Archives of Otolaryngology - Head & Neck Surgery

Kessler, Alexander;Potsic, William P.;Marsh, Roger R.

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290005001pmid: 8172698

Abstract Objective: To identify factors affecting the surgical success rate and reperforation rate in type 1 tympanoplasty. Controversy continues regarding the advisability of this procedure in young children, largely because of the likelihood of recurrent middle ear disease and eustachian tube dysfunction. Design: Retrospective medical record review of a case series. Setting: Pediatric hospital that serves both as a primary care and referral center. Patients: All private patients younger than 18 years, undergoing type 1 tympanoplasty from 1985 through 1989, for whom at least 6 months' follow-up was available. Two hundred nine tympanoplasties on 183 patients were included; 22 patients were excluded for insufficient follow-up. Main Outcome Measures: Surgical success was defined by confirmation of an intact tympanic membrane at least 6 months postoperatively. Procedures were deemed long-term successes if the tympanic membrane remained free of perforation to the end of follow-up. Results: The overall short-term surgical success rate was 92%, with 87% of ears remaining free of reperforation to the end of follow-up. If the perforation involved the margin, the surgical success and long-term success rates dropped to 86% and 77%, respectively. Although reperforation was more likely in patients younger than 6 years or in those with contralateral otitis media at surgery, even these groups had long-term success rates of 81% and 74%, respectively. Conclusions: Tympanoplasty may be considered at any age. Even in young children, there is a high likelihood of return to normal function.(Arch Otolaryngol Head Neck Surg. 1994;120:487-490) References 1. Bluestone CD, Cantekin El, Douglas GS. Eustachian tube function related to the results of tympanoplasty in children . Laryngoscope . 1979;89:450-458.Crossref 2. Bailey HAT. Contraindications to tympanoplasty, I: absolute and relative contraindications . Laryngoscope . 1976;86:67-69.Crossref 3. Dawes JDK. Myringoplasty . J Laryngol Otol . 1972;86:141-146.Crossref 4. Glasscock ME. Contraindications to tympanoplasty, II: an exercise in clinical judgment . Laryngoscope . 1976;86:70-76.Crossref 5. Raine CH, Singh SD. Tympanoplasty in children: a review of 114 cases . J Laryngol Otol . 1963;97:217-221.Crossref 6. Tos M, Lau T. Stability of tympanoplasty in children . Otolaryngol Clin North Am . 1989;2:15-28. 7. Koch WM, Friedman EM, McGill TJI, Healy GB. Tympanoplasty in children: the Boston Children's Hospital experience . Arch Otolaryngol Head Neck Surg . 1990; 116:35-40.Crossref 8. Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population . Arch Otolaryngol Head Neck Surg . 1987;113:1288-1290.Crossref 9. Smyth GDL, Hassard TH. Tympanoplasty in children . Am J Otol . 1980;1:199-205. 10. Lau T, Tos M. Tympanoplasty in children: an analysis of late results . Am J Otol . 1986;7:55-59.Crossref 11. Adkins WY, White B. Type I tympanoplasty: influencing factors . Laryngoscope . 1984;94:916-918.Crossref 12. Buchwach KA, Birck HG. Serous otitis media and type I tympanoplasties in children: a retrospective study . Ann Otol Rhinol Laryngol . 1980;89( (suppl 68) ): 324-325. 13. Sadé J, Berco E, Brown M, Weinberg J, Avraham S. Myringotomy: short-and long-term results in a training program . J Laryngol Otol . 1981;95:653-665.Crossref

Haddad, Joseph;Gonzalez, Carlos;Kurland, Geoffrey;Orenstein, David M.;Casselbrant, Margaretha L.

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290009002pmid: 8172699

Abstract Objective: To assess otitis media in children with cystic fibrosis. Design: Prospective prevalence survey. Setting: Otolaryngology and cystic fibrosis/pulmonology outpatient clinics, Children's Hospital of Pittsburgh (Pa), a regional referral center. Patients: Seventy patients, aged 4 months to 17 years, with documented cystic fibrosis who presented to the cystic fibrosis/pulmonary clinic with scheduled appointments were asked to volunteer for the study. The 70 patients recruited represent approximately one fourth of the children younger than 17 years with cystic fibrosis who were followed up by the cystic fibrosis/pulmonary clinic. Intervention: Ear, nose, and throat examination including pneumatic otoscopy, with tympanometry when indicated; relevant history taking. Main Outcome Measure: Presence or absence of otitis media. Results: Seven (10%) of the 70 patients had unilateral or bilateral otitis media. Conclusions: Children with cystic fibrosis have a low prevalence of otitis media compared with normal children.(Arch Otolaryngol Head Neck Surg. 1994;120:491-493) References 1. Welsh MJ, Fick RB. Perspective in cystic fibrosis . J Clin Invest 1987;80:1523-1526.Crossref 2. Riordan JR, Rommen JM, Kerem B, et al. Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA . Science . 1989;245: 1066-1073.Crossref 3. Boat TF, Welsh MJ, Beaudet AC. Cystic fibrosis . In: Scriver CR, Beaudet AC, Sly WS, Valle D, eds. The Metabolic Basis of Inherited Disease . 6th ed. New York, NY: McGraw-Hill International Book Co; 1989:2649-2680. 4. Kulczycki LL, Herer G, Butler J. Cystic fibrosis and hearing . Clin Pediatr . 1970; 9:390-402.Crossref 5. Forcucci RA, Stark EW. Hearing loss, speech-language, and cystic fibrosis . Arch Otolaryngol . 1972;96:361-364.Crossref 6. Siegel J, Taylor WF. Hearing of patients with cystic fibrosis . Arch Otolaryngol . 1970;92:523-524.Crossref 7. Jerger J, Neely J. Audiometric testing . Arch Otolaryngol . 1971;93:111-112.Crossref 8. Taylor B, Evans J, Hope G. Upper respiratory tract in cystic fibrosis . Arch Dis Child . 1974;49:133-136.Crossref 9. Bak-Pedersen K, Larsen PK. Inflammatory middle ear diseases in patients with cystic fibrosis . Acta Otolaryngol Suppl (Stockh) . 1979;360:138-140. 10. Forman-Franco B, Abramson AL, Gorvoy JD, Stein T. Cystic fibrosis and hearing loss . Arch Otolaryngol . 1979;105:338-342.Crossref 11. Cepero R, Smith RJH, Catlin F, Bressler KL, Furuta GT, Shandera KC. Cystic fibrosis: an otolaryngologic perspective . Otolaryngol Head Neck Surg . 1987; 97:356-360. 12. Casselbrant ML, Brostoff LM, Cantekin El. Otitis media with effusion in pre-school children . Laryngoscope . 1985;95:428-436.Crossref

Fujino, Akito;Tokumasu, Kohji;Yosio, Satosi;Naganuma, Hideaki;Yoneda, Satosi;Nakamura, Ken

