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Biomedical subjects

P S Roland

Publications and source records attributed to P S Roland.

At least 19 recordsLinked to original sources
PubMed2001

Inhalant allergy and Meniere's disease: Use of electrocochleography and intranasal allergen challenge as investigational tools.

INTRODUCTION: In an earlier study, we demonstrated the feasibility of using electrocochleography (ECoG) to document changes in inner ear function objectively after intranasal challenge of patients with inhalant allergy (with no prior immunotherapy) and Meniere's disease, using the antigen to which they were most sensitive. OBJECTIVE: We expand on this earlier study and continue to investigate the feasibility of this model in a subset of patients with inhalant allergy and Meniere's disease after immunotherapy. STUDY DESIGN: Prospective study of 11 patients identified with both Meniere's disease and inhalant allergy in the practices of 2 neurotologists at our institution. Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen to which they were most sensitive. This was followed by a second ECoG. RESULTS: Six of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11 had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2 patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG experienced vestibular symptoms after allergen challenge, whereas 2 of group 1 and 2 of group 2 had vestibular symptoms with abnormal ECoGs. CONCLUSION: This protocol is a useful tool for investigating the relationship of inhalant allergy and Meniere's disease, but needs a larger group of patients and further study to draw valid statistical conclusions.

Allergens↗
PubMed2001

Preoperative functional assessment of auditory cortex in adult cochlear implant users.

OBJECTIVES: To explore functional neuroanatomical responses to auditory stimulation before and after implantation. STUDY DESIGN: A prospective study of three cochlear implant candidates (pure-tone averages of 90 dB HL or greater bilaterally and hearing in noise test [HINT] performances of <40%) in which regional cerebral blood flow (rCBF) was assessed using single photon emission computed tomography (SPECT). METHODS: Candidates watched a 15-minute videotaped story under four conditions: audio presented monaurally in the right and left ears (aided), audio presented binaurally (aided), and visual-only presentation of the story. Five minutes into each story, 20 to 25 mCi of technetium 99m (99mTc) hexamethyl-propyleneamine-oxime (HMPAO) (Ceratec; Nycomed Amersham, Princeton, NJ, U.SA) was injected over a 30-second period to ensure that subjects were unaware of tracer administration. Subjects were scanned for 20 minutes using a PRISM 3000 gamma camera (Picker International, Cleveland, OH, U.S.A.). Data were normalized and co-registered, and subtraction images were compiled. Subtraction images contrasted activation patterns generated under the visual-only control condition to the auditory activation states acquired monaurally and binaurally. RESULTS: Right and left ear monaural stimulation in normal hearing subjects resulted in significant bilateral activation of Brodmann areas 41, 42, 21, 22, and 38. Although substantial intersubject response variability was noted, subjects generally failed to bilaterally activate these areas under monaural hearing aid presentations; however, bilateral activation of areas 41 and 22 was noted under binaural presentations. CONCLUSIONS: Despite relatively similar hearing losses in each ear, significant differences in preoperative auditory cortex activation were observed between ears. These data suggest that functional brain imaging provides a useful tool for exploring the responsiveness of the auditory cortex in cochlear implant candidates.

Acoustic Stimulation↗
PubMed2001

Verification of improved patient outcomes with a partially implantable hearing aid, The SOUNDTEC direct hearing system.

INTRODUCTION: Partially implantable hearing devices have been developed to address some of the user-perceived shortcomings of standard amplification systems. Partially implantable devices are purported to provide improved sound quality as a result of decreased occlusion, decreased feedback, and enhanced clarity resulting from increased high-frequency gain. Such improvements may result in greater user satisfaction. To justify selection of a partially implantable device and undergoing a minor surgical procedure, verification techniques must be used to document user improvement or increased satisfaction over conventional amplification. OBJECTIVE: To evaluate patient satisfaction with the SOUNDTEC direct hearing system. STUDY DESIGN: Within-subjects repeated measures design. METHODS: Objective and subjective evaluation pre- and post-implantation with the SOUNDTEC device. Verification techniques included tonal functional gain measures with traditional amplification and the SOUNDTEC device, word recognition in quiet (NU-6) and in noise (SPIN), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hough Ear Institute Profile (HEIP). RESULTS: Although there was no significant difference between optimal traditional amplification and the SOUNDTEC device for speech perception measures, the SOUNDTEC device yielded statistically significant increased high-frequency functional gain. Subjective reports indicated that the SOUNDTEC device provides a cleaner, more natural sound without feedback than traditional amplification. CONCLUSIONS: Partially implantable hearing aids may address some of the limitations of traditional amplification systems.

