摘要:

AbstractIn a general hospital, an early detection research program based on a high risk register and brain stem electric response audiometry (BERA) using click and frequency‐specific stimuli identified 631 at‐risk neonates from the well baby nursery and the neonatal intensive care nursery (ICN). BERA tests were done before discharge and four months later; comparison of outcomes revealed substantial discrepancies. From the follow‐up test, 51 cases of mild to severe hearing loss were identified.Experience from the research program has raised some issues relevant for establishment of service programs. Evaluation of all babies (general nursery and ICN) is justified on the basis of yield but is resource consuming; strategies for minimizing work load are discussed. Risk factor criterion levels affect case loading and yield. Frequency‐specific BERA identifies cases which would not be detected by click stimuli and which raise management questions. Deferral of testing to four months is feasible and de

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00001

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe Hearing Conservation Amendment published by the Occupational Safety and Health Administration (OSHA) in 1983 requires hearing conservation programs to be provided for over 5 million workers whose daily noise exposures exceed 85 dBA time‐weighted average. The permissible exposure level is 90 dBA, above which the use of hearing protectors is mandatory. Current policies rely heavily on periodic audiometry to detect early threshold shifts due to inadequate use of hearing protection or to individual variation in susceptibility to noise induced hearing loss (NIHL).Studies including over 1,000 noise exposed workers have shown that audiometry in the industrial setting is less reliable than clinical audiometry. Pure tone averaging markedly reduces test‐retest variability and should be incorporated into rules for decision‐making based on industrial audiometry. However, at least half of observed shifts are spurious. In addition, aging is an important confounding variable; in our data, about half of the population mean threshold shift seen was attributable to aging. Thus, only a minority of threshold shifts seen in industrial audiometry are due to NIHL. The large number of “false positive” shifts will inevitably eventually have the effect of ade factolowering of the permissible exposure level to 85 dBA.Otologic referral and major administrative action should be reserved for large or repeated threshold shifts. OSHA does not specify rules for otologic referral, but the criteria recommended by the American Academy of Otolaryngology‐Head and Neck Surgery are reasonable and should be supported. The necessity for otologic evaluation in the differential diagnosis of NIHL from other entities (particularly baseline audiometric abnormalities) is not universally appreciated; otolaryngologists need to educate their medical and nonmedical colleagues

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00002

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe results of conventional electronystagmography (ENG) sometimes are confusing. The Hallpike alternate binaural bithermal (ABB) caloric test is helpful diagnostically except for the group of “sick patients that have a normal test.” Conventional ENG tests also fall short in the area of objective confirmation of patient progress.What does each test tell us regarding site of lesion?1. Alternate binaural bithermal stimulation gives us information about the semicircular canals — particularly the horizontal semicircular canal — pickup head.2. Simultaneous binaural bithermal stimulation gives information brain stem connections — switching and relay.3. Rotation testing gives information about the processing by the brain — cent

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00003

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe immunohistochemical characteristics of the human olfactory system were studied using antiserum to the olfactory marker protein (OMP). OMP was detected in the olfactory receptor neurons and processes extending from the olfactory neuroepithelium to the olfactory bulb. The olfactory receptor cells located close to the epithelial surface also contained OMP. In severely degenerate regions, only a few OMP‐containing cells were observed. Differences in OMP‐staining intensity were noted among the olfactory receptor cells in thick neuroepithelium. Proliferating olfactory neuroepithelium contained OMP reactive and nonreactive olfactory receptor cells. The presence of OMP reactive and nonreactive olfactory neurons indicates the coexistence of two functionally different phases of olfactory neurons. These findings suggest that continuous cell turnover is occurring in human olfactory neuroepithel

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00004

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe immunocompromised human host may be subject to recurrent infection and/or malignant transformation. Signs and symptoms of depressed immunity generally reflect the degree of compromise. The laboratory diagnosis of the immune compromised host is presented. A review is given of the clinical manifestations and appropriate current therapy.

