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Biomedical subjects

S M Parnes

Publications and source records attributed to S M Parnes.

At least 19 recordsLinked to original sources
PubMed1997

Current concepts in the clinical management of patients with tinnitus.

The current management in tinnitus of sensorineural origin is reviewed. Epidemiological data demonstrates that 90% of patients with hearing loss experience some tinnitus. Approximately 1% of the population suffer from a chronic tinnitus that causes severe distress and requires some type of management intervention. Present non-surgical therapies include masking techniques, psychological counseling, and biofeedback. There are also a number of drugs that have been applied, the most common being antidepressants. These have had the most success in managing patients with tinnitus, although it is currently felt that antidepressants treat underlying psychological problems rather than directly affect the tinnitus. The other large class of drugs include benzodiazopans, in addition to a new synthetic analog of a natural prostaglandin E1, misoprostol. Despite the many drugs now available, none has been approved by the United States Food and Drug Administration for the treatment of tinnitus. Many surgical therapies have been advocated but are directed towards the treatment of concurrent vertigo or for tumors of the cerebellopontine angle, with tinnitus sometimes being relieved by the operation. Specific surgical procedures such as cochlear resection and microvascular decompressions lack clear-cut efficacy. Despite author bias and a myriad of treatment modalities at present, there is still no specific therapy that definitively relieves tinnitus clinically.

Humans↗
PubMed1997

Clinical applications of otoacoustic emissions in sudden hearing loss.

Sudden hearing loss (SHL) is a controversial topic for which no definitive practical guidelines exist. Studies employing vasodilators, plasma expanders, anticoagulants, and carbogen inhalations have shown no improvement over the rate of spontaneous recovery. At present, there is insufficient evidence to support medical treatment for SHL, except steroid therapy in selected patients. Distortion product otoacoustic emissions (DPOAEs) are sensitive to cochlear disorders and are absent in ischemic injury to the cochlea, but can persist in cochlear neuritis. In a prospective study of 10 patients who presented to Albany Medical Center from 1995 to 1996, three patients with intact DPOAEs at presentation had an average improvement of 33 dB in the pure-tone average (PTA) of 0.5, 1.0, and 2.0 kHz with steroid therapy, whereas five of seven patients with absent DPOAEs had no improvement in hearing despite steroid therapy in six patients. The presence of DPOAEs may be a useful prognostic factor that positively correlates with recovery from SHL.

Acoustic Stimulation↗
PubMed1997

Morbidity of combined therapy for the treatment of supraglottic carcinoma: supraglottic laryngectomy and radiotherapy.

Many surgeons find that patients have increased morbidity after supraglottic laryngectomy if postoperative irradiation is given, but this remains poorly documented. Twenty-nine patients undergoing supraglottic laryngectomy were retrospectively reviewed. Seventeen received postoperative radiotherapy, and 12 did not. The mean follow-up was 64 months. When compared to patients treated with supraglottic laryngectomy alone, irradiated patients had a significantly higher incidence of lifelong gastrostomy dependency (35% versus 0%; p = .03) and acute upper airway obstruction (29% versus 0%; p = .05). There was a trend toward greater tracheotomy dependency (24% versus 0%), aspiration pneumonia (35% versus 9%), and delayed independent swallowing (34.8 weeks versus 7.8 weeks) in the patients treated with combined therapy, but this difference was not significant. A morbidity index score was developed to evaluate the overall lifelong morbidity of these patients, and this was found to be significantly higher in patients treated with surgery and radiotherapy (2.29 versus 0.83; p = .04). Overall survival was equal in both groups. We have shown that radiotherapy increases the morbidity of supraglottic laryngectomy. This should be considered when planning treatment for patients with supraglottic carcinoma.

Adult↗
PubMed1996

Current concepts in the diagnosis and treatment of sudden sensorineural hearing loss.

