Biomedical subjects

P T Rowan

Publications and source records attributed to P T Rowan.

6 recordsLinked to original sources

PubMed1998

Effect of melatonin on tinnitus.

OBJECTIVE: Evaluate melatonin as a treatment for subjective tinnitus. STUDY DESIGN: Randomized, prospective, double-blind, placebo-controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7-day washout period between medications. SETTING: Outpatient, private, neurotology practice. PATIENTS: Thirty patients with subjective tinnitus. MAIN OUTCOME MEASURES: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview. RESULTS: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02). CONCLUSION: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus.

Adult↗

PubMed1998

Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial.

OBJECTIVE: To investigate the benefits of intratympanic administration of dexamethasone in the treatment of unilateral Meniere's disease, with particular attention to the symptoms of hearing loss and tinnitus. STUDY DESIGN: A prospective, randomized, double-blind, crossover study comparing improvements in hearing loss, tinnitus, aural fullness, and caloric vestibular response secondary to intratympanic dexamethasone and sodium hyaluronate injection versus placebo consisting of saline and sodium hyaluronate. SETTING: A private otology/neurotology practice. PATIENTS: Twenty patients diagnosed with either definite or probable Meniere's disease as defined by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium. All patients were < or =21 years old and were not receiving any other form of treatment for their Meniere's disease. Each patient's primary symptoms of concern were hearing loss, aural fullness, and roaring tinnitus. INTERVENTIONS: Three consecutive daily administrations of intratympanic dexamethasone or placebo to the involved ear. MAIN OUTCOME MEASURES: Changes in audiometric pure-tone averages, speech reception thresholds, caloric vestibular responses, scores on the tinnitus handicap inventories, questionnaires, and telephone interview responses. RESULTS: No significant changes were observed in any measured parameter. Patients were unable to consistently identify which medication was dexamethasone and which was placebo. CONCLUSIONS: Intratympanic administration of dexamethasone in a group of patients with unilateral Meniere's disease (Shea's stage IV) showed no benefit over placebo for the treatment of hearing loss and tinnitus.

Adult↗

PubMed1997

Head and neck manifestations of plasma cell neoplasms.

Multiple myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma are plasma cell neoplasms. They represent distinct manifestations of a disease continuum, whereby the clinical findings are critical to diagnosis. Plasma cell neoplasms are histologically similar, and distinguishing one from the other has significant implications for treatment and survival. Plasma cell neoplasms are relatively unusual malignancies of the head and neck region. We present a case series of plasma cell neoplasms involving the skull base, paranasal sinus, larynx, and mandible as an introduction to a complete review of the literature on plasma cell neoplasms of the head and neck area.

Adult↗

PubMed1997

Facial nerve monitoring among graduates of the Ear Research Foundation.

OBJECTIVE: This study aimed to evaluate the patterns of facial nerve monitoring among graduates of an otology fellowship in which monitoring is emphasized throughout training. STUDY DESIGN: This study involved a questionnaire administered to graduates of the Ear Research Foundation, Sarasota, Florida, U.S.A. (otology/neurotology fellowship). SETTING: The study was performed in academic and private practices of surveyed physicians. MAIN OUTCOME MEASURES: These included patterns of facial nerve monitor use and surgical results after facial nerve injuries. RESULTS: Nearly 100% of the graduates of the Ear Research Foundation continue to use facial nerve monitoring routinely in otologic surgery. Five cases of facial nerve injury in surgery for long-term disease were reported for all 15 neurotologists surveyed. CONCLUSION: Routine facial nerve monitoring is not considered the standard of care in most communities; however risk of facial nerve injury appears to be greatly reduced when this adjunctive technique is employed.

Adult↗

PubMed1997

Inner ear perfusion and the role of round window patency.

OBJECTIVE: The goal of this investigation was to evaluate the degree of round window membrane obstruction in the native state. The implications for the perfusion of the inner ear via the intratympanic instillation of medications are addressed. STUDY DESIGN: This was a retrospective chart review and a prospective intraoperative observation in the setting of an outpatient office. PATIENTS: The study population was composed of 41 patients who were undergoing middle ear endoscopy before perfusion of the inner ear with medication for the treatment of Meniere's disease, sudden sensorineural hearing loss, or tinnitus. INTERVENTION: Office-based laser-assisted tympanostomy and middle ear endoscopy was carried out in each case. Lysis of adhesions overlying the round window membrane was undertaken when the underlying round window membrane could not be visualized. MAIN OUTCOME MEASURES: Evaluation of the round window niche with regard to accessibility of the round window membrane was recorded for each patient studied. RESULTS: Of the 41 cases examined, 29 of the round windows were judged to be unobstructed, 7 were obstructed partially, and 5 were obstructed completely. CONCLUSION: A significant rate of round window obstruction exists among patients who have no history of manipulation to this area. Although, intuitively, we would expect prior middle ear surgery to increase the likelihood of obstruction, this is not uniformly the outcome. If intratympanic instillation of a medication is contemplated for the treatment of an inner ear disorder, considerations for the evaluation of the round window should be made to enhance adequate diffusion into the perilymph.

Aged↗

PubMed1996

Laser-assisted tympanostomy.

Laser-assisted tympanostomy (LAT) was performed in 70 ears to ventilate the middle ear space without using a pressure-equalizing tube. Using a CO2 laser attached to an operating microscope with a Microslad (microscope laser adaptor device), tympanostomies of 1.0 to 3.0 mm (average, 1.6 mm) in diameter were created and remained patent for an average of 3.14 weeks. Patency time was directly related to the size of the opening. Nearly all (97.9%) of the tympanostomies healed with no noticeable scarring and no persistent perforations. Seventy-eight percent of patients at the Florida Ear & Sinus Center (FESC, Sarasota, Fla.) and 84% of patients at the Head & Neck Surgery Group (New York) showed no evidence of recurrent effusion after a minimum follow-up of 3 months. LAT appears to be a safe, cost-effective procedure which can easily be performed in an office setting when bloodless opening in the tympanic membrane is needed for either treatment or diagnosis using endoscopes.

Adolescent↗