Biomedical subjects
Publications and source records attributed to J Stahle.
A retrospective study of 161 Meniére patients followed up for 9 years or more is presented. The development with respect to hearing, caloric response, vertigo and ability to work was analysed. The main functional loss was found to take place early in the course of the disease. There was an increase in bilaterality with time. Spontaneous relief in vertigo over the years has been noticed.
The histopathological picture in Meniere's disease was described for the first time in 1938, in two independent reports. One was by Hallpike & Cairns in Great Britain, and the other by Yamakawa in Japan. Selections of illustrations from these two reports have been compiled and compared.(ABSTRACT TRUNCATED AT 250 WORDS)
A retrospective study of 161 patients with Menière's disease followed up for 9 years or more is presented. The development, with respect to hearing, caloric response, vertigo, and ability to work, was analyzed. The main functional loss was found to take place early in the course of the disease. There was an increase in bilaterality with time. A spontaneous relief in vertigo over the years has been noticed.
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On the basis of data obtained from different sources, the incidence of clinical otosclerosis in Sweden in the year 1981 was estimated to be 6.1 cases per 100,000 population. This figure is lower than others reported previously. The annual incidence of stapedectomies is 8.3 per 100,000 population.
Ten-year clinical results are reported on the first five inner ear valve implants done in Sweden in 1975 and 1976. If the patient had a positive glycerol dehydration test (n = 4) the chances of excellent results for hearing at one year as well as complete elimination of vertigo were high. At ten years, two of the four patients with positive glycerol dehydration tests maintained excellent hearing and complete elimination of vertigo. One patient's hearing deteriorated, but he was still completely free of vertigo at ten years. One patient had a labyrinthectomy at three years, but now we would have considered a revision valve implant before a destructive procedure. The patients who had clinical evidence of bilateral disease did not do as well at ten years as patients with unilateral disease. With ten year follow-up it has been shown that the inner ear valve implant is a safe and effective nondestructive alternative to labyrinthectomy for salvaging patients who failed medical therapy.
Familial forms of Meniere's disease in which the main etiologic factor is probably genetic are described. Among ninety-one patients with Meniere's disease from the county of Uppsala, the disease could be classified as being of familial origin in 14%. Different modes of inheritance were revealed. Aberrations in chromosome 7 were found in one mother and her daughter.
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A retrospective study of 161 Meniere patients followed up for 9 years or more is presented. The development with respect to hearing, caloric response, vertigo and ability to work was analysed. The main functional loss was found to take place early in the course of the disease. There was an increase in bilaterality with time.
Fluctuations in hearing are thought to reflect varying degrees of endolymphatic hydrops. Spontaneous fluctuations are often reported by patients with idiopathic Meniere's disease and have been verified by audiometry in more than 50% of cases. The hearing loss occurs mainly during the first 5 to 10 years of the disease. It is therefore important to commence therapy, regardless of type, at an early stage. The varying course of the disease makes it difficult to assess the effect of medical treatment. Widely accepted recommendations include special diet, salt restriction, diuretics, corticosteroids, and vasodilators. Among diuretics, benzthiazides, potassium-sparing types, and furosemide have been considered beneficial. Transient improvement in hearing can be achieved by osmotic expanders such as glycerol, urea, mannitol, and isosorbide. Glycerol and urea have been widely used as test substances for confirmation of suspected endolymphatic hydrops. Urea and isosorbide, both of which can be taken orally, have also been used for medication.
Among 74 patients treated with cis-diamminedichloroplatinum in total doses of 130-590 mg/m2 body surface area, high tone hearing loss was observed in 3. The caloric and rotatory responses were reduced in 3 other patients. Optokinetic responses remained normal in all patients.
By using the quantification method for multidimensional qualitative data, 13 variables were analyzed. The younger the patient, the stronger was the correlation between age and positive glycerin and urea tests. At ages over 50 years no correlation with positive test results was found. The longer the duration of disease, the stronger was the correlation between this duration and a positive urea test. The glycerin test showed no correlation with the duration of the disease. Hearing losses of 40 to 69 dB. were correlated with both a positive glycerin test and a positive urea test. Greater hearing losses were correlated only to a positive glycerin test. Hearing losses less than 39 dB. were not correlated with positive results in either the glycerin or the urea test.
Hearing was studied in nineteen patients with Meniere's disease before and after administration of three different hyperosmolar solutions-glycerol, ethanol, and Mannitol. Ethanol and Mannitol were found to be much less effective than glycerol in producing hearing gain. Alternative mechanisms underlying the observed differences are discussed.
The petrous portion of the temporal bone in patients with Meniere's disease differs from that of healthy individuals mainly in its lack of periaqueductal pneumatization and its consequently short and narrow vestibular aqueduct. Diminished pneumatization may have an impact upon the tomographic reproducibility of the aqueduct. A total lack of periaqueductal pneumatization is prevalent in long-standing Meniere's disease. Tomography may serve as a tool by providing a basis for the choice of surgical procedure. Roentgenologic and histologic studies have indicated that the pars rugosa of the endolymphatic sac in normals mainly is housed inside the distal part of the vestibular aqueduct. In patients with Meniere's disease, the sac might be located outside the aqueduct and therefore deprived of the functions of the loose and highly vascular tissue normally surrounding it within the aqueduct. This might influence the total vascular supply of the sac, thereby interfering with its resorptive and immunodefensive functions.
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A resurgence of interest in surgery on the endolymphatic sac (ELS), not only for relief of vertigo but also for stabilization or improvement of hearing, has emerged. With the concept of operating early in the course of the disease after the diagnosis is well established, various modifications of existing procedures on the ELS have been utilized in an attempt to improve the overall results. One such major modification is the unidirectional inner ear valve implant modified from the eye valve for glaucoma. This valve implant has produced impressive one-year results for both hearing improvements and relief of vertigo in patients who were scheduled for labyrinthectomy. Subsequent preliminary reports by several investigators show good to excellent results for the hearing (AAOO--Class B or A) as well as the vertigo without consideration for the stage of the disease. This study presents primarily the step by step technique with drawings and a color atlas to facilitate the correct performance of this surgery.
A unidirectional inner ear valve implant was developed to direct excess endolymph out of the inner ear in the hydropic state (Ménière's disease) into the mastoid cavity. A detailed technical description of the valve implant is presented as well as some technical aspects of the valve implant based on the surgical anatomy of the endolymphatic sac.