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Biomedical subjects

C W Beatty

Publications and source records attributed to C W Beatty.

At least 19 recordsLinked to original sources
PubMed2000

Audiometric findings in patients with acoustic neuroma.

OBJECTIVE: Hearing loss remains the most common symptom associated with acoustic neuroma. This study documents the audiometric findings from 721 acoustic neuroma procedures. STUDY DESIGN: This was a retrospective study. The preoperative audiometric data were compiled and were analyzed by patient age, gender, tumor size, time of surgery, and neurofibromatosis Type 2 (NF 2). Postoperative audiometric data were arranged and compiled in the same way. The hearing classification proposed by the AAO-HNS was applied to all preoperative and postoperative cases. SETTING: Tertiary referral center. PATIENTS: Surgically confirmed acoustic neuroma patients who had not previously received surgical or radiosurgical therapy. Patients underwent surgery by the retrosigmoid approach. INTERVENTION: Surgical removal of an acoustic neuroma. MAIN OUTCOME RESULT: Provision of pure tone and speech data from a group of acoustic neuroma patients, including application of the recently introduced and accepted AAO-HNS hearing classification system. RESULTS: Preoperative audiometric data were obtained from 694 of 721 patients (96%), of whom 619 had measurable hearing. Postoperative audiometry was performed on 606 patients; 152 had usable data. The combined preoperative audiometric data revealed a high frequency sensorineural hearing loss. Word recognition was servicable. The postoperative pure tones and word recognition scores were worse than preoperative scores. Age, gender, tumor size, and time of surgery had some impact on the preoperative hearing and the postoperative result; NF 2 did not. CONCLUSIONS: The study confirms that hearing alteration is almost universal in acoustic neuroma patients. Hearing preservation is possible in a significant number of cases; however, the postoperative auditory function tends to be worse.

Adolescent↗
PubMed2000

Evaluation of posttonsillectomy hemorrhage and risk factors.

BACKGROUND: A 13-year retrospective study was undertaken to determine the incidence of posttonsillectomy hemorrhage, to evaluate potential risk factors, and to assess the efficacy and safety of ambulatory tonsillectomy. METHODS: From January 1985 to December 1997, 4662 patients underwent tonsillectomy at our institution. Ninety patients with posttonsillectomy bleeding were identified. For each patient with posttonsillectomy bleeding, 2 nonbleeding control subjects were selected and matched by age and sex to evaluate potential risk factors. RESULTS: Age was the only factor found to be statistically significant among the bleeding patients and the control group. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. In our experience, secondary hemorrhage was more common than primary hemorrhage, presenting most frequently on postoperative days 5 to 7. CONCLUSIONS: The incidence of posttonsillectomy bleeding in this review was 1.93%, and about half (47%) of the patients with posttonsillectomy hemorrhage returned to the operating room for hemorrhage control. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. Patients with posttonsillectomy hemorrhage, regardless of management, had a 12% incidence of subsequent hemorrhage. We found no difference in the incidence of posttonsillectomy bleeding between outpatient and inpatient procedures.

Adolescent↗
PubMed2000

Use of methotrexate for autoimmune hearing loss.

To assess the efficacy of low-dose methotrexate (MTX) given long-term for the treatment of autoimmune hearing loss, we performed a prospective open-label study of 11 patients with treatment-refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in 1 or both ears before enrollment despite traditional medical therapy. The MTX dose was 7.5 to 17.5 mg/wk. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in the pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%, whereas worsening was defined as a worsening of >10 dB in PT or a decrease of >15% in SD in at least 1 ear. The MTX was well tolerated. Among the 6 patients with Meniere's disease. 4 had improvement or resolution of vertigo, while 2 had no improvement. Disequilibrium improved in all 3 patients with Cogan's syndrome. According to the parameters defined above, hearing improved in 9 patients (82%), was unchanged in 1 patient (9%), and worsened in 1 patient (9%). Long-term low-dose MTX therapy may be a useful therapy for some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.

Adult↗
PubMed2000

The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial.

