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Biomedical subjects

J L Pulec

Publications and source records attributed to J L Pulec.

15 recordsLinked to original sources
PubMed1978

Human otoconia in surgical specimens.

The utricular otoconia of four patients, which were removed during surgical procedures (one for an eighth nerve section operation and three for removal of acoustic neuromas) with the use of the translabyrinthine approach, were observed with the scanning electron microscope. The otoconia of these patients showed some abnormal features. In three of the four patients, a number of otoconia were found to have cracked lines. One of these patients was a 14-year-old boy; the other patients were more than 40 years old. In the remaining case, the otoconial facet surfaces were rough, and a few otoconia were unusually shaped.

Adolescent↗
PubMed1978

Management of congenital ear abnormalities.

Congenital malformation of the ear has a complex origin and the possibility of hereditary, viral and toxic etiologies. The authors require audiometric evaluation, using the objective brain stem evoked response in young children, and polytomography of the middle and inner ears in all patients with atretic external auditory canals. Unilaterally atretic ear canals can be repaired electively at the discretion of the family and the patient, while in bilateral cases reconstruction is ideally done at approximately age four years. Regular follow-up is recommended to be certain that no cholesteatoma develops medial to an atretic external ear canal. The authors propose a working classification for congenital malformation of the ear. In the author's series of 35 operations for the repair of congenital ear abnormalities, 55% were improved to adequate levels of hearing without the use of a hearing aid. Eight exemplary cases and comments are presented.

Adolescent↗
PubMed1977

Trigeminal neuralgia: retrolabyrinthine selective posterior root section.

Experience gained from the treatment of 41 patients with 42 operations for the relief of Vth nerve pain over the past 5 years is reported. For the selective section of the posterior root of the trigeminal nerve 28 retrolabyrinthine procedures were performed for typical tic douloureux with complete lasting relief in 25; 1 was relieved with the addition of aspirin; and 2 were relieved by Tegratol even though it was ineffective before surgery. There were no deaths and no serious complications. None had facial paralysis or anesthesia dolorosa. The retrolabyrinthine approach to the posterior root of the trigeminal nerve is ideally suited for those patients with refractory tic douloureux or patients with facial pain secondary to other causes such as tumor. Because of its effectiveness and low morbidity, this procedure offers advantages over other surgical techniques.

Adult↗
PubMed1977

Indications for surgery in Mé Niére's disease.

Ménière's disease has been shown to have multiple causes, each of which requires a specific treatment. Patients who do not respond to medical treatment often are allowed to suffer prolonged disability from their symptoms or develop permanent hearing loss without the benefit of surgery. The physician's uncertainty regarding which patient will ultimately respond to medical treatment or have spontaneous remission of symptoms can cause a delay in what would otherwise have been definitive surgical treatment which would have allowed the patient to return to a happy and productive life. A careful analysis of 120 patients studied intensively for five years has shown that patients who exhibit specific characteristics and diagnostic findings will ultimately require surgery for control and relief of their symptoms, while others can be expected to recover with medical treatment. Fifty-six of the 120 patients ultimately required surgery to rid them of their symptoms. These patients were almost exclusively of the group considered to be idiopathic, viral, small internal auditory canal syndrome, or caused by physical or acoustic trauma. Those patients who had other causes for their Ménère's disease rarely required surgical treatment and were well controlled by specific medical therapy. These observations would seem to provide us with information which would allow patients who might be reasonably stages of their disease where conservative measures can more often be expected to give complete relief with preservation of hearing. The indications for surgery in patients with Ménière's disease based on this information will be reviewed. The use of this knowledge has significantly reduced the morbiditiy associated with Ménière's disease.

Adult↗
PubMed1977

Reconstruction of radical mastoid cavities: methods and results.

The radical mastoid cavity can be troublesome and odoriferous, may require frequent visits to an otologist, and may interfere with swimming and showering. Three procedures can be used to reconstruct the radical mastoid cavity. Soft tissue obliteration with autograft bone paste is the most versatile and commonly used technique. Reconstruction with homograft external auditory canal bone is useful for extremely large mastoid cavities that are free of infection. Use of these techniques in 35 patients since 1969 has resulted in dry, trouble free ears and improved hearing when reconstruction of the ossicular chain was performed. Use of this technique has helped patients with radical mastoid cavities to return to a normal active life style.

Anesthesia, Local↗
PubMed1977

Homograft tympanoplasty techniques and results for restoration of hearing.

