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Biomedical subjects

R A Chole

Publications and source records attributed to R A Chole.

At least 19 recordsLinked to original sources
PubMed1992

Tinnitus and vertigo in patients with temporomandibular disorder.

The association of tinnitus and vertigo with temporomandibular disorder (TMD) has been debated for many years. The observation that patients with TMD have otologic symptoms is confounded because tinnitus and vertigo are common symptoms in the normal population. The present study was conducted to determine if tinnitus and vertigo are actually more prevalent in patients with TMD than in appropriate age-matched controls. One control group was recruited from patients seeking care for health maintenance and the other from patients seeking routine dental care. We surveyed 1032 patients: 338 had TMD and 694 served as two age-matched control groups. Tinnitus and vertigo symptoms were significantly more prevalent in the TMD group than in either of the control groups. The mechanism of the association of TMD and otologic symptoms is unknown.

Adolescent↗
PubMed1992

Macrothrombocytopenia and progressive deafness: a new genetic syndrome.

We report a kindred with hereditary macrothrombocytopenia and progressive sensorineural hearing loss. Although the occurrence of hereditary sensorineural hearing loss associated with macrothrombocytopenia has been reported in a small number of families, varying degrees of renal pathology have always been present. In contrast to the previously reported syndromes involving a giant-platelet disorder and deafness, none of the family members in this report have had any evidence of renal dysfunction. The disorder was inherited in a linear pattern from great-grandmother to grandmother to mother to daughter. The clinical manifestations include hearing impairment that begins before the third decade and progresses to severe to profound bilateral hearing loss by the fourth decade. The platelet disorder manifests in early childhood and persists lifelong, although it tends to remain subclinical. Hematologic and ultrastructural findings will be contrasted to those found in Alport syndrome.

Blood Platelets↗
PubMed1992

Traumatic external auditory canal atresia.

Gunshot injuries in the periauricular region can result in massive tissue distortion and destruction. The soft tissue effects can be so dramatic that otologic abnormalities can be initially overlooked, especially by non-otolaryngologists. Delayed stenosis or complete closure of the external auditory canal can occur. We present two cases of post-traumatic ear canal atresia that were initially overlooked by non-otolaryngologists, until secondary plastic reconstructive operations were performed in which preauricular skin incisions entered into large canal cholesteatomas. These canal cholesteatomas resulted from total obstruction of the external auditory canal after trauma.

Adolescent↗
PubMed1992

Facial paralysis in temporal bone trauma.

A retrospective review of 36 patients with delayed-onset (19 patients) and immediate-onset (17 patients) traumatic facial paralysis was performed. We hypothesized that traumatic delayed-onset facial paralysis does not necessitate surgical decompression under any routine circumstances. Of 19 patients in this group, normal recovery (House grade 1) occurred in 94 percent of the patients without surgical intervention. The small percentage (6%) of these patients who failed to recover completely demonstrated mild degrees of weakness and synkinesis (House grade 2). Immediate-onset paralysis occurred in 17 patients. It has a much poorer prognosis. Seven patients with penetrating wounds had facial nerve transections, usually of the vertical portion of the facial nerve. Closed head injured patients with immediate-onset facial paralysis sustained injuries usually to the horizontal and perigeniculate portion of the facial nerve. For those cases in which surgical exploration of the traumatized facial nerve is indicated, the operating surgeon should have the capacity to enlarge the exposure with a translabyrinthine or middle-fossa dissection.

Adolescent↗
PubMed1991

Indomethacin inhibition of middle ear bone resorption.

Localized osteoclastic bone resorption is responsible for the pathological changes within the middle and inner ear, which result in hearing loss and vertigo in chronic otitis media and otosclerosis. The local control of osteoclastic bone resorption is incompletely understood. Various small, locally active molecules, cytokines, have been shown to affect resorptive processes. Additionally, prostaglandins and their inhibitors have been shown to modulate the resorptive process in a number of in vitro studies. In this study, indomethacin, a cyclooxygenase inhibitor, was tested in a model of localized bone resorption, the pressurized gerbil bulla. After the experimental period, indomethacin was found to inhibit the number of osteoclasts and the resorptive area on the inner surface of the bulla. Therefore, it is likely that endogenous cyclooxygenase metabolites are intermediates in the sequence of cellular events, which results in localized bone resorption as in some systemic models.

Animals↗
PubMed1991

Ibuprofen inhibits localized bone resorption in the middle ear.

