The common causes of hearing loss in adults.
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Adult↗
Biomedical subjects
S R Saeed
Publications and source records attributed to S R Saeed.
The implant-site split-skin graft technique for the bone-anchored hearing aid.
We describe the technique of implant-site split-skin grafting for the bone-anchored hearing aid (BAHA). Twenty-five patients have undergone this procedure (20 adults and five children) since 1993 with a minimum follow-up of 1 year. Fifteen adults were operated upon as single stage surgery, all other cases (including all children) were performed in two stages. In four patients (16%) significant early graft inflammation was encountered which settled with outpatient treatment. In one the abutment had to be temporarily removed to allow the graft to settle. All patients now have a stable graft site. This surgical technique is straightforward and a separate graft donor site is avoided. It would appear this technique results in a stable BAHA graft site with low associated morbidity.
Adolescent↗
The large vestibular aqueduct syndrome: the role of cochlear implantation in its management.
In recent years the large vestibular aqueduct syndrome has become an increasingly recognized cause of a progressive sensorineural hearing loss. Cochlear implantation, although not correcting the bony abnormality, does offer an avenue for rehabilitation for affected individuals and initial results are encouraging. Of 15 patients identified with the large vestibular aqueduct syndrome we have implanted seven (five adults and two children). All patients underwent an uneventful electrode insertion with uncomplicated postoperative periods. Three of our adult patients are showing very good initial results with BKB speech recognition scores of 100%, 74% and 66% with the implant alone. It is still early days with the children, but initial results are encouraging. A full review of the large vestibular aqueduct syndrome is given along with our results.
Adolescent↗
Petrosal cholesteatoma: management considerations for minimizing morbidity.
OBJECTIVE: This study aimed to analyze the surgical treatment of patients presenting with petrosal cholesteatoma. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Patients were referred to the University Department of Otolaryngology, Manchester Royal Infirmary, with surgically confirmed petrosal cholesteatoma. INTERVENTION: Interventions were diagnostic and therapeutic. MAIN OUTCOME MEASURES: Postoperative facial function, hearing loss, recurrent cholesteatoma, and petrous cavity morbidity in relation to preoperative signs, intraoperative findings, and surgical techniques were measured. RESULTS: Twenty-five patients were treated between 1979 and 1997. Complete preoperative facial paralysis was always associated with bony erosion around the geniculate ganglion, and facial nerve ischemia was thought to be an important factor. Resection of the ischemic nerve segment and end-to-end anastomosis over the posterior fossa dura allowed full removal of cholesteatoma matrix and reinnervation along a healthy and vascularized nerve. In five of the seven cases with recurrent disease, cholesteatoma was localized to the intrapetrous carotid or geniculate ganglion. The introduction of endoscopic techniques has allowed assessment of the full extent of disease and removal of cholesteatoma matrix missed using conventional microscopic visualization. Bipolar diathermy to areas of cholesteatoma, densely adherent to dura, is effective in destroying squamous epithelium. Patients with cavity obliteration and blind sac closure had minimal postoperative morbidity, and current magnetic resonance imaging techniques are effective in diagnosing and delineating recurrence. CONCLUSIONS: This study illustrates a gradual change in the treatment of patients with petrosal cholesteatoma. By defining the main areas of patient morbidity and using both recent technical advances and alternative surgical techniques, further improvement in patient outcome is envisaged.
Adolescent↗
Fortnightly review. Diagnosis and treatment of Ménière's disease.
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Diagnosis, Differential↗
Cochlear ossification after meningitis.
OBJECTIVE: This study aimed to assess the pathologic processes that result in ossification of the cochlear lumen after bacterial meningitis. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Profoundly deaf postmeningitic patients who underwent cochlear implantation were studied. INTERVENTIONS: Diagnostic and therapeutic observations were performed. MAIN OUTCOME MEASURES: The extent of cochlear ossification is classified and related to age at which infection occurred, cerebrospinal fluid leukocyte count, Gram's stain, organism, and delay between meningitis and implantation. The extent of ossification noted on high-definition computed tomographic (CT) scan is compared with surgical findings and related to the time delays between meningitis, imaging, and surgery. RESULTS: Ossification fell into three groups: gross ossification of the scala tympani and variable amounts of the scala vestibuli; partial ossification localized to the basal turn of the scala tympani; and no ossification. There was no correlation between the extent of ossification and the age when infected, type of pathogen, cerebrospinal fluid leukocyte count, and time delay between meningitis and implantation. Visualization of bacteria on Gram's stain was a highly sensitive measure of ossification (0.93) but was not specific (0.6) with positive and negative predictive values of 0.76 and 0.86, respectively. High-definition CT underestimated the extent of ossification in 50% of cases when performed within 6 months of meningitis. CONCLUSIONS: Ossification is either gross or localized to the basal turn of the scala tympani. If ossification does occur, it is rapid and complete within a few months of infection. The visualization of bacteria on Gram's stain is a sensitive indicator for the presence of ossification but has low specificity. High-definition CT, if performed within the first 6 months of meningitis, can be an inaccurate diagnostic tool and therefore should be performed as close to the date of surgery as possible.
