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1.
Ann Otol Rhinol Laryngol ; 110(5 Pt 1): 437-41, 2001 May.
Article in English | MEDLINE | ID: mdl-11372927

ABSTRACT

The preoperative and postoperative bone conduction (BC) thresholds were prospectively investigated in 24 patients with chronic ear disease in the form of cholesteatoma, chronic suppurative otitis media, or adhesive otitis media. All underwent tympanoplasty with mastoidectomy. Ossicular reconstruction was performed in 14, and the remaining 10 were still awaiting second-stage ossicular reconstruction at the time of this investigation. In each group, the postoperative results were compared with the preoperative results by the paired-samples t-test. In the ossicular reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds, as compared with the preoperative BC thresholds, at 250, 1,000, and 2,000 Hz, with the largest mean improvement observed at 2,000 Hz. No significant improvement was observed at any frequency for the group without ossicular reconstruction. Postoperative improvement of at least 10 dB at 2 or more frequencies was observed in 71% of the ossicular reconstruction group, as compared with 0% of the group that did not undergo ossicular reconstruction. The results support the theory that the elevated BC thresholds of patients with chronic ear disease result from the elimination, due to disease, of the middle ear contribution (from the inertial ossicular component and ossicular resonance) to the BC response. The results also suggest that the middle ear contribution to the BC response is restored with ossicular reconstruction.


Subject(s)
Bone Conduction/physiology , Ear Diseases/physiopathology , Ear Diseases/surgery , Adult , Aged , Chronic Disease , Diagnostic Techniques, Otological , Ear Ossicles/surgery , Endoscopy , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
2.
Laryngoscope ; 110(11): 1884-9, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11081604

ABSTRACT

OBJECTIVES/HYPOTHESIS: A paucity of research exists on trans-eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans-eustachian tube endoscopy. STUDY DESIGN: Twenty-two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans-eustachian tube endoscopic investigation. METHODS: Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx. RESULTS: The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing disease (> or = 20 y) than for persons without long-standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. CONCLUSIONS: The findings of trans-eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).


Subject(s)
Ear Diseases/diagnosis , Endoscopy/methods , Eustachian Tube , Adult , Cholesteatoma/pathology , Chronic Disease , Ear Diseases/pathology , Ear Diseases/surgery , Ear Ossicles/surgery , Endoscopes , Female , Humans , Male , Middle Aged , Mucous Membrane/pathology , Otorhinolaryngologic Surgical Procedures , Prospective Studies
3.
Am J Otol ; 21(1): 123-9, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10651446

ABSTRACT

HYPOTHESIS: To investigate the feasibility of a video and computer-assisted system for evaluating the temporal and spatial aspects of facial motion during selected facial expressions in a pilot group of six normal adults. Evaluation of the diverse medical and surgical treatments for facial paralysis and paresis cannot occur until objective, reliable, and sensitive measures of the spatial and temporal aspects of facial function at specific facial landmarks are developed. METHODS: Facial motion at predetermined facial locations was assessed using a commercially available computer-interactive motion analysis system, which is based on videography principles. The displacement, velocity, and acceleration data were averaged across all trials and subjects. Time plots also were obtained for the left versus right side. RESULTS: The greatest mean maximum displacement (resultant vector) occurred during the eyebrow lift expression, reaching 1.2 cm in magnitude. The mean maximum velocity (resultant vector), which ranged from 4.5 to 8.5 cm/s for the dynamic facial expressions, was greatest for the eyes closed tight expression. The mean maximum acceleration (resultant vector), which ranged from 193 to 465 cm/s/s, was greatest for the eyebrow lift expression. Symmetrical time plots were obtained. The system documented synkinesis by revealing substantial left upper eyelid motion during the nose-wrinkle expression in an illustrative case with slight left facial dysfunction. CONCLUSION: This approach to facial motion analysis is feasible for the simultaneous, multiregional, spatial-temporal assessment of facial expressions. Because motion at relatively remote regions could be quantified, this approach is potentially useful for the evaluation of synkinesis.


