摘要:

AbstractAfter 15 years of being involved in the surgical removal of acoustic tumors, otologists are still faced with the general opinion that large tumors are only managed by neuro‐surgeons. With improvement in surgical technique and the advancement of neurosurgery, large tumors can be successfully removed by the translabyrinthine or a combined approach.The purpose of this paper is to define how tumor size is determined, the diagnostic problems of large tumors, and the technical aspects of their surgical removal. There are many advantages to the combined translabyrinthine‐suboccipital procedure when employed by an otologist‐neurosurgeon team. Morbidity and mortality rates are lowered considerably by this m

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00001

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractRecurrent attacks of meningitis occurring independent of a systemic bacterial infection should be considered as a cerebrospinal leak either otorrhea or rhinorrhea. Three cases each with a different cause were diagnosed chiefly on the basis of the history and a bulging noninflammatory eardrum. Subsequent use of fluorescein intrathecally not only helped to confirm the diagnosis but was very useful at surgery in locating the leak in the dura of the oval window of the ear.Many materials have been used but autogenous temporal fascia or fascia lata seemed to be most effective in these cases. The sandwiching of the dura between two pieces of fascia is not only realistic but was found to be very effective. One piece of fascia between the arachnoid and dura and another between the dura and bone give a tight seal.

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00002

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractTwenty‐three cases of laryngeal papilloma have been treated and followed for four years utilizing laser excision and laser excision/immunotherapy. Fourteen cases responded well to laser excision alone, nine did not and immunotherapy was instituted as adjunctive treatment. To date, immunotherapy has contributed little to the relief in this group of refractory case

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00003

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractSurgical trauma inflicted upon the membranous labyrinth is an uncommon, but often catastrophic, complication of chronic ear surgery. Areas most vulnerable to injury are the oval window and the lateral semicircular canal. Methods of injury include subluxation of the footplate, fracture of the lateral canal by drill or chisel, and accidental opening of a fistula.Three cases of labyrinthotomy of the lateral canal during ear surgery are presented. Two occurred while drilling, and the other was associated with a dehiscence of the bony and membranous labyrinth from a cholesteatoma. The cases are documented by pre and postoperative audiograms, vestibular function tests, and photographs.Of interest is the fact that in none of these cases was cochlear function compromised. In one case the hearing actually improved. The dictum that an accidentally opened labyrinth will automatically result in a dead ear is shown to be not necessarily true. Possible explanations for this phenomenon are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00004

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractHistiocytic medullary reticulosis represents a proliferation of malignant histiocytes which produce pancytopenia through marrow involvement and the phagocytosis of granulocytes, leukocytes and platelets. The disease is typically characterized by a fulminant febrile course which results in death from a variety of complications due to pancytopenia or intercurrent infections. Its diagnosis is based on bone marrow aspiration or tissue section in which large histiocytes can be demonstrated phagocytizing red or white blood cells and platelets. Therapy has included irradiation, steroids, antibiotics, antimetabolites, and the like, but with poor results.Two patients with head and neck manifestations of histiocytic medullary reticulosis are described in detail. It is felt that refinements in diagnosis must still be made, since any patient survival may well be predicated by the early initiation of aggressive cytotoxic therapy.

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00005

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractPreoperative vestibular function was studied in 56 patients undergoing the endolymphatic subarachnoid shunt procedure for Meniere's disease by electronystagmographic recording of bithermal air caloric stimulation. Fifty‐two percent had normal vestibular function while 48% had a reduced vestibular response on the affected side using 20% difference as being significant. Best results of surgery with relief of vertigo were found in the group of patients with normal preoperative vestibular function (82%) while the group with reduced vestibular response preoperatively showed 63% with a good result.Postoperatively, 81% had a reduced vestibular response in the operated‐on ear with 62% obtaining relief of vertigo. In patients with normal vestibular function postoperatively, excellent relief of vertigo was obtained. Of patients with normal vestibular function preoperatively, 69% developed a reduced vestibular response postoperatively with only 55% having relief of vertigo.The results of surgery could be predicted more accurately using the results of vestibular function tests than audiometric data.It appears that for best results the endolymphatic subarachnoid shunt procedure should be performed early in the course of Meniere's disease when hearing is fluctuating and vestibular function is nor

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00006

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractResults of over two years' experience with an outpatient surgical center within a private otolaryngology clinic have demonstrated several advantages. Discussed herein are the history of outpatient surgical centers, and the development of our within clinic O.P.S.C. (Outpatient Surgery Center). Developmental stages described include investigation of liability exposure, securing state health department approval, enactment of state legislation, staffing, equipment, and obtaining third party carrier approval. Advantages to the patient, otolaryngologist, community, and third party carriers are enumerated. Statistics regarding types and numbers of procedures performed and types of anesthesia used are included. Experience with the O.P.S.C. indicates that it is a means of improving the delivery of otolaryngological surgical care.

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00007

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractVon Recklinghausen's Disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe‐au‐lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist.Case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment.The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofi‐bromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. “Elephantiasis” of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The overall malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00008

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractA retrospective analysis of 123 pediatric tracheostomies reveals an overall complication rate of 33%. Immediate complications were present in 12% or 15 patients. The most frequent immediate complications were pneumomediastinum and pneumothorax. Delayed complications occurred in 24% or 30 patients. The most frequent delayed complications were subglottic stenosis, fused vocal cords, and tracheal granuloma. Four patients died because of tracheostomy‐related complications. Age, underlying disease, and prior endotracheal intubation had a high degree of correlation with complications. The use of a mechanical respirator following tracheostomy did not appear to be significantly related to complications. Fifty percent of the delayed complications in this series were regarded as being unrelated to the tracheostomy or the trachesotomy tube itsel

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00009

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY

摘要:

AbstractDuring the 5‐year period (1971‐1976), 45 patients at the Shea Clinic underwent reconstructive surgery for tympanosclerosis. The most common ossicular chain problem was found to be malleus and incus fixation (33%); malleus, incus, and stapes fixation (22%); and stapes fixation (13%). The most successful reconstructive approaches included removal of tympanosclerosis from tympanic membrane or isolated plaque from ossicular chain, the use of the Partial Ossicular Replacement Prosthesis (PORP), and the Total Ossicular Replacement Prosthesis (TO

ISSN:0023-852X    

DOI:10.1288/00005537-197810000-00010

出版商:John Wiley&Sons, Inc.    

年代:1978

数据来源: WILEY