ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTBetween 1974 and 1991, hearing preservation surgery was attempted on 161 of 476 patients with a variety of cerebellopontine (CPA) tumors, at New York University School of Medicine. This included 146 unilateral acoustic neuromas, seven meningiomas, and six cases of neurofibromatosis. The suboccipital/retrosigmoid approach was used almost exclusively. The cochlear nerve was anatomically preserved in 131 cases, 32 percent of whom had successful hearing preservation. In the most successful group, hearing was preserved in 9 of 12 patients (75%). Success was defined as a postoperative pure-tone average (PTA) or speech reception threshold (SRT) of no more than 50 dB, and a speech discrimination score (SDS) of at least 50 percent. In those patients whose preoperative hearing was worse than this, success was based on a loss of no more than 10 dB in PTA or SRT, and 10 percent in SDS. Success was dependent mostly on extracanalicular (EC) tumor size, with the smallest tumors yielding the best results. When controlled for EC size, intracanalicular size and preoperative hearing were statistically significant variables. Origin from the superior vestibular nerve was also a favorable prognostic indicator. The character and duriation of hearing loss, the patient's age, and the histology of the tumor did not have prognostic value. Auditory monitoring with either auditory brainstem response (ABR) or direct eighth nerve electrodes did not have a significant impact on success. Complications were somewhat increased by attempted hearing preservation. Facial nerve function was type I or II in 93 percent of patients. Cerebrospinal fluid leaks occurred in 15 percent of cases, but only 4 percent required surgical repair. There was one death, a patient with a 2.5-cm tumor. Early in the series, when a classic long vertical nuchal incision was used, headache and neck pain were common.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTThe transtemporal or translabyrinthine approach is generally regarded as the most reliable method of ensuring total tumor removal and preservation of facial nerve function in the resection of a cerebellopontine angle tumor. This is particularly true in removing a tumor that has a significant extension into the patient's internal auditory canal. An anticipated deficit associated with the approach is a total hearing loss in the patient's hearing on the operated side. We have encountered a patient, however, who was serially documented as having serviceable hearing after a transtemporal removal of an acoustic schwannoma. Plausible reasons for the functional preservation of some of this patient's hearing are included in the discussion.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTThe speech perception abilities of 19 children with onset of deafness before age 3 years was examined after they received the Nucleus multichannel cochlear implant. The children were divided into two groups based on age at onset of deafness: children with congenital deafness (n = 8) and children with onset of deafness after birth but before age 3 (n = 11). There was no statistically significant difference between the scores of the two groups of subjects on 12 of the 13 speech perception test administered. This finding suggests that children who are born deaf have the potential to derive the same benefit from cochlear implants as do children who have had some exposure to spoken language before the onset of their deafness. Examination of performance in terms of communication mode revealed that prelingually deafened children with implants who used oral communication obtained significantly higher scores on only 2 of the 13 speech perception measures than did children who used total communication. The data suggest that communication mode does not appear to account for large differences in speech perception perforamence among prelingually deafened children with multichannel cochlear implants.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTThe sensitivity of gadolinium-enhanced magnetic resonance imaging (MRI) is such that inflamed areas of individual nerves can be visualized. Given this, might the lateral extent of an acoustic neuroma in the internal auditory canal be inaccurately depicted by MRI with gadolinium contrast due to variable enhancement in inflamed neural tissues? The authors studied the correlation between preoperative MRI and intraoperative observation of the lateral extent of tumor in the internal auditory canal (IAC) of 82 patients with acoustic neuromas. The surgeon made a visual determination of tumor extent when the lateral-most aspect of the tumor was exposed. The radiologist, blind to surgical findings, noted the degree of extension into the IAC based on the MRI. The majority (83%) of the tumors involved the lateral third and fundus of the IAC. Agreement between scans and surgical findings was excellent for tumors extending into the lateral third of the IAC, with a test sensitivity of 94 percent and a positive predictive value of 98.5 percent. Knowledge of the accuracy of MRI in demonstrating extent of tumor in the IAC is important in making decisions regarding surgical approach.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTBecause of the diminishing number of patients diagnosed with otosclerosis, the adequacy of residency training in stapedectomy techniques remains controversial. A prospective study, conducted from 1986 to 1991, assessed whether or not surgical outcome obtained by residents, under close supervision by otologic faculty, could be improved using a single stapedectomy technique. Comparison of pre- and postoperative hearing results (pure-tone averages of 500, 1000, and 2000 Hz) from 49 cases revealed closure of the air-bone gap to within 10 dB in 68 percent of procedures. Complications included failure to improve the conductive hearing loss, tympanic membrane perforations, transient facial nerve weakness, subluxation of the incus, and adhesions. The failure to improve the success rate in resident-performed procedures relates to the individual learning curve and the limited number of training cases.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTThe measurement of regional bone mineral density (rBMD) is a new method of evaluation of the human temporal bonein vitroorin vivo. Modified computed tomography (CT) enables us to collect a three-dimensional array of precise, reproducible bone density values, as well as high-quality CT images. Measurements are calibrated using phantoms of known composition and density. Conventional CT provides density information that is relative, qualitative, and lacks precise reproducibility over time. The rBMD technique provides precise numeric density measurements. Additional image processing capabilities are described.In vivodata from six normal temporal bones and from two patients with Paget's disease involving the temporal bone are presented to demonstrate the technique.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTDefinitive management of lesions of the lateral cranial base is surgical. Functional outcome is dependent on cranial nerve preservation. In 1988 an effort was made to decrease the incidence of tracheotomy, the duration of hospital stay, and the period prior to unassisted oral intake, by establishing more immediate acquisition of glottic competence through laryngeal rehabilitation. The experience of one author (JLN) in over 40 phonosurgical procedures under local anesthesia is presented. Although tracheotomy provides excellent airway protection, it is accompanied by substantial morbidity. The technique of phonosurgery has dramatically improved recovery and function outcomes of neurotologic skull base surgery patients, enabling them to realize “cure” rather than “control” of their disease.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTA computer-assisted, MRI-based technique of tumor volume determination was used to correlate preoperative hearing levels and long-term postoperative facial function with acoustic neuroma volume. Preoperative hearing was studied in a group of 41 patients subjected to direct tumor volume calculations and in another group of 131 patients in whom volume was extrapolated from the acoustic neuroma volume-diameter relation. Similarly postoperative facial function was correlated with acoustic neuroma volume in another 864 patients in whom long-term follow-up was available. Preoperative hearing levels were found not to be significantly related to tumor volume. However, postoperative facial function was significantly associated with tumor volume and was best predicted as a nonlinear function of diameter. Thus, tumor volume changes are important considerations in the clinical management of acoustic neuromas. Patients should be advised that even small changes in tumor diameter (especially in larger tumors) can result in tumor volume changes that may be associated with significant changes in postoperative facial function.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ABSTRACTIn 1988, the authors reported their experience in medical treatment of 66 children who had chronic suppurative otitis media, including the administration of intravenous antimicrobial agents. At the time of their initial treatment, 89 percent were successfully treated with medical treatment only, and the remaining 11 percent required surgical intervention. This report presents the long-term follow-up of 51 of those children who were available for study. Of these 51 patients, 40 (78%) had resolution of their initial of recurrent otorrhea, whereas 11 (22%) had surgery either initially or at the time of a recurrence. Medical management is successful in most children who have chronic suppurative otitis media, but surgical intervention should be considered if a cholesteatoma is suspected, if medical treatment is not effective in rapidly improving the chronic infection, or if the patient has recurrent disease over a relatively short period.

ISSN:0192-9763    

出版商:OVID    

年代:1993

数据来源: OVID