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Biomedical subjects

I K Arenberg

Publications and source records attributed to I K Arenberg.

At least 91 records · Page 5Linked to original sources
PubMed1980

The prognostic value of the glycerol test: a review of 60 ears with unidirectional inner ear valve implants.

The following are our conclusions in regard to glycerol test interpretation based on 60 valve implants: Negative Tests 1. A negative glycerol test result and no audiometric evidence of significant hearing fluctuations indicate that a patient is unlikely to have postoperative hearing that is better than his best preoperative hearing. 2. The patient with a negative test can still have an excellent chance (greater than 80 per cent) to be relieved of vertigo. 3. A negative test and no audiometric evidence of significant hearing fluctuations in a patient with cochlear Meniere's disease would contraindicate valve surgery. Positive Tests 1. A positive glycerol test, done under appropriate conditions with adequate audiometric controls, clinically confirms the histopathologic diagnosis of endolymphatic hydrops. 2. The patient will have a 30 to 40 per cent chance of having better postoperative hearing than his best preoperative hearing. 3. The patient will have an 80 to 90 per cent chance to be free of vertigo. 3. The patient will have an 80 to 90 per cent chance to be free of vertigo. 4. A positive glycerol test would be a contraindication for labyrinthectomy, since the patient has the potential for some hearing improvement as well as absence of vertigo.

Ear, Inner↗
PubMed1979

Endolymphatic sac valve implant surgery. I: The technique.

A resurgence of interest in surgery on the endolymphatic sac (ELS), not only for relief of vertigo but also for stabilization or improvement of hearing, has emerged. With the concept of operating early in the course of the disease after the diagnosis is well established, various modifications of existing procedures on the ELS have been utilized in an attempt to improve the overall results. One such major modification is the unidirectional inner ear valve implant modified from the eye valve for glaucoma. This valve implant has produced impressive one-year results for both hearing improvements and relief of vertigo in patients who were scheduled for labyrinthectomy. Subsequent preliminary reports by several investigators show good to excellent results for the hearing (AAOO--Class B or A) as well as the vertigo without consideration for the stage of the disease. This study presents primarily the step by step technique with drawings and a color atlas to facilitate the correct performance of this surgery.

Ear, Inner↗
PubMed1979

Endolymphatic sac valve implant surgery. II: The unidirectional inner ear valve implant.

A unidirectional inner ear valve implant was developed to direct excess endolymph out of the inner ear in the hydropic state (Ménière's disease) into the mastoid cavity. A detailed technical description of the valve implant is presented as well as some technical aspects of the valve implant based on the surgical anatomy of the endolymphatic sac.

Ear, Inner↗
PubMed1979

Low plasma renin concentration in patients with Meniere's disease (preliminary report).

Endolymphatic hydrops is the histopathologic hallmark of Meniere's disease. The cause of excess inner ear fluid is unknown, but the possibility of a systemic abnormality of fluid-solute regulation has been considered. One indicator of systemic fluid and electrolyte balance is the enzyme renin. Plasma renin levels were measured in patients with a clinical diagnosis of Meniere's disease and compared to a group of patients who did not have Meniere's disease. The mean plasma renin concentration of patients with Meniere's disease was statistically lower than that of the other subjects. The study's results are consistent with a systemic abnormality in fluid and solute regulation in some patients with M eniere's disease, leading to abnormal expansion of the extracellular fluid volume, and possibly contributing to endolympathic hydrops.

Ear Diseases↗
PubMed1978

Unidirectional inner ear valve implant for endolymphatic sac surgery in Meniere's disease.

In five patients with long-standing Meniere's disease, a unidirectional inner ear valve was implanted into the endolymphatic sac (ELS) to facilitate removal of excess endolymph in the hydropic state. These patients were all candidates for ablative surgery. They all had intractable vertigo and severe hearing losses. Four out of five patients had positive preoperative glycerol tests. In the patients with positive glycerol tests, the group averages before surgery were as follows: pure-tone average (PTA), 63 dB; speech reception threshold (SRT), 79 dB; and discrimination score, 27%. All of the patients, except a patient with a negative glycerol test, benefited from the surgery, including exceptional hearing improvements, averages of 21 dB in PTA, 30.5 dB in SRT, and 48% in discrimination, which remained so for at least a one-year minimum follow-up. All patients with preoperative positive glycerol tests had a class A result according to the criteria set forth by the American Academy of Ophthalmology and Otolaryngology. The cumulative follow-up exceeded the minimal requirements by a factor of 39 times. The only failure was in a patient with a negative glycerol test, which was predictable. Results of tomography confirmed the correct position of the valve without evidence of migration or extrusion even in the failure. This new valve appears to be a safe and more effective implant than Silastic sheeting alone or any other ELS implant in patients with a positive glycerol test.

Adult↗
PubMed1978

Incidence of Ménière's disease.

The incidence of Ménière's disease in Sweden for the year 1973 has been calculated as one case in a population of 2,163. This gives an overall incidence of 46/100,000. Extrapolating the Swedish incidence data to the population of the United States, there should have been 97,000 cases of Ménière's disease treated as inpatients or outpatients during the year 1973. The incidence in the United States of Ménière's disease, cochlear type, is considered to be even higher. In addition, the Swedish statistic for some other disorders, including otosclerosis, are reported. For otosclerosis, the yearly incidence in Sweden is 12/100,000 or one case in a population of 8,414. This could be extrapolated to 25,000 patients with clinical otosclerosis in the United States for the year 1973. By comparison, Ménière's disease, by stringent diagnostic criteria, is approximately four times as common as clinical otosclerosis. It is also more common than all laryngeal carcinomas, all salivary gland tumors, both benign and malignant, as well as acute epiglottitis and acute nephritis.

