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Biomedical subjects

H Silverstein

Publications and source records attributed to H Silverstein.

At least 163 records · Page 9Linked to original sources

Sodium loading of inner ear fluids.

A slow intracarotid infusion of hypertonic sodium chloride solution, 350 mEq/L, and potassium chloride, 5 mEq/L, was used to increase serum sodium chloride over a 90-minute period in 85 cats. A slow, steady rise in serum sodium occurred, which reached almost 208 mEq/L at the end of 90 minutes. A concomitant rise in sodium occurred in the cerebrospinal fluid and perilymph. In contrast, the sodium showed only a transient slight increase in the cochlear and vestibular endolymph. Endolymph potassium appeared to rise in order to balance out the increase in sodium concentration of the surrounding and extracellular fluids. The ratio of sodium to potassium ions in both the endolymph and perilymph compartment remained relatively constant before and after the infusion with hypertonic NaCl. After infusion, the total concentration of ions in endolymph was similar to that of perilymph. These experiments indicate that the endolymph compartment has a built-in mechanism for maintaining a low-sodium concentration while keeping ionic balance with the surrounding perilymph and serum.

Animals↗

Endolymphatic sac obstruction. Biochemical studies.

Inner ear fluids were studied biochemically in guinea pigs from 1 to 16 weeks after producing endolymphatic hydrops by obstructing the endolymphatic duct. Fluid collected from beneath the footplate showed changes of 50% of the animals indicating distension of the saccule. There was an increase in potassium concentration and decrease in sodium concentration of the collected fluid, indicating a traumatic mixing of endolymph and perilymph produced by rupture of the saccule during collection of the fluid. The smallest changes occurred at one week, and the greatest changes were found four months after endolymphatic sac obstruction. Similar findings were observed in studying inner ear fluids obtained from patients with Ménière's disease. Cochlear endolymph showed biochemical alterations after endolymphatic duct blockage. There was a two- to three-fold increase in sodium concentration and a decrease in potassium concentration with the total ionic concentration remaining approximately the same. Some guinea pigs showed similar changes in vestibular endolymph. This study indicates that in the guinea pig, endolymph obtained in the distended endolymph compartment has a slightly different sodium-potassium ratio as compared to the normal ear. In patients with Ménière's disease there may also be an elevation of endolymph sodium concentration. The significance of this change and hearing loss observed in experimental endolymphatic hydrops and Ménière's disease is open to speculation at the present time.

Animals↗

Streptomycin treatment for Meniere's disease.

This paper describes the author's 10-year experience using streptomycin sulfate in the treatment of Meniere's disease in the following: the classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease (eight patients); the classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear (five patients); the intratympanic treatment of unilateral Meniere's disease (four patients); and low dose intramuscular outpatient treatment in unilateral Meniere's disease (five patients). The results of bilateral vestibular ablation were similar to those obtained previously by Schuknecht and others: patients developed profound ataxia with a wide-based gait and oscillopsia, which improved rapidly over a period of months; approximately 30% of patients experienced significant improvement in hearing, which usually deteriorated again after several months; and all patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded similarly, and hearing was preserved in all cases. Intramuscular streptomycin ablation of the vestibular system is strongly recommended in place of surgery in the only hearing ear in Meniere's disease. Controlled intratympanic injection of streptomycin is not successful as yet because of difficulty in controlling the dose. Low dose subototoxic streptomycin treatment on an outpatient basis offers promise for relief of Meniere's attacks, and may improve hearing in some cases without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs which may reduce endolymph production may eventually be the treatment of choice for Meniere's disease.

Cochlea↗

Partial or total eighth nerve section in the treatment of vertigo.

Partial vestibular (singular) neurectomy under general anesthesia through a postauricular approach is an effective method of relieving incapacitating benign positional vertigo, as is the case in 14 of 16 patients (87%) so treated. Middle fossa vestibular neurectomy appears to be a worthwhile procedure to deinnervate the peripheral vestibular system while preserving hearing. The results of 27 middle fossa vestibular neurectomies indicate relief of vertigo in 85% of the patients. The results of treatment on 44 patients undergoing transmeatal-cochleovestibular neurectomy indicated that vertigo was relieved in 19 of 23 (82%) with Meniere's disease and improved in 50% of the patients with post-stapedectomy vertigo and sensorineural hearing loss. Tinnitus was cured or markedly improved in 80% of the patients with Meniere's disease and 70% of the patients with post-stapedectomy sensorineural hearing loss and tinnitus. The transmeatal-transcochlear approach to the internal auditory canal offers advantages over the transmeatal labyrinthectomy or translabyrinthine approach to the internal auditory canal.

Adult↗

Retrolabyrinthine vestibular neurectomy.

Vestibular neurectomy performed through the middle fossa or retrolabyrinthine approach is an effective method of denervating the labyrinth while preserving residual hearing. In the authors' opinion, the retrolabyrinthine approach is easier to perform, takes less time, and places the facial nerve in less jeopardy than the middle fossa procedure. The results of 26 cases of retrolabyrinthine vestibular neurectomy followed from six to 26 months indicate an 85% (22/26) cure rate of vertigo and a 79% (21/26) rate of hearing unchanged or improved.

Adult↗