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Biomedical subjects

G A Gates

Publications and source records attributed to G A Gates.

At least 73 records · Page 4Linked to original sources
PubMed1990

Hearing in the elderly: the Framingham cohort, 1983-1985. Part I. Basic audiometric test results.

Many studies have documented the decline in auditory function with age. We broaden that data base in this the first of a series of reports emanating from the auditory testing of the Framingham cohort during biennial exam 18. The results of the auditory questionnaire, hearing sensitivity, acoustic compliance measures, and word recognition tests obtained from 1662 men and women in their 60th through 90th decades are presented. Pure-tone thresholds increased with age but the rate of change with age did not differ by gender even though men had poorer threshold sensitivity. Maximum word recognition ability declined with age more rapidly in men than in women and was poorer in men than in women at all ages. Acoustic compliance and middle ear pressure did not vary with gender or age. Acoustic reflex thresholds to a contralateral stimulus at 1 kHz increased slightly with age, more in women than in men; ipsilateral acoustic reflex thresholds did not vary with age or gender. Hearing aids were being used in only 10% of subjects likely to benefit from amplification.

Acoustic Impedance Tests↗
PubMed1989

The safety and effectiveness of an implanted electromagnetic hearing device.

The records of 184 patients implanted with the XOMED Audiant Bone Conductor (XOMED Inc, Jacksonville, Fla) prior to March 1988 were reviewed retrospectively to determine the safety of this device. Complications were few and minor in nature. Effectiveness was judged from the audiometric data obtained from the 96 patients in the hearing part of this study, all of whom had improved hearing with the device. The mean preoperative pure-tone air-conduction three-frequency average threshold +/- SD in the implanted ear was 55.8 +/- 10.7-dB hearing level; postoperative average aided warble-tone threshold was 19.9 +/- 8.5-dB hearing level. The average improvement in threshold was 36.0 +/- 13.3 dB. Ninety-three percent of patients achieved socially adequate hearing, ie, mean aided sound-field thresholds of at least 30-dB hearing level, and 81% had thresholds of at least 25-dB hearing level. We conclude that the XOMED Audiant Bone Conductor is a safe and effective device for the surgical correction of conductive hearing loss.

Adolescent↗
PubMed1989

Sliding flap tracheoplasty.

The optimal method for surgical management of subglottic stenosis is based upon careful assessment of the location, caliber, length, and maturity of the stenotic segment, as well as associated conditions. For patients with a mature stenosis of short length, excision of the anterior arch of the cricoid and first ring and immediate reconstruction by means of a sliding flap of the next two to three rings of trachea offer a one-stage definitive treatment without the need for grafting. We report four cases of subglottic stenosis and one case of cricoid chondroblastoma in which reconstruction of the airway was successful and prompt. For carefully selected cases, sliding flap tracheoplasty may be a useful alternative to procedures in which the airway is expanded by means of grafting.

Adolescent↗
PubMed1989

Chronic secretory otitis media: effects of surgical management.

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p less than .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p less than .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p less than .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p less than .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p less than .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p less than .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.

Acoustic Impedance Tests↗
PubMed1989

High-frequency electrostimulation hearing after mastoidectomy.

This study was undertaken to measure the degree of high-frequency sensorineural hearing loss following mastoid surgery. Twenty-five patients undergoing mastoidectomy procedures were tested preoperatively, less than 2 days postoperatively, and at 30 days postoperatively using the Tonndorf Audimax 500 high-frequency audiometer. Electrostimulation thresholds in 1-kHz intervals, from 1 to 20 kHz, were measured, and the highest detectable frequency was determined to within 0.1 kHz. Surgical drilling time was recorded. Average drilling time was 51 minutes. A significant temporary threshold shift was observed, measurable at multiple frequencies, less than 48 hours after mastoidectomy. There was no clinically significant change in electrostimulation thresholds (measured in 1-kHz increments, from 1 to 16 kHz) preoperatively to 30 days postoperatively. A statistically significant average loss of 0.89 kHz in the highest frequency producing a measurable response was noted (p less than 0.05). Determinations of the highest measurable frequency may be the most sensitive measure of surgically-induced, high-frequency sensorineural hearing changes.

Adolescent↗
PubMed1989

Presbycusis.

Explore the source record for details and available documents.

Aged↗
PubMed1989

Cerebral shift after lateral craniofacial resection and flap reconstruction.

The biomechanical effects on the cranial contents after craniectomy and immediate soft-tissue flap reconstruction are substantial and potentially life threatening. Once the rigid protective covering of the skull is removed, the cerebral component of the cranial contents is vulnerable to rising extrinsic pressure. Intracranial pressure falls, brain compliance rises, and contralateral cerebral shift may occur by virtue of the craniectomy alone. However, if flaps filling the defect should compress by weight or swelling, even greater midline or craniocaudal shift of the brain may occur. We present three cases in which midline cerebral shift was documented by CT scan after flap reconstruction of lateral craniofacial/craniotemporal resection. Three other patients undergoing anterior craniofacial resection during the same time period for skin cancer (one patient) and esthesioneuroblastoma (two patients) had no shift in intracerebral contents. Symptomatic or asymptomatic intracranial shift may occur soon after substantial craniectomy and soft-tissue flap reconstruction. Midline shift from lateral resection and reconstruction is more likely than anteroposterior shift from anterior craniofacial resection. Strategies for minimizing this compression or shift are described.

Adolescent↗
PubMed1988

Delayed onset post-tympanotomy otorrhea.

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

Child↗
PubMed1988

The lateral facial approach to the nasopharynx and infratemporal fossa.

Surgical access to the nasopharynx and infratemporal fossa is restricted by the bony structures that support and define these areas. Traditional surgical approaches to the nasopharynx for removal of benign neoplasms follow three directions: (1) the anterior route via the nasal cavity and the maxillary and, if necessary, the ethmoid sinuses; (2) the inferior route through the palate; and (3) the anterolateral retromaxillary pathway via the gingivobuccal sulcus into the pterygoid space. These approaches provide fair access, but limited visibility and little technical control of the neurovascular supply. For the small- to medium-sized tumor, the experienced surgeon is able to successfully manage the majority of cases using these approaches, singly or in combination. However, in patients with larger tumors--when recurrence is more common--approaches offering greater visualization have been developed, such as Panje's facial biflap, Mann's transmaxillary, and Fisch's transtemporal. These provide better access and control at the cost of increased locoregional morbidity, long operating time, and considerable technical complexity. I have developed a simpler, more direct surgical approach that combines the exposure concepts of the head and neck surgeon with the microsurgical techniques of the otosurgeon. It has been applied to eight cases, with minimal morbidity and excellent results, and appears to be the procedure of choice for cases of angiofibroma with early intracranial extension. Subsequently, a similar approach, developed previously by Holliday, has been published in which access into the anterior temporal lobe, petrous apex, and clivus are gained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Effect of adenoidectomy upon children with chronic otitis media with effusion.

To investigate the mechanism whereby adenoidectomy influences the subsequent course of patients with chronic otitis media with effusion, we analyzed, on the basis of adenoid size, the outcomes of 476 children randomly assigned to receive, after paracentesis and aspiration of the middle ear, either no treatment, tympanostomy tubes, adenoidectomy, or both. The two groups receiving adenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size. This suggests that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidectomy is effective.

Adenoidectomy↗
PubMed1988

Controversy over tubes and adenoidectomy.

Dr. Bluestone then summarized the panelists' discussion by stating that there is now evidence that myringotomy alone for chronic otitis media with effusion has some efficacy but is probably no better than watching the child and not performing surgery. He also stated there are now some data to show that myringotomy and tube insertion for chronic otitis media with effusion appear to be more beneficial than either watching a child over a long period of time or performing myringotomy alone. However, the panelists made a plea that each child should be individualized on the basis of the duration of the effusion, the child's response to medication, the time of the year, distance from health care providers and other factors. Dr. Gates stressed that hearing loss was an important factor, but if hearing loss is a deciding factor, then serial audiograms or at least some assessment of hearing in the clinician's office should be performed. He also stated that there is now evidence that adenoidectomy is effective in certain children, but there is still an 80% recurrence rate and a 15% rate of failure in which children require repeat surgery. Dr. Bluestone suggested that parents and the child (if old enough) should be informed of what is known about the risks, costs and benefits of these surgical procedures. He recommended the clinician discuss with the parents the pros and cons of performing or not performing surgery, including the complications and sequelae of otitis media and also of tube insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1987

Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion.

To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.

Adenoidectomy↗
PubMed1987

Cisplatin and 5-fluorouracil chemotherapy in advanced or recurrent squamous cell carcinoma of the head and neck.

Fifty-three patients with advanced or recurrent squamous cell carcinoma of the head and neck (SCCHN) were treated with bolus cisplatin (CDDP) and 96-hour infusion of 5-fluorouracil (5-FU). Twenty-six patients with advanced disease (21 T4 and/or N3) and no prior therapy (NPT) received 2 to 3 cycles of chemotherapy prior to surgery and/or radiation. There were four complete responses (CR) and 12 partial responses (PR) to chemotherapy for an overall response rate of 61%. In 20 patients with locally recurrent or disseminated disease there was one CR and six PR for an overall response rate of 35%. All but one responding patient in both groups showed clear evidence of tumor response after the initial cycle of chemotherapy. Two of the five complete responders required at least three courses to achieve CR. Disease-free survival was poor: only five of 26 patients in the NPT group remain alive and free of disease 8 to 28 months from initial therapy. CDDP and 5-FU is an active combination for SCCHN, but survival benefit remains to be proven.

Adult↗