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Biomedical subjects

D S Poe

Publications and source records attributed to D S Poe.

At least 37 records · Page 2Linked to original sources
PubMed1993

Cartilage tympanoplasty for management of retraction pockets and cholesteatomas.

Retraction pockets of the tympanic membrane, often associated with dysfunction of the eustachian tube, can be destructive, leading to loss of hearing, ossicular erosion, and development of cholesteatomas. This retrospective study reviews results from 35 patients (38 ears) operated on from January 1988 to June 1991 whose composite cartilage-perichondrial grafts harvested from the tragus were used to reconstruct the tympanic membrane. Early grafts reinforcing the posterosuperior quadrant of the pars tensa showed some failures, with recurrent retraction in the attic. In later grafts, additional placing of cartilage under the pars flaccida prevented failures in the attic. Our indications, initial technique and refinements to the present form, and hearing results are discussed.

Cholesteatoma↗
PubMed1993

Translabyrinthine drillout from suboccipital approach to acoustic neuroma.

The suboccipital approach to acoustic neuroma surgery is used when preservation of hearing is desired or when the surgeon prefers the approach even when hearing cannot be saved. its major disadvantages are poor exposure of the lateral internal auditory canal and lack of precise bony landmarks to identify the facial nerve. When hopes for preservation of hearing are abandoned and complete removal of tumor is considered paramount, a wider drillout of the posterior temporal bone may be accomplished through the suboccipital approach. The posterior semicircular canal may be opened and followed into the vestibule. A translabyrinthine exposure of the vertical crest and full length of the internal auditory canal is readily obtained. Translabyrinthine drillout procedures were performed in 14 patients, and the technique was expedient and yielded excellent exposure. An abdominal fat graft was not required, and only one instance of leakage of cerebrospinal fluid occurred. Translabyrinthine drillout from the suboccipital approach is a useful adjunct when sacrifice of hearing is indicated.

Ear Neoplasms↗
PubMed1993

Intravenous fluorescein for detection of perilymphatic fistulas.

It has been reported, in animal models and recently in human beings, that intravenous fluorescein is taken up in perilymph and may be useful as a tracer for the detection of perilymphatic fistulas. We attempted to reproduce the results of these animal experiments. Twenty-one middle ears of eight cats and four dogs were exposed. Fluorescein was given intravenously. Fluorescence was initially noted in transudates pooling in the oval and round window niches. Fistulas created with a straight pick produced a bright fluorescence in the leaking fluids, possibly from a ruptured small membrane vessel. Fistulas created with the carbon dioxide laser and with complete hemostasis demonstrated no fluorescence. We concluded that intravenously administered fluorescein causes dramatic fluorescence of vessels and transudates that may be interpreted falsely as fluorescence of perilymph. Fluorescence was not evident in perilymph when complete hemostasis was obtained.

Animals↗
PubMed1992

Transtympanic endoscopy of the middle ear.

Modern optical technology has made available fiberoptic and rigid endoscopes with diameters of 2 mm and less with acceptable resolution. Endoscopes of small caliber were introduced through a strategically placed myringotomy or an existing perforation to perform exploration of the middle ear as an in-the-office procedure. This technique is now routinely used as an adjunct in the diagnostic evaluation of patients with suspected middle ear conditions. Exploratory surgery of the middle ear may be avoided or definitive procedures may be planned better based on endoscopic findings.

Adolescent↗
PubMed1992

Evaluation of perilymphatic fistulas by middle ear endoscopy.

Transtympanic endoscopy provides a unique opportunity to view the undisturbed contents of the middle ear. Fiberoptic and rigid endoscopes have been used for thorough examination of the middle ear without the need for local anesthetics or surgical trauma. Endoscopy is now routinely used in the evaluation of a perilymphatic fistula and the patient is awake during an intermittent forceful Valsalva maneuver. Oval and round windows in both ears of five cats were studied endoscopically to evaluate surgically created fistulas. Excellent visualization of the defect was obtained in all instances. Endoscopy is a useful office technique for the evaluation of perilymphatic fistula. It reduces the need for surgical exploration and provides a satisfactory examination of the middle ear. Obliteration of the window niche can even be performed through the myringotomy using autologous blood.

