摘要:

AbstractIatrogenic brain herniation, with meninges (meningoencephalocele) or without meninges (encephalocele), following mastoidectomy is rare. However, the seriousness of the complication and the potential for its prevention necessitate periodic review and emphasis.In this study, 6 patients with small iatrogenic dural injury during mastoidectomy, 1 patient with postoperative large encephalocele, and 2 patients with three spontaneous meningoencephaloceles are reviewed.These cases, and the literature, support the following:1.A dural injury is necessary for herniation.2.If the arachnoid remains intact, a meningoencephalocele results with the potential for cerebrospinal fluid leak into the middle ear and recurrent meningitis.3.If the arachnoid is not intact, an encephalocele results which presents predominantly as a mass without a cerebrospinal fluid leak.4.The dura and arachnoid may be torn during mastoidectomy, resulting in an immediate cerebrospinal fluid leak that can go easily unrecognized. Taking time to carefully inspect any area of dural exposure obviates this oversight.5.A satisfactory technique of tegmen and duralarachnoid repair in these ten cases is described.

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00001

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractRecent reports from Scandinavian authors have put forth the concept that hearing improvement following tympanoplasty is seldom satisfactory and difficult to obtain. This view is contradictory to the experience of most American authors. A study, therefore, was undertaken to evaluate the hearing results obtained by this author through the use of homograft material in middle ear and mastoid reconstruction.These hearing results are categorized according to time periods, types of reconstruction, and materials used. The hearing statistics are all taken from audiograms obtained one year or more postoperatively. These correspond with the type of reconstruction employed such as an intact ossicular chain, absence of the malleus, absence of the superstructure of the stapes, or both. Other categories include tympanoplasty with mastoidectomy or reconstruction of the posterior canal wall with homograft knee cartilage.The surgical techniques are not discussed in this article because they have been detailed in previous publications.

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00002

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractA study of 164 temporal bones with otosclerosis revealed stapes fixation in 123. Large lesions (4 mm or larger) were characterized by involvement of the cochlear endosteum, increased cellular activity, and bone resorption. Anatomical sites of predilection were:1.anterior to the oval window,2.margins of the round window, and3.apical‐medial wall of the cochlea. Two of the five ears with cochlear otosclerosis were from a patient with severe bilateral hearing loss. The size, cellular activity, and location of otosclerotic lesions showed no correlation with the magnitude of sensorineural hearing loss. Subjects over 69 years of age had greater bone‐conduction losses than age‐matched controls. Nine ears showed occlusion of the round window

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00003

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractWe treated 20 cases of acoustic neuromas in the last 2 1/2 years using the suboccipital approach with intraoperative monitoring of eighth nerve function in an attempt to preserve hearing. Total tumor removal was accomplished in 18 cases. Three tumors were small (less than 2 cm in size); 3 tumors were moderate sized (2 to 3 cm) and 14 tumors were large (greater than 3 cm). In 15 cases, all BAER components were lost during surgery. These patients had no postoperative hearing.In five patients there was intraoperative preservation of some or all BAER components. These included the three patients with small tumors and two other patients with moderate sized tumors. One patient with a moderate size tumor had preservation of wave 1 only, and had no postoperative speech discrimination. One patient with a small tumor retained all 5 BAER components, but had no postoperative hearing. Three patients in our series retained functional hearing after surgery, including 3 of 5 patients with tumors 2 cm or smaller.Intraoperative BAER monitoring appears to be useful in predicting postoperative hearing. Tumor size seems to be the primary factor in preservation of hearing following acoustic neuroma surgery.

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00004

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractLaryngeal electromyography can provide prognostic information when evaluating patients with vocal cord dysfunction. Twentyfour patients were studied to determine the predictive capacity of this test. Six patients had bilateral vocal cord paralysis, constituting a total of 30 vocal cords examined.Sixteen of these cords had decreased or absent motor unit potentials, fibrillations, or positive waves. None of these patients recovered function. Fourteen cords demonstrated either normal motor unit or polyphasic potentials. Return of mobility was evident in 11 of these cords. The combined total was 27 of 30 cords correctly predicted, demonstrating a 90% accuracy rate.

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00005

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe stratified squamous epithelium covering vocal cord polyps can vary from normal to hyperplastic and keratinized. We have analyzed the histology and cytokeratins of 11 of these polyps. Cytokeratins were separated on one‐dimensional SDS‐acrylamide gels to determine molecular weights. There was significant heterogeneity in the cytokeratins present in the different polyps. Comparison of histologic findings and cytokeratin content showed a correlation between extent of keratinization and presence of high molecular weight cytokeratins. We conclude that the epithelium of vocal cord polyps exhibit patterns of cytokeratins characteristic of both hyperproliferation and abnormal states of differentiation, which are mirrored by histologic variations, and that vocal cord polyps are a heterogenous group of benign lesi

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00006

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractCounseling of laryngectomy patients was studied by a questionnaire survey among 294 fellows of the American Society for Head and Neck Surgery and otolaryngology house officers (77% attendings and 23% residents). Seventy‐nine percent of respondents spent less than one hour counseling patients. Subjects emphasized during preoperative counseling included: extent of surgery, loss of speech, alternatives to surgery, immediate postoperative disfigurement, possible effects of surgery on life expectancy, and possibility of recurrence. At least 24% of physicians were unwilling to discuss the psychosocial effects laryngectomy.Ninety‐five percent of respondents often or always included family members in preoperative counseling sessions. The speech pathologist was utilized by at least 80% of the respondents to help with preoperative counseling. Differences in counseling practices between attendings and residents are discus

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00007

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractCricopharyngeal myotomy is an effective procedure for the treatment of swallowing disorders due to dysfunction of the upper esophageal sphincter and pharyngeal musculature. Eight patients with documented pharyngeal and sphincteric dysfunction have undergone myotomies with significant improvement in swallowing associated with restoration of oral feeding without aspiration in 5, while 3 patients have not improved. The preoperative work‐up and evaluation is discussed as well as criteria that may identify those patients most likely to benefit from this treatmen

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00008

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractLyme disease is a multisystemic illness caused by a tick‐borne spirochete. Once considered unique to the Connecticut coastline, thousands of cases are now documented throughout the United States, northern Europe, and Australia.Unilateral and bilateral facial paralysis may occur in up to 11% of patients with Lyme disease. This paper reviews the clinical course, distinguishing features, and outcome of 124 such palsies in 101 patients seen between 1975 and 1984. The 99.2% spontaneous recovery rate demonstrates the unequivocally excellent prognosis of this palsy and confirms that operative intervention is not indicated.The otolaryngologist should consider this etiology in all otherwise idiopathic facial paralyses, especially when presenting in summer months in endemic areas, or when bilateral. Positive Lyme disease spirochete titers are helpful in the diagnosis. We believe antibiotics should be given to patients with this facial palsy in order to treat any other concurrent manifestations of the illness and to prevent subsequent complication

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00009

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractLocalized laryngeal amyloidosis is a benign, rare tumor of the larynx. Six cases of laryngeal amyloidosis were evaluated and treated from 1967 through 1984. One case is that of an 8‐year‐old female: the youngest reported case. Therapy is directed towards surgical resection. The cases in this report had significant laryngeal involvement necessitating extensive surg

ISSN:0023-852X    

DOI:10.1288/00005537-198511000-00010

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY