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Biomedical subjects

G W Facer

Publications and source records attributed to G W Facer.

At least 19 recordsLinked to original sources
PubMed2000

Cochlear implantation after labyrinthectomy.

OBJECTIVE: The goal was to report a method used for intraoperative ear selection for cochlear implantation using electrical brainstem response. Initial patient response and the longer-term results of cochlear implantation after labyrinthectomy were compared. STUDY DESIGN: This was a specific retrospective review of a single case of cochlear implantation after labyrinthectomy. SETTING: The study involved a tertiary referral center in both an ambulatory and a hospital setting. PATIENT: The study involved a report of a single patient who was evaluated for a possible cochlear implant and successfully underwent cochlear implantation. INTERVENTIONS: A case study of a profoundly deaf individual is presented, including the diagnostic measures used to determine the candidacy for cochlear implantation, the ear selected, and the rehabilitation. MAIN OUTCOME MEASURES: Both early (3 months) and later (14 months) postoperative results clearly demonstrate that a cochlear implant in a patient with a previous labyrinthectomy can be beneficial. RESULTS: The early and later results after cochlear implantation are compared in a single case study. CONCLUSION: This case study demonstrates that there is improvement in sound awareness, speech recognition, and communication after cochlear implantation in a previously labyrinthectomized ear.

Aged↗
PubMed1999

Neural response telemetry with the nucleus CI24M cochlear implant.

OBJECTIVES: To review our intraoperative and postoperative testing protocol for cochlear implant patients. This study describes the methodologies and applications of a new technique called neural response telemetry (NRT) for the Nucleus CI24M cochlear implant system. NRT uses radiofrequency telemetry technology to measure the action potentials of the auditory nerve. STUDY DESIGN: We have developed a specific protocol for intraoperative testing of the implant device before, during, and after implantation. This includes device integrity tests, visual detection of electrical stapedius muscle reflexes (VESR), and NRT. METHODS: Our methodologies use the commercial software (Windows-based Diagnostic and Programming System [WIN-DPS] and NRT) for the Nucleus CI24M. We describe the details of our protocol used on all of the patients (14 adults and 14 children) who received CI24M implants at Mayo Clinic (Rochester, MN). Our protocol correlates the NRT threshold with the behavioral responses for each patient on at least four electrodes. RESULTS: From August 1, 1998, to December 31,1998, we completed electrode integrity tests, NRT, and VESR testing intraoperatively on 12 patients with the Nucleus CI24M. We have measured normal implant function on all 28 of our CI24M patients with one exception. One of our children had a device failure after approximately 4 months as a result of head trauma. We have also obtained NRT results from an additional 10 patients postoperatively. CONCLUSIONS: The measurement of device and electrode array function is quite simple with the CI24M software. These measurements can be obtained intraoperatively as well as postoperatively. We conclude that VESR and NRT measurements can be very helpful in programming for patients with cochlear implants, especially children, because they provides us with target settings for the speech processor.

Action Potentials↗
PubMed1998

Transtympanic gentamicin for Meniere's syndrome.

OBJECTIVES: Study the impact of transtympanic gentamicin on patients with unilateral Meniere's syndrome. Partial chemical labyrinthectomy is a relatively recent concept for the treatment of Meniere's syndrome. It uses the ototoxic effect of gentamicin to reduce the symptom of vertigo and maintain cochlear function. STUDY DESIGN: A prospective study using transtympanic gentamicin was begun in January 1994. Patients selected had failed medical therapy, but were not incapacitated. Patients had preinjection audiometric and electronystagmography data. Most had an imaging study. All had one injection, about half had more than one. Patients were seen 1 month after therapy and repeat studies were obtained. Repeat injection was performed if indicated. Follow-up from the chart or by telephone was obtained. Data were tabulated using the 1995 American Academy of Otologaryngology-Head and Neck Surgery guidelines. RESULTS: Through December 1996 43 patients with unilateral Meniere's syndrome were treated. The pretherapy function level was 3 through 5. After therapy the function level was 1 or 2. There was almost no change in cochlear function and no patient became deaf. Many patients had mild ataxia or dysequilibrium during the first 2 weeks following therapy. Most patients showed some decrease in labyrinthine function measured on electronystagmography. No attempt was made to ablate labyrinthine function. Seventeen of 18 patients had a vertigo index in the class A or B category after 2 years. CONCLUSIONS: Transtympanic gentamicin has become the treatment of choice for patients who fail medical therapy for Meniere's syndrome at the authors' institution.

Adult↗
PubMed1998

Irradiated rib cartilage graft for reconstruction of the tympanic membrane: preliminary results.

