Search PubMed⌕ Search

Biomedical subjects

E M Monsell

Publications and source records attributed to E M Monsell.

At least 19 recordsLinked to original sources
PubMed2000

Role of the specialty society in outcomes assessment: the development of COG*ENT.

The Cooperative Outcomes Group for ENT (COG*ENT), a clinical outcomes project of the American Academy of Otolaryngology--Head and Neck Surgery Foundation, was established to assess clinical outcomes of otolaryngological care of patients with two diseases, otitis media and rhinosinusitis. COG*ENT has produced an assessment tool with many potential applications. The development and early experience of the Foundation with this project are described, emphasizing the factors the authors believe are important for success.

Database Management Systems↗
PubMed1999

Hearing loss as a complication of Paget's disease of bone.

Hearing loss has long been known to be a complication of Paget's disease of bone. Older ideas about the mechanisms of hearing loss are being replaced by a new view based on experimental evidence from patients. Studies reviewed show no evidence of auditory nerve dysfunction and confirm a cochlear site of lesion. A loss of bone mineral density in the cochlear capsule is associated with both a high-tone hearing loss and a low-tone air-bone gap.

Aged↗
PubMed1997

Computerized dynamic platform posturography.

Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed. There are comments on future directions for research on computerized dynamic platform posturography and a summary and conclusion.

Diagnostic Techniques, Neurological↗
PubMed1997

Segmentation of acoustic neuromas with magnetic resonance imaging and Eigen image filtering.

OBJECTIVE: This study aimed to determine whether magnetic resonance imaging with Eigen image filtering can segment acoustic neuromas as a preliminary requirement to the development and validation of a volumetric method of measuring tumor size and growth using Eigen image filtering. STUDY DESIGN: This was an observational study. SETTING: The study was performed in an academic, comprehensive multi-specialty group practice. PATIENTS: Patients were a convenience sample of adults of both sexes who had acoustic neuromas identified by magnetic resonance imaging. Tumors ranged widely in size. INTERVENTION: Magnetic resonance imaging with digital image analysis using Eigen image filtering was the intervention. MAIN OUTCOME MEASURE: Observation and analysis of magnetic resonance images was the main outcome measure. RESULTS: The ability of magnetic resonance imaging with Eigen image filtering to segment acoustic neuromas of various sizes and shapes is illustrated. CONCLUSIONS: Magnetic resonance imaging with digital image analysis using Eigen image filtering is a promising method for volumetric measurement of acoustic neuroma size and growth. The potential for acoustic neuromas to grow may be underestimated by linear methods because of their relative lack of precision and of the geometric error that occurs in representing the volumetric growth of a three-dimensional tumor as a linear diameter.

Adult↗
PubMed1996

Preventive management of cerebrospinal fluid leakage in translabyrinthine surgery.

A simple technique can be used to prevent cerebrospinal fluid (CSF) leakage through the nose and the wound in translabyrinthine surgery. This method, evolved from Glasscock's technique of packing the eustachian tube, adds only 5 to 10 minutes to the procedure. The procedure was modeled in the temporal bones of 20 human cadavers, and the findings are described. With this technique, no nasal CSF leaks occurred in a consecutive series of 25 patients who underwent acoustic tumor surgery. Factors thought to be necessary for the success of the technique are discussed.

Adolescent↗
PubMed1996

Eustachian tube dysfunction.

There are several types of eustachian tube dysfunction, including obstruction and abnormal patency. This article presents an update on several selected areas of eustachian tube function and dysfunction, including surfactants, cleft palate, tympanic membrane atelectasis, abnormal eustachian tube patency, and long-term middle ear ventilation.

Cholesteatoma, Middle Ear↗
PubMed1995

Hearing loss in Paget's disease of bone: the relationship between pure-tone thresholds and mineral density of the cochlear capsule.

We have developed a unique method of quantitative computed tomography (QCT) that enables measurement of the density of the cochlear capsule in vivo. We performed pure-tone audiometry and QCT on 67 ears from 35 subjects with radiographically confirmed Paget's disease of the skull and on 40 ears from twenty volunteer subjects. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group affected by Paget's disease were -0.63 for left ears and -0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were -0.67 for left ears and -0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at p < 0.001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. These findings demonstrate the feasibility of precise and accurate density measurements in the temporal bone in vivo and support the use of the mean cochlear capsule density as a marker of disease effect. Alteration of cochlear capsule bone density may be related to the mechanisms of hearing loss in Paget's disease of bone.

Adult↗
PubMed1995

When paroxysmal positioning vertigo isn't benign.

The electronystagmographic auditory brainstem response and magnetic resonance imaging findings for a 33-year-old male with a 3.5 cm left vestibular schwannoma are presented. Of particular interest was the presence of an unusual positioning nystagmus following the Dix-Hallpike maneuver in the right head-hanging position. The patient demonstrated a nystagmus that was immediate in onset and not fatigueable upon repeated positioning. During positioning, the patient experienced a vertical bobbing sensation and dysphoria, but not rotational vertigo. Most importantly, the nystagmus had a predominant downbeating vertical component. the case illustrates the diagnostic significance of downbeating nystagmus elicited by the Dix-Hallpike maneuver.

Adult↗
PubMed1995

Hearing loss in Paget's disease of bone: evidence of auditory nerve integrity.

