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Biomedical subjects

Jamie M Rappaport

Publications and source records attributed to Jamie M Rappaport.

6 recordsLinked to original sources
PubMed2005

Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling.

OBJECT: Preservation of hearing has become a standard goal in selected patients undergoing surgery for a vestibular schwannoma (VS). This study was aimed at analyzing the role played by filling of the internal auditory canal (IAC) as well as those played by preoperative hearing quality, and tumor size in the postoperative preservation of serviceable hearing (SH). METHODS: Three hundred eighty-six patients with VS were treated. Hearing preservation was attempted in 128 cases (33.2%) by using intraoperative monitoring and following a retrosigmoid approach. The maximal extrameatal size of the tumor, its extension within the IAC, and pre- and postoperative hearing quality, according to the Gardner-Robertson classification, were evaluated. Preservation of SH was achieved in 24.2% of the 128 patients. With respect to tumor size, SH was preserved in 39% of 77 patients harboring a tumor 15 mm wide or smaller and in 2% of 51 patients with lesions 16 mm wide or larger (p < 0.001). With regard to filling of the IAC, among 63 patients harboring a tumor 15 mm or smaller, in whom magnetic resonance images were available, SH was preserved in 52.8% of 36 patients with partial filling and in 25.9% of 27 patients with complete filling (p = 0.032). Concerning preoperative hearing quality, in the patients with tumors 15 mm or smaller, SH was preserved in 46.5% of 43 patients with Gardner-Robertson Class I hearing and 29.4% of 34 patients with Class II hearing (p = 0.126). Both tumor size and the extent of IAC filling proved statistically significant in a multivariable analysis (p < 0.001 and p = 0.026, respectively). CONCLUSIONS: Incomplete filling of the IAC and a tumor size of 15 mm or smaller are independent favorable factors in SH preservation. Excellent preoperative hearing appears to have a positive impact but does not have statistical significance. Intraoperative monitoring is useful in guiding the dissection; however, the surgeon's knowledge of topographical landmarks and meticulous surgical technique remain the essential factors of success.

Adult↗
PubMed2004

2-year review of a novel vestibular rehabilitation program in Montreal and Laval, Quebec.

OBJECTIVE: To evaluate the benefits of a vestibular rehabilitation program (VRP) in the Montreal-Laval area. DESIGN: The VRP was conceptualized by a panel of experts including otolaryngologists, physiotherapists, and researchers from McGill University and its teaching hospitals. From February 1999 to December 2001, 117 patients were seen, and 88 of them completed the VRP. SETTING: The VRP has been established at the Jewish Rehabilitation Hospital in Laval, PQ, to provide specialized rehabilitation to clients suffering from vertigo, dizziness, and/or impaired balance owing to lesions or disorders of the vestibular system. MAIN OUTCOME MEASURES: Presence or absence of nystagmus or vertigo during the Dix-Hallpike test, Dizziness Handicap Inventory (DHI), and Dynamic Gait Index (DGI). RESULTS: Thirty-five patients with benign paroxysmal positional vertigo of the posterior canal were treated with canalith repositioning manoeuvres. All of the patients (100%) had absence of nystagmus or vertigo after one to four treatment sessions. Forty-six patients with vestibular deficits or dizziness-disequilibrium completed the VRP, which consisted mainly of individualized eye-head and balance home exercise programs. At the end of the VRP, there was a significant decrease in DHI score (31 vs 57; p < .01) and a significant increase in DGI score (18.4 vs 22.6; p < .01). CONCLUSIONS: A range of modest to major improvements was shown by comparing initial and discharge scores of patients who had completed vestibular rehabilitation. The VRP appears to be beneficial for patients with a variety of vestibular disorders. Further research is needed to continue optimizing vestibular rehabilitation.

Female↗
PubMed2004

High-resolution X-ray computed tomographic scanning of the human stapes footplate.

OBJECTIVES: The mechanical behaviour of the footplate and its annular ligament depends critically on their shape and orientation in the oval window, but accurate measurements have been difficult to make owing to their small size. Our aims are to visualize the footplate at high resolution and understand its dynamics. METHODS: The human cadaver stapes footplate was dissected, and very high-resolution x-ray computed tomographic (CT) scans, with voxel sizes from 4 to 8 pm, were performed. Locally developed software was used to reconstruct the images. RESULTS: The data permit us to explore minor details of shape and orientation. The footplate looks like a footprint, and the annular ligament has variable thickness, with a cleft (groove) in its anterior attachment to the oval window. The CT data also permit us to create a three-dimensional finite-element model that can simulate footplate motion. CONCLUSIONS: The results obtained lead to further understanding of the mechanical behaviour of the footplate and the annular ligament.

Humans↗