Search PubMed⌕ Search

Biomedical subjects

H Silverstein

Publications and source records attributed to H Silverstein.

At least 91 records · Page 5Linked to original sources
PubMed1987

A comparison of retrosigmoid IAC, retrolabyrinthine, and middle fossa vestibular neurectomy for treatment of vertigo.

A new procedure, the retrosigmoid internal auditory canal (IAC) vestibular neurectomy has been developed and presented. It involves a 3-cm retrosigmoid craniotomy removing the posterior wall of the IAC to the singular canal, with transection of the superior vestibular nerve and posterior ampullary nerve. This produces a complete denervation of the vestibular labyrinth and preserves the patient's hearing. All ten patients with Meniere's disease had their vertigo cured. Hearing was preserved to within 11 dB of the preoperative pure tone average in 9 of 10 cases. There were no serious complications, no cases of facial paralysis, and no cases of total hearing loss. These results compare favorably with the MFVN and the RVN. The retrosigmoid IAC vestibular neurectomy is an important improvement in the evolution of vestibular neurectomy for the treatment of vertigo.

Denervation↗
PubMed1987

Retrolabyrinthine or retrosigmoid vestibular neurectomy: indications.

Selective vestibular nerve section is indicated for the treatment of vertigo in unilateral Meniere's disease or other inner ear disorders, in patients with salvageable hearing. Since 1978, the retrolabyrinthine approach to the vestibular nerve in the cerebellopontine angle has been used extensively with good success and minimal morbidity. In an attempt to obtain more complete section of the vestibular nerve, the retrosigmoid-internal auditory canal approach was developed in 1985 and has been employed in 13 patients, all of whom obtained complete control of vertigo. The surgical techniques are presented with emphasis on the advantages and disadvantages of each approach. Relative indications and contraindications are suggested.

Ear, Inner↗
PubMed1986

The state of tinnitus after inner ear surgery.

A retrospective study of several procedures--for either treatment of vertigo or resection of acoustic neuromas--was performed to determine their effect on tinnitus. Subjective ratings of the state of tinnitus (resolution, improvement, maintenance, or deterioration) were obtained by questionnaire. Surgical procedures performed for correction of vertigo frequently alter tinnitus. In general, procedures that conserve hearing--namely, retrolabyrinthine vestibular neurectomy (RVN), middle fossa vestibular neurectomy (MFVN), and endolymphatic shunt procedures (ELS)--have a 50% to 65% chance of helping relieve tinnitus and up to a 22% chance of worsening tinnitus. When there is no serviceable hearing, cochleovestibular neurectomy (CVN) offers the best cure rate for tinnitus (76%) and the least chance of worsening tinnitus (3%). When hearing is minimal and the patient complains of tinnitus, a CVN--rather than a labyrinthectomy--should be recommended. However, when useful hearing is present, a CVN is not usually recommended for relief of tinnitus, since the actual cure rates are only 35%. When vertigo is not a complaint, there is currently no surgical procedure known that can be recommended for the treatment of tinnitus.

Diagnosis, Differential↗
PubMed1986

The unrecognized rotation of the vestibular and cochlear nerves from the labyrinth to the brain stem: its implications to surgery of the eighth cranial nerve.

The cochlear and vestibular nerves rotate 90 degrees from the inner ear to the brain stem. Most of the rotation occurs within the internal auditory canal (IAC); only minimal rotation occurs in the cerebellopontine (CP) angle. At the labyrinthine end of the IAC, the cochlear nerve--which at first lies anterior to the inferior vestibular nerve (saccular nerve)--rapidly fuses with the inferior vestibular nerve. It then rotates to become inferior as the nerves leave the porus acousticus. The cochleovestibular (C-V) cleavage plane lies in a superior-inferior direction in the lateral IAC and rotates to become anterior-posterior in the CP angle. In 25% of patients in whom no C-V cleavage plane can be seen, it is not possible to completely transect all vestibular fibers. The surgical implications are that the most complete vestibular neurectomy can be done only in the lateral IAC, the cochlear and inferior vestibular nerves, because of their intimate association, should not be separated in the mid-IAC, in order to prevent damage to the cochlear nerve, and to create a complete denervation of the vestibular labyrinth, only the posterior ampullary nerve along with the superior vestibular nerve should be transected.

Brain Stem↗
PubMed1986

Hearing preservation after acoustic neuroma surgery with intraoperative direct eighth cranial nerve monitoring: Part II. A classification of results.

