Violence and the ear and temporal bone.
Explore the source record for details and available documents.
Biomechanical Phenomena↗
Biomedical subjects
S E Kinney
Publications and source records attributed to S E Kinney.
Retrolabyrinthine transtentorial approach to lesions of the anterior cerebellopontine angle.
Various surgical approaches to the cerebellopontine angle have been used for removal of acoustic neuromas. A retrolabyrinthine transtentorial approach has been developed that allows (1) access to the anterior cerebellopontine angle and all portions of the basilar artery, (2) extra dural retraction of the lateral sinus and cerebellum while avoiding the vein of Labbé, and (3) preservation of hearing. This approach allows good exposure of tumor and accurate visualization of cranial nerves. To avoid complications, control of spinal fluid is mandatory and great care must be taken to avoid injury of the cranial nerves. The retrolabyrinthine or translabyrinthine transtentorial approach enables skilled neurosurgeons and neurotologists to gain access to lesions that are located in areas difficult to approach.
Adult↗
Specificity and sensitivity of dynamic posturography. A retrospective analysis.
Explore the source record for details and available documents.
Electromyography↗
Implementing a cochlear implant team in private practice or academic setting.
Explore the source record for details and available documents.
Academic Medical Centers↗
Cancer of the periauricular region.
Cutaneous carcinoma of the auricular and periauricular region can be diagnosed early and often can be cured; however, many of these tumors become difficult to treat because of local spread and regional metastasis. Those tumors that are not treated early often require more aggressive treatment with ear canal resection, partial temporal bone resection, or even parotidectomy and radiation therapy. Mohs histographic surgery combined with conventional excision affords the best marginal control for local eradication of these tumors.
Ear Neoplasms↗
Squamous cell carcinoma of the external auditory canal.
Squamous cell carcinoma of the external auditory canal is an unusual head and neck malignancy. It may occur in an ear in which there had previously been chronic inflammation, either in the external canal or middle ear. However, in most cases the etiology of the cancer is unclear. Treatment modalities have ranged from full therapy irradiation to formal temporal bone resection. Morbidity and mortality with these treatment plans alone have not been satisfactory. The purpose of this paper is to describe diagnostic and therapeutic approaches to squamous cell carcinoma of the external auditory canal used in the Department of Otolaryngology and Communicative Disorders of the Cleveland Clinic Foundation for the last 10 years.
Carcinoma, Squamous Cell↗
Autoimmune endolymphatic hydrops: five-year review.
This article reviews the authors' experience with autoimmune endolymphatic hydrops over the past 5 years. Twenty-seven of 52 patients with diagnosed autoimmune inner ear disease (52%) manifested endolymphatic hydrops, usually bilateral. Treatment consisted of low salt diet, diuretic, vestibular suppressant, and usually prednisone. Cytotoxic drugs and lymphocytoplasmapheresis were reserved for refractory cases. Audiometric followup (average, 23 months) was available in 12 patients. Using American Academy of Otolaryngology--Head and Neck Surgery guidelines, hearing improved or stabilized in at least one ear in nine patients and deteriorated bilaterally in three patients. Vestibular treatment results paralleled auditory treatment results. Autoimmune endolymphatic hydrops should be considered in the differential diagnosis when symptoms are bilateral and do not respond to conventional therapy or when immune laboratory tests are positive. In suspect patients, medical therapy with prednisone, and rarely cytotoxic drugs and lymphocytoplasmapheresis, should be recommended. Further research is needed to determine whether surgery should be performed in medically unresponsive cases.
Adolescent↗
Clinical diagnosis of immune inner-ear disease.
The purpose of this study was to develop a high-risk clinical profile of patients with autoimmune (immune-mediated) inner-ear disease. The records of 52 patients diagnosed over the past 5 years were reviewed. Age, sex, bilateral versus unilateral involvement, otologic symptoms, concomitant systemic immune disease, and presenting clinical diagnoses were recorded. The presenting diagnoses were Cogan's syndrome, Meniere's syndrome, Dandy's syndrome without hearing loss, or progressive sensorineural hearing loss without dizziness. Because Cogan's and Dandy's syndromes were relatively uncommon, the typical high-risk clinical profile was a middle-aged patient (often female) with bilateral, asymmetric, progressive sensorineural hearing loss, with or without dizziness, and occasional systemic immune disease such as rheumatoid arthritis. When a more common clinical diagnosis cannot be reached in suspicious patients, immune laboratory tests should be obtained and a trial of immunotherapy offered. Positive test results and beneficial response to therapy support a presumptive diagnosis of immune inner-ear disease.
