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Biomedical subjects

G B Brookes

Publications and source records attributed to G B Brookes.

At least 55 records · Page 3Linked to original sources
PubMed1993

Secretomotor rhinopathy after Le Fort I maxillary osteotomy. Case report.

Severe secretomotor (vasomotor) rhinopathy is a very uncommon nasal condition which is believed to result from marked autonomic neural imbalance to the nasal and lacrimal glands. It has not, to our knowledge, been reported after trauma or elective surgery. A patient is described who developed this condition after a Le Fort maxillary osteotomy. The clinical difficulties of establishing this diagnosis are highlighted, and contemporary management options are discussed.

Adult↗
PubMed1993

The use of clostridium botulinum toxin in palatal myoclonus. A preliminary report.

Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate giving rise to clicking objective tinnitus. The intrusive nature of the tinnitus prompts patients to seek medical advice but to date no single treatment modality has been shown to be consistently effective. We present three cases in whom various management regimens were unsuccessful and in whom botulinum toxin injection to the palatal muscles was undertaken. All three cases were rendered free of their tinnitus with complete abolition of the myoclonus. The questions of optimum dosage as well as frequency of injection will be answered as greater numbers are treated by this method.

Adult↗
PubMed1993

Current practice of stapedectomy in Great Britain.

Since the introduction of stapedectomy with reconstruction of the ossicular chain to Great Britain, many modifications in practice have taken place. The changes include patient selection, operative technique and the type of prosthesis used, as well as the number of operations performed yearly. The aim of this study is to attempt to establish the actual practice among British otolaryngology consultants by means of a simple questionnaire. Two hundred (50.3%) forms were analysed anonymously. The study confirms the decrease in the number of operations performed annually, the absence of centralization for this type of surgery in Great Britain and also demonstrated the trends towards stapedotomy and the practice of bilateral surgery amongst younger consultants.

Humans↗
PubMed1993

Effects of contralateral acoustic stimulation on otoacoustic emissions following vestibular neurectomy.

This study demonstrates that, following unilateral vestibular neurectomy, the inhibitory effect of contralateral acoustic stimulation on evoked otoacoustic emissions is absent. The patient acts as her own control in that the unoperated side shows normal suppression of otoacoustic emission amplitude with contralateral acoustic stimulation. The lack of interaural suppression of otoacoustic emissions on the sectioned side, in the presence of normal acoustic reflex threshold levels, provides evidence that observed phenomena are not merely a function of middle ear reflex activity. It is concluded that the lack of inhibition in the operated ear is due to the sectioning of the olivocochlear bundle within the inferior vestibular nerve, removing the efferent control of the receptor cells. Otoacoustic emissions recorded during contralateral acoustic stimulation may thus provide a rapid, non-invasive means of investigating the functional of the efferent auditory system.

Acoustic Stimulation↗
PubMed1993

Sensing and controlling rotational orientation in normal subjects and patients with loss of labyrinthine function.

The disability resulting from uni-or bilateral loss of vestibular function was assessed by exposing subjects, in darkness, to random rotational displacements on a motorized chair away from a "center" position and requiring them to rotate themselves back to center using a "joystick" control. Normal subjects were accurate within 10 to 15 percent over 180-degree rotations. Alabyrinthine subjects failed to sense their rotation to any useful extent. Subjects with unilateral loss of function as a result of surgery produced hypometric responses to ipsilateral rotation and large amplitude, but inaccurate responses to contralateral rotation. This pattern became more symmetric and normometric with adaptation to loss of function. The procedure promises to be a more useful measure of adaptation than assessing vestibulo-ocular reflexes.

Adult↗
PubMed1992

Use of protein electrophoresis in the diagnosis of cerebrospinal fluid rhinorrhoea.

The diagnosis of CSF rhinorrhoea on clinical grounds alone can be difficult. We describe how the use of non-invasive electrophoretic analysis of nasal secretions for tau protein (asialotransferrin) helped in the management of cases where the existence of a CSF leak was in doubt. Patients were thus saved unnecessary invasive investigations or surgery. A modification of the method of analysis, which improves diagnostic accuracy, is described.

Adult↗
PubMed1992

Solitary plasmacytoma of the skull base.

Plasmacytomas involving the skull base are rare lesions that may be well advanced by the time of diagnosis. Because of their anatomic site they may produce a variety of signs and symptoms, some of which may be vague, often resulting in delays in presentation and in appropriate investigations. We present such a patient, discuss the diagnosis and management, and give a review of the literature.

Diplopia↗
PubMed1992

Surgical management of cerebrospinal fluid rhinorrhoea.

