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M J Levenson

Publications and source records attributed to M J Levenson.

18 recordsLinked to original sources
PubMed1999

Methods of teaching stapedectomy.

OBJECTIVES: Establish a better method of teaching residents stapes surgery, with the goal of improving surgical outcome. STUDY DESIGN: A stapes surgery teaching module was developed with specific criteria to evaluate resident performance. A prospective study of stapes surgery performed by teaching module trained residents was compared with a retrospective review of stapes surgery performed by non-teaching module trained residents. METHODS: Four residents naive to stapes surgery were assigned to a stapes surgery teaching module. Stapedectomy of 20 temporal bones per resident, with six 3-hour laboratory sessions, was performed. Laser (CO2 and argon) as well as mechanical techniques were used. Specific scoring criteria were applied to measure performance. Results of actual stapes surgery of teaching module trained residents were compared with those of a comparable group of non-teaching module trained residents. RESULTS: Laser techniques in the laboratory resulted in statistically significantly better scores by defined criteria than mechanical techniques. Results of actual stapes surgery performed by teaching module trained residents demonstrated a trend toward better surgical results, although this was not statistically significant. CONCLUSIONS: Graded operative experience and standard temporal bone surgery courses may not adequately prepare residents for stapes surgery. A teaching module with criteria to evaluate performance better prepares residents for this delicate procedure. Lasers provide a significant advantage in the laboratory model and should be used by residents at surgery. Residents not wishing to perform stapes surgery because of career pathway should be encouraged to turn over their cases to fellow residents.

Curriculum↗
PubMed1997

DNA analysis of human cholesteatomas.

HYPOTHESIS: The hypothesis tested in this article is that if cholesteatomas are a low-grade squamous cell neoplasm, then evidence of genetic instability, in the form of abnormal or aneuploid amounts of DNA, should be evident. BACKGROUND: Cholesteatoma is a destructive lesion of the middle ear and/or mastoid process that produces complications by erosion of the temporal bone. The clinical hallmarks of cholesteatomas, namely invasion, migration, uncoordinated proliferation, altered differentiation, aggressiveness, and recidivism, are traits typically associated with the neoplastic cell. However, there is little evidence to support or refute the speculation that cholesteatomas are a low-grade squamous cell neoplasm. the existence of defects in the genetic complement of the major cellular constituents comprising a cholesteatoma, fibroblasts and keratinocytes, would support the speculation that cholesteatomas are a neoplasm, since cancers commonly manifest quantitative and qualitative alterations in the normal euploid complement of genetic information, resulting in a cell that has an abnormal or aneuploid amount of DNA. METHODS: DNA content (ploidy) within cholesteatoma tissues was measured by flow cytometry and image analysis. RESULTS: The DNA content of 11 human cholesteatomas and nine postauricular skin specimens was analyzed using flow cytometry, while the DNA content of 10 cholesteatoma specimens was analyzed using image analysis. Interpretable data was obtained from 10 cholesteatoma specimens and six postauricular skin specimens. One cholesteatoma specimen demonstrated an abnormal aneuploid DNA content, whereas the remaining nine cholesteatomas and the six postauricular skin specimens demonstrated a normal euploid DNA content. CONCLUSIONS: We conclude that, due to the lack of overt genetic instability, as evidenced by the presence of a normal euploid DNA content, cholesteatomas are not low-grade neoplasms.

Adult↗
PubMed1996

Beta-2 transferrin: limitations of use as a clinical marker for perilymph.

Beta-2 transferrin is a protein marker that can be used in the clinical setting to reliably identify the presence of cerebrospinal fluid (CSF). Recent literature has suggested that beta-2 transferrin can also be used as a clinical marker for perilymph. This study investigates the use of a beta-2 transferrin assay as a method to identify the presence of perilymph. Twenty-two patients were enrolled in the study. Fluid samples were obtained intraoperatively and tested for the presence of beta-2 transferrin. As expected, four CSF samples collected were positive for beta-2 transferrin; however, four known perilymph samples collected from patients undergoing cochlear implantation were negative for beta-2 transferrin, seven of nine known perilymph samples obtained during stapedectomies were negative for beta-2 transferrin, and four of five samples collected during middle ear explorations for fistula were negative for beta-2 transferrin. With current methodology beta-2 transferrin does not appear to be a reliable clinical marker for perilymph in the operative setting.

Biomarkers↗
PubMed1996

Canalplasty.

Canal stenosis and atresia can result from a number of causes, including congenital, inflammatory, neoplastic and iatrogenic pathologic conditions. Canalplasty is an eclectic collection of techniques designed to recreate a patent and trouble-free external canal. Despite the large number of etiologies, the principles of canalplasty are the same. The goal is the creation of a widely patent and physiologically intact canal wall. Both the bony and cartilaginous portions must be addressed surgically. Care should be taken to preserve the normal skin and adnexa for lining the canal, but if this is not adequate, skin grafts should be used to prevent healing by secondary intent. Overcorrection of stenosis is advised. We have presented our basic technique for canalplasty and discussed its alteration for specific disorders.

