Biomedical subjects

F M Byl

Publications and source records attributed to F M Byl.

At least 19 recordsLinked to original sources

PubMed1999

Stapes surgery in a residency training program.

OBJECTIVES: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. STUDY DESIGN: Retrospective analysis of techniques and results for 71 stapedectomy procedures. MATERIALS AND METHODS: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. RESULTS: Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. CONCLUSIONS: Residents can safely and successfully perform stapes surgery using a laser-assisted, small-fenestra technique.

Clinical Competence↗

PubMed1997

Endoscopic Zenker's diverticulotomy (Dohlman procedure): forty cases reviewed.

Pharyngoesophageal diverticula, first described in 1769, occur in an area of natural weakness between the inferior pharyngeal constrictor muscles of the pharynx and the cricopharyngeus muscle. The cause of these acquired diverticula is controversial, although most likely it is related to cricopharyngeus muscle dysfunction. Treatment is directed toward correcting the underlying sphincter dysfunction and managing the diverticulum. Endoscopic diverticulotomy requires division of the cricopharyngeus and the common wall between the esophagus and diverticulum, a technique popularized by Dohlman. We reviewed the results of 40 endoscopic diverticulotomy patients, ranging in age from 46 to 88 years, many of whom had significant existing comorbidities. The mean size of the diverticula was 4.1 cm, mean surgery time was 41 minutes, and mean hospital stay was 4.5 days. Thirty-seven of 40 patients, including 3 whose previous external procedure was not successful, returned to a regular diet, reported no regurgitation and were satisfied with the procedure. Complications in order of occurrence were pneumomediastinum (4 patients), urinary tract infection (2), upper respiratory tract infection (2), and lip laceration (1). Our results compare favorably with those of external approaches. The technique should be considered safe, expedient, and effective, particularly in patients with existing comorbidities.

Aged↗

PubMed1996

Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial.

In a double-blind study, we compared the final outcome of 99 Bell's palsy patients treated with either acyclovir-prednisone (53 patients) or placebo-prednisone (46 patients). For patients receiving acyclovir, the dosage was 2,000 mg (400 mg 5 times daily) for 10 days. Electrical tests included electroneurography and the maximal stimulation test. Univariate comparisons of outcome and electrical tests between the two groups were made with chi 2 analysis, Fisher's exact test, and t-tests. The outcome in acyclovir-prednisone-treated patients was superior to that in placebo-prednisone-treated patients. Treatment with acyclovir-prednisone was statistically more effective in returning volitional muscle motion (recovery profile of 10; p = .02) and in preventing partial nerve degeneration (p = .05) than placebo-prednisone treatment. The t-tests indicated that the recovery profile and index means were significantly better for the acyclovir-treated group (recovery profile t = 1.99, p = .051; recovery index t = 2.10, p = .040). We conclude that acyclovir-prednisone is superior to prednisone alone in treating Bell's palsy patients and suggest that herpes simplex is the probable cause of Bell's palsy.

Acyclovir↗

PubMed1993

Aneurysmal bone cyst of the mandible.

The aneurysmal bone cyst is a nonmalignant lesion that by expanding disrupts the architecture of the affected bone and destroys surrounding tissue. Developing rarely in the craniofacial region, and more commonly affecting the long bones and the spine, the lesion has characteristic radiographic features but is definitively diagnosed only by pathologic characteristics. Complete surgical excision is used to treat aneurysmal bone cyst, with either curettage or composite resection. Recurrence is common in incompletely excised lesions. Adjunctive cryotherapy reduces the risk of recurrence, and radiotherapy is reserved for nonresectable lesions. The case we report of a young man seen for a large mandibular aneurysmal bone cyst demonstrates the complexity of diagnosing and treating this condition.

Adult↗

PubMed1992

Audiometric comparison of Lassa fever hearing loss and idiopathic sudden hearing loss: evidence for viral cause.

