The place of fenestration in congenital ear surgery.
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Drainage↗
Biomedical subjects
C G Jackson
Publications and source records attributed to C G Jackson.
Glomus Tumors. Diagnosis, classification, and management of large lesions.
Glomus tumors of the temporal region and skull base can range in size from small microscopic lesions confined to the promontory to large destructive and neurologically aggressive agents of substantive incapacitation. Contemporary diagnostic and surgical technology has made definitive management of these historically dreaded management of these historically dreaded lesions confidently practical. Prompted by these advances, a new classification of glomus tumors is disclosed. The specific problem of the large chemodectoma at the skull base is addressed and a series of such cases reviewed. Surgical therapy is viewed as definitive, and the technique employed by the members of The Otology Group, PC, is described.
Airway Obstruction↗
Postauricular undersurface tympanic membrane grafting: a follow-up report.
The authors review 1,939 chronic ear surgeries in which 1,556 underwent some form of tympanic membrane grafting. The overall take rate was 93%. There was no selection of cases with regard to presence of infection, cholesteatoma, polyps, or granulation tissue at the time of surgery. There appeared to be no difference in the take rate based upon age of the patient, presence of infection, or cholesteatoma. Autogenous and homograft fascia performed well and there was no significant difference in take rate. Complications were minimal and were related more to the disease process than the grafting technique per se. In addition to reviewing the long-term follow-up of the original technique the authors present a method of dealing with tympanic membrane retraction pockets. Called a cartilage tympanoplasty this procedure incorporates a large piece of full thickness tragal cartilage with attached perichondrium into the substance of the tympanic membrane. With 2 years follow-up at this writing, this procedure has markedly reduced postoperative retraction pockets and recurrent cholesteatoma.
Follow-Up Studies↗
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↗
Glomus tumor surgery: the approach, results, and problems.
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Ear Neoplasms↗
Prenatal development of the microphthalmic eye in the golden hamster.
Prenatal development of the eye in a microphthalmic hamster strain ("anophthalmic white") is compared with established normal developmental periods. The mutant eye primordium is first distinguished at an average of ten gestational days (Period 6) by an incompletely invaginated optic cup, uniformly pseudostratified outer neuroepithelial layer and widely separated margins of the optic fissure. The outer layer of the mutant cup subsequently becomes abnormally thickened, especially posteriorly and midventrally, and, except in a few eyes with localized imperfect fusion, the optic fissure is unfused at twelve days (Period 9), by which time fusion is normally complete. At 13 to 15 days (Period 10-11) the fissure is unfused or irregularly fused in regions of variable location and extent. The occurrence of fissure fusion with concomitant loss of continuity between inner and outer epithelial layers is generally restricted to expanded anterior regions in 14-16 day (Periods 11-12) eyes. The presence of presumptive neural retina in the outer layer of the cup characterizes the mutant eye; and to varying degrees, in day 13-16 eyes, the presumptive neural retina (1) provides persistent continuity between the two cup layers, (2) forms both fused and unfused margins of the optic fissure, and (3) extends into an outer position of the optic cup. As early as 13 days (Period 10), nerve fibers are present in the outer layer of the cup, and by the last prenatal and first postnatal days (Period 12), ectopic nerve fiber bundles are widely distributed.
Animals↗
The acoustic reflex test in cochlear and eighth nerve pathology ears.
The clinical interpretation of acoustic reflex test results in ears with sensorineural impairment should be based on a consideration of three characteristics of the response: the reflex threshold hearing level, the reflex threshold sensation level, and the decay of the reflex. Examination of results in 152 ears with cochlear pathology and in 152 ears with acoustic tumor indicated that in some cases the combination of characteristics may be contradictory as to site of lesion. Regarding a contradictory response pattern as questionable -- neither confirming nor denying a specific site of lesion -- improves the predictive accuracy of the test through a reduction in the number of false identifications.
Adolescent↗
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↗
Skull base surgery.
Surgical inaccessibility, the obstacles of vital neural and vascular anatomy, and the overwhelming surgical mortality rate as a result of hemorrhage and sepsis have led surgeons to approach lesions of the skull base with understandable reluctance. We have, however, undergone a technical revolution in microsurgery, anesthesia, and neurodiagnosis. Innovative surgical minds have thus been armed with the technology to make surgery a reasonable alternative for these dreaded lesions. This article singles out the glomus tumor and its associated lesions, which the neuro-otologist must approach transtemporally. Their diagnosis and new treatment concepts are discussed. Old criteria for unresectability are redefined and new classifications are established. Surgery of these skull base lesions is discussed from the standpoint of the basic principles of exposure, hemostasis, and management of the facial nerve. Problems in rehabilitation of postoperative deficits are discussed.