Ear, External↗
PubMed1992

Necrotizing 'malignant' external otitis caused by Staphylococcus epidermidis.

Necrotizing "malignant" external otitis is a life-threatening skull base infection that originates in the external auditory canal and is characterized by otalgia and purulent aural discharge with external auditory canal cellulitis and granulation. Necrotizing external otitis, seen almost exclusively in elderly diabetics, is almost always caused by Pseudomonas aeruginosa. To our knowledge, there have been only six nonpseudomonal cases reported to date. We describe a 70-year-old diabetic man with necrotizing external otitis caused by Staphylococcus epidermidis, confirmed by serial cultures. This case was characterized by otalgia, purulent otorrhea, preauricular swelling, bony external auditory canal erosion, and a conductive hearing loss. Despite prolonged intravenous antistaphylococcal antibiotic therapy and frequent local débridement, the patient's symptoms never completely resolved. As demonstrated by the treatment failure, S epidermidis necrotizing external otitis, may represent a more refractory form of this already virulent disease process. We believe this to be the first reported case of necrotizing external malignant otitis caused by S epidermidis.

Aged↗
PubMed1991

Ciprofloxacin: drug of choice in the treatment of malignant external otitis (MEO).

Ciprofloxacin, a fluorinated quinolone with high efficacy against Pseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant external otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow-up of 18 months after completion of therapy. A new classification of malignant external otitis (MEO) is presented.

Aged↗
PubMed1989

The large vestibular aqueduct syndrome in children. A review of 12 cases and the description of a new clinical entity.

The large vestibular aqueduct as an isolated anomaly of the temporal bone has been previously identified radiologically, and its association with sensory neural hearing loss has been recognized. It has not, however, been defined as a distinct clinical entity in children. We studied 12 children, ages 3 to 9 years, with downward-fluctuating progressive high-frequency neurosensory hearing losses whose symptoms were thought to be related to the isolated enlargement of the vestibular aqueduct identified by high-resolution computed tomographic scanning. Previously it had been assumed that a large vestibular aqueduct is a temporal bone dysplasia that is a variant of the Mondini type of deformity and that the associated hearing loss is congenital in nature. Our clinical observations, however, indicate that the hearing loss in children with an isolated enlargement of the vestibular aqueduct is acquired during childhood. The natural history of this progressive deafness is reviewed, and a pathophysiologic hypothesis is presented.

Audiometry↗
PubMed1989

Spontaneous extracranial pneumatocele associated with mastoid hyperpneumatization.

Spontaneous extracranial pneumatoceles unassociated with trauma are rare. We report a case of spontaneous extracranial mastoid pneumatocele associated with exuberant pneumatization of the calvarium and mastoid. The patient presented with a compressible bulge over the base of the zygoma and superior to the pinna. Surgical exploration demonstrated a large air sac in continuity with nontraumatic bony defects of the tympanosquamous and tympanomastoid sutures.

Air↗
PubMed1989

Modern presentations of Bezold's abscess.

The use of antibiotics in suppurative otitis media has greatly diminished the incidence of complications. Deep neck abscess arising from acute mastoiditis, a disease thoroughly described by Frederick Bezold early in this century, has become rare. In the last three years we have treated five cases of deep neck abscess of otogenic origin at our hospital. These cases exemplify Bezold's classic description in their site of origin in the mastoid process and route of spread in the neck. However, our contemporary examples differed in clinical setting, latency of onset, and bacterial cause. In four of the cases, delay in diagnosis occurred because of failure to recognize the disorder. Computed tomography has proved valuable in the anatomic diagnosis and surgical planning. Renewed familiarity with the clinical presentations and pathogenesis of this now uncommon condition may prevent delay in diagnosis and initiation of therapy.

Abscess↗
PubMed1989

Congenital cholesteatomas of the middle ear in children: origin and management.

Cholesteatomas (epidermoids) of the middle ear appearing medial to a normal tympanic membrane are identified in increasing numbers of young children. The evidence that these lesions are congenital in origin includes the young mean age of presentation, the normal appearance of the middle ear mucosa in almost all cases of small lesions, normal mastoid pneumatization documented by computerized tomography, the relatively large number of children with associated minor or major congenital malformations, and the consistent 3:1 ratio of males to females with the disorder in all of the large series reviewed. A direct relationship between congenital cholesteatomas (epidermoids) of the middle ear and the epidermoid formation is supported by the position of the epidermoid formation at a histologic transition zone in the anterior superior lateral quadrant of the tympanic cavity, which is also the site of greatest occurrence of congenital cholesteatomas. The epidermoid formation may not always involute and as it expands it would be expected to become visible medial to the tympanic membrane in the anterior superior quadrant. It seems evident that as the congenital cholesteatoma expands it can block the eustachian tube; during a bout of otitis media the tympanic membrane could perforate and the cholesteatoma could become secondarily infected. The congenital cholesteatoma in this situation would be difficult or impossible to distinguish from the more common acquired type.

