Biomedical subjects
J L Pulec
Publications and source records attributed to J L Pulec.
Facial nerve angioma.
Angioma of the facial nerve is a rare benign tumor. Symptoms include progressive or sudden facial paralysis and, often, a facial twitch. Although angiomas have unique features, diagnosis and treatment is similar to that for facial nerve neuroma. Magnetic Resonance Imaging (MRI) with gadolinium infusion and thin-section Computed Tomography (CT) can often identify the lesion. Treatment by total excision and facial nerve grafting can provide a permanent cure with good restoration of facial function. Four cases are discussed.
Enzyme-potentiated desensitization: a major breakthrough.
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Classification of chronic suppurative otitis media: type IV.
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Facial paralysis: beginning the dialogue.
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Iatrogenic facial palsy: the cost.
The cost of iatrogenic facial paralysis can be high. Ways to avoid facial nerve injury during surgery and, should it occur, ways to minimize the disability and cost are discussed. These include adequate preparation and training by the surgeon, the exercise of sound judgment, the presence of high morals by the surgeon, adequate preoperative diagnosis and surgical instrumentation and thorough preoperative oral and written informed consent. Should facial nerve injury occur, immediate consultation and reparative decompression, anastomosis or grafting should be performed to obtain the best ultimate result. The value of prompt, competent, sympathetic and continuing concern offered by the surgeon to the patient cannot be over emphasized.
An absurd restriction to the practice of otolaryngology.
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Classification of chronic suppurative otitis media: type VI.
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The appropriateness of tympanostomy tubes for children.
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Comparison of vestibular autorotation and caloric testing.
The two most common stimuli of the vestibular system for diagnostic purposes are caloric and rotational head movements. Caloric stimulation, by delivering thermal energy to the lateral semicircular canal, is a well-studied method of vestibular testing, and its clinical usefulness has been established. Vestibular autorotation testing uses high-frequency (2 to 6 Hz), active head movements to stimulate the horizontal and vertical vestibulo-ocular reflex to produce measurable eye movements that can be used to calculate gain and phase. We compared the alternate bilateral bithermal caloric results with the vestibular autorotation test results obtained from 39 patients with peripheral vestibular disorders and from 10 patients with acoustic neuroma. In the peripheral disorder group, only 2 of 14 patients with equal caloric response (< 20% reduced vestibular response) had a normal vestibular autorotation test result. No patients with a reduced vestibular response greater than 21% had a normal vestibular autorotation test result. In the acoustic neuroma group, four patients had a normal reduced vestibular response, but all patients had an abnormal vestibular autorotation test result. We conclude that testing both the horizontal and vertical vestibulo-ocular reflexes in their physiologic frequency range with the vestibular autorotation test provides additional information that could be missed by conventional caloric testing. Therefore high-frequency rotational testing is a valuable addition to the vestibular test battery.
Multichannel cochlear implantation in a child with Brachmann-de Lange syndrome.
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Surgical treatment of vertigo.
The surgical treatment for vertigo can be accomplished by a number of operations to selectively attack specific areas of the ear or to try to accomplish certain definite changes in the ear. These are called ablation of the posterior semi-circular canal, endolymphatic subarachnoid shunt, middle fossa vestibular nerve section and destructive labyrinthectomy by the transcanal or post-auricular approach, or translabyrinthine section of the VIIIth nerve. In addition, carotid endarterectomy or section of the dorsal spinal rootlets may be indicated for conditions not directly related to the VIIIth nerve or the inner ear. Once a careful diagnosis has been made, the treatment must be adapted to each individual patient's need. No absolute criteria can be used for every patient who has benign disease. When an acoustic neuroma has been detected, it should be removed. With accurate diagnosis and the judicious employment of medical treatment and surgical procedures, physicians can give relief to the majority of their patients who complain of vertigo. A description of the surgical procedures is given. The indications for each operation and the results expected are summarized.
The discovery of the pathogenesis of Menière's disease.
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Permanent restoration of hearing and vestibular function by the endolymphatic subarachnoid shunt operation.
In cases of surgically treatable Meniere's disease, the endolymphatic subarachnoid shunt operation, when successful, can eliminate endolymphatic hydrops and restore function which has not been permanently damaged. This paper will demonstrate the restoration to normal of cochlear and vestibular function following successful endolymphatic subarachnoid shunt procedures. A series of 454 Endolymphatic Subarachnoid Shunt Operations performed on patients with Meniere's disease is reported. Twenty-six patients had surgery on their only hearing ear. Overall, the Endolymphatic Subarachnoid Shunt Operation offered success in sixty-five percent of operations performed. Cases of failure can often receive significant benefit from progressively more destructive procedures. The use of the Endolymphatic Subarachnoid Shunt procedure performed early in the course of Meniere's disease can significantly reduce the risk of permanent hearing loss and disability.
Temporal bone fracture post-tympanoplasty.
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Cochlear nerve section for intractable tinnitus.
Tinnitus is a common and often very disturbing symptom. The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery. Intractable subjective tinnitus originating within the cochlea or cochlear nerve can frequently be successfully treated by cochlear nerve section. The cochlear nerve must be severed medial to the spiral ganglion to obtain optimum results. One hundred fifty-one cases are reported. Complete relief of tinnitus was achieved in 101 patients, worthwhile improvement was obtained in 43 patients and 7 patients obtained no improvement. The indications for this surgery will be given. Careful examination, accurate diagnosis, and proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success.
Temporal bone fracture with facial palsy and total deafness.
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Hearing results in tympanoplasty.
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