PubMed Health⌕ Search

Biomedical subjects

M L Pensak

Publications and source records attributed to M L Pensak.

At least 37 records · Page 2Linked to original sources
PubMed1994

Intraoperative facial nerve monitoring in chronic ear surgery: a resident training experience.

Intraoperative facial nerve monitoring has been accepted as a valuable adjunctive modality to be employed in a variety of neurotologic and skull base surgical procedures. However, the role that electrical or mechanical stimulation assessment plays in chronic ear surgery is less well defined, especially in a residency training program. In this study, 250 consecutive operative cases of chronic otitis media, with and without cholesteatoma were monitored with the Xomed-Treace Nerve Integrity Monitor, NIM-2 system. Data regarding electrophysiologic monitoring parameters; electromechanical artifact, including system failure; and surgical outcome were analyzed. Although not a substitute for anatomic identification of the facial nerve, intraoperative monitoring provides an additional technique to optimize resident surgical education.

Adolescent↗
PubMed1994

Predictability of recovery from Bell's palsy using evoked electromyography.

The role of surgery in the treatment of idiopathic facial paralysis (Bell's Palsy) has been the subject of much controversy. Some have advocated aggressive surgical therapy to prevent nerve injury based on evoked electromyography (EEMG) results. The present study analyzes the outcome of 23 patients who presented with Bell's palsy and were evaluated with EEMG. Of the 15 patients who showed greater than 90 percent compound action potential reduction in the affected side, a widely used criterion for surgical decompression of the facial nerve, almost half (47%) had normal to near-normal recovery, and only three (20%) had residual severe dysfunction. Results infer that patients who meet surgical criteria based on EEMG results but who do not undergo surgery do not show a greater morbidity. The authors conclude that conservative criteria should be used when recommending facial nerve decompression.

Adolescent↗
PubMed1993

Asymptomatic osteomas of the middle ear.

Osteomas of the middle ear are extremely rare lesions. Of the nine cases reported, eight presented with conductive hearing loss. We recently treated two patients whose osteomas, of the promontory and of the posteroinferior tympanic wall, were asymptomatic. We suggest that middle ear osteomas need not be removed when they do not impinge on the sound conduction system.

Adult↗
PubMed1991

Management of the acoustic neuroma in an only hearing ear.

Heightened physician awareness of the sociologic and psychologic trauma related to deafness coupled with an increased emphasis on early diagnosis has prompted the employment of sophisticated diagnostic studies in an attempt at identification of an acoustic neuroma as a cause of hearing loss. Because profound bilateral hearing impairment is a catastrophic event, the management and care of an individual with an eighth nerve lesion in an only hearing ear remains a significant challenge for both patient and physician. In this article we will summarize our experience with this unique patient population through case presentations that will include diagnostic testing and intraoperative and perioperative findings. The literature regarding diagnosis and management will be reviewed. Recommendations for options available in the care of these patients will be discussed.

Journal Article↗
PubMed1991

Prediction of bithermal caloric response from monothermal stimulation.

The use of either cold or warm caloric stimulation alone as a screening tool for unilateral weakness has been suggested as a means of both shortening testing time and reducing patient discomfort. The validity of the monothermal caloric test must be well established before it can be routinely used in clinical situations. The purpose of this investigation was to re-evaluate the monothermal caloric test by examining the correlations between unilateral weakness derived from bithermal caloric stimulation compared to monothermal caloric results using either warm or cool stimulation alone. A retrospective analysis of 200 patients indicated significant correlations between bithermal and monothermal unilateral weakness for patients with unilateral weakness of less than 15% and greater than 30% for both warm and cool water stimulation. For patients with 15% to 30% unilateral weakness, the bithermal and monothermal calorics were significantly correlated for only the cool condition. When predicting normal or greater than 20% unilateral weakness, either of the monothermal calorics have greater than 85% efficiency, with specificity greater than 94% and sensitivity greater than 64%. However, the false-negative rate is 29% for warm and 36% for cool calorics. The high rate of false-negative findings indicates that screening tests have no place in a diagnostic battery, especially in view of the implications for missing significant pathology.

Adolescent↗
PubMed1991

Temporal bone resection.

It must be emphasized that the greatest impact of survival can only be obtained through an early diagnosis and a radical treatment program. Any granulation tissue must be sent for biopsy to rule out the possibility of malignancy in the setting of chronic otitis media. Once carcinoma is diagnosed, imaging studies must be obtained to define the extent of the tumor. Under diagnosis is the rule with these malignancies. Tumors limited to the external auditory canal can be adequately resected with a lateral temporal bone resection. Extension into the middle ear and mastoid aircell systems requires either a subtotal temporal bone resection or a lateral temporal bone resection with a radical mastoidectomy and petrousectomy. The inclusion of the petrous apex with the resection, as in a temporal bone resection, does not add to survival but increases morbidity. Radical postoperative radiation therapy is essential for maximum local control and survival with these malignancies.

Ear Canal↗
PubMed1991

The fluoroquinolones.

