Reducing temporal lobe retraction with the middle fossa approach using a lumbar drain.
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Brain Edema↗
Biomedical subjects
T J Balkany
Publications and source records attributed to T J Balkany.
Patterns of evoked otoacoustic emissions associated with acoustic neuromas.
Evoked otoacoustic emissions (OAEs) are assumed to reflect healthy outer hair cell function. Over the past few years, evoked OAEs have been shown to be useful as indicators of cochlear hearing loss. Because basic studies have shown that OAEs are extremely sensitive to cochlear anoxia and hypoxia, as well as to the adverse effects of many inner ear diseases, it is possible that these objective tests can provide some insight into the fundamental basis of the hearing loss exhibited by patients with acoustic neuromas. The primary aim of the present study was to examine the effects of acoustic neuromas on the amplitudes of evoked OAEs and to compare these findings with tumor-induced hearing levels. To this end, tests of behavioral audiometry, distortion-product otoacoustic emissions and transiently evoked otoacoustic emissions were performed on 44 patients with verified acoustic neuromas. The results demonstrated that the majority of ears with acoustic neuromas displayed one of two distinct patterns of evoked OAEs: a cochlear pattern or a noncochlear pattern. Although behavioral hearing thresholds were higher with larger tumors, OAE levels exhibited no clear relationship to tumor size. The present findings support the notion that acoustic neuromas may cause hearing impairment according to two types of influence that act at different levels of the peripheral auditory system. The tumor's cochlear effect on evoked OAE activity is most likely caused by an indirectly mediated compromise of the organ of Corti's vascular supply. It is probable that the direct pressure of the tumor on the eighth cranial nerve is responsible for the observed noncochlear effects.
Audiometry↗
Misleading the deaf community about cochlear implantation in children.
Activists are misleading the deaf community in an effort to generate opposition to cochlear implants in children. Their methods include both misinformation and the use of inflammatory, illogical rhetoric. To date they have been successful in causing anger, frustration, and overt violence among the culturally deaf with the use of such terms as "genocide" and "child abuse." Because the average reading level of a deaf residential high school graduate is at the third or fourth grade level, a small elite is able to control the interpretation and flow of complex information to many deaf people. It is a challenge to make accurate information, both positive and negative, accessible directly to deaf society. Just as the deaf have abandoned opposition to cochlear implants in adults, the same might be expected to occur in children when they and their parents become aware of the results of implantation.
Age Factors↗
Ophthalmologic abnormalities in the pediatric cochlear implant population.
To determine the nature and prevalence of ophthalmologic abnormalities in children with congenital or prelinguistic sensorineural deafness, we performed complete ophthalmologic examinations on 54 children aged 2 to 14 years from the University of Miami Ear Institute's Cochlear Implant Program. Of 54 children, 33 (61.1%) had some form of ophthalmologic abnormality, with the majority (24 patients; 44.4%) being refractive errors. Of 54 patients, two (3.7%) had strabismus and two (3.7%) had external adnexal anomalies. One child (1.8%) had cataracts. The cause of the deafness, which had previously been unknown, was determined in three of 54 cases (5.6%) as a result of ocular examinations documenting rubella retinopathy, tapetoretinal degeneration (Usher's syndrome), and iris heterochromia (Waardenburg's syndrome). Routine ophthalmologic examination must be mandated for this population, and the ophthalmologist should be encouraged to play a broader role in the care of children with deficiencies of both vision and audition.
Adolescent↗
Electric auditory brain-stem responses in nucleus multichannel cochlear implant users.
OBJECTIVE: The electrically elicited auditory brain-stem response (EABR) has been proposed as a tool for use in cochlear implant device setting. To systematically examine the relationships of psychophysical perceptions and EABRs, implant users underwent a series of comparative measurements. The characteristics of the EABR were assessed for their predictive value in determining the subjective measures needed to set the implant device. DESIGN: Characteristics of the EABR and various perceptual measures in a group of cochlear implant users served as compared variables in a correlational study. SETTING: The study was carried out in the audiology clinic of a university hospital. The audiology clinic maintained a fully equipped evoked potential laboratory, and was part of an otolaryngology department that supported a cochlear implant program. SUBJECTS: The subjects consisted of 10 consecutively selected postlinguistically deafened adult multichannel cochlear implant users. MAIN OUTCOME MEASURES: Morphology, latency, and amplitude measures of the EABR recordings were compared with behavioral perceptions of threshold, most comfortable and uncomfortable loudness levels. RESULTS: Perceptual measures of threshold were found to be significantly related to the threshold of the EABR across subjects and electrode position. Simple linear regression analysis was used to measure the degree of the relationship. An r value of 0.89 attests to a significant relationship. The EABR wave latencies and amplitudes were found to have no significant relationship to any of the perceptual measures examined. CONCLUSIONS: Although EABR cannot replace behavioral measurements for device setting, in difficult cases EABR thresholds may be used as a starting point from which to estimate settings for the device.
Adult↗
Visual function in children with congenital sensorineural deafness.
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Adolescent↗
Status of cochlear implantation in children. American Academy of Otolaryngology-Head and Neck Surgery Subcommittee on Cochlear implants.