Adult↗
The evolving treatment of necrotizing external otitis.
Necrotizing external otitis, or malignant external otitis, as initially described by Chandler, is a life-threatening Pseudomonas infection of the external auditory canal and skull base, which occurs most commonly in elderly diabetic patients. Historically, radical surgical intervention was the primary method of treatment. The treatment of choice has shifted during the past 20 years to aggressive systemic antibiotic therapy, with surgery reserved for those patients whose disease is resistant to medical therapy. Using this approach, 19 patients with necrotizing external otitis were treated at the Cleveland Clinic Foundation during the past 8 years. A 90% rate of cure was obtained. The diagnostic approach to patients suspected of having necrotizing external otitis, a classification scheme defining the extent of disease, delivery of systemic antibiotic therapy, indications for surgical intervention, and overall effectiveness of treatment are reviewed.
Aged↗
Intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: long-term follow-up.
One hundred four ears operated for cholesteatoma using the intact wall technique were studied in 1981. In the 1981 study, there was a 7% recurrence rate in adults and a 25% recurrence rate in children after a 5-year follow-up. Recognizing that chronic otitis media is often not controlled by surgery, long-term follow-up is necessary to evaluate a particular operative approach to control the disease and restore function. The purpose of this study is to reexamine the series of patients studied in 1981 and evaluate the status of the ear, as well as long-term functional results.
Adolescent↗
Transtragal, transtympanic electrode placement for intraoperative electrocochleographic monitoring.
Transtragal, transtympanic electrode placement was performed for the purpose of intraoperative electrocochleographic (ECoG) monitoring during seven suboccipital acoustic neuroma resections. The promontory, the tragus, and two external sutures stabilized the electrode during surgery. The only noted otologic sequallae of electrode placement were small circular lesions at tympanic membrane puncture sites. Satisfactory ECoG recordings were obtained in five of seven cases. Peak-to-peak N1 amplitudes were (on average) 13.4-fold larger than the corresponding amplitudes of peak I of the surface-recorded brainstem auditory evoked potential (BAEP) recordings. During acoustic neuroma resection, ECoG and BAEP recordings changed relatively independently, which suggests multiple mechanisms and/or sites of injury to the cochlea or cochlear nerve. However, once they had become manifest, none of the observed changes exhibited a tendency to return to preoperative patterns. Hearing was preserved postoperatively in only two of seven patients, one of whom could not be monitored due to technical difficulty. Transtragal, transtympanic electrode placement provided a rapid, stable, and safe method of obtaining intraoperative ECoG recordings. Although combined intraoperative monitoring of ECoG and BAEP responses appeared to provide more precise documentation of injury to the cochlea and/or cochlear nerve, it was probably not influential in preservation of hearing in this series.
Adult↗
Acoustic (loudspeaker) facial EMG monitoring: II. Use of evoked EMG activity during acoustic neuroma resection.
Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.
Adult↗
Malignancies of the external ear canal and temporal bone: surgical techniques and results.
A combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full-therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision-making process, is described. Twenty-four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone. This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%. It is concluded that a step-wise removal of all gross tumor, as opposed to an en bloc dissection of the temporal bone and skull base, followed by full-therapy irradiation gives equally as good, or even better, long-term survival for this malignancy of the external auditory canal and middle ear.
Adult↗
Results of sinusoidal harmonic acceleration test in one thousand patients: preliminary report.
