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Biomedical subjects

G B Brookes

Publications and source records attributed to G B Brookes.

At least 73 records · Page 4Linked to original sources
PubMed1985

Immune complex-associated deafness: preliminary communication.

During the last year patients presenting with progressive bilateral or sudden sensorineural deafness of unknown aetiology have been investigated for possible abnormal immune activity. Twenty-six cases are reported in which significantly raised circulating immune complexes were present, together with 2 cases of clinical autoimmune deafness where the complexes were normal. Thirty-six control subjects were also studied. Following a review of the clinical features, the pathogenesis of this new association with sensorineural deafness is discussed. In some cases the aetiology is probably autoimmune, and in others related to infection. In certain patients the deafness has been partly reversed by medical treatment with systemic steroids or plasma exchange. It is hypothesized that circulating immune complexes may reflect a previously unrecognized final common pathophysiological pathway in a variety of cochleovestibular disorders.

Adolescent↗
PubMed1985

Nutritional status--a prognostic indicator in head and neck cancer.

A prospective study into the nutritional status of 114 patients with untreated primary squamous cell carcinoma of the head and neck was undertaken to assess its possible prognostic value for survival. Nutritional status was evaluated by anthropometry, creatinine height index estimation, serum albumin and transferrin assays, and nitrogen balance studies. Weight change and other anthropometric indices found to be the most reliable nutritional parameters were averaged to derive a clinically useful, general nutritional status score. A nutritional deficit was found in 43 of the 114 patients (37.7%) and was associated with neoplasms of the upper gastrointestinal tract in more than 80% of the patients. Life table analysis showed a statistically very highly significant difference between the survival of the adequately nourished patients (57.5% at 2 years) and the survival of the undernourished patients (7.5% at 2 years) (chi 2 = 36.08; P = .0). These results indicate that nutritional deficiency is an important adverse prognostic factor in head and neck cancer. Undernutrition probably exerts its effect, at least in part, by causing secondary immunologic dysfunction.

Adult↗
PubMed1985

Vitamin D deficiency and otosclerosis.

A prospective study of 47 patients with otosclerosis was undertaken to investigate the possible etiologic role of vitamin D undernutrition. The population comprised 27 women and 20 men, with a mean age of 46.4 years (range 21 to 79). The disease was bilateral in 43 patients, and cochlear involvement was present in 84.4%. The mean duration of symptoms was 17.1 years. Vitamin D status was evaluated by measuring the plasma 25-hydroxy vitamin D3 (25-OHD), which is the main storage metabolite. Abnormally low 25-OHD levels were found in 10 patients (21.7%) and borderline low levels in another two. Raised serum alkaline phosphatase levels were present in 32.6%, calcium in 6.5%, and inorganic phosphate in 4.3%. Calcium and vitamin D replacement therapy resulted in significant hearing improvement in 3 of 16 patients; these data support a causal correlation. Vitamin D deficiency is probably a factor in the etiology of some cases of otosclerosis and is important, since the deafness resulting from cochlear involvement may be reversible.

Adult↗
PubMed1985

Vitamin D deficiency and deafness: 1984 update.

Vitamin D deficiency has been diagnosed in 27 patients with bilateral deafness in a period of just over 3 years. It should be considered in the differential diagnosis of unexplained bilateral cochlear deafness and may be important in the origin of some cases of otosclerosis, presbyacusis, and the deafness associated with chronic renal failure. Treatment should prevent progressive hearing loss, which may occasionally be partly reversible, and the development of clinical osteomalacia with more generalized skeletal symptoms.

Adult↗
PubMed1985

Unilateral Meniere's disease: is the contralateral ear normal?

Certain investigations in patients with unilateral Meniere's disease may on occasion show abnormalities in the completely symptomless contralateral ear. These tests include transtympanic electrocochleography, the acetazolamide cochlear hydration test, vestibular aqueduct tomography, and caloric testing. Eventually these ears may well become symptomatic. Previous studies have shown that otoadmittance changes are a sensitive indicator of glycerol-induced intracochlear pressure alterations in hydropic ears, but do not occur in patients without Meniere's disease. Otoadmittance parameters were evaluated in the asymptomatic ears of 73 consecutive patients with unilateral Meniere's disease. Satisfactory traces and adequate dehydration were achieved in fifty-nine. A significant change in the maximum conductance, similar to that often seen in symptomatic hydropic ears, was found in twenty-four cases (40.7%). The presence of functional abnormalities in well over one-third of asymptomatic ears means that they cannot be used as controls in clinical research studies. Furthermore, recognition of contralateral latent hydrops at the initial otologic assessment may modify the subsequent treatment strategy.

Acoustic Impedance Tests↗
PubMed1984

Oral acetazolamide in Menière's disease.