OBJECTIVE: To evaluate the advantages, disadvantages, safety, and results in reconstruction of the tympanic membrane using irradiated rib cartilage. STUDY DESIGN: Retrospective chart review. SETTING: A tertiary referral center. PATIENTS: All patients who had > or =6 months follow-up who underwent tympanoplasty or tympanomastoidectomy using irradiated rib cartilage graft at our institution from January 1, 1993 to December 31, 1996. INTERVENTION: Tympanoplasty or tympanomastoidectomy using homologous irradiated rib cartilage as graft material. MAIN OUTCOME MEASURES: Postoperative speech reception thresholds, speech discrimination scores, and air-bone gap were compared with preoperative levels. Complications directly related to irradiated rib cartilage tympanoplasty were sought. RESULTS: Speech reception threshold did not significantly change. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was < or =10 dB in 43.2% of patients and < or =20 dB in 70.3% of patients. There was a 16% complication rate regarding tympanoplasty in general. No complications unique to irradiated rib cartilage occurred. CONCLUSION: Irradiated rib cartilage is an alternative tympanoplasty material that may save operating time, spares patients an added incision, provides results similar to other grafting material, and is safe.

Adolescent↗
PubMed1997

Low-dose intratympanic gentamicin and the treatment of Meniere's disease: preliminary results.

The most disabling symptom for most patients with unilateral Meniere's disease is vertigo. Eradication of the diseased end organ is effective in eliminating the vertigo. Labyrinthectomy remains the "gold standard"; unfortunately, residual hearing is sacrificed to obtain this end. The purpose of this study is to evaluate low-dose intratympanic gentamicin for the control of vertigo and for the preservation of hearing. A single dose of gentamicin (10-80 mg) was injected into the middle ear space of 23 patients with unilateral Meniere's disease as an office procedure. Eighty-four percent of the patients had no episodes of vertigo during the last 6 months of follow-up. Pure tone average and word discrimination scores were unchanged as a group. Ninety-five percent of patients had a hearing loss at 6 and 8 kHz that averaged 7.5 dB. Caloric function was reduced in 93%. Low-dose intratympanic gentamicin is a safe, simple, office procedure that is effective in controlling the definitive vertiginous episodes in most patients with unilateral Meniere's disease. Control of vertigo can be obtained with preservation of hearing.

Absorption↗
PubMed1997

Use of magnetic resonance imaging and magnetic resonance angiography in diagnosis of sigmoid sinus thrombosis.

Magnetic resonance angiography is an established radiologic technique which is rapidly becoming useful in imaging the head and neck. Currently, this imaging modality is important in the diagnosis of sigmoid sinus thrombosis caused by otologic disease. Since the introduction of antibiotic therapy, the percentage of deaths attributed to intracranial complications from otitic disease has decreased from 2.5 to approximately 0.25% of documented deaths. Also, the incidence of sinus thrombosis within this group has decreased, but it is still a serious and potentially lethal condition. Sinus thrombosis is suspected clinically when mastoid disease progresses, with picket fence fever pattern, chills, headaches and signs of papilledema. Definitive diagnosis is necessary before surgical treatment. The Queckenstedt test is unreliable, computed tomography is better suited for demonstrating thrombosis of the sagittal sinus rather than the sigmoid sinus, and conventional angiography (although it provides excellent visualization) has the hazard of ionizing radiation and requires vessel puncture and the use of intraarterial contrast agents. We present two cases of thrombosis of the sigmoid sinus as an intracranial otologic complication which were diagnosed definitively with magnetic resonance imaging and magnetic resonance angiography. The combination of magnetic resonance imaging, which showed the thrombosis displaying abnormal signal intensity, and magnetic resonance angiography, which demonstrated the absence of flow in the sinus, was an ideal diagnostic tool. For both patients, treatment consisted of mastoidectomy, sigmoid sinus decompression and antibiotics.

Adolescent↗
PubMed1996

Nasofrontal duct reconstruction with silicone rubber sheeting for inflammatory frontal sinus disease: analysis of 164 cases.

The authors reviewed their experience in reconstructing the nasofrontal duct with thin silicone rubber sheeting in patients who had chronic inflammatory frontal sinus disease. The 164 patients were divided into four groups. The patients in group 1 had the traditional modified Lynch procedure, while those in group 2 had certain technical variations of the modified Lynch operation. The patients in the other two groups had major technical variations: those in group 3 had a primary osteoplastic flap approach and those in group 4 had revisions of failed osteoplastic flap with fat obliteration operations. Surgical indications included mucopyocele (87 patients), chronic frontal sinusitis (71 patients), osteomyelitis (2 patients), acute sinusitis (2 patients), and subacute sinusitis (2 patients). Follow-up averaged 47 months. At their last clinic visit, 157 patients (96%) were asymptomatic. Forty-six revision procedures were performed in 30 patients (18% of initial cases). There were no major complications. Nasofrontal duct reconstruction using thin silicone rubber sheeting is technically straightforward, safe, and effective.

