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Biomedical subjects

J B Farrior

Publications and source records attributed to J B Farrior.

At least 19 recordsLinked to original sources
PubMed1999

Teflon-wire piston or stainless-steel bucket stapes prosthesis: does it make a difference?

The goal of this study was to determine whether postoperative (implantation of a stapes prosthesis) hearing gain and the amount of air-bone gap overclosure are more improved with the Teflon-wire piston or with the stainless-steel bucket prosthesis. We retrospectively reviewed the outcomes of 82 surgeries that had been performed by the primary author; 41 of these patients had received a Fisch Teflon-wire piston, and 41 had received a Bailey-modified Robinson stainless-steel bucket prosthesis. The mean hearing gain for the patients who received the Teflon-wire piston was 23.3 dB after primary stapes surgery and 20.5 dB after revision surgery. Patients who received the stainless-steel bucket prosthesis experienced a mean hearing gain of 20.7 and 20.3 dB, respectively. Following primary stapes surgery, the air-bone gap overclosure was 4.4 dB with the Teflon-wire piston and 5.2 dB with the stainless-steel bucket prosthesis. There was no statistically significant difference in either hearing gain or air-bone gap overclosure between the two prostheses.

Adolescent↗
PubMed1998

Postauricular myocutaneous flap in otologic surgery.

Management of a large mastoid defect resulting from skull base operations or extensive surgical procedures because of chronic ear disease continues to challenge the otologic surgeon. Various local muscle or periosteal rotation flaps have been used to help reduce the size of the postoperative mastoid cavity. With these techniques there are problems with flap retraction and epithelization that may result in delayed healing or chronic drainage. Closure of the ear canal and tissue obliteration of the mastoid results in a maximal conductive hearing loss. A postauricular myocutaneous flap based on the occipital artery and sternocleidomastoid muscle has been used effectively to reconstruct mastoid defects after both surgical procedures for chronic ear disease and skull base operations. The skin muscle flap reduces the mastoid cavity and promotes rapid healing of the surgical defect. Although postauricular myocutaneous flaps have been found to be reliable, their viability may be compromised by arterial embolization used in larger glomus tumors. Indications for and creation of a postauricular myocutaneous flap, with results in 18 cases, are presented.

Adolescent↗
PubMed1998

Reconstruction after temporal bone resection.

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy. Sleeve resection was managed with tympanoplasty, canalplasty, or obliteration of the external auditory canal (10). There were 24 lateral temporal bone resections and four subtotal temporal bone resections. Larger defects created by lateral and subtotal temporal bone resections required closure with a combination of temporalis flaps and local rotational cutaneous flaps (13). Lower island trapezius flaps (five), free flaps (four), and pectoralis major flaps (two) were also used. Indications and efficacy of each method are discussed, and treatment outcomes are presented.

Adult↗
PubMed1996

Long-term results using ossicular grafts.

Sculpted autologous ossicle and cortical bone grafts were the first materials successfully used to reconstruct the ossicular chain in chronic ear surgery. Over the last 20 years, the use of biocompatible implants has been popularized; as a result, bone grafts have fallen into disfavor with most otologists. To determine if autologous bone grafts remain stable with time, 115 cases in which autologous bone grafts were used between 1971 and 1984 were reviewed. Eighty patients underwent Type III tympanoplasty, stapes arch present. Thirty-five underwent Type IV tympanoplasty, stapes arch absent. Minimum follow-up was 2 years; 30 patients were followed for > or = 10 years. In Type III tympanoplasty, overall the initial air/bone gap was 19.7 dB at 6 months, with 59% of those with improved hearing at 15 dB air/bone gap or better. Hearing remained stable for 10 years with overall hearing of 19.2 dB air/bone gap and 50% with an air/bone gap of < or = 15 dB. In Type IV tympanoplasty, the average air/bone gap was 26 dB at 6 months, with 70% of those having improved hearing with < or = 20 dB air/bone gap. At 10 years, the overall air/bone gap was 29.3 dB, with only 28% maintaining an air/bone gap of < or = 20 dB. Poor eustachian tube function and collapse of the middle ear air space were found to be the primary causes for long-term failure. The initial hearing results using autologous bone are comparable with those achieved with synthetic prosthesis. Hearing results using autologous bone remained stable through 5 years. Beyond 5 years, Type III tympanoplasty remained stable, while there was deterioration in Type IV tympanoplasty due to poor eustachian tube function.

Adolescent↗
PubMed1995

Missile injuries to the temporal bone.

Gunshot injuries to the head and neck are frequently seen in patients brought to a level I trauma center. These injuries result in great morbidity and mortality and a significant expenditure of health care dollars. Missile injuries to the temporal bone, though less common, can likewise be devastating. Common sequelae include vertigo, deafness, facial nerve paralysis, and death. A series of missile injuries to the temporal bone treated at Tampa General Hospital during 1993 prompted a review of head and neck missile injuries in our trauma registry over the past 4 years (1989 to 1993). More than 100 patients were shot in the head or neck; 25 of them had injury to the temporal bone. Outcomes included facial nerve injury (8), deafness (9), vertigo (3), and death (13).

Adolescent↗
PubMed1994

Small fenestra stapedotomy for management of progressive conductive deafness.

Progressive conductive deafness may be caused by otosclerosis, a bone fixation of the stapes that causes reduced transmission of sound from the eardrum to the inner ear. Since the late 1950s, stapes surgery has been considered the treatment of choice for alleviating hearing loss due to otosclerosis. Over the past 20 years, there has been a decline in the number of stapes operations done. As a result, there are concerns regarding results of the stapes surgery done today compared with the results of such surgery when it was done more frequently. In this paper, I retrospectively review 603 stapes operations that I did at the Farrior Ear Clinic between 1981 and 1991. There were 484 primary stapes operations. Hearing results using the small fenestra technique showed closure of the air-bone gap to 10 dB or less in 96% of cases. During the same period, 119 revision operations were also done. The surgical technique, operative findings, and hearing results are presented. In both primary and revision stapes surgery, the hearing results of this series are compatible with the results of earlier, larger series. My findings show that stapes surgery is still the treatment of choice for hearing loss due to otosclerosis.

Adolescent↗
PubMed1991

Glomus tumors of the temporal bone: electron microscopic and immunohistochemical evaluation.

Glomus tumors arising in the temporal bone are now recognized as being part of the diffuse neuroendocrine system. Material from 12 glomus tumors was studied by means of electron microscopic and immunohistochemical techniques to determine whether there was an association between tumor size, patient age, and the neuroendocrine functions of these tumors. Electronmicroscopic evaluation (seven tumors) revealed a highly variable concentration of neurosecretory granules. Immunohistochemical staining (nine tumors) demonstrated that glomus tumors do arise from neural ectoderm and that they all contain serotonin. The concentration of serotonin seems to correlate with the concentration of neurosecretory granules seen on electronmicroscopy. In addition, higher levels of serotonin were found in two patients who were in their late sixties. It is possible that some of the neuroendocrine activity associated with glomus tumors could be the result of the release of serotonin.

Adult↗
PubMed1989

Cholesteatoma in 3-D.

1. In Shambaugh's primary acquired cholesteatoma, the surgical approach of choice is the direct endaural transcanal modified radical mastoidectomy and tympanoplasty in continuity. 2. In Shambaugh's classification of the secondary acquired cholesteatoma developing in a previously pneumatic mastoid with the infection of short duration, the postauricular transcortical mastoidectomy and facial recess approach and tympanoplasty in continuity is worthy of consideration if there is a reasonable possibility that the eustachian tube function may return to normal. 3. In Shambaugh's classification of a secondary acquired cholesteatoma in a large mastoid with the infection of long duration, there is probably cicatricial stenosis of the eustachian tube with a postauricular transcortical mastoidectomy and facial recess approach. It is probably a futile procedure because of the high incidence of recurrent attic retraction cholesteatoma requiring a secondary modified radical mastoidectomy. 4. Recurrent attic retraction cholesteatoma is subject to external reinfection and may cause a subperiosteal abscess or other complications many years after the primary surgery. 5. Residual cholesteatoma is the "bug bear" of any closed technique. This self-contained cyst is slow growing and may not become apparent for many years. Since it is not subject to reinfection, it is an insidious, destructive, silent lesion which may ultimately present itself as a postauricular pitting mass, erosion of the canal wall, facial paralysis, or a fistula in the labyrinth. 6. In invasive cholesteatoma and in long-standing secondary acquired cholesteatoma, the attempted preservation of the canal wall is a futile process and the surgeon is able to perform more accurate surgery with the direct primary transcanal approach to the mastoid.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesteatoma↗
PubMed1989

Surgical approaches to cholesteatoma.

