ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTIt is generally recognized that surgery for congenital aural atresia is difficult. In an effort to select those patients who have the greatest chance of success, we have developed a grading scheme based on the preoperative temporal bone CT scan and the appearance of the external ear. Patients are graded on a possible best score of 10. The stapes is assigned the highest rating (2 points), while all other entrees on the scale are 1 point. The grade assigned preoperatively has been shown to correlate well with the patient's chance of success, herein defined as a postoperative speech reception threshold of 15 to 25 dB. A patient with a preoperative grade of 8/10 would, therefore, have a 80 percent chance of achieving this threshold. Patients with scores of 5/10, or less, are not considered surgical candidates, because the risk of the operation would outweigh the potential benefits. We have found that the grading system allows us to avoid impossible surgical cases while allowing for a reasonable prediction of the hearing outcome.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTTinnitus is common in patients with acoustic tumors and may be the initial symptom leading to diagnosis. We might anticipate that tumor removal would alleviate preoperative tinnitus. However, few have studied this systematically. Further, the effect of tumor removal in those with no preoperative tinnitus has rarely been examined. In this study, a questionnaire was sent retrospectively to patients who had undergone surgical removal of an acoustic tumor, addressing the characteristics of tinnitus, and asking whether surgery had directly affected tinnitus. A total of 134 questionnaires were returned. Those who indicated preoperative tinnitus tended to show small but statistically significant improvements in the perceived severity of the tinnitus after surgery, although the symptom rarely resolved entirely. Those with no preoperative tinnitus have an approximately 50 percent chance of developing it following surgery.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTThe use of aminoglycosides for selective vestibular function ablation without hearing alteration is described in the literature. Parenteral administration of streptomycin for the alleviation of vertigo in cases of bilateral Meniere's disease is well accepted. The instillation of aminoglycosides into the middle ear to produce a similar result, has been successfully used in the treatment of unilateral Meniere's disease. However, the use of chemical vestibulectomy has not gained acceptance as a practical means of treatment when compared to vestibular neurectomy. The reason for this is not clear, but may stem from the lack of definitive protocol for the application and lack of treatment results that have been assessed according to an acknowledged standard (i.e., the American Academy of Otolaryngology Criteria). A prospective study was undertaken to examine the efficacy of chemical vestibulectomy as the treatment for vertigo in unilateral, incapacitating Meniere's disease. A standardized drug administration protocol was utilized, and academy criteria for the assessment of treatment were applied. This report details the first group of patients to complete 2 years of post-treatment follow-up. Based on our experience, we conclude that chemical vestibulectomy is an efficient alternative to surgery. A standardized regimen of drug vestibulectomy is an efficient alternative to surgery. A standardized regimen of drug administration that can be carried out on an outpatient basis is put forward.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTDuring the last decade, vestibular neurectomy has become a more frequently performed procedure to cure symptoms of inner ear vertigo while preserving hearing. In an effort to determine the results of vestibular neurectomy across the country, a questionnaire was prepared and sent to the 350 members of the American Otologic Society and the American Neurotology Society. Results of that survey indicated that 2,820 vestibular neurectomy procedures were performed by 58 surgeons. Ninety-two percent (2,590 cases) were performed through the posterior fossa approach. Of these, 1149 cases (44%) were through the retrolabyrinthine approach, 940 cases (36%) were through the retrosigmoid approach, 307 cases (12%) were through the combined retrolabyrinthine-retrosigmoid approach, and 194 cases (8%) were unspecified as to which posterior fossa approach was used. The remaining 230 cases (8%) were through the middle fossa approach. Sectioning of the vestibular nerve was done by the otologist in 58 percent of cases, by the neurosurgeon in 12 percent, and by either surgeon in 30 percent. Classic Meniere's disease, the most common indication for vestibular neurectomy, resulted in the best cure rate of 91 percent. Other inner ear diseases such as traumatic labyrinthitis and vestibular neuronitis had a lower cure rate of 74 to 81 percent. Hearing was preserved to within 20 dB of the preoperative pure-tone thresholds in 87 percent. There were no deaths, 11 cases of meningitis and 16 cases of facial paralysis, 15 of which occurred after middle fossa surgery, representing a 7 percent incidence of facial paralysis after middle fossa surgery. Eleven of the 15 cases resulted in permanent paralysis and four in temporary paralysis. One case of temporary paralysis followed a posterior fossa approach. Thirty-three patients had complete hearing loss, 8 had wound infections, and 26 had cerebral spinal fluid leaks. As their first procedure, endolymphatic sac surgery was recommended by 21 surgeons (36%), and vestibular neurectomy by 14 surgeons (24%); 18 surgeons (31%) use both procedures. The remaining five surgeons (9%) did not respond to this question. Results from this survey indicate that vestibular neurectomy, performed most commonly through a posterior fossa approach (92%), is an effective and safe method for the cure of vertiginous attacks while preserving hearing and has a low incidence of facial paralysis and other complications.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTThe inner ear pathology of experimental perilymphatic fistula (EPLF) is described. EPLF was produced by injecting artificial perilymph into the subarachnoid space, or by suctioning 4 μL of perilymph through one of the round window membranes of the guinea pig. The animals were either killed immediately, or were kept alive for 3 weeks to 3 months. The conventional celloidin embedding method was employed for morphologic study. Vestibular function of the animals was tested by observing spontaneous nystagmus and positional nystagmus after the experiment. The caloric test was also performed. Various pathologic changes of the membranous labyrinth were observed. In the cochlea these included rupture or collapse of Reissner's membrane, bulging of Reissner's membrane, loss of hair cells, and compression of the organ of Corti. Pathology of the otolithic organs and semicircular canals mainly consisted of collapse of the membranous labyrinth. Clinical symptoms in patients with perilymphatic fistula (PLF) are explained, based on our experimental findings. Electronystagmography (ENG) of EPLF animals showed either no caloric response or, with a longer duration, caloric irregularity. Prolonged unsteadiness in patients may be due to “floating” labyrinth.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTRACTIn this after-dinner address, the speaker presents the evolution of the current understanding of perilymphatic fistula, its causes, and diagnosis.

ISSN:0192-9763    

出版商:OVID    

年代:1992

数据来源: OVID