Subject(s)
Endolymphatic Sac , Vestibular Aqueduct , Vestibular Diseases/diagnosis , Adult , Endolymphatic Sac/diagnostic imaging , Endolymphatic Sac/pathology , Hearing Disorders/etiology , Humans , Magnetic Resonance Imaging , Male , Syndrome , Tomography, X-Ray Computed , Vestibular Aqueduct/diagnostic imaging , Vestibular Aqueduct/pathology , Vestibular Diseases/diagnostic imaging , Vestibular Diseases/physiopathologyABSTRACT
The risk for ear injury from molten metal or hot sparks produced during welding procedures is small, but the effects can be significant. Burns, tympanic membrane perforations and chronic otorrhoea are the most common results. Rare cases of inner ear injury and facial nerve paralysis have also been reported. Two cases recently encountered at our institution highlight the risk that exists for facial nerve injury. One patient suffered a significant facial nerve injury and deafness, while the other had a transient facial paresis. The injuries occurred when molten metal (slag) and a hot spark fell into the ear canal while welding. Neither subject was using ear protection at the time. These two cases are presented to highlight the rare but significant hazard of transtympanic facial nerve injury that exists during welding procedures. The use of ear protection is strongly advocated during welding operations that place the ear at risk.
Subject(s)
Deafness/etiology , Ear, Middle/injuries , Facial Paralysis/etiology , Foreign Bodies/complications , Occupational Diseases/etiology , Welding , Adolescent , Adult , Humans , MaleABSTRACT
Many institutions require that tracheotomies be performed in the operating room. Movement of critically ill patients dependent on multiple life support systems is technically difficult, labor intensive, and potentially dangerous for the patients. Between 1983 and 1992, 1088 tracheotomies were performed on patients ages 1 week to 94 years at the University of Rochester affiliated hospitals on critically ill patients as isolated procedures. The procedure was performed in the Intensive Care Units (ICU) on 996 patients, (92.9%), whereas 92 patients (7.1%) had tracheotomies in the operating room (OR1). An additional 346 tracheotomies took place in the operating room in conjunction with other head and neck procedures (OR2). Incidence of perioperative bleeding (within 48 hours) was 2.3% in the ICU group, 2.1% in the ORI group, and 2.0% in the OR2 group. Incidence of stomal infection was also similar among the three groups at 1.8%, 2.1%, and 1.5%, respectively. Tube dislodgement in all groups was a complication. No statistical differences were noted among the three groups (ICU, OR1, OR2) at the p < 0.01 level. Criteria for performing the tracheotomy in the ICU are delineated and discussed.
Subject(s)
Tracheotomy/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Child , Child, Preschool , Critical Care/statistics & numerical data , Evaluation Studies as Topic , Female , Humans , Incidence , Infant , Infant, Newborn , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Male , Middle Aged , New York/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Safety , Suture Techniques , Tracheotomy/methods , Tracheotomy/statistics & numerical dataABSTRACT
Transtympanic facial nerve paralysis resulting from a penetrating injury through the external auditory canal is a rare occurrence. The common mechanism of paralysis is direct fracture or penetration of the fallopian canal. Slag injuries of the ear caused by hot sparks or molten metal are well known to otolaryngologists because they often result in chronic tympanic membrane perforations and chronic otorrhea. We have encountered two unusual cases of transtympanic slag injury to the ear that resulted in facial nerve injury. In one patient, a significant inner ear injury also occurred. A pathophysiologic mechanism of thermal injury is proposed, and the use of ear protection in welders is discussed.
Subject(s)
Ear, Middle/injuries , Facial Paralysis/etiology , Tympanic Membrane/injuries , Wounds, Penetrating/complications , Adolescent , Adult , Alloys , Follow-Up Studies , Foreign Bodies/complications , Humans , Male , MetallurgyABSTRACT
Magnetic resonance (MR) imaging has quickly emerged and already replaced computerized tomography (CT) in the evaluation of cerebellopontine angle (CPA) lesions, although even MR scanning may occasionally yield equivocal results. We recently studied six patients with a new MR image-enhancing contrast, gadolinium-DTPA (Gd-DTPA). All patients were suspected of having CPA pathology, and the standard MR scan was either negative, equivocal, or left unanswered questions regarding confirmed lesions. The Gd-DTPA-enhanced MR scan confirmed tumors or added useful information in five of six patients.