Subject(s)
Facial Nerve/physiopathology , Facial Paralysis/diagnosis , Facial Paralysis/physiopathology , Image Processing, Computer-Assisted/methods , Movement/physiology , Video Recording/methods , Adult , Facial Expression , Feasibility Studies , Female , Humans , Male , Pilot Projects , Reproducibility of Results , Sensitivity and Specificity
4.
Prim Care ; 25(3): 583-617, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9673322

ABSTRACT

The diagnosis and investigation of a patient with bilateral, severe-to-profound sensorineural hearing loss is presented. The steps toward cochlear implantation, including tests of audition, balance, radiographic imaging, and the pre- and postrehabilitation period, are reviewed. The two major cochlear implants available today, and future developments within the cochlear implant, are presented.


Subject(s)
Cochlear Implantation , Audiometry , Child , Cochlear Implantation/adverse effects , Cochlear Implantation/economics , Cochlear Implants/adverse effects , Cochlear Implants/economics , Costs and Cost Analysis , Diagnosis, Differential , Hearing Aids , Hearing Disorders/diagnosis , Humans , Perioperative Care , Postoperative Care
5.
Laryngoscope ; 106(9 Pt 1): 1115-8, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8822716

ABSTRACT

Upper-lid gold-weight insertions and lower-lid-shortening procedures are standard surgical techniques used to restore eyelid function and protect the cornea in patients with facial nerve paralysis. Different opinions exist in the literature regarding the correct timing and the morbidity of these interventions. The retrospective analysis of 45 patients over a 5-year period revealed extrusion of the gold weight in one (2.2%) patient and delayed infections in three (6.6%). Sixty percent of all gold-weight insertions were performed within 4 weeks after the onset of facial nerve paralysis. We strongly favor gold-weight insertion, often combined with lower-lid-shortening procedures, as a simple, reliable, reversible, and successful technique for early rehabilitation of the paralyzed eyelid. Using these guidelines, we have markedly reduced the need for tarsorrhaphies.


Subject(s)
Eyelid Diseases/surgery , Eyelids/surgery , Facial Paralysis/surgery , Gold/therapeutic use , Prostheses and Implants , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Surgery, Plastic/methods , Time Factors
6.
Am J Otol ; 17(1): 133-6, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8694117

ABSTRACT

The differental diagnosis of aural polyps includes both benign and malignant processes, including carcinoma. We present the case of a polyp arising after trauma to the ear. The entire external auditory meatus was occluded, causing a maximal conductive hearing loss on the affected side. This did not appear to be a typical aural polyp and carcinoma was suspected. Biopsy revealed the mass to be a leiomyoma of the external auditory canal. This benign tumor was treated by complete excision. The clinical and pathological findings of this extremely rare tumor of the external auditory canal are described. To our knowledge, this is the first reported case of leiomyoma arising from the external auditory canal in the English literature.


Subject(s)
Ear Neoplasms/pathology , Ear, External/pathology , Leiomyoma/pathology , Audiometry , Diagnosis, Differential , Ear Neoplasms/diagnosis , Ear Neoplasms/surgery , Ear, External/surgery , Hearing Loss, Conductive/diagnosis , Humans , Leiomyoma/diagnosis , Leiomyoma/surgery , Male , Middle Aged , Polyps/diagnosis , Tomography, X-Ray Computed
7.
J Otolaryngol ; 24(3): 168-79, 1995 Jun.
Article in English | MEDLINE | ID: mdl-7674443