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290013003pmid: 8172700

Abstract A modified controlled study on treatment effects of vestibular training (VT) for benign paroxysmal positional vertigo was performed. The VT was compared with courses of patients in three different groups: patients treated by medication, by VT, and by VT with medication during 8 weeks. It was statistically confirmed by global judgments of symptoms and signs that improvement rates of positional nystagmus and vertigo were higher in the two groups treated by VT with and without medication than the improvement rate in the medication alone group. In the groups treated by VT, the effects were not influenced by time since onset of disease or by patient age. It is therefore assumed that VT can be used as a first-choice treatment in patients with benign paroxysmal positional vertigo, even in long-term cases or older patients. (Arch Otolaryngol Head Neck Surg. 1994;120:497-504) References 1. Cawthorne TE. The physiological basis for head exercises . J Chart Soc Physiother . 1944:106-107. 2. McCabe BS. Labyrinthine exercises in the treatment of diseases characterized by vertigo: their physiologic basis and methodology . Laryngoscope . 1970;80: 1429-1433.Crossref 3. Hecker HC, Haug CO, Herndon JW. Treatment of the vertiginous patients using Cawthorne's vestibular exercises . Laryngoscope . 1974;84:2065-2072.Crossref 4. Dix MR. The rationale and technique of head exercises in treatment of vertigo . Acta Otorhinolaryngol Belg . 1979;33:370-384. 5. Shumway-Cook A, Horak FB. Rehabilitation strategies for patients with vestibular deficits . Neurol Clin . 1990;8:441-457. 6. Norre ME, Deweedt WD. Treatment of vertigo based on habituation, II: technique and results of habituation training . J Laryngol Otol . 1980;94:971-977.Crossref 7. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo . Arch Otolaryngol . 1980;106:484-485.Crossref 8. Tokumasu K, Tasiro N, Goto K, et al. Symptoms and their time course in the patient of acute peripheral vestibular lesion . Practica Otologica Kyoto . 1982; 75:237-244.Crossref 9. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system . Ann Otol Rhinol Laryngol . 1952; 6:987-1016. 10. Martinez DM. The effect of Serc (betahistine hydrochloride) on the circulation of the inner ear in experimental animals . Acta Otolaryngol . 1972;305:29-47.Crossref 11. Oosterveld WJ. Betahistine dihydrochloride in the treatment of vertigo of peripheral vestibular origin: a double-blind placebo-controlled study . J Laryngol Otol . 1984;98:37-41.Crossref 12. Norre ME, Beckers A. Benign paroxysmal positional vertigo in the elderly: treatment by habituation exercises . J Am Geriatr Soc . 1988;36:425-429. 13. Shitara T. Age-related changes in the otorhinolaryngological field . Tokyo Seiki Shuppansha . 1980:105-106.

Le, Chap T.;Lindgren, Bruce R.;Daly, Kathy A.;Giebink, G. Scott

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290021004pmid: 8172701

Abstract Objective: An application of the clinical otitis media profile is proposed for the evaluation of treatments in clinical studies of otitis media. Methods: Methods include a statistical test of significance and measures of "treatment difference." This article focuses on the method, not any particular study; however, an example is given to illustrate the ideas. Conclusions: The proposed method substantially increases powers of statistical tests, as compared with the use of a two-point scale algorithm, when applied to study changes of the middle ear condition over time or to compare treatment effects. The proposed evalution method is applicable to any medical drug treatment for groups that may not be comparable, even with randomization, for baseline severity. Applied to surgical treatment, it can be used for long-term evaluation; however, short-term evaluation is impossible because the needed tympanometric, static admittance, and width measurements cannot be obtained in the presence of functioning tubes. To achieve this objective, it is necessary to use another profile or diagnostic procedure.(Arch Otolaryngol Head Neck Surg. 1994;120:507-509) References 1. Howie VM, Schwartz RH. Acute otitis media: one year in general pediatric practice . AJDC . 1983;137:155-158. 2. Teele DW, Klein JO, Rosner B, et al. Epidemiology of otitis media during the first 7 years of life in children in greater Boston: a prospective cohort study . J Infect Dis . 1989;160:89-94.Crossref 3. Le CT, Daly KA, Margolis RH, Lindgren BR, Giebink GS. A clinical profile of otitis media . Arch Otolaryngol Head Neck Surg . 1992;118:1225-1228.Crossref 4. Giebink GS, Daly K, Buran DJ, Satz M, Ayre T. Predictors for postoperative otorrhea following tympanostomy tube insertion . Arch Otolaryngol Head Neck Surg . 1992;118:491-495.Crossref 5. Kendall MG. Rank Correlation Methods . London, England: Griffin; 1948. 6. Agresti A. Generalized odds ratio for ordinal data . Biometrics 1990;36:59-67.Crossref 7. Goodman LA, Kruskal WH. Measures of association for cross-classification . J Am Stat Assoc . 1954;49:732-764. 8. Paradise JL, Smith CG, Bluestone CD. Tympanometric detection of middle ear effusion in infants and young children . Pediatrics . 1976;58:198-210. 9. Cantekin El, Bluestone CD, Fria TJ, Stool SE, Beery QC, Sabo DL. Identification of otitis media with effusion in children . Ann Otol Rhinol Laryngol . 1980;89 ( (suppl 68) ):190-195.

Le, Chap T.;Hunter, Lisa L.;Margolis, Robert H.;Daly, Kathy A.;Lindgren, Bruce R.;Giebink, G. Scott

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290025005pmid: 8172702

Abstract An otitis media with effusion algorithm developed by Paradise et al has become the basis for many studies of otitis media. However, it has been shown to be too ambitious (low specificity) and too optimistic (absence of fluid does not necessarily mean normal ears). We developed a four-point profile to characterize the condition of the middle ear, but it cannot be used when the eardrum is perforated (with a functioning tube or chronic perforation). We propose a three-point profile for use without an intact tympanic membrane, and we report the validation of the profile by findings at myringotomy and by the preoperative profile. This postoperative profile and the previously described profile for ears with an intact tympanic membrane should increase the accuracy of middle ear assessment in following the course of otitis media over time. (Arch Otolaryngol Head Neck Surg. 1994;120:513-516) References 1. Paradise JL, Smith CG, Bluestone CD. Tympanometric detection of middle ear effusion in infants and young children . Pediatrics . 1976;58:198-210. 2. Cantekin El, Bluestone CD, Fria TJ, Stool SE, Beery QC, Sabo DL. Identification of otitis media with effusion in children . Ann Otol Rhinol Laryngol . 1980;89 ( (suppl 68) ):190-195. 3. Giebink GS, Batalden PB, Le CT, Lassman FM, Buran DJ, Seltz AE. A controlled trial comparing three treatments for chronic otitis media with effusion . Pediatr Infect Dis J . 1990;9:33-40.Crossref 4. Giebink GS, Batalden PB, Russ JN, Le CT. Cefaclor vs amoxicillin in treatment of acute otitis media . AJDC . 1984;138:287-292. 5. Daly K, Giebink GS, Le CT, Lindgren BR, Batalden PB, Anderson RS. Determining risk factors for chronic otitis media with effusion . Pediatr Infect Dis J . 1988;7:471-475.Crossref 6. Daly K, Giebink GS, Batalden PB, Anderson R, Le CT, Lindgren B. Resolution of chronic otitis media with effusion with the use of a stepped treatment regimen of trimethoprim-sulfamethoxazole and prednisone . Pediatr Infect Dis J . 1991;10:500-506.Crossref 7. Giebink GS, Le CT, Paparella MM. The epidemiology of otitis media with effusion in children . Arch Otolaryngol Head Neck Surg . 1982;108:563-566.Crossref 8. Giebink GS, Ripley ML, Shea DA, Wright PF, Paparella MM. Clinical-histopathological correlations in experimental otitis media: implications for silent otitis media in humans . Pediatr Res . 1985;19:389-397.Crossref 9. Le CT, Daly KA, Margolis RH, Lindgren BR, Giebink GS. A clinical profile of otitis media . Arch Otolaryngol Head Neck Surg . 1992;118:1225-1228.Crossref 10. Giebink GS, Daly K, Buran DJ, et al. Predictors for postoperative otorrhea following tympanostomy tube insertion . Arch Otolaryngol Head Neck Surg . 1992; 118:491-495.Crossref 11. Shanks JE, Stelmachowicz PG, Beauchaine KL, Schulte L. Equivalent ear canal volumes in children pre- and post-tympanostomy tube insertion . J Speech Hear Res . 1992;35:936-941. 12. Hunter LL, Margolis RH, Daly KA, Giebink GS. Relationship of tympanometric estimates of middle ear volume to middle ear staus at surgery . In: Abstracts of the Fifteenth Midwinter Research Meeting of the Association for Research in Otolaryngology . Des Moines, Iowa: Association for Research in Otolaryngology; 1992:69. 13. Suetake M, Kobayashi T, Takasaki T, Sekita Y, Koinuma N. Middle ear air volume and prognosis of secretory otitis media: application of discriminant analysis for the prediction of prognosis . In: Proceedings of the Fifth International Conference on Otitis Media . New York, NY: Dekker Periodicals; 1993:270-272.