OBJECTIVE: To compare the canalith repositioning procedure (CRP) with a sham maneuver for the treatment of benign paroxysmal positional vertigo. PATIENTS AND METHODS: We recruited 50 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination (Dix-Hallpike maneuver). Patients were randomized to either the CRP (n = 24) or a sham maneuver (n = 26). Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 10 days for both groups. Resolution of symptoms was reported by 12 (50%) of the 24 patients in the CRP group and by 5 (19%) of the 26 patients in the sham group (P = .02). The results of the Dix-Hallpike maneuver were negative for positional nystagmus in 16 (67%) of 24 patients in the CRP group and in 10 (38%) of 26 patients in the sham group (P = .046). CONCLUSION: The CRP is effective treatment of benign paroxysmal positional vertigo, and this procedure can be performed by general internists on outpatients with this disorder.

Chi-Square Distribution↗
PubMed1999

Assessment of dysequilibrium after acoustic neuroma removal.

OBJECTIVE: Published data evaluating the rate of dysequilibrium after acoustic neuroma removal are inconsistent. The purpose of this investigation was to determine the incidence and severity of dysequilibrium and quality of life in a group of patients after acoustic neuroma surgery. STUDY DESIGN: The study design was a retrospective chart review and survey that included demographic and medical history questions, the Dizziness Handicap Inventory (DHI), the UCLA Dizziness Questionnaire (UCLA-DQ), and the Health Status Questionnaire (HSQ). SETTING: The study was conducted in a multispecialty tertiary care clinic. PATIENTS: Two hundred thirty-seven subjects who underwent initial surgical removal of an acoustic neuroma between January 1990 and June 1997 were studied. MAIN OUTCOME MEASURES: Correlation of dysequilibrium with age, gender, and tumor size was measured. Survey analysis including DHI, UCLA-DQ, and HSQ scores. RESULTS: Sixty-five percent of patients reported persistent dysequilibrium after surgery. A majority of those with dysequilibrium had DHI, UCLA-DQ, and HSQ scores that suggested minimal impact on the quality of life. The HSQ scores were statistically significantly poorer for the patients with dysequilibrium than for those without dysequilibrium. CONCLUSIONS: Sixty-five percent of patients reported dysequilibrium after acoustic neuroma removal. The quality-of-life impact was mild.

Cranial Nerve Neoplasms↗
PubMed1998

Bone cement reconstruction of the ossicular chain: a preliminary report.

OBJECTIVE: To determine the feasibility and efficacy of using a bone cement, Oto-Cem, to reconstruct the ossicular chain. STUDY DESIGN: Prospective clinical trial on nine consecutively chosen adult patients with ossicular chain defects. PATIENTS AND SETTING: Nine patients with ossicular chain defects involving the long process of the incus were treated at the Carolina Ear and Hearing Clinic. The ossicular chain was reconstructed using bone cement by itself or in conjunction with a stapes prosthesis. MAIN OUTCOME MEASURES: Preoperative audiograms were compared with audiograms 3, 6, and 12 months after reconstruction. RESULTS: There was a mean pure-tone average (PTA) improvement of 15 dB in patients undergoing incus to stapes suprastructure reconstruction with the bone cement. The incus to mobile footplate reconstruction (using a stapes prosthesis attached to the newly reconstructed incus) resulted in a 34-dB PTA postoperative improvement. Two of the three patients with incus to oval window repairs experienced a 10-dB improvement in PTA. One of the three patients experienced a loss in speech discrimination and a 2-dB loss in PTA. CONCLUSIONS: Despite the limited number of patients, this preliminary study demonstrates the effectiveness of Oto-Cem in reconstructing a foreshortened incus. There was a substantial hearing improvement in all but one patient in the incus to stapes or the incus to footplate categories.

Auditory Threshold↗
PubMed1998

Transtympanic gentamicin for Meniere's syndrome.