A number of surgical approaches have been advocated for the removal of cholesteatoma. Specific indications for particular surgical approaches are given. The author describes his technique in detail. Suggestions for altering the basic techniques to fit individual patients' needs are also given.

Cholesteatoma↗
PubMed1989

Eustachian tube function in tympanoplasty.

This paper describes central and peripheral eustachian tube function in relation to tympanoplasty. Central obstruction of the eustachian tube at the pharyngeal orifice is frequently correctable and is not a contraindication to tympanoplasty, whereas chronic cicatricial peripheral obstruction of the eustachian tube at the isthmus is a contraindication to tympanoplasty. These findings are based on tubal patency pressure studies measured with a mercurial manometer with the patient performing the Valsalva maneuver, with catheterization of the eustachian tube, and with politzerization. If the patient can autoinflate the middle ear and if the eustachian tube will open with politzerization, then the likelihood exists that there is no peripheral obstruction of the eustachian tube and you have a good candidate for tympanoplasty. When there is a perforation of the ear drum, the best test for eustachian tube function is microscopic examination of the middle ear mucosa. If the middle ear mucosa is perfectly normal, then you know that you have good eustachian tube function and can proceed with the tympanoplasty.

Catheterization↗
PubMed1987

Surgical management of congenital conductive deafness.

Today's otologic surgeon has the opportunity to restore normal serviceable hearing in patients with congenital conductive deafness using tympanoplasty with ossicular chain reconstruction, stapedectomy, or fenestration of the horizontal semicircular canal. The particular surgical approach used is determined by the abnormalities found in the congenitally deformed ear. I report a series of 18 patients who had operation for congenital conductive deafness during a four-year period at the Farrior Clinic. The study results show the efficacy of surgical reconstruction in producing an improvement in hearing.

Audiometry, Evoked Response↗
PubMed1987

Stapedectomy and round window closure.

Round window closure is an uncommon complication of advanced otosclerosis found in 1% of 30,000 stapedectomy cases. A review of 81 patients representing 110 operation cases was made to determine what factors may alert the otologic surgeon to the patient with round window closure and what factors may identify the patient who will achieve the greatest benefit from stapedectomy.

Adult↗
PubMed1986

Stapedectomy for the home temporal bone dissection laboratory.

During the last 15 years, there has been a steady decline in the number of stapedectomies performed. Suggestions have been made to limit the residents' training in stapes surgery as well as to determine who is qualified to perform stapedectomies. It is well recognized that the skills and precision required for a stapedectomy are different from those used in chronic ear surgery and, if these precise techniques are not used on a regular basis, one will lose the dexterity required for this operation. A technique has been developed that enables the resident or infrequent operator to improve his skills with stapedectomy in the laboratory, prior to being confronted with a patient. It should help to improve the residents' surgical experience as well as maintain the surgical skills required for this operation.

Dissection↗
PubMed1985

Management of the chronically draining ear.

Management of the chronically draining ear requires careful assessment as to the source and predisposing factors leading to recurrent infections. Surgery should be planned to remove all irreversible disease and to seal the middle ear in a single operation, whether this requires a simple myringoplasty or extensive mastoidectomy, ossicular chain reconstruction, and tympanoplasty. Before surgery, every effort should be made to control the infection medically. After surgery, periodic irrigation with acetic acid alcohol will help to keep the ear clean and trouble-free. This paper will describe an approach to the assessment and management of the chronically draining ear in a single operation.

Cholesteatoma↗
PubMed1985

Facial nerve identification in children.

A surgical technique utilizing common anatomic landmarks has been developed to aid in the safe identification of the facial nerve in children. Anatomic dissections demonstrated that the facial nerve trunk can be consistently found in a triangle formed by the sternocleidomastoid muscle, posterior belly of the digastric muscle, and cartilaginous ear canal. Because of the superficial course of the facial nerve in infants and the underdevelopment of surrounding structures, the standard techniques for identification of the facial nerve trunk in adults would jeopardize the nerve in children, and an alternative technique for identifying the facial nerve has been developed.

Child↗