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00005

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractPatients with acquired immune deficiency syndrome (AIDS) frequently present with signs and symptoms referable to the head and neck. Three hundred ninety‐nine patients with AIDS presented at the University of California, San Francisco and its affiliated hospitals from 1980 to April 1984. One hundred sixty‐five patients (41%) with AIDS presented with, or had on initial evaluation, head and neck manifestations. Of that group, 58 (35%) had cutaneous, oral, and pharyngeal lesions of Kaposi's sarcoma; 51 (31%) had oral, pharyngeal, esophageal, or laryngeal candidiasis; 36 (22%) had chronic cough and shortness of breath; 13 (8%) had rapidly enlarging neck masses; and 7 (4%) had herpes simplex lesions.With the increasing number of cases of AIDS it is important for the otolaryngologist to be aware of these presentati

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00006

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractIdiopathic (Bell's) facial palsy is a self‐limiting, non‐life threatening, and spontaneously remitting disorder. The natural history of Bell's palsy is favorable: 84% of 1011 patients with Bell's palsy studied by one investigator recovered satisfactorily without treatment, and no valid clinical trials conducted to date have provided definitive evidence that treatment with steroids or surgery improves upon this figure. The authors studied 273 patients with Bell's palsy to evaluate the prognostic significance of evoked eleetromyography in predicting the possible benefit of transmastoid facial nerve surgical decompression. The results indicated that even when evoked electromyography was used to select those patients who might benefit most from transmastoid surgery, outcome in patients treated surgically was no better than can be expected to occur without treatment. Based upon these observations, transmastoid facial nerve surgery is not recommended to treat Bell's palsy because no benefits have been identified which outweigh the risks of surg

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00007

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe operative findings of 66 patients who underwent revision mastoid surgery for recurrent chronic otitis media were analyzed for the causes of failure of the primary procedures. Recurrent cholesteatoma was found in 41% of the canal wall down and 70% of the canal wall up procedures requiring revision. Additional causes of failure included granulation tissue in unexenterated cells, particularly in the tegmental cells (41% of all cases and 64% of cases without cholesteatoma) and cells of the sinodural angle (38% of all cases and 58% of cases without cholesteatoma). The need for thorough exenteration of cells, particularly the tegmental cells and cells of the sinodural angle, mastoid tip, and facial recess, and the importance of lowering the facial ridge in canal wall down procedures were stressed.Following these principles, the success rate in creating a dry ear in 48 patients who had undergone from one to three previous mastoid procedures was 85% (mean follow‐up three years

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00008

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe role of the subepithelial space (SES) has not received sufficient attention in assessing pathogenesis, pathology, and, therefore, clinical diagnosis and treatment of the various forms of otitis media (OM). Temporal bones from patients with OM were classified as cases of acute purulent (POM), serous (SOM), mucoid or secretory (MOM), or chronic otitis media (COM). Controlled morphometric studies were made of cellular components of the SES, along with studies of the epithelium and middle car space. Corollary studies of biochemistry, cellular components, and prostaglandins (PGs) were done on fluid from the human middle ear. Middle ear effusions (MEE) from animal models of SOM, MOM, and POM were analyzed biochemically. Findings are surprising in that the SES was more actively involved in all forms of OM than had been thought, especially in MOM and COM. Implications are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00009

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractChildren with congenital atresia of the external auditory canal require an early assessment of hearing and a determination of the degree of atresia and associated pathology by polytomography and/or high‐resolution CT scanning.We analyzed the otologic findings in 302 ears (239 patients) with severe atresia of the external auditory canal. Eighty‐seven primary or revision surgeries were performed. Fifty‐three percent obtained a residual conductive deficit of 20 dB or less. Lateralization of the tympanic membrane graft was the primary cause of failure in obtaining good hearing results. The use of split‐thickness skin graft instead of a full‐thickness skin graft to cover the reconstructed external canal has decreased the incidence of restenosis and revisio

ISSN:0023-852X    

DOI:10.1288/00005537-198504000-00010

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY