摘要:

AbstractThe treatment of glomus jugulare tumors is controversial. Changes in the surgical treatment of glomus jugulare tumors at The House Ear Clinic have allowed complete resection in 85% of patients with minimal morbidity and no surgical mortalities. Our experience with 52 previously untreated patients with glomus jugulare tumors is reviewed.Two primary surgical techniques were used. The mastoid/neck approach was used in 9 patients with small tumors limited to the jugular bulb. The infratemporal fossa approach was used in the remaining 43 tumors. Lower cranial nerve preservation was possible in the majority of patients with normal preoperative function. Modifications in the management of the facial nerve during the infratemporal fossa approach have resulted in good recovery of facial function (House grade I/VI or II/VI) in 95% of patients. Most patients (85%) were able to fully resume all preoperative activities. Our results suggest that surgical management is the treatment of choice in younger patients with glomus jugulare tumors.

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00001

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPerhaps the most devastating complication in otologic surgery is that of inadvertent injury to the facial nerve. A review of 22 patients who had sustained an iatrogenic facial nerve injury was conducted. Although the most common procedure being performed during the injury was mastoidectomy (55%), a surprising number of patients had injury during tympanoplasty (14%) or during removal of exostoses (14%). The most common area of injury to the facial nerve in this series was in the tympanic segment. In 79% of the patients, the facial nerve injury was not detected at the time of surgery. All patients underwent surgical exploration of the facial nerve. Otologic surgeons are cautioned to be familiar with the normal course of the facial nerve and to be aware of the potential for facial nerve injury when performing transcanal surgery.

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00002

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractReported cases of toxic shock syndrome (TSS) following nasal surgery or functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting fromStaphylococcus aureusphage I toxic shock syndrome toxin 1 (TSST‐1), and it is characterized by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, priorS aureusphage I colonization, as well as low antitoxin antibody levels.1Of the 1700 FESS procedures performed at our institution, 3 cases were complicated by classic TSS, with 2 additional patients having a postsurgical course compromised by a milder degree of TSS. Diagnostic criteria, clinical presentation, management, and etiology are discussed, and the possibility of a continuum from mild‐to‐classic TSS is addr

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00003

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe management of autoimmune sensorineural hearing loss (SNHL) continues to challenge the otologist. Steroids and cyclophosphamide, the two traditional medications for this malady, are often associated with serious adverse reactions. In an effort to use a less toxic medication, the authors treated five autoimmune SNHL patients with low‐dose oral methotrexate. Methotrexate has been found to be very effective in rheumatoid arthritis patients with acceptable adverse reactions. Preliminary results from this study indicate that methotrexate has the potential of being effective for autoimmune SNHL and associated otologic symptoms. Tolerance has been very good and side effects have been minima

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00004

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPhenytoin has previously been shown to protect against motion sickness induced by Coriolis stimulation. The purpose of our series of investigations was to investigate further the efficacy of phenytoin for motion sickness prophylaxis and to gain insight into its mechanism of action. We tested participants with electronystagmography, off‐vertical rotation, sea travel, and parabolic flight after they received phenytoin or placebo. Blood levels of at least 9 μg/mL were found to protect against motion sickness. Electronystagmography showed significant decreases in the gain of the vestibuloocular reflex in participants receiving phenytoin. Few side effects were seen with drug levels in the 9 to 15 μg/mL range. Phenytoin is an effective motion sickness countermeasure that may exert its effect through a combination of central nervous system and peripheral vestibular effe

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00005

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractFifty‐four patients with primary neoplasms of the anterior skull base were treated by craniofacial resection with curative intent. The most common tumor was esthesioneuroblastoma (24), followed by squamous cell carcinoma (10). The overall 2‐year and 5‐year survivals were 75% and 49%, respectively. High‐grade tumors, grades 3 and 4, had a poorer prognosis. Tumor size, dural involvement, sphenoid sinus involvement, age, and sex had no significant influence on survival when examined by multivariate survival analysis. Sixteen complications were noted in the postoperative period. Cerebrospinal fluid leakage occurred in 2 patients and loss of frontal bone occurred in 4. There were no operative or perioperative deaths. Craniofacial resection permits surgical resection of the majority of anterior skull base tumors with acceptable mo

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00006

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe recent demonstration of free‐floating particles in the endolymph of the posterior semicircular canal in patients with benign paroxysmal positional vertigo (BPPV)1has renewed interest in the physiology and treatment of this entity. The particle repositioning maneuver (PRM) relocates the free‐floating particles from the posterior semicircular canal back into the utricle, relieving the patient of bothersome, often long‐standing vertigo.This report represents a prospective study of 27 consecutive patients seen with a diagnosis of BPPV. Eighty‐four percent of the patients treated with the particle repositioning maneuver who had no other associated pathology were cured or significantly improved with this new technique. Two patients who failed conservative management went on to surgical intervention with the posterior semicircular canal occlusion.The authors find the particle repositioning maneuver effective for many patients with benign positional vertigo and recommend it as the first‐line treatment modality

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00007

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractExophthalmos from Graves' disease can result in visual disability and cosmetic deformity. Surgical treatment of this disorder is now possible through an intranasal endoscopic approach that allows removal of the medial orbital wall and floor without an external incision. Endoscopic orbital decompression was performed on 22 orbits in 14 patients for treatment of progressive exophthalmos. Local anesthesia was used in five cases. Sixteen procedures involved a concurrent lateral orbital decompression performed through an external approach. There were no intraoperative or postoperative complications. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 3.2 ± 1.1 mm (range 2 to 4.5 mm) by endoscopic decompression alone. When a lateral decompression was also performed, proptosis was reduced by an additional 2.4 mm, for an average improvement of 5.6 ± 1.7 mm (range 2 to 8 mm). Endoscopic orbital decompression appears to be a safe technique for the treatment of exophthalmos that can be performed effectively with the patient under general or local anesthesi

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00008

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractSensorineural hearing loss (SNHL) which is sudden in onset, fluctuating, and/or progressive complicates medical management, hearing aid selection, and individualized educational planning for a hearing‐impaired child. In spite of multidisciplinary evaluation and intervention, a gradual decrease in auditory acuity may continue unabated in a significant number of cases. Intercurrent middle ear disease and inconsistent audiologic technique can account for threshold variation in some cases. The study population consisted of 229 children (132 boys; 97 girls) aged 1 to 19.9 years at first audiogram which revealed at least a mild degree of sensorineural hearing loss in one or both ears (35 unilateral), and who demonstrated threshold variation of 10 dB or more in at least one ear at one or more of the standard audiometric test frequencies (250, 500, 1000, 2000, 4000, and 8000 Hz) and were without concurrent middle ear disease (mean length of follow‐up, 4.9 years; mean number of audiograms, 10.3). Of 365 ears demonstrating threshold variation of 10 dB or more, 22 (6%) had purely progressive losses without intercurrent upward fluctuation, 208 (57%) had fluctuating thresholds with gradually progressive losses, and 135 (37%) had intermittent threshold fluctuation without permanent deterioration. The probability of contralateral threshold fluctuation if one ear fluctuated was 0.91, while the probability of contralateral progressive SNHL if one ear progressed was 0.67. Demographic data, presumptive etiology, degree of initial SNHL, audiometric configuration, and symmetry of threshold variation were considered as potential predictors of the likelihood of threshold fluctuation and/or progress

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00009

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIt has been recently noted that laryngeal paralysis results in a complex alteration of the glottis. The membranous segment of the paralyzed vocal fold is shortened, and, during phonation, patients use hyperfunction to shorten the normal vocal fold to about the same length. Additionally, if the paralyzed vocal fold is not near the midline, the angle between the membranous and cartilaginous segments of the vocal fold is decreased, resulting in a “posterior” gap which cannot be closed by hyperadduction of the normal side. To determine whether arytenoid adduction addresses these problems, videolaryngoscopy was analyzed in 11 patients before and after surgery, and results were compared to patient satisfaction and acoustic and aerodynamic assessment. The posterior gap and glottic competence were improved in all patients, but only 6 had improvement in symptoms. Two had persistent vocal fold bowing but achieved good function after Teflon® injection. Three patients, all with paralysis for more than 20 years, had no increase in vocal fold length and very little subjective vocal improvement. Arytenoid adduction is most effective in acute cases. Poor functional results in chronic paralysis are related to failure to achieve vocal fold lengthening, presumably due to soft‐tissue contr

ISSN:0023-852X    

DOI:10.1288/00005537-199408000-00010

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY