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Biomedical subjects

J L Sheehy

Publications and source records attributed to J L Sheehy.

At least 19 recordsLinked to original sources
PubMed1991

Tympanoplasty: to stage or not to stage.

No unanimity of opinion exists in regard to staged operations in tympanoplasty. The controversy centers around the degree to which one should attempt to obtain hearing improvement in badly diseased ears. The major factor is the extent of the mucous membrane disease. We review the history of staging, the mucous membrane indications for staging, and the variations involved in canal-wall-down (CWD) procedures. The opinions of nineteen other otologists also are presented, nine of whom do not regularly or ever stage tympanoplasty.

Humans↗
PubMed1990

Tympanoplasty: review of 400 staged cases.

Staging of tympanoplasty is important in the management of patients with chronic otitis media. It allows establishment of an air-containing middle ear space and adequate postoperative hearing levels in a large proportion of patients with severely diseased ears. The results of 400 staged procedures performed over a 3-year period at the House Ear Clinic, Los Angeles are reported. Staging was performed in 75% of tympanoplasty with mastoidectomy cases and in 15% of ears not requiring mastoid surgery. Closure of the air-bone gap to 20 dB or less occurred in 68% of patients with intact stapes. Mucous membrane problems were the most common reason for staging. Almost one third of cases with middle ear cholesteatoma at the first stage had residual disease on reexploration. Staging of tympanoplasty continues to be an important technique in management of severely diseased ears.

Adolescent↗
PubMed1989

Sensorineural loss in chronic otitis media. Is it clinically significant?

Charts of 161 patients with unilateral chronic otitis media were reviewed for evidence of sensorineural hearing loss, defined as the difference in preoperative bone conduction thresholds between diseased and normal contralateral ears. Mean bone conduction differences were small but statistically significant, ranging from 5.6 to 12.8 dB across the frequencies. Approximately 45% of the subjects had differences greater than 10 dB for high frequencies, but less than 12% had a difference greater than 20 dB for the pure-tone average. Significant relationships were found between sensorineural hearing loss and the presence of acquired cholesteatoma in the middle ear, diseased mucosa of the promontory and hypotympanum, and diseased ossicles. These findings suggest that more severe middle ear disease may result in sensorineural hearing loss. However, for the majority of subjects, the amount of sensorineural hearing loss was judged not to be clinically significant.

Adult↗
PubMed1989

Acquired cholesteatoma in adults.

The objectives of cholesteatoma surgery are to obtain a safe, dry, hearing ear. Controversies in regard to accomplishing these objectives center on indications for staging the operation and management of the mastoid using either a canal-wall-up or canal-wall-down procedure. The author discusses in detail the indications for each procedure.

Adult↗
PubMed1987

Cochlear otosclerosis: a review of audiometric findings in 150 cases.

Audiometric findings and histories were reviewed for 150 patients diagnosed by polytomography as probable cochlear otosclerosis cases. Most patients were under 65 and had a relatively short duration of hearing impairment. Most had a mild to moderate loss with excellent speech discrimination. Seventy-five percent of the ears had acoustic reflex findings indicative of minimal stapes fixation. We recommend the acoustic reflex test for identification of patients with probable cochlear otosclerosis.

Adult↗
PubMed1985

Cholesteatoma surgery in children.

We recently reviewed the records of 1024 operations for aural cholesteatoma, of which 181 were in children. Our surgical management was the same as for adults. Complications of the disease (labyrinthine fistula, facial paralysis, total sensorineural impairment, and meningeal complications) were less common in patients under 16 years of age. This appears to be related to duration of disease rather than to age. The disease in children tends to be more difficult to eradicate. Staging the operation is required more frequently and there is a higher incidence of residual disease at planned second-stage operations. Postoperative serous otitis media, though infrequent, was more common in those patients 16 years of age and older than in children. Persistence of this middle ear fluid, requiring a ventilation tube, was more common in younger children. The functional results of reconstructive middle ear surgery were the same in adults and children.

Adolescent↗
PubMed1984

TORPs and PORPs in tympanoplasty: a review of 1042 operations.

We reviewed 1042 operations in which a Plasti-Pore prosthesis was used for reconstruction of the sound pressure transfer mechanism. In all cases cartilage was interposed between the prosthesis and the tympanic membrane or graft. The short-term hearing results for these cases are the same as for other techniques but the hearing is more stable in the long run. Other advantages of this technique are a reduced incidence of recurrent and residual cholesteatoma. Extrusion occurred in 7% of the cases but has become less frequent with recent refinements in technique. We intend to continue using Plasti-Pore prostheses in tympanoplasty.

Cartilage↗
PubMed1984

TORPs and PORPs: causes of failure--a report on 446 operations.

This is a review of the causes of failure in 5 1/2 years of personal experience with TORPs and PORPs. Prosthesis extrusion, the cause of failure in less than 5% of 446 TORP and PORP operations, usually was the result of a mucous membrane or eustachian tube problem. Severe sensori-neural hearing impairment occurred in less than 1%, and these were operations in which the oval window was opened. Unsatisfactory hearing was the cause of failure in 18%.

Cochlear Implants↗
PubMed1983

Tympanoplasty with mastoidectomy: present status.

There are many problem areas in tympanoplasty surgery. For the most part the extent of the problems relates directly to how vigorously one pursues a good functional result: the harder the surgeon tries, the more problems he may have. There are also many controversial areas in tympanoplasty, most of which relate to technique. In regard to tympanic membrane grafting and management of the sound pressure transfer mechanism, how well the surgeon performs the operation is far more important than which of the variety of techniques he uses. In relation to obtaining an air-containing mucous membrane-lined middle ear space and the management of the mastoid, there are many philosophical and emotional factors. There are many ways to manage the mastoid in cholesteatoma surgery, all of which can be successful if properly performed. We use all procedures but prefer the intact canal wall technique. The major advantage of the intact canal wall procedure is that the surgeon may avoid a post-operative mastoid cavity. The main disadvantages of this technique are the problems of recurrent and residual cholesteatoma, problems that necessitate a two-stage procedure in the majority of patients.

Cholesteatoma↗
PubMed1983

Doc's proplugs.

Explore the source record for details and available documents.

Ear Protective Devices↗
PubMed1983

A review of cholesteatoma: 1978-1981.

This is a review of the English literature relative to cholesteatoma, from 1978 through 1981. The material is presented in 13 categories: histopathology, pathogenesis, congenital cholesteatoma, cholesteatoma in children, surgical technique, complications of the disease, postoperative cholesteatoma, petrous apex cholesteatoma, reports from the Shambaugh-Shea Workshop (1979), cholesteatoma following intubation, external auditory canal cholesteatoma, extramastoid cholesteatoma, and miscellaneous articles. References are listed for all relevant articles. An abstract preceded by [AA] indicates that this is the author's abstract. An abstract not preceded by [AA] indicates an edited abstract. Material in brackets is an abstract or a comment by this reviewer.

Bibliographies as Topic↗