Child, Preschool↗
PubMed1989

Management of congenital pediatric cholesteatomas.

During the past 10 years discrete middle ear congenital cholesteatomas have been detected with greater frequency in young children. The increased recognition of this condition is probably related to the pediatricians' greater awareness of this defect, their improved facility with pneumatic otoscopy, and effective audiometric and tympanometric screening procedures. This early detection while the lesions are small and localized facilitates their surgical removal. Clinically, it would appear that congenital cholesteatomas can be subdivided into two categories according to their anatomic locations. The anterior lesions present as an isolated pearl that arise from an area on the anterior surface of the malleus, are usually associated with normal hearing, and have pneumatized mastoids. The posterior lesions do not seem to originate from a clearly defined anatomic area, have a higher incidence of sclerotic mastoids, and erode the ossicular chain commonly producing a hearing loss. The anterior middle ear cholesteatoma probably arises from a persistent epidermoid formation, a structure that normally is present during fetal development of involutes by the 33rd week of gestation. The origin of cholesteatomas arising in the posterior middle ear space remains more controversial.

Adolescent↗
PubMed1988

Congenital cholesteatomas in children: an embryologic correlation.

The clinical findings in 37 children with congenital cholesteatoma of the middle ear, 17 of which have not been previously reported, are presented. Clinical findings and surgical observations are correlated with recent developmental studies. It is hypothesized that congenital cholesteatoma may originate from an epidermoid formation, which has been identified in the anterior superior lateral tympanic cavity adjacent to the anterior annulus during fetal development, and which normally is present early in development, involuting by 33 weeks' gestation. It is proposed that the epidermoid formation may not always involute, and could serve as an embryologic anlage of congenital cholesteatomas.

Adolescent↗
PubMed1987

Otosclerosis surgery in a resident training program.

Controversy exists regarding the appropriateness of offering all residents training in stapes surgery due to dwindling case loads in residency programs nationally. A recent study indicated poorer results for stapes surgery performed by residents than results obtained by practicing otologists. One hundred consecutive stapedectomies performed by residents over a three-year period at our institution were reviewed retrospectively, with the objective of determining whether these results should be generalized.

Adult↗
PubMed1986

A review of twenty congenital cholesteatomas of the middle ear in children.

Cholesteatomas, arising within the middle ear space behind an intact tympanic membrane, have been detected more frequently in recent years. This article reviews 19 children (with a mean age of 4.3 years) who underwent surgery over a 7-year period for removal of cholesteatomas from behind intact tympanic membranes. Most of these children were referred by pediatricians who had detected an asymptomatic whitish middle ear mass. Many had histories of treatment for otitis media. Patients with similar histories were excluded from the series if there had been a prior perforation, myringotomy, or otologic surgery. In the series, one fourth of the children had associated congenital malformations, and there were 3 times as many boys as girls. In two thirds of the cases, the cholesteatoma was manifested as an anterior-superior middle ear mass that seemed to arise from the processus cochleariformis, undersurface of malleus area. Many could be removed via an extended anterior tympanotomy operative approach. The results of surgery are reviewed. The possible origins of these localized cholesteatomas are considered. Are they congenital defects that arise from misplaced keratinizing epithelium? Do they arise from mesenchymal cells whose differentiation is stimulated by inflammatory changes within the middle ear?

Child↗
PubMed1984

Melkersson-Rosenthal syndrome.

The Melkersson-Rosenthal syndrome (MRS) is a rare condition characterized by the triad of familial relapsing peripheral facial palsy, facial edema, and lingua plicata. Within a well-documented family aggregate of MRS, an index case simultaneously demonstrated all the elements of the triad, as well as gingival changes similar to those of cheilitis granulomatosa. When the incomplete or oligosymptomatic forms are considered, the MRS may be more common than previously thought.

Adolescent↗
PubMed1984

Laryngeal tuberculosis: review of twenty cases.

Despite a dramatic reduction in incidence of laryngeal tuberculosis over the last three decades, tuberculous involvement still has to be considered in the differential diagnosis of laryngeal lesions. The majority of the 20 cases in our series consists of patients in whom the working diagnosis of carcinoma of the larynx was initially made. These patients presented with the chief complaint of hoarseness of several months duration, frequently associated with dysphagia, but in most cases with chest symptoms that were not prominent despite the fact that most of these patients had far advanced pulmonary tuberculosis. This presentation consists of a detailed analysis of 20 cases, and a discussion of the incidence, pathogenesis, clinical presentation and management of laryngeal tuberculosis.

Adult↗