Finkelstein, Yehuda;Ophir, Dov;Talmi, Yoav P.;Shabtai, Avraham;Strauss, Michael;Zohar, Yuval

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290029006pmid: 8172703

Abstract Objective: To document the prevalence of adult-onset otitis media with effusion (OME), and to determine its causes, diagnostic approach, and therapeutic management. Design: A prospective study of 167 consecutive patients with adult-onset OME. Endoscopic examination of intranasal and nasopharyngeal structures with special attention to the eustachian tube orifices was performed in all paients. In 65 patients computed tomography of the skull base, neck, and paranasal sinuses was also performed. Results: Paranasal sinus disease, predominantly of the ethmoid system, was found to be the dominant causal factor in 110 patients (66%). Smoking-induced nasopharyngeal lymphoid hyperplasia and adult-onset adenoidal hypertrophy, two entities herein described, were the cause of OME in 15 patients (19%). Various other causes were found in 31 patients. Head and neck tumors, mainly nasopharyngeal carcinomas, were found in only eight patients (4.8%). The cause of adult-onset OME could not be determined in three patients (1.8%). Conclusions: Contrary to common belief, adult-onset OME is not an uncommon disease. Nasendoscopy is the mainstay of diagnostic evaluation in most patients. Computed tomography is also an important tool in most selected cases. Appropriate treatment of sinusitis resulted in resolution of OME in most patients. Sinusitis is the most common causal factor of adult-onset OME, but nasopharyngeal and parapharyngeal space-occupying lesions should be ruled out in all cases.(Arch Otolaryngol Head Neck Surg. 1994;120:517-527) References 1. Schuknecht F, Zaytoun GM, Moon CN. Adult-onset fluid in the tympanomastoid compartment . Arch Otolaryngol . 1982;108:759-765.Crossref 2. Myers EM, Beery QC, Bluestone CD, Rood SR, Sigler BA. Effect of certain head and neck tumors and their management on the ventilatory function of the eustachian tube . Ann Otol Rhinol Laryngol . 1984;93( (suppl 114) ):1-16. 3. Finkelstein Y, Talmi PY, Rubel Y, Bar-Ziv J, Zohar Y. Otitis media with effusion as presenting symptom of chronic sinusitis . J Laryngol Otol . 1989;103:827-832.Crossref 4. Finkelstein Y, Talmi PY, Nachmani A, Hauben DJ, Zohar Y. Levator veli palatini and eustachian tube function . Plast Reconstr Surg . 1990;85:684-692.Crossref 5. Finkelstein Y, Talmi YP, Zohar Y. On the cause of sinusitis in patients with cleft palate . Arch Otolaryngol Head Neck Surg . 1990:116:490. 6. Magnuson B. On the origin of the high negative pressure in the middle ear space . Am J Otolaryngol . 1981;2:1-12.Crossref 7. Falk B. Sniff-induced negative middle ear pressure: study of a consecutive series of children with otitis media with effusion . Am J Otolaryngol . 1982;3:155-162.Crossref 8. Slavin RG, Cannon RE, Friedman WH, Palitang E, Sundaram M. Sinusitis and bronchial asthma . J Allergy Clin Immunol . 1980;66:250-257.Crossref 9. Cohen D. A new concept of malignant external otitis . In: Fisch U, Valvanis A, Yasargil MG, eds. Neurological Surgery of the Ear and the Skull Base . Amsterdam, the Netherlands: Kugler & Ghedini; 1989:503-510. 10. Benecke JE. Management of osteomyelitis of the skull base . In: Fisch U, Valvanis A, Yasargil MG, eds. Neurological Surgery of the Ear and the Skull Base . Amsterdam, the Netherlands: Kugler & Ghedini; 1989:497-502. 11. Manning SC, Vuitch F, Weinberg AG, Brown E. Allergic aspergillosis: a new recognized form of sinusitis in the pediatric population . Laryngoscope . 1989; 99:681-685.Crossref 12. EI-Guindy A. A correlative manometric and endoscopic study of tubal function in dry central perforation of the tympanic membrane . J Laryngol Otol . 1991; 105:716-720.Crossref 13. Dharam P. Sinus infection and adenotonsillitis in pediatric patients . Laryngoscope . 1981;91:997-1000. 14. McBride TP, Doyle WJ, Hatden FG, Gwaltney JM. Alterations of the eustachian tube, middle ear, and nose in rhinovirus infection . Arch Otolaryngol Head Neck Surg . 1989;115:1054-1059.Crossref 15. Rundcrantz H. Posture and eustachian tube function . Acta Otolaryngol (Stockh) . 1970;263( (suppl 68) ):15-17.Crossref 16. Knight LC, Eccles R. The effect of postural changes and upper respiratory tract infection on middle ear pressure . Acta Otolaryngol (Stockh) . 1991;111:1075-1082.Crossref 17. Glasier CM, Ascher DP, Williams KD. Incidental paranasal sinus abnormalities on CT of children: clinical correlation . AJNR Am J Neuroradial . 1986;7:861-864. 18. Havas TE, Motbey JA, Gullane PJ. Prevalence of incidental abnormalities on computed tomography scans of the paranasal sinuses . Arch Otolaryngol Head Neck Surg . 1988;114:856-859.Crossref 19. Nass L, Holliday RA, Reede L. Diagnosis of surgical sinusitis using nasal endoscopy and computerized tomography . Laryngoscope . 1989;99:1158-1160.Crossref 20. Lundgren K, Ingvarsson L. Microbiology of acute otitis media . In: Sade J, ed. Acute and Secretory Otitis Media . Amsterdam, the Netherlands: Kugler & Ghedini; 1986:175-179. 21. Hemlin C, Brauner A, Carenfelt C, Wretlind B. Nasopharyngeal flora in otitis media with effusion: a comparative semiqualitative analysis . Acta Otolaryngol (Stockh) . 1991;111:556-561.Crossref 22. Bernstein JM, Dryja DM, Loos BG, Dickson DP. Restriction fragment mapping of nontypable Haemophilus influenzae: a new tool to study this middle ear pathogen . Otolaryngol Head Neck Surg . 1989;100:200-206. 23. Takahashi H, Fujita A, Honjo I. Effect of adenoidectomy on otitis media with effusion, tubal function, and sinusitis . Am J Otolaryngol . 1989;10:208-213.Crossref 24. Ophir D, Halperin D, Gilboa S, Marshak G. Obstructing adenoids in adolescents—changing trends? J Otolaryngol . 1993;22:91-93. 25. Kamel RH, Ishak EA. Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study . J Laryngol Otol . 1990;104:965-967.Crossref 26. Grady D, McClung JE, Veltri RW, et al. Association of Epstein-Barr virus with acute exudative tonsillitis . Otolaryngol Head Neck Surg . 1982;90:11-15. 27. Barzan L, Carbone A, Tirelli U, et al. Nasopharyngeal lymphatic tissue in patients infected with human immunodeficiency virus . Arch Otolaryngol Head Neck Surg . 1990;116:928-931.Crossref 28. Wake M, McCullough DE, Binnington JD. Effect of nasogastric tube on eustachian tube function . J Laryngol Otol . 1990;104:17-19.Crossref 29. Yoon H, Paparella MM, Schachren PA. Systemic vasculitis: a temporal bone histologic study . Laryngoscope . 1989;99:600-608.Crossref 30. Finkelstein Y, Talmi YP, Zohar Y, Rubel Y, Laurian N. Can uvulopalatopharyngoplasty be harmful to eustachian tube function? Acta Otolaryngol (Stockh) . 1987;104:511-520.Crossref 31. Stammberger H. Endoscopic endonasal surgery—concepts in treatment of recurring rhinosinusitis, I: anatomic and pathophysiologic considerations; II: surgical technique . Otolaryngol Head Neck Surg . 1986;94:147-156.

