摘要:

Our experience with transcutaneous electrical stimulation for tinnitus suppression has been with the Theraband Headset from Audimax Inc. The purpose of this article is to review the highlights of the patients who exhibited tinnitus suppression and/or tinnitus control, and to provide an update of our results and techniques using external electrical stimulation with prolonged stimulation (stage IV). Patient selection is considered critical to the success of external electrical stimulation for tinnitus suppression. The key elements include the clinical finding of a peripheral site of lesion of the tinnitus; positive maskability of the symptom of tinnitus; absence of active ear disease; absence of a vestibular asymmetry; and absence or minimal evidence of dysfunction of the central auditory system. The protocol described for patient selection allows for tinnitus identification, the differentiation of clinical tinnitus types, and the clinical application of the concept of the dynamic range of electrical tinnitus suppression. External electrical tinnitus suppression is believed effective in a limited number of patients clinically identified as having a tinnitus site of lesion primarily peripheral in location and cochlear in type. The present device is not commercially available at this time. Both specific and general suggestions are proposed for the standardization of methods of reporting results of electrical tinnitus suppression and tinnitus control.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Ceruminoma is a catch-all term that has caused much confusion both in the literature and in clinical practice in regard to the specific histologic diagnosis and proper treatment for tumors arising from the ceruminous glands of the external ear canal. The termceruminomahas been used in the past to refer to both benign and malignant lesions. To clarify the terminology and better determine appropriate treatment, two cases of benign adenoma of the ceruminous glands along with their histopathologic findings will be presented. The specific characterization of the individual types of ceruminous gland neoplasms, their clinical manifestations, histopathology, and recommended treatment will then be discussed. Finally, suggestions for the appropriate nomenclature for these rare tumors will be reviewed.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Perilymphatic fistulas are well documented in the otolaryngologic literature as a cause for both auditory and vestibular symptoms. The anatomic location of fistulas has been clinically confirmed in both the oval and round windows. Furthermore, membranous tears within the cochlea have been described post mortem and may be the cause of the remaining fistulas which are suspected but not confirmed surgically. A fourth source of perilymph fistula has previously been suggested by Okano and Harada. During the past several years, surgical confirmation of perilymph leakage from two microfissure areas has been observed. These cases will be briefly discussed along with their clinical implications. Speculation as to the type of hearing loss caused by fistulas will be offered. Hypotheses concerning the various symptoms encountered in patients and the location of the defect will also be addressed.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Previous experimental studies have demonstrated structural damage of the organ of Corti and stria vascularis following application of combination antibiotic otic drops to the middle ear. In this investigation the ototoxic effects of neomycin and polymyxin B (two antibiotics often used together in ototopical preparations) were separately evaluated after administration of each agent to the middle ear cavities of chinchillas and baboons. The antibiotics were administered in saline solution at the same concentrations used in Cortisporin Otic Suspension (3.5 mg/ml neomycin base, 10,000 units/ml polymyxin B). In both the rodent and primate, polymyxin B consistently produced greater cochlear damage than did neomycin. In fact, the extent of hair cell loss and strial injury produced by polymyxin B alone was, in many cases, comparable to that previously observed after application of Cortisporin Otic Suspension itself. Hair cell loss in the baboon was markedly less severe than in the chinchilla. It is believed that differences in position and structure of the round window membrane are important factors in the differing levels of ototoxicity observed in the rodent and primate.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Over the past few years there have been reports discussing the preservation of hearing after the removal of acoustic neuromas through the middle cranial fossa or the suboccipital approaches. This is a complex issue with many facets and controversies. In an attempt to answer at least some of these controversies, this article reviews the experience of our group. Preservation of hearing was attempted in thirty-four cases out of 220 acoustic neuromas. In twenty cases the middle fossa approach was used: All tumors were less than 2 cm from the fundus, and in four patients the tumor was bilateral. In sixteen of the twenty (80%) the cochlear nerve was spared; in ten of twenty (50%) measurable hearing was retained, but in only four (20%) was the postoperative hearing serviceable according to the 50/50 rule. In fourteen cases the suboccipital approach was used: All but two of the tumors were smaller than 2 cm. In three patients the tumor was bilateral. The cochlear nerve was preserved in ten of the fourteen cases (71.4%). Measurable hearing was present in four of fourteen cases postoperatively (28.6%); none had serviceable hearing according to the 50/50 rule. Hearing was not preserved in any bilateral tumor case. The middle fossa and the suboccipital approaches are discussed as well as the relative merits of each procedure in preservation of hearing.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Optokinetic nystagmus (OKN) was studied in ten patients with vestibular neuritis, and in seventeen patients with unilateral and thirteen patients with bilateral infratentorial lesions and compared with OKN in fifty healthy subjects. Mean and maximum slow phase velocity of OKN was calculated as well as the asymmetry of responses. The efficiency of the different variables in OKN, in discriminating between different lesion sites, was tested in a linear discriminant function analysis. Slow phase velocity of OKN could satisfactorily separate patients with infratentorial lesions from healthy subjects or subjects with vestibular neuritis. Asymmetry of OKN did not contribute further to the correct diagnosis.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A clinical evaluation of speech processing strategies for the Nucleus 22-electrode cochlear implant showed improvements in understanding speech using the new F0F1F2 speech coding strategy instead of the F0F2 strategy. Significant improvement in closed-set speech recognition in the presence of background noise was an additional advantage of the new speech processing strategy.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A randomized prospective double-blind study was performed testing the value of phenoxymethylpenicillin in conjunction with middle ear surgery. The patients were evaluated for clinical signs of infection and with bacteriologic cultures both pre- and postoperatively. No difference in clinical signs of infection was noted between the pre- and postoperative evaluations. A significantly larger number of patients, however, presented with postoperative positive bateriologic cultures as compared with the preoperative cultures. This increase was particularly evident in the placebo group. The two microorganisms that were found in increased numbers postoperatively wereStephyhcoccus epidermidisandPseudomonasstrains. The value of prophylactic antibiotic treatment and phenoxymethylpenicillin treatment in particular is discussed.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Clinicians view cholesteatoma as a middle ear condition in which stratified squamous epithelium produces non-self-cleansing amounts of keratin. This clinical definition includes retraction pockets as well as big, deep-seated epidermoids. The two may have different origins, and they often require different therapeutic approaches. Clearance and control of shallow retraction pockets may be achieved with suction cleaning. Larger or longstanding retraction pockets, if not too deep, may be excised, and the tympanic membrane grafted. Deep-seated cholesteatomas require more elaborate surgery, whether they involve advanced retraction pockets or big and deep-seated middle ear epidermoids. The intact wall technique, though elegant, has about a 50% failure rate, regardless of the surgeon's skill. The failures are due to either retraction pocket formation, with or without posterior wall atrophy or the reappearance of epidermoids (so-called residual disease). Reconstruction of the bony defect in the scutum does not prevent retraction pocket formation. It is obvious that an approach that envisages successful removal of the matrix as curing the disease is too simplified. The intact wall operation should be reserved for ears with extensive mastoid pneumatization and small cholesteatomas. Most ears with cholesteatoma (85%) are, however, poorly pneumatized and they fare best with a small radical conservative (modified) mastoidectomy. The procedure should aim at creating the smallest mastoid cavity possible. Small mastoid cavities, possessing a tympanic membrane, an adequate mastoplasty, and no recess behind the facial ridge, will be found to be dry in about 90% of cases. A technique for achieving a minimal mastoid cavity is described.

ISSN:0192-9763    

出版商:OVID    

年代:1987

数据来源: OVID