Adult↗
PubMed2001

Microbiology of normal external auditory canal.

OBJECTIVES: To isolate and characterize bacteria and fungi from the healthy ear and to obtain susceptibility profiles on each bacterial isolate. STUDY DESIGN: Prospective. METHODS: Specimens were collected from the external canals and cerumen of healthy subjects. Species-level identification was obtained by combining phenotypic and genotypic data. End-point minimal inhibitory concentration testing was performed using National Committee for Clinical Laboratory Standards recommended methods. RESULTS: One hundred sixty-four subjects were cultured. Seventeen canal and 16 cerumen specimens showed no growth. One hundred forty-eight cerumen specimens yielded 314 organisms, including 23 fungi. One hundred forty-seven canal specimens yielded 310 organisms, including 7 fungi. Of 291 bacteria isolated from cerumen, 99% were Gram-positive. Of 302 bacteria isolated from the canal, 96% were Gram-positive. Staphylococci were 63% of both the cerumen bacteria and the canal bacteria. Coryneforms represented 22% of the bacteria in cerumen and 19% in the canal. Turicellaotitidis was the primary coryneform isolated from both the canal and the cerumen. Streptococci-like bacteria were 10% from the cerumen, 7% from the canal. In both cerumen and canal, Alloiococcusotitis was more than 95% of the streptococci-like bacteria. Fifteen gram-negative organisms were isolated from the canal and cerumen, including four Pseudomonas aeruginosa strains. The percentages of Staphylococcus epidermidis isolates that had high-level resistance (> or =8 microg/mL) were as follows: to neomycin, 28% from cerumen and 11% from the canal; to oxacillin, 28% from cerumen and 25% from the canal; and to ofloxacin, 15% from cerumen and 19% from the canal. CONCLUSIONS: Turcellaotitidis and A. otitidis were present with a much higher frequency than previously described, lending evidence that they be considered normal otic flora. Corynebacterium auris, previously reported only in children, was isolated from normal adults.

Adult↗
PubMed2001

Chronic external otitis.

Chronic external otitis is probably a disease of mixed etiology; infection and hypersensitivity both play an important role. As such, these two components must be recognized and respected. Steroids are the mainstay of medical management. Antibiotics should be used cautiously and probably on an intermittent basis. The disease appears to be exacerbated by any manipulation of the canal, including aggressive cleansing. Medical therapy will slow the development of fibrosis in some cases, but it does not always prevent it. Once stenosis has progressed to the point that conductive hearing loss develops, surgery will restore hearing and prevent restenosis in at least 80% of cases.

Humans↗
PubMed2000

Outpatient cochlear implantation in the pediatric population.

Studies have shown that the incidence of complications in pediatric cochlear implant surgery is related to the age of the child, with a higher complication rate in younger patients. Consequently, many surgeons advocate admitting these children overnight. We began our pediatric cochlear implant program starting in June 1991 using the Nucleus 22-channel cochlear implant. To date, 65 children have undergone implantation, all on an outpatient basis. To evaluate safety, complication rate, and patient satisfaction, we gave the parents of the patients a questionnaire survey to complete. All patient charts were also retrospectively reviewed. More than 90% of parents surveyed responded that they were satisfied with the outpatient treatment of their children. There were no perioperative complications or readmissions. Cochlear implantation can be safely and effectively performed on an outpatient basis without an increase in morbidity. Day surgery reduces hospital costs at least $2500.

Adolescent↗
PubMed2000

Vestibular dysfunction in Gulf War syndrome.

METHODS: Vestibular complaints of Gulf War veterans were characterized by a nested case-control study of 23 veterans with 3 different Gulf War syndromes and 20 matched control subjects. All subjects completed a standardized symptom questionnaire and underwent standard audiovestibular tests administered by audiologists blinded to group identities. RESULTS: The prevalence of reported dizzy spells was higher in veterans with Gulf War syndromes 1 (100%), 2 (85%), and 3 (100%) than in controls (25%, P < 0.0001). Dizzy spells were more frequent, lasted longer, and involved a wider variety of accompanying symptoms in veterans with syndrome 2 than in those with syndromes 1 and 3. Audiovestibular testing showed greater interocular asymmetry of nystagmic velocity on sinusoidal harmonic acceleration in syndromes 1 (P = 0.015) and 2 (P = 0.002), greater asymmetry of saccadic velocity in syndrome 2 (P = 0.4), diminished nystagmic velocity after caloric stimulation bilaterally in syndrome 3 (P = 0.02 to 0.04), more subjects with pathologic nystagmus (P = 0. 09), and greater interside asymmetry of wave I to III interpeak latency on auditory brain stem response in syndromes 1 (P = 0.005) and 2 (P = 0.07). Asymmetry of gain on sinusoidal harmonic acceleration and pathologic nystagmus were most strongly associated with symptoms of paroxysmal vertigo (P = 0.002 and 0.07, respectively); asymmetry of saccadic velocity, with the severity of vertigo (P = 0.004); and abnormal caloric response, with chronic dysequilibrium (P = 0.006). CONCLUSIONS: The findings are compatible with a subtle neurologic injury from organophosphate-induced delayed neurotoxicity.