Yamasoba, Tatsuya;Kikuchi, Shigeru;Sugasawa, Masashi;Yagi, Masato;Harada, Takehiko

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290042007pmid: 8172704

Abstract Objective: To study the pathophysiological features of acute low-tone sensorineural hearing loss without vertigo (ALHL) and its correlation with Meniere's disease. Design: Retrospective review of medical charts of patients with ALHL. Setting: University hospital clinic. Participants: Eighty consecutive patients with ALHL, including 45 patients whose conditions were followed up for more than 3 years (average, 5 years 2 months; range, 3 years 3 months to 8 years). Outcome Measures: Age and sex distributions and results of audiological and neuro-otological tests, initial outcome, recurrence rates, and differences between patients with and without recurrence. Results: About 75% (62/80) of the patients were between the ages of 30 and 60 years and the female-male ratio was 2:6. Positive glycerol test results were found in 74% (26/35) of patients and abnormally increased negative summating potential/action potential ratio in 63% (50/80). No abnormalities were found on neurootological tests. Hearing loss improved within 3 months in 84% (67/80) of the patients. Of 45 patients followed up for more than 3 years, 28 (62%) showed no evidence of recurrence, 12 (27%) developed cochlear Meniere's disease, and five (11%) developed classic Meniere's disease. No significant differences were found at the first examination between patients with and without recurrence. Conclusions: These results suggest that ALHL may be caused by endolymphatic hydrops confined to the cochlea and that ALHL does not always lead to cochlear or classic Meniere's disease.(Arch Otolaryngol Head Neck Surg. 1994;120:532-535) References 1. Enander A, Stahle J. Hearing in Meniere's disease: a study of pure-tone and audiograms in 334 patients . Acta Otolaryngol (Stockh) . 1967;64:543-556.Crossref 2. Bjork H. The prognosis in Morbus Meniere . Acta Otolaryngol Suppl (Stockh) . 1964;188:157-161.Crossref 3. Walsh TE. Meniere's disease . Laryngoscope . 1958;68:279-287.Crossref 4. Abe T. Acute sensorineural hearing loss in low frequencies . Otolaryngol Tokyo . 1982;54:385-392. 5. Yamasoba T, Sugasawa M, Yagi M, Harada T, Futaki T. Clinical observations of acute low-tone sensorineural hearing loss considered as cochlear hydrops . Jpn J Otolaryngol . 1990;94:219-228.Crossref 6. Mori N, Asai A, Suizu Y, Ohta K, Matsunaga T. Comparison between electrocochleography and glycerol test in the diagnosis of Meniere's disease . Scand Audiol . 1985;14:209-213.Crossref 7. Futaki T, Kitahara M, Morimoto M. A comparison of the furosemide and glycerol tests for Meniere's disease: with special reference to the bilateral lesion . Acta Otolaryngol (Stockh) . 1977;83:272-278.Crossref 8. Eggermont JJ. Summating potentials in Meniere's disease . Arch Otorhinolaryngol . 1979;222:63-75.Crossref 9. Coats AC. The summating potential and Meniere's disease, I: summating potential amplitude in Meniere and non-Meniere ears . Arch Otolaryngol . 1981; 107:199-208.Crossref 10. Ohashi T, Takeyama I. Clinical significance of SP/AP ratio in inner ear diseases . ORL J Otorhinolaryngol Relat Spec . 1989;51:235-245.Crossref 11. Goin DW, Staller SJ, Asher DL, Mischke RE. Summating potential in Meniere's disease . Laryngoscope . 1982;92:1383-1389. 12. Kitahara M, Takeda T, Yazawa Y, Matsubara H, Kitano H. Pathophysiology of Meniere's disease and its subvarieties . Acta Otolaryngol Suppl (Stockh) . 1984; 406:52-55. 13. Watanabe I. Meniere's disease: with special emphasis on epidemiology, diagnosis and prognosis . ORL J Otorhinolaryngol Relat Spec . 1980;42:20-45.Crossref 14. Haye R, Quist-Hanssen SV. The natural course of Meniere's disease . Acta Otolaryngol (Stockh) . 1976;82:289-293.Crossref 15. Tokumasu K, Kawao R, Goto K, et al. Clinical differential diagnosis in both Meniere's disease and sudden deafness in an early stage . Pract Otol Kyoto . 1977;70:1749-1757. 16. Maki T. Natural course of Meniere's disease . Pract Otol Kyoto . 1984;77:259-282.Crossref

