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Biomedical subjects

S R Wolf

Publications and source records attributed to S R Wolf.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Electrode applicator for endolaryngeal electromyography of the larynx with local anesthesia].

Electromyography of the internal laryngeal muscles is not yet a routine examination. To improve the technique, we developed a new applicator for easy and safe endolaryngeal placement of electrodes, which is now routinely used. Application of the electrodes is successful in a higher percentage of patients than with applicator forceps used previously. Additionally, the danger of displacement of needles within the pharynx or larynx and of injury of the mucosa has been completely eliminated. This application technique can be recommended for endolaryngeal placement of wire electrodes for laryngeal electromyography.

Anesthesia, Local↗
PubMed1995

On the site of transcranial magnetic stimulation of the facial nerve: electrophysiological observations in two patients after transection of the facial nerve during neuroma removal.

The site of stimulation of the facial nerve after transcranial temporo-occipital magnetic stimulation is being controversially discussed, particularly whether the nerve is stimulated in the root exit zone in the cerebellopontine angle or whether stimulation originates within the bony canal of the facial nerve. In two case reports, the neurophysiological findings after the surgical transection of the facial nerve during the extirpation of a large acoustic and a facial nerve neuroma are presented. In both cases, transcranial magnetic stimulation of the facial nerve produced compound muscle action potential 4 and 2 days after the dissection of the facial nerve at the internal auditory canal and in the supralabyrinthine portion. These findings indicate that the site of stimulation in transcranial magnetic stimulation can be located to the course of the facial nerve within its bony petrosal canal distal to the external genu.

Action Potentials↗
PubMed1995

Facial nerve involvement in patients with acoustic neurinomas. Examination with magnetic single- and bi-stimulation.

The diagnosis of acoustic neurinomas is usually made by auditory and vestibular testing and magnetic resonance imaging. As clinical involvement of the facial nerve is infrequent, occurring only in large tumours, only little is known about the subclinical involvement of the facial nerve. Transcranial magnetic stimulation of the VIIth cranial nerve in the temporal bone, adjacent to acoustic neurinoma growth, seems to be an adequate instrument for electrophysiological measurements of minimal nerve lesions without clinically obvious facial palsy. In 70% out of 97 patients with surgically and histologically confirmed acoustic neurinomas, obvious elongation of the intratemporal conduction time of the facial nerve was found. This affection was dependent on tumour size. No correlation was found to preoperative or postoperative facial nerve function and hearing function. The latencies of the conduction time showed a tendential increase in patients with a more difficult grade of surgery and of facial nerve preparation due to fibrous adhesions and nerve spreading on the tumour capsule. A completely new stimulation modality, the application of two magnetic stimuli in quick succession, was applied for the first time in acoustic neurinoma patients, and revealed facial nerve involvement by acoustic neurinoma growth. Facial nerve involvement in acoustic neurinoma can be detected by transcranial magnetic stimulation even in patients with small and medium sized tumours but with clinically normal facial function.

Cranial Nerve Neoplasms↗
PubMed1995

Clinical survey of Meniére's disease: 574 cases.

Only 27% out of 574 patients suffering from Meniére's disease initially started with the typical Meniére's triad. A great advantage in order to diagnose Meniére's disease can be established with the telemetric-ENG. With this equipment it is possible to verify a nystagmus outside the clinic (at home, at work) at any time in patients suffering from vertigo attacks. Most of our patients showed an omnifrequent sensorineural hearing loss on the affected side. Many of our patients with Meniére's disease suffered from internal diseases (e.g. hypotonia, hyperlipidemia, diabetes mellitus), allergy or an affection of the paranasal sinuses, which may constitute co-factors triggering Meniére's disease.

Adolescent↗
PubMed1995

[Intraoperative facial nerve monitoring in parotid surgery].

