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J J Shea

Publications and source records attributed to J J Shea.

At least 19 recordsLinked to original sources
PubMed2001

Delayed facial palsy after stapedectomy.

OBJECTIVE: To study the incidence, pathogenesis, and prevention of delayed facial palsy after stapedectomy. STUDY DESIGN: Retrospective case review. SETTING: Otology/neurotology referral center. PATIENTS: A series of 2152 stapedectomy procedures in 2106 patients over 12 years. INTERVENTION: Delayed facial palsy after stapedectomy was studied. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grading system and serum antibody titer tests for herpes simplex virus type I and type II, and varicella zoster virus. RESULTS: Delayed facial palsy occurred in 11 of 2152 procedures. Delayed facial palsy occurred from 5 to 16 days (mean 8) after stapedectomy. Predisposing factors were bony facial canal dehiscence with bare or bulging facial nerve herniation in 5 patients; chorda tympani nerve stretched, manipulated, or cut in 2 patients; granulomatous reaction to Gelfoam in 1 patient; fever blisters on the upper lip in 1 patient; and sinusitis in 2 patients. Elevated anti-varicella antibody titers were found in all 6 patients studied. Anti-herpes simplex type I and II antibody titers were elevated in 5 of 6 patients. Acyclovir was effective in preventing delayed facial palsy in 1 patient who had undergone revision stapedectomy and experienced delayed facial palsy after previous stapedectomy in the same ear with elevated anti-herpes antibody titer. CONCLUSIONS: Delayed facial palsy occurred in 0.51% of patients after stapedectomy. Serologic investigation suggests activation of latent herpesvirus. Mechanical irritation of the facial or chorda nerve during operation may trigger the activation. The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.

Adult↗
PubMed2000

External aperture of the vestibular aqueduct in Meniere's disease.

OBJECTIVE: To study the relationship of the length of the external aperture of the vestibular aqueduct and the ratio of the summating potential and action potential (SP:AP) in patients with Meniere's disease. STUDY DESIGN: Retrospective case study. SETTING: Neurotology referral center. PATIENTS: Fifty-four patients with Meniere's disease and nine control subjects without Meniere's disease. INTERVENTION: The external aperture of the vestibular aqueduct was measured from a three-dimensional surface reconstruction computed tomography scan. Transtympanic electrocochleography was performed on patients with Meniere's disease. MAIN OUTCOME MEASURE: The length of the external aperture of the vestibular aqueduct in the Meniere's disease ears was related to the SP:AP ratio in the Meniere's disease ears and compared with controls. RESULTS: The average length of the external aperture was 3.79 +/- 2.92 mm in Meniere's disease ears and 5.35 +/- 1.73 mm in the control ears (p < 0.05). An enlarged SP:AP ratio was found in 95% of ears in the group with nonvisible external apertures of the vestibular aqueduct, 91% of ears in the <5 mm group, 58% of ears in the 5-7 mm group, and 29% of ears in the >7 mm group (chi-square = 24.814; p = 0.000). CONCLUSIONS: The length of the external aperture of the vestibular aqueduct in patients with Meniere's disease is significantly shorter than in those without Meniere's disease. Endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, was related to the length of the external aperture of the vestibular aqueduct. The shorter the external aperture, the more often the SP:AP ratio was enlarged. A short or nonvisible external aperture of the vestibular aqueduct is a predisposing factor to the development of Meniere's disease.

Audiometry, Evoked Response↗
PubMed1999

Stapedectomy for far-advanced otosclerosis.

OBJECTIVE: This study aimed to describe far-advanced otosclerosis and to present the authors' results with stapedectomy in 78 ears with far-advanced otosclerosis. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an Otology/Neurotology tertiary referral center. PATIENTS: Stapedectomy was performed on 78 ears of 60 patients with far-advanced otosclerosis, and the results followed from 1 to 21 years with a mean of 5 years. INTERVENTION: Stapedectomy was performed on all ears with far-advanced otosclerosis. MAIN OUTCOME MEASURE: Hearing for air conduction (AC) and bone conduction (BC), speech discrimination, and impedance were tested on all patients before and after operation. The Rinne test was performed on all ears with a 256-cycle magnesium tuning fork. The pure-tone average for AC and BC was computed for 500, 1,000, and 2,000 Hz. Hearing improvement was defined as air-bone gap closure to 10 dB or less and/or AC improvement of 20 dB or more, with no decline in speech discrimination score of more than 10%. RESULTS: Hearing improvement was achieved in 52 (66.7%) of 78 ears of all operations. In group 1, AC was greater than 90 dB, BC was greater than 60 dB, and hearing improved in 26 (81.2%) of 32 ears of operations. In group 2, AC was greater than 90 dB and no measurable BC and hearing improved in 11 (68.8%) of 16 ears of operations. In group 3, there was no measurable AC and BC greater than 60 dB and hearing improved in two (50%) of four ears of operations. In group 4, there was no measurable AC and BC and hearing improved in 11 (42.3%) of 26 ears of operations. Nonmeasurable BC became measurable in 42.9% of ears, nonmeasurable AC became measurable in 73.3% of ears, and all of these became aidable after operation. CONCLUSIONS: A negative Rinne test result with a 256-Hz magnesium tuning fork proved to be the best test to separate far-advanced otosclerosis from sensorineural hearing loss of other causes. Stapedectomy is of benefit in most ears with profound hearing loss of far-advanced otosclerosis, especially in those ears with some measurable hearing by AC.

