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Biomedical subjects

S C Parisier

Publications and source records attributed to S C Parisier.

At least 19 recordsLinked to original sources
PubMed1992

Auditory perception changes after reimplantation in a child cochlear implant user.

The ability to remove cochlear implants from children and subsequently reimplant a more complex device in the same ear was the concern of this single case study. A postlinguistically deafened child, J.L., received a single-channel cochlear implant 1 yr after contracting meningitis and suffering a profound bilateral sensorineural hearing loss. After 3 yr of successful implant use, J.L. suffered an internal coil failure. She was then explanted and reimplanted with a multichannel cochlear implant in the same ear. This case report details her speech perception skills with her single-channel cochlear implant, a vibrotactile aid, and a multichannel cochlear implant. Results from auditory perceptual measures suggest that the explantation/reimplantation process was technically feasible with no adverse effects on J.L.'s ability to utilize a more sophisticated device and to exceed her previous performance levels.

Acoustic Stimulation↗
PubMed1992

Surgery for recurrent and residual cholesteatoma.

One hundred twelve patients (116 ears) were treated for recurrent and residual cholesteatoma. A retrospective review revealed that 66% had undergone canal wall down mastoidectomy at the previous surgery. The surgical procedure at revision was selected on the basis of an intraoperative assessment of the extent of disease, and clinical prediction of eustachian tube function. The average period of follow-up was 3.4 years. Revision surgery was successful in providing the patient with a safe, dry ear in 105 (91%) of 116 cases. Surgical principles and hearing results are presented.

Adult↗
PubMed1991

Cochlear implants: indications and technology.

Over the last decade, the field of cochlear implants has progressed to the point where many postlinguistically deaf adults can use a multichannel device to understand speech without lipreading. The remainder are able to use their devices to aid in lipreading and to discriminate environmental sounds. It is anticipated that improved processing schemes will be developed so that the cochlear implant user can expect better speech perception with these devices. Eventually, a more sophisticated cochlear implant that has the capability of permitting good speech discrimination may supplant hearing aids for severely deafened individuals. Regardless of future developments, the present-day systems effectively restore auditory function to profoundly deafened children and adults.

Cochlear Implants↗
PubMed1991

Management of labyrinthine fistulas caused by cholesteatoma.

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall-down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long-term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.

Adolescent↗
PubMed1991

Ciprofloxacin: drug of choice in the treatment of malignant external otitis (MEO).

Ciprofloxacin, a fluorinated quinolone with high efficacy against Pseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant external otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow-up of 18 months after completion of therapy. A new classification of malignant external otitis (MEO) is presented.

Aged↗
PubMed1991

The development of a Children's Implant Profile.

The decision to provide a child with a cochlear implant is quite complex, as it must include consideration not only of the implant itself but also of the habilitative services necessary following the surgical procedure. To provide a systematic means of selecting hearing-impaired children for cochlear implants, a team at Children's Hearing Institute, Manhattan Eye, Ear and Throat Hospital, developed the Children's Implant Profile (ChIP). There is no one profile of a successful implant user--at least 11 factors appear to contribute to successful implantation. In the ChIP, each factor is evaluated on a three-point scale: (1) no concern, (2) mild-to-moderate concern, and (3) great concern. A profile showing "no concern" on all 11 factors denotes clear acceptability of the child as an implant candidate. A profile including several ratings in the "mild-to-moderate concern" category suggests a need for further study to determine if improvements could be made in projected outcomes before initiating surgical procedures. Finally, ratings of "great concern," especially on more than one factor, indicate a very limited probability of successful implant outcomes, at least at the time of evaluation. A case study is presented to demonstrate the relationship between the evaluated factors and to show how the profile is used to address and remedy areas of concern.

Child↗
PubMed1991

Recidivism in congenital cholesteatoma surgery.

Forty-four cases of congenital cholesteatoma in the pediatric age group have been treated surgically. There have been three residual cholesteatomas, which were localized to the anterior aspect of the malleus and were easily excised. Two cases of postero-superior retraction pockets developed post-operatively, and these were treated by conventional tympanomastoid surgery with excision of the retraction pocket and grafting. All five of the patients with recidivism have experienced no further difficulty.

Child, Preschool↗
PubMed1991

Cochlear otosclerosis presenting in children: a case report.

A case of cochlear otospongiosis in a 14-year-old is reviewed. The patient, who had a strong family history of otosclerosis corrected with stapes surgery, presented with a mild-to-moderate predominantly neurosensory hearing loss and absent stapes reflexes. A CT scan demonstrated changes characteristic of otospongiosis. The relevant literature was reviewed and fluorides as a possible therapy discussed.

Adolescent↗
PubMed1990

Cochlear implant flap complications.