Since the advent of brainstem auditory evoked response audiometry and computerized tomography, small acoustic neuromas are more frequently found. Often the patient has serviceable hearing, which we would like to preserve during complete tumor removal. Since 1978, sixteen patients with acoustic neuromas have been operated upon through the retrosigmoid suboccipital approach, with the goal of hearing preservation. In 1983, we began using intraoperative direct eighth nerve monitoring, which produced a rapid assessment of cochlear nerve function during the excision of small acoustic neuromas. The tumors varied in size from intracanalicular lesions to one lesion with a 3.0 cm protrusion medial to the porus acousticus. In eight of sixteen cases, intraoperative monitoring was used, and in four of the patients hearing was preserved. In eight cases, intraoperative monitoring was not used, and hearing was preserved in only two patients. The overall success rate--in total tumor removal with hearing preservation--was 37%. Hearing was preserved in six of eight patients who had tumors which measured less than 1.5 cm. In this group of cases, two of the patients had a Class I good hearing result (PTA 0 to 30 dB and 70 to 100% discrimination), one patient had Class III nonserviceable hearing, (PTA 65 to 75 dB and 25 to 45% discrimination), and three patients had Class IV poor hearing, (PTA 80 to 100 dB and 0 to 20% discrimination). We found that continuous monitoring of direct eighth-nerve-evoked action potentials were extremely valuable and rapidly indicated reversible cochlear nerve trauma.

Adult↗
PubMed1986

A comparison of PORP, TORP, and incus homograft for ossicular reconstruction in chronic ear surgery.

This report presents the results of 210 cases over a 10-year period using PORPs, TORPs, and notched incus homografts (NIH), for ossicular reconstruction in chronic ear surgery. There were 192 adults and 18 children. The surgical technique utilized temporalis fascia in an underlay technique with canal skin covering the outer surface of the fascia. Intact canal wall mastoid-tympanoplasty, as a one-stage procedure, was used for most cases. Homograft nasal cartilage was placed between the Plasti-Pore prosthesis and the graft. Notched incus homografts were prepared prior to surgery and stored in 4% formalin. There were 149 mastoid-tympanoplasties and 61 tympanoplasties performed. Revision of our cases was performed in 16.6%. Within 3 months of surgery, 86% of adults, and 44% (8/18) of children had dry, healed ears free of disease. The graft take rate was 96%. In adults, a total of 99 NIH, 50 TORPs, and 43 PORPs were implanted. In adults, the closure of the air-bone gap to 20 dB or less occurred in 58% using TORPs, 67% using PORPs, 76% using NIH-Partial replacement, and 20% using NIH-Total replacement. Excluding the cases that failed for reasons other than conductive hearing loss, the results improved to 69% for TORPs, 77% for PORPs, 77% for NIH-P, and 27% for NIH-T. In adults, the extrusion rate was 5.5% for Plasti-Pore and 3% for NIH. In children, the extrusion rate was 17% for Plasti-Pore prostheses. From this study, it appears that PORPs and TORPs with homograft nasal cartilage are satisfactory prostheses for chronic ear surgery in adults. In children, Plasti-Pore prostheses should be avoided unless the ear is healed, aerated, and stable. NIHs are good prostheses when the stapes is intact, but they are inferior to the TORP when placed on the footplate. Also, the NIH requires preparation prior to surgery and may be difficult to obtain. We plan to continue using PORPs and TORPs in chronic ear surgery until a better technique is found, or the complication rate becomes unacceptable.

Adult↗
PubMed1986

Vertigo.

Explore the source record for details and available documents.

Ear, Inner↗
PubMed1985

Preoperative and postoperative growth rates in acoustic neuromas documented with CT scanning.

Sequential computerized tomography (CT) allows us to determine the growth rate of acoustic neuromas. Prior to CT scanning, a variability in tumor growth rates was recognized on the basis of clinical signs. After incomplete tumor removal, some patients experienced rapid recurrence, whereas others lived many years without recurrence. We used CT scanning to study tumor growth rates in a heterogeneous group of 21 patients. Thirteen elderly patients were given annual scans after incomplete tumor removal, while eight patients who had not had surgery are likewise being followed up. Early detection and complete tumor removal with preservation of hearing and facial function remain the goal in vigorous and healthy patients. However, a large number of older, infirm patients with acoustic neuromas may not require surgery or be candidates for incomplete tumor removal. Because rapid tumor growth may necessitate total tumor removal even in older patients, a better understanding of the growth rates may permit us to take a more scientific approach in planning these patients' management.

Adult↗
PubMed1985

Micropuncture of the tympanic membrane after tympanoplasty.