Einer, Håkan;Tengborn, Lilian;Axelsson, Alf;Edström, Staffan

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290046008pmid: 8172705

Abstract Objective: To evaluate the possible causal role of pathologic hemostatic mechanisms in sudden hearing loss. Design: The study was prospective. Setting: The patients were hospitalized, and all tests were performed at the hospital. Patients: Thirty-two consecutive patients with sudden hearing loss participated, as well as a control group of 28 healthy individuals. The control group was matched with regard to body mass index. Main Outcome Measures: Venous blood analyses were made regarding general blood parameters, as well as specific hemostatic parameters. Results: Twenty-five of the patients had some kind of aberration of specific hemostasis parameters; seven patients had an increase in the activity of the plasminogen activator inhibitor 1 (ie, a glycoprotein associated with diminished fibrinolysis) compared with that in the control group (P<.05). Increased plasminogen activator inhibitor levels were most frequently observed among the patients who were overweight. Seven of the oldest patients had an increase of D-dimers, ie, a degradation product of fibrin, and most of these patients had a history of cardiovascular disease. Conclusion: Although isolated aberrations in the hemostatic pathway were observed, we concluded that pathologic hemostasis does not seem to have a decisive importance for the pathogenesis of sudden deafness.(Arch Otolaryngol Head Neck Surg. 1994;120:536-540) References 1. de Kleyn A. Sudden complete or partial loss of function of the octavus-system in apparently normal persons . Acta Otolaryngol (Stockh) . 1944;32:407-429.Crossref 2. Bomholt A, Bak-Pedersen K, Gormsen J. Fibrinolytic activity in patients with sudden sensorineural hearing loss . Acta Otolaryngol (Stockh) . 1979; (suppl) 360: 184-186. 3. Friedrich G. Zur Ätiologie und Pathogenese des Hörsturzes . Laryngol Rhinol Otol . 1985;64:62-66.Crossref 4. Hesse G, Hesch RD. Bewertung von Risikofaktoren bei verschiedenen Formen der Innenohrschwerhörigkeit . HNO . 1986;34:503-507. 5. Jaffe BF. Hypercoagulation and other causes of sudden hearing loss . Otolaryngol Clin North Am . 1975;8:395-403. 6. Klemm E, Altmann E, Lange O. Rheologische Probleme der Mikrozirkulation und Konsequenzen medikamentöser Hörsturztherapie . Laryngol Rhinol Otol . 1983;62:62-64.Crossref 7. Browning GG, Gatehouse S, Lowe GDO. Blood viscosity as a factor in sensorineural hearing impairment . Lancet . 1986;1:121-123.Crossref 8. Hildesheimer M, Bloch F, Muchnik C, Rubinstein M. Blood viscosity and sensorineural hearing loss . Arch Otolaryngol Head Neck Surg . 1990;116:820-823.Crossref 9. Ciuffetti G, Scardazza A, Serafini G, Lombardini R, Mannarino E, Simoncelli E. Whole-blood filterability in sudden deafness . Laryngoscope . 1991;101:65-67.Crossref 10. Vague P, Juhan-Vague I, Aillaud MF, et al. Correlation between blood fibrinolytic activity, plasminogen activator inhibitor level, plasma insulin level, and relative body weight in normal and obese subjects . Metabolism . 1986;35:250-253.Crossref 11. Nilsson IM, Olow B. Determination of fibrinogen and fibrinogenolytic activity . Thromb Diathes Haemorrh . 1962;8:297-310. 12. van Hinsbergh VWM. Regulation of the synthesis and secretion of plasminogen activators by endothelial cells . Haemostasis . 1988;18:307-327. 13. Jansson JH, Norberg B, Nilsson TK. Impact of acute phase on concentrations of tissue plasminogen activator and plasminogen activator inhibitor in plasma after deep-vein thrombosis or open heart surgery . Clin Chem . 1989;35:1544-1545. 14. Almér LO, Öhlin H. Elevated levels of the rapid inhibitor of plasminogen activator (t-PAI) in acute myocardial infarction . Thromb Res . 1987;47:335-339.Crossref 15. Hamsten A, Wiman B, De Faire U, Blombäck M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction . N Engl J Med . 1985;313:1557-1563.Crossref 16. Landin K, Tengborn L, Smith U. Elevated fibrinogen and plasminogen activator inhibitor (PAI-1) in hypertension are related to metabolic risk factors for cardiovascular disease . J Intern Med . 1990;227:273-278.Crossref 17. Sundell B, Nilsson TK, Hallmans G, Hellsten G, Dahlén GH. Interrelationships between plasma levels of plasminogen activator, lipoprotein(a), and established cardiovascular risk factors in a North Swedish population . Atherosclerosis . 1989;80:9-16.Crossref 18. Hamsten A, Walldius G, Szamosi A, et al. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction . Lancet . 1987;2:3-8.Crossref 19. Elias A, Aillaud MF, Roul C, et al. Assessment of D-dimer measurement by ELISA or latex methods in deep vein thrombosis diagnosed by ultrasonic duplex scanning . Fibrinolysis . 1990;4:237-240.Crossref

