摘要:

AbstractFat myringoplasty is a simple office technique for repairing tympanic membrane perforations. It involves wedging a piece of fat from the ear lobule into the perforation. A search of the literature failed to reveal any controlled studies on the efficacy of this method, which may allow patients to avoid more invasive procedures. Controlled perforations in guinea pig tympanic membranes were treated with fat my‐ringoplasties, paper patches, or no intervention. Four weeks following the procedures, ears were examined and photographed under the microscope and studied histologically. The fat myringoplasty healing rate exceeded the rates of both the control and paper‐patch groups. Results were stratified with respect to location and size of perforations. The results and histological studies suggest that controlled studies in humans are warran

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00001

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractIn this communication, an extension of the retro‐labyrinthine approach that has permitted safe, effective access to the petrous tip and clivus is presented. The basic technique involved complete mastoidec‐tomy, preservation of the middle and inner ear structures, removal of the sigmoid and middle fossa plates, middle and posterior fossa craniotomies, ligation of the superior petrosal sinus, and division of the ten‐torium. Nine cases that exemplified the versatility of this approach constituted the basis of this paper: 2 cholesteatomas, 2 basilar artery aneurysms, 2 chordomas, and 3 meningiomas. The indications for, and complications of, this method have been disc

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00002

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractOssification of the cochlea following meningitis presents a surgical challenge. Electrode mapping, especially in the young child, is difficult given the uncertainty of electrode contact with viable neural elements. This paper reviews surgical technique and the use of auditory brainstem responses to map the electrodes.A 4‐year‐old child deafened by meningitis at age 20 months had bilateral cochlear ossification by computed tomography. At surgery, a canal wall‐down mastoidectomy and closure of the ear canal were performed. A trough around the modiolus was drilled, and the electrode array was placed in it. Post‐operatively, the patient gave aversive or no responses to electrode stimulation. To assess electrode function, auditory brainstem responses to individual electrode activation were obtained under general anesthesia. Functioning electrodes could thus be selected for mapping. The patient now responds well t

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00003

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractFrom 1979 to 1988,17 patients presented to Duke University Medical Center for treatment of subdural empyema. Empyemas were caused by sinusitis in 53% of the patients and by otitis media in 12%. None of those with otologic causes required mastoid drainage, while all patients with sinus infections required sinus drainage. External frontoethmoidectomies were associated with a lower incidence of fronto‐ethmoid re‐exploration (P= 0.048), and antrosto‐mies with a lower incidence of maxillary re‐exploration (P= 0.111), than were more limited drainage procedures. Sinus drainage performed simultaneously with neurosurgical drainage reduced the incidence of sinus re‐exploration (P= 0.167), neurosurgical re‐exploration (P= 0.048), and length of hospitalization

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00004

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractIntracranial activation of the facial nerve is now possible with the noninvasive techniques of magnetic stimulation. Brief magnetic pulses generated by a coil overlying the parietal scalp elicit compound muscle action potentials of similar shape and amplitude and greater latency than those produced by electroneurography. Mapping studies demonstrate the compound muscle action potentials to be of constant latency and varying amplitude with changing coil location. Maximum compound muscle action potential amplitudes are obtained with the coil center located in a rectangular area superior and posterior to the ear canal. A comparison of large and small diameter coils showed them to be equally effective for painless facial nerve stimulation; however, the smaller coil allowed for a more localized field of activation. Magnetic stimulation has the potential to provide cross‐the‐lesion testing of facial nerve funct

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00005

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractFacial nerve neuromas are uncommon tumors often confused with other tumors of the temporal bone and cerebellopontine angle. Radiologically, it may be impossible to differentiate an intracanalicu‐lar facial nerve neuroma from an acoustic neuroma. We present three case reports of facial nerve neuromas arising within the internal auditory canal to show the important magnetic resonance imaging features of these tumors. One tumor extended into the cerebellopontine angle, middle cranial fossa, and middle ear. Another filled the internal auditory canal and extended through the cerebellopontine angle to the brain stem. The third occurred in a patient who had neurofibromatosis as well as numerous other intracranial tumors. We feel that gadolinium‐enhanced magnetic resonance imaging provides the most useful information in the preoperative assessment of this disor

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00006

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractPhotodynamic therapy, which consists of the selective destruction of tumors using a combination of a photosensitizer administered systemically (dihe‐matoporphyrin ether) and an argon dye‐pumped laser, has provoked profound interest amongst oncologists and has particularly titillated head and neck oncologists with its potential. Unfortunately, no multi‐institutional trials for head and neck tumors have been introduced, and the literature is replete with anecdotal reports from individual researchers on the management of advanced cancers for palliation, superficial early cancers, and field cancerization of the mucosa (“condemned mucosa”)‐ A personal 5‐year experience with 41 head and neck cancers was reviewed, as was the current literature. An attempt was made to place in perspective the true role and future direction of th

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00007

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractA review of the literature suggested that prolonged treatment time may lessen the probability of cure for patients with advanced squamous cell carcinoma of the upper aerodigestive tract. To shorten treatment time, rapid sequence treatment (RST) was devised in which chemotherapy, surgery, and irrada‐tion were administered in a total treatment time of 8 weeks. Twelve patients were treated and followed 3 years or longer. Medical complications were minor. Osteonecrosis occurred in each of the first five patients and was the only major complication of the protocol. Surgical techniques were modified, and no additional patient developed osteonecrosis. No patient developed local or regional recurrence. Two patients developed distant metastases and three other patients developed second primaries. Absolute survival was 50%. Rapid sequence treatment is an aggressive and potentially hazardous protocol that yielded encouraging results in this pilot stud

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00008

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe monothermal differential caloric test allows determination of vestibular recruitment and de‐cruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Meniere's disease. This study examined patients having unilateral Meniere's disease. Nystagmus beat frequency (NBF) and slow‐component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmo‐graphic findings showing unilateral dysfunction were present in 54% of patients by slow‐component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lat‐eralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow‐component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow‐component velocity to determine unilateral hypofunction and relative vestibula

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00009

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractCoronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the “background” prevalence of these findings are needed to determine their clinical relevance.A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbi‐nate, Haller's cells, and pneumatization of the unci‐nate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons.Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus‐like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region.Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus

ISSN:0023-852X    

DOI:10.1288/00005537-199101000-00010

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY