Biomedical subjects
Publications and source records attributed to F B Simmons.
Snoring caused by oropharyngeal obstruction and some cases of obstructive sleep apnea syndrome can be cured or considerably lessened by resecting redundant tissue from patients' oropharynx and soft palate. Preoperative, and in some instances postoperative, sleep monitoring is a necessary part of evaluating these conditions.
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Surgical resection of physiologically unneeded palate and oropharyngeal tissue can completely stop a large part of social snoring problems and benefit at least 50% of persons with the obstructive sleep apnea syndrome. We report detailed results of the conditions of 28 patients who underwent 50 palatopharyn-goplasty (PPD) operations done by us since the concept was introduced two years ago. The results clearly prove that the social snoring problem of most patients can be fixed. The results are inconclusive as to just how PPP surgery fits into predictive management of sleep apnea. For some patients it is an effective alternative to tracheotomy.
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Obstructive sleep apnea syndrome (OSAS), a disabling disorder that leads to life-threatening cardiorespiratory events during sleep, has been treated by tracheostomy. This article reports long-term follow-up data of 50 patients who have undergone this procedure, and the indications for surgery are summarized. Surgery may result in secondary local and general acute and subacute complications, but, on a long-term basis, patients were completely relieved of clinical symptoms, returned to full activity, and adapted normally to social and familial life. Temporary closure of the tracheostomy during sleep led to recurrence of obstructive sleep apnea.
The Crib-o-gram neonatal hearing screening project has detected 42 babies with handicapping degrees of hearing loss, mainly sensorineural. In apparently normal newborns the incidence is 1:1000 births. For graduates of the sick baby (intensive care) nursery, it is 1:52. Intrauterine and neonatal anoxia occurred in 73% of the latter group and was clearly the most common risk factor. Aminoglycosides had no obvious effect. The correlation between specific items in the medical histories and threshold pure tone audiograms was poor and unpredictable for any individual child. In general, anoxia tends to be associated with increased high-frequency hearing loss. Hearing losses were asymmetrical in 43% and probably progressive in 32% (average increase, 33 db). Only one child may have developed the hearing loss after hospital discharge, thus indicating that most, if not all, early childhood deafness is present in the neonatal period.
A newborn hearing screening technique (the Crib-o-gram) originally proposed by Simmons and Russ (1974) is described. The number of babies tested has now grown to over 12,000. The report presents follow-up data on the Crib-o-grain hearing screening program at Stanford University Medical Center. Improvements in test procedure and scoring have resulted in a current detection rate of 93%.
Left-right (y-axis) vestibulo-spinal torque responses were recorded from two of four intramodiolar stimulus electrodes placed for auditory stimulation in one human subject. For both electrodes, shorter (100 msec) stimuli caused either subjective or objective head turning whereas stimuli lasting longer than 0.5 sec caused either subjective or objective body tilt depending upon the electrode stimulated. The two electrodes tested also showed strikingly different auditory and vestibular effects. Stimulation of the remaining two electrodes caused no detectable vestibulo-spinal responses.
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Some patients with sudden hearing loss actually have two membrane breaks, one at the oval or round window and one further inside the cochlea. One may heal spontaneously and the other not, or both, or neither. It is very likely impossible to detect this early from the threshold audiogram, because the intracochlear breaks allows endolymph and perilymph mixing which spreads over much of the anatomically normal clchlea causing diffuse loss of function. This theory is illustrated by three case histories.
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An infant's hearing loss is detectable at any age. In spite of the importance of identifying deafness early, we do a poor job largely because the medical community is neither aware nor convinced that finding hearing loss is worth the trouble. There are two public health strategies for early detection, the high risk register (family history, hyperbilirubinemia, prematurity, rubella, and maxillofacial anomalies) and behavioral screening. The advantages and disadvantages are discussed. The incidence of handicapping hearing loss in newborns is 1 per 380 births and 1 per 61 in babies admitted to an intensive care nursery. This is higher than generally believed and may be one favorable result of using a new automated hearing screening system--the Crib-o-gram. In most deaf babies there is more than one risk factor present. Evaluating a hearing suspect baby demands a high index of suspicion, and taking the parent's suspicions seriously. The chances that a hearing loss exists at one year of age is about 1 in 4 on parental suspicion alone, regardless of what the physician's opinion might be. Immediate referral upon suspicion needs to occur more often than it does.