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Biomedical subjects

M J Wareing

Publications and source records attributed to M J Wareing.

At least 19 recordsLinked to original sources
PubMed2003

Intratympanic gentamicin for Ménière's disease; a survey of current UK practice.

Intratympanic gentamicin is increasingly used in the treatment of Ménière's disease. Many protocols have been published for its use, but there is little difference in outcome between them. The goal of the study was therefore to assess current UK practice in the use of intratympanic gentamicin. A postal and e-mail survey of consultant ENT surgeons in the UK was conducted. Of 34 consultants who regularly used intratympanic gentamicin, 21 used a protocol based upon a single intratympanic dose of gentamicin via a needle through the tympanic membrane and repeated after at least a week. The remaining 13 used either a regime of more frequent administration or attempted a more complicated route of delivery in an effort to improve reliability and selectivity of action. In the absence of evidence demonstrating benefit from regimens of increased complexity the majority of consultants are using the simplest possible protocol.

Anti-Bacterial Agents↗
PubMed2003

Epistaxis as a rare presenting feature of glomus tympanicum.

Glomus tumours are the most common primary neoplasms of the middle ear, typically benign and slowly progressive. Pulsatile tinnitus and ipsilateral hearing loss are the most common symptoms at presentation by far; otalgia, aural fullness and otorrhoea being less frequent. A case of primary glomus tympanicum presenting with recurrent epistaxis, previously unreported in the literature, is described and associated imaging presented.

Adult↗
PubMed2001

Meningioma in the internal auditory canal.

A case is presented of an entirely intracanalicular meningioma in a 48-year-old woman that was excised via a conventional translabyrinthine approach to the internal auditory canal (IAC). Pre-operative magnetic resonance imaging (MRI) suggested that the tumour was a vestibular schwannoma (VS). Histological examination confirmed the intra-operative impression that the tumour was a meningioma. Although VS is by far the commonest intracanalicular tumour, the differential diagnosis includes meningioma. MRI is unable to distinguish between these two entities when the tumour is located entirely in the internal auditory canal.

Ear Canal↗
PubMed2000

Long-term middle-ear effects of middle-ear/eustachian tube packing after translabyrinthine surgery.

The purpose of this study was to evaluate the long-term effect on middle ear and eustachian tube function following the packing of the middle-ear space to prevent cerebrospinal fluid rhinorrhoea at the termination of translabyrinthine vestibular schwannoma removal. This was an observational study of a sample of 14 patients examined between two and five years post-operatively. Photo-otoscopy and tympanometry were performed bilaterally to evaluate appearance and function. All operated middle ears were air-containing although eight out of 14 showed scarring as evidence of operative intervention. There were no drum retractions. Ten out of 14 middle-ear compliance peaks were lower in the operated ear with four flat traces. Two out of 14 were the same and two out of 14 showed high compliance. The middle-ear pressure was always within the normal range when determinable. This technique appears to have no detrimental effects on the middle ear and does not permanently obliterate the eustachian tube. The reduced compliance in the majority of cases is probably a result of scarring and fibrosis. When drum hypermobility is seen this is accounted for by incus removal.

Acoustic Impedance Tests↗
PubMed1999

Cochlear gene therapy: current perspectives.

Gene therapy has the potential to revolutionize therapy for hearing disorders. Advances in our understanding of the molecular basis of hearing combined with techniques for intracochlear gene transfer are leading us closer to clinical applications. Potential areas of interest are reviewed and experimental success using adeno-associated virus to effect intracochlear gene transfer is discussed.

Animals↗
PubMed1999

Myxoid chondrosarcoma of the external auditory meatus.

Extraskeletal myxoid chondrosarcoma presenting in the head and neck is extremely rare. Histological diagnosis is difficult and requires close co-operation between clinician, radiologist and pathologist. The tumour has a good prognosis in comparison to myxoid chondrosarcoma of the bone but surgical resection may be difficult due to its gelatinous nature. We present a case of extraskeletal myxoid chondrosarcoma originating in the external auditory meatus of a 42-year-old man. This is the first report of this tumour in this site.

Adult↗
PubMed1998

Laser assisted uvulopalatoplasty: six and eighteen month results.

Our ongoing evaluation of the results of laser assisted uvulopalatoplasty (LAUP) for snoring is presented. Follow-up between 18 and 24 months post-treatment completion, of patients with a successful result at six months, reveals that 22 per cent of these patients suffer failure of snoring control between these two evaluation points. This equates to an overall success rate at this time of 55 per cent. LAUP, like other surgical remedies for snoring, has a continued relapse rate. This must be considered when counselling patients.

Adult↗
PubMed1998

Pyoderma gangrenosum producing saddle nose deformity.

Pyoderma gangrenosum affecting the nose is rare and this may lead to diagnostic confusion because of the large differential diagnosis. As diagnosis is made, largely, on the basis of exclusion the treatment of pyoderma gangrenosum may be unduly delayed. The condition is often disfiguring, particularly following inappropriate surgical intervention, and early diagnosis is therefore important. We present a case of pyoderma gangrenosum managed initially in the community with minor surgery and resulting in the rare complication of saddle nose deformity.

Aged↗
PubMed1998

Osteologic classification of the sphenopalatine foramen.

Textbook descriptions and illustrations of the opening of the sphenopalatine foramen (SPF) into the nasal cavity place it above and behind the posterior end of the middle turbinate (i.e., within the superior meatus). Although true for some skulls, this is not the situation for the majority and may be of importance, because the major blood supply to the nasal cavity enters via this route. Having studied 238 lateral nasal walls, the authors propose a classification of the osteology of the sphenopalatine foramen. In class I (35%) the opening of the SPF is purely into the superior meatus with a notch or foramen in the middle turbinate/ethmoidal crest of the palatine bone. In class II (56%) the SPF spans the ethmoidal crest (i.e., opens into both the superior and middle meati). In class III (9%) there are two separate openings into the superior and middle meati. These findings may explain the route of the artery to the inferior turbinate and indicate the need for care in dealing with the posterior end of the middle turbinate. They may also suggest a potential site for dealing with "difficult" epistaxis via an intranasal route.

Cadaver↗
PubMed1998

The Clarion Multi-Strategy Cochlear Implant--surgical technique, complications, and results: a single institutional experience.

OBJECTIVE: This study aimed to review a single institution's experience with Clarion Multi-Strategy Cochlear Implant with respect to surgical technique, surgical complications, and rehabilitative outcome. STUDY DESIGN: This study was a review of patients implanted with the Clarion Multi-Strategy Cochlear Implant. SETTING: The setting was a tertiary referral center with care delivered in the inpatient and outpatient environment. PATIENTS: The first 37 patients were implanted under an Investigational Device Exemption as part of the Food and Drug Administration (FDA) clinical trial of the Clarion implant. Subsequent patients were implanted after the device received FDA approval. Patients met the following criteria for implantation: 18 years of age or older, psychological and emotional stability, profound postlingual deafness without evidence of middle ear disease, one cochlea at least partially patent, and marginal or no benefit from conventional hearing aids. INTERVENTION: Patients received implantation with the Clarion Multi-Strategy Cochlear Implant. MAIN OUTCOME MEASURES: Measured were presence or absence of surgical complications and auditory performance with open- and closed-set word and sentence recognition testing. RESULTS: A total of 47 patients have been implanted. Three patients have suffered complications: two cases of delayed-onset facial palsy both resolved with steroid therapy and one case of internal cochlear stimulator migration required refixation. Significant improvement in speech understanding has been seen in the majority of patients who were implanted within the first 6 months of device use. Specifically, at 6 months, scores on CID (Central Institute for the Deaf) sentences (implant alone) improved from a preoperative mean of 9% to a mean of 72%, and scores on the NU-6 (Northwestern University) monosyllabic word test increased from a preoperative mean of 3% (range, 0-20%) to a mean of 32% (range, 0-70%). More than two thirds (68%) of the adults were able to understand at least 50% of sentences over the telephone, and half were able to understand at least 75% of the sentence material. CONCLUSIONS: The authors' institutional experience with the Clarion Multi-Strategy Cochlear Implant shows minimal surgical morbidity and significant improvement on all open-set test measures of sentence and word recognition.

Adult↗
PubMed1997

Psychogenic stridor: diagnosis and management.

Psychogenic stridor is a rare cause of apparent acute upper airway obstruction, usually occurring in young female adults. The alarming presence of inspiratory stridor leads to suspicion of organic disease, with urgent management directed towards treatment of suspected pathology. Careful history taking may suggest the correct diagnosis and early examination of the larynx, preferably by fibreoptic nasendoscopic examination, may identify the underlying abnormality of paradoxical adduction of the vocal cords on inspiration, accounting for the stridor. This characteristic feature allows a positive diagnosis to be made and may avoid potentially harmful and inappropriate interventions. Three cases are presented, illustrating an evolution of management.

Adolescent↗
PubMed1997

CT appearances of external ear canal cholesteatoma.

External ear canal cholesteatoma (EECC) is rare in ear, nose and throat (ENT) practice. Two cases, one bilateral, are described. Computed tomography demonstrates the extent of bony involvement. Erosion of the external canal should not be overlooked when reviewing CT of the petrous bone in cases of discharge from the ear. EECC may necessitate surgery and delay in the diagnosis of EECC can result in progressive bony destruction.

Adult↗
PubMed1996

Acrokeratosis paraneoplastica: Bazex syndrome.

Bazex syndrome, or acrokeratosis paraneoplastica, is a cutaneous paraneoplastic syndrome characterized by psoriasiform lesions associated with, usually, a squamous cell carcinoma of the upper aerodigestive tract. We present a case of Bazex syndrome associated with metastatic cervical squamous cell carcinoma with an unknown primary. The features of the condition are discussed in the light of current knowledge.

Aged↗
PubMed1996

Regional postgraduate training in otolaryngology: a study programme.

For the last three years the South East Thames Regional Training Committee (SETRTC) in Otolaryngology has held a series of training days for the Senior House Officers and Higher Surgical Trainees (HSTs) working in the region. These have proved popular and reportedly useful for the trainees. Although such a programme requires a widespread commitment from both trainers and trainees there are benefits in terms of both education and morale. We discuss these issues and make practical suggestions from our experience.

Education, Medical, Graduate↗