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Biomedical subjects

J Nedzelski

Publications and source records attributed to J Nedzelski.

At least 19 recordsLinked to original sources
PubMed2001

Reliability of the Sunnybrook Facial Grading System by novice users.

OBJECTIVES: To evaluate the intrarater and inter-rater reliability of the Sunnybrook Facial Grading System (SFGS) by novice users. DESIGN: Prospective interval study using one measurement instrument. SETTING: Tertiary teaching hospital (Sunnybrook & Women's College Health Science Centre). METHODS: Twenty-two patients with a wide spectrum of facial dysfunction recorded on videotapes were rated using the SFGS by eight novice observers independently in two different sittings separated by 3 weeks. The order of patients was randomized for the second sitting. Intraclass correlation coefficients were calculated for component scores and for total scores within and between raters. RESULTS: The intrarater reliability coefficients for the eight raters ranged from .838 to .929. This largely overlaps with the data obtained in previous studies with expert raters. The inter-rater reliability for all eight raters at time 1 was .982 and for time 2 was .970. This is higher than what was previously obtained with expert raters. CONCLUSION: The SFGS is as reliable when applied by novice users as by expert users.

Facial Nerve Diseases↗
PubMed2000

Does intratympanic gentamicin treatment for Meniere's disease cause complete vestibular ablation?

OBJECTIVE: To determine changes in vestibular function following intratympanic gentamicin (ITG) treatment for Meniere's disease and to correlate changes with the need for further treatment. STUDY DESIGN: Prospective case series. PATIENTS: One hundred and three patients with disabling unilateral Meniere's disease who had failed a minimum of 6 months medical treatment. MAIN OUTCOME MEASURES: Vestibular function was measured by electronystagmography (ENG) caloric testing before and serially following treatment. Caloric responses were classified as normal (excitability difference [ED] < 25%), bithermal response (ED > or = 25%), positive response to ice water only, and absent ice water response. RESULTS: Twenty-one percent of patients had a bithermal caloric response, 62% had an absent ice water response, and 17% had an ice water response only 1 month following treatment. Mean follow-up was 27.3 months (range = 1-106 months). Eighty-four patients had one treatment course only. Fourteen patients required a further course of treatment due to recurrence of vertigo; 38% of these had recovery of caloric function. Significantly more patients with normal caloric function prior to initial treatment required further treatment compared to those with initial reduced caloric function (p < .05). Patients rendered absent ice water responsive were significantly less likely to require further treatment than those with a persistent caloric response (p < .0001). CONCLUSION: An absent ice water response is highly predictive of adequate vertigo control. Regimens of ITG that aim to completely ablate vestibular function are recommended.

Adult↗
PubMed2000

Surgical outcome after paediatric cochlear implantation: diminution of complications with the evolution of new surgical techniques.

OBJECTIVE: Cochlear implantation is a commonly performed surgical procedure with specific aspects in the paediatric population. The surgical outcome associated with this procedure in a paediatric population is analyzed. METHOD: A retrospective study was performed of all children receiving a cochlear implant at The Hospital for Sick Children from 1990 to 1998. During this period, 104 patients received a cochlear implant. RESULTS: The complications encountered were classified as major (4%), minor (3%), and device failure (2%). The surgical techniques developed to decrease complications are discussed. CONCLUSION: Paediatric cochlear implantation is a safe procedure with a low incidence of complications. Nevertheless, the surgeon is now facing new challenges with cochlear implantation performed in patients with an abnormal cochlea, who carry a higher rate of complications, and cochlear reimplantation in case of device failure.

Adolescent↗
PubMed2000

[Surgical techniques and complications of pediatric cochlear implantation].

INTRODUCTION: Cochlear implantation has been performed in children since 1980, with thousands of children already implanted. The incidence of complications is around 7 to 10% in the literature. METHODS: This is a retrospective study of all children receiving a cochlear implant at the Hospital for Sick Children over 9 years. Surgical technique and outcome are analysed. RESULTS: There were 7 complications, all successfully treated, and involving no further consequences. 4 reimplantations were performed for device failure. DISCUSSION: Paediatric cochlear implantation is associated with a low incidence of complications. In this series, no complications were encountered on reimplantation.

Adolescent↗
PubMed1998

Surgical outcomes of paediatric cochlear implantation: the Hospital for Sick Children's experience.

