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Biomedical subjects

I K Arenberg

Publications and source records attributed to I K Arenberg.

At least 55 records · Page 3Linked to original sources
PubMed1985

Electrocochleography and symptoms of inner ear dysfunction.

We examined the relationship between electrocochleographic test results and symptoms associated with Meniere's disease-endolymphatic hydrops (MD-ELH). Extratympanic electrocochleography (ECochG) was performed on 55 consecutive patients (110 ears) suspected of having MD-ELH, and the results compared with the clinical symptoms of the patients on the day of recording. Referring symptoms included sensorineural hearing loss, aural fullness or pressure, tinnitus, vertigo, and all combinations of these four. There was a statistically significant difference between ECochG findings when symptoms were absent compared with when one or more symptoms were present. Furthermore, the presence of hearing loss combined with aural fullness or pressure was the strongest predictor of a positive ECochG, as characterized by an enlarged summating potential action potential amplitude ratio.

Audiometry↗
PubMed1985

Middle ear irrigation during insertion of ventilation tubes.

Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space infection with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16 to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.

Child, Preschool↗
PubMed1985

Distribution and density of subepithelial collagen in the endolymphatic sac in patients with Meniere's disease.

Our understanding of the histology and histopathology of the endolymphatic sac (ELS) is based on both temporal bone preparations and biopsy material. The current study will provide the basis for an ultrastructural analysis of the spectrum of pathologic changes observed in biopsy specimens from patients with endolymphatic hydrops in Meniere's disease. Emphasis is placed on the distribution and density of subepithelial collagen in the ELS of normal and hydropic patients. This study will be the light microscopic basis for an ultrastructural clinicopathologic correlation of inner ear tissue from the ELS with the clinical stage of the disease.

Aged↗
PubMed1984

Radiographic classification of the vestibular and cochlear aqueducts: the paired correlation between normal and abnormal vestibular aqueduct and cochlear aqueduct anatomy.

Multidirectional tomography (MDT) can be useful in determining the caliber, shape, and course of the vestibular aqueduct (VA) and cochlear aqueduct (CA). Clinical decisions have been based on the findings from MDT. Unfortunately, the clinical utility of these observations has been confusing and controversial because similar MDT techniques were not used. This study will address some of the difficult questions and clinical controversies derived from MDT observations. This new perspective has evolved with the use of high resolution computed tomography (HRCT). An analysis of 750 petrous bones for the occurrence of the various types of VAs and CAs using Gado's classification, further vestibular aqueduct and a variation of Gado's classification for the cochlear classification is reported. The distribution of the possible paired types of VA and CA are evaluated. MDT results indicate that the paired analysis in patients with inner ear dysfunction is not useful, cost effective, diagnostic, or of prognostic value. MDT can provide clinically valid observations of periaqueductal and perilabyrinthine pneumatization which is helpful in anticipating the size and position of the endolymphatic sac at the time of surgery for those few patients who may benefit from endolymphatic system surgery. However, when a comparison is made between MDT and CT of 60 ears in those same patients, the clinical limitations of MDT for inner ear diagnosis and prognosis became apparent. The future for HRCT scanning with reformatting holds potential for clinically meaningful visualization of inner and middle ear structures previously expected from MDT imaging.

Cochlea↗
PubMed1982

Ultrastructural analysis of endolymphatic sac biopsies. Biopsy technique and identification of endolympathic sac epithelium.

This study describes the technique and instrumentation necessary to perform a double-wall biopsy of the endolymphatic sac (ELS). Since this technique protects the lumen of the ELS, which is within the center of the biopsy sample surrounded by the lateral and medial wall, the ultrastructure of the ELS epithelium, luminal contents, and perisaccular connective tissue tends to represent the in vivo status. The biopsy specimen can be analyzed by electron microscopy for clinical-pathologic correlation. Ultrastructural analysis (1) provides definite identification of the ELS and epithelium, (2) may provide insight into a possible role of the ELS in the pathogenesis of endolymphatic hydrops, and (3) can provide much improved clinical-pathologic correlation over only light microscopic studies.

Biopsy↗
PubMed1982

Revision endolymphatic sac and duct surgery for recurrent Meniere's disease and hydrops: failure analysis and technical aspects.

Endolymphatic system surgery for Meniere's disease has been shown to be effective in selected cases; however, some patients do not achieve substantial long-term relief from their symptoms in spite of early success and may require revision surgery. Revision endolymphatic system surgery has been reported in the literature in 9.7% to 16.3% of patients. As part of an ongoing prospective analysis of endolymphatic valve implant surgery, the first 400 procedures performed over 6 years were analyzed to determine the rate and cause for revision surgery. Fifty-four of 386 (13.9%) of endolymphatic valve implants performed by the authors required revision. Fourteen cases initially operated on elsewhere are also analyzed. The most frequent causes of failure was outflow tract obstruction caused by temporalis fascia, previously used to anchor the valve. Since that technique has been abandoned, the revision rate of primary valve implants is 6.7%.

Ear, Inner↗
PubMed1982

Prevention of complications and failures in endolymphatic system surgery.

Endolymphatic system surgery for Meniere's disease has been shown to be effective in selected cases. However, substantial long term relief of symptoms may not be achieved in some patients in spite of early success and revision surgery may be required. Revision endolymphatic system surgery has been reported as being required in 9.7 to 16.3 per cent of the patients. As part of an ongoing prospective analysis of endolymphatic valve implant surgery, the first 400 procedures we performed over six years were analyzed to determine the incidence and reasons for revision surgery, as well as the incidence and nature of the intraoperative and postoperative complications. Fifty-four (13.9 per cent) of 386 endolymphatic valve implant operations performed by the authors required revision. The results in 14 patients initially operated on elsewhere were also analyzed. The most frequent cause of failure was outflow tract obstruction by temporalis fascia, previously used to anchor the valve. Since that technique has been abandoned, the revision rate of primary valve implants has been 6.7 per cent. The valve implant for hydrops appears to be a safe and effective treatment with a minimum of complications. A thorough understanding of the surgical anatomy as related to surgical technique and instrumentation is essential in minimizing the risk of failure resulting in a revision or a complication. The incidences of complications in the first 400 valve implant operations were: "dead ear" resulting from various causes, 2.5 per cent; transient facial nerve paresis, 0.75 per cent; permanent facial nerve damage, none; cerebrospinal fluid leaks, 4.5 per cent (one requiring surgical closure, 0.25 per cent); wound infections, 1.25 per cent; postoperative malignant hyperthermia, one case (0.25 per cent). There were no cases of meningitis and no deaths. The complications and related factors as well as a failure analysis of the pressure sensitive unidirectional inner ear valve implant for hydrops are evaluated in detail.

Ear, Inner↗
PubMed1981

Cochlear abnormalities in Alport's syndrome.

The cochleae of four patients with a diagnosis or suspicion of Alport's syndrome were examined by microdissection and surface preparations. Strial atrophy, found in all cases, was most pronounced in the middle and apical turns and mainly involved the inferior margin of the stria. Numerous vacuoles were seen in the spiral ligament behind the atrophic stria. The youngest patient, aged 16 years, who had little or no hearing loss, showed limited hair cell degeneration. The other two patients had severe hearing loss and extensive sensory cell loss of unusual distribution. In the specimens from the second patient, the extent of hair cell loss was fairly even throughout, but the loss of inner hair cells was far more severe than the loss of outer hair cells. In the third case, the loss of outer hair cells was most pronounced in the apical half of the cochlea. All of these specimens had only a mild secondary nerve degeneration. The specimens from the fourth patient were poorly preserved and showed only nerve degeneration.

Adolescent↗