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Biomedical subjects

S A Bhansali

Publications and source records attributed to S A Bhansali.

12 recordsLinked to original sources
PubMed1999

Current status of electronystagmography testing.

ENG testing, whether computerized or not, remains the most useful means of assessing the vestibular system. The caloric test provides invaluable site-of-lesion information that objectively documents a peripheral vestibular lesion. Double (bithermal) caloric irrigation of each ear provides a more thorough and wider range test of inner ear function than a single caloric irrigation because the vestibular system is both excited and inhibited, causing responses in opposite directions, which are important in evaluating patients with underlying spontaneous nystagmus. In an age in which economically efficient and clinically effective diagnostic methods are in high demand, ENG testing remains the gold standard of vestibular function tests.

Calorimetry↗
PubMed1994

Intraoperative electrocochleography during endolymphatic sac surgery: clinical results.

Thirty-eight patients who underwent endolymphatic shunt surgery with intraoperative electrocochleography were questioned regarding control of symptoms. The average follow-up period was 2 years (range, 7 to 40 months). Sixteen (42%) patients showed improvement in the intraoperative electrocochleography potential, 12 (32%) showed worsening, and 10 (26%) showed no change. Complete or substantial control of dizziness was achieved in 36 (95%) patients, and insignificant control in only 2 (5%) patients. Hearing improvement was noted in 4 (11%) patients, and hearing loss in 13 (34%). No correlation was found between intraoperative electrocochleography improvement and dizziness control. However, three of the four patients who had hearing improvement also had the greatest improvement in intraoperative electrocochleography recording. Intraoperative electrocochleography may help the surgeon more accurately identity the true endolymphatic sac and duct.

Adult↗
PubMed1993

Fluorescein use in the detection of perilymphatic fistula: a study in cats.

A stained or colored perilymph would be a valuable tool to otologists for the detection of a perilymph fistula. We studied the effect of intravenously injected fluorescein on the inner ear in seven cats. Still and video photography was used to clearly document our findings. Intravenously injected fluorescein appeared within the soft tissue in less than 1 minute and stayed there for at least 3 1/2 hours. Fluorescence around the round window niche resulted from soft tissue (mucosal) fluorescence and extravasation of interstitial fluid (transudate). No fluorescence of perilymph was detected. Because of this, we do not believe intravenously injected fluorescein is useful in the detection of perilymph fistula. Intrathecal injection caused quick and intense staining of labyrinthine fluid.

Animals↗
PubMed1993

Oscillopsia in patients with loss of vestibular function.

Contrary to standard teaching, many patients with bilateral vestibular loss clearly deny oscillopsia or imbalance in darkness. In an attempt to characterize these patients within the larger population of all patients with bilateral vestibular loss, the rotation and posturography test results of 22 patients with bilateral vestibular loss were reviewed. In addition, dynamic visual acuity was assessed with an eye chart test. There was a poor relationship between oscillopsia and dynamic visual acuity or rotation testing. There were three patterns of response on rotation testing, and loss of high-frequency gain was seen in as many patients who reported oscillopsia as did not. There were some patients with normal gain values at all frequencies tested who reported oscillopsia. It may be that the change in the VOR, rather than the absolute VOR loss, is responsible for the production of oscillopsia. On the basis of this and other studies, treatment strategies for patients with bilateral vestibular loss are suggested.

Adolescent↗
PubMed1992

Management of metastatic glomus jugulare tumors.

METASTATIC GLOMUS JUGULARE TUMORS (JUGULAR PARAGANGLIOMAS) ARE VERY UNCOMMON: consequently, no single report has been able to accurately describe their biologic or clinical behavior, and there are no established guidelines on caring for patients with these tumors. Identification of metastatic paraganglioma can be difficult because these tumors are known to occur synchronously, many other tumor types appear histologically similar to paragangliomas, and histologically the metastasis may not resemble the primary tumor. Immunohistochemistry, using neuroendocrine markers, and electron microscopy are the two most useful techniques available to identify definitely paragangliomas. A few studies have shown differences in the immunohistochemical staining patterns between benign and metastatic paragangliomas. We reviewed the literature and include two additional cases of metastatic glomus jugulare tumors in this article. We discuss the clinical management of these patients, the importance and usefulness of immunohistochemistry in characterizing these tumors, and their clinical outcomes.

