Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
Add more filters










Database
Language
Publication year range
1.
Otol Neurotol ; 22(5): 696-700, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11568682

ABSTRACT

OBJECTIVE: The exact mechanism of hearing loss, the most common presenting symptom in patients with vestibular schwannomas, remains unclear. To test whether increased pressure in the internal auditory canal from tumor growth is responsible for this clinical finding, the intracanalicular pressure in patients harboring these tumors was measured. STUDY DESIGN: Prospective study. SETTING: Tertiary referral hospital. PATIENTS: Fifteen consecutive patients undergoing a retrosigmoid approach for resection of vestibular schwannomas were included in the study. INTERVENTION: The intracanalicular pressure in every patient was measured by introducing a pressure microsensor into the internal auditory canal. The pressure readings, which were performed before tumor resection, were then correlated with tumor size and respective preoperative hearing status. RESULTS: Placement of the pressure monitor into the internal auditory canal revealed a biphasic waveform in every patient. Whereas the mean intracanalicular pressure was 20 mm Hg, there was significant variability among patients (range, 1-45 mm Hg). The intracanalicular pressure directly correlated with the amount of tumor in the internal auditory canal (r > 0.63, p < 0.012) but not with the total tumor size (r 0.075). Furthermore, eight patients with class A preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery classification) had lower intracanalicular pressures than did five patients with class B hearing (16 +/- 5 vs. 28 +/- 4). Although this observation suggested an inverse correlation between the intracanalicular pressure and hearing function, the difference between the two groups was not statistically significant (p = 0.14). CONCLUSION: Pressure on the cochlear nerve as a result of tumor growth in the internal auditory canal may be responsible for hearing loss in patients with vestibular schwannomas. Modification of surgical techniques to address the elevated intracanalicular pressure may be beneficial in improving hearing preservation in these patients.


Subject(s)
Ear, Inner/pathology , Neuroma, Acoustic/pathology , Cochlear Nerve/physiopathology , Cranial Nerve Diseases/etiology , Cranial Nerve Diseases/physiopathology , Humans , Neuroma, Acoustic/complications , Prospective Studies , Speech Reception Threshold Test
2.
Laryngoscope ; 110(11): 1837-42, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11081596

ABSTRACT

OBJECTIVES/HYPOTHESIS: Large vestibular aqueduct syndrome (LVAS) is a significant cause of hearing loss in early childhood. Many theories on the origins and causes of LVAS have been proposed, including arrest or maldevelopment of the vestibular labyrinth in embryonic life. Prior studies have described postnatal and adult vestibular aqueduct anatomy, but none has analyzed aqueduct growth throughout embryonic life. This study was undertaken to characterize the growth of the developing vestibular aqueduct to gain a better understanding of the possible origins of LVAS. STUDY DESIGN: Basic science, temporal bone histopathological study. METHODS: Serial sections from 48 temporal bones from human embryos ranging in age from 5 weeks' gestation to full term were studied with computer image analysis. Measurements of vestibular aqueduct internal and external aperture, midportion diameter, and length were analyzed to obtain a growth model of development. RESULTS: The vestibular aqueduct grows in a nonlinear fashion throughout embryonic life. All parameters fit a similar growth curve and never reached a maximum or began narrowing during development. Growth in one parameter correlated well with growth of another. There was good side-to-side correlation with all but the external aperture. CONCLUSIONS: Most of the membranous labyrinth reaches adult size by 20 weeks' gestation, but the vestibular aqueduct grows throughout embryonic life. The measurements and growth model obtained in this study are not consistent with the theory that LVAS results from an arrest in development early in fetal life. The data suggest that LVAS may result from postnatal and early childhood maldevelopment.


Subject(s)
Vestibular Aqueduct/embryology , Gestational Age , Humans , Syndrome , Vestibular Aqueduct/abnormalities
4.
Laryngoscope ; 107(9): 1210-6, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9292605

ABSTRACT

This study reports the preliminary results of an outcomes approach to analysis of the effectiveness of endolymphatic sac decompression (ELSD). Using the medical outcomes survey's 36-item, short-form health survey (SF-36), we assessed the quality of life in 33 patients with disabling Meniere's disease undergoing ELSD for medically intractable vertigo. Results indicate that patients with 1995 American Academy of Otolaryngology--Head and Neck Surgery (AAO/HNS) class A or B outcomes showed no significant difference from population norms on the SF-36, whereas patients with AAO/HNS classes C to E outcomes scored significantly below norms. Six patients who were given the SF-36 preoperatively scored consistently below population norms. Postoperatively, they showed a statistically significant improvement and were statistically equal to norms. These findings suggest that the SF-36 is a good measure of the quality of life impairment in patients with disabling Meniere's disease. In addition, SF-36 scores correlated well with the 1995 AAO/HNS classification.


