Biomedical subjects

Jack M Kartush

Publications and source records attributed to Jack M Kartush.

8 recordsLinked to original sources

PubMed2005

Staged resection of large acoustic neuromas.

OBJECTIVE: Surgical removal of large (>3 cm) acoustic neuromas is associated with poor long-term facial nerve function results and higher complication rates. This study analyzes whether long term facial nerve function and the incidence of neurological and vascular complications is improved by resection of large acoustic neuromas in 2 or 3 stages. PATIENTS AND METHODS: Among 660 patients who underwent surgical resection of acoustic neuromas between 1989 and 2002 by the senior author (J.M.K.), 34 (5%) patients underwent a staged resection of their large-sized tumors: stage I via a retrosigmoid craniotomy and stage II via a translabyrinthine approach. A retrospective chart review was performed. Tumor size, completeness of tumor removal, tumor recurrence, facial nerve function, and any complications were noted. RESULTS: The average tumor size was 4.4 cm with a mean postoperative length of follow-up of 6 years after the last surgery. Thirty-one patients underwent a 2-staged resection and 3 patients underwent a 3-staged resection. After their last surgery, 32 (94%) patients had excellent long-term facial function grades of House-Brackmann (H-B) I, one was H-B III, and one was H-B VI. All patients had a total or near-total (>98%) resection. There were no tumor recurrences on follow-up MRI scans. From these 71 operations, no patients required reoperation for a CSF leak. There were no deaths, strokes, hydrocephalus, or meningitis. CONCLUSION: In conjunction with the reported technical refinements, staged resection of large tumors significantly reduces morbidity and improves long-term facial nerve function. EBM RATING: C.

Facial Nerve↗

PubMed2005

Otologic effects of topical mitomycin C: phase I-evaluation of ototoxicity.

HYPOTHESIS: To determine ototoxicity of topical mitomycin C when placed in the middle ear at varying concentrations. BACKGROUND: Despite meticulous surgical technique and diligent postoperative care, some patients develop excessive scar and granulation tissue in the middle ear or mastoid cavity. Poor wound healing may result in infection, tympanic membrane perforation, or conductive hearing loss, which may necessitate further surgery. Use of topical mitomycin C in the ear may be beneficial in reducing scar and granulation tissue formation. This phase of the study was developed to determine the safety of topical mitomycin C in the rat model relative to ototoxicity. METHODS: Twelve Sprague-Dawley rats were evaluated with auditory brainstem response testing before and after treatments. Topical mitomycin C was injected in the middle ear of the right ear of eight animals. Varying concentrations of 0.125 to 0.5 mg/ml were used. Saline was injected in the left ear of each animal to serve as a control. Four separate animals were evaluated with placement of topical mitomycin C on Gelfoam into the middle ear. In two animals, Gelfoam was placed in the middle ear for 1 minute and then removed. In two animals, Gelfoam was placed in the middle ear and left in place. Auditory brainstem response testing was performed at 4 weeks and at 8 weeks. RESULTS: Using a high concentration of mitomycin C (>0.25 mg/ml) resulted in ototoxicity, with an increase in the auditory brainstem response threshold at 4 weeks and at 8 weeks. At low concentrations (<0.20 mg/ml), no change in auditory brainstem response threshold was noted. Animals treated with Gelfoam soaked in mitomycin C showed no change in auditory brainstem response threshold. CONCLUSION: The results of this study indicate that topical mitomycin C on Gelfoam applied in the middle ear appears safe when low concentrations are used, even in the rat, which has a higher susceptibility to gentamycin toxicity than humans. Higher concentrations may lead to ototoxicity based on changes in Wave V on auditory brainstem response. This treatment may prove to be an important option for patients suffering from chronic granulation tissue or scar tissue in the external or middle ear.

Administration, Topical↗

PubMed2004

Oral dextromethorphan reduces perioperative analgesic administration in children undergoing tympanomastoid surgery.

OBJECTIVE: To determine whether oral dextromethorphan (1 mg/kg) given one hour prior to surgery decreases opioid administration in the perioperative period in children undergoing tympanomastoid surgery. METHODS: This was a prospective randomized double-blinded and placebo-controlled study in which 20 male and 18 female children (age 11.5 +/- 3.5 years) were enrolled. Nineteen children received dextromethorphan (DM), while the other 19 received placebos. Postoperative pain was assessed using a visual analogue scale and a pain score of > or =5 was treated with intravenous morphine sulfate. Patients were discharged home on oral oxycodone. RESULTS: The total doses of fentanyl administered during surgery were higher in the placebo group compared to the DM group (4.1 +/- 2 vs 2.6 +/- 1.4 microg/kg, P = 0.02) and the total doses of intravenous morphine administered in the postoperative period were also higher in the placebo group compared to the DM group (150 +/- 80 vs 73 +/- 56 microg/kg, P = 0.004). The placebo group had a higher pain score at the time of admission to the Day Surgery Unit (DSU) and a higher maximum pain score, compared to the DM group, during their combined stay in the Post-Anesthesia Care Unit and DSU (7.3 +/- 1.5 vs 3.1 +/- 2.6, P = 0.001). CONCLUSIONS: Premedication with DM reduces the need for opioid administration in the perioperative period in children undergoing tympanomastoid surgery. EBM RATING: A.

Administration, Oral↗

PubMed2003

Endolymphatic sac-vein decompression for intractable Meniere's disease: long term treatment results.

