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Biomedical subjects

Sam J Marzo

Publications and source records attributed to Sam J Marzo.

17 recordsLinked to original sources
PubMed2007

Facial paralysis associated with glomus jugulare tumors.

OBJECTIVE: To review the intraoperative findings and facial nerve management in nine patients who presented with facial paralysis associated with glomus jugulare tumors. STUDY DESIGN: A retrospective analysis of patient medical records. SETTING: Tertiary care academic medical center. PATIENTS: All patients who presented with facial paralysis and a glomus jugulare tumor who underwent surgical resection of their tumors at our institution. INTERVENTION: A postauricular infratemporal fossa approach for tumor removal and greater auricular interposition neural repair. MAIN OUTCOME MEASURE: Intraoperative facial nerve findings and long-term facial recovery. RESULTS: One hundred two patients underwent a postauricular infratemporal approach for resection of glomus jugulare tumor from July 1988 through July 2005. Nine of these patients presented with ipsilateral facial paralysis. The medial surface of the vertical segment was invaded by tumor in all nine cases. Facial recovery at 2 years was House-Brackmann Grade III in eight patients and Grade IV in one individual. Facial recovery did not significantly change after 2 years (mean follow-up of 7.4 years). DISCUSSION: Facial nerve invasion of the vertical segment occurred in 9 (9%) of 101 patients in our series. Facial nerve resection with interposition grafting resulted in House-Brackmann Grade III in eight (89%) of nine patients. Facial nerve dissection and preservation was not possible when preoperative facial paralysis was evident.

Adult↗
PubMed2006

Perioperative complications with the bone-anchored hearing aid.

OBJECTIVE: To discuss perioperative complications associated with the bone-anchored hearing aid (BAHA) and their management. STUDY DESIGN AND SETTING: A retrospective review of 58 patients who underwent implantation of BAHA for unilateral conductive, mixed, or sensorineural hearing losses was performed at a tertiary referral center. RESULTS: Between September 2003 and June 2005, 58 patients underwent implantation of a BAHA. There were 30 female and 28 male patients, with a mean age of 48 years (range 8-80 years). Complications occurred in 19% (11/58) of patients. Most adverse events were seen early in the series. The most common complication, partial or complete loss of the skin graft, occurred in 10% (6/58) of patients. These were managed successfully with local wound care. Five percent (3/58) of patients had skin growth over the abutment. Two of these cases were managed with office debridement, whereas 1 patient required revision under general anesthesia. There was implant extrusion in 3% (2/58) of patients, and both of these patients later underwent successful reimplantation. All patients had their implant activated 3 months after surgery. There were no perioperative or postoperative deaths. CONCLUSION: Complications related to BAHA implantation are relatively minor and usually involve partial or complete loss of the skin graft. Most complications were successfully managed in the office.

Acoustic Stimulation↗
PubMed2006

Combined transtemporal access for large (>3 cm) meningiomas of the cerebellopontine angle.

OBJECTIVES: Large meningiomas of the cerebellopontine angle present a formidable surgical challenge due to tumor vascularity, neural attachment, and brain stem compression. The purpose of this paper is to present our use of the combined transtemporal approach in the surgical treatment of 29 large meningiomas. STUDY DESIGN AND SETTING: Twenty-nine patients with large meningiomas of the CPA were surgically treated through a combined retrosigmoid-transpetrosal-transcochlear approach at our tertiary care academic medical center from July 1995 through July 2004. Data was collected from a retrospective medical records review. RESULTS: Total tumor removal was achieved in 19 of 29 (67%) of the patients and the facial nerve was anatomically preserved in 26 of 29 (89%) of the cases. Cerebrospinal fluid leakage was seen in 3.5% of the patients and additional transient cranial nerve deficits were noted in 14% of the cases, but no significant neurologic sequelae occurred. Of the 10 patients with residual tumor, 6 have been stable without growth, 2 were treated with reoperation for regrowth of disease, and 2 were controlled with localized radiotherapy. CONCLUSIONS: This combined lateral transtemporal approach provided wide exposure to the cerebellopontine angle and optimized the surgical extirpation of 29 large meningiomas presented in this series. EBM RATING: C-4.

