Biomedical subjects

T B Molony

Publications and source records attributed to T B Molony.

8 recordsLinked to original sources

PubMed1998

Spontaneous otogenic pneumocephalus. Case report and review of the literature.

Pneumocephalus is commonly seen in clinical neurosurgical practice. Typical causes include trauma, tumor, and infection. Pneumocephalus may also occur iatrogenically at the time of intracranial surgery; it is not pathological and may be seen routinely on postoperative neuroimaging. Pneumocephalus is rarely encountered in the absence of the aforementioned entities. The authors report on an elderly woman in whom spontaneous intraventricular pneumocephalus occurred because of a congenital defect in the left tegmen tympani. Eustachian tube closure and middle ear exclusion were used to obliterate the fistulous connection. This case illustrates both an unusual cause and a unique treatment for spontaneous otogenic pneumocephalus.

Aged↗

PubMed1996

Decision making in vestibular neurectomy.

Indications for vestibular neurectomy have traditionally included intractable Meniere's disease, chronic vestibular neuronitis, vestibular hydrops, and posttraumatic vertigo. Between 1990 and 1993, 28 retrosigmoid vestibular neurectomies were performed for various peripheral vestibulopathies for which medical management failed. These were divided into two groups: Meniere's disease and non-Meniere's disease. The non-Meniere's disease group included the diagnosis of vestibular hydrops and chronic vestibular neuronitis. Results were analyzed by using the 1985 American Academy of Otolaryngology (AAO) criteria for Meniere's disease. Statistical analysis revealed a highly significant difference (chi 2 Fischer, p = 0.001), with the Meniere's group being highly successful and the non-Meniere's group being unsuccessful. We conclude that retrosigmoid vestibular neurectomy is a safe and effective modality for the management of Meniere's disease for which medical management failed. Patients with non-Meniere's vestibulopathies should be treated with other modalities.

Adult↗

PubMed1993

Cogan's syndrome manifesting as sudden bilateral deafness: diagnosis and management.

Cogan's syndrome is an uncommon entity of nonsyphilitic interstitial keratitis with vestibulo-auditory disturbances. Although it is unusual, Cogan's syndrome should be considered in the differential diagnosis of patients with sudden hearing loss, even when they lack ophthalmologic symptoms. Systemic manifestations are not uncommon and, along with serologic and hematologic abnormalities, may help in making the diagnosis, which requires a high index of suspicion. Treatment with steroids has largely been based on symptoms. We suggest using the C-reactive protein level as a monitor of subclinical disease activity; it is therefore beneficial in the adjustment of steroid therapy. We have described the case of a 41-year-old woman who sought treatment for an upper respiratory infection syndrome and severe vertigo. Evaluation included hematologic and serologic studies, lumbar puncture, and CT and MRI scans. Abnormal findings consisted of an elevated white blood cell count and an ESR of 112 mm/hr. Six days later, profound, bilateral sensorineural hearing loss developed suddenly. Intensive corticosteroid and vasodilator therapies were instituted, but there was no improvement in hearing levels. Ten days later eye pain and redness developed, and ophthalmologic evaluation revealed an interstitial keratitis consistent with Cogan's syndrome. Steroid eye drops and oral prednisone therapy promptly relieved the eye symptoms. Steroid tapering was associated with diffuse joint pain and swelling consistent with a systemic vasculitis. After rheumatologic consultation, steroid dosage was titrated to the CRP level and ESR, and vasculitic symptoms resolved. Hearing levels did not improve, and the patient had cochlear implantation. Thirteen cases of bilateral sudden deafness due to Cogan's syndrome have been reported previously. This is the first case in which there were no immediate eye symptoms.

Adult↗

PubMed1993

CO2 laser stapedotomy.