Neurophysiological monitoring of cranial motor nerves has proved to be of value in cerebellopontine and skull base surgery. Unfortunately, facial nerve monitoring has been used infrequently for routine parotid gland surgery because suspicion of expense, possible unreliability and the requirement for extra personnel. This study presents clinical experience at the University of Erlangen with facial nerve monitoring during parotid gland surgery done by residents. Advantages are also emphasized for the experienced ENT-surgeon for use during revision parotidectomy. In 35 consecutive patients with benign parotid gland tumors intraoperative monitoring of the facial nerve was done using two different two-channel electromyography units. Bipolar coaxial electrical stimulation was superior to the monopolar stimulation mode. The average operative time and postoperative functional results were compared with those of a control group consisting of 24 patients without monitoring. Findings demonstrated a reduction is operative time and better functional outcome in the patient group with monitoring. Additionally four patients had to undergo total revision parotidectomy because of recurrent benign tumors, while one patient suffered from chronic parotitis due to sialolithiasis and required complete parotidectomy for relief of symptoms. No patient developed permanent facial paresis and nerve monitoring proved to be very helpful for identification and protection of the facial nerve in scar tissue.

Electric Stimulation↗
PubMed1995

[What should be recommended to a patient with a small radiologically suspected acoustic neuroma?].

OBJECTIVE: Criteria for therapeutic decision-making for intrameatal acoustic neurinomas that are suspected radiologically. DESIGN: Retrospective evaluation. PATIENTS: 114 surgically treated patients of the ORL Dept. of the University Erlangen-Nuremberg. OUTCOME MEASURES: Rate of complications. Preservation of facial nerve function and hearing. Preoperative time course of hearing. Reliability of radiological examination. Progression of symptoms and tumor growth. THERAPY: Surgical exposure and complete removal by the enlarged middle cranial fossa approach. RESULTS: In 47% of cases surgery confirmed a neurinoma limited to the internal auditory meatus. In 41%, tumors were larger than expected and had protruded into the cerebellopontine angle, indicating preoperative tumor growth during an average period of 5.4 months before surgery could be completed. The remaining 12% of patients were found to have a facial neurinoma, meningioma or non-tumorous lesion of the internal auditory canal. No permanent neurological deficits or fatalities occurred in any of the patients treated. Facial function was favorable in 88% and moderate pareses or synkineses occurred in 12%. The degree of hearing preservation depended on the preoperative situation. When the preoperative pure-tone average (at 0.5, 1, 2 and 4 kHz) was 30 dB or less, hearing levels of less than 90 dB could be preserved in 70% of cases. Findings also demonstrated that the complication rate and success of function preservation were similar to younger patients in patients older than 60 years (n = 21). Without surgery auditory acuity decreased by 10 dB per year. The volume of intrameatal neurinomas in 7/10 cases followed by MRI doubled during a median following time of 32 months. CONCLUSIONS: Acoustic neurinoma surgery by the enlarged middle cranial fossa approach is a safe procedure with low complication rates. The percentages of preservation of facial function and hearing can be excellent in cases with small tumors and good preoperative hearing. To date no parameter has been found to predict tumor growth or the time course for hearing loss in individual cases. Surgical ablation of radiologically suspected, small acoustic neurinoma by the transtemporal approach is recommended.

Adolescent↗
PubMed1995

[Pneumolabyrinth. Radiologic sign of perilymph fistula].

Post-traumatic cochleo-vestibular symptoms can be caused by peri-lymph fistulas, although these cannot be proven preoperatively in most cases by direct clinical examination. A rare case of a traumatic burst fracture of the promotory wall with a consequent perilymph fistula is presented. A preoperative computed tomographic finding of air in the basal turn of the cochlea and superior semicircular canal (pneumolabyrinth) is a reliable sign of perilymph fistula and justifies operative exploration for closure of the fistula. High-resolution computer tomographic imaging of the petrous bones in patients with post-traumatic cochleo-vestibular disturbances is mandatory.

Adult↗
PubMed1994

[Does transcranial magnetic stimulation provide improved assessment of "idiopathic" facial paralysis? Initial results].

