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Biomedical subjects

J J Shea

Publications and source records attributed to J J Shea.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1978

Bilateral sudden deafness following combined insecticide poisoning.

A case of combined poisoning due to exposure to an aerosol containing both malathion and methoxychlor (sold under the trade name Ortho TM Orchard Spray in the United States) ps presented. The following unusual features occurred in the course and outcome of the poisoning: slow onset of symptoms and signs, bilateral profound and permanent sensorineural hearing loss, and residual peripheral neuropathies in the extremites. The possible potentiation of the usually low toxicity of malathion is suggest and discussed.

Adult↗
PubMed1978

Surgical treatment of tympanosclerosis.

During the 5-year period (1971--1976), 45 patients at the Shea Clinic underwent reconstructive surgery for tympanosclerosis. The most common ossicular chain problem was found to be malleus and incus fixation (33%); malleus, incus, and stapes fixation (22%); and stapes fixation (13%). The most successful reconstrucitve approaches included removal of tympanosclerosis from tympanic membrane or isolated plaque from ossicular chain, the use of the Partial Ossicular Replacement Prosthesis (PORP), and the Total Ossicular Replacement Prosthesis (TORP).

Ear Ossicles↗
PubMed1977

Proplast in the middle ear and oval window of cats.

Poly(tetrafluoroethylene) carbon fiber implant material (Proplast), an all-plastic material, was evaluated for use in otologic surgery. Response to the implant was studied in the middle ear and vestibule of 14 cats by placing the Proplast in the oval window after stapedectomy. After a one year follow-up, it appears that Proplast was tolerated well, causing no inflammatory reaction in either the vestibule or cochlea, or in the middle ear cavity. Fibrous tissue ingrowth was found throughout the implant, and a fibrous tissue membrane covered both the vestibular and the tympanic surfaces of the Proplast. Being well tolerated by both middle ear and inner ear tissues, this porous, all-plastic material offers several otologic applications.

Animals↗
PubMed1977

Evaluation of diatrizoate meglumine (Hypaque) in treatment of sudden hearing loss.

Thirty patients with sudden hearing loss were treated with diatrizoate meglumine (Hypaque) and a vasodilator regimen. Of these patients, 30% had a good response, 23% had a moderate response, and 47% had no response. These results were superior to the results obtained in a group of patients with sudden hearing loss treated with vasodilators alone. A possible mode of action is discussed and the details of a new study outlined.

Adult↗
PubMed1976

Proplast implants used in otology and in facial reconstructive surgery.

Proplast, a self-stabilising alloplastic material, was evaluated in ear surgery and in facial reconstructive surgery. Proplast implants were used on 33 patients to reconstruct the ossicular chain (total or partial ossicular replacement prosthesis), or to rebuild the mastoid cavity. The lack of extrusion over a 24-month period is encouraging. In facial reconstructive surgery 11 patients received Proplast implants to augment and restore facial contours. Contamination with saliva remains a problem, owing to the high porosity of Proplast, which could harbour infection. When Proplast was sterile when implanted, no extrusion appeared over a 12-month period. Although the patients presented here were followed up for a relatively short time, they provide reason for some optimism that the vexed question of alloplastics applied in the field of ear, nose and throat surgery may be solved.

Chin↗
PubMed1976

Symposium: Congenital anomalies of the middle ear. IV. Management of profuse perilymph leak.

Profuse perilymph leak during an otological operation can be controlled by inserting an epidural teflon cannula into the lumbar subarachnoid space and draining away the excess spinal fluid. After about 100 cc is removed the perilymph leak stops, and the oval window can be sealed with a living seal, such as vein, and the operation completed. The catheter is left in the subarachnoid space for about four days, with a bottle on the distal end positioned to remove no more than 150 cc of spinal fluid per day. Results with two patients in which this maneuver was used to control profuse perilymph leak are reported.

Catheterization↗
PubMed1976

The mast cells of the inner ear.