Adolescent↗
PubMed1998

Forty years of stapes surgery.

OBJECTIVE: This study reports the results of 14,449 stapedectomy operations performed during the past 40 years. STUDY DESIGN: The study design was a retrospective case review. Approximately 100 operations were selected from each of the past 40 years, for a total of 5,444 operations, from which the results with the whole group were extrapolated. SETTING: All operations were performed in a hospital during the first 30 years and in an ambulatory surgery center in the past 10 years. PATIENTS: All patients in the study were the private patients of the author and were operated on by him personally. These patients had otosclerosis only. INTERVENTIONS: Stapedectomy was performed on all patients. MAIN OUTCOME MEASURES: The change in hearing after the operation was reported. Using the hearing of the average for 500, 1,000, and 2,000 Hz, the criteria for success were defined as closure of the air-bone gap to 10 dB or less and no decline in speech discrimination of >10%. RESULTS: In the primary stapedectomy group, success was achieved in 95.1% of ears after 1 year, 94.7% of ears after 2-5 years, and 62.5% after >30 years. In the revision stapedectomy group, success was achieved in 71.1% after 1 year, 62.4% after 2-5 years, and 59.4% after 6-36 years. CONCLUSIONS: The immediate success rate after primary and revision stapedectomy declines slowly over time, because of delayed conductive hearing loss and further sensorineural hearing loss, more than one would expect in matched control subjects without otosclerosis. Stapedectomy has stood the test of time as the first successful microsurgical operation.

Adolescent↗
PubMed1998

Action potential latency shift by rarefaction and condensation clicks in Menière's disease.

Transtympanic electrocochleography using rarefaction and condensation clicks was performed on 122 ears of 112 patients, including 98 ears of 89 patients with Menière's disease (MD) and 24 ears of 23 patients without Menière's disease (NMD). The mean action potential (AP) latency difference between rarefaction and condensation clicks was 0.40 +/- 0.37 msec in the MD group and 0.06 +/- 0.07 msec in the NMD group (p < .01). An AP latency shift > 0.2 msec was found more often in the MD group (62.2% vs 8.3%) and in ears with an enlarged summating potential and AP ratio (69.7% vs 36.4%). The results suggest that comparison of rarefaction and condensation latencies may serve as a useful addition to electrocochleography in the diagnosis of MD.

Acoustic Stimulation↗
PubMed1998

Summating potential and action potential ratio in Meniere's disease before and after treatment.

OBJECTIVE: This study aimed to compare the summating potential and action potential ratio (SP:AP) in patients with Meniere's disease before and after various surgical and medical treatments as an indication of change in endolymphatic hydrops to study the progression of Meniere's disease. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an otology-neurotology referral center. PATIENTS: Eighty-eight ears of 84 patients with Meniere's disease received medical treatment in 18 ears and surgical treatments including endolymphatic shunt in 12 ears, streptomycin perfusion of the lateral semicircular canal in 9 ears, streptomycin perfusion of the middle ear in 33 ears, and dexamethasone perfusion of the middle ear in 16 ears. INTERVENTION: Transtympanic electrocochleography (ECoG) was performed in all patients before treatment and 1-57 months after treatment (mean, 13.5 months) with a 2-year interval in 28 patients. MAIN OUTCOME MEASURE: An enlarged SP:AP ratio (> or = 0.40) was used as the diagnostic criterion for endolymphatic hydrops. RESULTS: Overall, an enlarged SP:AP ratio was found in 75% of ears before treatment and 78% after treatment. The SP:AP ratio, when enlarged, remained enlarged in 91% of ears. A nonenlarged SP:AP ratio before treatment became enlarged after treatment in 41% of ears. In American Academy of Otolaryngology-Head and Neck Surgery stage 1 Meniere's disease (pure-tone threshold average < or = 25 dB), an enlarged SP:AP was found in 58% of ears before treatment and 79% after. Twenty-five (89%) of 28 patients followed for 2 years were free of vestibular symptoms after treatment, and in 22 patients (79%), the SP:AP remained enlarged. The distribution of an enlarged SP:AP ratio was associated with the duration of disease (chi-square = 33.5552, p < 0.01). CONCLUSIONS: The development of endolymphatic hydrops, as indicated by an enlarged SP:AP, is part of the progression of Meniere's disease. The longer the duration of the disease, the more likely the SP:AP ratio will be enlarged. These findings indicate that endolymphatic hydrops as detected by ECoG was not reversed in this study by the treatments used. Despite the absence of definitive spells of vertigo in most patients, endolymphatic hydrops as evidenced by an enlarged SP:AP ratio persisted.