Adult↗
PubMed2006

Long-term results with operated sinus tympani retraction cholesteatoma.

OBJECTIVES: Utilizing an endaural approach, we described the surgical treatment of 29 cases of sinus tympani retraction cholesteatoma in 1996. The purpose of this paper is to provide long-term results in this group of patients. STUDY DESIGN AND SETTING: A retrospective chart analysis of 29 previously reported patients was undertaken in an effort to identify hearing results and the risk of cholesteatoma recurrence following sinus tympani retraction surgery. RESULTS: The follow-up period ranged from 9 to 16 years (mean of 13.2 years). Speech discrimination (SD) and conductive hearing (CH) decline occurred in 23 of 28 patients, but only on the average of 5.6% and 9 dB throughout the speech frequencies, respectively. Speech discrimination and conductive hearing improved in 5 of 28 patients; one patient was lost to follow-up. One patient developed a recurrent cholesteatoma requiring a canal wall-down mastoidectomy. CONCLUSIONS: The endaural approach for sinus tympani cholesteatoma provided stable hearing in most of the patients in this series. One cholesteatoma recurrence required conversion to a canal wall-down mastoidectomy. This developed in a noncompliant patient, whose pars tensa retraction deepened as a result of failure to have his ventilation tube replaced. Semiannual office visits are recommended in patients who undergo this otologic approach for sinus tympani cholesteatoma.

Adolescent↗
PubMed2006

Intracranial schwannomas of the lower cranial nerves.

OBJECTIVE: To present our experience in the diagnosis and management of 39 patients with lower cranial nerve schwannomas of the posterior fossa. STUDY DESIGN: A retrospective chart review of patient medical records. SETTING: Tertiary care, academic medical center. PATIENTS: All patients with intracranial lower cranial nerve schwannomas treated surgically in our institution between July 1998 and July 2005. INTERVENTION: A retrosigmoid, transcondylar, or combined approach was used for tumor recurrence. RESULTS: Thirty-nine patients underwent surgical resection, with complete tumor removal in 32, near-total resection in 5 patients, and subtotal tumor excision in 2 patients. Long-term (mean, 8.2 years) magnetic resonance imaging surveillance demonstrated recurrent tumor in 2 of 32 complete resections and slow regrowth in 2 of 7 patients with known residual disease. Only one of these four patients required reoperation. DISCUSSION: Intracranial schwannomas of the lower cranial nerves are relatively uncommon and may present with subtle or no clinical symptoms. Successful surgical resection with low risk of tumor recurrence can be achieved with the retrosigmoid or transcondylar approach. Morbidity, in this series, was primarily related to lower cranial nerve deficits.

Adult↗
PubMed2005

Intratympanic steroid perfusion for refractory sudden sensorineural hearing loss.

OBJECTIVE: Patients with sudden sensorineural hearing loss (SSHL) can benefit from systemic steroid therapy. Unfortunately, some patients are not candidates for steroid therapy due to concern over possible complications. Furthermore, not all patients will benefit from steroid administration. This study evaluates the potential benefits and safety of treating patients with SSHL refractory to oral steroids with intratympanic steroid therapy. METHODS: A retrospective case review was performed on all patients who presented with sudden sensorineural hearing loss refractory to oral steroid therapy during the past year. Seventeen patients were identified. All patients underwent intratympanic steroid administration, via MicroWick placement and/or round window catheter placement. RESULTS: Nine patients with sudden sensorineural hearing loss showed an improvement with intratympanic steroid therapy, consisting of MicroWick placement with dexamethasone drop (Decadron) administration for 1-2 weeks and/or round window catheter placement with steroid perfusion. Only one of the patients presenting with hearing loss present for greater than 8 weeks benefited from intratympanic therapy. Complications were few and included tympanic membrane perforation, chronic otitis media, dysequilibrium, and dysguesia. CONCLUSIONS: Intratympanic steroid therapy can be beneficial in treating patients with sudden sensorineural hearing loss refractory to oral steroid use. EBM RATING: C.