Adolescent↗
Cochlear implantation in the deaf-blind.
OBJECTIVE: This study aimed to examine the outcome and rehabilitation of cochlear implantation in a select group of individuals: the deaf-blind. STUDY DESIGN: The study design was a retrospective and prospective case evaluation of the deaf-blind implantees. SETTING: The study was conducted at a national adult and pediatric cochlear implant center. PATIENTS: A total of eight adult and two pediatric blind or visually impaired individuals undergoing cochlear implantation for severe or profound deafness participated. Evaluation of the history, etiology of blindness and deafness, and outcome of the cochlear implantation was examined. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation were performed. MAIN OUTCOME MEASURE: Bamford-Kowal-Bench (BKB) sentence scores were measured. RESULTS: Individually and as a group, these patients respond exceptionally well to cochlear implantation. The BKB scores are above the average for the sighted cochlear implantees. This raises the question of heterosensory substitution. CONCLUSIONS: Cochlear implantation has a major role to play in the rehabilitation of certain deaf-blind individuals, and these patients may be among the most worthwhile to consider for implantation. The implant team must acquire additional rehabilitative skills, and the strength of the deaf-blind culture must be taken into consideration.
Adolescent↗
Otorhinolaryngological training in Europe--a comparative study.
Postgraduate training in the United Kingdom is undergoing radical changes following the 'Calman Report'. Commissioned in response to a European Union (EU) Directive, this contained recommendations to allow reciprocal recognition of all EU trained specialists. We present the findings of a postal questionnaire sent to representatives of the European Federation of Oto-Rhino-Laryngological Societies and the otolaryngology professors of the UK and Ireland with a response rate of 62.7%. Aspects assessed included clinical and surgical experience, examinations, teaching, research, length, regulation and perception of training. The programmes share similar teaching and research experience but substantial differences exist in most other areas. The accredited UK trainee has a much wider clinical and surgical repertoire than those from the Continent. Greek trainees were trained to the lowest minimum standard. The requirements of a training system are largely determined by the level of clinical experience and surgical skill required by an independent specialist in a given country.
Europe↗
Deafness and cholesteatoma complicating fracture of the mandibular condyle.
A case of posterior fracture-dislocation of the mandibular condyle which resulted in conductive deafness and cholesteatoma is presented. Initial management by condylectomy improved auditory canal patency but failed to prevent the development of cholesteatoma, necessitating mastoid surgery. Although major complications following fractures of the condyle are not common the need to consider the possibility of damage to the ear in such fractures is emphasised.
Adult↗
Survival times of Provox valves.
This study was performed to assess the survival times of the Provox valve in the Manchester area. Thirty-nine patients from four hospitals, representing 81 valve failures, were studied. The effects of the timing of the tracheo-oesophageal puncture, previous radiotherapy, and the presence and timing of cricopharyngeal myotomy on valve life were analysed. Regression analysis using an extension of the Cox model to allow strata showed that the lifetime of the first valve only is adversely affected by previous radiotherapy. The other covariates do not have a statistically significant effect on valve survival. The median valve survival is 4.5 months, (range one to 12 months). A small percentage of valve users with particularly frequent valve failures may require additional support and prolonged anti-fungal therapy.
Adult↗
Palatal myoclonus affected by neck posture.
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Botulinum Toxins↗
Rehabilitation of the paralysed face: results of facial nerve surgery.