Adolescent↗
PubMed1977

The surgical anatomy of the endolymphatic sac.

The endolymphatic sac (ELS) and vestibular aqueduct (VA), which play a notable role in the pathogenesis of endolymphatic hydrops and Meniere disease, were identified in all anatomic and tomographic materials. More than 100 temporal bones were used for microdissection, tomography, and plastic molds. Normal subjects and Meniere disease patients were studied tomographically (N = 63) and observed during ELS surgery (N=49). In Meniere disease there is, with increassing duration of diseases, a decrease in the periaqueductal and opercular air cell pneumatization, with a concomitant shorter and straighter VA. This correlates with a decreased ELS luminal patency, and a more inferiorly positioned ELS. These factors help to explain both the difficulties of visualizing the VA by tomography in Meniere disease as well as the occasional difficulties reported by others in satisfactorily identifying the ELS at sac surgery. All observations are made from the surgeon's viewpoint to enhance clinical identification of the ELS.

Adult↗
PubMed1977

Static compliance of the eardrum in Meniere disease.

A recent study compared the acoustic impedance values in the affected and unaffected ears of patients with unilateral Meniere disease, and suggested that the higher impedance measured in the affected ears was due to increased intralabyrinthine pressure (endolymphatic hydrops). The present study does not support these findings. This conclusion is based on the static compliance of 17 patients with unilateral Meniere disease, measured during the glycerin test. Glycerin, an osmotic diuretic, produces transient improvements in pure-tone threshold and/or speech discrimination in the affected ear only. Orally administered glycerin is thought to cause these improvements by reducing endolymphatic hydrops. We were unable to find any change in static complicance after glycerin ingestion. Also no difference between the affected and unaffected ears, either before or after glycerin, was noted.

Adult↗
PubMed1977

Endolymphatic sac surgery for hearing conservation in Meniere disease.

Thirty-five patients with Meniere disease underwent endolymphatic sac decompression and drainage with a Silastic sac-mastoid shunt. On the basis of patients' responses to a questionnaire and on analysis of preoperative and postoperative audiometric studies, we found the method to be an effective means for conservation or improvement of hearing and for relief of vertigo in patients with positive glycerol tests. Of the 35 patients, eight had negative glycerol tests and did not benefit from surgery (P less than .001). Of the 27 patients with positive glycerol tests, 70.4% (19) had no further vertigo, and 18,5% (5) had decreased frequency or severity of attacks (an overall relief of vertigo in 88.9%). Hearing was improved in 16 (59.2%) and stabilized in five (18.5%). Subjectively, 85.2% (23/35) of the patients were satisfied with the hearing results of their operation.

Adolescent↗
PubMed1977

Therapeutic options in Meniere's disease.

Emphasis on treatment in Meniere's disease has recently shifted from a concentration on the vertiginous component alone to include conservation or improvement of hearing as well. This presentation tabulates the current otological literature's reports of both the medical and surgical options available in the treatment of Meniere's disease. The authors conclude that these more recent reports deemphasize the importance of the vertiginous component, while emphasizing the importance of the hearing component in evaluation of the efficacy of any therapeutic modality. Furthermore, these reports indicate that endolymphatic sac decompression and drainage surgery alone offers a considerable chance for conservation or improvement in hearing, as well as relief of vertigo in early cases of reversible, fluctuating hearing deficits. In nonreversible or nonfluctuating hearing deficits with hearing worth conserving, vestibular neurectomy with excision of Scarpa's ganglion yields the best results.

Ear, Inner↗
PubMed1977

Diaphoresis and Meniere's disease.

The effect of diaphoresis on patients with Meniere's disease (labyrinthine hydrops) previously has not been reported. With the use of two distinct activities to produce diaphoresis, we were able to document substantial transient improvements in pure-tone threshold, speech-reception threshold, and speech discrimination concurrent with a decrease in tinnitus and fullness in two patients with unilateral Meniere's disease that had been diagnosed previously by the glycerin test. The two diaphoretic activities were (1) strenuous exercise, including periodic visits to the sauna, and (2) passive activity consisting of repetitive visits to the sauna. Glycerin, an osmotic diuretic, produces similar temporary beneficial effects primarily in patients in the fluctuant hearing stage of Meniere's disease. The glycerin test is being used in several clinics as an adjunct for the diagnosis of endolymphatic hydrops.

Adult↗
PubMed1976

Pre and post-glycerol special audiometric tests battery results in endolymphatic hydrops.

The glycerol test for endolymphatic hydrops was administered to 17 patients exhibiting classical symptoms of Meniere's disease. A complete battery of audiometric tests including the SISI, TTD (Rosenberg variation). ABLB, Sweep Frequency Bekesy, two tests of speech discrimination (Rush Hughes and Northwestern), and air and bone conduction thresholds were administered pre and post-glycerol ingestion in order to determine the effect of osmotic diuresis. Improvement in pure-tone sensitivity and speech discrimination scores were most often observed. Among the special audiometric tests only the SISI scores exhibited changes, however, these could be related to the threshold changes. There were no significant differences observed in the threshold tone decay tests nor in the ABLB. The sweep frequency Bekesy test revealed only the changes which were observed in pure-tone sensitivity.

Acoustic Stimulation↗