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Biomedical subjects

D G Pappas

Publications and source records attributed to D G Pappas.

13 recordsLinked to original sources
PubMed1992

Spontaneous temporal bone cerebrospinal fluid leak.

Eight patients with spontaneous cerebrospinal fluid leak of temporal bone origin are presented. Pertinent history and surgical findings are reviewed and contrasted with 33 previously reported patients. Unilateral ear fullness and mild hearing loss are the most common presenting symptoms. Profuse clear otorrhea following myringotomy is virtually pathognomonic. Diagnostic methods including high-resolution computed tomography, magnetic resonance imaging, and contrast cisternography are discussed. The indications for transmastoid and combined transmastoid/middle fossa surgical repairs are compared. Both surgical approaches were found to be equally effective. We favor the transmastoid as the initial approach because of simplicity, safety, and the ability to visualize both the middle fossa and posterior fossa plates as well as the middle ear.

Adult↗
PubMed1991

A newly recognized etiology of Meniére's syndrome. A preliminary report.

Many etiologic agents for Meniére's syndrome have been proposed, suggesting a heterogeneous nature for this disorder. Dissimilar etiologies could, of course, yield disparate responses to uniform treatment. Although electrocochleography has provided us with some objective diagnostic criteria, the actual identification of Meniére's syndrome rests predominantly on clinical criteria. Several of our patients with dysautonomia presented with classical symptoms of Meniére's syndrome. Twenty-five of these patients were treated with increased fluid and sodium intake and flurocortisone, a mineralcorticoid agent. Our favorable results have led us to postulate a heretofore unrecognized etiology for Meniére's syndrome, and speculate on some of the previously reported responses of Meniére's syndrome to corticosteroid treatment.

Audiometry, Evoked Response↗
PubMed1990

High-resolution computed tomography: determination of the cause of pediatric sensorineural hearing loss.

High-resolution computed tomograms (HRCT) reveal strikingly little variation in the dimensions of inner ear structures among people with normal hearing. However, a subgroup of people exist who have a sensorineural hearing loss (SNHL) and morphologically normal HRCT scans, yet have subtle radiographic aberrations based on measurements of inner ear dimensions. These changes might have resulted from teratogenic influences during the late first to mid second trimester, a time when the inner ear has achieved adult form, yet continues to enlarge to adult size. A retrospective study of HRCTs on three groups of ears was performed to determine inner ear structure dimensions. Group I, the control group, consisted of 50 ears with no SNHL and no discernible abnormalities on HRCT. In group II, there were 70 ears with SNHL and obvious abnormalities on HRCT. Group III, the test group, was composed of 140 ears with SNHL and "normal" HRCTs. Groups II and III were analyzed, applying the normal dimensions derived from group I. When compared to the control group (I), all of the ears in group II were abnormal. Moreover, 75% of the ears in group III had subtle differences not apparent unless measurements were made. Two or more abnormal dimensions were found in 32%. Findings and implications are thoroughly discussed.

Adolescent↗
PubMed1989

Perilymphatic fistula in pediatric patients with a preexisting sensorineural loss.

A specific group of 28 children (38 ears) with a preexisting sensorineural hearing loss (SNHL) was studied to determine if a perilymphatic fistula (PLF) was the cause of a progression in their hearing loss. A PLF was identified surgically in six of these ears, but there was no evidence of any defect found in 32 ears. The symptoms shared by the cases in which a fistula was found included a traumatic event (including exertion), CT scan evidence of inner ear defects, hearing threshold decreases of 25 to 30 dB, and vertigo or postural instability.

Adolescent↗
PubMed1989

Cavernous hemangiomas of the internal auditory canal.

Cavernous hemangiomas are vascular malformations that are seldom found in the central nervous system. Four cavernous hemangiomas of the internal auditory canal and one of the cerebellopontine angle have been reported previously. We present a series of seven (six of which have never been reported) cavernous hemangiomas limited primarily to the internal auditory canal. Whereas all cases but one had marked unilateral sensorineural hearing loss, only two had preoperative facial nerve dysfunction. There are no specific symptoms or physical or audiometric findings to differentiate cavernous hemangiomas from acoustic neuromas. However, a hemangioma should be suspected when facial paralysis is present in conjunction with a small intracanalicular tumor as demonstrated by computed tomography or magnetic resonance imaging. The former reveals calcium stippling in the lesions, whereas magnetic resonance imaging reveals a high signal intensity on both T1- and T2-weighted images.

Adult↗
PubMed1986

Dizziness and the autonomic dysfunction syndrome.

Dizziness resulting from inner ear or CNS disease has been well described. However, there is a large number of patients for whom dizziness does not seem to be related to either the ears or the CNS. We postulate an abnormality in the autonomic nervous system of such patients and have used standard tilt testing and Valsalva methods to assess the abnormality. Based on the results of these tests, we can suggest therapeutic options.

Adolescent↗
PubMedDate not supplied

The value of including optokinetic nystagmus testing in electronystagmography.

Seventy-nine out of 172 patients with abnormal horizontal or vertical optokinetic nystagmus had a specific condition or disease that was diagnosed following a complete ENG. Ocular vertigo, MS, motion sickness, brain stem lesions, cerebellar tumors, cerebellar atrophy, parietal lobe tumors, and Harada syndrome were the diagnoses made. Optokinetic asymmetry--horizontal, vertical, or a combination of these--was the most consistent finding in these conditions (Table). In six patients with cerebellar tumor, abnormal findings on OPK testing suggested the need for further evaluation when physical and neurologic examinations, brain scans, and EEG were normal. Surgery confirmed the diagnosis of cerebellar tumor with these patients. This study suggested the importance of using five progressively faster drum speeds in both the horizontal and vertical planes. All patients who had proven or strongly suspected MS had eye-speed fatigability as the drum speed increased, that is, as the drum speed increased, the eye speed decreased. It is suggested that optokinetic studies be included in the ENG. Vertical asymmetry, although not as common as horizontal, should be included in that 14 patients had only this finding.

Brain Diseases↗