Shortly after tympanoplasty the cause of conductive hearing loss may be difficult to ascertain. If the cause is related to poor eustachian tube function, early aeration of the middle ear should produce an immediate improvement in hearing. A procedure for aerating the middle ear consists of introducing 0.5 cc of air through the graft with a tuberculin syringe and an angled 1.25-inch, 27-gauge needle. Between 1978 and 1983, 75 patients, or 19% of those having tympanoplasties or mastoid tympanoplasties, underwent the micropuncture procedure. Forty-five patients had a hearing improvement after the procedure and there were no complications. It appears that micropuncture of the tympanic membrane is an easily performed, relatively painless, safe procedure after tympanoplasty. It is a useful diagnostic procedure that may also improve the ultimate results of tympanoplasty surgery.

Air↗
PubMed1985

Retrolabyrinthine vestibular neurectomy with simultaneous monitoring of eighth nerve and brain stem auditory evoked potentials.

We have used retrolabyrinthine vestibular neurectomy in 36 of 49 cases as the primary surgical procedure to relieve vertigo. Most of the patients (46 of 49) had Meniere's disease. Results indicate that 71% (35 of 49) of the patients had no vertigo after the operation, while 22% (11 of 49) had much improvement. Hearing was maintained within 20 dB of the preoperative level in 78% (38 of 49) of the patients. During surgery in the last 23 patients, direct nerve potentials were recorded from the middle ear promontory and the intracranial cochlear nerve. Brain stem auditory evoked responses were simultaneously recorded in the last 10 patients. It appears that the intraoperative direct cochlear nerve potentials can be used as a sensitive monitor of trauma to the cochlear nerve during and after vestibular neurectomy. If the latency of the eighth nerve action potential changes less than 0.3 msec and the waveform does not change after vestibular neurectomy, there is an excellent chance that hearing at 1 month after surgery will be within 15 dB of the level before surgery. The retrolabyrinthine vestibular neurectomy has replaced the middle fossa vestibular neurectomy and the endolymphatic subarachnoid shunt procedure in our clinic.

Brain Stem↗
PubMed1985

Conservative management of acoustic neuroma in the elderly patient.

A subtotal resection through the translabyrinthine approach should be used in the treatment of large symptomatic acoustic neuromas in patients over the age of 65. This approach will consistently relieve the patient's symptoms of brain stem compression, reduce postoperative morbidity and complications, and preserve facial nerve function. In the elderly, after subtotal resection, the remaining tumor in 80% of cases appears to remain dormant during the average six year follow-up (1-16 year range). Eighty percent of acoustic neuromas not operated upon, appear to grow at a slow rate (0.2 cm/yr) while 20% grow at a fast rate (1 cm/yr). Patients over the age of 65 with small acoustic neuromas do not need surgical intervention. Yearly CT scanning is recommended to determine the growth rate of the acoustic neuroma. A conservative approach should be used in the treatment of all acoustic neuromas in the elderly.

Age Factors↗
PubMed1985

Retrolabyrinthine vestibular neurectomy with and without monitoring of eighth nerve potentials.

Retrolabyrinthine vestibular neurectomy is a safe and effective treatment for Meniere's disease and inner ear vertigo. Hearing was maintained within 20 dB of the preoperative level in 83% of our patients and speech discrimination scores were preserved within 20% in 80%. Intraoperative monitoring of audiometric evoked potentials, employed to study the possible causes of hearing loss, provided rapid, sensitive detection of trauma to the auditory system. Our patients benefited from this technique--those who underwent retrolabyrinthine vestibular nerve section, as well as those who experienced acoustic neuroma surgery, where hearing preservation is a goal. Direct intraoperative monitoring of eighth nerve function continues to be a standard part of our surgical practice.

Ear, Inner↗
PubMed1985

Evoked serial electromyography in the evaluation of the paralyzed face.

Serial evoked electromyography (EEMG) is a reliable, objective, repeatable test of facial nerve function. It is very important in the initial patient evaluation in determining percent degeneration of the facial nerve. A response of 0-20% will usually result in incomplete return of facial function while responses of 60% or better will usually result in normal function. With viral facial paralysis (Bell's palsy, herpes zoster oticus), serial EEMG after several weeks has little value in predicting the final percent recovery of facial function. If there is no EEMG response, the diagnosis of viral facial paralysis is questionable and serial tests should be done until facial function begins to return. If there is no return of facial function or EEMG responses, the diagnosis is probably a tumor and the nerve should be explored. When surgical manipulation of the facial nerve has resulted in partial facial weakness, EEMG helps predict the degree of recovery of facial function. EEMG results of 60% or better will result in normal facial function while EEMG results of 25% or less will result in incomplete return of facial function. Serial testing is not necessary in this group of patients. After transection and repair of the facial nerve, serial EEMG is of value in showing continuity of the repair. Lack of improvement in EEMG over 5-12 months and no return of facial function indicates poor prognosis.

Ear Diseases↗