Administration, Oral↗
PubMed2005

Recurrent pleomorphic adenoma of the parotid gland.

OBJECTIVES: To assess the long-term results in the management of 42 patients with recurrent pleomorphic adenoma of the parotid gland. STUDY DESIGN: A retrospective analysis of 42 patients who underwent parotidectomy for recurrent pleomorphic adenoma was performed to study presenting clinicoradiographic features, surgical technique, facial nerve management, and the long-term risk of recurrence. RESULTS: All 42 patients had multi-focal, nontender recurrent nodules following one to four prior surgical procedures and 6 patients underwent prior radiotherapy. Surgical procedures included subtotal parotidectomy in 12 patients, total parotidectomy in 18 patients, parotidectomy with facial nerve resection in 7 cases, and subtotal petrosectomy with facial nerve resection in 5 individuals. The 2 patients with malignant transformation died of disseminated lung and bone metastasis. Twenty-nine of the remaining 40 patients had no recurrent disease. Seven patients developed local parotid bed or cutaneous recurrent disease, 2 patients died of unrelated causes, and 2 patients were lost to follow-up. CONCLUSIONS: All 7 patients with recurrent disease underwent subtotal parotidectomy with "negative" surgical margins. Total parotidectomy or subtotal petrosectomy with facial nerve resection in selected cases may reduce the risk of multiple episodes of pleomorphic adenoma recurrence. Two of 42 patients were found to have carcinoma ex-pleomorphic adenoma, both of these patients underwent prior radiotherapy, and both died of metastatic disease.

Adenoma, Pleomorphic↗
PubMed2005

Closure of complex lateral skull base defects.

OBJECTIVE: To discuss surgical reconstructive options and complications in patients with extensive lateral skull base defects. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Eligibility criteria included patients seen between July 1999 and July 2003 with malignant neoplasms of the lateral skull base requiring surgical therapy, with resultant surgical defect not amenable to primary closure. INTERVENTION: Surgical extirpation of malignant skull base neoplasm requiring free tissue transfer or rotational flap closure. MAIN OUTCOME MEASURE: Closure and healing of surgical defect, intraoperative and postoperative complications, patient survival. RESULTS: There were 11 patients, 8 males and 3 females, with an average age of 65 years. Eight patients required trapezius flap reconstruction, whereas one patient required temporalis rotational flap closure, and two patients required rectus abdominus free tissue transfers. There was one perioperative death secondary to cardiac disease. There were no immediate wound complications. One patient developed a delayed partial trapezius flap failure successfully treated with a rectus abdominus flap. CONCLUSIONS: The trapezius rotational flap is a reliable means of closing complex lateral skull base defects with minimal morbidity.

Abdominal Muscles↗
PubMed2004

Diagnosis and management of post-traumatic vertigo.

OBJECTIVES/HYPOTHESIS: Patients with post-traumatic vertigo can be difficult to treat secondary to the chronicity of their symptoms. Patients can have peripheral, central, and combined vestibular deficits. Furthermore, no comprehensive guidelines exist for returning these patients to work. The objectives of the study were to discuss diagnosis, management techniques, and guidelines for returning these patients to work. STUDY DESIGN: Retrospective analysis of a tertiary referral neurotology and balance clinic. METHODS: Between July 1997 and July 2003, 2390 patients with chief complaints of vertigo and/or dizziness were analyzed. Of these, 16 patients met the requirements for inclusion in the study, including head trauma and/or concussion and residual vertigo. Their inpatient and outpatient charts, imaging studies, audiograms, vestibular tests, and physical therapy evaluations were reviewed. All patients had at least 6 months of follow-up. RESULTS: There were 5 women and 11 men, with an average age of 42 years. Five patients had symptoms consistent with traumatic perilymphatic fistulas, and two patients had symptoms consistent with post-traumatic Meniere's syndrome. Surgical therapy was not beneficial in relieving dysequilibrium. Balance testing results did not predict return-to-work status. Eleven patients were not allowed to return to work in any capacity, two patients were allowed to return to work with limited duties, and three patients were allowed to return to work with no restrictions. CONCLUSION: Post-traumatic vertigo can result in chronic symptoms. Balance testing did not predict the ability of patients to return to work. Surgical intervention might not control patient symptoms. Many patients were unable to return to work.

