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Biomedical subjects

Paul Fagan

Publications and source records attributed to Paul Fagan.

10 recordsLinked to original sources
PubMed2005

Conservative management of sporadic unilateral acoustic neuromas.

Our objective was to review retrospectively patients with a unilateral acoustic neuroma managed by observation. One hundred patients with tumours (<24 mm) were followed a median 25.5 months. Thirty-six acoustic neuromas grew with four growth patterns. No factors were associated with growth. Eighty percent of growing tumours grew in the first year. Eleven patients proceeded to surgery. Twenty-two patients were eligible for hearing preservation surgery; five of the 15 available for analysis subsequently lost eligibility. In conclusion, selected patients can be safely observed with serial imaging and follow up. Size increase in the first year may predict future growth. Delaying surgery until required by symptoms or tumour growth does not result in more morbidity for the patient. Some may lose the opportunity for hearing preservation surgery but operating on all would result in more sustaining a loss of hearing in the first few years after diagnosis.

Adult↗
PubMed2004

Conventional behind-the-ear hearing aids after subtotal petrosectomy with blind sac closure.

OBJECTIVE: To overcome the limitations of monaural hearing resulting from a subtotal petrosectomy and blind sac closure by fitting of a behind-the-ear hearing aid. STUDY DESIGN: Three patients were fitted with aids. Patient satisfaction and the decision to buy the aids were recorded. RESULTS: Three patients reported good hearing result despite the absence of the middle ear structures. CONCLUSION: For patients troubled by the limitations imposed on hearing with a unilateral conductive loss following a subtotal petrosectomy and blind sac closure, a behind-the-ear aid is a simple and easy option to try, if the residual canal allows fitting of the aid.

Adult↗
PubMed2004

Endolymphatic sac tumors: a review of the St. Vincent's hospital experience.

OBJECTIVE: To describe the clinical, radiologic and histopathologic features of endolymphatic sac tumors using the St Vincent's Hospital experience with these tumors to highlight important aspects of tumor diagnosis and treatment. Possible explanations are given for the apparent increasing incidence of these tumors. STUDY DESIGN: Retrospective review of the senior author's (P.A.F.) database of skull base lesions. SETTING: Tertiary referral teaching hospital. PATIENTS: All patients with a proven diagnosis of endolymphatic sac tumor treated at St Vincent's Hospital, Sydney. OUTCOME MEASURES: Survival in months, after surgery. RESULTS: Seven cases of endolymphatic sac tumors. All were treated surgically. Mean follow-up of 70.2 months (range, 6-144 mo). CONCLUSION: Endolymphatic sac tumors are becoming increasingly recognized because of awareness of their existence as a separate entity from middle ear tumors. This has been achieved by improved imaging and histopathologic techniques. Surgery is the mainstay of treatment.

Adenocarcinoma, Papillary↗
PubMed2004

Complications of occipital bone pneumatization.

Four cases of occipital bone pneumatization and subsequent complications are described, which include a pathological fracture of C1 and the occipital bone, spontaneous subcutaneous emphysema and pneumatocele formation. Reviews of the published literature and possible aetiological factors have been discussed.

Accidental Falls↗
PubMed2004

Long-term outcome of modified radical mastoidectomy.

The primary aim of treatment of cholesteatoma is to attain a dry, safe, stable ear, free of disease. Maintaining or improving hearing is important but the pursuit of a hearing result should not compromise this primary aim. This study reviews the long-term outcome of 133 patients, suffering from advanced disease, who underwent modified radical mastoidectomy between 1995 and 2000. Of these, 49 per cent had had previous mastoid surgery elsewhere. A dry, waterproof ear was attained in 95 per cent of patients. In 77 per cent of patients, hearing was unchanged or improved. In this period, there were two cases of significant post-operative loss in bone conduction, including one dead ear secondary to suppurative labyrinthitis. There were epithelial pearls on follow up in two per cent. These results indicate that when properly performed, modified radical mastoidectomy provides safe surgical access and clears disease with low recurrence rates while mostly maintaining or improving hearing.

Adolescent↗
PubMed2003

A radiologic study of the tympanic bone: anatomy and surgery.

OBJECTIVE: The aim of this study was to obtain data on the anatomic structure of the tympanic bone using parasagittal reformatted images created from high-resolution axial computed tomographic scans. In particular, the thickness of the bone in the region of the temporomandibular joint and the floor of the external auditory canal was assessed. The findings are discussed with particular emphasis on the relevance to surgery in this area. BACKGROUND: Surgical management of the tympanic bone forms the basis of canalplasty, which is an essential step in the management of disorders of the external auditory canal. Adequate canalplasty is also crucial in the provision of access for tympanoplasty and to ensure optimal cavity geometry in canal wall down mastoidectomy. Tympanic bone removal is a major step in approaches to the lateral skull base and infratemporal fossa. The tympanic bone is also important because it has critical neurovascular relations in this region of the skull base. METHODS: Computed tomography of the tympanic bone (parasagittal reformatted images) in 54 consecutive adults. RESULTS: The mean thickness of the anterosuperior, anteroinferior, and inferior aspects of the tympanic bone are 2.6, 2.8, and 8 mm, respectively. CONCLUSION: Canalplasty is safely performed in the regions outlined. The technique of canalplasty described in this article is essential for good exposure in external ear, middle ear, mastoid, and skull base surgery.

Adult↗
PubMed2002

A hole in the drum. An overview of tympanic membrane perforations.

BACKGROUND: Tympanic membrane perforations are common and can be categorised into either acute or chronic. Acute perforations are usually traumatic or inflammatory in origin and heal spontaneously. Chronic perforations may be associated with underlying progressive disease. OBJECTIVE: To differentiate between safe and unsafe perforations and describe management principles for these conditions. DISCUSSION: The majority of acute tympanic membrane perforations heal spontaneously. Those that do not can be considered for surgical repair. Chronic perforations should be viewed as either safe or unsafe depending on the risk of progression to significant complications. Unsafe perforations are often associated with cholesteatoma (an epidermoid cyst of the middle ear and mastoid air cell system). Cholesteatoma destroys bone and causes serious ear and intracranial complications--surgery is commonly required.

Anti-Infective Agents, Local↗