One thousand patients with dizziness were tested by sinusoidal harmonic acceleration with frequencies of .01, .02, .04, .08, and .16 Hz. Two hundred fifty (25% of data base) were randomly selected for this study. One hundred forty-eight diagnoses were confirmed: 66 (45%) patients had a clinical diagnosis of peripheral vestibular dysfunction, 28 (19%) had central vestibular dysfunction, and 53 (36%) had dizziness of undetermined cause. This preliminary study investigated the response patterns of phase (latency), asymmetry (slow phase preponderance), and gain (output/input) as they correlated with each of the above patient groups. The main response pattern was a varying degree of asymmetry with normal or abnormal latency. Persistent abnormal phase pattern indicated permanent vestibular damage and could not be used reliably to differentiate peripheral from central vestibular dysfunction. Asymmetry changed with time and correlated with patients' symptoms. The dynamic pattern of asymmetry could be used to differentiate peripheral from central vestibular dysfunction. Gain was a reliable and essential measure of the sensitivity of the vestibular system and the validity of the rotational response.
Dizziness↗
Facial nerve dissection by use of acoustic (loudspeaker) facial EMG monitoring.
The development of the surgical microscope in 1953, and the subsequent development of microsurgical instrumentation, signaled the beginning of modern-day acoustic neuroma surgery. Preservation of facial nerve function and total tumor removal is the goal of all acoustic neuroma surgery. The refinement of the translabyrinthine removal of acoustic neuromas by Dr. William House significantly improved preservation of facial nerve function. This is made possible by the anatomic identification of the facial nerve at the lateral end of the internal auditory canal. When the surgery is accomplished from a suboccipital or retrosigmoid approach, the facial nerve may be identified at the brain stem or within the internal auditory canal. Identifying the facial nerve from the posterior approach is not as anatomically precise as from the lateral approach through the labyrinth. The use of a facial nerve stimulator can greatly facilitate identification of the facial nerve in these procedures.
Acoustics↗
Immune reactivity in Bell's palsy.
Although the pathogenesis of acute facial (Bell's) palsy is probably multifactorial, some investigators believe that the disorder results from autoimmune demyelination and is perhaps related to previous viral infection. The purpose of this study was to identify immune mechanisms which might contribute to Bell's palsy. The lymphocyte transformation test and immunofluorescence were evaluated with a soluble homogenate of unrefined peripheral nerve antigens. Three antigen-nonspecific tests were also studied. Results in 14 patients with Bell's palsy were compared with those in 21 controls. To be eligible for study, patients with Bell's palsy had to be seen within 10 days of onset of weakness. The control group included 5 patients with facial nerve dysfunction from other causes and 16 normal volunteers. No patient or control had previously received steroids. Five patients with Bell's palsy and one normal volunteer had abnormal lymphocyte transformation (p less than .05). Virtually all other tests were normal. These results. suggest that some instances of Bell's palsy result from cell-mediated immunity against peripheral nerve antigens. They also encourage further research in steroid and other immunotherapy.
Adult↗
Predictive value of laboratory tests in "autoimmune" inner ear disease: preliminary report.
The purpose of this prospective, controlled study was to estimate the prevalence of immune-mediated (autoimmune) inner ear disease in a high-risk patient population, in order to determine the predictive value of a positive lymphocyte transformation test. The high-risk group was defined as any dizzy patient with unilateral or bilateral-asymmetric sensorineural hearing loss, who had not previously received immunotherapy. From more than 400 consecutive patients with a chief complaint of dizziness, 58 were entered into the study over an 8-month period. The control group consisted of 15 normal volunteers. Thirteen patients (22%) one control (7%) had positive lymphocyte transformation tests. The data suggest that positive results in "high-risk" patients are more common than previously believed. Assuming test sensitivity is 96%, specificity 93%, and disease prevalence 22% in high-risk patients, the predictive value of a positive lymphocyte transformation test using inner ear membranes is 79%. That is, approximately three fourths of all positive results are true positives. Positive results in suspected patients, therefore, should be considered true positives, and treatment recommended. Future research should attempt to refine the putative antigen(s), further define "high risk" patients, and prospectively verify these preliminary results.
Adolescent↗
Autoimmunity in otology.
Experimental and clinical studies over the past ten years have confirmed that immune-mediated disease can involve the external, middle, and/or inner ear. Autoimmune inner ear dysfunction can result from systemic or localized disease. The pathogenesis of autoimmunity and the responsible antigen(s) of the inner ear is not known at present. The clinical course, laboratory test results, and treatment response often follow a consistent pattern but in some cases may be highly variable. Empirical treatment of autoimmune inner ear disease has produced encouraging preliminary results, and further research should provide better understanding of these otoimmune disorders.
Adolescent↗