ABSTRACT

The classic management of children and adolescents with unilateral aural atresia, with or without microtia, is to assess audition, to exclude cholesteatoma formation both clinically and radiologically, to offer amplification in unilateral cases, and to consider surgical repair in bilateral cases. However, evidence indicates that children with unilateral hearing loss from any cause are at risk for delayed language development, attention deficit, and poor school performance. Favourable factors for reconstruction of hearing include a normal bone line with good word discrimination, a normal or recognizable auricle (microtia grade I or II), radiographic evidence of an air-containing middle ear cleft with an estimated volume close to the normal side, the presence of ossicles, the facial nerve running in its expected (though abnormal) course, and the absence of any syndrome affecting mid-face development or of any associated mandibular malformation. In unilateral pediatric cases, only minor auricular malformations (grades I and II) were considered for otologic repair. If microtia was more severe (grade III and IV), or if the child had any other mid-face or mandibular problem, otologic repair was delayed until these were corrected. In many cases, otologic repair was deferred throughout childhood. A summary of selection criteria, case examples, and outcomes of surgery will be presented. Carefully selected unilateral cases may be reconstructed during childhood. Unfavourable cases should be amplified or observed.


Subject(s)
Ear, External/abnormalities , Patient Selection , Adolescent , Audiometry , Child , Congenital Abnormalities/classification , Congenital Abnormalities/diagnosis , Congenital Abnormalities/rehabilitation , Congenital Abnormalities/surgery , Counseling , Female , Hearing Aids , Humans , Male , Preoperative Care , Skin Transplantation
8.
Otolaryngol Head Neck Surg ; 111(1): 70-5, 1994 Jul.
Article in English | MEDLINE | ID: mdl-8028946

ABSTRACT

We describe a surgical technique in which the middle fossa craniotomy ordinarily used for facial nerve decompression and related surgery is extended superiorly to allow the harvest of a split-thickness calvarial graft. This graft allows the tegmen defect in middle fossa surgery to be repaired without shortening the original craniotomy plate. Avoiding the usual temporoparietal depression after middle cranial fossa surgery is both a structural and cosmetic benefit for the patient.


Subject(s)
Bone Transplantation , Craniotomy/methods , Adult , Encephalocele/surgery , Facial Nerve Diseases/surgery , Female , Humans , Male , Nerve Compression Syndromes/surgery , Skull Fractures/surgery , Temporal Bone/injuries
9.
J Otolaryngol ; 22(6): 401-8, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8158733

ABSTRACT

The thorough investigation of patients presenting with sudden or fluctuating hearing loss, ringing or vertigo includes serology to exclude otosyphilis. Treatment of otosyphilis with penicillin and corticosteroids has achieved improvement in hearing, tinnitus and vertigo, but not in all patients. Selecting which patient with positive serology will benefit from treatment remains a difficult clinical problem. All patients presenting to The New York Eye and Ear Infirmary with cochleovestibular dysfunction of unknown aetiology and positive syphilis serology were assumed to have otosyphilis and were treated with intravenous penicillin, if non-allergic, and steroids. Lumbar puncture and HIV testing were performed. Eighteen patients were treated. Hearing (SRT and/or discrimination) improved in 4 of 16 patients with hearing loss (25%), tinnitus decreased in 10 of 14 (71%) and dysequilibrium improved in 6 of 9 (66%). Factors associated with a good response included fluctuating symptoms, especially hearing, hearing loss less than five years, and age less than 60. Improvement was unrelated to the severity of the loss or previous therapy. Patients with CSF abnormalities, including two patients with HIV disease, had subjective improvement. A summary of our results and a treatment protocol are presented.


Subject(s)
Cochlear Diseases/diagnosis , Syphilis/diagnosis , Vestibular Diseases/diagnosis , Acquired Immunodeficiency Syndrome/complications , Adult , Aged , Cochlear Diseases/complications , Cochlear Diseases/drug therapy , Female , HIV-1 , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/etiology , Humans , Male , Middle Aged , Syphilis/complications , Syphilis/drug therapy , Tinnitus/drug therapy , Tinnitus/etiology , Vertigo/drug therapy , Vertigo/etiology , Vestibular Diseases/complications , Vestibular Diseases/drug therapy
10.
Otolaryngol Head Neck Surg ; 108(6): 680-7, 1993 Jun.
Article in English | MEDLINE | ID: mdl-8516005

