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Biomedical subjects

N M Sperling

Publications and source records attributed to N M Sperling.

13 recordsLinked to original sources
PubMed2001

Otologic manifestations of Chiari I malformation.

OBJECTIVE: To assess the prevalence of otologic symptoms in patients undergoing surgical decompression for symptomatic Chiari I malformation. STUDY DESIGN: Cross-sectional, prospective, nonrandomized. SETTING: Urban tertiary referral center. PATIENTS: Patients with Chiari I malformation before surgical intervention. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Results of completed questionnaire. RESULTS: Sixteen consecutive patients with Chiari I malformation completed the self-administered questionnaire. Eighty-one percent of patients reported episodic aural fullness, 81% reported tinnitus, 69% reported vertigo, and 56% reported fluctuating hearing loss. Headaches were reported as frequently as aural fullness and tinnitus. CONCLUSIONS: Most patients with Chiari I malformation have symptoms that mimic primary otologic pathologic changes. The existence of common pathophysiologic mechanisms is proposed.

Adult↗
PubMed2000

Diagnosis and management of the lateralized tympanic membrane.

OBJECTIVE: Lateralization of the tympanic membrane (TM) is associated with significant morbidity. In a series of 14 patients, we make observations to illuminate this condition for the diagnosing and treating physician. STUDY DESIGN: Chart review of 14 consecutively treated patients. METHODS: We analyzed the presenting signs and symptoms, etiology, audiometric data, and operative findings of patients with a lateralized tympanic membrane (TM). RESULTS: The etiology was postsurgical in 13 patients (there were four aural atresia repairs and nine tympanoplasties), with 2 patients having had multiple previous surgeries. Presentation averaged more than 5 years after the latest surgery. Presenting symptoms included hearing loss in 10, tinnitus in 3, vertigo in 3, and otorrhea in 2 patients; 3 patients were nonsymptomatic at the time of presentation. The average air-bone gaps were 39 dB before treatment and 29 dB after treatment. Operative findings included cholesteatoma in six patients. Eight patients healed with the TM in the normal position; one had TM retraction, one had a TM perforation, and three had a recurrent lateralization. CONCLUSION: The lateralized TM is primarily, but not necessarily, a complication of otological surgery. It may be associated with considerable morbidity, including hearing loss and cholesteatoma. Patients may present several years after their surgery, occasionally as an incidental finding. Surgical repair is often necessary for significant underlying disease, but re-establishment of a normal TM can be challenging.

Adolescent↗
PubMed1999

A patient-benefit evaluation of unilateral congenital conductive hearing loss presenting in adulthood: should it be repaired?

OBJECTIVE: To evaluate subjective and objective outcomes of surgical therapy in congenital conductive hearing loss (HL) presenting in adulthood. The impact of hearing restoration on quality of life (QOL) for these patients may differ from those with acquired HL. STUDY DESIGN: Retrospective review of five patients treated surgically. METHODS: Standard audiometry was completed. Patients completed a subjective questionnaire as well as subjective (open-set) questions. A seven-point Likert scale was used for closed-set responses with 1 representing the worst possible outcome and 7 being best. RESULTS: The average four-frequency improvements in pure-tone average and air-bone gap were 18 dB (range, 7-29 dB) and 16 dB (range, 2-30 dB), respectively. An average score was obtained for each closed-set question. The highest-scoring items were for overall improvement of QOL (average score, 6), followed by perceived improvement in hearing (average score, 5.6). Other positive responses were improved ability to use the telephone (four of five patients) and improved localization of sound (four of five patients). Negative subjective responses included prolonged dysequilibrium in two of five, prolonged adjustment period in three, and dysgeusia in one patient. CONCLUSION: Important components of outcome are likely to escape our review if only objective measures are used to evaluate surgical outcomes. These results suggest that improved hearing in this population provides specific improvements in lifestyle and is perceived as a significant improvement in overall QOL.

Adult↗
PubMed1999

Malleus ankylosis: a clinical, audiometric, histologic, and surgical study of 123 cases.

OBJECTIVE: Malleus ankylosis is a cause of conductive hearing loss that can be difficult to assess, particularly in association with otosclerotic stapes fixation. The aim of this study is to seek the clinical and audiometrical features unique to this pathology. STUDY DESIGN: The study design was a review of malleus ankylosis cases and an analysis of functional results after ossiculoplasty. SETTING: The study was performed at Jean Causse Clinic in France. PATIENTS: The authors reviewed a series of 123 ears in 112 patients who underwent surgery for incudo-mallear ankylosis from January 1991 to September 1997. INTERVENTION: The surgical technique depends on the type of pathology encountered. In case of associated stapedial fixation, a stapedotomy with vein graft interposition and reconstruction with a total prosthesis will be performed during a same step. MAIN OUTCOME MEASURES: Clinical evaluation, preoperative and postoperative audiometrical evaluation, operative findings, histologic examination, and postoperative functional results. RESULTS: In our series, a postoperative air-bone gap smaller than 10 dB was obtained in 77% of cases. These results confirm the possibility of managing both pathologies in a single surgical step. CONCLUSION: Incudo-mallear ankylosis remains an unusual pathology but should be systematically assessed during surgery and preferably after separation of the incudo-stapedial joint. A preoperative diagnosis is difficult to ascertain; some audiometrical features allow a suspicion. In this series, it is shown that otosclerosis can be responsible for ankylosis as seems to be confirmed by the two cases presented in this study.

Adolescent↗
PubMed1998

Aural symptoms and hearing loss in patients with lupus.

