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Biomedical subjects

J J Shea

Publications and source records attributed to J J Shea.

At least 19 recordsLinked to original sources
PubMed1991

Streptomycin perfusion of the labyrinth.

The combination of fluctuant hearing loss, fullness, tinnitus and dizzy spells we call Meniere's disease is thought to be caused by endolymphatic hydrops. Most patients with the clinical picture of Meniere's disease do have endolymphatic hydrops but some patients with endolymphatic hydrops do not have the clinical picture of Meniere's disease. It would appear there is an, as yet unknown, immune-mediated, cause for Meniere's disease, in addition to endolymphatic hydrops, and this immune-mediated cause may aggravate those ears with endolymphatic hydrops. While medical treatment with a low-salt diet, diuretics and steroids are of value in some patients when given early in controlling dizzy spells and improving the hearing, there is usually no real, long-term benefit. Since none of these "shunts" of the sac could remain open for more than a few hours, they could have no more direct benefit than a one-time drainage of endolymph, while doing harm to the fluid absorption, immune response and phagocytosis roles of the endolymphatic sac. The various vestibular neurectomy operations, while usually stopping the dizzy attacks, are both difficult and potentially dangerous, but more important, do nothing for the hearing loss. The one direct attack on the problem, both easy to perform and certain to relieve the dizzy attacks, is to destroy the vestibular receptors with streptomycin. This destructive action on the stereocilia and sensory cells, without damage to the rest of the vestibular system and the cochlea, has been verified by two cat experiments with streptomycin by Norris et al. and Norris & Shea and two guinea pig experiments with gentamicin by Kimura.(ABSTRACT TRUNCATED AT 250 WORDS)

Ear, Inner↗
PubMed1991

Medical and surgical treatment of Menière's disease.

To create a rational treatment system for Meniere's disease, it is helpful to recall what is known for sure and what is probably true about Meniere's disease, so as to recognise the stages through which the disease passes from beginning to end. Meniere's disease is a complex disorder of the inner ear, characterised by fullness, tinnitus, fluctuant hearing loss and dizzy spells. Meniere's disease is always associated with, and probably caused by endolymphatic hydrops, although all patients with endolymphatic hydrops do not have Meniere's disease. Meniere's disease is almost always associated with, and probably caused by a small, underdeveloped, abnormally-placed, malfunctioning endolymphatic sac. The first stage is entirely cochlear, where endolymphatic hydrops usually begins, with fullness, tinnitus and low-tone, sensorineural hearing loss, and is most amenable to medical treatment. In the second stage, the endolymphatic hydrops is more widespread, involving the vestibular labyrinth as well. There is fluctuant, low-tone sensorineural hearing loss, fullness and tinnitus, together with dizzy spells. In the third stage, the hearing loss is more severe and no longer fluctuates, with poor comprehension, but fullness, tinnitus, and dizzy spells are the chief complaints. In the fourth and final end-stage, the hearing is very bad, at 55 to 60 db, and no longer fluctuates, with very poor comprehension, fullness and tinnitus, but usually no more dizzy spells, although the patient is unsteady, especially in the dark. Most ears in Stage IV have reduced or absent response to rotation test.

Female↗
PubMed1990

Endolymph pressure in Menière's disease.

During the streptomycin perfusion/shunt of the lateral semicircular duct operation for Meniere's disease, the lateral semicircular duct is exposed by removal of the bone of the lateral semicircular canal. Before perfusion with streptomycin and creation of a shunt in the lateral semicircular duct, the pressure in the lateral semicircular duct is measured while electrocochleography is being recorded. In most ears with Meniere's disease, the pressure necessary to indent the lateral semicircular duct is 2 to 3 mm of water. The pressure is more in those ears with a large negative summating potential than in those with a normal negative summating potential. The pressure is less after the shunt in the lateral semicircular duct is created and the negative summating potential returns to normal. In some ears with the classic picture of Meniere's disease, the endolymph pressure is normal and there is a normal negative summating potential. Presumably, one should not create a shunt in the lateral semicircular duct in ears with normal pressure.

Audiometry, Evoked Response↗
PubMed1990

Speech recognition ability as a function of duration of deafness in multichannel cochlear implant patients.