ABSTRACT

Human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), has reached worldwide epidemic proportions and is increasing. Otologists, neurotologists, and audiologists practicing in metropolitan centers in North America can expect to encounter patients with HIV-related illnesses, including patients with AIDS-related complex (ARC) and AIDS. Five representative cases are presented: chronic otitis media, facial palsy, Gradenigo's syndrome with facial paralysis, otosyphilis, and Kaposi sarcoma of the mastoid. The common link in all cases was HIV infection. This presentation discusses the management of several HIV-infected patients with otologic and neurotologic findings. HIV infection has extended to all parts of North America. The worldwide incidence is increasing. As the epidemic continues to unfold, new challenges to both the diagnosis and treatment of otologic and neurotologic disease in HIV-positive patients will confront the audiologist and otolaryngologist. Recommendations for the safety of the examining audiologist and treating physician are given.


Subject(s)
HIV Infections/complications , Otorhinolaryngologic Diseases/complications , Abducens Nerve , Adult , Child , Chronic Disease , Cranial Nerve Diseases/complications , Cranial Nerve Diseases/microbiology , Facial Paralysis/complications , Facial Paralysis/microbiology , Female , Humans , Male , Mastoid , Middle Aged , Neurosyphilis/complications , Neurosyphilis/microbiology , Otitis Media/complications , Otitis Media/microbiology , Otorhinolaryngologic Diseases/microbiology , Sarcoma, Kaposi/complications , Sarcoma, Kaposi/microbiology , Skull Neoplasms/complications , Skull Neoplasms/microbiology
11.
Laryngoscope ; 103(4 Pt 1): 406-15, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8459750

ABSTRACT

Surgery for congenital auricular atresia places the facial nerve at risk because of its potential aberrancy; iatrogenic facial paralysis is a well-known potential risk. Five cases of congenital auricular atresia are presented. All patients had intraoperative monitoring of the facial nerve. The facial nerve was found to be abnormally displaced, usually due to hypoplasia of the tympanic ring. Preoperative and postoperative facial nerve function was unchanged by surgery. Facial nerve monitoring is an important adjunct in congenital ear surgery because it allows for early and precise identification of the nerve in the absence of normal surgical landmarks and provides for continuous monitoring of the nerve.


Subject(s)
Ear, External/abnormalities , Ear, External/surgery , Ear, Middle/abnormalities , Ear, Middle/surgery , Facial Nerve/physiopathology , Monitoring, Intraoperative , Adult , Classification , Ear Ossicles/abnormalities , Ear Ossicles/surgery , Electromyography/methods , Facial Nerve/pathology , Facial Paralysis/complications , Facial Paralysis/physiopathology , Female , Hearing/physiology , Humans , Male , Middle Aged , Ossicular Prosthesis , Temporal Bone/abnormalities , Temporal Bone/surgery , Tympanic Membrane/abnormalities , Tympanic Membrane/surgery
12.
Otolaryngol Head Neck Surg ; 108(1): 27-35, 1993 Jan.
Article in English | MEDLINE | ID: mdl-8437871

ABSTRACT

The Torok Monothermal Caloric Test has been described as offering a strong advantage over bithermal caloric testing because it can distinguish labyrinthine from retrolabyrinthine lesions. Weak and strong irrigations of room-temperature water are administered to each ear and the ratios of strong to weak nystagmus responses compared to those of normal individuals. Ratios that fall below normal are said to represent decruitment and to denote retrolabyrinthine disease. Ratios that exceed normal are said to represent recruitment and to denote labyrinthine lesions. We attempted to verify the clinical value of the Monothermal Caloric Test by examining patients with known labyrinthine (N = 9) and retrolabyrinthine (N = 25) lesions. Ten patients with dysequilibrium and nonlocalizing testing were also examined. The test was performed exactly as described by the originator. Decruitment was found either unilaterally or bilaterally in 56% of patients with retrolabyrinthine lesions. However, it occurred on the side of the lesion in only 42%. Decruitment was also found in 47% of patients without retrolabyrinthine lesions, including 63% of those with unilateral Meniere's disease. Recruitment was never found on the side of a labyrinthine lesion. A description of the test and a summary of our results are presented. We conclude that the Monothermal Caloric Test is moderately sensitive to the presence of retrolabyrinthine lesions, but lateralizes poorly and is not highly selective. The test was found to be insensitive to the presence of labyrinthine disease.