Brain Neoplasms↗
The argon laser in acoustic tumor surgery.
CO2 laser surgery has been employed successfully in the larynx for the past ten years. Because of the nature of the CO2 beam, it is necessary to mount the laser itself onto the operating microscope, thereby making it difficult to adapt to otologic microsurgery. The ability of the argon laser to be transferred through a fiber optic bundle has made it possible to introduce a whole new concept to microsurgery of the ear and adjacent structures. The argon laser has been used by the authors, on a routine basis, in all acoustic neuroma surgery for the past ten months (30 cases). The purpose of this paper is to present their preliminary experience. Surgical technique is covered in detail describing the many advantages the laser has provided in the management of these difficult lesions.
Adult↗
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↗
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↗
Brainstem evoked response audiometry in confirmed eighth nerve tumors.
Brainstem evoked response audiometry has been described as an effective predictor of eighth nerve disease. This study reports audiologic findings in 52 cases of surgically confirmed eighth nerve and cerebellopontine angle tumors. The results of brainstem audiometry were consistent with an eighth nerve lesion in 51 cases. Its use in site of lesion tests is highly recommended.
Audiometry, Evoked Response↗
Vascular anomalies of the middle ear.
The patient presenting with a red mass behind the eardrum and a pulsating tinnitus may well have a vascular tumor. One must be ever mindful, however, that the mass may represent a congential vascular anomaly. The most common one seen is the uncovered jugular bulb in which the vessel extends superiorly into the middle ear to or above the incudostapedial joint. More rare is the uncovered and posteriorly displaced carotid artery. The purpose of this paper is to review the literature on the subject of vascular anomalies of the middle ear and temporal bone and to discuss the diagnosis and management of these lesions. Illustrative case reports with color photographs are presented as well.
Adolescent↗
Facial paralysis of neoplastic origin: diagnosis and management.
The individual with a progressive (weeks to months) facial weakness should be considered to have a tumor involving the facial nerve until proved otherwise. All individuals experiencing a facial paralysis must undergo a thorough neurotologic evaluation to establish the etiology. Bell's palsy is a diagnosis by exclusion. While computerized axial tomography (CAT) scans, polytomography and arteriograms are extremely helpful, these studies very often fail to demonstrate intrinsic tumors involving the facial nerve. For this reason all individuals experiencing a progressive facial paralysis should have an exploration of their facial nerve from the internal auditory canal (IAC) through the stylomastoid foramen into the parotid gland. The purpose of this paper is to present a series of cases of facial paralysis having as their etiology intrinsic or extrinsic neoplasms. Clinical patterns are established, diagnostic protocols formulated and the results of surgical management reviewed.
Adolescent↗
Primary adenoma of the middle ear.
Primary neoplasms of the ear are indeed unusual. Adenomatous middle ear tumors are even more unusual and have been, in previous presentations, uniformly labeled adenocarcinoma. Radical therapeutic approaches have therefore often been recommended. More recent literature has confidently established the existence of the entity of benign primary middle ear adenoma. In two reports only twenty-three cases have been recorded. The purpose of this article is to add two such cases to the literature. Current concepts in diagnosis and histopathogenesis are presented. Treatment guidelines are suggested.
Adenoma↗
Bilateral pulmonary fibro-cavitary disease and eosinophilia.
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Adult↗
Immune response of a patient with deficiency of the fourth component of complement and systemic lupus erythematosus.
The clinical details of a five-year-old boy with systemic lupus erythematosus and an inherited deficiency of the fourth component of complement (C4) have been reported elsewhere. In this study of his immune responses, immunization with bacteriophage phi X 174 demonstrated diminished antibody formation, abnormal immunologic memory and failure to switch from IgM to IgG during secondary response. We also noted persistent lymphopenia and reductions in peripheral-blood T lymphocytes, lymphocyte responses to mitogens and allogeneic cells and granulocyte chemotaxis. Kinetic studies revealed that delayed activation of the alternative pathway was corrected by purified C4 only if the classical pathway was not blocked. This finding is consistent with the concept that minute amounts of C3b provided through the classical pathway are necessary to prime the properdin system. Inability to activate the classical complement pathway, abnormal kinetics of alternative-pathway activation and depressed antibody responses to a T-cell-dependent antigen may predispose C4-deficient patients to viral infection or immune-complex formation.
Antibodies, Bacterial↗