Blakley, Brian W.;Gupta, Anil K.;Myers, Steven F.;Schwan, Sabina

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290051009pmid: 8172706

Abstract Objective: To determine whether abnormalities in routine blood tests were associated with increased susceptibility to hearing loss induced by cisplatin chemotherapy. Design: Cohort study of patients with head and neck cancer receiving cisplatin chemotherapy who underwent audiometric testing. Setting: A large, university-based hospital; part of a larger study regarding rehabilitation of patients with cancer. Patients: Forty-two patients with head and neck cancer who agreed to participate underwent at least three serial treatments with high-dose cisplatin therapy. Routine blood tests and audiometric testing were performed before each course of chemotherapy. One hundred eighty audiograms were performed. Outcome Measures: A deterioration of auditory threshold of 15 dB or more at one frequency or of 10 dB or more at three or more frequencies was considered a significant loss. Only frequencies at and below 4000 Hz were considered. Results: Multiple analysis of variance results indicated that decreased serum albumin level, hemoglobin level, red blood cell count, and hematocrit were associated with an increased likelihood of significant hearing loss during chemotherapy. Conclusions: Patients in poor general medical condition with low levels of red blood cells or serum proteins are at increased risk for development of hearing loss from cisplatin chemotherapy. We recommend that hearing be tested before chemotherapy begins and after the first course of cisplatin. If there is no significant hearing loss at or below 4000 Hz at that time, then subsequent audiometric testing is required only if symptoms of hearing loss develop.(Arch Otolaryngol Head Neck Surg. 1994;120:541-546) References 1. Weaver A, Flemming S, Kish J, et al. Cis-platinum and 5-fluorouracil as induction therapy for advanced head and neck cancer . Am J Surg . 1982;144:445-448.Crossref 2. Rybak L. Cis-platinum associated hearing loss . J Laryngol Otol . 1981;95:745-747.Crossref 3. Böheim K, Bichler E. Cisplatin-induced ototoxicity: audiometric findings and experimental cochlear pathology . Arch Otorhinolaryngol . 1985;242:1-6.Crossref 4. Nakai Y, Konishi K, Chang KC, et al. Ototoxicity of the anticancer drug cisplatin: an experimental study . Acta Otolaryngol . 1982;93:227-232.Crossref 5. Aguilar-Markulis NV, Beckley S, Priore R, Mettlin C. Auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy in genitourinary cancer patients . J Surg Oncol . 1981;16:111-123.Crossref 6. Van der Hulst RJAM, Dreschler WA, Urbanus NAM. High frequency audiometry in prospective clinical research of ototoxicity due to platinum derivatives . Ann Otol Rhinol Laryngol . 1988;97:133-137. 7. Helson L, Okonkwo E, Anton L, Cvitkovic E. Cis-platinum ototoxicity . Clin Toxicol . 1978;13:469-478.Crossref 8. Laurell G, Borg E. Ototoxicity of cisplatin in gynaecological cancer patients . Scand Audiol . 1988;17:241-247.Crossref 9. Laurell G, Jungnelius U. High-dose cisplatin treatment: hearing loss and plasma concentrations . Laryngoscope . 1990;100:724-734.Crossref 10. Myers SF, Blakley BW, Schwan S, Rintelmann WF, Mathog RH. The 'plateau effect' of cis-platinum-induced hearing loss . Otolaryngol Head Neck Surg . 1991; 104:122-127. 11. McHaney VA, Thibadoux G, Hayes FA, Green AA. Hearing loss in children receiving cisplatin chemotherapy . J Pediatr . 1983;102:314-317.Crossref 12. Baum ES, Gaynon P, Greenberg L, Krivit W, Hammond D. Phase II study of cis-dichlorodiammineplatinum (II) in childhood osteosarcoma: children's cancer study group report . Cancer Treat Rep . 1979;63:9-10. 13. Pasic TR, Dobie RA. Cis-platinum ototoxicity in children . Laryngoscope . 1991; 101:985-991.Crossref 14. Hartmann O, Pinkerton CR, Philip T, Zucker JM, Breatnach F. Very-high-dose cisplatin and etoposide in children with untreated advanced neuroblastoma . J Clin Oncol . 1988;6:44-50. 15. Kopelman J, Budnick AS, Sessions RB, Kramer MB, Wong GY. Ototoxicity of high-dose cisplatin by bolus administration in patients with advanced cancers and normal hearing . Laryngoscope . 1988;98:858-864.Crossref 16. Green DS. Pure tone air-conduction testing . In: Katz J, ed. Handbook of Clinical Audiology . 2nd ed. Baltimore, Md: Williams & Wilkins; 1978:98-109. 17. Hayes DM, Cvitkovic E, Golbey RB, Scheiner E, Helson L, Krakoff IH. High dose cis-platinum diammine dichloride: amelioration of renal toxicity by mannitol diuresis . Cancer . 1977;39:1372-1381.Crossref 18. Oriana S, Bohn S, Spatti G, Zunino F, Di Re F. A preliminary clinical experience with reduced glutathione as protector against cisplatin-toxicity . Tumori . 1987;73:337-340. 19. Markman M, D'Acquisto R, lannotti N, et al. Phase-1 trial of high-dose intravenous cisplatin with simultaneous sodium thiosulfate . J Cancer Res Clin Oncol . 1991;117:151-155.Crossref 20. Myers SF, Blakley BW, Schwann S. Is cis-platinum vestibulo-toxic? Otolaryngol Head Neck Surg . 1993;108:322-328. 21. Schweitzer VG, Dolan DF, Abrams GE, Davidson T, Snyder R. Amelioration of cisplatin-induced ototoxicity by fosfomycin . Laryngoscope . 1986;96:948-958. 22. Patton TF, Himmelstein KJ, Belt R, Bannister SJ, Sternson LA, Repta AJ. Plasma levels and urinary excretion of filterable platinum species following bolus injection and IV infusion of cis-dichlorodiammineplatinum (II) in man . Cancer Treat Rep . 1978;62:1359-1362.

Vernon, Jack A.;Press, Linda S.

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290057010pmid: 8172707

Abstract Objective: To determine if the characteristics of tinnitus produced by head trauma are specific and exclusive when compared with other origins of tinnitus. Design: Retrospective study using clinic test results and data from the Tinnitus Data Registry compiled from questionnaires, interviews, and testing. Tinnitus produced by head injury was compared with tinnitus of mixed origins, including no known origin. Setting: A tinnitus referral clinic where all patients must see an otologist or an ear, nose, and throat physician prior to attending the clinic. Patients: All patients had severe to moderately severe constant tinnitus and presented with tinnitus as the primary symptom. Results: No exclusive characteristics were found to describe head injury–induced tinnitus. The tinnitus for the group with head injury was statistically significantly (P=.004) louder and occurred with greater incidence of continuing pain in the ears. The group with head injury also had more episodes of dizziness and a more severe form of tinnitus. However, no marked difference was noted in pitch of tinnitus, complexity (number of sounds) of tinnitus, or the minimum masking level. Conclusions: This retrospective study found that tinnitus induced by head injury was significantly (P=.004) louder than tinnitus induced from other causes but, interestingly, did not require higher levels of masking. The patients with head injury–induced tinnitus more frequently (P=.0003) displayed residual inhibition although the duration of residual inhibition was not different from that of the comparison group. Other symptoms associated with the tinnitus onset were more frequently mentioned by the group with head trauma–induced tinnitus, except for the condition of pressure sensation in the ears. Using a severity questionnaire, the group with head trauma–induced tinnitus rated their tinnitus as being more severe than did the comparison group. However, such things as pitch of the tinnitus, masking level, acceptance of wearable maskers, general hearing level, and complexity of the tinnitus did not distinguish the two groups.(Arch Otolaryngol Head Neck Surg. 1994;120:547-551) References 1. Lackner JR. The auditory characteristics of tinnitus resulting from cerebral injury . Exp Neurol . 1976;51:54-62.Crossref 2. Wechsler IS. A Textbook of Clinical Neurology . 5th ed. Philadelphia, Pa: WB Saunders Co; 1944. 3. Vernon J. Assessment of the tinnitus patient . In: Hazell J. Tinnitus . New York, NY: Churchill Livingstone Inc; 1987:71-96. 4. Meikle MB. Methods for evaluation of tinnitus relief procedures . In: Aran J-M, Duman R, eds. Proceedings of the IV International Tinnitus Seminar . Amsterdam, the Netherlands: Kirgler; 1992:555-562. 5. Meikle MB, Whitney SW. Computer-assisted analysis of reported tinnitus sounds: proceedings of the 2nd International Tinnitus Seminar . J Laryngol Otol Suppl . 1984;9:188-192.Crossref 6. Meikle MB, Walsh ET. Characteristics of tinnitus and related observations in over 1800 tinnitus clinic patients: proceedings of the 2nd International Tinnitus Seminar . J Laryngol Otol Suppl . 1984;9:17-21.Crossref 7. Vernon JA, Fenwick JA. Identification of tinnitus: a plea for standardization . J Laryngol Otol Suppl . 1983;9:45-53. 8. Vernon JA, Meikle MB. Measurement of tinnitus : an update. In: Kitahara M, ed. Tinnitus Pathophysiology and Management . Tokyo, Japan: Igaku-Shoin; 1988: 36-52. 9. Vernon JA, Fenwick JA. Tinnitus 'loudness' as indicated by masking levels with environmental sounds . J Laryngol Otol Suppl . 1983;9:59-62. 10. Fowler EP. The 'illusion of loudness' of tinnitus: its etiology and treatment . Laryngoscope . 1942;52:275-285. 11. Vernon JA. Some observations on residual inhibition . In: Paparella MM, Meyerhoff WL, eds. Sensorineural Hearing Loss and Tinnitus: Ear Clinics International, I . Baltimore, Md: Williams & Wilkins; 1981:138-144.