Adolescent↗
PubMed1998

A personal history of stapedectomy.

Aristotle has said the essential ingredient of tragedy is first hubris. Fame leads to the hubris that offends the gods, who send great punishment. This is so true in the history of stapedectomy. The three distinct eras of surgery for otosclerosis teach us a lot about what happens in science and in life. The first stapes era began in Europe, ahead of its time, and in those halcyon days before the turn of the century, the Belle Epoch, proceeded, uncorrected to its tragic extreme, and then was stopped suddenly, quite rightly, by the establishment. The fenestration era proceeded to an extreme, when its technical master Julius Lempert would allow no criticism or improvement in "his" one-stage endaural technique, however good, nor would he accept the new mobilization and stapedectomy operations, and he and it ended badly. The fact that Jenkins and Holmgren would make an opening in the lateral semicircular canal and then close it in the epitympanum, not open to the ear canal, to expect to improve hearing is amazing. Until Sourdille went to Stockholm and saw one closed fenestration operation performed by Holmgren and devised his "open to the ear canal technique," the closed fenestration operation was not reasonable. Then Sourdille came to New York City, and Lempert heard him speak and read and reread his publication and greatly improved on his operation. It was Lempert's one-stage endaural open operation that gave the fenestration operation the worldwide acceptance it gained. The second stapedectomy era began before the fenestration era ended with the accidental and originally unrecognized mobilization of the stapes by Rosen and my resurrection of stapedectomy. I realized in reading the literature of the past that stapedectomy was not necessarily fatal to the ear or the patient as was generally believed, and what was needed was to seal the oval window with a living elastic membrane and reconstruct the sound-conducting mechanism of the middle ear with a biocompatible implant prosthesis to make it successful. But for me, in 1955-1956, the "Zeitgeist" was finally right. I realized the stapes could be removed and covered the oval window with a vein graft, and Harry Treace made me a biocompatible implant prosthesis out of the newly discovered Teflon. For a new technology to be accepted, it must be much better than what it replaces, and stapedectomy was much better than fenestration. In the new microsurgical era of otology that began, improvements in the stapedectomy operation came from everywhere and were readily accepted. Stapedectomy has now become so successful, like many treatments in medicine, the problem has now largely disappeared. If the measles virus is the cause of the growth of the otosclerotic focus, as it seems to be, then vaccination against measles eventually will eliminate the hearing loss of otosclerosis completely. What the history of stapedectomy reveals is the truth of the quotation from Ecclesiastes, "There is nothing new under the sun." Progress is only made when the Zeitgeist is right, by someone who puts together the truths of the past with the new discoveries of the present.

Ear Diseases↗
PubMed1997

Use of cranial surface anatomic fiducials for interactive image-guided navigation in the temporal bone: a cadaveric study.

OBJECTIVE: Because of the intricate anatomy of the temporal bone, we examined the feasibility and reliability of cranial surface anatomic fiducials to register computed tomographic images of the temporal bone by using a frameless image-guided system. METHODS: One-millimeter thick computed tomographic slices and the smallest possible field of view were used to register 10 dry and 10 fresh temporal bones from cadavers. The fiducials used for registration included the umbo of the tympanic membrane, emissary foramina, the asterion, various sutures, the tip of the mastoid process, and Henle's spine. RESULTS: Mean initial fiducial registration error ranged from 0.6 to 0.7 mm, and was reduced to 0.5 and 0.4 mm for the dry cranial and cadaveric studies, respectively, by eliminating or reregistering inexact fiducials. Mean target localization error ranged from 0.91 to 2.44 mm for superficial structures of the temporal bone in the dry cranial specimens and from 0.71 to 1.52 mm for deep structures such as the facial nerve, semicircular canals and ossicles in the cadaveric study. CONCLUSION: Interactive image-guided navigation in the temporal bone is possible with registration of cranial surface anatomic fiducials. It may be useful to the neurosurgeon and otologist in identifying critical anatomic structures of the temporal bone encountered during the translabyrinthine, retrolabyrinthine presigmoid, and suboccipital approaches.

