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Biomedical subjects

A Sismanis

Publications and source records attributed to A Sismanis.

At least 55 records · Page 3Linked to original sources
PubMed1990

Objective tinnitus in benign intracranial hypertension: an update.

Previously, the authors reported that objective pulsatile tinnitus can be the major or only manifestation of benign intracranial hypertension. This report updates the authors' experience with 31 patients managed over the past 7 years. Benign intracranial hypertension should be suspected in all patients with pulsatile-objective tinnitus, especially when the patient is a young, obese female with headaches and/or visual disturbances. Papilledema and small ventricles or an empty sella on computerized tomography are almost diagnostic. The diagnosis is confirmed by elevated spinal fluid pressure on lumbar puncture. In such patients, angiography is not indicated. Furosemide and acetazolamide are very effective. Ligation of the internal jugular vein is contraindicated.

Adult↗
PubMed1990

Auditory-evoked responses in benign intracranial hypertension syndrome.

In this study, auditory brainstem-evoked responses were conducted on 28 patients with otologic symptoms (pulsatile tinnitus, hearing loss, aural fullness) secondary to benign intracranial hypertension syndrome. Abnormalities consisting mainly of prolonged interpeak latencies were detected in one third of these patients. It is speculated that the pathophysiologic mechanisms responsible for these auditory brainstem-evoked abnormalities are stretching-compression of the cochlear nerve and brainstem caused by the intracranial hypertension and/or primary edema of the same structures due to the benign intracranial hypertension syndrome itself. Normalization or improvement was noticed in the majority of the patients after management. Since the number of patients in this study is small, it is felt that the diagnostic and prognostic value of this test needs further evaluation.

Adult↗
PubMed1989

Chronic otitis media: surgical failures and management.

Failure of primary tympanomastoid surgery to control chronic otitis is a difficult otologic problem. The facial nerve, middle fossa dura, and inner ear structures are at high risk because of distorted anatomy from the primary surgery and/or recurrent disease. In this article our techniques and experience with 42 revision procedures for recurrent chronic otitis with and without cholesteatoma are presented. Control of otorrhea and/or cholesteatoma was achieved in 93% of the cases; however, this might be less after 5 years of follow-up. The mean postoperative air-bone gap was 25 dB, and this is a 6 dB improvement from the preoperative level. Revision tympanomastoid surgery was very effective and safe in the management of this difficult problem. For cholesteatoma in particular, the canal wall down technique is our procedure of choice.

Adolescent↗
PubMed1989

Paralysis of the recurrent laryngeal nerve by an extracapsular thyroid adenoma.

We treated a patient with an ectopic thyroid adenoma that caused recurrent laryngeal nerve paralysis and upper aerodigestive tract compression. After excision of the mass and release of the compressed recurrent nerve, the true vocal cord function returned almost to normal. We review the literature, diagnosis, and management of thyroid disease associated with vocal cord paralysis.

Adenoma↗
PubMed1987

Otologic manifestations of benign intracranial hypertension syndrome: diagnosis and management.

Benign intracranial hypertension (BIH) is a syndrome characterized by increased intracranial pressure (IIP) without focal signs of neurological dysfunction. The diagnosis is essentially made by exclusion of various causes of IIP. The classic presenting symptoms of BIH are headache and/or visual disturbances. Otologic manifestations of this syndrome have not been described in detail. In this thesis, 20 BIH patients with associated otologic symptoms were thoroughly studied over a 5-year period. The author concludes that 1. objective pulsatile tinnitus and low frequency hearing loss can be the major or only manifestation of this syndrome; 2. diagnosis is established by lumbar puncture and elimination of other causes of IIP; 3. medical management is very effective with surgery reserved for patients with deteriorating vision or with disabling tinnitus.

Adult↗
PubMed1986

Coexisting otosclerosis and Ménière's disease: a diagnostic and therapeutic dilemma.

The coexistence of otosclerosis and Meniere's disease is well documented; however, otosclerosis may not be recognized in patients presenting mainly with Meniere's symptoms and, therefore, treatment may not be effective. In this paper, eight patients with otosclerosis and Meniere's disease are presented. The diagnosis of coexisting otosclerosis and Meniere's was initially missed in most of these patients. Medical and surgical treatment had been unsuccessful. Diagnostic and therapeutic guidelines for management of these patients are discussed. Our preliminary conclusions are: 1. otosclerosis should be diagnosed in patients with Meniere's disease, especially when bilateral or when suggested by clinical and/or laboratory findings, and 2. the addition of sodium fluoride to diet-diuretic management of such patients appears effective.

Adult↗
PubMed1986

External ear canal cholesteatoma.

External ear canal cholesteatoma (EECC) is a rare otologic entity. Erosion of the inferior canal wall and accumulation of keratin debris are consistent findings. In the past there had been confusion between EECC and keratosis obturans, and they were thought to represent the same disease process. Currently, based on clinical and pathologic findings, it is believed that they are two different entities. In this article we present our experience in treating eight patients with EECC. For limited lesions, local debridement and curettage of necrotic bone is effective management. For more extensive lesions, canalplasty or tympanomastoidectomy is indicated.

Adult↗
PubMed1985

Otologic symptoms and findings of the pseudotumor cerebri syndrome: a preliminary report.

Pseudotumor cerebri or benign intracranial hypertension is a syndrome characterized by increased intracranial pressure without focal signs of neurologic dysfunction. The clinical manifestations of this syndrome are usually headache and/or disturbance of vision. Although tinnitus, hearing loss, and vertigo have been described in association with intracranial hypertension, otologic symptomatology as the presenting manifestation of this syndrome has not been previously reported. In this article we report the otologic symptoms and findings of two pseudotumor cerebri patients, one of whom presented with pulsatile tinnitus. The pathogenesis of the otologic symptoms, diagnostic workup, and management of these patients are discussed.