A recently published prospective study on acute sensorineural deafness in Lassa fever among a West African population showed the audiometric pattern of a known virally induced hearing loss. Using the audiometric data from the patients with Lassa fever in that study, we analyzed and classified the initial hearing loss and final recovery into three groups by pure-tone average values and then did the same for 222 patients with idiopathic sudden hearing loss (SHL) in our study. Statistical analyses of the severity of initial hearing loss and the hearing recovery pattern indicate that the clinical course of our 222 patients with idiopathic SHL showed no statistically significant differences from the clinical course of the patients with Lassa fever. We found a marked difference in age, however, and a clinically significant difference in the incidence of bilateral hearing loss. In reviewing the literature on sudden sensorineural hearing loss, we found no apparent relation between severity of viral illness and initial hearing loss or subsequent recovery. Cummins et al. suggest that virally induced hearing loss in Lassa fever is linked to the host's immune response and not to the viremia. We thus propose a virally induced immune response mechanism for idiopathic sensorineural SHL. Further prospective studies are needed for verification.

Acute Disease↗

PubMed1991

Endoscopic diverticulotomy for the treatment of Zenker's diverticulum.

First described by Mosher in 1916, endoscopic treatment of Zenker's diverticulum has since been reported infrequently in the surgical literature and continues to engender controversy. Between 1978 and 1989, we treated 11 unselected patients surgically for pharyngoesophageal diverticula. Endoscopic diverticulotomy was used in 11 patients and an external approach was used in the others. The endoscopically treated patients had no serious complications, resumed oral intake early, and were discharged from the hospital earlier. Our review of the surgical literature confirmed our experience with the efficacy and safety of the procedure. We therefore recommend endoscopic diverticulotomy as being equal to external approaches with regard to effectiveness; and it affords the patient a shortened hospital stay and more rapid return to to the premorbid state.

Aged↗

PubMed1990

The beneficial effect of methylprednisolone in acute vestibular vertigo.

To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo. Extensive neurotologic examination confirmed the diagnosis. If no significant reduction of vertigo occurred within the first 24 hours of treatment, patients were instructed to switch medications. Patients were followed up prospectively for 1 month. Of the 10 patients receiving methylprednisolone, 9 had a marked reduction of vertiginous symptoms and 1 switched to the placebo medication. Of the 10 patients receiving placebo, 3 had relief of vertiginous symptoms, while the 7 with persistent symptoms switched to methylprednisolone and had subsequent effective reduction of vertigo within 24 hours. The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo. One patient receiving methylprednisolone had a relapse of symptoms when the dosage was tapered, but symptoms again remitted when the dosage was increased to 32 mg/d. From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo.

Acute Disease↗

PubMed1990

Audiological manifestations of Ramsay Hunt syndrome.

Ramsay Hunt syndrome is known to cause audiological signs and symptoms, including sudden, unexpected hearing loss. We carried out a retrospective review of the audiological manifestations of 186 patients with Ramsay Hunt syndrome, measuring their hearing loss patterns, hyperacusis, tinnitus, herpetic rash, facial paralysis, pain and vertigo. Statistical correlations of these parameters were equated with prognosis. Prognosis for eventual hearing recovery is, in general, excellent. Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss.

Adolescent↗

PubMed1989

Computer-generated three-dimensional reconstruction of the cochlea.

Computer-generated three-dimensional reconstructions of the nerve fibers from the organ of Corti to the spiral ganglion were used to determine the optimum maximal length of the cochlear implant electrode. The spiral ganglion within the modiolus is much shorter than the organ of Corti. The spiral ganglion has 1 3/4 turns and reaches no higher than the middle of the second turn of the organ of Corti, which has 2 3/4 turns. The spiral ganglion is concentric and basal with respect to the organ of Corti. The spiral ganglion dendrites within the osseous spiral lamina of the basal turn project radially, nearly perpendicular to the central axis of the modiolus. Upon entering the modiolus, they turn basally at an angle of approximately 120 degrees. The projection of dendrites within the osseous spiral lamina became increasingly oblique as the ganglion extended apically. The organization of the cochlear nerve results from the spiraling of the ganglion. These findings are in agreement with previous reports. Implications of these findings and their possible relevance to the optimum length of the cochlear implant electrode are discussed with reference to cochlear damage resulting from longer electrodes.