A 10-year retrospective review of patients presenting with cerebrospinal fluid (CSF) rhinorrhoea was performed and the success and morbidity resulting from extracranial and craniotomy repair techniques were compared. A classification based upon the aetiology of CSF rhinorrhoea is presented and the radiological techniques used to identify the fistula site are discussed. An emphasis is made upon managing patients on an aetiological basis. This study revealed that extracranial methods of repair had a high success rate with low attendant morbidity. Although craniotomy had comparable success rates this was at the expense of an increase in patient morbidity. Where appropriate, extracranial methods of repair should be the preferred surgical option.

Adult↗
PubMed1991

Tegmental dehiscence and brain herniation into the middle ear cleft.

The tegmen tympani may occasionally be breached by herniation of the temporal lobe with or without dural cover. The clinical presentation may be obvious with CSF otorrhoea but less so with apparent middle ear effusion, CSF rhinnorrhoea, conductive hearing loss, recurrent meningitis or intracranial sepsis. Diagnosis requires suspicion of the condition, which may be aided by radiological imaging. Surgical repair is to be recommended: various techniques are available but bone enveloped by fascia placed by subtemporal approach is preferred. The features of this problem are highlighted by four cases.

Adult↗
PubMed1991

The sphenoiditis spectrum.

This retrospective, comparative study involves 13 patients with sphenoiditis from 2 specialist centres: the Royal National Throat, Nose and Ear Hospital, Gray's Inn Road (7 patients) and the National Hospital for Nervous Diseases, Queen's Square (6 patients). It was found that the ENT patients had a very much longer history, had more nasal symptoms, and suffered none of the neurological complications attributable to the disease. All the neurological patients presented with a complication after a comparatively short history and had few nasal symptoms. One ENT patient was found to have a mucopyocoele, whereas 5 were found in the neurological patients, all of whom had bony deficiencies demonstrated by radiology and at surgery. Once diagnosed and treated the ENT patients all made full recoveries while 3 of the neurological patients remain with sequelae of the disease. Our study suggests that dehiscences of the surrounding bone increase the risk of potentially serious intracranial problems from sphenoiditis, whereas the chronicity of symptoms is of secondary importance.

Adolescent↗
PubMed1991

Post-traumatic external nasal neuralgia--an often missed cause of facial pain?

Pain about the bridge of the nose is often a diagnostic dilemma. There is an important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by anaesthesia can be achieved and cure is possible by division of the anterior ethmoidal nerve. This rare cause of facial pain is presented using two illustrative cases.

Denervation↗
PubMed1991

Treatment of post-traumatic external nasal neuralgia.

Pain about the bridge of the nose is often a diagnostic dilemma. There is a small but important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by local anaesthesia is diagnostic and cure is possible by division of the anterior ethmoidal nerve. We present a series of six cases to illustrate this rare cause of facial pain.

Adolescent↗
PubMed1991

False ankylosis of the temporomandibular joint after otologic and neurotologic surgery.

Two cases of ankylosis of the temporomandibular joint (TM) after otologic and neurotologic surgery involving an approach through the temporal fossa are reported. The etiology is believed to be that of fibrous contracture within the temporalis muscle, which is incised during the procedure. If the possibility of this rare complication is anticipated, the immediate instigation of prophylactic jaw exercises and forced opening with tongue depressors can significantly limit morbidity. If the condition is allowed to become established, then surgical correction by coronoidectomy may be necessary.

Adult↗
PubMed1990

Dislocated arytenoid: an intubation-induced injury.

Three reports describing the morbidity resulting from intubation-induced arytenoid cartilage dislocation are presented. Significant factors contributing to such an injury are: retrognathia, dental malocclusion, a large tongue base and intubation inexperience. We advise that in all patients who undergo a difficult intubation the possibility of arytenoid dislocation should be considered. A ventilating bronchoscope should be readily available upon extubation, to deal with any acute airway problem that may arise. Treatment modalities are discussed and the advantages of a combined anaesthetic and ENT approach highlighted.

Arytenoid Cartilage↗
PubMed1986

Circulating immune complexes in Meniere's disease.

Sixty-six patients with Meniere's disease were studied for possible general immunologic abnormalities. The disease was bilateral in 20 cases, causing active symptoms in 49. Thirty-six healthy control subjects were also studied. Immune activity was assessed by quantitative measurement of the circulating immune complexes, serum immunoglobulin assay, and acetate electrophoresis, and by an autoantibody screen to a battery of ten general tissue antigens. Thirty-six (54.5%) of the 66 patients with Meniere's disease were found to have significantly raised circulating immune complex levels compared with one (2.9%) of the 36 controls. A statistically significant increased incidence of autoantibodies was also found in the Meniere's group.

Adolescent↗