OBJECTIVES: We sought to determine the long-term efficacy of endolymphatic sac-vein decompression surgery on patients with classic Meniere's disease. STUDY DESIGN AND SETTING: Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria, starting stage, functional level, vertigo class, and hearing results were addressed. We studied 68 patients with classic Meniere's disease from a tertiary, private otology-neurotology practice. Patient data were gathered by retrospective chart review, questionnaire, and patient interview. All patients underwent endolymphatic sac-vein decompression with an average follow-up period of 55 months. RESULTS: Median functional level before surgery was level 4, improving to level 2 after surgery. Eighty-one percent of patients showed improvement in functional level, 12% remained stable, and 7% declined. Long-term vertigo control was 47% in class A, 25% in class B, 9% in class C, 3% in class D, and 16% in class F. Twenty percent of patients were in hearing stage I Meniere's disease; 31%, stage II; 44%, stage III; and 5%, stage IV. Eighteen percent of patients showed improvement in hearing class, 64% were stable, and 18% declined. CONCLUSION: Endolymphatic sac-vein decompression surgery is a safe, nondestructive surgical option for Meniere's disease that offers durable control of vertigo and stabilization of hearing for the majority of symptomatic patients. SIGNIFICANCE: The beneficial long-term outcome of the endolymphatic sac-vein decompression supports its continued use as a first-line treatment option in intractable Meniere's disease.

Adult↗

PubMed2002

Intratympanic ciprofloxacin and the human labyrinthine sampling model.

OBJECTIVE: The aim of the study was to investigate the potential absorption of intratympanic ciprofloxacin through the human round window membrane. STUDY DESIGN: A prospective study. METHODS: Ciprofloxacin was instilled into the middle ear of 10 patients undergoing acoustic tumor removal. The lateral semicircular canal and vestibule were subsequently opened and, using a microsyringe, labyrinthine fluid was aspirated. A sample each of serum and cerebrospinal fluid was also drawn. RESULTS: Into each middle ear, 0.5 mL ciprofloxacin (0.3%) was instilled. The time interval between the ciprofloxacin application to the round window membrane and sampling of labyrinthine fluid and plasma ranged from 9 to 120 minutes. There was no measurable ciprofloxacin in the labyrinthine fluid, cerebrospinal fluid, or serum of 10 patients. CONCLUSION: The lack of measurable absorption of intratympanic ciprofloxacin into the inner ear indicates that the chance of ototoxicity when ciprofloxacin is used clinically, even in the presence of a tympanic membrane perforation, is low.

Aged↗

PubMed2002

Over-under tympanoplasty.

OBJECTIVE: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures. STUDY DESIGN: This study was a retrospective case review. SETTING: Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits. PATIENTS: One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years. INTERVENTION: Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included. MAIN OUTCOME MEASURES: Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. RESULTS: All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB. CONCLUSION: Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.

Adolescent↗

PubMed2002

Rapid elevation of gentamicin levels in the human labyrinth following intravenous administration.

HYPOTHESIS: Adequate quantities of labyrinthine fluid can be sampled from the human labyrinth to perform quantitative analysis of medications. A rapid elevation of intralabyrinthine gentamicin levels after intravenous administration can be measured. A model for the sampling of human inner ear fluid in this manner is described. BACKGROUND: The risk of aminoglycoside ototoxicity has been a long-standing concern. The kinetics of gentamicin diffusion into the inner ear have been extrapolated to humans from various animal models. The validity of extrapolation to humans is unknown. We have developed a new model to measure the uptake of gentamicin in vivo. METHODS: A single intravenous dose of gentamicin (80 mg) was given perioperatively to 13 patients undergoing translabyrinthine acoustic neuroma surgery. The lateral semicircular canal and vestibule were opened and a microsyringe was used to obtain a sample of labyrinthine fluid concomitant with a serum sample. The gentamicin concentration of the labyrinthine fluid and serum was analyzed using a standard chemistry analyzer. RESULTS: After parenteral administration of gentamicin, fluid was obtained from the inner ear of 13 acoustic neuroma patients. Inner ear concentrations were between 1.0 and 3.8 mg/L. Serum gentamicin levels ranged from 1.2 to 10.5 mg/L. CONCLUSIONS: This method allows the sampling of intralabyrinthine fluid in humans. Gentamicin was noted immediately in the labyrinth after intravenous administration. This model may be expanded to measure other compounds given either by intravenous or transtympanic routes.

Adult↗

PubMed2002

Round window gentamicin absorption: an in vivo human model.

OBJECTIVE/HYPOTHESIS: Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured. STUDY DESIGN: A prospective study. METHODS: Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative). The lateral semicircular canal and vestibule were opened, and by means of a microsyringe, labyrinthine fluid was aspirated. A sample of serum was also drawn. In all patients cerebrospinal fluid was also drawn. The samples were analyzed using a standard chemistry analyzer. RESULTS: Intratympanic gentamicin diffused through the round window membrane and achieved concentrations in the labyrinthine fluid ranging from 0 to 16 mg/L. Intratympanic gentamicin was absorbed into the systemic circulation in 4 of 11 patients with serum levels ranging from 0.3 to 0.4 mg/L. No gentamicin was detected in the cerebrospinal fluid. CONCLUSIONS: Intratympanic gentamicin diffuses rapidly through the round window membrane and achieves significant levels in the inner ear. Thus, this new model can be used to assess round window permeability to clinically relevant medications such as steroids and ototopical antibiotics.

Adult↗