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Biomedical subjects

S C Parisier

Publications and source records attributed to S C Parisier.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cochlear implant mechanical failures.

Cochlear implants have proven to be an effective treatment for profoundly deafened individuals. Unfortunately, like most mechanical devices, these implants occasionally cease to function. The rate at which the cochlear implant fails, however, does not appear to be the same in adults and children. The failure rate for children far exceeds that observed in adults. The overall failure rate reported by Cochlear Corporation notes that whereas only 3% of the adults have had this type of problem, 9% of the children have had failed internal receivers. This research reports on the experiences of a large implant facility in the Northeast. The clinical presentation and the evaluation of children suspected of having an implant failure are reviewed. The mechanical causes for failures are analyzed. Intraoperative findings and results of reimplantation surgery are presented. The possible causes for the increased incidence of failure in children are discussed.

Age Factors↗
PubMed1996

Canalplasty.

Canal stenosis and atresia can result from a number of causes, including congenital, inflammatory, neoplastic and iatrogenic pathologic conditions. Canalplasty is an eclectic collection of techniques designed to recreate a patent and trouble-free external canal. Despite the large number of etiologies, the principles of canalplasty are the same. The goal is the creation of a widely patent and physiologically intact canal wall. Both the bony and cartilaginous portions must be addressed surgically. Care should be taken to preserve the normal skin and adnexa for lining the canal, but if this is not adequate, skin grafts should be used to prevent healing by secondary intent. Overcorrection of stenosis is advised. We have presented our basic technique for canalplasty and discussed its alteration for specific disorders.

Ear, External↗
PubMed1995

Delayed diagnosis and fate of congenital cholesteatoma (keratoma).

OBJECTIVE: To analyze clinical presentation, modes of detection, growth pattern, operative findings, and results of surgery in children 3 years old or older who had extensive congenital cholesteatoma (keratoma). DESIGN: Survey, case series. SETTING: Two academically affiliated medical centers: a children's hospital and an eye, ear, and throat hospital, both located in major metropolitan cities. PATIENTS: Twenty-five children selected according to specified criteria. INTERVENTION: Tympanomastoid surgery, ie, canal wall up and canal wall down, some with ossicular reconstructive surgery. MAIN OUTCOME MEASURE: Audiologic assessment (speech reception threshold) and recurrence (recidivism) of cholesteatoma. RESULTS: Incidence of recidivism, 52%. Hearing maintained within the range of normal to mild hearing impairment postoperatively in 91% of the patients for whom complete data are available. CONCLUSIONS: Congenital cholesteatoma may grow for years without causing signs or symptoms and, having grown without early detection, can extend to involve the epitympanum and mastoid antrum, cause ossicular erosion, and even extend to the middle cranial fossa. To adequately remove a congenital cholesteatoma that has gone undetected for many years, exposure of the anterior epitympanum is often necessary and removal of both the body of the incus and the head of the malleus often is required. Since congenital cholesteatoma usually develops in a child with a well-pneumatized mastoid that would create a large mastoid bowl if exteriorized, the otologic surgeon is likely to hesitate in using the canal wall down mastoidectomy technique. Alternatives to the canal wall down mastoidectomy technique, which can achieve reasonably good hearing results and avoid creation of a large mastoid bowl, include planned two-stage canal wall up surgery or canal preservation with primary reconstruction and close follow-up with otomicroscopy and serial computed tomographic scans.

Adolescent↗
PubMed1995

Cochlear implant performance in a deaf child of deaf parents: a case study.

Marie represents a unique case in the population of cochlear implant users, in that she is from a family of deaf individuals. Her auditory perceptual performance after 2 years of implant use is commensurate with that of other children of similar ages and durations of deafness. Although her speech production performance is also not atypical, the special circumstances in the home might cause additional delay. Studies have traditionally shown that deaf children of deaf adults exhibit superior ability in both social and academic domains when compared to deaf children of hearing parents. The cochlear implant provides yet another tool to add to the already-identified advantage extended this group by their family circumstance. It is unfortunate that these children for whom the device can offer enhanced abilities may be the very children that are denied access to it by the deaf community.

Auditory Perception↗
PubMed1994

Programming the cochlear implant based on electrical acoustic reflex thresholds: patient performance.

