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Biomedical subjects

J W House

Publications and source records attributed to J W House.

At least 19 recordsLinked to original sources
PubMed1992

Tympanosclerosis of the stapes: hearing results for various surgical treatments.

When tympanosclerosis involves the tympanic membrane or the lateral ossicles, treatment is usually straightforward and uncomplicated. When the stapes is involved, therapy is more controversial and may be more difficult. We report our results in 154 patients who underwent different surgical procedures for tympanosclerosis of the stapes. Followup was up to 10 years. Pure-tone average threshold was significantly improved (p < 0.05) in patients who underwent mobilization procedures or stapedectomy for definitive treatment. The air-bone gap was less than 20 dB at 6 months postoperative in 72% of patients and less than 30 dB in 90%. At 6 months, 2 years, and 5 years there were no statistically significant differences in hearing results between stapedectomy and mobilization patients, some of whom were followed for up to 10 years. No patient had a profound hearing loss after surgery. Surgical treatment for tympanosclerosis of the stapes is a safe procedure, with hearing results similar to those of surgery for other chronic ear diseases involving the ossicular chain.

Adult↗
PubMed1991

Perilymph fistulas: the House Ear Clinic experience.

The diagnosis, evaluation, and surgical treatment of perilymph fistulas has recently been the focus of a great deal of attention in otology. Authors have focused on perilymph fistulas as the cause of hearing loss and vertigo in many diverse situations. Additionally, surgical repair has been suggested when there is little objective support for intervention. To address some of the problems inherent in the diagnosis and treatment of perilymph fistulas, records of patients operated on at the House Ear Clinic during the past 12 years were reviewed retrospectively. Eighty-six patients were surgically explored for fistulas during this period. Thirty-five (40.7%) fistulas were found, and 51 ears were patched whether fistulas were found or not. Of the 80 patients who were seen for follow-up, 35 (43.8%) were subjectively better, and 45 (56.2%) were the same. Although the number of fistulas found and the number of patients improved were similar, the composition of the two groups was different. On the basis of audiometric results, improvement in hearing occurred in only 18.7% of the patients. None of the demographic factors or diagnostic tests were predictive of either the presence of a fistula or the therapeutic outcome. Further work is required to facilitate the preoperative diagnosis of fistulas and to design appropriate surgical intervention.

Adolescent↗
PubMed1991

Perilymphatic fistula: surgical experience in the United States.

One survey sent to 6953 individual otolaryngologic practices and 106 departments of otolaryngology at teaching hospitals in the United States, and a more limited survey of 75 patients operated on for perilymphatic fistula (PLF) at the House Ear Institute, addressed aspects of managing PLF: surgical incidence, reliability of diagnostic test, preoperative observations, and disability after surgery. Of surgeons sampled, 93% estimated incidence of PLF surgery to be less than or equal to 1 per 1000 otolaryngologic outpatient visits. The most reliable diagnostic indicators were history, symptomatology, and tympanometric and electronystagmographic fistula tests. About 72% of surgeons reported less than 4 weeks' average delay before surgery. Most surgeons and patients (greater than or equal to 70%) rated length of disability before return to work, exposure to noise, travel by airplane, swimming, and heavy lifting, at several weeks to several months. Diving was the most restricted activity. Results suggest that incidence of surgery and disability with PFL in the United States is very limited.

Acoustic Impedance Tests↗
PubMed1990

Is there consensus in perilymph fistula management?

A perilymph fistula is an abnormal communication between the inner ear fluids and the middle ear space. This article identifies areas of agreement in perilymph fistula management based upon 167 questionnaire responses from active surgeons of the American Otological Society and the American Neurotological Society. The average respondent performed 4.6 fistula explorations among 197 otologic surgeries (some of these were myringotomies) per year. The following statements represent areas of general agreement. The single most important feature of the history is previous trauma or barotrauma. At present no test can replace clinical judgment; however, despite sound judgment and sophisticated testing, it is very difficult to document the presence or absence of a fistula preoperatively. Most often the diagnosis is based on the total clinical picture: history, physical examination, and laboratory testing.

Ear Diseases↗
PubMed1990

Adenomatous tumors of the middle ear and mastoid.

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate. The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens. Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facial nerve. On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions: 1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology. 2. There is a high rate of local recurrence. 3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary. 4. Primary surgical treatment is required.

Adenocarcinoma↗
PubMed1989

Perilymph fistulas in children: experience of the Otologic Medical Group.

We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Neuromas of the facial nerve.

Forty-eight patients with facial nerve neuromas were treated at the Otologic Medical Group Inc. between 1974 and 1985. The most common presenting symptoms were hearing loss and tinnitus. Facial paralysis occurred in 22 patients (46%). A mass behind the tympanic membrane was seen on otoscopy in 14 patients (29%). These tumors typically involved more than one segment of the nerve and eroded otic capsule bone in 14 patients (29%). High resolution computed tomography (CT) was highly accurate in determining the extent and location of these tumors. Restoration of the continuity of the nerve was undertaken at the time of tumor removal. The major determinant of the ultimate status of facial nerve function was the duration of preoperative paralysis.

Adolescent↗
PubMed1988

Vertigo in postoperative follow-up of otosclerosis.

Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.

Follow-Up Studies↗
PubMed1987

Acoustic tumor management in senior citizens.

