children nationwide. Scores ranging from marginal closed-set speech discrimination to 40 percent on open-set speech recognition tests were obtained. Surgical procedure, placement, and number of electrodes as well as number of channels in use affect the ultimate performance of these patients.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To preserve hearing during vestibular neurectomy and acoustic neuroma removal, the cochlear nerve must be identified. Present techniques, including monitoring eighth nerve action potentials, help the surgeon identify those maneuvers that increase the risk of nerve injury but do not help in the anatomic identification of the cochlear nerve or the cochlear-vestibular cleavage plane. The purpose of this study was to demonstrate an electrophysiologic method of identifying the cochlear portion of the eighth cranial nerve. A flush-tipped, bipolar electrode recording probe was used to directly record responses to monaural click stimuli from the cochlear nerve but not from surrounding tissue. It was also used to delineate the cochlear-vestibular cleavage plane. Stimulus intensity levels over 25 dB sensation level tended to reduce the accuracy of nerve identification, and lower levels prolonged recording time. This technique and its application to posterior fossa surgery is discussed.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID