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Biomedical subjects

F M Rizer

Publications and source records attributed to F M Rizer.

At least 19 recordsLinked to original sources
PubMed1997

Stapedectomy in patients with small air-bone gaps.

Controversy exists concerning stapedectomy for patients with small air-bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air-bone gap. One hundred fifty-four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure-tone average (PTA) improved 16.7 dB and overdosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overdosing even small air-bone gaps due to otosclerosis.

Audiometry, Pure-Tone↗
PubMed1996

Early speech changes in children with multichannel cochlear implants.

A number of studies have demonstrated that cochlear implants provide an improved auditory signal and enhance the development of speech-perception and production skills for profoundly deaf children. However, exactly when these early speech skills begin to develop remains unclear. To explore this issue, we observed, for a 1-year period, four prelingually deaf children who underwent implantation consecutively within 1 month of each other, and we paid particular attention to the first few months of rehabilitation. We found immediate speech scores as early as the first day of implant tune-up. Speech production continued to improve rapidly throughout the first 4 months but exhibited a generally slower rate of progress in some of the speech-production skills at 1 year. We also found vowel-production skills to be the easiest to achieve, with word-pattern recognition and consonant voicing of intermediate difficulty. Consonant placing and manner of consonant production were the hardest skills to achieve. Results of speech-perception tests 1 year after implantation were markedly improved over preimplantation levels in three of the four children. These early speech changes stress the need for maximization of the capability of the cochlear implant by institution of immediate and intensive speech rehabilitation efforts for prelingually deaf children.

Child↗
PubMed1996

Acoustic reflexes, auditory brainstem response, and MRI in the evaluation of acoustic neuromas.

Patient records were reviewed to determine whether persons with absent acoustic reflexes have a higher incidence of abnormal auditory brainstem response (ABR) results in the absence of a cerebellopontine angle (CPA) tumor than those with normal acoustic reflexes. Results showed patients with absent reflexes to have borderline or abnormal ABR results in 45.2% of the cases. Patients with normal reflexes had borderline or abnormal ABR results in 14.2% of the cases. Results indicate that magnetic resonance imaging is a more appropriate test for patients with absent reflexes, since ABR was often nondiagnostic for a CPA tumor in this group.

Evoked Potentials, Auditory, Brain Stem↗
PubMed1996

Prosthesis on a mobilized stapes footplate.

Managing a mobilized footplate in stapedectomy surgery can be challenging. Between 1963 and 1992, 145 footplates were inadvertently mobilized during otosclerosis surgery. After a vein graft, a 4.0-mm Robinson prosthesis was placed on all footplates, making no attempt to remove the footplate. There were 73 thin, blue footplates and 72 thick, white footplates. Hearing results in the thin, blue footplate group was 97% successful and 100% satisfactory at 3 years. No footplate refixed. In the thick, white group, hearing was 60% successful and 72% satisfactory at 6 months. Footplate refixation was found at revision in all but one unsuccessful case. After revision, the thick, white group had 79% successful and 89% satisfactory hearing results at 3 years. No patient in either group was worse. We conclude that placing a vein graft and a Robinson prosthesis is a safe and effective technique for a mobilized footplate. If the footplate is thin and blue, there is little or no risk of refixation. If the footplate is thick and white, approximately 30% will require revision.

Follow-Up Studies↗
PubMed1996

Stapedectomy in the elderly.

Clinical records were reviewed to examine the effectiveness of stapedectomy in patients 70 years and older. A total of 154 patients was studied, including 11 with profound hearing loss with long-standing otosclerosis. Ages at the time of surgery ranged from 70 to 92 years (mean, 76.3 years). The mean pure-tone average (500, 1,000, 2,000, and 4,000 Hz) improved 30.6 dB after surgery for the 143 patients in the main otosclerotic group and 26.8 dB for the patients in the profound-hearing-loss group. The rate of successful stapedectomies for the 70(+)-year-old patients (90.9%) and the younger comparison group (90.0%) were similar. These findings extend the documented range of stapedectomy as a safe and effective procedure through the eighth decade of life.

Aged↗
PubMed1994

Far-advanced otosclerosis.

Far-advanced otosclerosis (FAO) is an uncommon diagnosis. Hearing levels in patients with FAO may range from profound loss, by air conduction and fragmentary bone conduction thresholds, to no measurable air or bone conduction thresholds. Thus, FAO may be difficult to distinguish from a sensorineural hearing loss. This report presents the results of surgery in 73 ears with FAO, 77 percent of which had improvement in air conduction thresholds of greater than 20 dB. Discrimination was improved by more than 15 percent in 54 percent of cases, and 75 percent realized improvement in use of a hearing aid. There was no evidence that success was related to preoperative hearing. The surgical results of a subgroup of 14 patients having bilateral FAO were also analyzed. For all 14, similar surgical outcomes were achieved in both the initial and the contralateral ear, with six successes bilaterally and eight failures bilaterally. Although far advanced otosclerosis is uncommon and difficult to diagnose, surgery is worthwhile.

Acoustic Stimulation↗
PubMed1994

Simultaneous presentation of facial nerve neuroma and otosclerosis.

Otosclerosis often occurs as a unilateral mixed or conductive hearing loss. In the absence of retrocochlear findings, otologists usually do not pursue further diagnostic testing. A patient who presented to the Warren Otologic Group with a unilateral mixed hearing loss is discussed. He was followed for 1 year with the intent of scheduling a stapedectomy. Two weeks prior to the surgical date, the patient developed a sudden hearing loss and was admitted to the hospital for treatment. Magnetic resonance imaging demonstrated a tiny, enhancing mass in the lateral internal auditory canal, measuring 7 mm in diameter. At surgery, the tumor was found to originate at the union of the nervus intermedius and the facial nerve. The simultaneous occurrence of facial nerve neuroma and otosclerosis is discussed, with emphasis on a thorough evaluation of all unilateral mixed hearing losses, including those attributable to otosclerosis.

Adult↗
PubMed1991

Perilymph fistulas: the House Ear Clinic experience.

The diagnosis, evaluation, and surgical treatment of perilymph fistulas has recently been the focus of a great deal of attention in otology. Authors have focused on perilymph fistulas as the cause of hearing loss and vertigo in many diverse situations. Additionally, surgical repair has been suggested when there is little objective support for intervention. To address some of the problems inherent in the diagnosis and treatment of perilymph fistulas, records of patients operated on at the House Ear Clinic during the past 12 years were reviewed retrospectively. Eighty-six patients were surgically explored for fistulas during this period. Thirty-five (40.7%) fistulas were found, and 51 ears were patched whether fistulas were found or not. Of the 80 patients who were seen for follow-up, 35 (43.8%) were subjectively better, and 45 (56.2%) were the same. Although the number of fistulas found and the number of patients improved were similar, the composition of the two groups was different. On the basis of audiometric results, improvement in hearing occurred in only 18.7% of the patients. None of the demographic factors or diagnostic tests were predictive of either the presence of a fistula or the therapeutic outcome. Further work is required to facilitate the preoperative diagnosis of fistulas and to design appropriate surgical intervention.

Adolescent↗
PubMed1990

Staging for cholesteatoma in the child, adolescent, and adult.

A closed tympanomastoidectomy with subsequent staged surgical procedures leading to the excision of cholesteatoma was validated as described. All elements of staging with a 10-year experience of 354 patients are covered according to categories of child (0 to 9 years), adolescent (10 to 15 years), and adult. The child differed from the adolescent and adult in the following manner: more recurring cholesteatomas, greater ossicular necrosis, poorer hearing results, less aggressive residual cholesteatoma, and significantly poorer results with pars flaccida cholesteatoma than pars tensa cholesteatoma. After the end stage, 90% of the cases remained closed, with acceptable hearing in 60% of the patients.

Adolescent↗
PubMed1989

Perilymph fistulas in children: experience of the Otologic Medical Group.

We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

A postoperative audiometric evaluation of cochlear implant patients.

As the benefits of the cochlear implantation become more defined, many investigators hope that these devices can be offered to patients with a lesser degree of hearing loss. Accordingly, it is necessary to investigate the audiometric thresholds in the implanted ear after surgery. Preservation of the residual hearing after implantation would support the claims that surgery and the presence of a cochlear implant do not adversely affect the implanted ear.

Audiometry↗
PubMed1988

The management of congenital cholesteatoma: surgical results of 42 cases.

Radical surgery for congenital cholesteatoma leaves the patient, usually a child, with an ear that requires care for life. At the Otologic Medical Group, the intact canal wall technique has been used for many patients with cholesteatoma. To determine results of this management in the treatment of congenital cholesteatoma, we reviewed records of all patients treated between 1974 and 1985. Forty-two ears were studied in 41 patients. A closed middle-ear space was achieved in all cases, and an intact canal wall was maintained in 41 (98%). Follow-up averaged 4.3 years. Of the 41 cases with serviceable hearing before surgery, 28 (68%) had postoperative hearing within 10 dB of the best preoperative bone conduction threshold. Thirty-eight of the 41 achieved a final hearing result within 20 dB of the best bone conduction threshold.

Child↗
PubMed1988

Cochlear histopathology in the labyrinthectomized ear: implications for cochlear implantation.

Limited damage to the cochlea and preservation of hearing after labyrinthectomy have been the subject of many case reports. One might hypothesize that, even when hearing is lost, there may be less damage to the cochlea than anticipated, and some neural elements that can be electrically stimulated may be preserved. Four labyrinthectomized temporal bones on file at the House Ear Institute were evaluated histopathologically. All had some remaining spiral ganglion cell population, the neural element that we think is stimulated by the intracochlear electrode. We also examined the population of hair cells and dendrites and the presence and extent of cochlear ossification, factors that may influence the performance of a cochlear implant. This is the first study of its type. Results indicate that cochlear implantation in the labyrinthectomized ear may be feasible.

Cochlea↗
PubMed1987

Induced temporary threshold shift in guinea pigs.

The etiology of an incidentally discovered temporary threshold shift observed in an experimental animal (Harley guinea pig) is discussed with its potential implications for auditory research.

Animals↗
PubMed1987

Reconstructing the absent lenticular process.

When a surgeon encounters an absent lenticular process of the incus, he must either reposition the incus or attempt to bridge the small gap between the remaining incus long process and the stapes capitulum. Our solution to this problem is to place a Lippy modified Robinson stapes prosthesis on the stapes footplate and attach it to the remaining long process, thus bypassing the stapes superstructure. This modified Robinson prosthesis has a portion of the well removed allowing the eroded long process to enter from the side. The hearing results of 63 cases at 6 months (two-thirds of which had a concurrent tympanoplasty) are 67% within 10 dB and 91% within 20 dB of the preoperative bone hearing level. The use of an existing and proven prosthesis provides both stability and, to date, the most successful hearing results for reconstructing the absent lenticular process.

Ear Ossicles↗
PubMed1987

Lateral sinus thrombosis: diagnosis and treatment--a case report.

Lateral sinus thrombosis is a difficult diagnostic problem. Specialized computerized tomography allows non-invasive preoperative visualization of sinus contents enabling the surgeon to make a definitive diagnosis with appropriate preoperative planning. This case report details these specialized techniques and their application to a case of lateral sinus thrombosis.

Child↗