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Biomedical subjects

K K Adour

Publications and source records attributed to K K Adour.

At least 19 recordsLinked to original sources
PubMed1999

A preliminary study of cocaine absorption from the nasal mucosa.

OBJECTIVE/HYPOTHESIS: To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. STUDY DESIGN: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. METHODS: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group II received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group III received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5, 10, 15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. RESULTS: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group III, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. CONCLUSIONS: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 min is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.

Anesthetics, Local↗
PubMed1996

Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial.

In a double-blind study, we compared the final outcome of 99 Bell's palsy patients treated with either acyclovir-prednisone (53 patients) or placebo-prednisone (46 patients). For patients receiving acyclovir, the dosage was 2,000 mg (400 mg 5 times daily) for 10 days. Electrical tests included electroneurography and the maximal stimulation test. Univariate comparisons of outcome and electrical tests between the two groups were made with chi 2 analysis, Fisher's exact test, and t-tests. The outcome in acyclovir-prednisone-treated patients was superior to that in placebo-prednisone-treated patients. Treatment with acyclovir-prednisone was statistically more effective in returning volitional muscle motion (recovery profile of 10; p = .02) and in preventing partial nerve degeneration (p = .05) than placebo-prednisone treatment. The t-tests indicated that the recovery profile and index means were significantly better for the acyclovir-treated group (recovery profile t = 1.99, p = .051; recovery index t = 2.10, p = .040). We conclude that acyclovir-prednisone is superior to prednisone alone in treating Bell's palsy patients and suggest that herpes simplex is the probable cause of Bell's palsy.

Acyclovir↗
PubMed1995

An analysis of the Adour-Swanson and House-Brackmann grading systems for facial nerve recovery.

Lack of uniformity in reporting facial nerve recovery in patients with facial nerve paralysis has been a major disadvantage in comparing treatment modalities. To remove subjectivity from the analysis, we devised a facial paralysis recovery profile as a system for measuring facial motion. This profile has been used since 1968 at Kaiser Permanente Medical Center, Oakland, California. The House facial paralysis grading system was introduced in 1983 for clinical use and was modified by Brackmann in 1985. This latter system has since been accepted by the American Academy of Otolaryngology-Head and Neck Surgery in the United States as the standard used in reporting results. In a prospective study of 54 patients, we tested multiple parameters that affect accurate reporting. We tested reliability and accuracy of facial measurements by using 30 control subjects and 3 independent examiners. We used Pearson correlation coefficients to statistically analyze results. To compare our system with the House-Brackmann grading system, we measured facial motions of 24 patients randomly selected from our data bank. All had incomplete returns of facial function and facial defects associated with faulty regeneration of a partially denervated facial nerve. Our overall results show defects in the House-Brackmann system which should be addressed. We offer the Adour-Swanson grading system as a reliable, easy-to-use, suitable alternative to the House-Brackmann system.

Face↗
PubMed1994

Otological complications of herpes zoster.

Otological complications of varicella-zoster virus (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, hyperacusis (dysacousis), vertigo, dysgeusia, and decreased tearing. Cranial nerves V, IX, and X are often affected. Gadolinium-enhanced magnetic resonance imaging demonstrates enhancement of the geniculate ganglion and facial nerve. These manifestations are identical to Bell's palsy but are more severe and carry a graver prognosis. Eight percent of Bell's palsy patients eventually are diagnosed as "zoster sine herpete." A new case of Ramsay Hunt syndrome will occur every 52 minutes, compared to every 10 minutes for a new case of Bell's palsy.

Ear Diseases↗
PubMed1992

Audiometric comparison of Lassa fever hearing loss and idiopathic sudden hearing loss: evidence for viral cause.

