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ABSTRACT: Although cranial neuropathies are common disorders in multiple sclerosis patients, multiple cranial nerve involvement is an unusual occurrence. Correlation of clinical symptoms with magnetic resonance imaging evidence of demyelinating central nervous system lesions can confirm the diagnosis. The authors report on the case of a 43-year-old woman who initially was thought to have suffered a brainstem infarct but, in fact, had developed multiple cranial nerve functional deficits. Treatment of multiple sclerosis remains primarily supportive in nature, with corticosteroids used for acute exacerbations and chronic progression.
Ear, nose, & throat journal 03/1999; 78(2):118-21. · 0.66 Impact Factor
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ABSTRACT: The effect of high levels of linear acceleration (G) on the cochlea has never been studied prospectively.
Linear acceleration at high levels has no effect on the human cochlea as demonstrated by a comparison of pre- and post-exposure measurements.
There were 22 healthy volunteers who underwent exposure to up to 9 G in a military aviation training centrifuge. Prior to exposure they were screened for cochleovestibular disorders and underwent tympanometry, audiometry and distortion product otoacoustic emissions testing (DPOAE). Immediately after exposure, they underwent serial testing of each of these parameters until they returned to baseline.
There was no significant change in tympanometry in any subject. Audiometry revealed a temporary threshold shift of 30 db at 6 kHz in one ear of a single subject. This was accompanied by a complete loss of DPOAE at the same frequency. DPOAE did not return to baseline at 2 weeks even though the audiogram had reverted to baseline by 8 d. Four other ears displayed significant losses of emissions at single frequencies without an accompanying change on the audiogram.
This study demonstrates that accelerative stress may cause transient injury to the cochlea. The mechanism of injury due to acceleration is probably ischemia, although a purely mechanical effect on the outer hair cells cannot be precluded. These data also reinforce a growing body of evidence that demonstrates the greater sensitivity of DPOAE over psychoacoustic testing in detecting early or subclinical cochlear damage.
Aviation Space and Environmental Medicine 02/1998; 69(1):40-4. · 0.88 Impact Factor
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Otolaryngology Head and Neck Surgery 01/1998; 117(6):S131-3. · 1.72 Impact Factor
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The Journal of otolaryngology 09/1997; 26(4):281-3. · 0.50 Impact Factor
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ABSTRACT: Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague-Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post-auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen-absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen-absorbable hemostat and absorbable gelatin film in this animal model.
Otolaryngology Head and Neck Surgery 05/1997; 116(4):454-7. · 1.72 Impact Factor
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ABSTRACT: Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.
Clinical Infectious Diseases 07/1996; 22(6):1105-6. · 9.15 Impact Factor
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ABSTRACT: Adhesion of the tympanic membrane to the promontory may occur in chronic otitis media or in the postoperative ear. Silicone plastic sheets are commonly used to form a physical barrier to adhesion. These sheets are generally well tolerated, but they are subject to occasional extrusion, encapsulation, or foreign body reaction. The ideal barrier to adhesion formation would be a nonreactive, flexible, absorbable substance that would obviate long-term toxicity considerations. In this study polydioxanone sheets were compared with silicone plastic sheets in the middle ear of the Mongolian gerbil. The eustachian tube was cauterized to create severe tympanic membrane retraction. A fabricated sheet of polydioxanone was implanted in the middle ear of 30 Mongolian gerbils and compared with silicone plastic sheets implanted in another group of 30 animals. A sham operation was performed on the other ear to serve as a surgical control. Evaluation of the temporal bones at 5, 10, and 15 weeks showed no significant differences in the rate of adhesion formation, effusion formation, or polymorphonuclear infiltration by the Fisher exact test. There was histologic evidence that polydioxanone was still providing an effective barrier at 10 weeks. The results of this study demonstrate that polydioxanone sheets are as effective and as well tolerated as silicone plastic sheets in an animal model. Further study of polydioxanone in this role is warranted.
Otolaryngology Head and Neck Surgery 03/1995; 112(2):303-7. · 1.72 Impact Factor
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ABSTRACT: Cochlear implantation becomes more common with every passing year. Since adequate exposure of the round window requires a facial recess approach, facial nerve variation and anomalies could potentially alter the surgical approach significantly. We report the case of a patient with a variation of facial nerve anatomy. The nerve was found to be lateral to the annulus in its mastoid segment and required retrofacial dissection to approach the round window. A good result was achieved in this patient, demonstrating that facial nerve anomalies need not be a barrier to successful implantation. The reported congenital anomalies of the facial nerve are discussed, along with their influence on cochlear implantation. A knowledge of these variations is mandatory for those engaged in implant surgery.
Ear, nose, & throat journal 10/1994; 73(9):667-9. · 0.66 Impact Factor
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ABSTRACT: Transtracheal oxygen catheters are being increasingly used because of savings in oxygen usage and patient preference. The complications of the catheter are believed to be minor and easily managed. Inspissated mucous collections that form at the tip of the SCOOP 1 (Transtracheal Systems, Denver, Colorado) catheter have been reported but are usually easily expectorated by the patient. This report describes a patient who had development of acute respiratory compromise from crusted mucoid impaction of the trachea secondary to transtracheal catheter use. General anesthesia and rigid bronchoscopy were required for removal of the obstructing impaction. Unexplained worsening of respiratory symptoms in patients with transtracheal oxygen catheters should be addressed by prompt stripping of the catheter.
Chest 06/1992; 101(5):1465-6. · 5.25 Impact Factor
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ABSTRACT: Hypothyroidism is not commonly considered a complication of radiotherapy for head and neck cancer. A series of 96 patients treated with radiotherapy alone or combined with surgery for head and neck cancer was retrospectively studied. All patients had radiation ports that included the thyroid gland. Hypothyroidism after radiotherapy was documented in 26% of all patients. The majority of patients had subclinical hypothyroidism manifested by elevated thyroid-stimulating hormone (TSH) levels. The incidence of hypothyroidism dramatically increased to 65% when radiotherapy was combined with surgery that included a partial thyroidectomy. In addition, we report the unusual occurrence of massive head, neck, and hypopharyngeal edema caused by severe hypothyroidism in two patients. We advocate routine monitoring of head and neck cancer patients for hypothyroidism after radiotherapy involving the thyroid gland and recommend levothyroxine replacement therapy for subclinical hypothyroidism.
Otolaryngology Head and Neck Surgery 08/1990; 103(1):10-3. · 1.72 Impact Factor
