Biomedical subjects
I F Stewart
Publications and source records attributed to I F Stewart.
Limitations of ABR as a hearing test as exemplified in multiply handicapped adults.
Some limitations of the audiometric application of the click-evoked ABR are exemplified in the results for this sample of multiply handicapped hearing-impaired adults. Normal ABR thresholds were not necessarily indicative of normal hearing. Complete absence of ABR was not necessarily associated with total deafness. These findings underscore the need for conservative interpretation when the ABR is used to assess hearing of neurologically impaired patients at risk for more central auditory dysfunction. Additional diagnostic information in problematic cases may be obtained with cortical auditory potentials. Electrophysiological data must, in turn, be integrated with behaviorally obtained results.
After early identification--what follows? A study of some aspects of deaf education from an otolaryngological viewpoint.
Otolaryngologists have accepted their role in the early diagnosis of the deaf and hard of hearing child: however, the social implications and habilitative programs embarked upon may often be regarded as unrelated to the practice of otolaryngology. The otolaryngologist is a key member of the team responsible for early detection and diagnosis, and he must become as involved with the available educational programs as are the other highly qualified competent individuals bringing expertise to the problem. The reason for emphasizing this area is that the otolaryngologist has witnessed a number of a major expansions in knowledge which have occurred in the past 15 years. These include: 1. Early identification of deafness through screening programs. 2. Early diagnosis through peripheral and brain stem evoked response audiometry. 3. Improvement in amplification in hearing aids. 4. Earlier placement in educational programs, many of which have been the center of controversy, particularly in the past 15 years. 5. Emphasis on continued research and development of programs such as the Cochlear Implant. A historical review of deaf education is presented together with an evaluation of the various claims made by the supporters of the auditory-oral vs. total communication techniques. No totally convincing argument for either system can be advanced. There is considerable doubt that the tri-stimulus, or total communication approach to teaching of the deaf, has any superiority over the auditory-oral approach. There are failures with both philosophies and the "deaf voice" is a stigma often associated with either system's graduates. A 13-year follow-up case study is presented in which the child was enrolled in an auditory-oral program. Comments are made as the child was followed through home training to preschool and on to complete integration in the regular school system. The implications of such a study for the Otolaryngologist, particularly with regard to early identification in order to avoid linguistic delay, are outlined.
Familial central neurofibromatosis.
The condition of central neurofibromatosis, while well documented in neurology literature, has tended to be amalgamated into acoustic neuromas associated with peripheral neurofibromatosis (or Recklinghausen's disease) in otolaryngology literature. The history of a unique family that has demonstrated four generations of bilateral acoustic neuromas has been outlined to show that central neurofibromatosis is a distinct entity related but not identical in clinical and biochemical aspects to Recklinghausen's disease. This article in intended to acquaint the otolaryngologist with the presentation and management of central neurofibromatosis.
Effectiveness of transtympanic neurectomy in management of sialorrhea occurring in mentally retarded patients.
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Giant cell lesions of the maxilla.
A case of giant cell lesion arising from the maxilla is presented. The final clinical and pathological interpretation was of a true giant cell tumor. A review of the literature reveals giant cell lesions of the maxilla to be rare, with the dominant interpretation being giant cell reparative granuloma. On rare occasions, these lesions have been reported as true giant cell tumors. The histogenesis of these lesions in unknown. They may arise from cells of undifferentiated connective tissue, bone marrow, or from abnormal hyperplasia of osteoclasts. The modality of treatment and prognosis is dependent upon the final diagnosis.
Newborn infant hearing screening - a five year pilot project.
The criteria for screening infants' hearing in the newborn nursery are reviewed. The problems encountered are discussed and a screening program outlined. Over 12,000 newborn infants were screened for hearing over a five year period and a total of eight were confirmed deaf - an incidence of one in 1,500 live births.
Upper alveolar carcinoma--a 30 year survey.
Primary malignancy of the upper alveolus is an infrequent type of intra-oral carcinoma. This study reviews in detail 50 patients with a primary tumor of the upper alveolus who were treated at the Cancer Control Agency of British Columbia and Vancouver area hospitals, between 1940-1970 inclusive. Sixteen per cent had exposure to possible industrial carcinogens; 34 per cent had previous leukoplakia. The common presenting symptoms were pain (78 per cent) and swelling (64 per cent). Only 22 per cent had tumors confined to the upper alveolus. Fifty-two per cent had extensive lesions (i.e. T3 and T4). Twenty-six per cent had palpable cervical lymph nodes with potential metastatic disease. Treatment consisted of surgery, radiotherapy, or a combination of both. Complications are detailed. The five year survival rate is 44 per cent; and the 10 year survival rate 24 per cent. Treatment rationale is discussed.