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Biomedical subjects

H Silverstein

Publications and source records attributed to H Silverstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

Surgical ablation of the vestibular system in the treatment of Meniere's disease.

When Meniere's disease becomes refractory to medical management, a variety of highly effective surgical options are available. A selective nerve section can relieve the disabling vertigo of Meniere's disease while preserving hearing. When the hearing on the involved side is nonserviceable, a labyrinthectomy is an important alternative. An eighth nerve section makes a complete preganglionic ablation possible with the additional benefit of relieving tinnitus in over two thirds of selected patients.

Ear, Inner↗
PubMed1996

Hearing results after posterior fossa vestibular neurectomy.

The effect of posterior fossa vestibular neurectomy on postoperative hearing levels of 172 patients was studied at 1 week, 1 month, 1 year, and 18 to 24 months. According to the 1985 American Academy of Otolaryngology-Head and Neck Surgery guidelines for reporting treatment outcome, 66% of patients had improved or unchanged hearing at 18 to 24 months. One-week postoperative hearing was poorer than at 1 month or later follow-up. Permanent profound hearing loss occurred in 4.7% of patients. In patients who had worse than 80 dB pure-tone average and 20% speech discrimination score hearing loss before surgery, 68% improved above this hearing level, and 16% improved to better than 50 dB pure-tone average and 50% speech discrimination after surgery. This suggests that it may be worthwhile to preserve the cochlear nerve in certain patients who may otherwise be candidates for labyrinthectomy. These hearing results are comparable with other treatment modalities including endolymphatic sac surgery.

Adolescent↗
PubMed1996

Vestibular neurectomy: a histological and clinical study of results.

Posterior fossa vestibular neurectomy has become one of the most effective surgical procedures for control of vertigo symptoms in Menière's disease. A small group of patients continue to have vertigo and demonstrable vestibular function by electronystagmography (ENG) post-operatively. Another group of patients may have no vertigo, despite residual vestibular function on caloric testing. In an effort to correlate histological findings with clinical outcome, nerve biopsies were taken from seven patients undergoing vestibular neurectomy. Fibre counts of nerve biopsies were compared with clinical, audiometric and ENG results. Results of this study demonstrate that complete reduction of vestibular response (on caloric testing) and clinical cure of vertigo can be obtained despite a variable number of nerve fibres at vestibular neurectomy.

Adult↗
PubMed1996

Laser-assisted tympanostomy.

Laser-assisted tympanostomy (LAT) was performed in 70 ears to ventilate the middle ear space without using a pressure-equalizing tube. Using a CO2 laser attached to an operating microscope with a Microslad (microscope laser adaptor device), tympanostomies of 1.0 to 3.0 mm (average, 1.6 mm) in diameter were created and remained patent for an average of 3.14 weeks. Patency time was directly related to the size of the opening. Nearly all (97.9%) of the tympanostomies healed with no noticeable scarring and no persistent perforations. Seventy-eight percent of patients at the Florida Ear & Sinus Center (FESC, Sarasota, Fla.) and 84% of patients at the Head & Neck Surgery Group (New York) showed no evidence of recurrent effusion after a minimum follow-up of 3 months. LAT appears to be a safe, cost-effective procedure which can easily be performed in an office setting when bloodless opening in the tympanic membrane is needed for either treatment or diagnosis using endoscopes.

Adolescent↗
PubMed1996

Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report).

Intratympanic instillation of Depo-Medrol (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.

Aged↗
PubMed1995

Use of endoscopes for chronic ear surgery in children.

OBJECTIVE: To determine whether an endoscopic second-look examination of the mastoid and middle ear could replace an open second-look mastoidectomy. DESIGN: Patients were examined endoscopically. The findings were compared with a standard open mastoidectomy procedure during the same operation. The mastoid can be inspected through a small postauricular incision and the middle ear can be inspected through a myringotomy incision or tympanomeatal flap. PATIENTS: Ten patients aged 6 to 16 years. RESULTS: Endoscopic findings correlated exactly with open mastoidectomy findings in all cases. CONCLUSION: In light of this study an open second-look mastoidectomy may be avoided if minimal or no recurrent cholesteatoma is found during the endoscopic exploration. The use of the ridged endoscope has added another dimension to the standard microsurgical techniques used in pediatric otology. The indications, techniques, and findings of otoendoscopy in the management of chronic otitis media in children will be presented.

Adolescent↗
PubMed1995

Lightning injury of the tympanic membrane.

Lightning injury to the ear is known, but specific reports are lacking. Four patients with tympanic membrane perforations who were managed surgically are reported. Their presentations, evaluations, intraoperative findings, and outcomes are discussed as they relate to the proposed pathogenic mechanisms. The authors' standard wide exposure tympanoplasty approach with two layer tympanic membrane repair is described. The added steps in performing this procedure may be necessary to ensure a good result in this unique group of patients.

Adolescent↗
PubMed1994

Prediction of facial nerve function following acoustic neuroma resection using intraoperative facial nerve stimulation.

Methods of monitoring the facial nerve during posterior fossa surgery continue to evolve. In an effort to predict acute and final facial nerve function following acoustic neuroma resection, the lowest current applied to the facial nerve at the brainstem necessary to elicit facial muscle response was measured using strain gauge and electromyographic facial nerve monitors. A retrospective analysis of 121 patients who had undergone acoustic neuroma surgery was performed. Sixty-five patients had intraoperative facial nerve monitoring and 44 had sufficient data for inclusion in this study. The acute and final facial nerve functions, according to the House-Brackmann classification, were assessed with regard to intraoperative stimulation-current thresholds. Nineteen of 20 patients who required 0.10 mA or less to elicit a facial muscle response had a House-Brackmann grade I facial nerve outcome. The upper limit of the 95% confidence interval of stimulation threshold for patients with a final grade I facial nerve function is 0.17 mA. All of the patients in this study, with stimulation thresholds ranging up to 0.84 mA, had a final grade III or better result. A poor outcome in our series, a final grade III facial nerve function, is best predicted by a poor acute result, specifically an acute grade VIA facial nerve function. We suggest that it is possible to predict the facial nerve function based on intraoperative threshold testing.

