Biomedical subjects
J J Shea
Publications and source records attributed to J J Shea.
Temporary loss of hearing after salt loading in glycerol test.
We report the case of a male patient with hearing loss in the right ear, tinnitus, attacks of vertigo, and audiologic and otoneurologic symptoms of inner ear disease in whom investigations were carried out to clarify the pathogenesis of these disorders. First a glycerol test was performed with salt loading. On the third day of salt loading prior to the glycerol test, a sudden deterioration in hearing developed in the affected ear, and the patient complained of tinnitus and vertigo. He was given the usual dose of glycerol but no improvement in hearing occurred. As a result of the initiated vasodilating therapy, hearing was improved and his complaints ceased.
Findings and long-term surgical results in the hearing loss of osteogenesis imperfecta.
Osteogenesis imperfecta (OI) is an inherited connective-tissue disorder of variable penetrance. With OI, the triad of blue sclera, osseous fragility, and a conductive hearing loss is known as the van der Hoeve-de Kleyn syndrome. Blue sclera with a conductive loss may be a clinical subgroup of OI. Clinical findings and long-term surgical results in 62 operations in 43 patients with blue sclera are given. Osteogenesis imperfecta differs from otosclerosis in the following ways: (1) earlier onset (in the second and third decades of life), (2) more severe middle ear involvement, and (3) a higher incidence of sensorineural hearing loss. One year after stapedectomy, 38 (75%) of 51 operations had complete closure of the air-bone gap. Of the 24 operations followed up for an average of seven years (range, two to 18 years), 15 patients (62%) had no deterioration in their immediate postoperative hearing gain. Our study supports the concept that OI is clinically distinct from otosclerosis and establishes surgical intervention for its conductive hearing loss as a reasonable alternative to amplification.
Asymptomatic schwannoma of the cochlear nerve.
During systematic study of temporal bone histopathology at The Deafness Foundation, Memphis, we found an unsuspected small schwannoma arising solely from the cochlear nerve, compressing the facial nerve within the internal auditory canal. The primary temporal bone pathologic finding was bilateral otosclerosis. Compression of the facial nerve by schwannomas of the cochlear nerve is well know to occur at a late stage and produce a lower motor neuron facial paralysis but, in the present case, although the growth of th tumor compressed the facial nerve trunk, no paralysis was noted. Hearing test of the ear associated with the tumor, performed ten months before death, revealed a mixed conductive-sensorineural deafness. Surprisingly, the speech reception threshold was 75 dB, with a speech discrimination score of 70%.
Polyethylene sponge total ossicular replacement prosthesis. A histopathologic study.
The histopathologic findings of a functioning high-density polyethylene sponge (Plastipore) total ossicular replacement prosthesis in a patient who died of unrelated causes are reported herein. The lack of inflammatory cell infiltration of foreign-body giant cells within, or adjacent to, the prosthesis helps substantiate the safety and efficacy of Plastipore in the reconstruction of the ossicular chain.
Myringoplasty for anterior tympanic membrane perforations.
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Management of the stapes footplate with special reference to otosclerosis.
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Autophony and the patulous eustachian tube.
Autophony and the patulous Eustachian tube is a real but rare clinical entity often misdiagnosed because the symptoms so mimic those of middle ear effusion. The diagnosis is made by the history of fullness or blockage and hearing ones own voice and breath sounds in the ear. The drum is usually atrophic and moves with respiration but this may not be visible. The usual past history is of weight loss. The diagnostic test is to observe a regular increase or decrease in middle ear pressure when increasing or decreasing the ambient pressure while measuring the impedance in a pressure chamber. The usual variations in pressure with opening and closing of the tube are not seen because the tube remains open all the time. Few patients need operative intervention and explanation is all that is usually required. When surgical treatment is necessary the application of 20% silver nitrate to the lumen of the tube on a wire covered by cotton has given results with few complications. Injection of Teflon paste anterior to the mouth of the Eustachian tube has been stopped by the manufacturer of the paste because of serious complications caused by the Teflon paste being accidentally injected into the internal carotid artery. Why some patients with a patulous tube and movement of the drug with respiration have no symptoms and other patients with very bothersome symptoms have so few objective signs and no movement of the drum, that can be observed with respiration, remains a mystery that needs further study.
The medical treatment of tinnitus.
Currently there are three methods of treating patients with intractable tinnitus, a physical one using masking (Vernon, 1977), a psychosomatic method using biofeedback (House et al., 1977), and a chemical treatment using intravenous lidocaine and the oral anticonvulsants--carbamazepine, primidone and lidocaine amine. The latter seems to be the most promising, being easier to use, less time-consuming, more accurate to assess, and relying less on the patient's active participation and intelligence. The only disadvantages of the chemical method are the serious side-effects of the drugs in use. This can be managed by careful administration of these drugs and monitoring of the patient. In the future, new anticonvulsants with fewer side-effects will certainly be produced. It may be that chemical treatment can be combined with the masking and/or the biofeedback methods with a synergistic result. Another possible use of carbamazepine is in the treatment of palatal myoclonus and other similar disorders. Further clinical studies are needed to corroborate this application of the treatment.
Diatrizoate meglumine (hypaque) treatment for sudden hearing loss.
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Recent advances in pediatric otology.
An overview of the clinical applications of electroencephalic response audiometry, electrocochleography, and hypocycloidal polytomography are presented. Biocompatible ossicular implants provide a new and superior method of ossicular chain reconstruction. A case in which all of these newer modalities of diagnosis and treatment were used is presented.
Size of the mastoid air cell system in children with middle ear effusion.
The mastoid air cell system probably functions as an air reservoir. Among adults with chronic otitis media a small mastoid air cell system is prevalent In cases of chronic nonpurulent middle ear effusion among children, the reports have been contradictory concerning the size of the mastoid air cell system. In the present investigation, white children with long-standing problems of middle ear effusion have been examined by means of X-rays of the mastoid process in the lateral projection and the size of the air cell system measured by planimetry. The size of the air cell system was found to be significantly smaller in comparison with normal white children.
Traumatic perilymph fistula.
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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.
The surgical treatment of Ménière's disease.
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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.
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.