OBJECTIVES: Study the impact of transtympanic gentamicin on patients with unilateral Meniere's syndrome. Partial chemical labyrinthectomy is a relatively recent concept for the treatment of Meniere's syndrome. It uses the ototoxic effect of gentamicin to reduce the symptom of vertigo and maintain cochlear function. STUDY DESIGN: A prospective study using transtympanic gentamicin was begun in January 1994. Patients selected had failed medical therapy, but were not incapacitated. Patients had preinjection audiometric and electronystagmography data. Most had an imaging study. All had one injection, about half had more than one. Patients were seen 1 month after therapy and repeat studies were obtained. Repeat injection was performed if indicated. Follow-up from the chart or by telephone was obtained. Data were tabulated using the 1995 American Academy of Otologaryngology-Head and Neck Surgery guidelines. RESULTS: Through December 1996 43 patients with unilateral Meniere's syndrome were treated. The pretherapy function level was 3 through 5. After therapy the function level was 1 or 2. There was almost no change in cochlear function and no patient became deaf. Many patients had mild ataxia or dysequilibrium during the first 2 weeks following therapy. Most patients showed some decrease in labyrinthine function measured on electronystagmography. No attempt was made to ablate labyrinthine function. Seventeen of 18 patients had a vertigo index in the class A or B category after 2 years. CONCLUSIONS: Transtympanic gentamicin has become the treatment of choice for patients who fail medical therapy for Meniere's syndrome at the authors' institution.

Adult↗
PubMed1998

Irradiated rib cartilage graft for reconstruction of the tympanic membrane: preliminary results.

OBJECTIVE: To evaluate the advantages, disadvantages, safety, and results in reconstruction of the tympanic membrane using irradiated rib cartilage. STUDY DESIGN: Retrospective chart review. SETTING: A tertiary referral center. PATIENTS: All patients who had > or =6 months follow-up who underwent tympanoplasty or tympanomastoidectomy using irradiated rib cartilage graft at our institution from January 1, 1993 to December 31, 1996. INTERVENTION: Tympanoplasty or tympanomastoidectomy using homologous irradiated rib cartilage as graft material. MAIN OUTCOME MEASURES: Postoperative speech reception thresholds, speech discrimination scores, and air-bone gap were compared with preoperative levels. Complications directly related to irradiated rib cartilage tympanoplasty were sought. RESULTS: Speech reception threshold did not significantly change. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was < or =10 dB in 43.2% of patients and < or =20 dB in 70.3% of patients. There was a 16% complication rate regarding tympanoplasty in general. No complications unique to irradiated rib cartilage occurred. CONCLUSION: Irradiated rib cartilage is an alternative tympanoplasty material that may save operating time, spares patients an added incision, provides results similar to other grafting material, and is safe.

Adolescent↗
PubMed1998

Preoperative identification of patients at risk of developing persistent dysequilibrium after acoustic neuroma removal.

OBJECTIVE: This study aimed to identify preoperative signs or symptoms that correlate with poor postoperative vestibular compensation after acoustic neuroma removal. STUDY DESIGN: The study design was a retrospective chart review. SETTING: The study was conducted at a tertiary care center. PATIENTS: A total of 210 patients who had acoustic neuromas removed via the retrosigmoid approach from January 1, 1990, to July 1, 1995, participated. MAIN OUTCOME MEASURES: Persistent dysequilibrium for > 3 months after surgery was measured. RESULTS: Age (p = 0.002), gender (p = 0.007), presence of preoperative dysequilibrium (p = 0.005), duration of preoperative dysequilibrium > 3.5 months (p = 0.003), and central findings on electronystagmography ( p < 0.001) were related to poor outcome. CONCLUSIONS: The authors found 31% of patients to have dysequilibrium lasting > 3 months after surgical removal of an acoustic neuroma. Age > 55.5 years, female gender, constant preoperative dysequilibrium present for > 3.5 months, and central findings on electronystagmography were associated with a worse outcome.

Adult↗
PubMed1997

Low-dose intratympanic gentamicin and the treatment of Meniere's disease: preliminary results.

The most disabling symptom for most patients with unilateral Meniere's disease is vertigo. Eradication of the diseased end organ is effective in eliminating the vertigo. Labyrinthectomy remains the "gold standard"; unfortunately, residual hearing is sacrificed to obtain this end. The purpose of this study is to evaluate low-dose intratympanic gentamicin for the control of vertigo and for the preservation of hearing. A single dose of gentamicin (10-80 mg) was injected into the middle ear space of 23 patients with unilateral Meniere's disease as an office procedure. Eighty-four percent of the patients had no episodes of vertigo during the last 6 months of follow-up. Pure tone average and word discrimination scores were unchanged as a group. Ninety-five percent of patients had a hearing loss at 6 and 8 kHz that averaged 7.5 dB. Caloric function was reduced in 93%. Low-dose intratympanic gentamicin is a safe, simple, office procedure that is effective in controlling the definitive vertiginous episodes in most patients with unilateral Meniere's disease. Control of vertigo can be obtained with preservation of hearing.