Cephalometry↗
PubMed1997

Cochlear microphonics in Ménière's disease.

The pathophysiology of hearing deterioration in Ménière's disease (MD) is unclear. Hair cell loss has been proposed to be the cause of severe hearing loss in Ménière's disease. The cochlear microphonic (CM) is known to be the receptor potential of the outer hair cells in the cochlea. This study measured the CM in Ménière's disease and investigated its relationship with the degree of hearing impairment and endolymphatic hydrops. Transtympanic electrocochleography (ECoG) using rarefaction (RAR) and condensation (CON) tonebursts at 1 kHz was performed on 130 ears of 119 patients. Ninety six ears were diagnosed to have MD and 34 were diagnosed non-Ménière's disease (NMD). The mean amplitude of the CM was 33.10 +/- 46.04 microV in the MD group and 13.15 +/- 12.77 microV in the NMD group (p < 0.001). Enlarged negative summating potential and action potential ratios (SP:AP > 40%) were found in 81.3% of the MD group and 17.6% of the NMD group. In the MD group, the CM in the group with an enlarged negative SP was 36.98 +/- 49.78 microV, and 16.31 +/- 15.88 microV in the group without (p < 0.01). The CM was 34.33 +/- 49.28 microV in the pure-tone average (PTA) < or = 25 dB group, 46.97 +/- 58.31 microV in the 26-40 dB group, 29.12 +/- 42.62 microV in the 41-70 dB group, and 26.20 +/- 22.41 microV in the > 70 dB group (p > 0.05). The CMs in 11 pairs of MD ears and sensorineural hearing loss (SNHL) ears with matching hearing (MD 44 dB, SNHL 45 dB) were measured. They were 71.42 +/- 75.94 microV and 7.90 +/- 5.89 microV, respectively (p < 0.01). Our study shows that the CM is higher in ears with endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, than ears without and the CM shows no statistical difference in groups with different levels of hearing loss. These findings suggest that hearing loss with a large CM in Ménière's disease patients may be the result of an alteration of cochlear mechanics and only severe hearing loss with a small CM is caused by hair cell loss. The CM measurement, to evaluate the hair cell status, may be helpful in identifying patients whose hearing may be recoverable if the underlying hydrops can be corrected. Our data do not permit the conclusion that an enlarged CM can be used in the diagnosis of MD.

Adult↗
PubMed1997

The role of dexamethasone or streptomycin perfusion in the treatment of Meniere's disease.

There is ample clinical and animal evidence that, in most patients, Meniere's disease is an immune-mediated disorder in a small, misplaced, malfunctioning endolymphatic sac that causes endolymphatic hydrops, the essential pathology of this disease. If this is so, then the potent anti-inflammatory steroids are the ideal first treatment for Meniere's disease and other immune-mediated diseases of the inner ear, and streptomycin perfusion is the ideal second treatment for those who do not respond to dexamethasone perfusion. The diagnosis, selection of patients, and details of operation with the results are presented. Results have been good with relief of dizzy spells and preservation of hearing in most patients after dexamethasone perfusion and relief of dizzy spells in those patients not responding to the dexamethasone perfusion by streptomycin perfusion.

Anti-Bacterial Agents↗
PubMed1996

Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management.

Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal-infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.

Adolescent↗
PubMed1996

Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Ménière's disease.

Recent clinical and laboratory evidence indicates that Meniere's disease is an immune-mediated disease. Dexamethasone perfusion of the inner ear through the round window plus intravenous dexamethasone often will stop the dizzy spells, reduce the fullness and low-frequency tinnitus, and sometimes improve the hearing in patients with Meniere's disease. The dexamethasone must act mostly on the endolymphatic sac and, to a lesser extent, on the stria vascularis and spiral ligament, the known targets of immune response in the inner ear, to reduce the endolymphatic hydrops and restore the fluid dynamics of the endolymph. Despite the good results with streptomycin perfusion, the number of patients with further hearing loss is large, so dexamethasone perfusion with intravenous dexamethasone should be tried first. The initial response to dexamethasone perfusion plus intravenous dexamethasone has been very good, with very little risk of further hearing loss, and it holds great promise for the future.