Sudden hearing loss (SHL) has been a controversial topic in the literature for the past several decades. Although much theoretical work has been done regarding its diagnosis and treatment, no useful practical guidelines exist for application to current patient management. Many authors have discussed the various treatment protocols available to treat this entity, but only a handful of dated, clinical studies supporting these treatments are available. More recent studies applying treatment protocols including vasodilators, plasma expanders, anti-coagulants, and carbogen inhalations have shown no improvement over the rate of spontaneous recovery without therapy. Except in cases of therapy directed toward known predisposing factors, there is insufficient evidence in the literature to support medical treatment for SHL, although steroid therapy appears to be useful in selected patients. Our own review of 14 patients with SHL is presented. A standard diagnostic and therapeutic approach based on a comprehensive review of the literature is described that can be applied to most patients presenting with SHL.

Administration, Inhalation↗
PubMed1996

Advances in the development of the interferometric otoscope.

Present measurement techniques for middle ear function have inherent limitations because they are either spatially insensitive (acoustic immittance) or descriptive and qualitative in nature (otoscopy). By integrating advances in electrooptic technology (fiber optics, miniature diode lasers, solid-state detector arrays) and digital processing, further advances are possible. On the basis of measurements taken with electronic speckle-pattern interferometry on human temporal bones and models, we demonstrate quantitative static and dynamic vibration/displacement characteristics of the tympanic membrane with high spatial resolution. Our presentation emphasizes advantages of optically based methods and demonstrates computerized signal processing capable of fringe localization, enhancement, and counting. Miniaturization and real-time digital image processing in the clinical setting is the goal of this research.

Humans↗
PubMed1995

Electronic speckle pattern interferometry of the vibrating larynx.

Laser holography is a technique that creates a three-dimensional image of a static object. This technique can be applied to the analysis of vibrating structures. Electronic speckle pattern interferometry uses a laser for illumination of the vibrating object and solid state detectors and digital hardware technology for capturing and processing the image in real time. This was performed on a human cadaver larynx and is the first time an interferogram of vibrating vocal cords has ever been obtained. Dark and bright interference fringes are seen that represent the vibratory motion of the vocal folds. These are presented in still photos as well as real-time on videotape. This method can provide advantages over current techniques of laryngeal study: it is sensitive to motion in the vertical dimension, and the digital data can be quantitatively analyzed. Application of this technique to study the larynx should eventually be a valuable clinical tool and provide quantitative research data.

Adult↗
PubMed1995

P-glycoprotein expression in the squamous cell carcinoma of the tongue base.

P-glycoprotein (PGP), which is a product of the multidrug resistance gene (MDR1), is an active transmembrane efflux pump responsible for detoxifying normal cells as well as rendering tumor cells resistant to chemotherapy. It has also been implicated to be expressed by more aggressive cancers. It has not been well described in squamous cell carcinoma of the head and neck. In this investigation, an attempt was made to characterize advanced squamous cell carcinoma of the base of tongue with respect to expression of PGP. Using immunohistochemical techniques two anti-PGP monoclonal antibodies (JSB1 and C494) were used to detect PGP in these lesions, and an attempt was made to correlate levels of PGP staining and various tumor parameters. Usefulness of PGP in predicting survival and time to recurrence was also examined for these advanced lesions. All 33 base of tongue lesions showed staining for PGP with these monoclonal antibodies. This was the first study examining utility of C494 in detecting PGP in squamous cell carcinoma at this site. Increased level of PGP expression was seen in better-differentiated tumors as well as in tumors with diploid DNA. A trend of higher PGP expression and decreased survival emerged. This may represent a true relationship, but inherent heterogeneity of PGP expression within cells cannot be excluded. Both antibodies examined appear to be useful in the investigations of PGP distribution in squamous cell carcinomas of the head and neck sites by immunohistochemical techniques. Prognostic value of the level of PGP expression remains to be seen.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1994

Anomalous cross-modal plasticity following posterior fossa surgery: some speculations on gaze-evoked tinnitus.

