Biomedical subjects
C L Reams
Publications and source records attributed to C L Reams.
Results of surgical treatment for Menière's disease.
In 1985 the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium established revised guidelines for reporting treatment results for Menière's disease. Since then little information regarding the newly adapted criteria and their effects on the evaluation process has appeared. Thus we compared the results of different surgical procedures for Menière's disease using both the 1985 and 1972 guidelines. One hundred nine surgical procedures from 1969 to 1985 were reviewed. Six different surgical procedures were evaluated: the Cody-Tack, cochleosacculotomy, endolymphatic mastoid shunt, endolymphatic subarachnoid shunt, translabyrinthine vestibular nerve section, and transcanal labyrinthectomy. Results show that 68% of patients who had a Cody-Tack procedure continued to have vertiginous episodes in the same frequency postoperatively. Hearing was worse in 17 of these 25 patients. Of the patients who had a cochleosacculotomy, most had significant control of their vertiginous symptoms, but 10 patients had greater than 10 dB hearing loss postoperatively. Patients who had an endolymphatic mastoid shunt performed had better results when the 1972 guidelines were applied. In this group, the 1985 guidelines indicate that only 35% of the patients had significant relief of their vertiginous symptoms and 47% had hearing loss greater than 10 dB postoperatively. Six of the seven patients who underwent an endolymphatic subarachnoid shunt obtained significant relief of their vertiginous episodes, but hearing loss was more than 10 dB in four patients. Those patients who had either a labyrinthectomy or a translabyrinthine vestibular nerve section had relief of their vertiginous episodes. We conclude that the new guidelines appear to be superior to the 1972 guidelines for reporting results for the treatment of Menière's disease.
Vascular lesions of the middle ear.
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Reconstruction of radical mastoid cavities: methods and results.
The radical mastoid cavity can be troublesome and odoriferous, may require frequent visits to an otologist, and may interfere with swimming and showering. Three procedures can be used to reconstruct the radical mastoid cavity. Soft tissue obliteration with autograft bone paste is the most versatile and commonly used technique. Reconstruction with homograft external auditory canal bone is useful for extremely large mastoid cavities that are free of infection. Use of these techniques in 35 patients since 1969 has resulted in dry, trouble free ears and improved hearing when reconstruction of the ossicular chain was performed. Use of this technique has helped patients with radical mastoid cavities to return to a normal active life style.
Homograft tympanoplasty techniques and results for restoration of hearing.
The use of a homograft tympanic membrane with and without attached ossicles, staging the operation, and the use of sculptured homograft or autograft ossicles have improved the results in tympanoplasty. The indications and techniques of homograft tympanoplasty are described, and the results in 99 primary cases and 11 cases with repair of a mastoid cavity are given. The overall graft success rate was 86 per cent. In patients with an intact ossicular chain, the conductive loss was reduced to less than 20 dB. in 88 per cent. A hearing loss less than 20 dB. was obtained in 68 per cent with an intact stapes, in 77 per cent when the stapes superstructure was absent, and in 79 per cent in stapedectomy done at a second stage. The use of homograft material has provided the means for significantly improving the results in our patients who require tympanoplasty.
The surgical treatment of dizziness.
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Tympanomastoidectomy. A 25-year experience.
Since 1956, 1,540 tympanomastoidectomy procedures for cholesteatoma or chronic suppurative otitis media with mastoiditis have been performed; 180, done from 1972 through 1980, were reviewed in detail for effectiveness of surgery, control of disease, and hearing results. The majority of the procedures were done for cholesteatoma. Almost all of these had preoperative sclerotic or poorly developed mastoids as judged by x-ray examination. A limited open-cavity technique with one-stage tympanic repair has resulted in long-term control of cholesteatoma in the mastoid segment in almost every case and reasonable success in control of middle ear disease and preservation or improvement in hearing. Properly performed modified radical mastoid cavities seldom cause problems in postoperative care, do not preclude swimming, and do not impair concomitant tympanoplastic repair. Failure to control disease in the middle ear or to improve hearing is the major problem. Revision tympanoplasty can correct some of these remaining problems, but is usually an elective procedure.