OBJECTIVE: Systemic lupus erythematosus causes widespread tissue injury from deposition of immune complexes. The prevalence of aural symptoms in this disease was evaluated. METHODS: The presence of tinnitus, hearing loss, and fluctuating hearing was evaluated by a self-directed questionnaire in patients aged 65 or less from a lupus clinic. Patients reporting aural symptoms were compared with those reporting none, by use of demographics and disease duration. Comparison was also made with historic serologic data. Audiometry was offered to all patients with lupus reporting aural symptoms and was completed in 10. RESULTS: Twenty-six (31%) of 84 patients with lupus reported aural symptoms. Patients reported a combination of symptoms: unilateral hearing loss with or without tinnitus in 13 (15%) of 84 and bilateral hearing loss with or without tinnitus in 14 (17%) of 84. No statistical difference was measured between symptomatic and asymptomatic patients when compared by average age, duration of disease, history of noise exposure, head trauma, and infectious ear diseases. Statistically significant differences were detected only when comparing average creatinine and C3 levels. Of those patients tested by audiometry, 7 of 10 had abnormal pure-tone thresholds. Asymmetric findings were present in 6 of these 7 patients tested. CONCLUSION: Aural symptoms are prevalent among patients with lupus. Asymmetric symptoms and hearing loss are most common. The cause may relate to immune-complex disease and/or vasculitis.

Adolescent↗
PubMed1998

The precochlear approach to the anterior petrous apex: an anatomic study.

The petrous apex is the most inaccessible portion of the temporal bone and surgical exposure presents considerable challenge. The transmastoid precochlear approach offers a direct intra temporal route to this region, providing good visual exposure with cochlea preservation. An anatomic study of 20 human temporal bones was performed to delineate the landmarks for this approach. Measurements to the tegmen tympani, carotid artery, and the anterior-superior limit of the cochlea were made from the cochleariform process, a constant landmark in the middle ear. Distances to the tegmen averaged 5.4 mm (range: 3.5-9 mm), to the carotid artery 9.3 mm (8-11 mm), and the cochlea 3.1 mm (2-5 mm). The entry to the apex admitted an average burr size of 3.5 mm (2-7 mm). We anticipate this approach will prove useful in the treatment of benign petrous apex lesions.

Journal Article↗
PubMed1993

Symptomatic versus asymptomatic endolymphatic hydrops: a histopathologic comparison.

One of the unanswered questions in Meniere's disease research is the pathophysiology by which the classic symptoms are produced. A histopathological study was undertaken to identify the pathological features of symptomatic endolymphatic hydrops and their relationship to these symptoms. Two groups of temporal bones were examined, compared, and described. The first group was from patients with symptoms of Meniere's disease (n = 29). Temporal bones in the second group were chosen for the presence of endolymphatic hydrops and the absence of otologic symptoms (n = 13). Significant differences were noted in the severity of hydrops, the frequency of membrane ruptures, the endolymphatic duct, and coexistent pathologic conditions. Ruptures were seen in 38% of temporal bones from symptomatic patients and in only 8% of temporal bones from patients with asymptomatic endolymphatic hydrops. Based on this study and a review of the literature, the authors believe that the symptoms and findings of Meniere's disease are explained best on the basis of both chemical and physical mechanisms being operational intermittently and together.

Cochlea↗
PubMed1990

Parotid disease associated with human immunodeficiency virus infection.

Cystic parotid enlargement is a newly recognized manifestation of HIV infection. It commonly occurs early in the spectrum of HIV-related illnesses and may be part of LAS. Serologic confirmation of HIV infection and CT imaging usually establishes the diagnosis. Cytologic or histopathologic evaluation may be required for diagnostic confirmation and for management.

AIDS-Related Complex↗
PubMed1989

Congenital cholesteatomas of the cerebellopontine angle.

Thirty cases of congenital cholesteatomas of the cerebellopontine angle (CPA) treated over a period of 20 years are reviewed with regard to their clinical features, the pathophysiology of their symptoms, and their management. The predominant symptoms were related to cranial nerves VII and VIII and headaches. Signs and symptoms were divided into those caused by local involvement of the cholesteatoma, increased intracranial pressure, or both. Diagnostic procedures from invasive procedures such as ventriculography to more sophisticated noninvasive procedures including computed tomography and magnetic resonance imaging are discussed. The surgical management of 27 congenital cholesteatomas was accomplished via a posterior cranial fossa approach. Total excision of the cholesteatoma was the aim but was carried out in only five (18%) patients because of concern regarding the preservation of nearby neurovascular structures. Partial excision was possible in 22 (82%) patients. To minimize re-formation, the residual cholesteatoma was carefully cauterized with the aid of the operating microscope and bipolar diathermy without damaging surrounding neurovascular structures. Follow-up has ranged from 2 to 15 years, with four (13%) cases of re-formation.

Adolescent↗
PubMedDate not supplied

Cystic parotid masses in HIV infection.

Cystic enlargement of the parotid gland is a newly described manifestation of infection with human immunodeficiency virus (HIV). A review of 15 such patients with respect to clinical presentation, natural history, and management is presented. Follow-up ranges from 1 to 27 months, averaging 10 months. In 47% of the patients, parotid swelling was the chief complaint leading to the diagnosis of HIV infection. T-cell analysis revealed the tendency for this lesion to occur in the early stages of immunodeficiency when T-cell counts are high. Histologic examination revealed findings resembling benign lymphoepithelial lesion. It is felt that these lesions are a local manifestation of a systemic disease and treatment should be tailored with this in mind. Surgical excision may not be necessary. Fine-needle aspiration (FNA) was found to be useful diagnostically and therapeutically. Recognition of this entity is essential for the head and neck specialist in providing an early diagnosis of HIV infection.

AIDS-Related Complex↗