Acoustic neuroma surgery: outcome analysis of patient-perceived disability.

OBJECTIVE: Numerous studies have investigated the outcome of acoustic neuroma (AN) treatment using classical medical measures. In an effort to describe the long-term lifestyle consequences of AN removal from the patient's perspective, patients filled out detailed questionnaires concerning their functional status. STUDY DESIGN: This was a retrospective survey. SETTING: This study was performed at a tertiary referral center. PATIENTS: A total of 130 late postoperative acoustic neuroma patients were surveyed a minimum of 6 months following surgery (average, 39 months). Survey response rate was 65% (130/200). MAIN OUTCOME MEASURES: The main outcome measures were the patient's perception of their hearing, balance, facial expression, and eye function in relation to its impact upon the activities of daily life. A comparison of pretreatment with long-term posttreatment functional levels. RESULTS: When asked to designate their "most significant" symptom, hearing loss was by far most prevalent (61.3%), followed by balance troubles (14.3%) and facial weakness (10.1%). The relatively low incidence of facial weakness as the patient's dominant complaint was somewhat surprising. When considering the incidence of each symptom, women were more likely to complain of facial weakness, dry eye, and headache, whereas men had a marginally higher incidence of hearing loss and imbalance. Patient age had no apparent influence upon either the distribution or severity of symptomatic complaints. Both hearing in the tumor ear and overall auditory function (e.g., the ability to understand in a restaurant) tended to worsen following surgery. One finding, which was both unanticipated and intriguing, was the improvement in sound localization ability reported by 57% of patients following surgery. Although the proportion of patients complaining of frequent tinnitus increased postoperatively, the number of patients who found the tinnitus troublesome decreased markedly. In terms of balance function, only 31% preoperatively and 15% postoperatively described themselves as free of balance difficulties. An aid to ambulation (e.g., cane, walker) was needed in five patients (4%) preoperatively, two of whom regained the ability to walk independently following tumor removal. CONCLUSIONS: These functional outcome data provide much useful information to both patient and clinician to consider when contemplating the optimal course of AN management. Although virtually all acoustic neuroma patients have some degree of persistent symptoms over the long-term, the data indicates that most of these are attributable to the tumor itself as opposed to the after effects of its surgical removal. The relatively slight differences between preoperative and late postoperative symptom profiles was a rather unanticipated finding. As the degree of disability tends to increase with larger tumor sizes, these data tend to support a policy of early intervention.

Socioeconomic impact of acoustic neuroma surgery.

OBJECTIVE: This study aimed to assess the impact of acoustic neuroma (AN) surgery on socioeconomic function. STUDY DESIGN: This study was a retrospective postal survey. SETTING: The study was performed at a tertiary referral center. PATIENTS: One hundred thirty late postoperative AN patients were surveyed a minimum of 6 months after surgery (average 39 months). The survey response rate was 65% (130 of 200). MAIN OUTCOME MEASURES: These included effect of AN surgery on employability, income, activities of daily living, social involvement, and psychological well-being. RESULTS: When comparing preoperative occupational status with latest follow-up, 2 of 125 (1.6%) became unemployed from their usual occupations. An additional 15 of 125 (12%) retired, attributing their retirement to the effects of the tumor itself (3), an aftermath of surgery (2), and causes unrelated to their AN (10). After AN removal, two formerly unemployed patients became employed. Among those remaining employed, there was no significant impact of surgery on either income or work responsibility. Return to normal activity was gradual: < or = 6 weeks, 31%; < or = 3 month, 64%; and < or = 6 months, 84%. Among activities of daily living, the tasks most often impaired (both before and after tumor removal) were ladder climbing and night driving, whereas dressing and bathing were seldom problematic. Overall, patients reported a minor decline in ability to perform routine daily activities after tumor removal. Social function (contact with friends, community involvement, and participation in sports) changed little after surgery. The incidence of both stress and depression decreased slightly after tumor removal. CONCLUSIONS: The economic, social, and psychological impact of AN and its surgical management appears to be relatively minor, with few individuals having life altering consequences.