The therapeutic efficacy of oral acetazolamide has been evaluated in a small pilot study of 14 patients with Menière's disease (23 hydropic ears). Symptomatic improvement was found in 4 cases. In 2 of these patients the improvement was not sustained, whilst another had to stop the drug due to the development of bilateral renal calculi. A deterioration in symptoms was seen in 3 cases. Significant adverse side-effects were encountered in 6 of the 13 patients (46.2 per cent) who complied with drug dosage instructions. It is suggested that this high incidence of side-effects may be consistent with a general metabolic difference between Menière's patients and normal subjects. We conclude that oral acetazolamide has no place in the medical treatment of Menière's disease.

Acetazolamide↗
PubMed1984

Myasthenia gravis in otolaryngological practice.

A retrospective study of 48 unselected patients with myasthenia gravis was undertaken to evaluate the head and neck manifestations of this disease and to examine the role of the otolaryngologist in diagnosis and management. Oropharyngeal features were found in 56% of patients at presentation. In 20 the initial complaint was of one or more symptoms referable to the upper aerodigestive tract, whilst in 9 (18.8%) these were the only symptoms. The importance of maintaining a high index of clinical suspicion is emphasized, as the early muscle weakness is invariably mild and fluctuant. Contemporary aspects of the aetiology, diagnosis and management are considered. Particular attention is focused on the characteristics of the stapedius reflex in this disorder, as this is probably the most sensitive objective test for assessing defective neuromuscular transmission.

Adolescent↗
PubMed1984

Benign intracranial hypertension complicating glomus jugulare tumor surgery.

A case is reported in which excision of the jugular bulb during glomus tumor surgery resulted in the development of postoperative benign intracranial hypertension. The pathogenesis of this previously unreported complication of glomus tumor surgery is discussed, and the principles of management are reviewed.

Adult↗
PubMed1984

Post-traumatic cholesteatoma of the external auditory canal.

Post-traumatic cholesteatoma of the external auditory canal is a rare condition which is not mentioned in any of the American or British otological reference works. Three cases are described, and the pathogenesis, management, and medico-legal implications discussed.

Adult↗
PubMed1983

Pharyngeal stenosis in Behçet's syndrome. The first reported case.

Behçet's syndrome is a very uncommon, chronic multisystem inflammatory disorder that may affect the gastrointestinal tract. Esophageal involvement is rare, and to my knowledge, secondary stenosis of the pharynx has not been previously reported as a complication. A case is described in which dysphagia caused by pharyngeal stenosis was a presenting feature in this condition and obstructive airway symptoms subsequently developed.

Adult↗
PubMed1983

Malignant fibrous histiocytoma of the ethmoid sinus.

Malignant fibrous histiocytomas are soft-tissue tumours of histiocytic origin that occur infrequently in the head and neck region. There are no completely reliable histologic criteria for the diagnosis of malignancy. Only five MFHs arising primarily from the ethmoid sinus have been reported in the literature. A further case is described in which the diagnosis was only definitely established following ultrastructural examination. Local tumour recurrence occurred in both the nasal cavity and nasopharynx eighteen months following primary combination treatment by radiotherapy, cytotoxic chemotherapy and surgery. Multicentric synchronous tumour recurrence has not been previously described in MFH involving the head and neck. This feature may account for the well documented high local recurrence rate following apparently complete surgical ablation.

Ethmoid Sinus↗
PubMed1983

Vitamin D deficiency--a new cause of cochlear deafness.

Ten patients are reported with bilateral cochlear deafness which was associated with vitamin D deficiency. The features of these cases are discussed following an overview of the clinical aspects and diagnosis of vitamin D deficiency. The most likely pathogenesis is localized demineralization of the cochlea resulting in secondary morphological changes. Replacement therapy resulted in unilateral hearing improvement in two of the four patients in whom the response to treatment could be assessed. This suggests a previously unrecognized causal correlation between vitamin D deficiency and cochlear deafness. Impaired vitamin D activity may be important in the aetiology of otosclerosis, presbyacusis and the deafness associated with chronic renal failure. Vitamin D deficiency should be considered in the differential diagnosis of unexplained bilateral cochlear deafness. It is important, as this 'new' metabolic type of sensorineural deafness may be reversible, and may also lead to the diagnosis of early osteomalacia before more serious generalized skeletal symptoms can occur.

Adult↗
PubMed1983

Ménière's disease. A practical approach to management.

The management of Ménière's disease continues to provide a formidable clinical challenge, mainly because its precise aetiology is unknown. The unpredictable natural history of the condition has consistently bedevilled attempts to evaluate therapeutic efficacy, and there have been no entirely satisfactory prospective controlled clinical trials of any specific medical or surgical treatment. Although no form of medication has been convincingly shown to influence the long term course of the disease, many drugs may be useful in the control of vertigo. In recent years conservation of hearing has assumed equal importance to the control of vertigo as the therapeutic goal. Indications for conservative endolymphatic sac surgery, which appears to offer the best prospect of preventing the progressive deafness which invariably accompanies the established condition, are discussed. The necessity for a flexible therapeutic approach to the management of Ménière's disease is underlined.

Audiometry, Evoked Response↗