The cochlear implant is a medical device, part of which is placed surgically, that uses electrical stimulation to provide hearing. For almost a decade, investigational studies have been ongoing to define its safety and efficacy in profoundly deaf children. During this period, more than 500 children aged 2 through 17 years have been implanted with either a single-electrode or multielectrode device. Extensive auditory, speech, educational, and psychologic testing has been performed before and after implantation. Results show that the cochlear implant provides auditory detection over much of the speech signal. Compared with the preimplant period, there is significant improvement in auditory discrimination and speech production skills. Limited open-set word and sentence recognition is possible for at least some children. Complications with the device have been minimal. The cochlear implant can provide sound to deaf children unable to benefit from hearing aids. The complex assessment, rehabilitation, and parent counseling should be performed by centers with the multidisciplinary staffs necessary to provide effective care for patients with this specialized auditory prosthesis.
Adolescent↗
Loss of residual hearing after cochlear implantation.
Many cochlear implant recipients have some measurable hearing prior to implantation. Animal studies have demonstrated some loss of viable neural elements resulting from both mechanical insertion trauma and long-term electrical stimulation. The effect of implantation of a long intracochlear multichannel electrode array and subsequent electrical stimulation on residual hearing was evaluated. Forty consecutive cochlear implant recipients were assessed by audiometry at the Colorado Ear Clinic between July 1985 and June 1988. Twelve of these patients (30%) had some measurable residual hearing before implantation, although all had profound hearing loss, with no understanding of speech. All patients received a multichannel cochlear implant with all 22 electrodes inserted in each patient by an experienced cochlear implant surgeon. Audiometric testing was repeated between 2 and 24 months after implantation. Pure-tone threshold responses in the implanted ear were significantly reduced postimplant, while pure-tone threshold responses in the nonimplanted ear were stable.
Adult↗
The Tullio phenomenon and perilymph fistula.
Establishing the diagnosis of perilymph fistula remains a dilemma. At this time, identification of an active perilymph fistula can be confirmed only by surgery. On the basis of clinical history and audiovestibular testing, 54 patients underwent middle ear exploration for possible perilymph fistula at the Colorado Ear Clinic between July 1980 and June 1986. This group represents approximately 1% of all surgical procedures performed during that period. Seven patients (12%) were found to have the Tullio phenomenon preoperatively. Six of these were found to have active, free-flowing fistulas at the time of exploration. The presence of a Tullio phenomenon may be helpful in preoperative assessment of a patient with suspected perilymph fistula.
Acoustic Stimulation↗
The dizzy child.
Dizziness in childhood may be the result of significant vestibular or central nervous system pathology. It is the responsibility of otolaryngologists and neurologists to provide appropriate diagnosis and treatment of these disorders.
Child↗
Radiographic imaging of the cochlear implant candidate: preliminary results.
Preoperative radiographic imaging of the temporal bone is well accepted in otology for both the diagnosis of disease and the delineation of anatomic structure for surgical planning. Until recently radiographic techniques have unfortunately failed to demonstrate fibrous or bony obstruction of the basal turn of the cochlea, which may cause difficulties during cochlear implantation. Intraoperative findings have been correlated with preoperative imaging in a consecutive group of six cochlear implant recipients and a series of consistent radiographic signs that may indicate the presence of obstruction of the scala tympani have been identified. A classification system has been developed. Based on thin-section high-resolution computerized tomography (HRCT), the system has been used preoperatively on six cochlear implant recipients. In addition, a systematic evaluation of the temporal bone has been developed for precochlear implant evaluation. This includes the thickness of the parietal bone for seating of the receiving device, the degree of pneumatization of the mastoid, the measurement of the size of the facial recess, the description of the size and orientation of the round window niche, and the patency of the basal turn of the cochlea.
Adult↗
Ventilation tube surgery and middle ear irrigation.
Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10%-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space effusion with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces, and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post-tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16% to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.
Adolescent↗
Auditory dehydration testing: glycerol versus urea.
Auditory dehydration testing with oral hyperosmolar substances is commonly used in the evaluation of patients with suspected endolymphatic hydrops. Endolymphatic hydrops is assumed to be temporarily reduced in some cases, resulting in an improvement in hearing. Unfortunately, ingestion of glycerol, the most frequently used oral agent, often causes severe headache, vomiting, or both. Urea has recently been used as an alternative. A study of patients with Meniere's disease was designed to compare the effectiveness of glycerol versus urea in inducing a temporary improvement in hearing thresholds. Three hundred patients received either glycerol or urea. Fifty-seven percent of the glycerol patients had positive hearing results compared with 77% of the urea patients. Temporary hearing improvements following urea ingestion may not be caused by a rise in serum osmolality alone, since this occurs with glycerol but not with urea.
Adolescent↗
Middle ear irrigation during insertion of ventilation tubes.
Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space infection with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16 to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.
Child, Preschool↗
Radial port microcatheter.
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Catheterization↗
An overview of the electronic cochlear prosthesis: clinical and research considerations.
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Clinical Trials as Topic↗
A prospective study of infection following tympanostomy and tube insertion.
An incidence of postoperative infection of up to 15 percent has been reported following middle ear ventilation tube surgery. This rate of complication would be considered unacceptable following most other operative procedures. A controlled prospective study of 107 children undergoing tympanostomy and tube surgery over a 1-year period was undertaken. Subjects were randomly assigned to receive antibiotic-steroid otic drops at the time of surgery and for 1 week afterward, oral ampicillin for 24 hours preceding and 3 days following surgery, or no prophylactic treatment. The overall infection rate within four weeks of surgery was 12 percent. Purulent otorrhea occurred in 18 percent of those receiving no prophylactic treatment, in 13 percent receiving ampicillin, and in 6 percent receiving antibiotic-steroid otic drops. Postoperative infection was related to preoperative history of status otitis media and to previous placement of ventilation tubes.
Adolescent↗