OBJECTIVE: Cochlear implantation in children represents a special challenge for the otologist because of such factors as skull dimensions and postimplantation temporal bone growth. As implant programs accrue increasing numbers of children, surgical factors relating to outcomes can be analyzed. METHOD: A retrospective study was performed of all children receiving a cochlear implant from January 1990 through May 1997 at The Hospital for Sick Children (HSC). The surgical procedure as well as the complications encountered were examined. Fifty two children, 28 females (54%) and 24 males (46%) were implanted. RESULTS: Overall, the average age at time of implantation was 7.0 years (range, 1.9-17.3 yr). The presumed cause of deafness was acquired in five children (10%) and congenital in the remaining 47 patients (90%). A recognized syndrome was associated with the hearing loss in only three patients. There were two minor complications (3.8%) and two major complications (3.8%) with an overall complication rate of 7.6%. There were no episodes of device or electrode migration. Two surgical innovations are also discussed: 1) a new periosteal flap design which decreases device mobility, and 2) a new technique for electrode fixation (NED's knot). CONCLUSION: The HSC experience represents the largest paediatric cochlear implant series in Canada. The findings indicate that the procedure is safe and is associated with infrequent morbidity.

Adolescent↗
PubMed1998

A study of vestibular schwannomas using positron emission tomography and monoclonal antibody Ki-67.

OBJECTIVE: This study aimed to evaluate the role of positron emission tomography (PET) as an in vivo determinant of tumor aggressiveness and growth. STUDY DESIGN: The study design was a prospective pilot study. SETTING: Positron emission tomography was performed at the Clarke Institute of Psychiatry. All patients were treated at the Sunnybrook Health Science Centre. Both institutions are affiliated with the University of Toronto, Toronto, Canada. PATIENTS: The study consisted of five consecutive patients with vestibular schwannomas with tumor size of 1 cm or larger within the cerebellopontine angle. One was a recurrent tumor and four were primary tumors. INTERVENTIONS: Preoperative PET studies were conducted using 18-fluorodeoxyglucose (FDG) as a radionuclide tracer to measure glucose metabolism within tumors. Tumors were processed and immunostained against Ki-67 nuclear antigen; their proliferative potentials were quantified based on immunoreactivity of tumor cells. MAIN OUTCOME MEASURES: Tumor metabolic activity on PET was compared with that of contralateral cerebellum to arrive at an FDG index. This number was compared with clinical parameters and Ki-67 reactivity. RESULTS: On PET, all tumors showed less metabolic activity than the cerebellum. The FDG uptake varied greatly between tumors independent of clinical parameters. All the tumors had a low proliferative index (<5%) with immunohistochemistry; there were quite a bit of intralesional variations in proliferative activities. CONCLUSION: Large tumor size and recurrent disease did not correlate well with increased FDG uptake on PET. Similarly, they did not show increased cellular activities as expressed by Ki-67 immunostaining.

Adult↗
PubMed1997

Comparative psychophysical evaluation in cochlear implantation: electrical and magnetic stimulation.

Transtympanic electrical stimulation, either in the form of round window or promontory placement of electrode prior to cochlear implantation is an accepted and commonly used psychophysical tool. Certain response parameters have been identified as predictors of outcome. This study compared the subjective auditory responses generated by promontory electrical stimulation (PES) with those from two noninvasive modalities, namely peritympanic electrical stimulation (PTES) and transcranial magnetic stimulation (TMS). Ten postlingually deafened adult cochlear implant candidates were studied. Standard psychophysical parameters were obtained from patients undergoing PES and PTES. A more subjective form of evaluation was conducted for TMS. Subsequently, nine patients received the multichannel Nucleus (Cochlear Corp., Denver, CO, U.S.A.) implant and one patient a Clarion (Advanced Bionics, Sylmar, CA, U.S.A.) implant. Compared with PES. PTES elicited increased threshold responses with similar dynamic ranges between 50 and 400 Hz of stimulation. The differences were, by and large, insignificant. PTES appeared to be a useful alternative in selected individuals owing to its noninvasiveness. TMS, on the other hand, was incapable of clearly inducing auditory percepts. It also produced concomitant facial and trigeminal stimulation, limiting its potential use as a prognostic tool.

Adult↗
PubMed1997

The Paediatric Cochlear Implant Program at the Hospital for Sick Children, Toronto.

Ontario has a province-wide program for provision of cochlear implants. Toronto's Hospital for Sick Children is one of three designated centres that service the paediatric population. This cochlear implant program was established in 1989. Since that time, 37 children (as of May 1996) have been provided with cochlear implants. The program also services Ontario residents who were implanted elsewhere. In the following, we provide a detailed description of the program, including the processes through which children are selected as candidates, the follow-up studies that we carry out, and the roles of various health care professionals involved. We present a demographic survey of our patient population to date, and discuss some of the important issues relating to candidacy.

Child, Preschool↗
PubMed1994

The horizontal vestibulo-ocular reflex gain during active and passive high-frequency head movements.

