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Biomedical subjects

A W Langman

Publications and source records attributed to A W Langman.

At least 19 recordsLinked to original sources
PubMed1998

Surgical labyrinthectomy in the older patient.

OBJECTIVE: Ablation of vestibular function is a highly efficacious option in the treatment of disabling vertigo arising from unilateral labyrinthine dysfunction. Regardless of the method used to ablate vestibular function, permanent posttreatment impairment of the balance function will develop in a number of treated patients. Many physicians who are involved in the care of the older patient with episodic vertigo are reluctant to recommend or perform a vestibular ablation procedure, because this treatment may result in permanent disequilibrium, which may be more detrimental to the older patient than the episodic vertigo. This study evaluates the outcome in older patients who underwent unilateral surgical labyrinthine ablation. METHODS: A retrospective analysis was done of the cases of 30 patients, all more than 60 years old, who underwent unilateral vestibular ablation because of disabling episodic vertigo by either transmastoid labyrinthectomy (n=22) or transcanal labyrinthectomy (n=8). RESULTS: Episodic vertigo was controlled in 95.5% of the patients in the transmastoid labyrinthectomy group and in 100% of those in the transcanal labyrinthectomy group. Postoperative imbalance was present in 22.7% of patients in the transmastoid labyrinthectomy group and in 62.5% of those in the transcanal labyrinthectomy group. CONCLUSIONS: Vestibular ablation is a viable option in the treatment of disabling vertigo in the older patient. A transmastoid labyrinthectomy may be preferable to a transcanal labyrinthectomy because the incidence of permanent posttreatment imbalance is less with a transmastoid labyrinthectomy.

Aged↗
PubMed1996

Cochlear implants in children.

Cochlear implants allow the rehabilitation of children with severe to profound hearing loss. They are beneficial for not only postlingual children with hearing loss but also for children with congenital or prelingual hearing loss. Issues regarding cochlear implant candidacy and surgery are discussed. The results of cochlear implants in children and the complications related to cochlear implant surgery in children are reviewed.

Child↗
PubMed1996

Accuracy of high-resolution computed tomography in cochlear implantation.

Multichannel cochlear implants are a proven method for the auditory rehabilitation of individuals who have severe-to-profound sensorineural hearing loss. These devices typically require insertion into the scala tympani of the cochlea to provide auditory stimulations. A patent scala provides the best chance for an adequate insertion of the electrode array. Preoperative high-resolution computed tomography imaging has traditionally been used to determine the patency of the scala tympani. Its ability to accurately predict the patency of the cochlea has been questioned in several retrospective studies. A prospective study was undertaken in 28 consecutive individuals undergoing cochlear implant surgery to compare the findings on high-resolution computed tomography with the surgical findings in an attempt to determine high-resolution computed tomography's accuracy. Cochlear obstruction caused by ossification was accurately predicted in six of six individuals but overestimated in the round window region in three individuals. High-resolution computed tomography accurately predicted patent cochleas in 19 individuals. No false-negative results were encountered. In this study sensitivity of high-resolution computed tomography was 100%, and specificity was 86%. High-resolution computed tomography appears to be more helpful than previously reported for determining cochlear patency.

Acoustic Stimulation↗
PubMed1996

Ear candles--efficacy and safety.

Ear candles are a popular and inexpensive alternative health treatment advocated for cerumen removal. A hollow candle is burned with one end in the ear canal with the intent of creating negative pressure and drawing cerumen from the ear. If effective, significant savings could result from the use of ear candles. This study evaluates the efficacy and safety of this alternative method for cerumen management. Tympanometric measurements in an ear canal model demonstrated that ear candles do not produce negative pressure. A limited clinical trial (eight ears) showed no removal of cerumen from the external auditory canal. Candle wax was actually deposited in some. A survey of 122 otolaryngologists identified 21 ear injuries resulting from ear candle use. Ear candles have no benefit in the management of cerumen and may result in serious injury.

Cerumen↗
PubMed1995

Ear candles.

Explore the source record for details and available documents.

Complementary Therapies↗
PubMed1995

Sensorineural hearing loss with delayed onset of vertigo.

Sensorineural hearing loss with delayed onset of vertigo is a syndrome in which episodic vertigo arises in a person who has preexisting unilateral severe-to-profound sensorineural hearing loss. This syndrome has an ipsilateral form in which the vertigo arises from the poorer hearing ear and a contralateral form in which the aural symptoms arise from the better hearing ear. The existence of this syndrome has only been noted within the past two decades. This report details our clinical experience with 17 persons with the ipsilateral form of this disorder. The onset of the vertigo after the occurrence of the hearing loss was quite variable. It ranged from 1 to 60 years after the development of the hearing loss. The hearing loss occurred for several reasons. Most patients had hearing loss due to an unknown cause. The development of the vertigo and the timing of the onset of the vertigo were not related to the cause of the hearing loss. Bithermal caloric testing identified the offending labyrinth in most patients who underwent ablative vestibular surgery. Ablative vestibular surgery was performed in 13 of the 17 persons in this study because of disabling symptoms. In all 13 cases, the episodic vertigo was eliminated. Surgical treatment for sensorineural hearing loss with delayed-onset vertigo, as with all surgery for vertigo, should be based on the severity of the afflicted person's symptoms.

