Search PubMed⌕ Search

Biomedical subjects

D B Kamerer

Publications and source records attributed to D B Kamerer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Single-stage management of cholesteatoma.

Surgical management of chronic otitis media with cholesteatoma can be performed in a single-stage procedure, with revision surgery necessary because of recurrent disease or electively with unsatisfactory hearing results. We retrospectively reviewed 164 cases with cholesteatoma surgically managed from 1980 through 1986. In total there were 11 tympanoplasties, 36 canal wall-up mastoidectomies, 81 canal wall down modified radical mastoidectomies, and 36 radical mastoidectomies. The recidivistic rate for cholesteatoma in patients available for 5-year followup was 11% for tympanoplasties, 19% for canal wall-up mastoidectomies, 5% for canal wall-down modified radical mastoidectomies, and 0% for radical mastoidectomies. Hearing results were best in patients who required tympanoplasty alone, followed by those who underwent canal wall-down procedures. Single-stage management of cholesteatoma with modified radical mastoidectomy (canal wall-down) required fewer revisions for recidivistic cholesteatoma and achieved better hearing results than canal wall-up procedures. We conclude, therefore, that staging is not necessary. Improved hearing may likely be achieved with a second procedure, but this is at the patient's discretion.

Adolescent↗
PubMed1992

Beta 2 transferrin application in otology.

The diagnosis and management of perilymphatic fistula has received considerable attention in recent years. Despite the use of sophisticated technology, the diagnosis of perilymphatic fistula continues to rest primarily upon clinical suspicion and the exclusion of other disorders. In addition, the confirmation of a perilymphatic fistula during surgical exploration is usually based upon the subjective observation of fluid pooling in niches of the middle ear. A sensitive and objective laboratory test for identifying perilymph in the middle ear would be a useful adjunct for the diagnosis and management of perilymphatic fistula. The objective of this paper is to demonstrate the potential utility of beta 2 (beta 2) transferrin assay in the diagnosis of perilymphatic fistula. To accomplish this objective, we confirmed that beta 2 transferrin is present in living human perilymph and is absent in the normal or inflamed middle ear. In addition, the utility of beta 2 transferrin assay in the diagnosis of cerebrospinal fluid otorrhea is presented.

Aged↗
PubMed1991

Familial sensorineural hearing loss: a correlative study of audiologic, radiographic, and vestibular findings.

A multidisciplinary approach to the study of a family with autosomal dominant sensorineural hearing loss is presented. The affected family members underwent extensive clinical and laboratory evaluation. They were found to have various degrees of bilateral congenital inner ear anomalies as imaged by computed tomography. The degree of structural abnormalities in the inner ears correlated with the severity of hearing impairment. Vestibular testing revealed nonspecific abnormalities generally correlating with audiologic and radiographic findings. This report presents a unique form of sensorineural hearing loss not previously described and is the first in-depth clinical study of nonsyndromal "Mondini dysplasia" occurring in a family.

Adult↗
PubMed1991

The role of preoperative CT scans in staging external auditory meatus carcinoma: radiologic-pathologic correlation study.

Survival is related to the pathologic extent of tumor in external auditory meatus (EAM) carcinoma. This study assesses the validity of preoperative CT scans in staging EAM carcinoma. The accuracy of staging EAM carcinoma with preoperative CT scans was evaluated by comparing radiography and histopathology. Patients who received preoperative CT scan were selected from a retrospective series of 35 temporal bone resections for EAM squamous cell carcinoma. The CT scans were systematically reviewed for tumor involvement in 12 anatomic areas. The histopathology slides for the corresponding patients were reviewed according to the same criteria. CT scan findings accurately diagnosed the extent of tumor involvement identified during histopathologic examination. These tumors demonstrated the capacity to spread along existing anatomic pathways as well as direct bone erosion. We conclude that preoperative CT scans accurately stage EAM squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1991

Odontoma of the middle ear cleft.

Odontoma of the middle ear cleft is an unusual cause of conductive hearing loss. We report two cases and discuss the developmental mechanism by which this anomaly may occur. The differential diagnosis of calcified masses in the middle ear is also discussed.

Adult↗
PubMed1991

Metastatic atrial myxoma to the temporal bone: case report.

A 25-year-old male underwent right mastoid surgery for removal of a soft tissue mass. At age 29 a left cardiac atrial myxoma was excised. At age 34 an expanding right supra-auricular mass with extension into the middle and posterior fossa necessitated total temporal bone resection. Pathology proved to be myxoma. Retrospective review of tissue obtained from the initial mastoid procedure was also myxoma. The temporal bone lesion was considered to be persistent and metastatic atrial myxoma. A review of atrial myxomas and this most unusual metastatic presentation is discussed.

Adult↗
PubMed1990

Malignant external otitis: utility of CT in diagnosis and follow-up.

Malignant external otitis is a severe bacterial infection of the bone and soft tissues of the base of the skull that is frequently difficult to diagnose. The effectiveness of antibiotic therapy is likewise difficult to assess. Serial computed tomographic (CT) scans were obtained in 11 consecutive patients with malignant external otitis at time of diagnosis and periodically after conclusion of antibiotic therapy. All patients demonstrated abnormalities of the external auditory canal, with or without bone destruction. Soft tissue or fluid in the middle ear and mastoid, around the eustachian tube, and in the parapharyngeal space (both pre- and poststyloid) was seen in greater than 50% of the cases. While remineralization of bone was not seen, soft-tissue disease improved dramatically, and recurrence or persistence could be corroborated by detection of more extensive soft-tissue changes. By delineating the extra- and intracranial extent of disease, serial CT scans enable one to make the diagnosis, determine the extent of infection, document recurrence, exclude progression, and confirm resolution of malignant external otitis.