Adolescent↗
PubMed1995

Reconstruction of caudal end of septum. A case for transplantation.

OBJECTIVE: To examine the results of complete removal and reconstruction of the caudal end of the septum with emphasis on long term success. DESIGN: A case series reviewing the surgical outcome of 45 consecutive cases of transplantations for severely deformed of absent caudal ends of the septum. After at least 18 months, all 45 patients were given a postoperative evaluation. SETTING: All procedures were performed at Mayo Clinic, Rochester, Minn. PATIENTS: Forty-five patients (36 male and nine females) ranged in age from 7 to 78 years, with a mean age of 38 years. Twenty-seven patients had severe caudal end deformities, and 18 patients had absent or flaccid caudal end. OUTCOME MEASURES: Subjective assessment included the opinion of the patient, rhinologic examination, and photographic analysis. Anterior mask rhinomanometry was performed to measure nasal resistance. Clinically noted complications were documented when present. RESULTS: Subjectively, 36 (80%) of the 45 patients reported "normal" nasal breathing, and seven patients (15.6%) reported improved nasal breathing. Objective preoperative and postoperative rhinomanometry data, available in 28 cases, was related to the subjective findings. The longevity of the caudal end transplant was confirmed by reviewing the data from the 33 patients who were followed up more than 1 year. Ninety percent of the patients were free of complications. CONCLUSION: Objective and subjective results showed excellent long-term results. The caudal end of the nasal septum can be removed safely and reconstructed.

Adolescent↗
PubMed1995

Averaged electrode voltages used to identify nonfunctioning electrodes in cochlear implants: case study.

We present the case of an adult male whose internal cochlear implant unit failed. Several months elapsed following initial stimulation with the implant before the problem was identified and corrected. The sequence of the failure and its detection are detailed. Following reimplantation, the patient did not initially report improved sound quality. However, within a week of the initial stimulation of the second device, he reported being able to identify environmental sounds, and speech began to sound the way he remembered it before he lost his hearing. We suggest a method of detection that might improve the early identification of a nonfunctioning device or of nonfunctioning individual electrodes. Knowledge of specific nonfunctioning electrodes is important in device adjustment, especially for young children.

Audiometry, Pure-Tone↗
PubMed1995

Intratympanic gentamicin treatment: preliminary results in two patients with Menière's disease.

Menière's disease is a vestibular disturbance characterized by episodic vertigo, tinnitus, and fluctuant hearing loss. The long-term effectiveness of available medical and nonablative surgical treatments has been variable, with frequent symptom recurrence. Vestibular neurectomy and labyrinthectomy, surgically ablative techniques, provide more permanent relief from vertiginous attacks. However, these procedures pose possible morbidity and cochlear risk. In this paper, preliminary results are presented for two patients who underwent intratympanic gentamicin application. Like surgical labyrinthectomy, intratympanic use of gentamicin is intended as an ablative procedure, but with potentially less risk to hearing. More vestibulotoxic than cochleotoxic, gentamicin initially disrupts the endolymph-secreting vestibular dark cells, thereby preventing endolymphatic hydrops development. Following gentamicin application, both patients demonstrated a significant change in peripheral vestibular function, as characterized by a reduction of caloric response, impaired posturography performance, and reduced low-frequency gain on rotary chair testing. Posturography performance subsequently improved, confirming functional compensation. Both patients reported relief from vertiginous attacks. However, word recognition ability was significantly worse in one of these two patients. Changes in pure-tone thresholds were minimal.

Audiometry, Pure-Tone↗
PubMed1995

Cochlear implantation in the senior citizen age group using the Nucleus 22-channel device.

Cochlear implantation has become a recognized beneficial method of assisting in the rehabilitation of the profoundly deaf individual. The only device that is currently approved by the Food and Drug Administration for implantation in children and adults in the United States is the Nucleus 22-channel device. Since 1988, the Nucleus is the only device that has been implanted at the Mayo Clinic, Rochester, Minnesota. Fifty-six patients ranging in age from 3 to 85 have received implants. Twenty-five (45%) were over 55 and 14 (25%) were 65 or older. All of the patients over 55 are currently using their implants. Several of the patients over 65 are continuing to be gainfully employed. The benefits, complications, and results are addressed.