Subject(s)
Endolymphatic Sac/surgery , Meniere Disease/surgery , Adult , Aged , Attitude to Health , Case-Control Studies , Ear, Inner/surgery , Female , Humans , Male , Mastoid/surgery , Meniere Disease/psychology , Middle Aged , Outcome Assessment, Health Care , Patient Satisfaction , Quality of Life , Silicone Elastomers , Stents , Surveys and Questionnaires , Treatment Outcome , Vertigo/psychology , Vertigo/surgery
5.
Int J Radiat Oncol Biol Phys ; 27(2): 363-9, 1993 Sep 30.
Article in English | MEDLINE | ID: mdl-8407411

ABSTRACT

PURPOSE: The feasibility of reducing overall treatment time by 2 weeks in the curative radiotherapeutic management of head and neck cancer patients is reported in a pilot trial of Hyperfractionated, Accelerated Radiotherapy with Dose Escalation (HARDE). This regimen prescribes 76 Gy in 5 weeks to definitive head and neck cancer patients, and 65 Gy in 5 weeks to high-risk postoperative patients. The linear quadratic model is used to compare predicted tumor cell kill with HARDE versus that expected with conventional fractionation (CF). MATERIALS AND METHODS: Between January 1991 and March 1992, 40 head and neck cancer patients were treated with HARDE at the University of Wisconsin Comprehensive Cancer Center. Case-matched controls treated with CF were identified from patients treated at the same institution between 1980-1990, based on tumor site, stage, and extent of prior surgery. Individual patient treatment data (total dose, fraction size, overall time) rather than idealized schedule data from each group were analyzed using the linear quadratic model. RESULTS: Seventy-nine case-matched controls were identified for comparison with HARDE patients. The predicted increase in log cell kill for HARDE patients over case-matched controls was 1.5 and 1.3 logs, respectively, in the definitive and postoperative settings. This difference in log cell kill projects an improvement in locoregional tumor control for HARDE patients of between 10-25%. HARDE patients experience very brisk acute mucosal reactions and moderately prolonged mucosal healing, however, 91% have completed therapy without a treatment break. CONCLUSION: A 2-week reduction in overall treatment time for curative head and neck cancer patients is feasible while maintaining doses > 70 Gy. Based on radiobiologic predictions, such treatment intensification may significantly improve rates of locoregional tumor control. However, intensified acute mucosal reactions accompany such accelerated therapy.


Subject(s)
Laryngeal Neoplasms/radiotherapy , Mouth Neoplasms/radiotherapy , Pharyngeal Neoplasms/radiotherapy , Radiotherapy Dosage , Case-Control Studies , Feasibility Studies , Humans , Pilot Projects , Time Factors
7.
Skull Base Surg ; 1(2): 97-105, 1991.
Article in English | MEDLINE | ID: mdl-17170829

ABSTRACT

True cholesteatomas developing medial to the labyrinth and facial nerve with extension into the petrous apex are uncommon lesions. More recent techniques of total matrix removal and obliteration require the otoneurosurgeon to be knowledgeable of intratemporal facial nerve mobilization techniques. Total cholesteatoma matrix removal and obliteration may obviate the need for frequent care of the exteriorized cavity. However, these procedures can be associated with extensive recurrence from residual disease and close radiographic follow-up is a necessity. We review our experience with ten cases of petrous apex keratoma treated with both techniques. Six cases were managed with an exteriorization technique and four patients underwent subtotal petrosectomy with obliteration. Advantages, disadvantages, and complications of both methods are presented and guidelines for selecting a particular approach are suggested.

8.
Laryngoscope ; 100(7): 687-92, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2362528

ABSTRACT

Cochlear implantation is an accepted medical treatment for profound bilateral postlinguistically acquired hearing loss. Because cochlear implants are still in the process of development, a detailed evaluation of the results of implantation is essential. However, the capability of predetermining the auditory benefit of a cochlear implant is limited and depends upon a number of factors. This report focuses upon the ability of computed tomography (CT) to predict surgical success and audiological results of multichannel cochlear implantation. It also addresses how the disease state might affect the functional benefit of the implant. After undergoing routine clinical and audiological evaluations, 28 cochlear implant candidates underwent CT scans in order to evaluate cochlear patency prior to surgery. Subsequently, 24 patients were implanted with either a single-or 22-channel device. Surgical findings were noted and postoperative audiological assessments of sound detection and speech discrimination were made. The CT risk factors that diminish the likelihood of a successful cochlear implant result are discussed based upon a retrospective comparison of preoperative CT results, surgical findings, and postsurgical audiological evaluations of the 14 patients who received a 22-channel implant. Analysis of the predictive capability of CT will allow clinicians to use that procedure more effectively in the presurgical assessment of cochlear implant candidates.


Subject(s)
Cochlea/diagnostic imaging , Cochlear Implants , Hearing Loss, Bilateral/diagnostic imaging , Hearing Loss/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Audiometry/methods , Female , Hearing Loss, Bilateral/physiopathology , Hearing Loss, Bilateral/surgery , Humans , Male , Middle Aged , Predictive Value of Tests , Preoperative Care , Retrospective Studies , Risk Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...