Adult↗
PubMed2000

Stereotastic radiosurgery for glomus jugulare tumors.

OBJECTIVES/HYPOTHESIS: Surgery is considered to be the mainstay of treatment for glomus jugulare tumors. A subset of patients are poor surgical candidates based on age, medical problems, tumor size, or prior treatment failure. The purpose of this study was to review our results with stereotactic radiosurgery (gamma knife treatment) in this group of patients, with particular attention to adverse reactions and symptom relief. STUDY DESIGN: Retrospective review and phone survey. METHODS: Charts were reviewed for size and location of tumor, history of previous treatment, symptoms before and after treatment, amount of radiation received, acute and late complications, and functional level before and after treatment. Pre-treatment and posttreatment magnetic resonance imaging scans were also reviewed. Identified patients were then contacted for a phone interview. RESULTS: Eight patients were identified. Phone interviews were conducted with four patients. Four patients had failed previous treatment. Follow-up ranged from 7 to 104 months. One patient experienced an acute complication: intractable vertigo requiring hospitalization. No patient experienced delayed cranial neuropathies. No patient reported worsening of any of the following symptoms: pulsatile tinnitus, hearing loss, facial weakness, hoarseness, or difficulty swallowing. Three patients reported improvement in their pulsatile tinnitus. Two patients reported improvement in hearing loss, and one patient each reported improvement in vertigo and difficulty swallowing. CONCLUSIONS: Preliminary results suggest that stereotactic radiosurgery is useful to control symptoms and may be delivered safely in patients with primary or recurrent glomus jugulare tumors who are poor surgical candidates.

Aged↗
PubMed2000

An animal model for external ear canal inflammation.

OBJECTIVE: To develop an animal model for testing efficacy of anti-inflammatory drugs designed to treat external ear canal (EAC) disease. METHODS: Histological and morphometric methods were used to characterize EAC inflammation produced by topical application of tetradecanoylphorbol acetate (TPA) in mice. The effects of both single and repeated TPA applications were studied. A treatment trial was performed to evaluate the effects of a ciprofloxacin/hydrocortisone suspension on TPA-induced EAC inflammation. In 10 animals, two bilateral applications of TPA were made, spaced 24 hours apart. Immediately after the second TPA application, otic suspension was applied unilaterally four times over a 48-hour period. The contralateral EACs were left untreated to provide TPA-only controls. RESULTS: Twenty-four hours after a single TPA application, EAC skin showed polymorphonuclear (PMN) leukocyte infiltration, vascular dilation, and thickening of the dermis and epidermis. Dermal and epidermal thickening were more pronounced after two TPA applications and PMN leukocyte infiltration remained high 48 hours after a second TPA placement. After treatment with the otic suspension, PMN leukocyte counts were reduced by an average of 76% relative to EACs that received TPA only. There was also statistically significant reduction of dermal swelling and a trend toward reduced epidermal thickness. Vascular dilation was clearly reduced as well EACs that received four applications of the suspension alone showed no adverse effects compared with those that received saline. CONCLUSION: TPA-induced inflammation of the mouse EAC provides a suitable model for testing the therapeutic efficacy of anti-inflammatory agents being considered for clinical use.

Administration, Topical↗
PubMed1999

Extra-articular synovial chondromatosis of the temporomandibular joint: pitfalls in diagnosis.

Synovial chondromatosis is a benign disease that only rarely affects the temporomandibular joint. When it does, disease is usually confined to the joint space itself but can occasionally extend beyond the joint capsule into the parotid gland, temporal bone, or cranium. The local clinical behavior, radiographic appearance, and histopathologic features can combine to create the appearance of a malignant lesion. We report a case of synovial chondromatosis that affected the temporomandibular joint and presented as an external auditory canal mass. The lesion was thought to be a chondrosarcoma prior to the definitive resection. Pitfalls in the diagnosis and management of synovial chondromatosis are discussed.

Chondromatosis, Synovial↗
PubMed1999

Open-cavity tympanomastoidectomy.