Localized osteoclastic bone resorption plays a significant role in the pathogenesis of several diseases of the middle ear as well as orthodontic tooth movement and long bone remodeling. The mechanisms of control of localized bone loss and systemic bone resorption may be different but both may be mediated by a final common pathway which includes prostaglandins. Prostaglandins seem to have a predominantly stimulatory effect on bone resorption, although the exact mechanism is poorly understood. Ibuprofen, a nonsteroidal antiinflammatory drug, is known to inhibit the synthesis of prostaglandins. It is likely that ibuprofen, through its inhibition of prostaglandin synthesis, would decrease the localized osteoclastic bone resorption in a previously described animal model system. Mongolian gerbils were divided into three groups: low dose ibuprofen (10 mg/kg per day), high dose ibuprofen (30 mg/kg per day), and a control group. Following surgical implantation of catheters to the right bullae of each gerbil, pressure was applied for 8 days, stimulating osteoclastic bone resorption. After killing the animals and histomorphometric analysis of the bullae from each, comparisons were made between each group using osteoclast surface (percentage of bone area covered by osteoclasts), osteoclast number (number of osteoclasts/mm bone length), and osteoclast profile area (in microns2). Significantly lower osteoclast surface (Oc.S/BS) was found in pressurized bullae from both treatment groups when compared with pressurized bullae from controls (P less than 0.05) and significantly lower osteoclast number (N.Oc/T.L) in pressurized bullae from both treatment groups when compared with pressurized bullae from controls (P less than 0.05). These differences were found to be dose-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Cochlear bone erosion: effects on cochlear hair cells. A scanning electron microscopy study.

Cochleae from gerbils with normal middle ears were compared with cochleae from gerbils with experimentally induced cholesteatomas that were in contact with the cochlear wall (stage III cholesteatomas). Cochleae from gerbils with stage III cholesteatomas were further divided into two groups: one without erosion of cochlear bone, and one with cholesteatoma-induced bone erosion but without cochlear fistulae. The cochleae with bone erosion showed significant loss of outer hair cells in the middle and apical turns, but not in the basal turn. The cochleae with stage III cholesteatomas but without bone erosion did not differ from normal controls. These results suggest that an ototoxic agent, involved in the process of bone erosion, acts through the bony cochlear wall.

Animals↗
PubMed1990

Nasolacrimal duct obstruction after endoscopic sinus surgery.

Intranasal endoscopic sinus surgery has several potential ocular complications, including visual loss, diplopia, retrobulbar hemorrhage, and epiphora. We treated eight patients with persistent nasolacrimal duct obstruction after endoscopic sinus surgery. All patients required dacryocystorhinostomy to achieve a patent lacrimal system drainage. To our knowledge, this is a previously unreported complication in the ophthalmologic literature. The relevant anatomy of the nasolacrimal duct is discussed in addition to surgical procedures for avoidance and treatment of iatrogenic injury to the system. Endoscopic sinus surgery is a highly successful procedure that is rapidly gaining popularity among otolaryngologists. As the number of patients undergoing this type of surgery increases, an increase in the relative number of ocular complications should be anticipated.

Adult↗
PubMed1990

Management of tracheal lesions in Hurler syndrome.

Hurler syndrome is a rare mucopolysaccharide storage disease that becomes clinically apparent during early childhood as mucopolysaccharide deposits form in skeletal and soft tissues. Progressive mucopolysaccharide deposition in the oropharynx and tracheal connective tissues leads to airway obstruction if untreated. Tonsillectomy, adenoidectomy, and tracheostomy have been utilized to provide symptomatic relief of upper airway obstruction. Treatment of tracheal lesions by laser excision is a recent innovative method for the management of airway obstruction in children with Hurler syndrome. We describe two boys with Hurler syndrome whose mucopolysaccharide tracheal lesions were excised by utilization of the carbon dioxide laser.

Child↗
PubMed1990

Inhibition of osteoclast recruitment at a local site by 1-hydroxyethylidene-1,1-bisphosphonate (HEBP).

We hypothesized that bisphosphates, a class of antiosteolytic drugs that affect bone cells, may block localized bone modeling in the middle ear. Prior studies have shown that transmitted pressure in the middle ear leads to osteoclastic bone resorption. Catheters were surgically implanted into the middle ear cavity (bulla) of 31 Mongolian gerbils. The animals were then divided into two groups, one subset receiving a bisphosphonate, and the other receiving no drug. Positive air pressure was applied to one middle ear, and the other side served as a control. At the end of the experimental period, tissue specimens were obtained, and histomorphometric evaluation of the ventral bullae was performed. Significant differences in osteoclast surface, osteoclast number, and mean individual osteoclast profile area led us to conclude that administration of the bisphosphonate used at the dose studied inhibits localized recruitment and activation of osteoclasts.

Air Pressure↗
PubMed1989

Rapid induction of localized bone resorption in the auditory bulla of the Mongolian gerbil, Meriones unguiculatus, by increased air pressure.