Subject(s)
Cerebellar Neoplasms/diagnosis , Cerebellopontine Angle/pathology , Magnetic Resonance Imaging/methods , Neuroma, Acoustic/diagnosis , Organometallic Compounds , Pentetic Acid , Adult , Contrast Media , Female , Gadolinium , Gadolinium DTPA , Humans , Male , Middle AgedABSTRACT
The localization of a cerebrospinal fluid fistula producing cerebrospinal fluid otorrhea can be very difficult. However, the exact anatomic localization of the bony defect is important when selecting the surgical approach to repair. Case reports of two patients in whom spontaneous cerebrospinal fluid otorrhea occurred following pressure equalization tube placement for middle-ear effusion are presented. Nuclear magnetic imaging supplemented CT scan findings, providing noninvasive localization of the defect. Preoperative impressions were confirmed at surgery. In addition to discussing the use of magnetic resonance imaging in evaluating cerebrospinal fluid otorrhea, the literature will also be reviewed.
Subject(s)
Brain Diseases/diagnosis , Cerebrospinal Fluid Otorrhea/diagnosis , Fistula/diagnosis , Magnetic Resonance Imaging , Temporal Bone/pathology , Tomography, X-Ray Computed , Brain Diseases/etiology , Child, Preschool , Female , Fistula/etiology , Humans , Male , Middle Aged , Middle Ear Ventilation/adverse effectsABSTRACT
Bilateral acoustic tumors are one of the most difficult problems in acoustic tumor surgery. Total tumor removal with preservation of hearing has seldom been achieved in the past. Recently, hearing has been successfully preserved if the tumors are small when removed. We present the case of a child with a family history of von Recklinghausen's disease associated with bilateral acoustic tumors. A high index of suspicion of bilateral tumors and a thorough work-up resulted in the early diagnosis of small tumors. The tumors were removed with preservation of normal hearing.
Subject(s)
Ear Canal , Ear Neoplasms/diagnosis , Neurofibromatosis 1/diagnosis , Adolescent , Ear Canal/surgery , Ear Neoplasms/surgery , Female , Humans , Neurofibromatosis 1/genetics , Neurofibromatosis 1/surgeryABSTRACT
Glomus tumors of the temporal bone are usually classified as either glomus tympanicum or glomus jugulare, depending on the site of origin. This report describes another anatomical site within the temporal bone from which glomus tumors may arise--the facial canal.
Subject(s)
Cranial Nerve Neoplasms/pathology , Facial Nerve/pathology , Glomus Tumor/pathology , Cranial Nerve Neoplasms/complications , Facial Paralysis/etiology , Female , Glomus Tumor/complications , Humans , Middle AgedABSTRACT
Histiocytosis X is a relatively rare disease presenting as 3 clinical syndromes: eosinophilic granuloma, Hand-Schuller-Christian disease, and Abt-Letterer-Siwe disease. Although the clinical expressions of the disease differ, the underlying histopathology appears to be the same. Since the disease frequently involves and not infrequently presents in the head and neck region, it is particularly relevant to the otolaryngologist. We have recently treated two young children presenting with bilateral otorrhea. Although histiocytosis X was entertained early in the evaluation of these patients, the diagnosis was difficult and prolonged in both cases. One case ultimately required electron microscopic study to confirm the diagnosis. Important aspects of the diagnosis are reviewed. Treatment of histiocytosis X includes surgery, radiation therapy and chemotherapy. These treatment strategies are discussed, with particular emphasis on the management of the ear involvement.
Subject(s)
Ear Diseases/pathology , Histiocytosis, Langerhans-Cell/pathology , Child, Preschool , Ear Diseases/diagnosis , Ear Diseases/therapy , Female , Histiocytosis, Langerhans-Cell/diagnosis , Histiocytosis, Langerhans-Cell/therapy , Humans , Tomography, X-Ray ComputedABSTRACT
Cation transport in a population of stomatocytic red blood cells (RBC) is abnormal in the following respects. First, active transport against a gradient, defined as the nonisotopic net accumulation of Na+ or loss of K+ induced by 0.1 mM ouabain, is markedly elevated (7.3 and 6.3 mEq/liter cells/hr for Na+ and K+, respectively), but the Na+:K+ active transport ratio is normal. Apparent uncoupling of the Na+ and K+ isotope transport is due to disproportionately increased ouabain-sensitive 24Na+-23Na+ exchange (32.7 mEq/liter cells/hr), which is measured as a portion of 24Na+ isotope efflux. Second, cation transport is unresponsive to variations in internal Na+ concentration but decreases with decreasing extracellular Na+.