At the Eastern Section Meeting of the Triological Society January 26, 1990, Levinson et al reported outstanding success with ciprofloxacin in the treatment of malignant otitis externa. Moreover, several of the individuals so managed had been refractory to conventional therapy with semisynthetic penicillin and aminoglycoside protocols. This new class of antibiotics may result in a profound change in our management of patients with otologic, neurotologic, and skull base infections.

Bacterial Infections↗
PubMed1991

Viral hepatitis.

Explore the source record for details and available documents.

Chronic Disease↗
PubMed1991

Central auditory function.

Central auditory disorders in children and adults have become more widely recognized in patients seen by otolaryngologists and audiologists. This article briefly defines those clinical entities, discusses the historic background of testing, and describes current and future test approaches to assessment of central auditory disorders.

Audiometry, Evoked Response↗
PubMed1990

Thoughts on the management of chronic facial, head, and neck pain.

As previously stated in this paper, the therapeutic goal in the management of patients with chronic pain conditions in the face, head and neck is management and rehabilitation, striving for a 50 percent decrease in pain, a 50 percent increase in function and mobility, and a 50 percent decrease in medication with the elimination of agents with an addicting potential. These results will best be obtained through proper diagnosis and utilization of the aforementioned techniques in an interdisciplinary fashion as has been described.

Analgesics↗
PubMed1989

A paraneoplastic syndrome associated with glomus tumors of the skull base? Early observations.

Independent secretion of vasoactive substances by glomus tumors of the skull base is widely recognized. Surgical removal of these tumors often results in an unexplained prolonged postoperative ileus, even in cases in which the vagus nerve is preserved. There is evidence that these tumors may secrete neuropeptides, such as cholecystokinin, in addition to catecholamines. A retrospective analysis of cases of glomus tumors of the skull base operated on at The Otology Group was carried out to correlate preoperative neuropeptide levels, vagus nerve status at surgery, and duration of postoperative ileus. High circulating levels of cholecystokinin associated with these tumors may be responsible for the unexplained phenomenon of prolonged postoperative ileus. The relevance of neuropeptides to the postoperative management of these patients is discussed. Preventive measures that may avert the potentially lethal complications of aspiration and negative nitrogen balance are described.

Catecholamines↗
PubMed1989

The early signs and symptoms of neurotologic complications of chronic suppurative otitis media.

The delay in the diagnosis of neurotologic complications of chronic suppurative otitis media has been explained in a number of ways, including antibiotic suppression, surgical drainage, and a lowered index of clinical suspicion because the problem is relatively rare today. Twelve cases of neurotologic complications of chronic suppurative otitis media were reviewed to determine the early and late findings that should raise the physician's index of suspicion. Purulent, malodorous drainage, headache, and fever were the significant early findings. Altered mental status was a late finding, and usually indicated established intracranial infection. By drawing attention to the early findings, we hope to lower the morbidity and mortality associated with these complications.

Brain Abscess↗
PubMed1989

Neuroaudiologic abnormalities in patients with type 1 neurofibromatosis.

Although the protean manifestations of neurofibromatosis have been studied for many years, much is yet to be learned about this disease in young children. Specifically, little is known about the prevalence and significance of early neurotologic abnormalities in this population. Our review of the recent literature, however, failed to identify any publication on the use of ABR and acoustic reflex testing in the pediatric neurofibromatosis population. This study reports on a standardized differential diagnostic battery conducted on 44 children diagnosed as having neurofibromatosis. Results of the neuroaudiologic battery indicated that 32% of the children had significant abnormalities on ABR and acoustic reflex dynamic tests. This is a substantially higher prevalence of abnormalities than reported by another group at a recent NIH concensus meeting on neurofibromatosis. Discussion of the implications of these findings regarding evaluation protocols, as well as management for this select patient population, will follow.

Acoustic Impedance Tests↗
PubMed1989

Rhabdomyosarcoma of the ear and temporal bone.

Rhabdomyosarcoma, the most common soft tissue sarcoma of childhood, involves the temporal bone in approximately 7% of reported cases. Until recently, the outcome of this disease was always fatal. The recent Intergroup Rhabdomyosarcoma Study Group (IRS-I) reported on the efficacy of multimodality therapy consisting of multiagent chemotherapy, radiation, and surgical resection when indicated. Twelve patients with rhabdomyosarcoma involving the temporal bone were treated between 1966 and 1988. Three patients were treated according to the IRS-I protocols and the remaining nine patients received various combinations of treatment modalities. Ten patients succumbed to their disease, most with distant metastases or intracranial extension. Two patients are alive; one at 5 1/2 years and one at 19 years. It is apparent that, although survival for rhabdomyosarcoma in general has improved with the use of IRS-I protocols, prognosis remains poor for disease involving the temporal bone and other parameningeal sites.

Adolescent↗
PubMed1989

The surgical anatomy and approaches to lesions of the lower basilar artery and vertebral artery union.

The neural and vascular anatomy of the posterior fossa and bony skull base is of interest to both neurosurgeons and otologists charged with the evaluation and management of patients demonstrating lesions in this region. Despite well described approaches to pathology in this area, access to the lower basilar artery and clivus remains a significant challenge. This report highlights the pertinent anatomic details of the fossa, describes the bony dimensions relevant to surgical access, and reviews two unconventional approaches to the lower basilar upper vertebral artery union.

Basilar Artery↗