Subject(s)
Caloric Tests/methods , Labyrinth Diseases/diagnosis , Evaluation Studies as Topic , Follow-Up Studies , Humans , Labyrinth Diseases/physiopathology , Meniere Disease/diagnosis , Meniere Disease/physiopathology , Neuroma, Acoustic/diagnosis , Nystagmus, Pathologic , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity
13.
Laryngoscope ; 102(11): 1255-9, 1992 Nov.
Article in English | MEDLINE | ID: mdl-1307698

ABSTRACT

Traditional treatment of otosyphilis with penicillin and corticosteroids has achieved hearing improvement; however, selecting which patients with a positive fluorescent treponemal antibody absorption (FTA-ABS) test will benefit from treatment remains a problem. In order to study this problem, 18 patients with cochleovestibular dysfunction of unknown etiology and positive syphilis serology were treated with intravenous penicillin and corticosteroids. In addition, lumbar puncture and human immunodeficiency virus (HIV) testing were performed on all patients. Hearing improved in 5 (31%) of 16 patients, tinnitus decreased in 11 (85%) of 13, and vertigo improved in 6 (86%) of 7. Factors associated with hearing improvement were hearing loss present less than 5 years, fluctuating hearing, and age less than 60. Improvement was unrelated to the severity of the loss or previous therapy. All patients with cerebrospinal fluid abnormalities, including two patients with HIV disease, had subjective improvements. A diagnostic and treatment protocol is presented.


Subject(s)
Amoxicillin/therapeutic use , Cochlear Diseases/drug therapy , Penicillin G/therapeutic use , Prednisone/therapeutic use , Probenecid/therapeutic use , Syphilis/drug therapy , Vestibular Diseases/drug therapy , Adult , Aged , Amoxicillin/administration & dosage , Cardiolipins , Cerebrospinal Fluid/cytology , Cerebrospinal Fluid/microbiology , Cholesterol , Clinical Protocols/standards , Cochlear Diseases/diagnosis , Cochlear Diseases/physiopathology , Decision Trees , Drug Therapy, Combination , Female , Fluorescent Treponemal Antibody-Absorption Test , Hearing Tests , Humans , Male , Middle Aged , New York City , Penicillin G/administration & dosage , Phosphatidylcholines , Prednisone/administration & dosage , Probenecid/administration & dosage , Syphilis/diagnosis , Syphilis/physiopathology , Vestibular Diseases/diagnosis , Vestibular Diseases/physiopathology
14.
Otolaryngol Clin North Am ; 25(4): 745-80, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1470437

ABSTRACT

This article has attempted to set out in a logical, step by step fashion the approach to a dizzy or vertiginous patient. All that has been said will not apply to every patient. The investigator must above all be patient and thorough in obtaining the history--this is by far the most important step in the process. The physical examination is tailored to the complaint. Investigations include examinations of hearing, balance, serum chemistry, and radiology. Most otolaryngologists limit themselves to the diagnosis and limited medical management of dizziness and vertigo. It is required, however, that any physician treating dizzy patients have an understanding of the larger medical and surgical picture. A systematic and thorough approach to the dizzy patient will often yield the diagnosis, exclude otologic causes for imbalance, and ultimately set the patient on a proper course of treatment.


