Search PubMed⌕ Search

Biomedical subjects

D A Moffat

Publications and source records attributed to D A Moffat.

At least 37 records · Page 2Linked to original sources
PubMed2000

Metastases from glomus jugulare tumours.

This review describes the features of glomus jugulare tumours with metastases. There were 100 sites of metastasis in the 53 cases previously reported. The sites of metastasis may be summarized as bone (33), lungs (23), lymph nodes (19), liver (nine) and other (16). Metastases presented up to 30 years after the initial treatment. The mean age of patients was 45 years and the sex ratio was approximately two females to one male, with no significant difference compared to non-metastatic tumours. There was a significantly higher incidence of pain and a significantly lower incidence of hearing loss at presentation compared to non-metastatic tumours. The commonest treatment was a combination of surgery and radiotherapy. The duration of symptoms before diagnosis was significantly shorter and the rates of persistent or recurrent local disease and death were significantly higher than for non-metastatic tumours. This review highlights the fact that glomus jugulare tumours are not always benign.

Glomus Jugulare Tumor↗
PubMed2000

Cavernous haemangioma of the internal auditory canal.

Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas. Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enhancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.

Adult↗
PubMed2000

Positional vertigo as a first symptom of a cerebellopontine angle cholesteatoma: case report.

We report a case of a cerebellopontine angle cholesteatoma whose initial sign was benign paroxysmal positional vertigo (BPPV). Positional vertigo caused by a central pathology is extremely rare and is usually accompanied by other suspicious features. In this case, there were no additional neurotologic symptoms or signs. The only abnormalities were seen on Dix-Hallpike testing, but because they were not consistent with a diagnosis of BPPV, the decision was made to proceed to imaging. Diagnostic rigor is required when evaluating positional vertigo, as with all symptoms of imbalance, if such cases are not to be overlooked.

Adult↗
PubMed2000

An investigation of the audiologic handicap associated with unilateral sudden sensorineural hearing loss.

OBJECTIVE: To determine the incidence of tinnitus and associated handicap after unilateral sudden sensorineural hearing loss (SSNHL); in addition, to determine the hearing handicap experienced as a consequence of such a loss. STUDY DESIGN: Identification of patients and determination of demographic and audiologic data by retrospective case review; determination of handicap and distress by postal questionnaire. SETTING: Teaching hospital department of otolaryngology. PATIENTS: Thirty-eight patients were identified as having been treated for a unilateral sudden sensorineural hearing loss in the period 1988 through 1997. Of those, 21 (55.3%) replied to the questionnaire. MAIN OUTCOME MEASURES: Audiometric data at admission and at 4-week follow-up, Tinnitus Handicap Inventory (THI), visual analogue scales of tinnitus loudness and distress, Hearing Handicap Inventory in Adults (HHIA). RESULTS: The questionnaire responder group did not significantly differ from the questionnaire nonresponder group on demographic nor audiometric variables, and hence were considered to be a representative sample. Tinnitus was present in 14 patients (67%). Hearing handicap was found in 86% of patients (of the 21 questionnaire responders) and tinnitus handicap in 57% (of the 14 with tinnitus). Correlations were found between tinnitus loudness, distress, and handicap. There was no correlation between time elapsed since SSNHL and tinnitus or hearing handicap, nor was there a correlation between the extent of audiometric loss and hearing or tinnitus handicap. A strong negative correlation was, however, found between recovery in audiometry in the first 4 weeks after onset and tinnitus and hearing handicap. The audiometric status of the contralateral ear correlated with hearing handicap. CONCLUSIONS: A majority of patients after unilateral SSNHL have a perceived handicap associated with tinnitus and hearing. Although this condition is an otologic emergency, careful thought should be given to the audiologic rehabilitation of this patient group.

Adult↗
PubMed1999

Does choice of hearing selection criterion and reporting criteria affect the hearing preservation rate in vestibular schwannoma surgery?

With increasing refinement in the surgery of vestibular schwannoma the aims of complete tumor removal and facial nerve preservation have been largely fulfilled. However, the reputation of and place for hearing-preservation surgery still remain uncertain. A major part of this uncertainty is the result of difficulties in interpretation of the various reported results of hearing-preservation surgery. Meaningful comparison between series is difficult because of the varied number of postoperative reporting criteria commonly in use today. Although it is acknowledged that the postoperative reporting criteria affect the hearing-preservation rates, what is not readily appreciated is that preoperative selection criteria for hearing-preservation cases can also significantly affect the success rate of hearing-preservation acoustic neuroma surgery. This article models the many possible outcomes of hearing-preservation schwannoma surgery by use of the previously reported Cambridge series as an illustrative example. With these models some understanding can be gained of the effect of choosing various preoperative and postoperative hearing criteria on the overall hearing-preservation success rate.

Hearing Tests↗
PubMed1999

An aneurysm of the petrous internal carotid artery.