Surgical implantation of a multichannel cochlear prosthesis has become a widespread treatment for profound hearing loss. The relationship between duration of hearing loss and speech recognition ability was examined in 20 postlinguistically deafened adults using the Nucleus 22-Channel Cochlear Prosthesis. Data analysis indicated statistically significant negative correlations between duration of profound hearing loss and postoperative performance on the Central Institute for the Deaf Everyday Sentence Test and the Northwestern University Monosyllabic Word Test (NU-6). Age at implantation and age at onset of profound hearing loss were not found to be significantly correlated with performance on the two measures. These findings are discussed in terms of patient counseling and prediction of potential benefit to the patient.

Adult↗
PubMed1990

Selective chemical vestibulectomy.

In an attempt to destroy selectively the affected peripheral vestibular labyrinth in patients with intractable vertigo as a result of Meniere's disease, a known quantity of streptomycin was introduced within the bony labyrinth following fenestration of the horizontal semicircular canal. Initial laboratory results in animal models proved that near total ablation of the vestibular end-organs (including the hair cell population of the cristae ampularis, utricle, and to some extent the saccule) could be achieved chemically without involvement of the cochlear hair cell population. The exact dose required to accomplish this in the animal model was 250 micrograms of streptomycin. However, this dose proved excessive in initial human application possibly because the animals had excellent hearing in nondiseased ears while our patients uniformly had long standing inner ear disease with marked decrease in auditory thresholds. The current dose of streptomycin utilized is 125 micrograms, and patients treated thus far have maintained (or improved) their preoperative audiologic pure tone average. The aim of this preliminary report is to detail our developmental animal research and subsequent clinical application of selective chemical vestibulectomy (SCV) in 15 patients with intractable vertigo as a result of Meniere's disease, which have failed conventional medical management.

Adolescent↗
PubMed1989

Perfusion of the inner ear with streptomycin.

Any medical or surgical treatment of Meniere's disease is always suspect because the natural history is so variable and the pathologic physiology is not well-known. Even the occurrence rate in one and both ears is not known. It is certainly true that endolymphatic hydrops, caused by the failure of absorption of endolymph in the endolymphatic sac, is the principal pathology in the classical, fully developed Meniere's disease. While the endolymphatic shunt operation is correct in theory, in most ears, it does not work because the surgeon does not always locate the lumen of the sac and when located, the shunt tube does not remain open. While vestibular neurectomy is more likely to give permanent relief of vertigo as compared to the endolymphatic sac operation, the operation is difficult and dangerous and does nothing for the hearing. The vestibulotoxic action of the aminoglycocide antibiotics, especially streptomycin, when introduced into the perilymph of the lateral semicircular canal will destroy the vestibular receptors without making the hearing worse, and by acting on the dark cells, reduce the production of endolymph. Perfusion of the perilymph with streptomycin through an opening in the bony lateral semicircular canal is the operation of choice for Meniere's disease, benign paroxysmal postural vertigo and other forms of vertigo. So far 66 such operations have been done during the last three years with very encouraging results.

Aged↗
PubMed1986

A simple autologous fibrinogen glue for otologic surgery.

A simple method of concentrating a patient's own fibrinogen for use with a thrombin/calcium solution--to produce a coagulum-type tissue glue for otologic surgery--is presented. The principal advantages of this system include a simple modification of the cryoprecipitate technique, which can be easily performed in any hospital laboratory using a minimal amount of the patient's blood, and the use of autologous fibrinogen, which completely rules out the possibility of transmission of hepatitis or AIDS viruses. Useful tips on preparation and use of this autologous tissue glue, based on experience over the past 2 years, will be presented.

Aprotinin↗
PubMed1979

Diatrizoate meglumine (Hypaque) treatment for sudden hearing loss.

During the 24 month period ending in December 1978, 31 patients with sudden idiopathic sensorineural hearing loss were treated with vasodilators and Hypaque. Fifteen patients met the treatment criteria of being treated within the first month following onset, no vertigo, and the hearing loss was not complete. Twelve patients (80%) had complete return of their hearing. Two patients (13%) had partial return of their hearing, and 1 patient (6%) had no response to treatment. Of the 16 patients treated who did not meet the criteria, 6 patients (38%) had complete return of their hearing. Eight patients (50%) had partial return of their hearing and 2 patients (12%) had no return of their hearing.

