Biomedical subjects
Publications and source records attributed to J Helms.
If a patient with Menière's disease or a sudden deafness does not respond to adequate therapy, an acoustic neuroma should be excluded. This is achieved by a positive contrast cisternography using multidirectional tomography. The examples might have shown that sometimes acoustic neuromas present with atypical symptoms, with sudden deafness or even with the typical symptoms of morbus menière.
A lingual thyroid gland was transposed below the skin of the neck with the main vessels remaining intact. Metabolic parameters did not change during the control period of 21/2 years. This procedure could be an alternative to resection of free transplantation of lingual thyroid.
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The transtemporal vestibular neurectomy permits an ablation of the peripheral end organ with only a low risk to the cochlea. In a totally deaf ear the internal auditory meatus is reached by a translabyrinthine approach. Besides the vestibular nerve the chochlear nerve is cut to reduce tinnitus. The neurectomy is a destructive procedure. It should be performed in otherwise resistent cases of Menière's disease.
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The amplitudes of the stapes footplate movements were determined in human temporal bones when the ossicular chain was drilled with a cutting and a diamond burr. High movements result in comparison to physiological data. The frequency distribution resembles the dB (A) curve. The intensity compared to sound pressure levels on the ear drum is higher than I30 dB. The pressure is constant over the period of contact between the burr and the ossicle. Most likely these unphysiologic movements of the stapes footplate can cause inner ear damage as we had to admit in a case of facial nerve decompression.
Six patients with symptoms suggestive of acoustic neuromas showed a wided, contrastfilled internal auditory meatus during positive contrast meatography on tomographic cuts. These results suggest that widening of the internal auditory meatus may not always be due to a space-occupying lesion. The explanation for these findings is not known. No comparable findings have been published in the relevant literature. Surgical intervention, which is frequently harmful and carried out because of a misdiagnosed acoustic neuroma can only be avoided by carrying out cisternography with positive contrast materials and tomography in the Stenvers' and Schüller projection.
Forty-one tumours in the cerebello-pontine angle were found as a result of 207 Duroliopaque cisternograms. In all 37 patients who came to operation, the position and size of the tumour, as shown radiologically, could be confirmed. The value of positive contrast cisternography was greatest in the smaller tumours. 35 tumours were less than 2.5 cm. in their vertical diameter. Twenty-four tumours were predominantly extra-meatal, were predominantly extra-meatal, four predominantly intra-meatal and 13 extra- and intra-meatal as well. In only 23 patients was there enlargement of the internal acoustic meatus, either absolutely or by comparison with the other side. In 18 patients there was no significant difference in the meati on the two sides. These facts and the observation that there may be idiopathic meatal widening in the presence of typical symptoms of an acoustic neuroma, but without a tumour being present, underlines the importance of positive contrast cisternography. A high degree of accuracy for tumour less than 2.5 cm. can only be obtained by using the method in conjunction with multi-dimensional tomography.
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In the treatment of Menière's disease, surgical procedures are available when conservative measures have failed. The most distressing symptom of vertigo can frequently be arrested, tinnitus reduced and hearing improved. Sudden deafness due to round window rupture is treatable. The most important disorder with labyrinthe symptoms is the acoustic neuroma, the smaller ones of which can be operated on by otologists in collaboration with neurosurgeons using the transtemporal or translabyrinthine approach with preservation of the facial nerve.
The following cases are demonstrated:postoperative deafness probably caused by abnormal blood supply to the cochlea, clinical findings of an acoustic neuroma without tumor, atrophy of cochlear and vestibular nerves, bone-like tissue growth in the labyrinthine trauma, hearing improvement after removal of an arachnoid cyst from the internal auditory canal.
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