Internal carotid artery aneurysms are a rare cause of pulsatile tinnitus and conductive hearing loss but should be borne in mind when there is a suspected diagnosis of glomus jugulare or high-riding jugular bulb. Most cases are congenital. We present a case of otorrhagia which was initially thought to be a glomus jugulare, the diagnosis of internal carotid artery aneurysm was made at angiography and treated by balloon embolization.

Adult↗
PubMed1999

Hearing preservation in solitary vestibular schwannoma surgery using the retrosigmoid approach.

The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by the retrosigmoid approach at Addenbrooke's Hospital, Cambridge, during a 10-year period are presented. The hearing-preservation rate, using audiometric criteria set by others as "serviceable hearing" (Wade PJ, House W. Otolaryngol Head Neck Surg 1984;92:1184-93; Silverstein H, et al. Otolaryngol Head Neck Surg 1986;95:285-91; Cohen NL, et al. Am J Otol 1993;14:423-33) was 8% (4 of 50 cases). When the more stringent selection criteria of near-normal hearing and reporting criteria of socially useful hearing preservation (pure-tone average < 30 dB/speech discrimination score > 70%) is used, the hearing-preservation rate is 4.8% (1 of 21 cases). The only preoperative factor that may predict a favorable hearing-preservation outcome is normal auditory brain stem response morphology (Fisher's exact 2-tailed test, P < 0.001). The number of suitable candidates for hearing-preservation surgery are few. Reasonable indications for attempted vestibular schwannoma surgery with hearing preservation are discussed.

Adolescent↗
PubMed1998

Effective anaesthesia for transtympanic electrocochleography.

The objective of this study was to quantify the anaesthetic effect of EMLA cream during transtympanic electrocochleography (TTECochG) and thereby to determine if the application of EMLA should be recommended in routine practice of electrocochleography (ECochG). ECochG provides useful information in patients with inner ear fluid disorders. A major concern regarding transtympanic positioning of the electrode in ECochG is patient discomfort. Previous work has suggested that EMLA cream may make this technique more tolerable to patients. A prospective randomized study was performed evaluating the discomfort associated with unilateral TTECochG in a group where EMLA cream was used to anaesthesize the tympanic membrane (n = 24), and in a group where no anaesthesia was used (n = 22). A statistically significant difference was evident between the discomfort ratings of the groups (P < 0.0001, Mann-Whitney U test), the discomfort being greater in the no anaesthesia group. EMLA cream has thus been shown to alleviate the level of discomfort associated with TTECochG and so to be an acceptable modification of this technique.

Adult↗
PubMed1998

Clinical acumen and vestibular schwannoma.

OBJECTIVE: This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors. STUDY DESIGN: This study was a retrospective case review of 473 patients with vestibular schwannoma. SETTING: The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center. PATIENTS: A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied. MAIN OUTCOME MEASURES: Measured were the principal presenting symptoms and the criteria for audiologic management. RESULTS: Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney U test; tied p value = 0.0002), shorter length of history (tied p value < 0.0001), and better preserved hearing (tied p value < 0.001) than the typical otologic presentation group. These clinical correlates are related to tumor morphology, and it is hypothesized that the site of the neurilemmal-glial junction (medial or lateral) has an effect here. If the U.S. criteria for the treatment of a patient by an audiologist are applied to this series of patients, then 7 patients (1.5%) would not have had the diagnosis of vestibular schwannoma. If the U.K. criteria are applied, this number of missed tumors is 17 (3.6%). The addition of unilateral tinnitus as an indicator of the need for otologic investigation reduced the number of patients who might be missed to 2 (0.42%) for the U.S. cases and 5 (1.1%) for the U.K. cases. CONCLUSIONS: Of patients with vestibular schwannoma, 10.7% have an atypical principal presenting symptom, and this group of patients has significantly larger tumors than those patients who present typically. This finding is of particular relevance to the entry point of such cases to the healthcare system. A number of patients with vestibular schwannoma appear to pass the criteria for treatment by an audiologist without reference to an otologic opinion. These patients may not be investigated from an early stage with potential implications for increased morbidity.

Adolescent↗
PubMed1998

An alternative method for dealing with cerebrospinal fluid fistulae in inner ear deformities.

OBJECTIVE: This study aimed to review the management of cerebrospinal fluid (CSF) fistulae in the setting of developmental inner ear deformity. STUDY DESIGN: The study design was a case review, close examination of preoperative radiology, and corresponding intraoperative images. TECHNIQUE: A definitive method of CSF fistula closure is described using previously known techniques used commonly in skull base surgery. CONCLUSIONS: The use of a multiple-level, reinforced wound closure technique is necessary to definitively close CSF fistulae in extreme inner ear deformity and to prevent further episodes of CSF leak and meningitis.

Audiometry, Pure-Tone↗
PubMed1998

Use of autologous osteocyte containing bone pate for closure of tegmental defects.

