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Biomedical subjects

J L Sheehy

Publications and source records attributed to J L Sheehy.

At least 37 records · Page 2Linked to original sources
PubMed1982

Stapedectomy: incus bypass procedures. A report of 203 operations.

The records of 203 stapedectomy operations in which we used a prosthesis from the malleus handle or a columella from the tympanic membrane were reviewed; 63 operations were primary stapedectomies, and 85% had a postoperative conductive deficit of 15 dB or less. The most common single indication for an incus bypass procedure was idiopathic malleus head fixation. Sixty-six operations were revision stapedectomies; 65% had a postoperative deficit of 15 dB or less. In 50% the bypass indication was necrosis of the incus. There were 74 stapedectomies in a previously fenestrated ear; 60% had a postoperative deficit of 15 dB or less. Incus bypass procedures in stapedectomy, when indicated, yield satisfactory hearing results. Otolaryngologists who perform stapedectomy must be familiar with these procedures.

Adipose Tissue↗
PubMed1982

Myringotomy and ventilation tubes: a report of 1,568 ears.

We reviewed the records of all patients who had a myringotomy and insertion of a ventilation tube at Otologic Medical Group during a 6-year period; there were 2,266 intubations on 1,568 ears. Uncomplicated serous otitis media was the indication in 1.055 ears; 19% developed brief episodes of otorrhea. Persistent otorrhea necessitated tube removal in 9 ears, all but 2 of which became dry. These 2 patients required mastoid surgery. We conclude that myringotomy and insertion of a ventilation tube in serous otitis media is associated with infrequent complications, and these complications are probably related more to the underlying disease process than to the ventilation tube.

Adolescent↗
PubMed1981

Revision stapedectomy: a review of 258 cases.

We reviewed the records of 258 revision stapedectomy operations performed at the Otological Medical Group during an eight year period. Displacement of the prosthesis to the inferior edge of the window was the commonest cause of failure (41%) and occurred predominately in wire-Gelfoam pad cases. An oval window fistula, a short prosthesis or bony closure of the window were causes of failure in 9% each. Incus necrosis was the cause of failure in 5%. Less than 50% of the operations resulted in postoperative conductive deficit of 10 db or less. The results were better than this in incus bypass procedures, in revisions of cases in which a tissue graft was used over the oval window and in revisions of ears initially operated on elsewhere. Severe sensorineural hearing impairment was the result in 7% of the operations and half of these impairments were dead ears. The majority of these adverse results followed a repeat drill out of obliterative otosclerosis or followed reopening of the oval window in patients with a postoperative inner ear problem other than a fistula. We concluded that 1. revision stapedectomy is a less satisfactory procedure than primary stapedectomy; 2. there is rarely an indication for a repeat drill out of obliterative otosclerosis; and 3. the oval window membrane usually should not be disturbed in revision stapedectomy in a patient with inner ear symptoms unless there is a fistula.

Adult↗
PubMed1981

Total obliteration of the mastoid, middle ear, and external auditory canal. A review of 27 cases.

In the past 22 years, 27 patients had undergone total obliteration of the mastoid, middle ear, and external auditory canal. Most of the patients had severely diseased ears, many with multiple previous operations. When performed for chronic otorrhea, the operation resulted in a dry ear in all but two cases, though healing was prolonged in some. Secondary revisions for hearing were unsuccessful. We review the indications for this procedure and the experience of others who had used similar techniques. Though seldom indicated, the mastoid obliteration operation results in a dry ear in almost all patients.

Adolescent↗
PubMed1981

Cochlear otosclerosis: acoustic reflex findings.

Progressive cochlear impairment develops in a small percentage of patients with clinical otosclerosis, apparently owing to involvement of the cochlea by the otosclerotic bone. In recent years it has been postulated that otosclerosis frequently produces a pure sensorineural hearing impairment without stapedial involvement. We investigated the acoustic reflex responses in a group of patients diagnosed as sensorineural otosclerosis and compared these reflex findings with the findings in patients with confirmed otosclerosis but with a minimal conductive impairment. In the minimal conductive hearing impairment group we substantiated the findings of others that the negative on-off reflex is common in otosclerotic patients whose conductive impairment is 10dB or less. In the group with cochlear otosclerosis we found abnormal reflexes in 58 percent of the patients. These findings indicate that stapedial involvement is common in patients thought to have pure sensorineural otosclerosis.

Adolescent↗
PubMed1980

Intravenous histamine in otologic practice. Side effects in 2,347 administrations.

Intravenous (IV) histamine has been used extensively at the Otologic Medical Group, Inc, Los Angeles, for 30 years in the treatment of various conditions in which vasospasm was thought to play a part in the cause. We report the findings on 2,347 IV histamine administrations to 622 patients during a 33-month period. Dizziness was the indication for treatment in half of the patients. Sensorineural hearing impairments was the diagnosis in an additional 44%, and the majority of these had had a sudden impairment. Side effects were uncommon, never serious, and bore no relationship to the results of the histamine skin test or the patient's general medical problem. The IV histamine treatment resulted in improvement in symptoms in 36%, and almost half of those improvements were immediate.

Adult↗
PubMed1980

Cholesteatoma with intact tympanic membrane: a report of 41 cases.

