Biomedical subjects
R J Keim
Publications and source records attributed to R J Keim.
When to suspect an acoustic neuroma and newer methods available for diagnosis.
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Meningitis: the influence of routine otolaryngologic consultation on morbidity and mortality in 290 cases.
A prospective study was designed to obtain data on all meningitis patients admitted to a large county Communicable Disease Unit. The epidemiologic and clinical features of 290 cases were analyzed to ascertain the effect of routine O.R.L. consultation on the morbidity and mortality of this disease. The results of physical examination provided current statistics as to the existence of ear, nose, and throat diseases associated with meningitis.
Evaluating the patient with dysequilibrium.
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Problem ear infections: what to do when the patient just doesn't get better.
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Common ear diseases: recognition and management.
External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.
How aging affects the ear.
With aging, a different variety of ear diseases becomes more common. External ear disease is often a local reflection of generalized skin problems aggravated by retained water or local manipulation. Hearing loss may be the result of long-standing middle ear disease rather than aging. In this situation, the inconveniences and possible dangers of a chronically infected ear may be resolved with surgical intervention. Nasopharyngeal or lymphomatous disease must be suspected in any geriatric patient manifesting middle ear disease for the first time. Like presbyopia, presbycusis is a normal consequence of aging. It may be severe, but it does not lead to total deafness and equally involves both ears. Early discovery of the condition and institution of hearing rehabilitation methods will minimize the individual's communicative handicap and tendency to withdraw from society. Unilateral or asymmetric sensorineural hearing loss should be thoroughly evaluated for the purpose of identifying a curable and potentially life-threatening disease.
Blink nystagmus.
A pattern of eye movement similar to vestibular nystagmus associated with blink is characterized. This artifact can be seen in asymptomatic, otologically normal subjects and is considered to have different meaning than lateral conjugate deviation of the eyes on forced closure of the lids (Cogan sign). Since this nystagmus artifact is most evident during electronystagmographic testing for spontaneous and semispontaneous nystagmus, its importance can be overestimated. Simultaneous monitoring of horizontal and vertical eye movement presently provides a definitive means of identification.
Positional nystagmus in association with macroglobulinemia.
Summary--Waldenstrom's macroglobulinemia is a malignant lymphoproliferative disease associated with a monoclonal macroglobulinemia. Most explanations of the cochlear and vestibular symptoms in this disease have dealt with vascular thrombotic or hemorrhagic phenomena. Five patients currently being treated for macroglobulinemia have been reviewed. Three patients gave a history of periodic dizziness and underwent extensive neuro-otologic examination. The results suggestsed an alternate mechanism for the pathophysiology of the vestibular disturbance in macroglobulinemia. Vestibular examination by use of electronystagmography provided information which suggest that the cupulae may be altered by the macroglobulins to act as gravity receptors.
Thermal hazard during mastoid surgery.
Torque speed characteristics of two mastoid drills were measured. Potential temperature elevations in temporal bones were calculated from these measurements. Measured temperature elevations in temporal bones drilled without irrigation agreed well with predictions. Irrigation was demonstrated to be of critical importance in minimizing thermal hazard from mastoid drills.
Thermal hazards in mastoid surgery: an evaluation of instruments and irrigation techniques.
Study of the mechanical properties of three commonly used mastoid drills disclosed major differences in their power and potential for heat production. Based on available information regarding heat tolerance of neural tissue, all drills were found capable of producing hazardous temperature elevations. After testing several irrigation techniques, continuous and copious suction irrigation was found to be most effective in preventing bone heating.
Detection of middle ear disease in cleft-palate patients.
A prospective study of 17 cleft-palate patients under the age of 37 months was performed. The otoscopic findings, as reported by the primary physician and otolaryngologist, were compared with the results of tympanometry. Preoperatively, all tympanograms were abnormal. Ears with an AS pattern were not described as abnormal by any physician, and postoperatively, these ears all progresses to a more advanced stage of disease.
A new drill for otolaryngology.
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