The use of a homograft tympanic membrane with and without attached ossicles, staging the operation, and the use of sculptured homograft or autograft ossicles have improved the results in tympanoplasty. The indications and techniques of homograft tympanoplasty are described, and the results in 99 primary cases and 11 cases with repair of a mastoid cavity are given. The overall graft success rate was 86 per cent. In patients with an intact ossicular chain, the conductive loss was reduced to less than 20 dB. in 88 per cent. A hearing loss less than 20 dB. was obtained in 68 per cent with an intact stapes, in 77 per cent when the stapes superstructure was absent, and in 79 per cent in stapedectomy done at a second stage. The use of homograft material has provided the means for significantly improving the results in our patients who require tympanoplasty.

Adult↗
PubMed1976

Geniculate neuralgia: diagnosis and surgical management.

Pain in the ear is a common complaint for which patients consult their otolaryngologist. A rare cause is geniculate neuralgia, which has also been called tic douloureux of the nervus intermedius. In its most typical form, it is characterized by severe paroxysmal neuralgic pain centered directly in the ear. The pain may also be of gradual onset and of a dull, persistent nature, with occasional sharp, stabbing pain. The diagnostic features and two new surgical techniques for its treatment are described. Afferent sensory facial nerve fibers are shown to pass not only through the nervus intermedius, but also through the main motor trunk of the facial nerve. Excision of the nervus intermedius and/or of the geniculate ganglion by the middle cranial fossa approach without the production of facial paralysis, in any of 15 cases with geniculate neuralgia is reported. Use of these new techniques, sometimes in combination with selective section of the Vth cranial nerve, has been successful in relieving the pain of geniculate neuralgia.

Adult↗
PubMedDate not supplied

Eustachian tube lymphatics.

Serous otitis media is the most common cause of hearing impairment. The role of lymphatic obstruction in the pathogeneis of serous otitis media is significant. A method for removeal of the human Eustachian tube specimen and two techniques for identification of Eustachian tube lymphatic capillaries are described. One involves the antemorten intratympanic installation of Berlin blue. The other utilizes electron microscopy. Lymphatic capillaries cannot be reliably differentiated from blood capillaries with the light microscope. With electron microscopy, lymphatic capillaries can be differentiated from blood capillaries by differences in the basement membrane. The lymphatic capillary has gaps in the basement membrane with large nuclei in the wall. A blood capillary has a continuous basement membrane and sometimes red blood cells be be identified in the lumen. Using these methods, Eustachian tube lymphatic capillaries in the human are described for the first time in this report.

Adolescent↗
PubMedDate not supplied

Neurilemoma of the jugular foramen. Transmastoid removal.

The authors present two cases in which the palsies of the IX, X, XI and XII nerves heralded the presence of a neurilemoma within the jugular foramen. Temporary bone polytomography, retrograde jugular venography, and pantopaque posterior fossa myelography allowed the nature and extent of the tumor to be predicted accurately prior to the operation. The tumors were completely removed using a transmastoid-extended facial recess approach without labyrinthectomy, supplemented in one case by exploration of the upper cervical portion of the internal jugular vein. This technique has avoided the complications which attend removal by way of the posterior fossa. We feel that transmastoid removal merits more extensive clinical trial.

Accessory Nerve↗
PubMedDate not supplied

Tinnitus: diagnosis and treatment.

Few conditions are seen as commonly by the otologist and are more poorly understood than subjective tinnitus. Tinnitus has been reported in as high as 80% of patients seen in an otolaryngology practice. This symptom is especially marked in patients with a hearing problem and can be so severe that it becomes incapacitating. Careful diagnosis and classification of tinnitus is important for understanding of the problem. Identification of the frequency and intensity of masking, using a tinnitus analyzer, is useful in selecting the form of treatment. Analysis of the history, physical findings and the use of special electrocochleography and brain stem evoked response audiometry help to identify the site of lesion, which may be within the cochlea, cochlear nerve, cochlear nucleus, brain stem, midbrain or auditory cortex. Specific disease entities should be identified and treated. Lesions of the end-organ or cochlear nerve can be treated when necessary by translabyrinthine or middle cranial fossa section of the cochlear nerve. Tinnitus from cervical nerve lesions can be treated by rhizotomy. The use of a hearing aid or introduction of a sound with a tinnitus masker has been found to be 82% effective in suppressing tinnitus. Maskers can be combined with a hearing aid in some cases. The pathogenesis of tinnitus is discussed, but the method of action of tinnitus relief by auditory stimulation is still unclear. A thoughtful and complete examination with our new diagnostic tools and the judicious selection of therapy now makes it possible to give relief to the majority of patients suffering with disturbing tinnitus.

Adult↗