Osteoclastic bone resorption can be induced within the auditory bulla of the Mongolian gerbil by minute increases in air pressure. The objective of this study was to determine the rate at which osteoclasts are induced in areas of resorption and to compare the rate of osteoblast recruitment. Stainless steel tubes were implanted into the middle ears of 31 male gerbils through which a static pressure of 10 mm Hg above atmospheric was applied. The animals were killed at intervals (0, 1, 2, 4, 6, and 8 days) and the ventral wall of the bulla was studied histomorphometrically. The osteoclast area and osteoclast number were measured along the inner surface of the bone of the bulla; the activity of osteoblasts of the outer surface was also estimated. A significant increase in osteoclasts was found over time (P less than 0.0001). There was no significant increase in osteoclasts at 1 day (P = 0.5) but at 2, 4, 6, and 8 days there was a significant increase (P less than 0.03). Osteoblast activity on the outside of the bulla wall paralleled osteoclast activity. In this quantifiable, experimental system, a localized modeling process may be induced within 2 days without the confounding elements of localized trauma or inflammation inherent in other models of localized bone remodeling.

Air Pressure↗
PubMed1989

Cochlear hair cell stereocilia loss in LP/J mice with bone dysplasia of the middle ear.

LP/J inbred mice spontaneously develop bony lesions of the middle ear and otic capsule that are similar to those of human otosclerosis and tympanosclerosis. These mice also have progressive loss of hearing due to cochlear hair cell loss. The purpose of this study was to describe quantitatively the deterioration and loss of cochlear hair cells to serve as a basis for future experiments attempting to alter the course of this disorder. Cochleas from 37 LP/J inbred mice were examined by scanning electron microscopy. The stereocilia loss in the cochlea was evident as early as 15 weeks of age and progressed from the basal turn to the apex. Outer hair cells were affected more than inner hair cells. As outer hair cells deteriorated we observed fusion, bending, and breakage of stereocilia. There were no apparent differences in the mode of deterioration among the three rows of outer hair cells. Stereocilia fusion of inner hair cells occurred at an older age, and giant, elongated stereocilia were found in some of the animals.

Animals↗
PubMed1989

Comparative histology of the tympanic membrane and its relationship to cholesteatoma.

The purpose of this study was to determine whether anatomic differences in the tympanic membranes of various species could explain differences in the propensity to form aural cholesteatomas and retraction pockets. Tympanic membranes from humans, dogs, cats, rabbits, guinea pigs, rats, gerbils, and mice were examined histologically. The pars flaccida and pars tensa varied greatly among the species studied. The guinea pig's pars flaccida was very small and had a thin lamina propria. In contrast, the lamina propria of the rabbit and cat pars flaccida were thick. The amount of collagen, elastin, mast cells, and macrophages varied widely. The human and gerbilline tympanic membranes were anatomically dissimilar; for example, the human pars flaccida and pars tensa contained more and denser collagen than did those of the gerbil. The presence of macrophages or mast cells did not correlate with the propensity to develop cholesteatomas. Therefore, anatomic differences among these species do not explain why some develop aural cholesteatomas and others do not.

Animals↗
PubMed1989

Post-traumatic cholesteatoma.

Cholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented.

Adult↗
PubMed1988

The Rinne test for conductive deafness. A critical reappraisal.

The Rinne tuning fork test for the detection of conductive hearing loss is the most widely used tuning fork test in clinical medicine. However, the frequency of the tuning fork used to perform the test has not been standardized. In a study of 200 patients with known air-bone gaps, we found that the 256-Hz tuning fork was more sensitive than the 512-, 1024-, and 2048-Hz tuning forks for discriminating conductive from sensorineural hearing deficits. However, the occurrence of false-positive responses limits its usefulness. Therefore, we believe that the 512-Hz tuning fork should become the standard tuning fork used in performance of the Rinne test to screen patients for conductive hearing loss.

Audiometry↗
PubMed1988

A randomized clinical trial of topical gentamicin after tympanostomy tube placement.

Purulent otorrhea is the most common complication of tympanostomy with tube placement. Some authors report an incidence of over 30%. We have evaluated topical gentamicin solution for prophylaxis in a controlled, randomized, prospective clinical trial. Nine patients of the 102 in the study developed otorrhea in the first two postoperative weeks. All nine were in the control group of 46. The 56 patients receiving prophylactic gentamicin had no cases of purulent otorrhea. Several other characteristics of the patients and the procedures were examined as possible risk factors for otorrhea. None were statistically significant, but the younger patients had a higher rate of infection. We recognize the theoretical risk of ototoxicity, but conclude that instillation of topical gentamicin is an effective prophylactic technique for preventing purulent otorrhea after tympanostomy.

Administration, Topical↗