A recently published prospective study on acute sensorineural deafness in Lassa fever among a West African population showed the audiometric pattern of a known virally induced hearing loss. Using the audiometric data from the patients with Lassa fever in that study, we analyzed and classified the initial hearing loss and final recovery into three groups by pure-tone average values and then did the same for 222 patients with idiopathic sudden hearing loss (SHL) in our study. Statistical analyses of the severity of initial hearing loss and the hearing recovery pattern indicate that the clinical course of our 222 patients with idiopathic SHL showed no statistically significant differences from the clinical course of the patients with Lassa fever. We found a marked difference in age, however, and a clinically significant difference in the incidence of bilateral hearing loss. In reviewing the literature on sudden sensorineural hearing loss, we found no apparent relation between severity of viral illness and initial hearing loss or subsequent recovery. Cummins et al. suggest that virally induced hearing loss in Lassa fever is linked to the host's immune response and not to the viremia. We thus propose a virally induced immune response mechanism for idiopathic sensorineural SHL. Further prospective studies are needed for verification.

Acute Disease↗
PubMed1991

Endoscopic diverticulotomy for the treatment of Zenker's diverticulum.

First described by Mosher in 1916, endoscopic treatment of Zenker's diverticulum has since been reported infrequently in the surgical literature and continues to engender controversy. Between 1978 and 1989, we treated 11 unselected patients surgically for pharyngoesophageal diverticula. Endoscopic diverticulotomy was used in 11 patients and an external approach was used in the others. The endoscopically treated patients had no serious complications, resumed oral intake early, and were discharged from the hospital earlier. Our review of the surgical literature confirmed our experience with the efficacy and safety of the procedure. We therefore recommend endoscopic diverticulotomy as being equal to external approaches with regard to effectiveness; and it affords the patient a shortened hospital stay and more rapid return to to the premorbid state.

Aged↗
PubMed1991

Hilger facial nerve stimulator: a 25-year update.

Percutaneous nerve excitability testing using the Hilger facial nerve stimulator was introduced about 25 years ago. The test is reliable, easy to use, and inexpensive; it continues to be the most frequently used method for predicting prognosis of facial nerve disorders. Between 1966 and 1974, we recorded 10,243 nerve excitability tests on 865 patients with a mean of 3.29 tests for each peripheral branch and 3.43 for the trunk. Using a multiple regression model, we determined the effect on nerve stimulation values of age, sex, race, diabetes, hypertension, partial or complete clinical paralysis, diagnosis of herpes zoster, year of testing, and eventual facial paralysis recovery profile. We discuss statistical reliability, provide a table of interpretive results, and offer "tips and traps" invaluable to the practitioner. A prospective study of 25 patients with residual facial paralysis was evaluated by two separate otolaryngologists to determine intertester reliability.

Adult↗
PubMed1991

Medical management of idiopathic (Bell's) palsy.

Experience with treating more than 400 cases of Antoni's palsy, the findings of autoimmune reaction, and recent gadolinium-enhanced magnetic resonance imaging reports in "idiopathic" Bell's palsy verify the hypothesis that the disease results from a viral geniculate ganglionitis. The diagnosis no longer needs to be one of exclusion. We now are capable of establishing a positive diagnosis, permitting the clinician to initiate treatment with corticosteroids and acyclovir confidently. Facial nerve compression and electrotherapy are not advised. It is suggested that the term idiopathic Bell's palsy be replaced with Antoni's palsy as the first step in changing erroneous concepts of the past.

Adrenal Cortex Hormones↗
PubMed1990

The beneficial effect of methylprednisolone in acute vestibular vertigo.

To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo. Extensive neurotologic examination confirmed the diagnosis. If no significant reduction of vertigo occurred within the first 24 hours of treatment, patients were instructed to switch medications. Patients were followed up prospectively for 1 month. Of the 10 patients receiving methylprednisolone, 9 had a marked reduction of vertiginous symptoms and 1 switched to the placebo medication. Of the 10 patients receiving placebo, 3 had relief of vertiginous symptoms, while the 7 with persistent symptoms switched to methylprednisolone and had subsequent effective reduction of vertigo within 24 hours. The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo. One patient receiving methylprednisolone had a relapse of symptoms when the dosage was tapered, but symptoms again remitted when the dosage was increased to 32 mg/d. From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo.

Acute Disease↗
PubMed1990

Audiological manifestations of Ramsay Hunt syndrome.