Aural cholesteatoma may present itself as an unexplained hearing impairment without either perforation or otorrhea and without radiologic evidence of bone destruction. The etiology is probably congenital. In our cholesteatoma cases, 3.7% occur in individuals with an intact tympanic membrane. Most of these patients have had the disease 5 years or less and 50% are under 20 years of age. Complications of the disease are uncommon in this group. All but 1 of our 41 cases were managed with the intact canal wall technique. Most were reexplored (planned second-stage) and residual disease was encountered in 32%. One should keep the possibility of a congentital cholesteatoma in mind wheneger encountering a unilateral serous otitis media or an unexplained unilateral conductive hearing impairment, regardless of the patient's age.

Adult↗
PubMed1980

Stapedectomy in children.

The records of 34 children and teenagers with a conductive hearing impairment and an intact and mobile tympanic membrane have been reviewed; 20 patients had a congenital hearing impairment. Stapedectomy was performed on 13 patients with satisfactory results in 12. In 3 cases the operation was terminated because of oval window or facial nerve abnormalities. In 4 cases there was no evidence of an ossicular problem, a so-called inner ear conductive hearing loss. Fourteen patients had otosclerosis, the youngest being 9 years old. Twenty-four stapedectomies were performed on this group with satisfactory results in 22. We conclude that the results of stapedectomy in children appear to be as satisfactory as results in adults.

Adolescent↗
PubMed1980

Cholesteatoma surgery in children.

We recently reviewed the records of 1024 operations for aural cholesteatoma. One hundred and eighty one of these were on children. Complications of the disease occurred more frequently in those whose disease had existed 20 years or more. As such, complications of the disease were less common in children. Our surgical management of cholesteatoma in children is the same as in adults. We are more likely, however, to perform the operation in two stages in children, and more likely to find residual cholesteatoma at the second-stage operation. There were no differences in the functional results in children and adults.

Adolescent↗
PubMed1979

Cholesteatoma surgery: management of the labyrinthine fistula--a report of 97 cases.

Preoperative, operative and postoperative findings in 97 cases of labyrinthine fistula are presented. Most of these patients had had symptoms of chronic otitis media for 20 years or more and manifested some degree of sensorineural hearing impairment. Two-thirds had experienced dizziness. The fistula was limited to the lateral semicircular canal in 83 cases and involved the labyrinth more extensively in 14 instances. The intact canal wall technique was used in less than 60% and an open cavity technique in 25% of the cases. Severe or total sensorineural hearing impairment developed postoperatively in 8% of the lateral canal cases and in over half of the extensive fistula cases. Five percent had incapacitating dizziness for up to six months postoperatively. When a labyrinthine fistula is encountered in an only hearing ear we usually recommend a classical modified radical mastoidectomy. In other instances the procedure performed will vary with the status of the opposite ear, the extent of the fistula, the sensorineural function of the involved ear and the size of the mastoid.

Adolescent↗
PubMed1979

Tympanoplasty: TORPS and PORPS.

We reviewed 106 cases in which PlastiPoreTM prostheses were used for ossicular reconstruction. In all cases a piece of cartilage was interposed between the prosthesis and the tympanic membrane graft to prevent the potential problem of prosthesis extrusion. With total ossicular replacement prostheses (TORPs) 55% closed to within 10 db and 85% closed to within 20 db of the bone conduction level. Closure to within 10 db of the bone conduction level was accomplished in 64% of partial ossicular replacement prostheses (PORPs) cases. These results are better than obtained previously with either ossicles or cartilage alone.

Ear Cartilage↗
PubMed1979

Stapes surgery at the Otologic Medical Group.

We reviewed the records of 498 primary stapedectomy cases in regard to duration of disease, age at surgery, oval window pathology, hearing results, dizziness, and tinnitus. Ninety percent of the cases in which a tissue graft had been used as an oval window covering obtained a postoperative hearing level within 10 dB of the preoperative bone conduction. Postoperative sensorineural hearing impairment occurred infrequently and was two to three times more common in cases in which Gelfoam had been used as an oval window covering as compared to tissue grafts. Postoperative dizziness of one degree or another persisted at four months in 2 percent of the cases and was a problem for the patient in two cases (0.4%). This dizziness was likewise more common in Gelfoam cases. We concluded that tissue grafts are a better covering for the oval window than Gelfoam both in regard to hearing improvement and lack of postoperative complications.

Adult↗
PubMed1978

Management of the labyrinthine fistula.

Preoperative, operative and postoperative findings in 97 cases of labyrinthine fistula are presented. The majority of patients had had symptoms of chronic otitis media for 20 years or more and manifested some degree of sensorineural hearing impairment. Two-thirds had experienced dizziness. The fistula was limited to the lateral semicircular canal in 83 cases and involved the labyrinth more extensively in 14 instances. The intact canal wall technique was used in less than 60% and an open cavity technique in a quarter of the cases. Severe or total sensorineural hearing impairment developed postoperatively in 8% of the lateral canal cases and in over half of the extensive fistula cases. Five per cent had incapacitating dizziness for up to 6 months postoperatively. When a labyrinthine fistula is encountered in an only hearing ear, a classified modified radical mastoidectomy is usually recommended. In other instances, the procedure performed will vary with the status of the opposite ear, the extent of the fistula, the sensorineural function of the involved ear and the size of the mastoid.

Adolescent↗
PubMed1978

TORPs and PORPs in tympanoplasty.

In an attempt to improve results in ossicular reconstruction, a newly introduced material, PlastiPore, has been evaluated over a short term. The techniques employed are described in detail and the use of a lateral covering material such as tragal cartilage is advocated as a means of preventing extension of this foreign material. The results in over 100 ears are better than those obtained with previous methods.

Ear Cartilage↗