Adult↗
PubMed1985

Bilateral peritonsillar abscesses and quinsy tonsillectomy.

Two patients presented with history, symptoms, and clinical findings suggesting unilateral peritonsillar abscesses. At the time of quinsy tonsillectomy, the patients were found to have pus present in the contralateral peritonsillar spaces. These findings prompted a review of the literature to determine the actual frequency of bilateral peritonsillar abscesses and to reassess the approach to treatment of patients presenting with peritonsillar abscesses.Peritonsillar abscess frequently develops following the onset of acute tonsillitis, and it is possible that this process occurs bilaterally with the developmental stages of the abscesses being different on each side. Intensive antibiotic treatment, incision and drainage of the obvious abscess probably suppresses the development of and masks the presence of the abscess on the opposite side.Quinsy tonsillectomy has been indicated previously for patients not responding to intravenous antibiotic treatment and incision and drainage of their peritonsillar abscess. The possibility of a subclinical contralateral peritonsillar abscess being present is an additional indication for proceeding with a quinsy tonsillectomy, especially in patients who remain febrile after apparent satisfactory drainage of the clinically evident abscess.

Adult↗
PubMed1984

Twenty-five years' experience treating cerebro-rhino-orbital mucormycosis.

Mucormycosis is an acute fungal disease with high mortality exhibiting craniofacial, pulmonary, cutaneous, gastrointestinal and disseminated forms. Cerebro-rhino-orbital (CRO) mucormycosis is the type that most frequently involves the structures of the head and neck. While usually non-pathogenic, these saprophytic organisms can be particularly lethal in chronically debilitated patients. Between the years 1957 and 1982, 18 cases of CRO mucormycosis were seen at the Medical College of Virginia Hospital and the McGuire VA Medical Center. Four illustrative cases of CRO mucormycosis are presented to emphasize: the importance of clinical awareness of the disease, the necessity of tissue biopsy for diagnosis, the need of appropriate management of any underlying disorder, administration of amphotericin-B, and the performance of adequate surgery.

Adult↗
PubMed1982

Management of bilateral acoustic tumors.

Bilateral acoustic tumors, often felt to represent a central form of von Recklinghausen's disease, pose a particularly challenging problem to the otologist. This retrospective study reviews the evaluation and surgical results in 15 patients with bilateral acoustic tumors from whom 23 tumors were removed. Early diagnosis can be achieved by clinical awareness of the disease, thorough radiologic evaluation, and appropriate family screening. Total tumor removal with preservation of hearing is usually possible if the lesion is not larger than 1.0 cm. Total removal with hearing preservation is usually not possible if the lesion is larger than 2.0 cm. Hydrocephalus and additional tumors can complicate the overall clinical picture. Guidelines for appropriate management of bilateral acoustic tumors are based on tumor size, hearing sensitivity, and associated intracranial pathology.

Adolescent↗
PubMed1981

Clinical electroneurography: statistical analysis of controlled measures in twenty-two normal subjects.

Electroneurography, an objective electrophysiologic measurement of a muscle compound action potential, is used to assess the integrity of a peripheral motor nerve. This paper describes how to perform electroneurography with particular attention to control of patient and instrumentation variables. Twenty-two normal adult subjects were tested in a balanced, designed experiment. The resultant average difference between the right and left halves of the face was not significant. The standard deviation of this difference was divided into three components: test-retest daily, and intersubject. The data suggest that the most significant source of error in electroneurography is test-retest variability (p less than 0.05) and that repeated and averaged measures on a given patient will increase the precision of the test. As further understanding and experience are gained, electroneurography measurements should be interpreted in light of clinical findings and more traditional tests.

Action Potentials↗
PubMed1981

Microscopic otologic photography using a standard 35-mm camera.

For years microscopic otologic photography required expensive sophisticated equipment or specialized camera attachments. Recently one of the authors reported using an automatic 35-mm single lens reflex camera to reproduce high-quality slides. The authors now describe how reliable, inexpensive microscopic otologic photography can be performed using a pre-set standard 35-mm single lens reflex camera without the need for metering, automatic adjustments, or sophisticated equipment.

Cranial Fossa, Posterior↗
PubMed1980

Prognostic indicators in induction cis-platinum bleomycin chemotherapy for advanced head and neck cancer.

A complete response to induction cis-platinum bleomycin chemotherapy significantly increases the probability of local tumor control and overall disease-free survival. Factors that favor a good response to chemotherapy are tumor histology (well differentiated), location of the primary site (oral cavity and oropharynx), nodal status (N0) and size of the primary lesion (t3 better than T4). Increased cellular maturation after chemotherapy correlates with an improved clinical response. The importance of induction and maintenance chemotherapy in the treatment of advanced head and neck cancer still needs to be determined with larger randomized series. Reliable predictors of therapy outcome are needed for realistic treatment planning, especially when the potential morbidity is considered.

Bleomycin↗
PubMed1980

A comparative study of neuropathologic changes following pulsed and direct current stimulation of the mouse sciatic nerve.

A controlled study was undertaken to determine whether potentially harmful neuropathologic changes occur in a nerve stimulated with direct current or pulsed current in an experimental setting simulating a clinical procedure. Pulsed current stimulation for 5 and 25 seconds' duration produced nonspecific inflammatory changes similar to those observed in nonstimulated control nerves. Equivalent direct current stimulation produced not only frequent myelin degeneration but also occasional axon degeneration. The pulsed current stimulator thus appears to be equally effective yet far safer than the direct current stimulator.

Animals↗