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D B Welling

Publications and source records attributed to D B Welling.

47 records · Page 3Linked to original sources
PubMed1992

Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions.

Patients with compensated unilateral vestibular lesions often have no detectable abnormality on conventional posturography. The purpose of this study was to determine whether a change in head orientation could improve the diagnostic sensitivity of the test for these patients. Twenty-four patients with known unilateral vestibulopathy and twenty-four normal controls were tested on the EquiTest apparatus in four head positions: head centered, head tilted right, head tilted left, and head extended. The sensory organization test was performed for each head position, using a single trial for each sensory condition. The test sequence was randomized to account for simple order effects. The subject's equilibrium was quantified by a performance index and a composite score of all sensory conditions was calculated for each head position. Patients with unilateral vestibulopathy had more postural sway with the head tilted contralateral to the side of lesion. The difference between the mean composite scores for ipsilateral and contralateral head tilts was statistically significant (p less than 0.05). When individual trials were compared, equilibrium scores were significantly different only for sensory conditions that required vestibular input. Head extension increased postural sway in both patients and controls. Equilibrium scores were significantly different for all sensory conditions in which the support was sway-referenced. We suggest that the results of head extension in patients are similar to those found in normal individuals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Avulsion of the anomalous facial nerve at stapedectomy.

Injury to the facial nerve in an anomalous location overlying the oval window at the time of stapedectomy has rarely been reported. The authors recently have encountered three patients with such injuries. The facial nerve was found at the time of reexploration to run directly over the oval window. A fourth patient was explored primarily for a conductive hearing loss and the same anomalous course was discovered. The purpose of this report is to alert the otologic surgeon to this rare but potentially catastrophic anomaly and to review the pertinent embryology and management of these malformations.

Adult↗
PubMed1991

Unilateral sensorineural hearing loss rehabilitation.

The Audiant Bone Conductor has been heralded as an aid for use in conductive hearing loss; however, its possible use in unilateral sensorineural hearing loss (SNHL) has also been proposed. Between July 1987 and July 1989, profound unilateral sensorineural hearing loss has been rehabilitated in 43 patients using the Xomed Audiant Bone Conductor. Patients who were willing to participate in this clinical trial and who were felt to be good contralateral routing of signals (CROS) aid candidates were selected preoperatively. Audiometric followup, selection criteria, patient satisfaction, and complications are discussed.

Adult↗
PubMed1990

Acoustic neuroma: a cost-effective approach.

A cost-effective approach to the diagnosis and treatment of acoustic neuromas continues to evolve as diagnostic methods improve. In the past 7 months, since gadolinium-enhanced magnetic resonance imaging (MRI) has become available in our practice, our screening and presurgical workup has changed. The purpose of this article is to outline the current philosophy of the senior authors in relation to acoustic neuroma management on the basis of 72 patients diagnosed from July 1988 to February 1989. With more sensitive diagnostic means, older less sensitive studies may be eliminated from the routine workup, thus maintaining cost-effectiveness while preserving the highest standard of patient care. The body of this article will review our current use of the many available diagnostic options and emphasize a cost-effective approach.

Adult↗
PubMed1989

Facial nerve function following irradiated cable grafts.

Facial nerve cable grafting preceding postoperative radiation therapy in patients undergoing facial nerve resection for malignant disease remains controversial. Twelve cases of postoperatively irradiated facial nerve cable grafts are reviewed in detail. Of nine patients with long-term evaluations, all have shown some return of facial nerve function, with seven having moderate to excellent return of function, as documented on videotapes and shown in still photographs. We conclude that cable grafting is the treatment of choice, even though postoperative radiation therapy is planned. Cable grafting should almost always result in facial function that is clearly superior to the function provided by static or dynamic slings.

Adult↗
PubMed1989

Management of bilateral acoustic tumors.

Bilateral acoustic tumors (Neurofibromatosis 2) have now been shown to arise in patients with gene abnormalities separate from those with von Recklinghausen's disease (Neurofibromatosis 1). The management of patients with this disease has long posed a particularly challenging problem for the neurotologist. This retrospective study reviews our series of 38 patients and updates a previous report. Thirty-four patients underwent surgical excision of tumors on one or both sides. Hearing conservation was attempted in 20 with hearing preservation possible in eight. Recent advances in understanding the hereditary etiology of this disease, changing methods for diagnosis, preferred surgical techniques, and guidelines for appropriate patient management are discussed.

Adult↗
PubMed1989

Glomus tympanicum tumors: contemporary concepts in conservation surgery.

The management of glomus tympanicum tumors is not a new subject. A review of the contemporary management concept is, however, needed for two reasons: 1. the recent literature has suggested radiation therapy as a treatment option in this surgical disease, and 2. patients who are referred to us for management of these tumors continue to exhibit errors in diagnosis and surgical approaches that are unnecessarily radical. The purpose of this paper is to review the diagnosis of these lesions and to prospectively differentiate them from the more extensive jugulare tumors. When type and extent of the tumor are properly determined, a surgical procedure can be planned that conserves as much normal ear anatomy and function as possible. Between May 1970 and July 1988, 60 patients with glomus tympanicum tumors were treated at the Otology Group, P.C., in Nashville, Tennessee. In 47 patients (78%), the tumors were removed using an extended facial recess approach. The external auditory canal wall was removed in seven patients (12%), and six patients underwent a transcanal approach. Total tumor removal was obtained in 90% of patients. Surgical management remains the mainstay of treatment for glomus tympanicum tumors.

Adult↗
PubMed1989

Petrous apex cholesteatoma.

In this chapter we have reviewed the etiology, diagnosis, and surgical treatment of petrous apex cholesteatoma. The etiology is usually congenital for those tumors arising within the apex, but acquired for lesions secondarily invading the apex. Diagnosis is primarily radiographic. CT remains an excellent modality for determining the extent of disease, whereas recent advances with MRI help in differential diagnosis. In our experience the middle fossa approach and the translabyrinthine-transcochlear approach allow the surgeon the best opportunity to effectively treat this rare and challenging tumor.

Adolescent↗
PubMed1988

Irradiated homologous cartilage grafts. Long-term results.

The use of irradiated homologous cartilage for the restoration of facial contour defects remains a controversial issue in reconstructive surgery. Both favorable and unfavorable reports can be found in the literature. Some basic research concerning the rate and mechanism of resorption has been completed but has failed to resolve the issue of the usefulness of this material in day-to-day practice. One frequently cited reference concerning the use of irradiated homologous cartilage in reconstructive surgery was coauthored by two of the present investigators ten years ago. In an effort to place this study in a long-term perspective, we examined 42 of the original 107 patients who formed the initial population base. Sixty-two of the original 145 irradiated homologous cartilage grafts have been followed up for an average of nine years, with an average resorption rate of approximately 75%. Eighteen of 24 grafts followed up from 11 to 16 years completely resorbed. In spite of complete graft resorption, some patients have maintained satisfactory facial contour with fibrous tissue replacement of the cartilage.

Absorption↗
PubMed1987

American Burkitt's lymphoma of the mastoid.

Primary clinical presentation of malignant lymphoma in the middle ear is rare. One case of African Burkitt's lymphoma involving the mastoid has been reported, but the case herein presented would appear to be the first case of American Burkitt's lymphoma in the literature. American and African varieties have distinct clinical presentations but are histologically identical. Chemotherapy is effective against these aggressive tumors. A 6-year-old boy with the first known case of American Burkitt's lymphoma of the mastoid is presented. He is doing well 23 months from the onset of symptoms.

Burkitt Lymphoma↗