Analysis of Variance↗
PubMed1994

Revision stapes surgery with and without laser: a comparison.

In this study, the results of 76 revision stapes surgeries performed from 1974 to 1992 were reviewed. Either the KTP or the argon laser was used in 40 operations. Prosthesis problems were the most common cause for revision (63%) followed by eroded/necrotic incus (29%) and adhesions (29%). Overall "success" in air-bone gap closure (air-bone gap < or = 10 dB) was 46% for first revisions and 33% for second or greater revisions. The "improvement" rate (air-bone gap < or = 20 dB) was 65% for first revisions and 53% for second or greater revisions. There was no statistically significant difference in hearing results between laser surgery and conventional technique. However, an absence of adhesions was noted when the laser had been used in the primary procedure.

Adolescent↗
PubMed1994

Vestibular nerve section.

In the nearly 90 years since Frazier first performed an eighth nerve section through the posterior fossa for the treatment of Ménières's disease, the surgical management of Ménière's disease has come full circle. With refinements in surgical technique and advancements in instrumentation, optics, illumination, and neuromonitoring, a procedure that was once resoundingly condemned by the otologic community is now regarded as the procedure of choice in patients with serviceable hearing. The vestibular nerve section has experienced a renaissance. The posterior fossa vestibular nerve section has undergone an evolution, and the combined retrolabyrinthine-retrosigmoid vestibular nerve section represents the highest form. It is a significant improvement over its predecessors and our procedure of choice in properly selected patients.

Humans↗
PubMed1994

Promontory testing in neurotologic diagnosis.

The ability of promontory testing (PT) to differentiate a retrocochlear from a cochlear lesion in a group of 88 patients having unilateral sensorineural hearing loss was assessed. Promontory stimulation was performed, using the Nucleus Promontory Stimulator (model Z10012, Cochlear Corporation, Melbourne, Australia), by placing a needle electrode transtympanically on the basal turn of the cochlea. Patients with measurable hearing gave inconsistent results. Patients who had undergone eighth nerve section or translabyrinthine removal of acoustic neuroma were used as controls. They had no perception of sound in response to electrical stimulation, and were unable to perform any part of the PT. Of nine patients with anacusis secondary to an acoustic neuroma, six were unable to perceive sound in response to electrical stimulation or perform any aspect of the PT. Of the three patients able to perceive sound, only one could perform the temporal difference limen (TDL) and gap detection (GAP) test. In patients with total deafness from other causes, 80 percent (24/30) were able to perceive sound with electrical stimulation, 46 percent (14/30) performed TDL, and 70 percent (21/30) performed the GAP tests. In patients with unilateral total deafness, promontory testing may aid in differentiating retrocochlear from cochlear lesions and help identify patients at risk for acoustic neuroma.

Analysis of Variance↗
PubMed1994

Endoscopy in otology and neurotology.

Since the early 1980s rigid endoscopes have been used by otorhinolaryngologists in the United States primarily for sinus surgery. Recently rigid endoscopes have been used as an adjunct to standard otologic and neurotologic procedures. Diagnostic inspection of the middle ear can be performed through a myringotomy incision to rule out perilymphatic fistula, for identification of cholesteatoma, or for evaluation of the status of the ossicular chain. During chronic ear surgery endoscopes can be used to locate hidden cholesteatoma in difficult to visualize areas such as the eustachian tube, attic, sinus tympani, and beneath an intact posterior canal wall. In acoustic neuroma surgery in which hearing preservation is an objective endoscopes are used to inspect the lateral aspect of the internal auditory canal (IAC) for residual tumor. During vestibular neurectomy endoscopes are used to view the IAC and to help identify the cochleovestibular cleavage plane. The applications, techniques, and limitations of rigid endoscopy in otology and neurotology are discussed.

Cholesteatoma↗
PubMed1993

An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms.

An algorithm has evolved for the management of patients with acoustic neuroma. Decisions as to surgery vs. observation, surgical approach, and whether hearing preservation should be attempted depend on age, patient symptoms, size of the tumor, residual hearing, and degree of facial nerve involvement at the time of surgery. Conservative management is used for patients over 65 years of age. This consists of observation or subtotal resection through a translabyrinthine approach, depending on the absence or presence of brainstem signs or symptoms. In patients under 65 years of age, hearing preservation is attempted through the retrosigmoid approach in tumors 1.5 cm or less if pure-tone average is less than 30 dB and the discrimination score is greater than 70%. The translabyrinthine approach is our preferred approach for tumors of any size when hearing is not serviceable. A near-total excision is performed when the facial nerve cannot be separated from the tumor. The rationale for this algorithm in the management of 130 cases of acoustic neuroma over the past 17 years is presented.

Adult↗
PubMed1993

A comparison of growth rates of acoustic neuromas: nonsurgical patients vs. subtotal resection.

A conservative approach to the management of acoustic neuromas in elderly patients has been used since 1971. Elderly patients without symptoms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical-subtotal resection is performed if brain stem compression is present or if tumor is growing rapidly. Twenty-three patients, ages 65 to 86 years, had initial nonsurgical management of their tumors. Growth rates could be determined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an average growth rate of 6.8 mm/yr eventually required surgery. No patient whose tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty-four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen patients followed postoperatively for more than 1 year demonstrated an average rate of regrowth of tumor of 0.7 mm/yr.

Aged↗