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Biomedical subjects

J M Epley

Publications and source records attributed to J M Epley.

13 recordsLinked to original sources
PubMed2001

Human experience with canalith repositioning maneuvers.

Three distinct pathological conditions, related to different means by which dense intralabyrinthine particles interfere with the function of a semicircular canal and cause nystagmus and vertigo, are amenable to treatment with repositioning maneuvers. Known as benign paroxysmal positional vertigo and variants, these conditions are better designated collectively by the term "vestibular lithiasis." Each form requires a different treatment strategy of head maneuvers and application of other modalities to restore normal semicircular function and thereby eliminate the positional nystagmus and vertigo. Real-time observation of the nystagmus induced by the particles during the maneuvers can greatly facilitate the repositioning process.

Ear, Inner↗
PubMed1996

Particle repositioning for benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo is a common condition that can be severely incapacitating. The causative mechanism is usually displaced dense particles (canaliths) in a semicircular canal. By means of canalith repositioning, these particles can be moved into the utricle and the symptoms completely resolved in a high percentage of cases. The protocol for procedure is discussed as well as the management of complications and recurrences.

Follow-Up Studies↗
PubMed1995

Positional vertigo related to semicircular canalithiasis.

My clinical and laboratory observations support the theoretical concept that the mechanism of typical nystagmus, and most forms of atypical transient nystagmus, is hydrodynamic drag by gravitating free densities--most commonly displaced otoconia--in the endolymph of a semicircular canal; and that these "canaliths" have a significant mechanical advantage, by virture of the canal/ampulla cross-sectional differential, over densities acting directly on the cupula. Positional vertigo related to apparent canalithiasis (benign paroxysmal positional vertigo) is a common cause of incapacitation. The profile of the concomitant nystagmus localizes the semicircular canal involved. The canalith repositioning procedure, appropriately administered and targeted according to the observed nystagmus, provides a highly effective means for control of symptoms and a valuable resource for diagnostic evaluation of the more complex case. Surgery is rarely indicated.

Ear Canal↗
PubMed1992

The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.

The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity-sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.

Adult↗
PubMed1977

Modified technique of iontophoretic anesthesia for myringotomy in children.

A modified technique is described for iontophoretic anesthesia in children who require myringotomy and insertion of a tube (tympanostomy). Principal modifications include the following procedures: (1) preoperative parenteral sedation; (2) relatively painless injection of lidocaine hydrochloride-epinephrine hydrochloride solution into the external auditory canal skin after iontophoresis alone to eliminate the extreme bony canal wall tenderness; (3) injection of lidocaine-epinephrine solution into an atelectatic middle ear to anesthetize the promontory for painless tube insertion; (4) substitution of a disposable ECG electrode for a metal plate electrode to eliminate the possibility of electrical burn from metal-to-skin contact. These modifications enhance the effectiveness and the safety of iontophoretic anesthesia, minimize the need for general anesthesia, and liberalize the indications for tympanostomy.

Adolescent↗
PubMedDate not supplied

Singular neurectomy: hypotympanotomy approach.

A modified surgical technique is described for singular neurectomy. The hypotympanotomy approach provides greater ease in exposing the singular canal. Delayed round window overhang removal provides decreased risk of round window trauma. Eight cases done by this technique indicated a lower complication rate than any reported transmeatal series. Selection criteria, results, and complications are discussed. The risk of cochlear damage limits singular neurectomy to patients who are severely incapacitated by benign paroxysmal positional vertigo. Compared with vestibular neurectomy, singular neurectomy avoid risks inherent in intracranial procedures, and the vertigo caused by surgical intervention is less pronounced.

Adult↗
PubMedDate not supplied

New dimensions of benign paroxysmal positional vertigo.

Twenty-nine patients who demonstrated the classic nystagmus of benign paroxysmal positional vertigo in the provocative, ear-down position had a high incidence of concurrent symptoms. These included vertigo provoked by arising, bending over, head rotation, linear acceleration, and vertical oscillation. Some have not been reported previously in relation to this syndrome. Elimination of both concurrent and classic symptoms via singular neurectomy in nine patients indicates a common pathophysiologic mechanism, probably involving cuplolithiasis in the posterior semicircular canal. These concurrent symptoms should be considered part of the syndrome.

Adult↗
PubMedDate not supplied

Reflexogenic vertigo treated by tensor tympani transection.

Two patients complained of severe vertigo following eructation or hiccup. One patient was poststapedectomy; the other had idiopathic cochlear degeneration. The symptoms were reproduced by Hennebert's test in the pathologic ear. The tensor tympani was transected in both patients. An endolymphatic sac procedure was performed concomitantly in the second patient. Both patients had immediate relief of symptoms. It is hypothesized that these reflex phenomena, which elicited vertigo, were accompanied by tensor tympani contraction, which resulted in medial movement of the stapes or prosthesis, and that this movement was transmitted via adhesions to vestibular endorgans to produce the described symptoms.

Adult↗
PubMedDate not supplied

Tympanic membrane debridement with the CO2 laser.

Precise control of tissue penetration can be provided by the CO2 laser at low power. AT 1 W, superficial lesions of the tympanic membrane were successfully extirpated in ten patients. The beam produced immediate delamination and carbonization of the external layer, which usually included the lesion, with no apparent effect on the underlying tissue. This charred layer was easily removed mechanically in a bloodless field. No permanent perforations resulted. Extirpation of canal lesions was less effective.

Adult↗