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Biomedical subjects

I K Arenberg

Publications and source records attributed to I K Arenberg.

At least 19 recordsLinked to original sources
PubMed1991

Intraoperative electrocochleographic monitoring of inner ear surgery for endolymphatic hydrops. A review of cases.

The purpose of this review of cases was to determine whether or not the SP/AP amplitude ratio changes during unidirectional inner ear valved shunt surgery for the decompression of the hydropic labyrinth in Meniere's disease. A series of 62 patients underwent shunt surgery over a 20 month period. In 43 cases (43 ears), ECoG responses were successfully recorded throughout the duration of surgery. A pair of two-tailed paired t-tests were computed for SP/AP amplitude ratios acquired during intraoperative ECoG monitoring at the baseline and closing stage of surgery. The first t-test compared the mean SP/AP amplitude ratios at baseline and closing for those cases in which the SP/AP amplitude ratio at baseline was abnormal (baseline > 35%). The t was significant, t(19) = 4.63, p < 0.01). The second t-test compared the mean SP/AP amplitude ratios at baseline and closing for those cases in which the SP/AP amplitude ratio at baseline was WNL (baseline < or = 35%). The t was insignificant, t(20) = 0.31, p > 0.05. Variations between baseline and closing measurements were categorized as either a reduction, no change (very stable over time), or an increase in the SP/AP amplitude ratio. A change in the SP/AP amplitude ratio from baseline to closing of > or = 7% (x = 2%, SD = 2%) was considered statistically significant. Overall (43 cases), 49% of the variations fell into the no change category, with 42% and 9% of the cases placed in the reduction and increase categories, respectively. Of the cases (22) in which the baseline measurement was outside the limits of normal, 64% showed a reduction, 32% showed no change, and 4% showed an increase in the SP/AP amplitude ratio at closing. Changes in the SP/AP amplitude were observed at various stages of the surgical procedure. Reductions were found at each of the five surgical steps identified, with the majority of the changes almost evenly divided between the stages of mastoid drilling and opening sac. Increases in the SP/AP amplitude ratio were found in four cases. The increases were observed during drilling of the mastoid bone in two cases and sac decompression and opening the sac in the remaining cases.

Acoustic Stimulation↗
PubMed1991

Vincent's violent vertigo. An analysis of the original diagnosis of epilepsy vs. the current diagnosis of Meniére's disease.

The authors propose to correct the historical misimpression that Vincent van Gogh's medical problems resulted from epilepsy. Rather, the authors propose his main medical problem was Meniére's disease. The authors have reviewed the 796 personal letters written by van Gogh. The symptoms of his Vertigo attacks, their presentation and duration as described in these letters, taken as a whole, are consistent with the clinical picture of Meniére's disease, not epilepsy. They point out that Prosper Meniére's description of his syndrome was not well known at the time of van Gogh's death, and was often misdiagnosed as epilepsy. During the last years of his life, van Gogh was labeled epileptic, although no rigid criteria for this diagnosis are evident. This diagnosis is still prevalent in the art history literature today. His symptoms included episodic vertigo and dizziness, physical imbalance, hearing symptoms, ear noises (tinnitus) as well as a presumed secondary psychological reaction to his physical symptomatology. van Gogh's diagnosis of epilepsy is based on written diagnosis in his medical records in 1889 when he was interred (voluntarily) in St. Remy at an asylum for epileptics and lunatics.

Art↗
PubMed1990

Van Gogh had Menière's disease and not epilepsy.

We intend to correct the historical error that Vincent Van Gogh's medical problems resulted from epilepsy plus madness, a diagnosis made during his life but for which no rigid criteria are apparent. Review of 796 personal letters to family and friends written between 1884 and his suicide in 1890 reveals a man constantly in control of his reason and suffering from severe repeated attacks of disabling vertigo, not a seizure disorder. His own diagnosis of epilepsy was made from the written diagnosis by Dr Peyron, the physician at the asylum of St Remy (France), wherein on May 9, 1889, Van Gogh voluntarily committed himself to the asylum for epileptics and lunatics. However, the clinical descriptions in his letters are those of a person suffering from Meniere's disease, not epilepsy. The authors point out that Prosper Meniere's description of his syndrome (an inner-ear disorder) was not well known when Van Gogh died and that it often was misdiagnosed as epilepsy well into the 20th century.