The presence of mast cells in the subepithelial connective tissue of the human endolymphatic sac has, to the best of our knowledge for the first time, been described. A hypothesis has been put forward in which these cells, which are known to contain histamin, heparin and serotonin, play an important role in the physiologic functions of the endolymphatic sac as well as in some pathologic states of the inner ear.

Animals↗
PubMed1975

Experimental endolymphatic hydrops and its relief by interrupting the lateral semicircular duct in guinea pigs.

It has been demonstrated that endolymphatic hydrops can be produced in guinea pigs by obliteration of the endolymphatic sac and this phenomenon was reproduced in our own laboratory. Interruption of the lateral semicircular duct of animals with labyrinthine hydrops produced a diminution of the hydrops in 4 out of 8 cases, and these did not show any collapse in the cochlear duct. It was considered that the hydrops was diminished by drainage of the surplus endolymph into the perilymphatic space, and that the cochlear duct was kept secure from collapse because of its distance from the operated lateral semicircular duct and of the utriculo-endolymphatic valve. Persistence of hydrops in the other four cases was thought to be due to closure of the operated lateral semicircular duct or to labyrinthitis. Although this series is not comprehensive enough, it seems to indicate that interruption of the lateral semicircular duct has a possibility of diminishing labyrinthine hydrops, as in cases of Ménière's disease, without hearing disturbance, provided that complications do not develop. Further investigation with many more animals, for a longer period of time after the operation, is required to gain more precisely detailed information.

Animals↗
PubMed1975

Definition of fluctuant hearing loss.

In summary, fluctuant hearing loss is defined as a disorder of the inner ear characterized by fullness, roaring tinnitus, and fluctuations in hearing. It is believed to be caused by an inadequate absorption of endolymph from the endolymphatic sac, with or without one or more metabolic disorders, that interferes with the delicate balance between the production and absorption of endolymph and thus produces cochlear hydrops. This triad of fullness, roaring tinnitus, and fluctuant hearing loss resulting from cochlear hydrops is much more common than the quadrad of true turning vertigo, fullness, roaring tinnitus, and fluctuant hearing loss due to vestibular and cochlear hydrops known as Meniere's disease. Although patients with fluctuant hearing loss only may eventually develop vertigo as the chief complaint and then be said to have Meniere's disease, it is remarkable how many patients continue to suffer mainly from cochlear symptoms at all times. It would appear, because of the greater frequency of fluctuant hearing loss than in Meniere's disease, that the cochlear labyrinth is more susceptible to hydrops than the vestibular labyrinth. For the purposes of diagnosis and treatment it is very useful to separate patients into those with fluctuant hearing loss and those with Meniere's disease.

Animals↗
PubMed1975

Diabetes mellitus in fluctuant hearing loss.

1. In 161 consecutive cases of fluctuant hearing loss and 13 control cases of other causes of deafness, patients were examined for their ability to metabolize a 100 gm. oral dose of glucose. 2. The plasma glucose level in response to the oral dose of glucose was measured at hourly intervals for three hours. 3. Insulin and proinsulin levels were measured in 46 cases of fluctuant hearing loss and in 13 control cases. 4. None of the control group showed borderline or diabetic tolerance curves. 5. Fourteen per cent of the patients with fluctuant hearing loss had borderline glucose intolerance curves and 19 per cent showed diabetic glucose tolerance curves. 6. In patients whose insulin and proinsulin levels were determined, the insulin response to an oral glucose load was typical of adult onset diabetes, i.e., delayed hyperinsulinemia with concomitant hyperglycemia. The hyperinsulinemia was not associated with hyperproinsulinemia. 7. We conclude that in patients with fluctuant hearing loss there is a significantly higher incidence of borderline or diabetic glucose tolerance than in the "control deafness" or "normal population" group.

Adult↗
PubMed1975

Diagnosis and treatment of fluctuant hearing loss.

Fluctuant hearing loss, a very real and common cause of sensorineural hearing loss, is probably due to cochlear hydrops resulting from an anatomically inadequate endolymphatic sac, poor circulation, and one or more metabolic disorders. In the early stages at least, it often responds to treatment.

Female↗