Blood Sedimentation↗
PubMed1990

Aural irrigation with water: a potential pathogenic mechanism for inducing malignant external otitis?

We hypothesized that the forcible introduction of water containing Pseudomonas aeruginosa into the ear canal of a susceptible host (an elderly diabetic with cutaneous hypoperfusion secondary to microangiopathy) was the inciting factor in the development of malignant external otitis. Tap water irrigation of the ears by a physician preceded the onset of symptoms in 61.5% (8/13) of cases of malignant external otitis. Two control subjects with known diabetes mellitus were matched for each patient by sex and age. Both groups were questioned on the nature and degree of aural water exposure, as well as history of ear disease. There were no significant differences between 13 patients and 26 control subjects for presence of ear disease (hearing loss, chronic infection, prior operations), swimming, showering, bathing, frequency of ear cleaning, or method of ear cleaning (washcloth, cotton applicator). Patients with malignant external otitis had a statistically significant higher incidence of aural irrigation with tap water when compared with control subjects. We suggest that a substantial number of cases of malignant external otitis may be iatrogenic.

Aged↗
PubMed1990

Staging proposal for external auditory meatus carcinoma based on preoperative clinical examination and computed tomography findings.

An accepted staging system for squamous cell carcinoma of the external auditory meatus is currently lacking and would permit accurate comparison of treatment strategies and results for patients with this unusual neoplasm. In order to develop such a staging system we reviewed the prognostic variables and the accuracy of radiographic diagnosis in 39 patients undergoing temporal bone resection for squamous carcinoma of the external auditory meatus. Predictors of poor survival were extensive tumor involvement, facial nerve paralysis, middle ear involvement, and cervical or periparotid lymphadenopathy. In a comparison of 12 specific anatomic sites, computed tomography was found to be an accurate indicator of histopathologically proven tumor invasion. On the basis of this clinical radiographic-histopathologic analysis, we propose a TNM staging system for external auditory meatus carcinoma utilizing preoperative computed tomography and physical examination. This system fulfills the requirements of the American Joint Committee on Cancer that a staging system should provide a sound basis for therapeutic planning for cancer patients by describing the survival and resultant treatment of different patient groups in comparable form.

Aged↗
PubMed1990

Vestibular recruitment in Meniere's disease.

The aim of this study was to search for vestibular recruitment in a sample of patients with Meniere's disease. Recruitment was defined as an abnormal growth of response with increasing stimulus intensity. Twenty-nine patients were tested with sinusoidal rotation of three different magnitudes at four different frequencies. We also searched for auditory recruitment in each patient via tests of auditory brain stem responses, acoustic reflexes, and loudness balance and discomfort level. Analysis of vestibular responses indicated, on average, a linear relationship between stimulus magnitude and response magnitude, ie, doubling the stimulus magnitude resulted in twice the response magnitude. Meniere's patients did not yield results significantly different (although they were more variable) from those of the normal subjects. The vestibular responses of patients with auditory recruitment did not differ systematically from those of patients without auditory recruitment. We conclude that vestibular recruitment, if it exists in patients with Meniere's disease, is not demonstrated by sinusoidal rotational testing.

Adult↗
PubMed1990

Primary fallopian canal glomus tumors.

Primary fallopian canal glomus tumor has been reported only once previously, although the occurrence of glomus body tissue in the fallopian canal was documented many years ago. Facial paresis as a presenting symptom of glomus tumors is well known, as is facial nerve invasion by glomus tumors. However, a primary fallopian canal glomus tumor that extends extratemporally to the pes anserinus is unusual. Although facial nerve grafting may be necessary for removal of some glomus jugulare tumors, the need for facial nerve grafting appears to be uniform in the patients with primary fallopian canal glomus tumors. The primary fallopian canal glomus tumors that we report did not involve the jugular fossa or the Jacobson's branch of the glossopharyngeal nerve. Both tumors did extend to the middle ear and mastoid and followed the facial nerve extratemporally. The latter features appear to typify primary fallopian canal glomus tumors.

Adult↗
PubMed1989

Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis.

Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin. The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit.

Aged↗
PubMed1989

Earth horizontal axis rotational responses in patients with unilateral peripheral vestibular deficits.

We evaluated the vestibulo-ocular reflex (VOR) of five patients with surgically confirmed unilateral peripheral vestibular lesions. Testing used both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotation. Results indicated that the patients had short VOR time constants, asymmetric responses to both EVA and EHA rotation, and normal EHA modulation components. These findings suggest that unilateral peripheral vestibular loss causes a shortened VOR time constant even with the addition of dynamic otolithic stimulation and causes an asymmetry in semicircular canal-ocular reflexes and one aspect of otolith-ocular reflexes.

Aged↗
PubMed1989

Squamous cell carcinoma of the external auditory meatus (canal).

A retrospective study of 35 patients with squamous cell carcinoma of the external auditory meatus treated at the Eye and Ear Hospital of the University of Pittsburgh was performed. The standard treatment was a temporal bone resection that corresponded to the extent of the lesion, followed by postoperative radiation therapy. The tumor extensions, symptoms, treatments, survival rates, and prognostic variables were reviewed. Overall, 12 of 35 patients survived. Lesions limited to the external auditory meatus with no erosion had excellent prognoses. Survival in intermediate lesions with bony erosion or middle ear involvement was related to the status of surgical margins after partial or subtotal temporal bone resections. Extensive lesions that involved the surrounding soft tissue or dura had poor prognoses. The survival value of total temporal bone resection remains unproved.

Aged↗