In a series of 52 patients who received cochlear implants, 4 patients suffered flap complications (7.7%). The problems encountered involved the postauricular flap and were usually minor in nature. None required explantation as a direct result of these complications. Flap ischemia in a patient with Cogan's syndrome and vasculitis, two cases of suture extrusion with one having exposure of the implant, and a case of receiver unit magnet extrusion repaired with a vascularized pericranial flap based upon temporalis muscle are presented. Flap design in patients who have had postauricular incisions demands special consideration. Principles useful for avoiding complications as well as their management are discussed.

Adult↗
PubMed1990

A matched-pairs comparison of single and multichannel cochlear implants in children.

Auditory capabilities of Nucleus 22 multichannel cochlear implant users were compared to those of matched 3M/House single-channel users. Six children who received either the 3M/House or Nucleus 22 cochlear implants were separated into three matched pairs. Group 1 consisted of two postlinguistically deafened adolescents, group 2 consisted of two prelinguistically deafened school-age children, and group 3 consisted of two perilinguistically deafened preschoolers. Participants were evaluated using auditory comprehension and discrimination tasks as indicated by the 3M/House and Nucleus 22 protocols. However, only tasks common to both were included here. While the 3M/House single-channel device has been under an IDE for children under the age of 18 years since 1984, the Nucleus 22 multichannel implant only recently became available for this age group. Thus, short-term evaluations at 6 months and 1 year postimplantation have been used for comparison. Two of the three groups indicated that the multichannel users performed as early as the 6-month level; the children in the third group performed equally. These results indicate that multichannel cochlear implants show great promise in deaf children.

Adolescent↗
PubMed1989

The large vestibular aqueduct syndrome in children. A review of 12 cases and the description of a new clinical entity.

The large vestibular aqueduct as an isolated anomaly of the temporal bone has been previously identified radiologically, and its association with sensory neural hearing loss has been recognized. It has not, however, been defined as a distinct clinical entity in children. We studied 12 children, ages 3 to 9 years, with downward-fluctuating progressive high-frequency neurosensory hearing losses whose symptoms were thought to be related to the isolated enlargement of the vestibular aqueduct identified by high-resolution computed tomographic scanning. Previously it had been assumed that a large vestibular aqueduct is a temporal bone dysplasia that is a variant of the Mondini type of deformity and that the associated hearing loss is congenital in nature. Our clinical observations, however, indicate that the hearing loss in children with an isolated enlargement of the vestibular aqueduct is acquired during childhood. The natural history of this progressive deafness is reviewed, and a pathophysiologic hypothesis is presented.

Audiometry↗
PubMed1989

Modern presentations of Bezold's abscess.

The use of antibiotics in suppurative otitis media has greatly diminished the incidence of complications. Deep neck abscess arising from acute mastoiditis, a disease thoroughly described by Frederick Bezold early in this century, has become rare. In the last three years we have treated five cases of deep neck abscess of otogenic origin at our hospital. These cases exemplify Bezold's classic description in their site of origin in the mastoid process and route of spread in the neck. However, our contemporary examples differed in clinical setting, latency of onset, and bacterial cause. In four of the cases, delay in diagnosis occurred because of failure to recognize the disorder. Computed tomography has proved valuable in the anatomic diagnosis and surgical planning. Renewed familiarity with the clinical presentations and pathogenesis of this now uncommon condition may prevent delay in diagnosis and initiation of therapy.

Abscess↗
PubMed1989

Management of cholesteatoma.

Although the effective control of acute otitis media has reduced the number of cases of acute coalescent mastoiditis, the incidence of chronic mastoiditis caused by cholesteatoma has not been decreased with antibiotic usage. Surgery is required for management. This article outlines preoperative management of patients with cholesteatoma and the approach for selecting the appropriate operative procedure.

Cholesteatoma↗
PubMed1989

Acquired cholesteatoma in the pediatric age group.

Successful treatment of cholesteatoma in children is based on the same principles of therapy used in adults. A clinical profile of children with acquired cholesteatoma is compared with that of adults. Issues related to aggressiveness of disease, pathophysiology, diagnostic problems, and treatment approaches are discussed.

Adolescent↗
PubMed1989

Surgical techniques and recidivism in cholesteatoma.

Cholesteatoma is a difficult disease to treat as demonstrated by the relatively high recidivism rate attained by the best of surgeons. The concept of recidivism encompasses all reoccurrence of the disease, regardless of the theorized origins. This is a term that should be accepted so that some uniformity may be introduced into the evaluation of this disease. A standard reporting format that includes the extent of the disease, the eustachian tube function, the integrity of the ossicles, and a uniform description of the surgical procedure would enhance future evaluations of this disease. The future of otology still lies in finding new ways to eradicate this disease and to avoid recidivism.

Adult↗