A large number of considerations determine whether an open-cavity or closed-cavity technique is most appropriate for an individual patient. These considerations in the selection of technique, as well as the advantages and disadvantages of both open-cavity and closed-cavity tympanomastoidectomy are reviewed in this article. Emphasis is placed on the technical details required to produce a problem free and functional open-cavity tympanomastoidectomy.

Counseling↗
PubMed1999

Electrocochleographic changes after intranasal allergen challenge: A possible diagnostic tool in patients with Meniere's disease.

Numerous observers have suggested a relationship between allergy and Meniere's disease, but objective proof has heretofore been limited. Using standard criteria, we studied a group of 7 patients with previously diagnosed Meniere's disease in whom significant allergy to 1 or more inhalants had also been diagnosed. Patients underwent a baseline electrocochleographic study followed by intranasal challenge with a carefully quantified amount of the allergen to which they were most sensitive. This was followed by a second electrocochleogram. Four of the 7 patients demonstrated at least a 15% increase in the summating potential/action potential ratio in 1 ear, associated with the production of subjective inner ear symptoms. We present this protocol as a potentially useful tool to further study whether inhalant allergy may be a causative factor in patients with Meniere's disease.

Administration, Intranasal↗
PubMed1997

Evaluation of neurologic function in Gulf War veterans. A blinded case-control study.

OBJECTIVE: To determine whether Gulf War-related illnesses are associated with central or peripheral nervous system dysfunction. DESIGN: Nested case-control study. PARTICIPANTS: Twenty-three veterans with factor analysis-derived syndromes (the cases), 10 well veterans deployed to the Gulf War (the deployed controls), and 10 well veterans not deployed to the Gulf War (the nondeployed controls). METHOD: With investigators blinded to group identities, participants underwent objective neurophysiological, audiovestibular, neuroradiological, neuropsychological, and blood tests. MAIN OUTCOME MEASURES: Evidence of neurologic dysfunction. RESULTS: Compared with the 20 controls, the 23 cases had significantly more neuropsychological evidence of brain dysfunction on the Halstead Impairment Index (P=.01), greater interside asymmetry of the wave I to wave III interpeak latency of brain stem auditory evoked potentials (P=.02), greater interocular asymmetry of nystagmic velocity on rotational testing, increased asymmetry of saccadic velocity (P=.04), more prolonged interpeak latency of the lumbar-to-cerebral peaks on posterior tibial somatosensory evoked potentials (on right side, P=.03, and on the left side, P=.005), and diminished nystagmic velocity after caloric stimulation bilaterally (P values range from .02 to .04). Cases (n=5) with syndrome 1 ("impaired cognition") were the most impaired on brain stem auditory evoked potentials (P=.005); those (n=13) with syndrome 2 ("confusion-ataxia") were the most impaired on the Halstead Impairment Index (P=.006), rotational testing (P=.01), asymmetry of saccadic velocity (P=.03), and somatosensory evoked potentials (P< or =.01); and those (n=5) with syndrome 3 ("arthro-myo-neuropathy") were the most impaired on caloric stimulation (P< or =.01). CONCLUSIONS: The 3 factor-derived syndromes identified among Gulf War veterans appear to represent variants of a generalized injury to the nervous system.

Adult↗
PubMed1997

Interinterpreter variability in determining the SP/AP ratio in clinical electrocochleography.

Calculating the SP/AP ratio in electrocochleography requires the interpreting audiologist to unequivocally identify the peak of the SP wave form. If different points are selected, different SP/AP ratios will result. To investigate this effect, 50 electrocochleographic tracings were sent to 10 different audiologists (500 tracings). Twenty of the wave forms sent to each audiologist were identified as "easy," 10 as "somewhat difficult," 10 as "very difficult," and 10 as "no response." The ranges and standard deviations of the resulting SP/AP ratios were quite high. Analysis of variance showed statistically significant differences in the very difficult and no response group. There is significant interinterpreter difference among SP/AP ratios calculated from the same tracing. This variability affects clinical patient management and investigational projects.

Analysis of Variance↗
PubMed1997

Vestibular evaluation in patients with early multiple sclerosis.

Multiple sclerosis (MS) is a chronic, debilitating disease characterized by multiple areas of focal demyelination that develop throughout the white matter of the central nervous system at varying times. Most patients report disequilibrium at some point in the course of their disease. When balance disturbance occurs early in the course of the disease prior to diagnosis, the patient may present to the otolaryngologist for evaluation. Are there any patterns of balance dysfunction that might suggest the diagnosis to the evaluating physician? An evaluation of ten patients with known early MS suggests that platform posturography and ENG is the test most likely to provide useful diagnostic information in patients with early MS.

Adult↗