Huang, Tsun-Sheng;Hsu, Jee-Ching;Lee, Fei-Peng

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290062011pmid: 8172708

Abstract Objective: To determine the efficacy of intraoperative electrocochleographic monitoring during endolymphatic sac–ballooning surgery for Meniere's disease. Design: At each of five surgical steps, the eighth nerve action potential (AP) amplitude and latency, summating potential (SP) amplitude, and SP/AP amplitude ratio were recorded. Data were analyzed using repeated measure analysis of variance. Patients: Electrocochleographs were successfully recorded in 97 patients during endolymphatic sac–ballooning surgery. Forty patients had an abnormal baseline ratio (group 1), and 57 patients had a normal baseline ratio. Results: Data showed that the SP/AP amplitude ratio reductions were significant only in group 1 patients. The SP/AP amplitude ratio was reduced in two thirds of the group 1 patients and unchanged in roughly the same proportion of group 2 patients. A significant reduction of SP/AP amplitude ratios was found to be always associated with prominent SP/AP ratios at the baseline, irrespective of glycerol test results, and only in cases of classic Meniere's disease, indicating that this dominant ratio is a very reliable indicator of Meniere's disease and endolymphatic hydrops. Importantly, reductions of SP/AP amplitude ratios were observed at every step to be consistently due to AP increase rather than SP decrease. Conclusions: It is theorized that the dominant SP/AP amplitude ratio found in patients with Meniere's disease and endolymphatic hydrops is caused by the inhibition of AP activity rather than by the enhancement of the SP resulting from the displacement of the basilar membrane toward the scala tympani owing to hydropic endolymph, as is generally believed. We conclude that electrocochleograpic monitoring is useful durig endolymphatic sac–ballooning surgery to provide a definitive delineation of the endolymphatic sac and its lumen; this delineation is the key to the success of such surgery.(Arch Otolaryngol Head Neck Surg. 1994;120:552-559) References 1. Eggermont JJ. Summating potentials in electrocochleography: relation to hearing disorders . In: Ruben RJ, Elberling C, Saloman G, eds. Electrocochleography . Baltimore, Md: University Park Press; 1976:67-87. 2. Gibson WPR. The use of intraoperative electrocochleography in Meniere's surgery . Acta Otolaryngol Suppl (Stockh) . 1991;485:65-73.Crossref 3. Arenberg IK, Obert AD, Gibson WPR. Intraoperative electrocochleographic monitoring of inner ear surgery for endolymphatic hydrops: a review of cases . Acta Otolaryngol Suppl (Stockh) . 1991;485:53-64.Crossref 4. Booth JB. Meniere's disease: the selection and assessment of patients for surgery using electrocochleography . Ann R Coll Surg Engl . 1980;62:415-425. 5. Staller S. Electrocochleography in the diagnosis and management of Meniere's disease . Semin Hear . 1986;7:267-277.Crossref 6. Huang T-S, Lin CC. Endolymphatic sac surgery for Meniere's disease: a composite study of 339 cases . Laryngoscope . 1985;95:1082-1086.Crossref 7. Huang T-S, Lin CC. Revision endolymphatic sac surgery for recurrent Meniere's disease . Acta Otolaryngol Suppl (Stockh) . 1991;485:131-144.Crossref 8. Coats AC. The summating potential and Meniere's disease, I: summating potential amplitude in Meniere and non-Meniere ears . Arch Otolaryngol . 1981; 107:199-208.Crossref 9. Ruth RA, Lambert PR, Ferraro JA. Electrocochleography: methods and clinical applications . Am J Otol . 1988;9:1-11.Crossref 10. Goin DW, Staller SJ, Asher DL, Mischke RE. Summating potential in Meniere's disease . Laryngoscope . 1982;92:1383-1389. 11. Kumagami H, Nishida H, Baba M. Electrocochleographic study of Meniere's disease . Arch Otolaryngol . 1982;108:284-288.Crossref 12. Gibson WPR. Essentials of Clinical Electric Response Audiometry . New York, NY: Churchill Livingstone Inc; 1978:59-106. 13. Gibson WPR, Moffat DA, Ramsden RT. Clinical electrocochleography in the diagnosis and management of Meniere's disorder . Audiology . 1977;16:389-401.Crossref 14. Coats AC, Jenkins HA, Monroe B. Auditory evoked potentials: the cochlear summating potential in detection of endolymphatic hydrops . Am J Otol . 1984;5: 443-446. 15. Klockhoff I. Glycerol test—some remarks after 15 years experience . In: Volsteen KH, Schuknecht H, Pfalz CR, et al, eds. Meniere's Disease: Pathogenesis, Diagnosis and Treatment . New York, NY: Thieme-Stratton Inc; 1981:148-151. 16. Imoto T, Stahle J. Glycerin and urea tests in Meniere's disease . Otolaryngol Clin North Am . 1983;16:37-48. 17. Ferraro J, Best L, Arenberg I. The use of electrocochleography in the diagnosis, assessment and monitoring of endolymphatic hydrops . Otolaryngol Clin North Am . 1983;16:69-82. 18. Ferraro J, Arenberg I, Hassanein R. Electrocochleography and symptoms of inner ear dysfunction . Arch Otolaryngol . 1985;111:71-74.Crossref 19. Coats A. The normal summating potential recorded from external ear canal . Arch Otolaryngol Head Neck Surg . 1986;112:759-768.Crossref 20. Coats A. Electrocochleography: recording techniques and clinical applications . Semin Hear . 1986;7:247-266.Crossref 21. Gibson W, Prasher D. Electrocochleography and its role in the diagnosis and understanding of Meniere's disease . Otolaryngol Clin North Am . 1983;16:59-68. 22. Takeda T, Saito H, Sawada I, Kitahara M. Pathogenesis of the broad waveform in electrocochleograms . In: Kitahara M, ed. Meniere's Disease . Tokyo, Japan: Springer-Verlag NY Inc; 1990:139-145. 23. Kitahara M, Takeda T, Yazawa T, Matsubara H. Electrocochleography in the diagnosis of Meniere's disease . In: Volsteen KH, Schuknecht H, Pfalz CR, et al, eds. Meniere's Disease: Pathogenesis, Diagnosis and Treatment . New York, NY: Thieme-Stratton Inc; 1981:163-169. 24. Eggermont J. Electrocochleography. In: Keidel Q, Neff W, eds. Handbook of Sensory Physiology: Clinical and Special Topics . New York, NY: Springer-Verlag NY Inc; 1976;5:626-705. 25. Savoia G, Esposito C, Belfiore F, Amantea B, Cuocolo R. Propofol infusion and auditory evoked potentials . Anaesthesia . 1988;43( (suppl) ):46-49.Crossref 26. Manninen PH, Lam AM, Nicholas JF. The effects of isoflurane and isoflurane–nitrous oxide anesthesia on brainstem auditory evoked potential in humans . Anesth Analg . 1985;64:43-47.Crossref 27. Durrant JD, Dallos P. Modifications of DIF summating potential components by stimulus biasing . J Acoust Soc Am . 1974;56:562-570.Crossref 28. Morrison A, Moffat D, O'Conner A. Clinical usefulness of electrocochleography in Meniere's disease: an analysis of dehydration agents . Otolaryngol Clin North Am . 1980;11:703-721. 29. Takeuchi S, Takeda T, Saito H. Pressure relationship between perilymph and endolymph in guinea pigs . Acta Otolaryngol (Stockh) . 1990;109:93-100.Crossref 30. Dauman R, Aran J-M, de Sauvage RC, Portmann M. Clinical significance of the summating potential in Meniere's disease . Am J Otol . 1988:9:31-38. 31. Klockhoff I, Lindblom U. Endolymphatic hydrops revealed by glycerol test . Acta Otolaryngol (Stockh) . 1966;61:459-462.Crossref 32. Snyder JM. Changes in hearing associated with the glycerol test . Arch Otolaryngol . 1971;93:155-160.Crossref 33. Moffat DA, Gibson WPR, Ramsden RT, Morrison AW, Booth JB. Transtympanic electrocochleography during glycerol dehydration . Acta Otolaryngol (Stockh) . 1978;85:153-166.Crossref 34. Coats AC, Alford BR. Meniere's disease and the summating potential, Ill: effect of glycerol administration . Arch Otolaryngol . 1981;107:469-473.Crossref