OBJECTIVE: This article aimed to describe a new technique for the reconstruction of middle fossa tegmental defects using autologous osteocyte containing bone pate. STUDY DESIGN: The technique is demonstrated using clinical photographs and x-ray examples of tegmental defects. TECHNIQUE: Pliable bone pate graft is manufactured using autologous bone dust, blood, iodine solution, and tissue glue (Tisseel; Immuno, Austria). The graft is placed accurately via a combined mini-middle fossa craniotomy and middle mastoidectomy approach. CONCLUSION: This new technique of middle fossa bony tegmental repair has considerable advantages over previously described methods that use rigid or synthetic materials.

Bone Transplantation↗
PubMed1998

An investigation of the effect of structured teaching on a group of tinnitus patients after vestibular schwannoma removal.

OBJECTIVE: This study aimed to determine the effect of a structured lecture and discussion on the tinnitus handicap and tinnitus intensity experienced by a group of patients who had undergone surgical removal of a unilateral vestibular schwannoma. STUDY DESIGN: The study design was a prospective repeated measures trial. SETTING: The study was conducted on a support group for patients with vestibular schwannoma based on a University Hospital Department of Neuro-Otology. PATIENTS: Twenty-one members of a vestibular schwannoma support group who attended a meeting entitled, "Living with Tinnitus" participated. All patients had undergone a surgical removal of a unilateral sporadic vestibular schwannoma. INTERVENTION: A structured lecture and a discussion on the nature of tinnitus and how to live with it by an audiological scientist was performed. MAIN OUTCOME MEASURES: Score on the tinnitus handicap inventory (THI) and associated functional, emotional, and catastrophic subscales and a visual analog scale (VAS) rating of tinnitus intensity were measured. Both measures were taken before intervention and 6 months after intervention. All measures were self-administered. RESULTS: Of 21 patients attending the lecture, 19 completed both preintervention and postintervention measures. Mean age was 58 years (range, 35-74 years). No significant difference was seen between pre-THI and post-THI total score, subscale scores, or VAS score. No correlation between THI score, VAS score, age, and length of postoperative period was seen. Although preintervention THI and VAS scores were not significantly correlated, there was a significant correlation between THI total and VAS score after intervention and THI functional subscale and VAS score after intervention. The study group was compared with the validation group for THI: significant differences were seen between sample postintervention emotional score and validation emotional score and between sample catastrophic scores and validation catastrophic score. In each case, the sample scores were lower (less handicap) than the validation scores. CONCLUSIONS: This intervention did not make a significant difference to the THI score of the sample group. The fact that the sample group had significantly different tinnitus handicap than the validation group is of note and indicative that postoperative tinnitus in patients with vestibular schwannoma does not lead to as great an emotional and catastrophic handicap as in a general tinnitus group.

Activities of Daily Living↗
PubMed1997

Extended temporal bone resection for squamous cell carcinoma.

OBJECTIVE: The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure. DESIGN: The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity. RESULTS: Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors. CONCLUSIONS: Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy.

Adult↗
PubMed1997

A molecular, clinical, and immunohistochemical study of vestibular schwannoma.

The molecular pathogenesis of vestibular schwannoma has been investigated by determining the extent of chromosome 22 loss of heterozygosity in 77 tumors and relating these findings to clinical and immunohistochemical indexes of tumor behavior. Loss of heterozygosity was looked for at eight chromosome 22q loci. Clinical details were obtained in all 77 cases, and a clinical growth index was calculated for each tumor. The proliferative index was estimated in all tumors by using a monoclonal antibody to the proliferating cell nuclear antigen and by calculating the labeling index. Forty percent (31 of 77) of the tumors showed allele loss, and in each case this loss involved the region of the neurofibromatosis type 2 gene. No evidence was found that the presence of chromosome 22 allele loss was associated with the clinical growth index. On the log scale, however, an association was seen between the clinical growth index and the proliferating cell nuclear antigen labeling index p = 0.001). These results suggest that chromsome 22 allele loss is a frequent event in vestibular schwannoma. Tumor behavior, however, appears to be independent of the chromosome 22 mutation. It is proposed that chromosome 22 allele loss and neurofibromatosis type 2 gene inactivation is an early event, possibly involved in the initiation of tumorigenesis in vestibular schwannoma. Tumor growth appears to be independent of this mutation and is likely to be determined by other as yet undefined factors.

Adult↗
PubMed1997

Chondrosarcoma of the petrous apex. Dilemmas in diagnosis and treatment.

A case of chrondrosarcoma of the petrous temporal bone is presented. Chondrosarcomas rarely occur intracranially and typically present apex mass. The dilemmas faced in the diagnosis and treatment of petrous apex chondrosarcomas are discussed. This case also gives interesting insight into the natural history of this tumour.

Chondrosarcoma↗