Adult↗
PubMed1995

Use of botulinum toxin to prevent facial nerve stimulation following cochlear implantation.

Facial nerve stimulation can develop because of the electric fields generated from an activated cochlear implant. This problem can usually be ameliorated by reducing or eliminating the current through the electrodes causing the undesirable stimulation. Occasionally there may be numerous electrodes that have to be deactivated in order to eliminate the facial nerve stimulation, and this may result in a marked reduction of auditory benefit to the cochlear implant user. Botulinum toxin causes transient neuromuscular blockade and has been shown to be effective in reducing or eliminating facial nerve hyperactivity due to a variety of causes. This report details the use of botulinum toxin in a patient with a cochlear implant who developed excessive facial nerve stimulation that necessitated the deactivation of 15 of the implant's 22 electrodes. After treatment with botulinum toxin, twice as many electrodes could be comfortably activated without causing facial nerve stimulation. The dynamic range was increased in 4 of the remaining 6 electrodes that were activated prior to treatment. The patient reported a marked improvement in sound quality and understanding of speech without lipreading as compared to her pretreatment performance. Treatment with botulinum toxin appears to be useful for patients who have excessive facial nerve stimulation after cochlear implantation.

Botulinum Toxins↗
PubMed1994

Cochlear implants in children.

Cochlear implants are no longer considered new or experimental technology. Difficulty in evaluating the degree of hearing loss and response to traditional forms of amplification in young children makes pediatric cochlear implant candidacy a complex issue. Cochlear implantation and, in particular, pediatric cochlear implantation, requires a team commitment with contributions from surgeons, audiologists, speech pathologists, psychologists, and special educators. Elements discussed include assessment and candidacy issues, surgical technique, elements of a cochlear implant team, outcome assessment, and potential complications. The decision to perform pediatric cochlear implantation should not be undertaken without serious consideration to the enormous commitment required in both financial and personnel terms.

Child↗
PubMed1993

Revision stapedectomy.

The need for revision stapedectomy surgery still exists despite the many changes that have occurred in the surgical technique for the treatment of stapedial otosclerosis over the past 30 years. Sixty-six revision stapes operations were analyzed to determine the causes of failure of previously operated cases of stapedial otosclerosis, and to evaluate the hearing results following a revision stapedectomy. Failure was most often due to erosion of the incus (41%), displacement of the prosthesis from the incus (24%), or migration of the prosthesis from the center portion of the oval window (24%). Postoperative improvement of hearing was observed in 81% of ears operated on for a conductive hearing loss. Closure to within 10 dB, however, occurred in 61%. Two ears suffered a deterioration in the sensorineural hearing level following the revision surgery. Speech discrimination scores following revision surgery were improved in 5% of ears and unchanged in the remainder. Although the overall hearing results are less favorable than those seen in primary stapedectomy, revision stapedectomy surgery should continue to be offered to patients whose primary stapes surgery failed or whose initial good result declined over time.

Adult↗
PubMed1993

Surgery for vertigo in the nonserviceable hearing ear: transmastoid labyrinthectomy or translabyrinthine vestibular nerve section.

Two of the surgical options that exist for the treatment of disabling vertigo arising from an ear with nonserviceable hearing are a transmastoid labyrinthectomy (TL) and a translabyrinthine vestibular nerve section (TLVNS). The major difference between the two operations is a section of the vestibular nerves with the TLVNS which removes all preganglionic vestibular tissue from the diseased inner ear. It has been inferred that a TLVNS should be the procedure of choice if hearing is not to be spared, because a TL results in an incomplete removal of preganglionic vestibular tissue, and that this remaining tissue might have continued or recurrent physiologic function resulting in further vertigo. The clinical outcome of 58 patients who had either TL or TLVNS for disabling vertigo arising from a nonserviceable hearing ear was investigated with respect to the control of vertigo and the development of postoperative balance dysfunction. The control of vertigo in the TLVNS and TL groups was 100% and 95.3%, respectively. This difference was not statistically significant. There was a tendency for postoperative dysequilibrium to be more frequent in the TLVNS group, but this finding did not reach statistical significance. A TL appears to offer the same benefit as TLVNS in the control of intractable episodic vertigo without the additional risks of TLVNS.

Adolescent↗
PubMed1993

Tissue-integrated prostheses in the rehabilitation of auricular defects: results with percutaneous mastoid implants.

Functional and cosmetic rehabilitation of the severely atretic auricle poses a formidable challenge. Conventional autologous grafts for auricular reconstruction may produce inconsistent results, and revision of failed grafts is often unsatisfactory. Osseointegrated implant systems to retain auricular prostheses provide an alternative approach in rehabilitating patients with severe auricular defects. Fourteen patients were implanted with 30 osseointegrating implants for rehabilitating major auricular defects and were followed for 1 to 3.5 years, yielding 143 implant observations. Symptomatic skin reactions to the percutaneous implant were noted in 3.5 percent of the observations. Implant extrusion did not occur. This evaluation of tissue-integrated prosthetic systems suggests this approach to be an extremely reliable alternative for selected patients with major auricular defects. The technique of implanting the retention unit is readily adapted to atresia repair.

Ear Diseases↗