Adult↗
PubMed1991

Long-term results after lateral cranial base surgery.

The surgical management of patients with slow-growing benign temporal bone neoplasms has been criticized because of its significant morbidity and mortality compared with results after radiation therapy, but long-term control by irradiation remains unproved. Long-term surgical results have not been studied previously. One hundred twenty-nine skull base operations were performed in 126 patients at the Otology Group, Nashville, Tenn., from January 1970 through May 1987. Fifty-eight patients responded to questionnaires focusing on recovery from loss of cranial nerves. All patients regained some degree of facial function (class V or better), no alimentary tubes or tracheotomies were in use, and no patients had debilitating aspiration. Long-term compensation from the cranial nerve deficits of lateral skull base surgery can be expected in most patients and should not be used as an argument for irradiation in patients with a long life expectancy at time of diagnosis.

Adolescent↗
PubMed1990

Diagnosis and management of paragangliomas of the skull base.

In appropriately selected patients, glomus tumors of the head and neck are best treated surgically. Unresectability is not a factor in therapeutic planning for local disease control. Existing techniques and exposures for tumor removal can be reliably applied to these paragangliomas, with acceptable morbidity and mortality. A team approach to this problem is mandatory.

Adult↗
PubMed1990

Pathologic findings in the labyrinthine segment of the facial nerve in a case of facial paralysis.

The histopathologic findings for a patient with acute facial paralysis caused by herpes zoster oticus who obtained no return of active facial function after 1 year are presented. All imaging studies were nondiagnostic. Biopsy of the labyrinthine segment was performed. Histopathologic analysis showed a sharp line of demarcation between sclerotic nerve proximal to and necrotic nerve distal to the meatal foramen area of the fallopian canal. This finding is consistent with observations that the lesion producing Bell's palsy and herpes zoster oticus usually is situated at the meatal foramen.

Adult↗
PubMed1990

Surgical management of cholesteatoma in an only hearing ear.

The patient with a cholesteatoma in an only hearing ear presents a management dilemma: how best to treat the patient to minimize the chances of developing a severe hearing loss in that ear. Twelve patients managed surgically for cholesteatoma in their only hearing ear are reviewed. The location and extent of the cholesteatoma, the type of operation performed, and postoperative hearing results are presented. Eleven of the 12 patients maintained their bone-conducted speech reception threshold to within 5 dB of the preoperative level during follow-up periods of 2 months to 4 years. Recommendations are made regarding preoperative evaluation, perioperative use of antibiotics and steroids, operative planning, ossicular reconstruction, and postoperative care. Special attention is given to the evaluation and management of the ear that has a fistula eroding into the cochlea and semicircular canals, both when suspected from preoperative imaging studies and when discovered intraoperatively.

Cholesteatoma↗
PubMed1990

Management of large dural defects in skull base surgery: an update.

The use of a ventriculoatrial shunt for long-term CSF diversion for reconstruction after resection of large skull base tumors with intradural extension has been discontinued. The concern about placing a permanent foreign body in a wound open for 12 to 18 hours is our primary reason for changing the technique. Our present approach uses a rectus abdominis microvascular free flap over the fascial closure of the dural defect. Although our experience with this technique is limited, the advantages over the technique used previously warrant its continued use.

Abdominal Muscles↗
PubMed1989

Long-term hearing results following middle fossa vestibular nerve section.

Hearing stabilization following middle fossa vestibular nerve section (MFVNS) has been observed to occur in a large percentage of patients (71% to 86%) after short-term followup. This study looks at the long-term audiological followup (5 to 15 years) of 46 patients who underwent a MFVNS for intractable Meniere's disease. Although the percentage of patients with stabilized hearing was relatively high within the first 2 years postoperatively (61%), it dropped to 41% after a longer followup of 5 to 15 years. When this patient population is divided into two groups based on their preoperative PTA, those patients in whom hearing had bottomed out to greater than or equal to 50 dB PTA preoperatively lost only 5 dB PTA over the course of the follow-up period. The patients with better preoperative hearing (less than 50 dB PTA) lost 30 dB PTA over the same follow-up period. As this pattern is similar to what has been observed in nonsurgically treated Meniere's patients, we conclude that the MFVNS has no beneficial effect on the hearing loss associated with Meniere's disease.