Subject(s)
Dizziness/diagnosis , Ambulatory Care , Central Nervous System Diseases/diagnosis , Diagnosis, Differential , Dizziness/etiology , Dizziness/therapy , Humans , Labyrinth Diseases/diagnosis , Vertigo/diagnosis , Vertigo/etiology , Vertigo/therapy , Vestibular Function Tests
15.
Otolaryngol Head Neck Surg ; 103(6): 1016-23, 1990 Dec.
Article in English | MEDLINE | ID: mdl-2126116

ABSTRACT

Facial paralysis can result in serious keratopathy because of corneal exposure and inadequate lacrimation. Thirty-seven patients underwent thirty-eight gold weight upper lid implants to rehabilitate paralysis of the eyelid from various causes. When indicated, implantation was combined with lower lid ectropion repair, medial canthoplasty or brow lift. Because of encouraging results in patients with longstanding facial paralysis, "early" implantation (within 1 month of paralysis) was offered to patients with severe lagophthalmos in whom (1) a severe neural injury was documented at the time of transtemporal surgery or (2) delayed, incomplete return of function was expected. Gold weight implantation resulted in excellent eyelid closure, protection, and cosmesis. There were no infections or extrusions. Lagophthalmos and exposure keratitis resolved or were significantly improved in all patients, and most were able to dispense with eyedrops and salves. Visual acuity improved in 95% of patients--a benefit even those without preoperative keratitis often achieved. A mild worsening of one patient's pre-existing astigmatism developed, which resolved after reimplantation with a lighter weight. The implant is easily removed from those patients who, having undergone early implantation, eventually recover adequate function. Gold weight loading has become our procedure of choice for eyelid rehabilitation.


Subject(s)
Eyelid Diseases/surgery , Eyelids/surgery , Facial Paralysis/surgery , Gold , Prostheses and Implants , Adolescent , Adult , Aged , Ectropion/surgery , Eyelid Diseases/rehabilitation , Facial Paralysis/rehabilitation , Female , Follow-Up Studies , Humans , Intraocular Pressure , Keratitis/surgery , Male , Middle Aged , Time Factors , Visual Acuity
16.
Laryngoscope ; 100(1): 5-9, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2293700

ABSTRACT

Transtympanic electric promontory stimulation is a psychoacoustic test used to assess residual acoustic neurons in profound sensorineural hearing loss. The test was performed in six patients who had previously undergone transmastoid (N = 5) or transcanal-oval window (N = 1) labyrinthectomy as a means of determining the feasibility of future cochlear implantation. Four patients had unilateral Meniere's disease, one had labyrinthitis, and one had delayed onset vertigo. All patients perceived a definite auditory sensation in the labyrinthectomized ear during stimulation. The results of threshold, dynamic range, and difference limen testing were similar to those obtained during preoperative stimulation of cochlear implant candidates (N = 12) who subsequently became successful users. There was no evidence of response degradations as the time following labyrinthectomy increased. The results of this study suggest the possibility of successful cochlear implantation following labyrinthectomy. Supporting histologic data are reviewed.


Subject(s)
Acoustic Stimulation/methods , Audiometry, Evoked Response/methods , Cochlear Implants , Ear, Inner/surgery , Hearing Loss, Sensorineural/physiopathology , Aged , Auditory Threshold , Electric Stimulation , Female , Functional Laterality , Hair Cells, Auditory/physiopathology , Humans , Male , Meniere Disease/surgery , Middle Aged , Spiral Ganglion/physiopathology
17.
Am J Otol ; 10(5): 393-401, 1989 Sep.
Article in English | MEDLINE | ID: mdl-2683804

ABSTRACT

This paper describes the diagnostic investigations and surgical treatment of a patient with bilateral lesions of the petrous apices. Many surgical methods were considered before choosing one that would allow simultaneous drainage and hearing preservation. A transsphenoidal, transclival route was used and the surgical goals achieved. A review of the pertinent otologic, neurosurgical and radiologic literature is presented. To our knowledge, this is the first case report in the English language of the transclival approach to both petrous apices.


Subject(s)
Bone Diseases/pathology , Cholesterol , Granuloma/pathology , Petrous Bone , Adult , Bone Diseases/diagnostic imaging , Bone Diseases/surgery , Diagnosis, Differential , Female , Granuloma/diagnostic imaging , Granuloma/surgery , Humans , Petrous Bone/diagnostic imaging , Petrous Bone/pathology , Radiography
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