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Biomedical subjects

D S Haynes

Publications and source records attributed to D S Haynes.

10 recordsLinked to original sources
PubMed2001

Surgery for chronic ear disease.

When surgically treating chronic ear disease, the physician strives to accomplish several surgical objectives. Chief among them is to achieve a safe ear. This article discusses specific techniques that the surgeon can employ to reach these goals, whether he or she is performing tympanoplasty, atticotomy, intact canal wall mastoidectomy, or an open-cavity procedure. The author has found that the techniques discussed in this article are useful, and sometimes even essential, to achieving surgical objectives and maximizing outcomes.

Chronic Disease↗
PubMed1999

Tinnitus. Current evaluation and management.

Evaluation and management of tinnitus presents a significant challenge to the internist and the otolaryngologist. Tinnitus may be divided into two basic categories: subjective and objective. The importance of a thorough history and physical examination is emphasized in this article. The steps in a complete evaluation and the rationale for referral to an otolaryngologist are outlined. Multidisciplinary care of the tinnitus patient is best coordinated by the otolaryngologist.

Audiometry↗
PubMed1996

Stapedectomy in profound cochlear loss.

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25-year period. Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss.

Aged↗
PubMed1996

Hearing conservation in surgery for glomus jugulare tumors.

The most common ground on which surgery for glomus jugulare (GJ) tumors is criticized is the perceived risk of functional incapacity that attends possible cranial nerve (CN) loss. It is aggregate lower CN loss that is most often highlighted as particularly disabling to the quality of postsurgical survival. The documented success of both conservation surgery and operative rehabilitation of phonopharyngeal surgical deficits has, however, neutralized much of this criticism. The issue of hearing conservation (HC) in neurotologic skull base surgery, on the other hand, has not been well documented toward this end. The presence of a GJ neoplasm need not reflexly nor technically forfeit preexisting hearing. HC is, admittedly, a subordinate priority to total tumor removal, successful distal control of the internal carotid artery, and even facial nerve integrity. Yet, in appropriately selected patients, existing operative technology permits hearing preservation, a noteworthy addition to the high-grade functional outcome we have come to reasonably expect of conservation surgery. Hearing salvage further serves to define the concept of neurotologic skull base surgery. Hearing preservation in 122 GJ tumor patients is reviewed. Intuitively, as for acoustic tumor, HC appears tumor size related. Selection criteria for conservation surgery and its operative technique are detailed. Outcome is appropriately scored. The radiation therapy literature on this subject will be assiduously scrutinized for comparison.

Audiometry, Pure-Tone↗
PubMed1996

Slow-flow phenomena in magnetic resonance imaging of the jugular bulb masquerading as skull base neoplasms.

Enhancement in the region of the jugular foramen on magnetic resonance imaging (MRI) is highly sensitive to the presence of a skull base neoplasm. Unfortunately, this imaging method lacks the specificity to be the sole criterion in the diagnosis of a lesion of the jugular foramen. Although well described in the radiological literature, the phenomenon of gadolinium enhancement of the relatively static blood in the jugular system continues to be erroneously diagnosed as glomus jugulare tumor. Instances of this phenomenon present in patients referred to our practice for surgical opinions before radiation therapy and/or definitive resection will be presented. The purpose of this communication is to bring this potential treatment pitfall to the attention of the neurotology community. Treatment planning for lesions of the lateral skull base cannot singularly be based on MRI findings but requires a healthy skepticism satisfied only by more complete evaluation.

Adult↗
PubMed1995

Twenty-five years of experience with stapedectomy.

The purpose of this report is to review the outcomes of patients undergoing stapes surgery by the senior author during the past 25 years, and to compare these results with those obtained in other series. A retrospective analysis of 902 patients who underwent stapes surgery by the senior author from 1970 to 1994 was performed. Twenty-two patients underwent stapedotomy; the remainder underwent stapedectomy. Pure-tone averages for air and bone conduction, air-bone gap closure, technique, complications, and patient satisfaction were compared with results obtained in other stapedectomy and stapedotomy series.

Adolescent↗
PubMed1995

Ossiculoplasty using the black hydroxylapatite hybrid ossicular replacement prostheses.

The problems of ossicular reconstruction in chronic ear surgery have led to the development of new ossicular replacement prostheses. Improvements in biocompatibility and design led to the development of hydroxylapatite hybrid (HaH) ossicular replacement prostheses. The senior author's (M.E.G.) experience with the Black HaH prostheses is reviewed. Sixty cases are grouped by procedure and prosthesis (19 TORPs and 41 PORPs) with a minimum follow-up of 1 year. Audiometric data are analyzed to determine the success rate in air-bone gap closure. Complication and extrusion rates are reviewed. These results are compared against those obtained using other prostheses using similar criteria, and this report serves as a follow-up on a previous paper on this subject by the senior author.

Adult↗
PubMed1993

Preservation of hearing in surgery for acoustic neuromas.

Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors; 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.

Adolescent↗
PubMed1992

Defect reconstruction and cerebrospinal fluid management in neurotologic skull base tumors with intracranial extension.

Intracranial extension (ICE) is the spread of tumor into the subarachnoid space through dura or along cranial nerve roots. The single-stage removal of the skull base tumor with its ICE has been confounded by cerebrospinal fluid management and defect reconstruction. The purpose of this report is to review a current protocol for managing the cranial base tumor and its ICE as a unit. The ventricular shunting paper of 1987 is retracted. All tumors were managed at a single stage. Defect reconstruction was size dependent. Ninety-eight neurotologic skull base tumors with ICE were managed from 1971 to 1991. The new protocol was initiated in 1987. Results specific to this group are highlighted. For glomus tumors, cerebrospinal fluid leak rates have been dramatically reduced overall from 14.5% to 4%. The leak rates for nonglomus tumors, overall, have improved slightly. Complications are discussed. The development of this surgical approach protocol improves the functional outcome in patients of surgeons who aspire to disease "cure" rather than "control."

Adolescent↗