Wilson, David F.;Talbot, J. Michael;Hodgson, R. Sterling

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290070012pmid: 8172709

Abstract Objective: Gadolinium-enhanced magnetic resonance imaging (MRI) is useful in assessing inflammatory and neoplastic lesions of the labyrinth and facial nerve. The following cases demonstrate the ability of MRI to differentiate neoplastic from inflammatory lesions within the labyrinth. Patients or Other Participants: Nine patients were selected with enhancing lesions of the labyrinth and the facial nerve identified on MRI. Intervention: Acyclovir and prednisone were prescribed for herpes zoster oticus; surgical removal of neoplastic lesions was performed. Main Outcome Measure: The hypothesis was developed in the course of clinical practice. No planned outcome was emphasized, as this article is based on the differential diagnoses of the cases reported. Results: Gadolinium-enhanced MRI is useful in differentiating neoplastic from inflammatory lesions within the labyrinth. Axial and coronal 3-mm sections with gadolinium enhancement were necessary for identifying these lesions and particularly for recognizing the sharp enhancement of the neoplastic margin in contrast to the dull cloudy margins of an inflammatory lesion. Conclusions: The MRI differentiation of these lesions is helpful in providing appropriate medical and surgical management of neoplastic and inflammatory lesions of the labyrinth.(Arch Otolaryngol Head Neck Surg. 1994;120:560-564) References 1. Seltzer S. Mark AS. Contrast enhancement of the labyrinth on MR scans in patients with sudden hearing loss and vertigo: evidence of labyrinthine disease . AJNR Am J Neuroradiol . 1991;12:13-16. 2. Murphy TP. MRI of the facial nerve during paralysis . Otolaryngol Head Neck Surg . 1991;104:47-51. 3. Murphy TP, Teller DC. Magnetic resonance imaging of the facial nerve during Bell's palsy . Otolaryngol Head Neck Surg . 1991;105:667-674. 4. Tien R, Dillon WP, Jachler RK. Contrast-enhanced MR imaging of the facial nerve in 11 patients with Bell's palsy . AJNR Am J Neuroradiol . 1990;11:735-741. 5. Daniels DL, Czervionke LF, Pojunas KW, et al. Facial nerve enhancement in MR imaging . Am J Neuroradiol . 1987;8:605-607. 6. Daniels DL, Czervionke LF, Millen SJ, et al. MR imaging of facial nerve enhancement in Bell's palsy or after temporal bone surgery . Radiology . 1989; 171:807-809.Crossref 7. Schwaber MK, Larson PC, Zealear DL, Creasy J. Gadolinium-enhanced magnetic resonance imaging in Bell's palsy . Laryngoscope . 1990;100:1264-1269.Crossref 8. LaBagnara J, Jahn AF, Habif DV, Solomon EM. MRI findings in two cases of acute facial paralysis . Otolaryngol Head Neck Surg . 1989;101:562-565. 9. Haberkamp TJ, Harvey SA, Daniels DL. The use of gadolinium-enhanced magnetic resonance imaging to determine lesion site in traumatic facial paralysis . Laryngoscope . 1990;100:1294-1300.Crossref 10. Mafee MF, Valvassori GE, Kumar A, et al. Tumors and tumor-like conditions of the middle ear and mastoid: role of CT and MRI . Otolaryngol Clin North Am . 1988;21:349-379. 11. Brogan M, Chaheros DW. Gd-DTPA–enhanced MR imaging of cochlear schwannoma . AJNR Am J Neuroradiol . 1990;11:407-408. 12. Adour KK. Cranial polyneuronitis and Bell's palsy . Arch Otolaryngol . 1976;102: 262-264.Crossref 13. Kilgore DP, Breger RK, Daniels DL, Pojunas KW, Williams AL, Haughton VM. Cranial tissues: normal MR appearance after intravenous injection of Gd-DTPA . Radiology . 1986;160:757-761.Crossref 14. Adour KK, Hilsinger RL, Byl FM. Herpes simplex polyganglionitis . Otolaryngol Head Neck Surg . 1980;88:270-274.

Hunsaker, Darrell

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290075013

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Numbers in parentheses represent the order of presentation in the published program. This report concerns the Western Section Meeting of the Triologic Society, which took place at the Sheraton Grande Torrey Pines, La Jolla, Calif, from January 7 through 9, 1994. Paul Ward, MD, Los Angeles, Calif, presented a fascinating prediction of the future of otolaryngology as his guest-of-honor address. With the legislative and administrative branches of government controlled by the Democrats, he predicts the most dramatic changes in society and medicine since the Social Security and Medicare acts of nearly 60 and 30 years ago, respectively. Health care constitutes 14% of the gross domestic product and increases 1% every 35 months. The cost of health insurance accounts for over $750 of each automobile manufactured. By 2004, we will need 5000 otolaryngologists vs 8000 now. Residencies must be reduced from the present 260 to fewer than 170. Dr Ward also

RICE, DALE H.;SHINDO, MAISIE;Schwartz, Michael

1994 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1994.01880290078014

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The 1993 fall meeting provided a diverse mix of topics in facial plastic and reconstructive surgery. Presented were a balance of papers covering basic science research, clinical procedures and experience, and a variety of workshops and masters seminars. Topics covered in workshops included "Evolving Concepts in Facial Rejuvenation," "Controversies in Surgical Treatment of the Aging Upper Face," "Reconstruction of Facial Cutaneous Defects," "A Comparison of Open and Closed Rhinoplasty Techniques," "The Complete Practice of Chemical Face Peeling," and "Laser Use in Facial Plastic Surgery." Masters seminars covered rhinoplasty, free flaps, blepharoplasty, face lift, facial reconstruction following Mohs surgery, cleft lip and palate, hair transplantation, and chemical peel. A recent addition to our facial plastic armamentarium is the glycolic acid peel. This is an α-hydroxy acid derived from sugar cane, which provides a mild peel likened to "a medical-grade facial." The peel can be done in an office setting with