To evaluate transcranial magnetic stimulation (TMS) in patients suffering from idiopathic facial palsy, results from 31 patients were reviewed. TMS was applied to the facial nerve by parieto-occipital, ipsilateral coil placement. At the time of the first examination (2-25 days after the onset of palsy), 11 of 31 nerves on the affected side were excitably by TMS. Patients were classified according to whether magnetic excitability of the facial nerve was possible (group I) or not possible (group II). In general, the percentage of patients with complete or nearly complete recovery of facial function was 97% following either a standard infusion therapy (corticosteroids, hydroxyethylstarch and pentoxifyllin) or orally administered corticoids (equal percentages in each group, respectively). In the first group of patients, 11 had facial nerves that were excitable with TMS and showed complete recovery of motor function within a median period of 7 weeks. In those patients with successful TMS only one experienced "crocodile tears" syndrome one year after Bell's palsy but without any further motor deficit of facial function. In patients with unresponsive nerve function following TMS 17 recovered without sequelae (median, 11 weeks), whereas 3 of 20 (15%) developed deficits of motor function. Two of these latter cases suffered from synkinesias (one that was slight after surgical decompression of the facial nerve and one severe) while one had facial contractures but without motor deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Current aspects in diagnosis and therapy of pediatric facial paralysis].

Between 1986 and 1992, 60 children with facial nerve palsy (FNP) were examined at the ORL hospital at Erlangen-Nuremberg University. By using blood and cerebrospinal fluid (CSF)-serological tests acute infection with Borrelia burgdorferi (B.b.) could be proved in 16 of 40 children (40%) whose pareses could not be clarified etiologically at first examination. Whereas all idiopathic FNP patients (22) had normal CSF-results, more than half of the B.b.-infected children showed pathological findings, with pleocytosis indicating meningitis. These findings demonstrated that lumbar puncture should be performed in children with FNP of unclear etiology, particularly in cases with positive borreliosis blood serology. The children with borreliosis received penicillin G or ceftriaxone intravenously for at least 14 days and patients with idiopathic FNP were treated with cortisone either orally alone or intravenously in combination with pentoxifylline and hydroxyethylstarch. The outcome in 95% of the patients showed that complete recovery was similar in borreliosis and idiopathic FNP irrespective of treatment with cortisone. Overall, 88% of the FNP recovered completely, indicating a favorable prognosis of FNP in children.

Adolescent↗
PubMed1993

[Tuberculosis in the otorhinolaryngologic area. A still current differential diagnosis].

Between 1986 and 1992 18 cases of tuberculosis of the cervical lymph nodes, the larynx, the middle ear, or the paranasal sinuses were diagnosed at the ENT clinic of the University of Erlangen-Nuremberg. A rare case of tuberculous infection of both the maxillary and ethmoidal sinuses and the pharyngeal tonsil is presented. All patients with involvement of the upper respiratory tract had concomitant productive pulmonary tuberculosis, whereas in tuberculous cervical lymphadenitis and otitis media the disease was regularly limited to the neck and the ear respectively. Preoperative microbiological testing pointed to a tuberculous origin in only 3 of the 18 patients, so that histological and microbiological examination of excision biopsy specimens was the most reliable test. As there was no apparent decrease in incidence over the 7 years, we conclude that tuberculosis remains an important differential diagnosis in ENT.

Adult↗
PubMed1993

[Preventive antibiotic administration in rhinoplasty. Tissue level and pharmacokinetics with reference to rhinoplasty techniques].

Prophylactic antibiotics (cefuroxime 1500 mg) were administered during induction of anesthesia to 34 patients undergoing nasal surgery. The infusion ended at the time of mucosa incision (mean infusion time: 22 min). A hemitransfixion incision was followed by elevation of the mucoperichondrium on both sides of the septum. The blood supply of the cartilage was thus diminished essentially. In the septal cartilage, the concentration of cefuroxime 68 min after the administrations of antibiotic was 28.1 micrograms/g; this concentration was 19.8 micrograms/g in the septal bone at 74 min. The mean peak plasma concentration was 158 micrograms/ml and the end half-life elimination time 77 min. High antibiotic concentrations in the cartilage resulted from passive diffusion through the septal mucosa and occurred at a mean time of 22 min. The time between the start of infusion at the induction of anesthesia and interruption of the septal blood supply by separating of the septum from overlying soft tissues was sufficient for developing high antibiotic concentrations. During nasal surgery the routine approach to the septum had no influence on the efficacy of antimicrobial prophylaxis.

