Biomedical subjects
Publications and source records attributed to R S Fenton.
Benign paroxysmal positional vertigo is the most commonly recognized form of self-induced vertigo. This paper describes other means by which patients have been able to induce vertigo to the extent that at times it has been incapacitating. Hypotheses for the production of these phenomena are suggested in a number of the cases. Some of the features cannot be explained on the basis of our present knowledge of the vestibular system.
Careful pre-operative planning is required before the nasal dorsum is changed in profile or width. The highlights of assessment are discussed together with a description of how the surgery should be performed. The advantages of using the external approach to the nasal dorsum are stressed.
External approach rhinoplasty has engendered controversy. The merits of the procedure are discussed, together with an outline of indications for its use. It is felt that this operation is a useful addition to the rhinoplastic art.
A case history is presented of a patient suffering from classical Ménière's disease who concurrently developed central serous retinopathy. On review, these conditions are found to have several features in common and on the basis of the changes seen by fluorescein angiography in the eye, an hypothesis is presented for the development of endolymphatic hydrops.
Three cases of Actinomycosis involving the facial region are presented with a discussion of the problems which can be encountered in the diagnosis and localization of this infectious disease.
It is generally agreed that in order to determine any difference in vestibular sensitivity between the two inner ears, the best clinical procedure involves a quantitative expression of the slow phase nystagmus response to standardized caloric (or rotatory) stimulation. The preferred procedure has involved averaging the slopes of a few of the nystagmus responses during the period of most intense activity and this has been accomplished either arithmetically or by means of an electronic computer. Although, such a sampling is often sufficient to enable a reliable diagnosis, occasions do arise when the results can be misleading unless comprehensive total presentations of the responses from the two labyrinths are available for reliable comparative evaluation. Such a procedure has been developed at the University of Toronto and used for clinical assessment at St. Michael's Hospital. The reliability of the method has been established as the result of testing over 800 patients with various vestibular disorders.
The chemo-therapy of vestibular disease has involved a wide spectrum of pharmacological agents insofar as their mode of action is concerned. In our experience, however, droperidol is one pharmaceutical agent which is remarkably effective in depressing vestibular disturbance regardless of etiology. This medication (also called Inapsine) belongs to a relatively new class of compounds known as butyrophenones and its pharmacological action can best be described as a dopa blocking agent. The activity of droperidol on the nervous system first became evident when it was used in combination with the potent analgesic fentanyl citrate in order to produce an anesthetic condition that has been termed neuroleptanalgesia. This mixture (also called Innovar) is rapid in action and results in complete suppression of vestibular activity of both normal subjects and those with Ménière's disease as described by Dowdy, et al., in a preliminary report. These impressive results have prompted us to evaluate the effectiveness of this medication in the treatment of different disorders of the labyrinth. The patients chosen for evaluation were referred for vestibular examination at the Toronto General and St. Michael's Hospitals. Electronystagmography was used to record objectively the effects of the drugs being tested while subjective symptoms including side effects were also noted. These studies involved 20 patients receiving Innovar while 12 patients were tested with Inapsine. Innovar administered in a single dose (droperidol 5 mg, fentanyl 0.1 mg) to patients undergoing acute episodes of vestibular disease (vestibular neuronitis and Ménière's disease) was found effective in the following symptoms and/or signs: nausea, vertigo, nystagmus, the positive past-pointing test and the Romberg test. Innovar appeared to be effective in the amelioration of vomiting although the population was too small to demonstrate statistical significance in this regard. The drug mixture appeared to have no effect on improving auditory acuity and had no significant effects on tinnitus. Adverse reactions to the drug combination were unusual, and, occurring in three patients, were mild as manifested by drowsiness. Since the above findings confirmed the marked effectiveness of the fentanyl-droperidol mixture in the management of vestibular disease, it was decided to determine the relative effectiveness of the droperidol component alone and this was determined by comparing the effectiveness of the drug with placebo in a double-blind study. Review of our findings involving this double-blind study indicates significant responses to Inapsine. This therapy clearly provided the statistically significant response (p less than 0.1, Fisher's Exact Test). This was particularly apparent at the 60-minute evaluation point. While some of the patients receiving Inapsine had recovered earlier, by 60 minutes none of the placebo patients but all of the Inapsine patients had recovered from the vestibular symptoms of Ménière's disease...