Patients with bilateral peripheral vestibular loss complain of varying degrees of oscillopsia and balance difficulties. Some are able to engage in sporting activities while others are completely disabled. An assumption that other inputs are available to the vestibulo-ocular reflex (VOR) enabling it to achieve some degree of visual stability during high-frequency head movement is reasonable. In this study, the gain of the horizontal vestibulo-ocular reflex in 10 healthy subjects was examined during active high-frequency head-on-body rotation (head free), and compared to high-frequency passive whole-body rotation (head fixed). A statistical difference in the gain (P < .002) was noted for all frequencies between the two groups. In those individuals undergoing passive whole-body high-frequency movements, the gain was observed to rise (above unity) with increasing frequency of rotation, while the gain during active head-on-body rotation remained close to 1.

Adult↗
PubMed1987

The University of Toronto cochlear implant study: a clinical overview.

The process of patient selection for a cochlear implant varies significantly from center to center. The University of Toronto Cochlear Implant Study Group has adopted a protocol which is unique in this regard. This overview highlights our selection process, details aspects of temporary electrode insertion and describes clinical findings considered to be of relevance.

Audiometry, Evoked Response↗
PubMed1986

The use of a temporary extracochlear electrode in preoperative testing of permanent implant candidates.

This paper describes hearing and speech perception in 9 post-lingually deaf adults fitted with a temporary single electrode, surgically positioned close to the round window niche. After baseline testing, unaided and aided binaurally with the high-power Phonic Ear PE 845, each subject was admitted to hospital for a period of 7 days. During each test session, stimuli were presented directly to the electrode lead by means of an isolation unit. Current thresholds, upper tolerable limits and gap detection were measured for various acoustical waveforms and stimulus frequencies. A laryngograph was used to test the discrimination of prelinguistic and suprasegmental speech features. The results indicated that the prosthesis could provide acoustic sensations of loudness, pitch and duration that changed with stimulus waveform, level of current and frequency, and a gap threshold less than 50 msec. Lipreading appeared to be a necessary adjunct for consonant discrimination.

Adult↗
PubMed1979

Immunological parameters in perennial rhinitis.

As part of a study of the effectiveness of beclomethasone dipropionate in perennial rhinitis five immunologically related parameters were measured. These included skin tests, total IgE, specific IgE, nasal and peripheral blood eosinophil counts. In addition, nasal biopsies were obtained in twenty out of sixty patients. It was apparent that patients with perennial rhinitis formed a heterogeneous group who could be divided into three groups based on the extent of immunological abnormality detected. Group 1 consisted of twenty patients who displayed no abnormality in any of the five parameters studied. Group 2 consisted of twenty-six patients in whom specific IgE was not detected but who had varying degrees of abnormal findings in the other laboratory parameters. The remaining fourteen patients formed a third group in whom specific IgE was detected in addition to abnormalities in other parameters. In general, patients with detectable specific IgE had a higher frequency of abnormal parameters, including abnormal histology of their nasal biopsy, than patients in whom no specific IgE was detected. The heterogeneous nature of perennial rhinitis is discussed. Despite the heterogeneous nature of the total patient group, the majority of patients (80%) treated with beclomethasone dipropionate improved compared to 20% improved in the placebo group. There was no difference in the drug effect between the three groups of patients.

Adolescent↗
PubMed1975

Diagnostic value of meatocisternography.

Based on a review of 123 consecutive examinations a classification of ten types of meatocisternograms is proposed. Surgical correlation in 53 of these cases has shown that other causes of intrameatal filling defects may mimic acoustic neurinoma presence. Furthermore, grouping of these 123 patients into three clinical groups on the basis of symptoms and findings has not resulted in a clear type correlation when using a mixture of the ethyl esters of 9- and 10- monoiodostearates (Duroliopaque). Based on an experience using this classification in well over 500 meatocisternograms, several proposals are made for the clinical management of cases of clear-cut or suspect acoustic neurinomas.

Arteries↗
PubMedDate not supplied

Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants.

A model of auditory performance and a model of ganglion cell survival in postlinguistically deafened adult cochlear implant users are suggested to describe the effects of aetiology, duration of deafness, age at implantation, age at onset of deafness, and duration of implant use. The models were compared with published data and a composite data set including 808 implant users. Qualitative agreement with the model of auditory performance was found. Duration of deafness had a strong negative effect on performance. Age at implantation had a slight negative effect on performance, increasing after age 60 years. Age at onset of deafness had little effect on performance up to age 60. Duration of implant use had a positive effect on performance. Aetiology had a relatively weak effect on performance.

Adolescent↗