Adult↗
PubMed1979

Luetic hydrops--diagnosis and therapy.

Nine patients presenting at the Shea Clinic over the past eight years with a history of fluctuant hearing loss were subsequently found to have neurosyphilis. Treatment has consisted of penicillin, given by various routes, oral steroids and vasodilator therapy. We have, based on recent investigations, begun using high dose intravenous penicillin in this regimen. Results have been encouraging in two patients, with rapid improvement in hearing. A protocol outline for diagnosis and therapy of syphilis is included in the discussion.

Administration, Oral↗
PubMed1978

Biocompatible ossicular implants.

Proplast and Plastipore, two new biocompatible implant materials that encourage tissue ingrowth, were used in 225 tympanoplasties. A 12 to 28-month follow-up shows that in 133 tympanoplasties using a drum-to-footplate or total ossicular replacement prosthesis (TORP), there was an average air conduction gain of 19 dB and 65% closure of the air-bone gap to within 20 dB. In 17 tympanoplasties using a drum-to-stapes or partial ossicular replacement prosthesis (PORP), there was an average air conduction gain of 20 dB and 100% closure of the air-bone gap. In 53 tympanoplasties/mastoidectomies using a TORP, there was an average air conduction gain of 19 dB and 87% closure of the air-bone gap. In 22 tympanoplasties mastoidectomies using a PORP, there was an average air conduction gain of 25 dB and 100% closure of the air-bone gap. Five (2.2%) of the 225 Plastipore prostheses have extruded.

Animals↗
PubMed1978

Management of tinnitus aurium with lidocaine and carbamazepine.

At present there are two methods of management of tinnitus: one old, by masking with a noise generator, and one new, by biofeedback. Neither of these methods is convenient and neither gets at the heart of the problem. A third method, using intravenous lidocaine as a test and oral carbamazepine therapy, was developed in the Pain Clinic of the Auckland General Hospital in New Zealand. This paper will report our brief experience with these drugs in the management of tinnitus and other similar disorders. Twenty-seven patients with intractable tinnitus had a significant reduction from a test dose of intravenous lidocaine and were treated with oral carbamazepine. Of this group 1 patient (4%) had complete relief, 21 patients (78%) had partial relief, and 5 patients (18%) had no relief. Complications were few and not serious, and either disappeared spontaneously or when the carbamazepine was stopped. One patient with palatal myoclonus, refractory to all other forms of treatment, had complete relief on a small dose of carbamazepine. It may be that palatal myoclonus, hemifacial spasm, and other such clonic convulsive disorders will be amenable to the same treatment.

Administration, Oral↗
PubMed1978

Ventilation of the atelectatic ear.

The absorption of gas from the middle ear--mastoid air cell system causes an average pressure decrease of 5 cm water per hour. Interference with the normal opening of the Eustachian tube causes increased negative pressure build-up, which stops gas absorption from the middle ear. High carbon dioxide tension is associated with metaplastic changes of mucosal stem cells into mucus producing cells. Ventilation of the middle ear is necessary for removal of the negative pressure as well as of the excess carbon dioxide. The problems associated with longterm ventilation tubes are reviewed, and some future prospects of permanent ventilation tubes are discussed.

Biocompatible Materials↗
PubMed1978

Hazards of ventilation tubes.

Ventilation tubes are not the treatment of choice in serous otitis media. Conservative measures should be tried first, with simple myringotomy for the evacuation of thick, rubbery fluids. Autoinflation, well tolerated by most children above 3 years of age, should be practiced daily for months to years, under periodic check-ups. Tube insertion should be reserved for younger children, as well as for recurrent and non-responsive cases. These are the cases in which a calculated risk is worth taking, as otherwise the patient is on an ineffective treatment. In those hard-to-manage ears, tubes seem to be justified, as their potential hazards are apparently outnumbered by the complication of untreated or maltreated serous otitis media.

Atrophy↗