Art↗
PubMed1989

Low frequency air-bone gap in Menière's disease without middle ear pathology. A preliminary report.

The audiograms of some patients suffering from Meniere's disease show an unexplained conductive component, or air-bone gap (ABG), predominantly in the low frequencies. Neither the history nor physical findings support poor eustachian tube function, ossicular chain abnormalities, chronic ear disease, physical trauma, or otosclerosis as a cause of this audiometric finding. In the present study, 40 patients diagnosed as suffering from classical Meniere's disease were evaluated audiometrically. Thirteen (32.5%) of these patients demonstrated a low frequency ABG. An otologic evaluation was performed on each patient who exhibited the abnormal finding, but no middle ear pathology was discovered. An otherwise unexplained low frequency ABG in patients with Meniere's disease suggests the possibility of an "inner ear" conductive hearing loss. This conductive component may result from endolymphatic hydrops or perilymphatic hypertension (i.e., an inner ear hyperpressure exerted against the medial surface of the stapedial footplate) rather than from middle ear pathology. "Inner ear" conductive hearing loss is thought to be caused by an increase in inner ear fluid volume (endolymphatic hydrops) and pressure (endolymphatic or perilymphatic hypertension), which dampens footplate mobility medially and which is directly related to a relative inner ear or labyrinthine hyperpressure. Since the footplate mobility is only dampened and not fixed, a stapedial reflex may still be elicited.

Adolescent↗
PubMed1989

Electrocochleographic effects of ear canal pressure change.

A series of Swedish studies has shown that the application of middle ear over-pressure may be effective in ameliorating the symptoms associated with Meniere's disease. Other studies have shown that electrocochleography (ECochG) is an effective tool in the identification of Meniere's disease, especially in the presence of active symptoms. Based on the therapeutic potential of middle ear overpressure as a treatment for Meniere's symptoms and on the relationship between these symptoms and ECochG, we investigated the effects of ear canal pressure change on human electrocochleographic components in normally hearing subjects. An experimental system combining an immittance audiometer probe and ear canal electrode was utilized to record extratympanic ECochG when different atmospheric pressures were applied indirectly to the middle ear via the sealed ear canal. All ECochG parameters except for the duration of the whole nerve action potential (AP) of the auditory nerve were significantly affected by pressure changes in the ear canal. Effects included an enlargement of the summating potential (SP) amplitude and of the SP:AP amplitude ratio at pressures above and below 0 decaPa (daPa). An important implication of our findings is that the status of the middle ear must be taken into account in the interpretation of ECochG results.

Action Potentials↗
PubMed1988

The Tullio phenomenon and perilymph fistula.

Establishing the diagnosis of perilymph fistula remains a dilemma. At this time, identification of an active perilymph fistula can be confirmed only by surgery. On the basis of clinical history and audiovestibular testing, 54 patients underwent middle ear exploration for possible perilymph fistula at the Colorado Ear Clinic between July 1980 and June 1986. This group represents approximately 1% of all surgical procedures performed during that period. Seven patients (12%) were found to have the Tullio phenomenon preoperatively. Six of these were found to have active, free-flowing fistulas at the time of exploration. The presence of a Tullio phenomenon may be helpful in preoperative assessment of a patient with suspected perilymph fistula.

Acoustic Stimulation↗
PubMed1988

ECoG results in perilymphatic fistula: clinical and experimental studies.