Cochlea↗

PubMed1989

Interaction of spatial perception, vestibular function, and exercise in young school age boys with learning disabilities.

Form rotation, figure directionality, and figure-ground discrimination were evaluated before and after 10 days of vestibular or aerobic exercises for 30 boys (7 to 12 yr.) who showed problems in learning, reading, and inattention. Eight subjects had normal vestibulo-ocular reflex (VOR) responses as determined by caloric and rotational testing. They were assigned to a vestibular program (Control Group I). The 22 subjects with abnormal VOR test responses were randomly assigned to either aerobic exercises (Experimental Group II) or a vestibular program (Experimental Group III). Spatial perceptual test scores varied widely, with the majority performing below age-expected norms but no significant differences on vestibular status appeared. Postexercise, only subjects completing the vestibular program made significant gains: Experimental Group III (abnormal VOR) made significant gains in accuracy and normal test responses compared to the other groups, and Control Group I made significantly greater gains in speed of spatial perceptual processing. For boys with problems in learning, reading, inattention, and vestibular function, a vestibular exercise program complementing a traditional or special educational program may enhance the spatial perceptual skills needed for reading.

Attention↗

PubMed1984

Sudden hearing loss: eight years' experience and suggested prognostic table.

The etiology, incidence, acute and late prognosis, and treatment of sudden hearing loss (SHL) are described variously in the literature. In an 8-year prospective study of 225 SHL patients, initiated in July 1973, overall, normal, or complete recovery occurred in 45% of patients and late otologic complications in 28%. Important prognostic indicators were severity of initial hearing loss and vertigo, time to initial audiogram, and elevated erythrocyte sedimentation rate; other indicators were age greater than 60 and less than 15 years, midfrequency audiogram configuration, and hearing status of the opposite ear. A common inflammatory cause is suggested for all degrees of severity in SHL, and a prognostic table is provided to aid the practitioner in predicting recovery. There is still no evidence that treatment achieves a result better than expected with spontaneous recovery.

Adolescent↗

PubMed1983

Acute cranial polyneuritis with vertigo after stapedectomy.

Acute vertigo occurring 48 hours after stapedectomy is assumed to be related to inner ear trauma. Similarly, acute vertigo occurring weeks after stapedectomy could be related to a fistula of the oval window. No one has tested the hypothesis that some of these cases could represent concomitant cranial polyneuritis. We report the development after stapedectomy of five cases of acute cranial polyneuritis with vertigo diagnosed by physical examination of the cranial nerves. In another case we determined that vertigo occurring after stapedectomy was not related to concomitant cranial polyneuritis. Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.

Adult↗

PubMed1980

The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study.

Double-blind studies were conducted for the treatment of idiopathic sudden hearing loss (ISHL) with oral steroids. The condition was defined as not less than a 30-dB loss over three contiguous frequencies in three days or less. Follow-up audiograms were obtained four weeks and three months later. Specific audiologic guidelines for the assessment of hearing recovery were used to ensure objectivity. Steroids had a statistically significant effect on the recovery of hearing in patients with moderate hearing losses. The nature of the hearing loss and its susceptibility to improvement with steroid therapy lend support to the hypothesis that viral cochlitis is the primary cause of ISHL.

Adult↗

PubMed1980

Ménière's disease as a form of cranial polyganglionitis.

Although endolymphatic hydrops is generally considered to be the most prominent factor in the etiology and pathology of Ménière's disease, we have concluded that this condition more probably represents a polyganglionitis caused by the herpes simplex virus with secondary hydrops changes. The wide range of symptoms occurring in the Ménière's disease complex is illustrated in seven selected cases which support this conclusion. Vestibular nerve section can stabilize hearing and relieve episodic vertigo by removing the locus of viral infection and precluding recurrent activation.