Adult↗
PubMed2003

Invasive fungal and bacterial infections of the temporal bone.

OBJECTIVES/HYPOTHESIS: Objectives were to highlight the importance of surgical therapy in treating invasive polymicrobial infections of the temporal bone, to discuss the importance of antifungal therapy, and to review the differential diagnosis of ear canal granulomatous disorders. STUDY DESIGN: Retrospective case review at a tertiary care medical center. METHODS: A retrospective chart review of all patients diagnosed with invasive polymicrobial temporal bone infections was performed. Four patients were identified. All patients required surgical therapy for definitive management. All patients were followed for at least 1 year or until death. RESULTS: Three of four patients had invasive fungi as pathogens. One patient had an occult squamous cell carcinoma. At the time of writing, one patient was free of disease, two were dead of disease, and one was alive with disease. CONCLUSION: Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.

Adult↗
PubMed2003

Intratympanic therapies for sensorineural hearing loss and vertigo.

The theory behind intratympanic therapy is that by instilling small amounts (0.5 cc) of medications into the middle ear, absorption into the inner ear occurs though the round window. The medicines exert their effects on the cochlear and vestibular end organs. The benefits of these therapies include: control of systemic side effects, and the ability to treat the patients in the clinic or outpatient setting with encouraging results. The purpose of this paper is to explain the potential role of intratympanic therapy in treating specific inner ear disorders.

Anti-Bacterial Agents↗
PubMed2003

Implantable hearing devices.

Hearing loss remains the most common sensory impairment in the United States. Fortunately, new treatments for this disorder are becoming available each year. This article reviews human ear anatomy, types and causes of hearing loss, and basic information on middle and inner ear implantable hearing devices. Risks, benefits, costs, and nursing care issues are discussed.

Cochlear Implants↗
PubMed2002

Facial paralysis caused by malignant skull base neoplasms.

OBJECT: Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. METHODS: The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. CONCLUSIONS: Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade of the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.

Adenocarcinoma↗
PubMed2002

Malignancy of the temporal bone.

Malignant tumors of the temporal bone are extremely rare, and the diagnosis is often delayed because of the difficulty of differentiating neoplasms from more common disorders found in the ear canal and middle ear. The degree of surgical extirpation is planned according to the determined clinicoradiographic extent of the tumor. Unfortunately, the radiographic assessment often underestimates the tumor involvement of neurovascular or bony structures, which may lead to an inadequate resection and life-threatening tumor recurrence.

Bone Neoplasms↗
PubMed2002

Intratympanic gentamicin therapy for persistent vertigo after endolymphatic sac surgery.

OBJECTIVES: To evaluate the role of intratympanic gentamycin therapy (ITGM) in controlling vertigo in patients with refractory Meniere's who have recurrent or persistent vertigo after endolymphatic sac surgery. STUDY DESIGN AND SETTING: A retrospective review of 491 patients seen in a university balance clinic between July 1999 and July 2000. Of these, 68 patients had Meniere's disease; 4 patients had recurrent vertigo after endolymphatic sac surgery and were followed for at least 1 year. These 4 patients received a series of ITGM injections. Outcome measures included control of vertigo and audiometric results. RESULTS: Three of 4 (75%) patients had control of their vertigo with ITGM therapy. The 1 patient who failed ITGM therapy underwent a successful vestibular neurectomy with ultimate control of his vertigo. No patients had progression of their sensorineural hearing loss. CONCLUSION: ITGM therapy can be used to control vertigo in selected patients with Meniere's disease who have persistent vertigo after unsuccessful endolymphatic sac surgery. SIGNIFICANCE: ITGM therapy may reduce the need for vestibular neurectomy in patients with refractory Meniere's disease after endolymphatic sac surgery.

Administration, Topical↗
PubMed2002

Facial paralysis caused by malignant skull base neoplasms.

OBJECT: Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. METHODS: The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. CONCLUSIONS: Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.

Adenocarcinoma↗