Journal Article↗
PubMed1992

Traumatic perilymphatic fistula: how long can symptoms persist? A follow-up report.

In the past 18 years 68 ears (average 3.8 per year) were explored for perilymphatic fistula (PLF). A total of nine (13%) ears had a fistula identified at operation. Patients with a previous history of otologic surgery were excluded from this review. The most common etiology for PLF was head trauma (4 of 9). Most patients had persistent symptoms lasting months (average 6.7). Eighty-three percent of all patients had sudden or fluctuating hearing loss, 77 percent had vertigo or dysequilibrium, and 61 percent had tinnitus. Vertigo was the most commonly improved symptom postoperatively, and only 25 percent of patients had improved hearing. There were no major complications. The authors discuss indications for operation, criteria for diagnosis of PLF, and audiometric and electronystagmographic findings. This report agrees with other recent data indicating that exploration for fistula is an uncommon procedure performed by otologists.

Adolescent↗
PubMed1990

Vestibular effects of chronic perilymph fistula in the cat.

Chronic, unilateral perilymph fistulae were created in cats by removal of the round window membrane and placement of a tympanostomy tube into the round window. Rotary chair, fistula, caloric, and vestibulospinal tests were performed before and after fistulization, and periodically for 2 weeks. At 2 weeks, patency of the fistula was documented by fluorescein injection into the spinal fluid and visualization of leakage into the middle ear bulla via the fistula. All the cats had a patent fistula at 2 weeks, but one of the three cats had a greater perilymph leak than the others. The cat with the more active leak had a spontaneous nystagmus toward the side of the fistula on the first postoperative day; this changed to nystagmus toward the opposite side by the third postoperative day. The other cats had a spontaneous nystagmus toward the opposite side from the first postoperative day. Most abnormal test results returned to normal in the first week after fistulization. Histologic study of the temporal bones revealed that the cat with the greater leak had a wider cochlear aqueduct than the other cats.

Animals↗
PubMed1989

Evaluation of the monothermal caloric test.

In 1970, Torok reported that patients with labyrinthine disease showed vestibular recruitment and that patients with retrolabyrinthine disease showed vestibular decruitment on the monothermal caloric test. Other investigators have failed to confirm these findings; however, their studies did not precisely replicate Torok's test procedure. Following Torok's procedure exactly, the monothermal caloric test was administered to normal individuals and to patients with well-documented vestibular lesions. Nine of ten normal persons showed normal responses and one person showed borderline decruitment. Six of eight patients who had lesions of the vestibular nerve or central vestibular pathways showed decruitment. Two patients with active Meniere's disease showed recruitment and one showed asymmetry. Two patients with Meniere's disease who had undergone endolymphatic sac operations showed normal responses. These findings support Torok's claim that the monothermal caloric test discriminates between labyrinthine and retrolabyrinthine vestibular pathology.

Adult↗
PubMed1989

Perilymph fistula.

PLF is an enigmatic otologic disease that may be congenital or acquired through surgery, trauma, neoplasm, or infection. The exact incidence of PLF is unknown, primarily because it is difficult to diagnose. A careful, thorough history is important in recognizing PLF. If a PLF exists, repair can be effected simply and quickly and may be very beneficial to the patient. There is a small but real risk of total hearing loss with operation to repair any PLF. Currently, the most useful diagnostic tests for PLF involve the vestibular system, and further studies of vestibular responses to PLF hold promise in improving our diagnostic ability.

Fistula↗