Tests for autoimmune disease in otology.
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Autoimmune Diseases↗
Biomedical subjects
B F McCabe
Publications and source records attributed to B F McCabe.
Preliminary assessment of the Los Angeles, Vienna and Melbourne cochlear implants.
We tested four patients using the single-channel cochlear implant from Los Angeles, three patients using the single-channel cochlear implant from Vienna, and two patients using the multichannel cochlear implant from Melbourne. Tests from the MAC battery and the Iowa Cochlear Implant Battery were used. Most patients were able to identify some environmental sounds. Three of the patients had difficulty distinguishing between male and female voices, and three could not distinguish between a noise and a voice. All patients had difficulty discriminating between unknown speakers of the same sex. A four-choice spondee test in noise showed that all patients suffered drastically from background noise. In all cases there was an improvement in lipreading ability with the implant. On a sentence test with a contextual cue seven patients got some words with sound alone. Results obtained with the multichannel implant are superior on several tasks, but we have tested too few patients to allow us any firm conclusions.
Auditory Perception↗
Ototoxicity of oral neomycin and vancomycin.
In contrast to parenteral neomycin, which may result in severe and progressive ototoxicity, oral neomycin has been widely used for 25 years, and its index of safety has been regarded as high. Ototoxicity is viewed as an uncommon complication of oral neomycin most likely to occur in patients with renal failure or gastrointestinal inflammation. Two cases of ototoxicity resulting from oral neomycin are presented. Serial audiometric and neomycin blood level testing are suggested as a means of auditory monitoring in patients receiving the drug. A review of experience with oral vancomycin indicates that this drug has not been shown to cause ototoxicity.
Administration, Oral↗
Malignant fibrous histiocytoma of the nose and nasopharynx.
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Adult↗
Nonlinear characteristics of single neurons in the vestibular nuclei.
The characteristics of response of 99 vestibular nuclei neurons were investigated in the cat anesthetized with pentobarbital sodium. All neurons responded to stimulation of the horizontal semicircular canals (HSCC) with prolonged 2, 4, 6, or 8 degrees/second2 angular acceleration. Neural response was recorded utilizing the single-neuron recording technique. The vestibular neurons responded nonlinearly to stimulation of the HSCC. Specifically (1) the time required to reach the maximum response level decreased nonlinearly with an increase in stimulus magnitude (SM); (2) the maximum response level increased nonlinearly with the increase in SM: (3) the neural response to excitatory stimulus was not the mirror image of that to an inhibitory stimulus. Several existing mathematical models were simulated by utilization of the IBM Continuous System Modeling Program, account for the nonlinear response of the vestibular nuclei neurons. The nonlinearities observed in the responses may be due to (1) nonlinear behavior of the end organ, (2) the influence of the CNS including the vestibular efferent system, or (3) the inherent neural properties of the vestibular nuclei.
Acceleration↗
Bilateral radical neck dissections.
Of 697 patients undergoing radical neck dissection for head and neck cancer, 91 (13%) had bilateral radical neck dissection. No operative deaths occurred. The complication rate was least for staged second neck dissections (17 patients). While overall surgical and medical complication rates for simultaneous bilateral neck dissections (11 patients) were greater than those after staged and delayed (53 patients) neck dissections, surgical complication rates alone for these three groups were comparable. The combined group of patients treated aggressively by simultaneous or staged second neck dissection had no greater complication rate than patients (ten) treated by second neck dissection when metastasis became clinically evident later. These findings and evidence that 55% of these patients were alive after five years or died of unrelated causes encourage us to support more aggressive surgical therapy in patients with manifest or likely occult bilateral metastases from a head and neck primary carcinoma.
Adult↗
Responses to step and repeated impulse accelerations in second order vestibular neurons of the cat.
The characteristics of response of 98 vestibular nuclei neurons were investigated in the barbiturate anesthetized cat. All type I and type II neurons (tonic and kinetic) responded to stimulation of the horizontal canals with step and impulse accelerations. Seventy-seven (79 per cent) neurons of all types demonstrated adaptation, while the remaining 21 (21 per cent) neurons showed either reverse adaptation or no adaptation. When the interval between impulses with impulse accelerations reached a critical minimum, the averaged response was remarkably like the response to step acceleration, including the rate of adaptation. A previously undescribed response decline to repetitive impulse acceleration was seen, which, while sharing some characteristics with habituation, appears to be more closely related to adaptation. Furthermore, the data suggest that adaptation seen at the vestibular nuclear level is more likely a central phenomenon rather than a peripheral one.
Acceleration↗
The prognostic significance of metastatic cervical lymph nodes.
The ability to predict accurately the clinical course of a patient with a malignancy is critically important to the patient's subsequent management. It has been well documented that the presence of metastatic nodal disease is associated with decreased patient survival. Survival data from a group of 242 head and neck cancer patients from the University of Iowa were analyzed to determine the significance of specific characteristics of metastatic lymph nodes. Evaluation of absolute numbers and percentages of positive nodes or node size generally was not useful. However, involvement of the posterior triangle nodes, noncontiguous nodal sites, or multiple sites was associated with a worse prognosis. When that was accurate enough to be of help to the clinician in prognostication. The single most important feature seems to be documentation of the presence of metastatic nodal disease, rather than particular features (i.e., number, size) of the metastatic nodes.
Carcinoma, Squamous Cell↗
Increased survival with surgery alone vs. combined therapy.
Recent investigations have questioned the efficacy of a combined therapy regimen with irradiation. The purpose of this study was to compare the survivals with surgery alone versus combined therapy (pre-op irradiation) and to analyze any apparent differences to identify the source(s) of failure. Two and five-year determinate survivals for this group identify the source(s) of failure. Two and five-year determinate survivals for this group were found to be significantly better for surgery alone. There is no instance where combination therapy is found to be statistically superior. An analysis of treatment failures showed that distant metastases occurred at a greater rate in the combined therapy patients than they did with those treated by surgery alone. The advisability of combined therapy using preoperative irradiation with its increased cost and morbidity to the patient is questioned if it does not improve survival over surgery used as a single modality.