Adolescent↗
PubMed1995

Vestibular effects associated with implantation of a multiple channel cochlear prosthesis.

This study revealed that some patients with cochlear implants have symptoms of vertigo and imbalance following implant surgery. Although most experience a resolution of these symptoms, some patients have more persistent disturbances of balance. A total of 52 patients were implanted with a Nucleus 22 channel cochlear implant device between September 1988 and February 1994. Preoperatively, all but five of the patients received a vestibular evaluation. Twenty-two of the 52 patients received both pre- and postoperative vestibular evaluation. The cochlear implant was worn and activated during the postoperative vestibular assessment. The vestibular assessment included electronystagmography, computerized dynamic posturography, and harmonic acceleration testing. Five of the 22 patients demonstrated bilateral vestibular weakness preoperatively; that is, no response to caloric stimulation or a total of less than 30 degrees per second for the four irrigations. These patients were not included in the caloric analysis portion of the study. The remaining 17 were divided into groups under 60 years of age (7 patients) and over 60 years of age (10 patients). Analysis of the pre-and postoperative caloric response of the implanted ear showed a significant drop in output for the group over 60 years of age. The difference for the group under 60 years of age was not significant. Forty percent of the patients in the over 60 age group and 43% of those in the under 60 age group developed a peripheral vestibular weakness postoperatively. However, younger individuals in general did not seem to have balance complaints and did not require vestibular rehabilitation as frequently as the older group. Potential cochlear implant candidates should be advised of the possibility of postoperative vestibular effects following cochlear implantation. Most of the symptoms are transient; however, there may be persistent symptoms of imbalance that may be benefited by vestibular rehabilitation.

Adolescent↗
PubMed1994

The Mayo Clinic experience with the cochlear implant.

The implantation of a cochlear electronic prosthetic device is an acceptable means of improving the communication ability of pre- and postlingually deafened children and adults. A significant number of patients in this series are in the senior citizen age group. It has been beneficial in improving communication ability in selected profoundly deafened individuals. There has been a significant improvement in the cochlear electronic prosthetic device since the initial report of Djourno in 1957.

Adult↗
PubMed1993

Middle ear adenoma and adenocarcinoma.

Adenomas and adenocarcinomas originating from the middle ear are few in number and have met with significant controversy in the literature. Our experience with 11 previously described patients is updated and five new cases are added. These tumors were seen in persons whose ages ranged from 7 to 77 years. The most common initial symptom was decreased hearing (11 cases), followed by otorrhea (4 cases), and otalgia (4 cases). At the time of diagnosis, facial nerve weakness was present in several patients (seven), and this was a poor prognostic sign. These glandular tumors engender controversy regarding histologic origin and the pathologic demarcation between adenoma and adenocarcinoma. In this review, we show that otorrhea, bone erosion, facial nerve involvement, and aggressive clinical behavior can be the result of lesions that appear microscopically benign. Furthermore, we present evidence of the similarity of these glandular lesions to paragangliomas and carcinoid tumors. Finally, pathologic data are presented to develop the previously unreported theory that the origin for this group of tumors is paraganglionic tissue.

Adenocarcinoma↗
PubMed1990

The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature.

Between 1944 and 1987, 112 patients with inverting papilloma of the nasal cavity were treated. The average duration of follow-up for this population was 6.2 years. The most common symptoms were nasal obstruction and history of previous surgery for nasal "polyps". Recurrence rates were lower when treatment consisted of lateral rhinotomy with medial maxillectomy (14%) vs. transnasal operation with a sinus procedure (35%) or transnasal operation alone (58%). Recurrence rates between men and women were not significantly different when treatment methods were analyzed; however, a higher-than-expected association with tobacco usage was noted. Eight (7%) of the 112 patients had associated nasal carcinoma. Current treatment is lateral rhinotomy with medial maxillectomy to prevent troublesome and potentially malignant recurrent disease.

Adolescent↗
PubMed1988

Vibrotactile device in patients with single-channel cochlear implant: a preliminary study.

Two patients who had been using 3-M Vienna extracochlear implants were given two-channel KS Sensoraid vibrotactile units to wear for 1 month. At the end of that period, several tests commonly used to assess cochlear implant function were administered to compare the effectiveness of the vibrotactile system with that of the cochlear implants. The results obtained from the vibrotactile devices were encouraging, although the units had some shortcomings. Overall, the subjects' test scores with the vibrotactile units were comparable to, if not slightly better than, those with the extracochlear implants.

Adult↗