Patients with perilymphatic fistula have been described as having symptoms similar to Meniere's disease and endolymphatic hydrops. Direct clinical or experimental evidence linking the two inner ear disorders has been lacking. An enhancement of the summating potential observed with electrocochleography suggests a diagnosis of ELH in both of these inner ear disorders. In this study, ECoG results of 27 patients with surgically confirmed PLF are reported. Fourteen patients with surgically confirmed spontaneous PLF had abnormal ECoG. Six of these 14 patients had normal hearing. The ECoG changes in patients with Meniere's disease and those with surgically confirmed PLF are identical, indicating the underlying pathologic change in both is hydrops. But there is no specific diagnostic abnormality on ECoG that differentiates these two inner ear disorders. Also, an experimental model of PLF was developed and studied in guinea pigs. "Inactive" PLF is defined as "an opening was made into the cochlea, but if no perilymph moved out through the fistula, it was defined as inactive" An "active" PLF occurs when perilymph actually moves from the inner ear out to the middle ear. ECoGs were recorded before and after creation of an "active" PLF. ECoG abnormalities were seen in "active" PLF and correlated with histologic data demonstrating ELH. An abnormally enhanced summating potential was demonstrated after active removal of perilymph through the experimentally created fistula. Cochlear duct histology showed hydropic distention of Reissner's membrane in the experimental ears and no changes in the membranous labyrinths of the unoperated, control ears.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1987

Ten-year follow-up on the first five inner ear valve implants for intractable vertigo in Sweden.

Ten-year clinical results are reported on the first five inner ear valve implants done in Sweden in 1975 and 1976. If the patient had a positive glycerol dehydration test (n = 4) the chances of excellent results for hearing at one year as well as complete elimination of vertigo were high. At ten years, two of the four patients with positive glycerol dehydration tests maintained excellent hearing and complete elimination of vertigo. One patient's hearing deteriorated, but he was still completely free of vertigo at ten years. One patient had a labyrinthectomy at three years, but now we would have considered a revision valve implant before a destructive procedure. The patients who had clinical evidence of bilateral disease did not do as well at ten years as patients with unilateral disease. With ten year follow-up it has been shown that the inner ear valve implant is a safe and effective nondestructive alternative to labyrinthectomy for salvaging patients who failed medical therapy.

Adult↗
PubMed1987

Results of endolymphatic sac to mastoid shunt surgery for Menière's disease refractory to medical therapy.

In the ten-year period ending July 1, 1986, 5475 dizzy patients were evaluated and treated medically at the Colorado Ear Clinic. Of these, 214 patients (4%) were diagnosed as having classic Meniere's disease refractory to medical therapy and underwent endolymphatic sac to mastoid shunt surgery. These patients were followed for a minimum of one year after surgery. The average audiometric follow-up was 35.1 months. Based on the American Academy of Otolaryngology-Head and Neck Surgery 1985 criteria for reporting results at one year, 60.3% had lower audiometric thresholds postoperatively (H1) or unchanged thresholds (H2) relative to the worst preoperative audiogram. Elimination of all vertiginous attacks was achieved in 73.9% (Vo). Adjunctive spells were not assessed. Disability was eliminated (Do) in 86%. Based on a prospective computerized analysis of forty pertinent variables, a profile of a classic Meniere's disease patient who has failed to improve with medical, allergic, dietary, exercise, or other conservative treatment and would be likely to benefit from endolymphatic sac to mastoid shunt surgery is established.

Adolescent↗
PubMed1986

Ventilation tube surgery and middle ear irrigation.

Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10%-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space effusion with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces, and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post-tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16% to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.

Adolescent↗
PubMed1986

Auditory dehydration testing: glycerol versus urea.

Auditory dehydration testing with oral hyperosmolar substances is commonly used in the evaluation of patients with suspected endolymphatic hydrops. Endolymphatic hydrops is assumed to be temporarily reduced in some cases, resulting in an improvement in hearing. Unfortunately, ingestion of glycerol, the most frequently used oral agent, often causes severe headache, vomiting, or both. Urea has recently been used as an alternative. A study of patients with Meniere's disease was designed to compare the effectiveness of glycerol versus urea in inducing a temporary improvement in hearing thresholds. Three hundred patients received either glycerol or urea. Fifty-seven percent of the glycerol patients had positive hearing results compared with 77% of the urea patients. Temporary hearing improvements following urea ingestion may not be caused by a rise in serum osmolality alone, since this occurs with glycerol but not with urea.

Adolescent↗