Auditory brainstem responses (ABRs) were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. Auditory brainstem responses were interpreted as normal in 56 ears; none were abnormal. Computed tomography and digital image analysis were used to quantify internal auditory canal (IAC) dimensions. The midlength diameter and minimum diameter of the IAC of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relation to hearing thresholds. Increased IAC length showed a limited relation to reduced hearing level in pagetic subjects, possibly consistent with bossing adjacent to the porus acusticus. Findings support the principle that hearing loss in Paget's disease of bone is generally associated with intact auditory nerve function and also support a cochlear site of lesion.

Audiometry, Pure-Tone↗
PubMed1995

Proliferation indices of vestibular schwannomas by Ki-67 and proliferating cell nuclear antigen.

Two immunohistologic demonstrations of markers of proliferating cells, Ki-67 and proliferating cell nuclear antigen, were applied to tissues from 10 vestibular schwannomas. Each method demonstrated three distinct rates of positively stained cells (p < .01 and p < .015, respectively, for each method). There was a one-to-one correspondence between the two immunohistologic methods in the assignment of cases to each growth rate category except for two cases (Spearman rank correlation r = 0.76, p < .05). These data support the concept of distinct growth rates in vestibular schwannoma. Tissues were also sampled from different areas of the same tumor within nine samples. The results suggest that tumor growth is not homogeneous within a tumor, but that proliferation may be more active near the surface.

Adult↗
PubMed1994

Application of quantitative computed tomography to Paget's disease of bone.

Serial evaluation of pagetic lesions is handicapped by the inability of conventional methods to reproduce precisely the positioning of the area of interest. A computed tomography method that provides visual and quantitative comparisons between data sets acquired at different times has been developed. The utility of this method is illustrated with an example of serial examinations that demonstrate the effect of treatment on small lytic lesions in the lumbar spine. A further demonstration is made of the ability of this method to identify and quantify lytic changes within the cochlear capsule.

Aged↗
PubMed1994

Results and outcomes in ossiculoplasty.

This article presents a series of goals and questions for future research in ossiculoplasty. Important technical questions include what are the best materials, prosthesis shapes, and techniques of placement for both immediate and long-term success. Important clinical questions include what improvements in communication should we expect, how should cases be selected, and how should patients be counseled. There are many variables that could affect reported results, including the selection of cases, audiometric techniques, the frequencies of hearing measurement, and the methods of data analysis. These are all discussed in this article.

Audiometry, Pure-Tone↗
PubMed1993

Measurement of regional bone mineral density: a new technique for the evaluation of the temporal bone.

The measurement of regional bone mineral density (rBMD) is a new method of evaluation of the human temporal bone in vitro or in vivo. Modified computed tomography (CT) enables us to collect a three-dimensional array of precise, reproducible bone density values, as well as high-quality CT images. Measurements are calibrated using phantoms of known composition and density. Conventional CT provides density information that is relative, qualitative, and lacks precise reproducibility over time. The rBMD technique provides precise numeric density measurements. Additional image processing capabilities are described. In vivo data from six normal temporal bones and from two patients with Paget's disease involving the temporal bone are presented to demonstrate the technique.

Aged↗
PubMed1993

Therapeutic use of aminoglycosides in Ménière's disease.

This article details the various effects of aminoglycosides used to treat individuals with Ménière's disease. Effects of aminoglycosides on hair cells and dark cells are described in addition to intramuscular streptomycin, intratympanic application of aminoglycosides, and the application of streptomycin to the lateral semicircular canal.

Aminoglycosides↗
PubMed1992

Labyrinthotomy with streptomycin infusion: early results of a multicenter study. The LSI Multicenter Study Group.

Early results for hearing and vertigo are reported for 47 labyrinthotomies with streptomycin infusion (LSI) by 13 coinvestigator-surgeons. Sixty-eight percent of patients had worse hearing after surgery (10 dB or 15% word recognition). Patients with a preoperative pure-tone average better than or equal to 40 dB appeared to suffer less postoperative hearing loss than those with a greater preoperative deficit. Severe to profound postoperative hearing loss was experienced by 27 patients (57%), all of whom had preoperative pure-tone averages worse than 40 dB. Opening the endolymphatic space was associated with a deleterious effect on hearing. Because of persistent vertigo, 17 percent of patients required a secondary procedure during the period of observation. These early results indicate that LSI is associated with a significant risk of postoperative hearing loss. Of the 13 coinvestigator-surgeons, four have stopped using LSI, while one considers his results satisfactory. The remaining surgeons have taken an intermediate position and feel it is useful in selected cases. Longer follow-up is required to judge the efficacy of LSI for controlling vertigo. We are currently studying these long-term results.

Adult↗
PubMed1990

Estrogen and progesterone binding by acoustic neuroma tissue.

Tissue samples from 37 acoustic neuromas were assayed for estrogen and progesterone hormone receptor binding by radioimmunoassay using a dextran-coated charcoal method and Scatchard plot analysis. Twenty-one of the samples were from men, and 16 of the samples were from women. Seven of 37 samples (19%) were positive for estrogen receptor and six of 36 samples (17%) were positive for progesterone receptor. Three of 37 samples (8%) were positive for both receptors. There was no correlation of estrogen receptor positivity with the sex of the patient. These results indicate that estrogen or progesterone receptor binding activity or both are present in a small subset of acoustic tumors. Evidence is lacking, however, that binding of estrogen to the receptor results in growth changes in the tumor. The empirical use of antiestrogen treatment in acoustic neuroma does not appear to be justified at the present time.

Adult↗