The case notes of 34 patients undergoing rehabilitative facial nerve surgery between 1978 and 1994 were retrospectively examined. Thirteen patients underwent facio-hypoglossal transposition with six achieving a facial nerve grade of IV (House-Brackmann scale) at 24 months post-surgery. Twelve patients underwent cable grafting of the facial nerve defect. Of these, 10 achieved a grade III result at 24 months. Nine patients underwent end to end anastomosis of the facial nerve, seven achieving a grade III result at 24 months after the repair. Re-routing of the facial nerve and the use of tissue glue to effect the anastomosis did not have an adverse effect on the outcome. Comparison of rerouted end to end anastomosis with non-re-routed cable grafting showed no difference. Patients presenting pre-operatively with facial weakness and those in whom nerve repair surgery was delayed for more than six months were less likely to have a good result.
Adult↗
Lasers in surgery for chronic ear disease.
This article describes specific situations in which the laser has been found to be useful in surgery for chronic ear disease. In the opinion of the authors, the most important application is the atraumatic removal of cholesteatoma from a mobile stapes. Additional uses include precise and hemostatic removal of diseased tissue (polyps, granulations, adhesions) and manipulations upon an intact ossicular chain without induction of vibrational trauma. Potential complications such as facial nerve and inner ear injury are considered.
Cholesteatoma, Middle Ear↗
Non-cholesteatomatous suppurative otitis media: facial nerve palsy in an immunocompromised patient.
A 47-year-old man developed a complete facial nerve palsy secondary to non-cholesteatomatous suppurative otitis media. At operation, this was seen to be due to destruction of the nerve from halfway along the horizontal segment to a point just distal to the second genu. The history of recent renal transplantation and subsequent immunosuppression was judged to be significant in the pathogenesis of the palsy.
Facial Paralysis↗
Magnetic resonance imaging: a cost-effective first line investigation in the detection of vestibular schwannomas.
Magnetic resonance imaging (MRI) is currently the 'gold-standard' investigation in patients with a unilateral sensorineural hearing loss. The procedure, however, is expensive and of limited availability. Instead, such patients often undergo a series of audiovestibular tests and computed tomography in an attempt to exclude or diagnose a vestibular schwannoma. We describe seven cases of unilateral vestibular schwannoma in which conventional assessment was either equivocal or failed to demonstrate a tumour subsequently diagnosed by magnetic resonance imaging. Two patients with neurofibromatosis type 2 are also reported to show how magnetic resonance imaging confirmed the presence of a second vestibular schwannoma despite CT that showed only a unilateral lesion. We also illustrate how limited protocol MRI of patients is slightly more expensive yet much more cost effective than the usual battery of tests and propose that it should be the first line investigation for patients in whom the clinical picture requires exclusion of a retrocochlear lesion. Not all of these early diagnosed tumours have been immediately removed. In some of the more elderly or infirm patients a 'wait and rescan' policy has been adopted. Nevertheless, the early establishment of the correct diagnosis facilitates the subsequent management of these patients.
Adult↗
Insulin receptors on the endolymphatic sac: an autoradiographic study.
Light microscopic autoradiographs were prepared of isolated guinea pig endolymphatic sac (ES) tissue incubated with iodine (I)-125-labeled insulin (insulin I 125). These demonstrated specific binding of the insulin I 125 to receptors in the ES. Receptor-mediated endocytosis of the insulin-receptor complex is postulated to occur, and the relevance of insulin receptors in the ES is discussed, with particular emphasis on the previously observed synthesis of hyaluronan from glucose by the ES.
Animals↗
Cochlear reimplantation.
Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.
Adult↗
Cochlear reimplantation.
Since its inception in 1988, the Cochlear Implant Programme in Manchester has successfully implanted 61 adults and 15 children. Of these 76 patients, 3 have undergone revision surgery, and these cases are presented. One patient was a 43-year-old blind man who underwent routine implantation with a Nucleus device. Six weeks after implantation the patient experienced sudden device failure following an electric shock from a domestic appliance. The patient was reimplanted with a similar device 3 weeks later and is making good progress. Assessment of the original implant showed a failure of one of the capacitors in the receiver-stimulator circuit. The second patient was a 51-year-old woman who underwent routine implantation with a Nucleus 22-channel device. The patient's audiologic performance fluctuated, and 14 months after the original procedure the patient was reimplanted. Analysis by the manufacturer suggested that the original implant was unstable at higher temperatures. The third patient, a 55-year-old woman, was implanted with an Ineraid multichannel device into the right cochlea. A postoperative radiograph showed the implant to be incorrectly positioned, and the procedure was revised 4 weeks later. Here it was found that the electrode system was running across the promontory, toward the eustachian tube orifice. This was reimplanted with satisfactory results.
Adult↗