We reviewed records of 116 consecutive acoustic tumor surgery patients aged 65 and older during the 10 years ending in 1984. One hundred six had total removal. Ninety-four (81%) had no intraoperative complications and 66 (57%) had no postoperative complications. Only one patient, who had previously undergone partial removal elsewhere, died. Because tumors grow at 2 mm per year, and because elderly patients can expect to live up to 18 more years, we recommend planned total removal of an acoustic tumor as the management of choice for senior citizens in good health. We feel that the advantages of immediate surgery outweigh the risks of delayed surgery when age is advanced, the tumor is enlarged, and general health may be declining.

Age Factors↗
PubMed1986

Calcitonin as treatment for hearing loss in Paget's disease.

Progressive hearing loss is a potential complication of Paget's disease, a metabolic disorder of accelerated bone formation and resorption. Calcitonin (Calcimar) is a recently introduced synthetic hormone used as a systemic treatment. Some studies have shown it to halt the progression of hearing loss. This is the first study of the effects of calcitonin on hearing loss to use a large number of patients with continuous use of the drug and long-term follow-up. It confirms that the drug is effective. We conducted chart reviews to compare the degree of hearing loss over time in 45 patients. Twenty-six patients have been taking salmon calcitonin for five to eight years to date and nineteen have received no treatment. Hearing loss was recorded at the initial examination (trial 1), one to four years later (trial 2), and then one to five years after the second evaluation (trial 3). Statistical analyses show a strong relationship between treatment and rate of hearing loss. The average hearing loss in the control group progressed from 47 dB in the first trial to 59 dB in the second trial to 75 dB in the third trial. Average hearing loss in the treated group remained at 47 dB over time. The difference in hearing loss over time between the two groups was less than 1 dB for the treated group and more than 28 dB for the control group. Results thus clearly show that calcitonin is effective in halting the progression of hearing loss in Paget's disease.

Aged↗
PubMed1986

Aural cholesteatoma extending into the posterior fossa.

The case of a residual aural cholesteatoma extending into the posterior cranial fossa after radical mastoidectomy is presented. The importance of distinguishing this lesion from primary cholesteatoma of the cerebellopontine angle is discussed. The safety of canal-wall-down procedures is also discussed.

Cerebellar Diseases↗
PubMed1984

Retrolabyrinthine vestibular nerve section: a viable alternative to the middle fossa approach.

Vestibular nerve section, whether by the middle fossa or retrolabyrinthine approach, is effective in relieving intractable vertigo while preserving hearing. However, the potential morbidity and technical difficulty of the middle fossa approach have limited its usefulness. In an attempt to determine if the two approaches produce comparable results, we evaluated 52 patients who underwent retrolabyrinthine vestibular neurectomy between April 1981 and March 1983 at the Otologic Medical Group. We compared their audiometric data and questionnaire responses with published data on patients who had a middle fossa vestibular neurectomy. Although differences between the two procedures do exist, the retrolabyrinthine method, with its 93% success rate in improving or resolving vertigo and its zero incidence of total sensorineural hearing loss, offers the surgeon a strong alternative to the middle fossa approach.

Adult↗
PubMed1984

Retrolabyrinthine section of the vestibular nerve.

When symptoms of dizziness and episodic vertigo cannot be controlled through medical management or drainage procedures such as endolymphatic subarachnoid shunt operations, selective vestibular nerve section may be necessary. In the 1920s eighth cranial nerve sections were performed by neurosurgeons through the suboccipital approach but were frequently associated with hearing loss and facial paralysis. The middle fossa approach has been popularized by Dr. William House and others as a method of selectively sectioning the vestibular nerve and preserving facial and cochlear function. More recently the suboccipital retrolabyrinthine approach has been described as a method of selectively sectioning the vestibular nerve. We have reviewed 42 cases of suboccipital retrolabyrinthine selective section of the vestibular nerve performed at the Otologic Medical Group over the past 2 years. The shortest follow-up on these patients has been 6 months. Thirty-two patients had preoperative diagnosis of Meniere's disease, and of these patients 25 had had previous endolymphatic subarachnoid shunt surgery. Eighty-five percent (27 patients) experienced complete relief of vertigo following surgery, while 6% (two patients) stated they were improved. Three patients reported no relief. There were 10 patients with dizziness who had a diagnosis other than Meniere's disease. In this diverse group three experienced complete relief of vertigo, five were improved, and two reported no improvement of vertigo following surgery. None of the patients lost his hearing as a result of the surgery and there was no facial weakness. One patient had postoperative CSF rhinorrhea and another had meningitis.

Dizziness↗
PubMed1983

Acute mastoiditis in children: a review of 54 cases.

Fifty-four children with acute mastoiditis were managed at the Los Angeles County-University of Southern California Medical Center from 1972 through 1982. Our criteria for the diagnosis of acute mastoiditis are acute or subacute otitis media, postauricular swelling and erythema, protrusion of the auricle, and clouding of mastoid air cells on radiographs. Thirty-one (57%) recovered with conservative therapy consisting of early myringotomy and intravenous antibiotic, usually ampicillin. Twenty-three patients were managed surgically. The indication for surgery in each case was the clinical diagnosis of subperiosteal abscess; mastoid radiographs played no part in the decision to operate. Two of the 23 patients managed surgically had only incision and drainage of abscess; simple mastoidectomy was performed on 20 and radical mastoidectomy on one. Etiologic bacteria were cultured in 21 instances, S. pyogenes was cultured in 9, S. pneumoniae was cultured in 6, H. influenzae in 1, enterococci in 1, anaerobes in 2, and M. tuberculosis in 2.

Acute Disease↗