Female↗
Trigeminal neurilemmoma presenting as a sphenoid sinus mass.
Trigeminal neurilemmomas have been known to invade the posterior fossa. Infratemporal fossa, encroach upon the lateral wall of the sphenoid sinus and extend along the three divisions of the trigeminal nerve. Herein described, is a patient with a trigeminal neurilemmoma that extended into the sphenoid sinus, necessitating transphenoidal excision.
Adult↗
Significance of node biopsy before definitive treatment of cervical metastatic carcinoma.
A survey was made of 714 radical neck dissections done alone or in combination with resection of a primary malignancy. Sixty-four (8.9%) of the patients had had a cervical node biopsy before diagnosis and definitive treatment. The complications of wound necrosis, local cervical recurrence, and distant metastasis were significantly higher in those patients than in patients who had had no biopsy or who had biopsy only at the time of definitive treatment. When 40 of the 64 patients were matched on the basis of age, sex, histological diagnosis, site and stage of the lesion and treatment protocol with 40 patients who had had no biopsy, this trend toward a higher complication rate when previous biopsy was done continued and was significantly higher for distant metastasis. The authors believe that these findings quantitatively confirm the accepted belief that, except for instances when no primary lesion can be found and the cervical mass must be biopsied for the purposes of diagnosis, such biopsy increases local complications and, by increasing the incidence of distant metastasis, decreases the chance for survival.
Biopsy↗
The incidence, site, treatment and fate of labyrinthine fistula.
Although the incidence of labyrinthine fistula appears to be similar in most reported series, the number of patients reported to have a positive response to the fistula test do not. This may be due to a lack of uniformity in the performance of the test. The method of the author, the direction of eye movement and its diagnostic significance are described. The occurrence and mechanism of severe sensorineural hearing loss in 5 out of 20 patients in whom the matrix was removed accidently from the fistula during mastoidectomy is discussed.
Cholesteatoma↗
The etiology of chronic otitis media.
Various current theories regarding the aetiology of chronic otitis media are considered in detail. The concept that it originates from an acute middle ear infection no longer appears tenable. Recent experimental work has demonstrated the role of invading skin causing invasive osteitis. It is postulated that in some instances osteitis may follow erosion of the metal skin and proceed to widespread chronic disease of the temporal bone. The important difference between obstruction and inadequacy of the Eustachian tube and the significance of the latter in chronic middle ear disease is emphsized. The Eustachian mechanism of cholesteatoma formation may best be studied by observing the development of retraction pockets following tympanoplasty.
Acute Disease↗
Research vistas in chronic otitis media.
In spite of recent major advances in our knowledge of the basic factors in diseases of bone and mucosa the mechanisms responsible for the development of cholesteatoma are still not known for certain. The role of connective tissue in determining the histologic character of the overlying epithelium deserves more attention. It is possible that more radical removal of connective tissue from the mastoid would result in a lower incidence of post operative cholesteatoma. A study of human temporal bones provides little evidence that retraction pockets are caused by underlying scar tissue. Although a vast weight of suspicion indicts malfunction of the Eustachian tube as the primary cause of chronic middle ear disease, the proof is lacking providing a supreme challenge for otologists of the future.
Animals↗
Iowa results of acoustic neuroma operations.
The records of 10 patients, who underwent removal of small vestibular schwannomas by the middle cranial fossa approach at the University of Iowa Department of Otolaryngology and Maxillofacial Surgery between October 1974 and November 1977, are reviewed. The principal deviation from previously described operative techniques is that after identification of appropriate landmarks, the internal auditory canal is first unroofed in its medial portion near the porus rather than following the facial nerve to the fundus of the canal. There were no intraoperative complications, but one patient died after a postoperative brain stem vascular accident. Another patient developed a cerebrospinal fluid leak and, subsequently, meningitis. Auditory function was preserved postoperatively in 8 of 10 patients, but only 6 retained auditory function after discharge from the hospital. Facial nerve function was normal immediately after surgery in 6 of the 10 patients, but return was incomplete in 2 patients more than 1 year after surgery. Postoperative routine and special audiometric studies are discussed.
Adult↗
The firm salivary mass in children.
The firm salivary gland mass arising in a child is uncommon, representing only 3.2% of all such salivary tumors at the University of Iowa. However, the fact that 57.1% of these tumors are malignant demands thorough diagnostic evaluation by the head and neck surgeon. Histologic diagnosis is strongly recommended. In view of the fact that most of these tumors have a favorable prognosis, lateral parotid lobectomy or total submandibular gland excision represented both an effective diagnostic and adequate therapeutic procedure for benign and low-grade malignancies. High-grade malignancies necessitate adjunctive therapy which is based on the biologic behavior of the particular histologic type.
Child↗
Some evidence for the efficacy of decompression for Bell's palsy: immediate motion postoperatively.
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Adult↗
Effect of radiation therapy on facial nerve cable autografts.
Facial nerve cable autografts were performed on 20 cats with 10 animals receiving 6,000 Rads of postoperative irradiation over six weeks. Testing by clinical appearance, pontograms, and axon counts showed no statistical difference in the operated only and the operated plus irradiated groups. Pontograms illustrated the clinical observance of spasticity, delay and weakness often seen after grafting. This animal work tends to verify the clinical impression that in patients requiring postoperative irradiation for a malignancy necessitating excision and grafting of the facial nerve, anticipated results should be equivalent to the facial nerve cable autografts without postoperative irradiation.
Animals↗