Biomedical subjects

D L Hoistad

Publications and source records attributed to D L Hoistad.

5 recordsLinked to original sources

PubMed2001

Update on conservative management of acoustic neuroma.

OBJECTIVE: To update the authors' experience with conservative management of acoustic neuromas. STUDY DESIGN: Retrospective chart review. SETTING: Private practice and tertiary care referral setting. INTERVENTION: Of 600 patients with acoustic neuroma, 102 were treated with the "wait and scan" treatment option. At least two magnetic resonance imaging scans were required of all patients. MAIN OUTCOME MEASURES: Change in tumor size over time was evaluated, as were clinical symptoms: hearing status, tinnitus, balance disturbance, aural fullness, vertigo, headache, and facial pain, numbness, or weakness. RESULTS: Of 102 patients, the average follow-up time interval was 28.5 months. Forty-five (44%) of 102 patients demonstrated a change in tumor size: an average total growth of 2.17 mm per year. In the remaining 54 patients (53%), no growth was demonstrated during a mean follow-up of 28.5 months. Three patients demonstrated actual tumor shrinkage. Of the 102 patients receiving conservative treatment, 85 (84%) reported hearing loss, 67 (66%) tinnitus, 37 (36%) balance disturbance, 29 (28%) aural fullness, 28 (27%) vertigo, 7 (7%) headache, 4 (4%) facial numbness, 2 (2%) facial weakness, and 0 (0%) facial pain. CONCLUSION: Conservative management-"wait and scan"-for selected patients with acoustic neuroma is a reasonable choice of management instead of radiation or microsurgery. In some situations the individual morbidities associated with surgery or radiation make those treatments not in the patient's best interests. A third option is necessary in patients who cannot or do not wish to undergo those other treatments.

Adult↗

PubMed2001

Long-term results of the first 500 cases of acoustic neuroma surgery.

OBJECTIVE: This retrospective study focuses on 2 outcome results after surgical intervention for acoustic neuroma: (1) facial nerve status, and (2) hearing preservation. STUDY DESIGN: A total of 484 patients with an acoustic neuroma. RESULTS: Postoperative facial nerve outcomes were significantly different (P < 0.001) according to the size of the tumors. Tumor size had even more influence on the immediate postoperative results. In addition, statistical significance (P < 0.05) was demonstrated in comparing facial nerve outcomes with the surgeon's surgical experience. We also noted that as the patient's age increases, the likelihood for facial dysfunction may increase for all postoperative intervals. The overall success rate of retaining useful hearing was 27% (26 of 95). Class A hearing was retained in 66% (10 of 15) of cases operated on through middle fossa approach in the last 5 years. CONCLUSION: This study demonstrates that tumor size and surgeon's experience are the most significant factors influencing the facial nerve status and hearing outcome after removal of acoustic neuroma.

Adolescent↗

PubMed1999

Sinusitis with contiguous abscess involvement of the clivus and petrous apices. Case report.

A wide spectrum of diseases may involve the clivus, such as primary neoplasms, metastatic disease, and inflammatory, vascular, hematopoietic, and infectious processes. Of these, osteomyelitis of the skull base and/or clival-petrous abscess are unusual, but may occur as a result of contiguous spread from the paranasal sinuses, namely, the posterior ethmoid and sphenoid, as was demonstrated by this patient. In this case report we discuss the pertinent anatomy, imaging studies, pathogenesis, and medical and surgical management of this case.

Abscess↗

PubMed1998

Histopathology of human temporal bone after cis-platinum, radiation, or both.

Preserving organs by use of multiple modalities has become protocol in treating squamous cell carcinomas of the head and neck, but cis-platinum and radiation can impair hearing. To determine the effect of cis-platinum, radiation, or a combination of these treatments on the temporal bone, we studied histopathologic slides of 15 human temporal bones: four after cis-platinum, five after radiation, two after combined treatment, and four from normal controls. Hair cells and cells in spiral ganglia were counted in reconstructed organs of Corti. Lumen-to-diameter indexes in arterioles near facial nerves were quantified for four normal controls and seven irradiated patients. Available audiograms were compared. Decreased spiral ganglion cells, loss of inner and outer hair cells, and atrophy of stria vascularis were demonstrated in groups receiving cis-platinum, radiation, and combinations, compared with age-matched controls. Arterioles around facial nerves demonstrated fibrinous clots within the intima, endothelial proliferation, and hypertrophy and fibrosis of vascular walls in smooth muscle. Fibrosis in connective tissue was clearly progressive after radiation. Cis-platinum and radiation can contribute to otologic sequelae, including sensorineural hearing losses, vascular changes, serous effusion, or fibrosis. Prophylactic treatments and techniques to deliver them should be considered for protection of temporal bones and preservation of hearing after oncologic modalities.

Adult↗

PubMedDate not supplied

Autoimmune sensorineural hearing loss: a human temporal bone study.

PURPOSE: To describe histopathologic findings in temporal bones of a patient whose clinical history suggests a sensorineural hearing loss (SNHL) of autoimmune origin. MATERIALS AND METHODS: Temporal bones from a patient with a history of ulcerative colitis, leukemia, and SNHL were examined by light microscopy. RESULTS: Histopathologic findings included: (1) organs of Corti missing or absent in all cochlear turns; (2) cells decreased in spiral ganglia, and lymphocytic infiltration; (3) absence of portions of the spiral prominence; (4) endolymphatic hydrops in basal, middle, and apical cochlear turns and in the saccule and utricle; (5) fibrosis and osteoneogenesis of a scala tympani of the basal turn of the cochlea, the posterior semicircular canal, and the canal of Cotugno; (6) fibrosis of the vestibular aqueduct and endolymphatic sac; and (7) lymphocytes in the endolymphatic sac, perisaccular area, inferior cochlear vein, and Rosenthal's canal. CONCLUSION: Histopathologic findings in the temporal bones of this patient with ulcerative colitis, sensorineural hearing loss, and vestibular symptoms closely parallel those in a previously reported animal study of autoimmunity and suggest the possibility of a SNHL of autoimmune origin.

Adolescent↗