Adult↗
PubMed1993

[Intraoperative monitoring of the facial nerve in transtemporal surgery of acoustic neurinoma].

Acoustic neuroma ablation by the enlarged middle cranial fossa approach results in a low incidence of postoperative facial nerve dysfunction. In 25 consecutive patients with tumors in the cerebellopontine angle with a diameter up to 2.3 cm, intraoperative monitoring of the facial nerve was evaluated. The facial nerve was monitored electrophysiologically with recordings of the spontaneous EMG and electrically evoked potentials (CMAP) from at least three groups of facial muscles. In 4 cases monitoring was helpful for identification and delineation of the facial nerve. The mechanically elicited potentials during tumor preparation and CMAP after electrical stimulation close to the brain stem were compared with the postoperative facial nerve function and the time course of recovery. If the ongoing EMG recordings resulted in potentials below 0.5 mV and the CMAP at the end of tumor preparation was higher than 0.5 mV, facial nerve function was normal in 9 of 10 cases on the first postoperative day. One patient had mild facial palsy. Poor results could be predicted if numerous discharges with amplitudes higher than 0.5 mV and affected CMAP after stimulation near the brain stem were found at the end of surgery. All 3 patients with these findings had facial paralysis at hospital discharge (an average of 9 days after the operation). Recovery from the palsies was found to be prolonged. Intraoperative monitoring of the facial nerve is now used routinely in surgery of the cerebellopontine angle and the internal auditory canal.

Adult↗
PubMed1992

[Peripheral facial paralysis as the first symptom of unknown metastatic primary tumor].

The spread of metastases to the brain and the leptomeninges is usually a terminal event in patients with known malignancies. We report on two patients, in whom the diagnosis of a diffusely metastasizing carcinoma was considerably delayed by the initial symptom of a peripheral facial nerve paralysis. The clinical, neuroradiologic and cerebrospinal fluid findings are discussed. A malignant neoplasm with diffuse or focal metastasis to the leptomeninges is a rare cause of peripheral facial paralysis of unclear genesis. The necessity of a lumbar puncture plus magnetic resonance imaging of the brain to enable an early diagnosis is emphasized.

Adenocarcinoma, Mucinous↗
PubMed1991

"Telemetric" electronystagmography: a new method for examination of nystagmus outside the clinic.

The diagnosis of the vestibular system is expanded by an newly developed system. It offers mainly two additional ways for the examination of eye movements: 1) Time and place independent, telemetric ENG recording by the patient himself. 2) Simultaneous visual examination of the nystagmus and ENG recording in clinic and surgery. The device contains of special, handy ENG recorder with digitalized storing of ENG curves. For easy application, special goggles with pre-installed electrodes have been combined with modified Frenzel's glasses. The recorded curves can be evaluated with the aid of a regular personal computer.

Electrodes↗
PubMed1991

[Transcranial magnetic stimulation of the facial nerve in patients with acoustic neuroma].

Magnetic stimulation of the human facial nerve was used in 30 patients with small or medium-sized acoustic neurinomas pre-operatively. Needle-EMG revealed symmetrical aspect in the orbicularis oris muscle on the affected and on the contralateral side. The latencies in the extracranial part of the facial nerve after supramaximal electric stimulation in the area of the stylomastoid foramen and the latencies after temporo-occipital, transcranial magnetic stimulation were measured. A comparison of the data showed a significant increase in the temporal conduction time (difference between latencies after transcranial magnetic stimulation and electrical mastoid stimulation) between the healthy and the affected side in most cases. This study revealed tendencies between prolongation of the latencies and the tumour size. No correlations were obtained to audiological or intra-operative findings.

Adult↗