A unique and intriguing form of subjective tinnitus evoked by eye gaze is reviewed. A new perspective is presented because this condition is sufficiently different from other forms of subjective tinnitus and its manifestation cannot be adequately explained by existing models or conceptual frameworks. Our examination of this topic considers pathophysiologic changes in the central nervous system in the context of deafferentation-induced plasticity. Potential neuroanatomical areas contributing to this effect include a number of distributed and functionally diverse areas in the brainstem and neocortex involved in the auditory control of eye movements. We also consider contemporary psychophysical methods to evaluate the perceptual correlates of this phenomenon and tools for the development of objective tinnitus measurements. Although theoretical and speculative in nature, this article is intended to stimulate interest in, advance knowledge of, and provide a better understanding about this condition.

Brain Stem↗
PubMed1994

Transsphenoidal hypophysectomy through the external rhinoplasty approach.

The external rhinoplasty approach is a refinement of the well-recognized sublabial transseptal technique for transsphenoidal hypophysectomy first introduced by Cushing in 1910. This article relates our experience with 111 cases of transsphenoidal hypophysectomy performed during a 10-year period (1982-1992) and includes a detailed description of our use of the external technique. Fifty-one patients were male, and 60 were female. Ages ranged from 12 years to 80 years, with an average of 46 years. One hundred one patients had pituitary adenomas, four had craniopharyngiomas, two had inverting papillomas, and there was one each of lymphoma, metastatic prostate cancer, pituitary abscess, and posttraumatic cerebrospinal fluid leak. Nine of the operations were for recurrent adenomas. Complications included 8 symptomatic anterior septal perforations and 13 asymptomatic posterior perforations. Five had transient cerebrospinal fluid rhinorrhea, five had perioperative hemorrhages, two had minor postoperative columellar deformities, and one had injury to the internal carotid artery requiring embolization. We have found the external technique for transsphenoidal hypophysectomy to be a reliable and facile means for nasal exposure of the sphenoid sinus and pituitary gland without loss of nasal tip projection or significant cosmetic deformity.

Adenoma↗
PubMed1994

The disconnected ear: phenomenological effects of a large acoustic tumor.

OBJECTIVE: To document the existence of a peripheral auditory disconnection syndrome in a 23-yr-old male with a large tumor of the right cerebellopontine angle using contemporary behavioral, electroacoustic, and electrophysiologic auditory tests. DESIGN: Single subject with repeated measures. RESULTS: In spite of a profound hearing loss in an ear with a large cerebellopontine angle tumor determined by behavioral audiometry, distortion product otoacoustic emissions, surface recorded brain stem auditory evoked potentials, and transtympanic electrocochleography (click evoked compound action potentials and tone evoked cochlear microphonics) demonstrated that the cochlea was intact and functional over a broad bandwidth and intensity range. CONCLUSIONS: A peripheral auditory disconnection syndrome is demonstrated in a 23-yr-old male with a large tumor of the cerebellopontine angle. In this instance, the tumor effectively deafferentated the peripheral from central auditory nervous system, resulting in profound hearing loss of presumed neural origin. It is suggested that other pathologic conditions/mechanisms could produce similar findings.

Adult↗
PubMed1993

Evaluation of cefixime in the treatment of bacterial maxillary sinusitis.

The efficacy and safety of cefixime, the first oral third-generation cephalosporin, were evaluated in a multicenter clinical trial involving 118 adult patients with acute sinusitis or acute exacerbations of chronic sinusitis. Patients received a single daily dose of 400 mg of cefixime for a mean duration of 10 days; 106 patients completed a course of therapy. Clinical cure and improvement were achieved in 90% of these patients (61% cured and 29% improved). Among the patients evaluated again 2 weeks after therapy, 91% had a sustained clinical cure or improvement. Sinus exudate specimens were obtained from all patients by transantral puncture before therapy. Pathogens were isolated from 76 patients (66%), the most common pathogens being Haemophilus influenzae, alpha-hemolytic streptococci, and Streptococcus pneumoniae. Eighty-six percent of pathogens were presumed eradicated. Three patients discontinued therapy because of side effects. The most frequently reported adverse effects were gastrointestinal, with 20% of patients reporting diarrhea. Cefixime was effective in the treatment of bacterial sinus infections in adults and was well tolerated.