The electrical acoustic reflex threshold (EART) has been shown to be a reliable estimate of behavioral comfort levels in both child and adult cochlear implant patients. The purpose of this study was to investigate the potential for using EARTs for programming the Nucleus cochlear implant. EARTs and behavioral comfort levels were obtained from 7 adult implant patients. Two programs or "maps" were made for each patient, one based on behavioral comfort levels and one based on EARTs. Performance on open set tests of speech recognition was measured with each map. Mean data suggest that speech perception is similar with both maps. Analysis of individual data revealed that, whereas 2 subjects performed better with the C-level maps, the remaining 5 subjects tended to perform either better with the EART map or equally well with both maps. These results suggest that EARTs may be an adequate substitute for comfort levels when programming the implant for patients who are unable to make reliable psychophysical judgments.

Adult↗
PubMed1994

Microfiberoptic evaluation of the middle ear cavity.

Endoscopic instruments have revolutionized surgical diagnosis and treatment. Recently, a high resolution microfiberoptic endoscope has been developed that has vast potential for otologic use. This microfiberoptic endoscope was used in cadaver and human studies to visualize the middle ear cavity. The technique used involved placing a 1.0-mm or smaller microfiberoptic scope into the middle ear via a tympanic membrane perforation, through a myringotomy tube or up the eustachian tube. Using the scope, the mesotympanum and hypotympanum can be well visualized. Similarly, the round window, oval window, ossicular chain, and related structures can be clearly demonstrated and recorded photographically. This technique has great potential to enhance diagnosis without open surgery.

Adolescent↗
PubMed1993

Differences in dendritic cells in congenital and acquired cholesteatomas.

Cholesteatomas are histologically benign, though biologically invasive lesions that arise from the migration of squamous epithelium of the ear. Acquired cholesteatomas usually arise in an antigenically active environment, i.e., a chronically and/or recurrently inflamed middle ear. In contrast, congenital cholesteatomas occur in an uninflamed environment. The potential role of dendritic cells (DCs) in the evolution of this lesion has not been thoroughly studied. By staining for S-100 protein, the authors evaluated the presence and distribution of DCs in cholesteatomas. Sixteen cases of cholesteatomas diagnosed from 1987 to 1989 were selected for this study. The formalin-fixed, paraffin-embedded sections were processed by a standard avidin-biotin peroxidase-antiperoxidase method for S-100 protein and for leukocyte common antigen (LCA). The presence and distribution of S-100 protein-positive DCs was evaluated and compared to canal wall skin. DCs were present in all cases. Nine acquired cholesteatomas had 5 to 16 epithelial DCs per high-power field (HPF). Seven congenital cholesteatomas were examined. Four with isolated congenital pearl-like cholesteatomas had 1 to 3/HPF epithelial DCs. In contrast, the three inflamed congenital cholesteatomas had 6 to 12/HPF DCs. The control uninflamed canal wall skin had only 1 to 3/HPF DCs. All DCs were LCA negative, as expected.

Adolescent↗
PubMed1993

Alteration in cholesteatoma fibroblasts: induction of neoplastic-like phenotype.

Cholesteatomas are invasive, locally destructive skin-like lesions that, after operative removal, have a significant recidivistic rate. These aggressive characteristics suggest a fundamental alteration in the biology of one or more of its constituents (i.e., keratinocytes, fibroblasts, and inflammatory cells). The cholesteatoma matrix was studied by subculturing it into its main cellular components. Short-term cell cultures of fibroblasts from cholesteatoma matrix and controls from ear canal and postauricular skin were established. These cultured fibroblasts were tested for invasiveness using the Boyden Chamber Assay of Albini. The cells were evaluated for their ability to migrate, attach to, and invade a basement membrane. Results of the motility and attachment of fibroblasts cultured from cholesteatoma, canal wall, and postauricular skin did not differ. However, fibroblasts from 12 of 12 cholesteatoma specimens were highly invasive, while those from postauricular and ear canal skin were either weakly invasive or not invasive. This represents the first report of an intrinsic defect in the biology of cholesteatoma. Invasive fibroblasts that demonstrate a loss of growth control, may provide a contact guidance mechanism that aggressively mobilizes the squamous keratinizing epithelium contributing to the invasive, aggressive behavior of cholesteatoma.

Adolescent↗
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↗