Adult↗
PubMed1989

A paraneoplastic syndrome associated with glomus tumors of the skull base? Early observations.

Independent secretion of vasoactive substances by glomus tumors of the skull base is widely recognized. Surgical removal of these tumors often results in an unexplained prolonged postoperative ileus, even in cases in which the vagus nerve is preserved. There is evidence that these tumors may secrete neuropeptides, such as cholecystokinin, in addition to catecholamines. A retrospective analysis of cases of glomus tumors of the skull base operated on at The Otology Group was carried out to correlate preoperative neuropeptide levels, vagus nerve status at surgery, and duration of postoperative ileus. High circulating levels of cholecystokinin associated with these tumors may be responsible for the unexplained phenomenon of prolonged postoperative ileus. The relevance of neuropeptides to the postoperative management of these patients is discussed. Preventive measures that may avert the potentially lethal complications of aspiration and negative nitrogen balance are described.

Catecholamines↗
PubMed1989

Facial reanimation by XI-VII anastomosis without shoulder paralysis.

Transposition of the spinal accessory (XI) and facial (VII) nerves has been used successfully in reanimation of facial paralysis, but because of the severity of symptoms associated with denervation of the trapezius muscle, this technique has largely been abandoned. Hypoglossal-facial (XII-VII) nerve anastomosis has now become a more favored procedure; however, the resultant hemiglossal atrophy carries some morbidity. Transposition of the sternocleidomastoid (SCM) branch of the accessory nerve as a way to avoid shoulder paralysis was reported more than 20 years ago with initially excellent results, yet few follow-up studies have been done. Twenty-one fresh cadaver dissections of the accessory nerve-SCM branch and facial nerve were performed to determine if adequate numbers of fascicle groups and sufficient proximal nerve length are available for an adequate end-to-end anastomosis without nerve interposition grafting. This paper presents our anatomic and histologic findings to support the use of proximal SCM nerve anastomosis to distal facial nerve in facial reanimation. When feasible, the use of this technique to correct facial paralysis is encouraged rather than hypoglossal-to-facial nerve anastomotic repair.

Accessory Nerve↗
PubMed1989

Cochlear implantation after transmastoid labyrinthectomy.

Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have an intact otic capsule prior to implantation. However, the suitability for implantation of patients who have undergone extensive procedures involving the otic capsule such as labyrinthectomy has not been directly addressed. This report documents a case of a patient deafened by a transmastoid labyrinthectomy who subsequently received a cochlear implant. Postimplantation performance of this patient was compared with the performance of three other postlingual implant recipients. The results suggest that labyrinthectomy is not a contraindication to auditory rehabilitation by a cochlear implant. The implications of implantation in a surgically manipulated otic capsule are discussed.

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↗
PubMed1989

What I think of sac surgery in 1989.

The senior author has performed shunt procedures routinely for medically refractory cases of Meniere's disease starting in 1964 and ending in 1984. Five hundred and sixty-eight consecutive patients were operated on and followed from 1970 to 1984. Combining the cases of C. G. Jackson, there have been a total of 676 procedures done at the Otology Group. Initially endolymphatic-subarachnoid (ES) shunts were used, then endolymphatic-mastoid shunts (EM), and most recently, the Denver valve has been employed. No significant difference between these procedures was noted in the control of vertigo or stabilization of hearing. Successful resolution of vertigo occurred in less than 60%. Sac surgery at the Otology Group, therefore, has been abandoned in favor of vestibular nerve section for the surgical management of medically refractory Meniere's disease with disabling vertigo.

Ear, Inner↗