Adult↗

PubMed1978

The true nature of Bell's palsy: analysis of 1,000 consecutive patients.

In a series of 1502 patients seen in our Facial Paralysis Research Clinic 1048 were diagnosed as having Bell's palsy. Review of clinical, epidemiologic, and laboratory data, plus review of the literature, has led to the conclusion that Bell's palsy is an acute benign cranial polyneuritis probably caused by reactivation of the herpes-simplex virus, and the dysfunction of the motor cranial nerves (V, VII, X) may represent inflammation and demyelinization rather than ischemic compression. Spinal fluid analysis suggests that the disease is a phenomenon of the central nervous system with secondary peripheral neural manifestations. With our presently available information, treatment of a viral disease with an anti-inflammatory agent is rational. Prednisone treatment started within the first week of the disease can restore better function to the paralyzed face than is achieved without such therapy, and facial nerve decompression has been unnecessary.

Adolescent↗

PubMed1978

Sudden Hearing Loss Research Clinic.

There is still a considerable lack of knowledge about the etiology and treatment of sudden hearing loss, despite renewed interest among investigators. There is still no treatment regimen that has been demonstrated to be effective. Other clinics should be established to elucidate the factors surrounding the etiology and to as with sudden hearing loss have another diagnosable disorder, but careful follow-up is necessary. In our series this figure was approximately one-third. Luetic labyrinthitis, perilymphatic fistula, fluctuant hearing loss or endolymphatic hydrops, and acoustic neuroma are among the diagnoses to be considered.

Acute Disease↗

PubMed1977

Seventy-six cases of presumed sudden hearing loss occurring in 1973: prognosis and incidence.

A sudden hearing loss (SHL) research clinic to which 30 members of an ENT Society refer patients, accumulates information about incidence, prognosis, recovery patterns, and treatment of SHL. The diagnostic protocol includes laboratory, audiometric, and radiologic studies; patients are followed for a minimum of 10 months. Among 76 patients seen in 1973, the diagnosis of idiopathic SHL was retained in 52; more specific diagnoses were established in 24. The incidence of SHL in the general population is estimated at 10.7 cases per 100,000. Although the therapeutic protocol was individualized, all patients with idiopathic SHL were advised to restrict dietary sodium, to discontinue use of stimulants, and were given instructions regarding activity. Twenty-six patients received prednisone. Results indicate that prednisone may have a beneficial effect when administered before the 10th day of SHL. Increasing age, hypertension, diabetes, and severe vertigo were found to be poor prognostic indicators. Outcome was significantly better in patients seen early in the course of their illness than in those seen later. Possible etiologic factors include vascular dysfunction and inflammatory response. Further studies of controlled series are needed to establish standards for diagnosis of SHL and its recovery pattern.

Adolescent↗

PubMed1977

Auditory symptoms associated with herpes zoster or idiopathic facial paralysis.

Auditory symptoms (hyperacusis, tinnitus, decreased hearing) have long been recognized to accompany herpetic or idiopathic facial paralysis. Twenty-nine percent of 1,080 patients with idiopathic facial paralysis and 37 percent of 172 with herpes zoster oticus facial paralysis had auditory symptoms. Abnormal related sensori-neural hearing loss was documented in only 11 of these 377 patients with auditory complaints. All of the 11 had a diagnosis of herpes zoster oticus. Sensori-neural hearing loss occurs in only about 6.5 percent of patients with herpes zoster facial paralysis, and no confirmed case of such loss in idiopathic facial paralysis has been reported. In patients presenting with sensori-neural hearing loss accompanying facial paralysis believed to be idiopathic, herpes zoster should be suspected even in the absence of vesicles. Factors favorable for recovery of auditory function include age 64 years or younger, mild initial hearing loss, a cochlear pattern of hearing loss, and absence of vertigo. Recovery of auditory function does take place; however, a high-tone sensori-neural loss may persist except in younger patients.

Adolescent↗