Biomedical subjects
J F Lehrer
Publications and source records attributed to J F Lehrer.
Value of human temporal bone studies in advancing the understanding of diseases of the ear.
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Clarification of endolymphatic sac surgery in patients with perilymphatic fistulas.
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Chemotherapy of bilateral acoustic neuromas.
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Diagnosis and management of vertigo.
Patients with vertigo may be best evaluated when the physician has the various entities that may be responsible clearly in mind. Those diseases listed in group II are more familiar to the primary care physician than those listed in group I, which belong more in the realm of neuro-otology than in general medicine and neurology. The proper use of history, physical findings, and laboratory evaluations will allow the clinician to classify the patient's problem and to initiate treatment and consider appropriate referral when indicated.
The role of endolymphatic sac surgery in the management of secondary endolymphatic hydrops associated with perilymphatic fistulas: preliminary observations.
The evidence for the existence of secondary endolymphatic hydrops in patients with perilymphatic fistulas is reviewed and the indications for treatment of such hydrops in patients with fistulas are discussed. The indications for and results of combined fistula repair by middle ear exploration and endolymphatic sac surgery in fifteen patients are presented. The preliminary results in these patients appear encouraging. Patients with recurrent perilymphatic fistulas, or with symptoms of attacks of spinning vertigo after fistula repair, and those who present with severe imbalance with findings of a perilymphatic fistula appear to be candidates for combined fistula and sac surgery.
Inhibition of mediator release by azatadine.
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Identification and treatment of metabolic abnormalities in patients with vertigo.
Hyperinsulinism, impaired glucose tolerance, and hypertriglyceridemia may be risk factors for atherosclerotic heart disease and have also been described in patients with vertigo, whose symptoms and findings responded to appropriate dietary therapy. We studied 100 patients in an otolaryngology practice to determine the role of these abnormalities in identifying patients suitable for dietary therapy and to assess the efficacy of dietary therapy in the treatment of vertigo in such selected patients. The determination of hyperinsulinism and hypertriglyceridemia were of value as supplements to the traditional glucose tolerance test in detecting reversible metabolic vertigo. Reactive hypoglycemia was found in only four patients and thus appears overdiagnosed as a cause of vertigo. Insulin resistance appears to be the basic abnormality in this syndrome, which, in our series, occurred predominantly in overweight patients.
Hypertrophic lingual tonsils and cough.
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Headache associated with IgE-mediated allergy: response to immunotherapy.
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Latency of the acoustic reflex in eighth-nerve tumor.
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Post-traumatic Meniere's syndrome.
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Perilymphatic fistula--a definitive and curable cause of vertigo following head trauma.
Vertigo or disequilibrium occurring in patients after concussive and nonconcussive head trauma may be due to a pathologic perilymphatic fistula from the inner ear through the oval and round window areas of the middle ear. Of 33 patients who had successful grafting of the fistulous area at middle ear exploration, 32 had resolution of vertigo, and 12 of 23 who had an associated hearing loss had improved hearing. Perilymphatic fistulas associated with vertigo and hearing loss after head trauma can be diagnosed with great certainty and are surgically curable in the great majority of cases. Patients with post-concussive syndrome, whose symptoms include vertigo or disequilibrium, should have a thorough otologic evaluation for the possibility of a perilymphatic fistula.
Recognition and treatment of allergy in sinusitis and pharyngotonsillitis. A preliminary report.
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Abnormalities of the stapedius reflex in patients with vertigo.
Analysis of the latency, amplitude, and rise characteristics of the stapedius reflex as demonstrated on a strip recorder revealed abnormalities in patients with vestibular neuronitis and other vertigo syndromes. The findings in vestibular neuronitis, acute labyrinthitis, perilymphatic fistulas, Meniere's disease, cerebrovascular insufficiency, and metabolic vertigo are described. Alterations in the stapedius reflex included increase in latency, decrease in amplitude, stepping of the rise, and absence of the reflex. This study suggests that absence of the reflex can be associated with vertigo as well as with acoustic neuromas and other retrocochlear lesions. The findings of abnormalities in vestibular neuronitis support a brain-stem localization as the site of lesion in this disease.
Use of the glycerin test in the diagnosis of post-traumatic perilymphatic fistulas.
A new application of the glycerin test in the diagnosis of post-traumatic perilymphatic fistulas is described. Temporary disappearance of abnormal responses to the fistula and Quix tests and improvement in the hearing occurred. The glycerin test was useful in confirming the diagnosis of post-traumatic perilymphatic fistula in 13 patients in whom fistulas were found at middle ear exploration.