Acute Disease↗
PubMed1992

Superficial siderosis of the central nervous system: a neglected cause of sensorineural hearing loss.

Superficial siderosis of the central nervous system is a rare, often unrecognized condition in which there is a deposition of intracellular and extracellular hemosiderin in the leptomeninges, subpial tissue, spinal cord, and cranial nerves as a result of chronic bleeding in the subarachnoid space. On the basis of our cases and a review of the literature, the majority of patients manifest sensorineural hearing loss in addition to cerebellar dysfunction, pyramidal tract signs, and progressive mental deterioration. Recent imaging techniques--particularly CT and MRI--can define the presence of iron deposition, confirming the diagnosis ante mortem. From post mortem specimens, histologic sections demonstrate severe damage to the eighth nerve, with microglial metabolism of iron. Cases will be presented to illustrate these points.

Adult↗
PubMed1992

Long-term morbidity and mortality in patients undergoing surgery for unilateral vocal cord paralysis.

Fifty-six patients who had undergone surgery for unilateral vocal cord paralysis (UVCP) were reviewed retrospectively. The etiologies; indications for surgery; timing of onset, diagnosis and surgery; complications; and survival rates are presented. Forty patients had neoplasms of which 32 were malignant and 8 were benign. UVCP was due to direct tumor involvement in 16 cases and surgical trauma in 21 cases. Mean survival for patients who presented with UVCP which was due directly to a malignancy was 5 months versus 22 months for those patients with UVCP due to surgical trauma during resection of malignancies. Mean survival for lung cancer patients was 5 months versus 24 months for patients with other malignancies. The etiology and manner of presentation of UVCP are important prognostic indicators which should be considered when planning surgical intervention for UVCP.

Adolescent↗
PubMed1992

The external rhinoplasty approach for rhinologic surgery.

The technique of external rhinoplasty has enjoyed a renaissance over the last ten years, primarily for cosmetic and functional septorhinoplasty, and we have found this to be an effective method for nasal reconstruction. Moreover, we have recognized the versatility of this approach for a variety of rhinologic problems and have utilized it for transsphenoidal hypophysectomy, sphenoidotomy, unilateral choanal atresia, septal perforation, nasal valvuloplasty and rhinophyma. We describe our technique and the rationale for employing it. We conclude that the enhanced exposure provided by the cutaneous decortication of the nose facilitates surgery of both the soft tissues and the supportive architecture of the nose.

Dermatologic Surgical Procedures↗
PubMed1991

Head and neck surveillance program for factory personnel exposed to asbestos.

Personnel at a local factory that manufactures brake linings and discs in which asbestos is a major component were requested to participate in an on-site surveillance program to detect head and neck abnormalities, specifically cancer. Demographic data included smoking histories and job descriptions that could be delineated into high- and low-asbestos exposure groups. In the first year, 322 factory workers had no cancer identified but 15% had laryngeal abnormalities, mostly laryngitis. Ninety-seven percent of those workers with abnormal findings were smokers, but there were a significant number in the high-asbestos group irrespective of smoking histories. From this report, high-risk individuals were identified and requested to continue in the program for monitoring. In the subsequent 3 years, these individuals and new personnel were examined. Similar results were obtained in that laryngitis was noted in 24% (95% of whom were smokers) with a stronger statistical association with the high-asbestos group. More important, one person previously identified as high-risk was noted to have stage I squamous cell carcinoma and was treated with radiotherapy. The results of this program suggest that individuals at high risk for the development of head and neck cancer can be identified and that such surveillance programs should be implemented in similar arenas.

Adult↗
PubMed1991

External rhinoplasty approach to transsphenoidal hypophysectomy.

The external rhinoplasty approach is a modification of the well recognized transseptal transsphenoidal hypophysectomy technique first introduced by Cushing in 1910. Our approach has been used successfully in 75 cases over a six year period, demonstrating its efficacy and safety. It provides a simple, reliable, rapid technique for exposing the septum and the floor of the nose with excellent exposure to the sphenoid sinus and pituitary gland. There has been no loss of nasal tip projection or other cosmetic deformity.

Adolescent↗