Administration, Topical↗
PubMed1995

Middle ear and inner ear effects on clinical bone-conduction threshold.

The measurement of bone-conduction thresholds is an integral part of audiologic evaluation. The relationship between bone-conduction and air-conduction thresholds is the differentiating diagnostic indicator between conductive and sensorineural hearing loss. At the same time, the influence of middle ear and inner ear structures upon the bone-conduction response has been well documented. We present two cases illustrating this influence and attempt to explain the clinical bone-conduction thresholds with operative findings.

Acoustic Impedance Tests↗
PubMed1995

Scanning electron microscopic observation of dark cells after streptomycin perfusion of the vestibule in guinea pigs.

Hearing has been stabilized in the majority of patients studied in the treatment of Meniére's disease with streptomycin. This observation suggests that effects of streptomycin may ameliorate endolymphatic hydrops, possibly by attenuating the activity of secretory tissue. The purpose of this study is to observe the dark cells of the utricle in guinea pigs after streptomycin perfusion of the vestibule. Twelve pigmented guinea pigs weighing 250-350 grams were used in this study. The vestibules in five guinea pigs were perfused monolaterally with 150 micrograms of streptomycin in artificial perilymph and, in seven, the vestibules were perfused only with artificial perilymph as a control group. Specimens were processed for observation with a scanning electron microscope. After streptomycin perfusion, the margin of the dark cells became indistinct. The luminal surface of the cells bulged out like a dome. The microvilli decreased or were absent, and some debris was deposited on the surface. In four of the five animals, the luminal membrane of the dark cell ruptured. The cytoplasm and organelle extruded into the endolymphatic space. After the cellular debris moved out into the endolymph, either a vanished cell or a nucleus in an empty nest was observed. These cells appeared damaged and destroyed. The results indicate that the dark cells in the membranous wall of the utricle were affected by streptomycin. The results lead to the assumption that streptomycin may reduce the volume of endolymph by damaging the dark cells of the utricle.

Animals↗
PubMed1995

Traumatic endolymphatic hydrops.

Traumatic endolymphatic hydrops is an accumulation of endolymph in the cochlear duct caused by traumatic insult. The causative mechanisms are: (1) fistulization of the bony labyrinth, which causes a disturbance in the normal perilymph-endolymph pressure relationship; (2) direct injury to the membranous labyrinth, which may be just a collection of fluid in the cochlear duct from irritation, resulting in endolymphatic hydrops that may not be progressive and may subside in a short period of time after injury and hearing loss may occur; and (3) injury to the endolymphatic fluid drainage system, including a temporal bone fracture in which the fissure happens to extend through the vestibular aqueduct, causing fibro-osseous blockage of the endolymphatic duct and surgical injury to the saccule with obstruction of the longitudinal flow of endolymph, resulting in endolymphatic hydrops that may be delayed in onset and is usually persistent. The diagnosis of traumatic endolymphatic hydrops is made by a history of trauma, such as barotrauma, a blow to the head, or perhaps a previous ear operation, such as stapedectomy; the presence of typical symptoms of endolymphatic hydrops, including fullness, tinnitus, fluctuant hearing loss, and episodic vertigo; and an elevated negative summating potential and an increased summating potential:action potential ratio by electrocochleography. Three patients are presented to demonstrate this clinical entity.

Adult↗
PubMed1994

Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin.

Streptomycin perfusion of the labyrinth through the round window membrane in the middle ear is a simple, safe, and effective way to stop the dizzy spells, fullness, and tinnitus of Ménière's disease without making the hearing worse. My results with 24 patients in the last 8 months are presented. Although the long-term effect of this operation remains to be seen, my experience with streptomycin perfusion of the labyrinth through the lateral semicircular canal leads me to believe these good results will be maintained in the future. Although the caloric response is not usually eliminated completely in the operated ear, it is reduced enough that the patient no longer has dizzy spells. Because the vestibular receptors are not completely destroyed, and the afferent and efferent nerves coming to and from them are undamaged, the patient compensates after this operation more quickly than when the vestibular receptors are completely destroyed by intramuscular or middle ear aminoglycoside, or when the afferent and efferent nerves of the vestibular receptors are cut as in labyrinthectomy or vestibular neurectomy. Hyaluronan is used to carry the streptomycin into the inner ear because it is known to penetrate the round window easily, and because being hygroscopic, it may reduce the amount of endolymph by osmosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Ear, Inner↗