Absorption↗
PubMed1997

Pain after acoustic neuroma surgery.

This article focuses on the incidence, pathophysiology, and management of pain removal of acoustic neuroma. The debate regarding the choice of surgical approach and frequency of headaches is reviewed. The proposed causes of postoperative headaches are discussed. Specific surgical strategies to minimize the risk for developing prolonged postoperative headaches are presented, and medical management options are summarized.

Headache↗
PubMed1997

Nonsurgical factors predictive of postoperative hearing for patients with vestibular schwannoma.

OBJECTIVE: The purposes of the study were to determine whether preoperative cochlear reserve as measured by evoked otoacoustic emissions (EOAE) as well as other hearing variables often associated with hearing preservation are correlated with hearing preservation after tumor removal and to determine whether any hearing variables are independent of tumor size as a predictor of hearing preservation. STUDY DESIGN: Preoperative audiologic data for 104 patients having vestibular nerve schwannomas removed via a retrosigmoid surgical approach were reviewed and subjected to factor analysis. SETTING: All patients were seen at the Mayo Clinic, Rochester, Minnesota. PATIENTS: The patient sample was divided into two groups based on hearing thresholds after surgery. Group I consisted of 73 ears without hearing preservation. The remaining 31 ears, group II, had preserved hearing (defined as average postoperative pure-tone thresholds < or = 85-dB HL for 0.5, 1, 2, and 3 kHz). MAIN OUTCOME MEASURES: Variables not predictive of hearing preservation were age, gender, tumor laterality, and cochlear reserve (EOAE). Variables predictive of hearing preservation were small tumor size, pure-tone hearing sensitivity, speech reception thresholds, word recognition scores, integrity of cochlear nerve (acoustic reflex thresholds, and auditory brain stem response [ABR] waveforms). RESULTS: A multivariate logistic regression analysis showed that only word recognition scores at 40-dB sensation level were independent of tumor size as a predictor of hearing preservation.

Acoustic Stimulation↗
PubMed1996

Conservative management of acoustic neuroma: an outcome study.

OBJECTIVE: This study analyzed selection criteria, clinical outcome, and tumor growth rates in patients with acoustic neuromas in whom the initial management strategy was observation. METHODS: A retrospective review of patients with conservatively managed unilateral acoustic neuromas was conducted. Minimum follow-up was 6 months. Patients with neurofibromatosis Type II were excluded. Differences in tumor growth rates were analyzed by use of the Wilcoxon rank sum test. RESULTS: Sixty-eight patients (31 men and 37 women) with a mean age of 67.1 years were followed for an average of 3.4 years after diagnosis. The reasons for a trial of observation included advanced age (55%), patient preference (21%), minimal symptoms (9%), poor general medical condition (7%), asymptomatic tumor (4%), and tumor in the only hearing ear (4%). Fifty-eight patients (85%) were successfully managed with observation alone. Ten patients (15%) ultimately required treatment (nine received microsurgical treatment and one patient underwent radiosurgical intervention) at a mean time interval of 4.0 years after diagnosis. Forty-eight tumors (71%) showed no growth and 20 (29%) enlarged during the study period. The mean tumor growth rate at the 1-year follow-up was significantly higher in the group requiring treatment (3.0 mm) than in the group not requiring treatment (0.36 mm) (P < 0.0001). Thus, the tumor growth rate at the 1-year follow-up was a strong predictor of the eventual need for treatment. CONCLUSION: Observation is a reasonable management strategy in carefully selected patients with acoustic neuromas. Diligent follow-up with serial magnetic resonance imaging is recommended, because some tumors will enlarge to the point at which active treatment is required.

Aged↗
PubMed1996

Far-field auditory brainstem response in neurotologic surgery.