Utility of helical computed tomography in the study of arytenoid dislocation and arytenoid subluxation.

Conventional computed tomography (CT) has been considered a mainstay in the evaluation of the larynx. A major difficulty with utilizing this modality, especially in the study of the arytenoid, is the time necessary to perform a thin-slice examination through a structure that has a propensity to move with respiration and swallowing. Helical CT not only significantly reduces the time necessary to study the larynx, but enables one to perform multiple high-resolution multiplanar reconstructions. Eleven patients with arytenoid abnormalities documented by strobovideolaryngoscopy or direct laryngoscopy were imaged with helical CT. A comprehensive radiographic examination illustrating the cricoarytenoid relationship in all of the subjects was completed in less than 20 seconds by using axial reconstructions in 2-mm-thick slices at 1-mm intervals, with subsequently derived sagittal and coronal reconstructions. Helical CT may be a useful adjunct in the diagnosis of arytenoid subluxation or dislocation.

Ethmoid bone sandwich grafting for caudal septal defects.

OBJECTIVE: To evaluate a new technique for correction of severe caudal septal defects. DESIGN: For all patients, preoperative photographs were graded with regard to the severity of caudal septal defects. Preoperatively, nasal airway breathing surveys were conducted and nasal tip projection (NTP) measurements were recorded. The caudal septal defects were then repaired with use of the ethmoid bone sandwich grafting technique. Photographs, NTP measurements, and an airway survey were then repeated 6 and 12 months postoperatively. Preoperative and postoperative assessments were compared and analyzed. Lateral nasal roentgenograms were obtained in five of 10 patients to assess resorption of the bone grafts. Complications were noted if present. SETTING: Urban medical center. PATIENTS: Ten volunteers with severe caudal septal defects causing both cosmetic and functional problems. All patients had undergone at least one previous submucous resection. OUTCOME MEASURES: Durability and degree of correction, maintenance of NTP, airway improvement, and morbidity. RESULTS: After 1 year, all patients maintained satisfactory correction of their caudal septal defect based on postoperative photographic grading and physical examination findings. The NTP was maintained in eight of 10 patients. Two patients experienced loss of NTP after 1 year that was not present 6 months postoperatively. Average airway improvement was 126.7% after 1 year. Postoperative roentgenograms showed only minor (< 10%) bone graft resorption. The only complication was a granuloma. CONCLUSIONS: The ethmoid bone sandwich grafting technique corrected severe caudal septal deviations while maintaining or strengthening structural support of the caudal septal strut without loss of NTP, airway compromise, or morbidity.

An epidemiologic study of maxillofacial trauma at University Medical Center in Lafayette, a regional referral center.

The authors retrospectively reviewed maxillofacial trauma admissions at University Medical Center in Lafayette, Louisiana, a Level II trauma center, over the 2-year period from July 1, 1990 to June 30, 1992. This study encompassed 208 fractures in 166 patients. All patients in this study group required surgical intervention for their maxillofacial injury. Variables examined in this cohort included age, race, gender, seasonal variation, fracture location, mechanism of injury, associated injuries, seatbelt utilization, substance abuse, surgical management, complications, operative duration, hospital stay, hour of presentation, and preoperative imaging modalities. The purpose of our study is to provide an epidemiologic review of maxillofacial trauma in the Acadian community of southwestern Louisiana.

Local anesthesia in blepharoplasty: a new look?

Forty volunteers were asked to compare pain from injection of buffered versus unbuffered local anesthetics given for upper lid and lower lid blepharoplasty. The concentration of the solution was 1 part 8.4% sodium bicarbonate to 5 parts local anesthetic. The surgeons performing the operations were asked to identify any difference in onset of action, hemostasis, or duration of action. Thirty-five of the 40 patients found the buffered anesthetic to be less painful and better tolerated. No difference in hemostasis or duration of action was noted between the buffered or unbuffered solutions, but the buffered solution produced faster onset of action.