Operative approaches to correct stapedial otosclerosis continue to be refined. In the last decade the use of the laser in stapedotomy has become increasingly common. The decision to use visible (Argon, KPT-532) versus invisible (CO2) lasers continues to be debated. CO2 laser light has ideal optical properties in micro-otologic surgery, but because of delivery problems its use was difficult. Recent advances in laser technology have facilitated the use of the CO2 laser. Eighty-four patients in the past 3 years have undergone small fenestra laser stapedotomy. Results are available on 82. Of these, 91% had closure of the air-bone gap within 10 db. Complications and morbidity were minimal. CO2 laser stapedotomy is a safe procedure with low morbidity in the correction of hearing loss caused by stapedial otosclerosis.

Humans↗

PubMed1992

Meningiomas of the jugular foramen.

Meningiomas of the jugular foramen manifest the same signs and symptoms as glomus jugulare tumors. They arise from arachnoid cells lining the jugular bulb and grow slowly, infiltrating the temporal bone and posterior fossa. These lesions, however, are more clinically treacherous than glomus tumors. Meningiomas infiltrate surrounding bone and nerve tissue and require wide margins of resection to prevent recurrence. Eight of these lesions have been managed in the past 5 years at the House Ear Clinic using modern imaging and skull base techniques. Two have recurred after "total" microsurgical removal. Presentation, radiologic evaluation, and management guidelines are reviewed.

Adult↗

PubMed1992

Extended middle fossa and retrolabyrinthine approaches in acoustic neuroma surgery: case reports.

Hearing conservation surgery for small acoustic neuromas is well accepted. At present, two approaches are primarily used: the suboccipital and the middle fossa. The middle fossa approach to the internal auditory canal has the advantage of using bony landmarks to identify and protect the facial nerve. Because of anatomic constraints presented by the superior semicircular canal however, its uses are limited to intracanalicular tumors or tumors protruding only slightly into the cerebellopontine angle. By extending the approach through the superior semicircular canal, a wide access to the cerebellopontine angle can be safely obtained. In this study three procedures, two through the superior semicircular canal and one through the posterior semicircular canal, were utilized for hearing conservation surgery. By immediately sealing off the canal ends, hearing preservation was accomplished in two out of three of these cases. The dictum that labyrinthine opening invariably leads to anacusis should be reconsidered. By utilizing approaches through the semicircular canal, it is possible that morbidity from this surgery may be reduced.

Cerebellar Neoplasms↗

PubMed1990

Surgical approaches to congenital atresia of the external auditory canal.

During the past 4 years, 22 patients with congenital atresia of the external auditory canal underwent 24 initial operations by either an anterior or transmastoid approach. No attempt at randomization was made, but the two groups were similar in number and pathology (in 14 cases approach was anterior and in 10 cases approach was transmastoid). Followup ranged from 6 months to 4 years. Hearing results were similar in the two groups (71% with air-bone gap less than 30 dB). There were no instances of facial nerve injury or sensorineural hearing loss. Facial nerve monitoring was used. Complications of stenosis and drainage were more common with the transmastoid approach. In both groups, hearing results were accomplished with the patients' intact ossicles or prosthetic reconstructions. Meticulous soft-tissue technique, with split-thickness grafts covering all exposed bone, is the key to preventing stenosis. For the three cases of patients with thick, acellular atresia plates, a different approach was developed. Maintaining proper orientation during the medial dissection is more difficult in these cases. By opening the antrum primarily and identifying the lateral canal, ossicles, and facial nerve, an ear canal can then be created anteriorly with these landmarks in view. An intact canal wall-like procedure is carried out. Although hearing results are similar, the anterior approach, because of fewer postoperative complications, is now our procedure of choice. Proper orientation and soft-tissue technique are the keys to successful correction of the congenitally atretic ear canal.

Adolescent↗

PubMed1986

Esophageal perforations: the role of computerized tomography in diagnosis and management decisions.

External drainage is indicated when a neck abscess results from esophageal or hypopharyngeal perforation. Diagnosis, extent of disease, and timing of abscess drainage have traditionally challenged the surgeon in management of the perforated esophagus or hypopharynx. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. Five specific case presentations feature diagnosis and management.

Abscess↗