This is a review of our experience using far-field auditory brainstem monitoring during acoustic neuroma removal. The observations are based on 144 consecutive cases beginning in 1986. The factors of importance are tumor size, preoperative auditory function, and the preoperative presence of a wave V on the auditory brainstem response. Our experience suggests that preservation of hearing in tumors > 2.5 cm is rare. It was observed that preserving wave V does not guarantee preservation of hearing. Conversely, loss of wave V does not preclude preservation of hearing. It has also been noted that the presence of only wave I preoperatively does offer some hope that hearing can be preserved postoperatively. Finally, postoperative hearing function is usually equal to or worse than the preoperative function. Only rarely does the postoperative function improve.

Adolescent↗
PubMed1996

Salivary gland choristoma of the middle ear: report of a case and review of the literature.

Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition that occurs at various locations within the head and neck. We present a 10-year-old boy with a salivary gland choristoma of the middle ear and compare findings with the 15 similar cases published in the English and German languages. Patients typically have a long-standing conductive hearing loss and visible middle ear mass. Operative findings include a lobulated middle ear mass of histologically normal salivary gland tissue attached posteriorly in the region of the oval window, together with absent or malformed ossicles. Frequently the mass is intimately associated with the facial nerve. The constancy of these findings has led to the proposal of an abnormal developmental syndrome. This syndrome will be described and possible explanations for its cause will be discussed.

Child↗
PubMed1995

Stereotactic radiosurgery using the gamma knife for acoustic neuromas.

PURPOSE: To assess the efficacy and toxicity of stereotactic radiosurgery using the gamma knife for acoustic neuromas. METHODS AND MATERIALS: Between January 1990 and January 1993, 36 patients with acoustic neuromas were treated with stereotactic radiosurgery using the gamma knife. The median maximum tumor diameter was 21 mm (range: 6-32 mm). Tumor volumes encompassed within the prescribed isodose line varied from 266 to 8,667 mm3 (median: 3,135 mm3). Tumors < or = 20 mm in maximum diameter received a dose of 20 Gy to the margin, tumors between 21 and 30 mm received 18 Gy, and tumors > 30 mm received 16 Gy. The dose was prescribed to the 50% isodose line in 31 patients and to the 45%, 55%, 60%, 70%, and 80% isodose line in one patient each. The median number of isocenters per tumor was 5 (range: 1-12). RESULTS: At a median follow-up of 16 months (range: 2.5-36 months), all patients were alive. Thirty-five patients had follow-up imaging studies. Nine tumors (26%) were smaller, and 26 tumors (74%) were unchanged. No tumor had progressed. The 1- and 2-year actuarial incidences of facial neuropathy were 52.2% and 66.5%, respectively. The 1- and 2-year actuarial incidences of trigeminal neuropathy were 33.7% and 58.9%, respectively. The 1- and 2-year actuarial incidence of facial or trigeminal neuropathy (or both) was 60.8% and 81.7%, respectively. Multivariate analysis revealed that the following were associated with the time of onset or worsening of facial weakness or trigeminal neuropathy: (a) patients < age 65 years, (b) dose to the tumor margin, (c) maximum tumor diameter > or = 21 mm, (d) use of the 18 mm collimator, and (e) use of > five isocenters. The 1- and 2-year actuarial rates of preservation of useful hearing (Gardner-Robertson class I or II) were 100% and 41.7% +/- 17.3, respectively. CONCLUSION: Stereotactic radiosurgery using the gamma knife provides short-term control of acoustic neuromas when a dose of 16 to 20 Gy to the tumor margin is used. Preservation of useful hearing can be accomplished in a significant proportion of patients.

Adult↗
PubMed1995

Impact of cranioplasty on headache after acoustic neuroma removal.

We reported previously the incidence of headache after the retrosigmoid removal of an acoustic neuroma as 23% at 3 months, declining to 9% at 2 years after surgery. In an attempt to reduce the incidence and the severity of these headaches, we made one change in our surgical procedure, which was to perform a cranioplasty with methyl methacrylate. Twenty-four patients underwent the cranioplasty and were followed for at least 3 months postoperatively. These patients were matched to 24 patients who did not undergo a cranioplasty. We found a 4% incidence of headache in the cranioplasty group and a 17% incidence in the matched group. No complications were related to this change in our procedure.

Adult↗