Ramsay Hunt syndrome is known to cause audiological signs and symptoms, including sudden, unexpected hearing loss. We carried out a retrospective review of the audiological manifestations of 186 patients with Ramsay Hunt syndrome, measuring their hearing loss patterns, hyperacusis, tinnitus, herpetic rash, facial paralysis, pain and vertigo. Statistical correlations of these parameters were equated with prognosis. Prognosis for eventual hearing recovery is, in general, excellent. Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss.

Adolescent↗
PubMed1989

Mona Lisa syndrome: solving the enigma of the Gioconda smile.

The Mona Lisa smile is presented as a possible example of facial muscle contracture that develops after Bell's palsy when the facial nerve has undergone partial wallerian degeneration and has regenerated. The accompanying synkinesis would explain many of the known facts surrounding the painting and is a classic example of Leonardo da Vinci as the compulsive anatomist who combined art and science.

Facial Expression↗
PubMed1988

Recurrent Bell's palsy: analysis of 140 patients.

Of 1,700 patients with facial paralysis seen in a retrospective study from 1969 through 1977 and 280 patients seen prospectively from 1983 through 1986, 7.1% had recurrence of Bell's palsy. In this group, the frequency of ipsilateral recurrence was equal to that for contralateral recurrence. The mean age at onset of Bell's palsy was 33.0 years; Bell's palsy recurred a mean of 9.8 years later. Recurrent facial paralysis did not indicate a worse prognosis for recovery regardless of which side was affected. There was no statistical difference between results for male patients or female patients, nor was there a statistically significant sex predominance, except in the age group 10 to 19 years. In our results, computed tomography (CT) scan in patients with recurrent Bell's palsy detected no facial-nerve neuroma. Of 77 patients followed a mean of 33 years after the first episode (range, 2.8 to 60 years), none showed progressive facial-nerve dysfunction or any signs of tumor. We conclude that an ipsilateral recurrence of facial paralysis without documented evidence of a tumor does not warrant a transmastoid decompression of the facial nerve. The results of our analysis were verified prospectively as well as retrospectively. A new classification system is introduced for ease of computer analysis and for simplified discussion of recurrent facial paralysis.

Adolescent↗
PubMed1986

Ramsay Hunt facial paralysis: clinical analyses of 185 patients.

In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kaiser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella-zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs, and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bell's (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bell's (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed.

Facial Paralysis↗
PubMed1985

Facial paralysis and Bell's palsy: a protocol for differential diagnosis.

In the past, most cases of facial paralysis have been erroneously labeled Bell's palsy. Bell's palsy has been synonymous with and defined as idiopathic facial paralysis affecting only the facial nerve within the confines of the temporal bone. In the last ten years, Bell's palsy has been redefined as viral polyneuritis, probably caused by herpes simplex reactivation, and its diagnosis is no longer reached by exclusion. This article discusses the signs, symptoms, and testing necessary to confidently and accurately differentiate Bell's palsy from other forms of facial paralysis. The nonspecificity of topographic diagnosis is discussed and statistical analysis of factors affecting prognosis are included.

Cranial Nerve Diseases↗
PubMed1984

Current medical treatment for facial palsy.

Medical treatment for facial palsy includes an accurate diagnosis and reliable estimate of prognosis as well as appropriate medication. Cranial polyneuritis (Bell's palsy and Ramsay Hunt syndrome), the most common cause of facial palsy, is an inflammatory, autoimmune, demyelinating disease best treated by parenteral steroids without surgical intervention. The antiviral agent acyclovir is now being tested as an adjunct to or replacement for steroid therapy. Trauma, the second most common cause of facial palsy, is often treated with steroids, but no controlled study has ever been performed. However, animal experiments clearly demonstrate that steroid treatment of a compressed facial nerve accelerates repair of the mechanical injury and decreases time of recovery. Acute otitis media with facial palsy is best treated with myringotomy, appropriate antibiotics, and steroid therapy. The use of steroids with antibiotics improves the resolution of middle ear exudate fourfold, compared with the use of antibiotics alone. Other treatment modes in selected cases are discussed. Physiotherapy in the form of electrical stimulation of the facial muscles is not advised.

Acyclovir↗