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Biomedical subjects

J W House

Publications and source records attributed to J W House.

At least 37 records · Page 2Linked to original sources
PubMed1990

Is there consensus in perilymph fistula management?

A perilymph fistula is an abnormal communication between the inner ear fluids and the middle ear space. This article identifies areas of agreement in perilymph fistula management based upon 167 questionnaire responses from active surgeons of the American Otological Society and the American Neurotological Society. The average respondent performed 4.6 fistula explorations among 197 otologic surgeries (some of these were myringotomies) per year. The following statements represent areas of general agreement. The single most important feature of the history is previous trauma or barotrauma. At present no test can replace clinical judgment; however, despite sound judgment and sophisticated testing, it is very difficult to document the presence or absence of a fistula preoperatively. Most often the diagnosis is based on the total clinical picture: history, physical examination, and laboratory testing.

Ear Diseases↗
PubMed1990

Adenomatous tumors of the middle ear and mastoid.

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate. The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens. Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facial nerve. On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions: 1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology. 2. There is a high rate of local recurrence. 3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary. 4. Primary surgical treatment is required.

Adenocarcinoma↗
PubMed1989

Perilymph fistulas in children: experience of the Otologic Medical Group.

We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Neuromas of the facial nerve.

Forty-eight patients with facial nerve neuromas were treated at the Otologic Medical Group Inc. between 1974 and 1985. The most common presenting symptoms were hearing loss and tinnitus. Facial paralysis occurred in 22 patients (46%). A mass behind the tympanic membrane was seen on otoscopy in 14 patients (29%). These tumors typically involved more than one segment of the nerve and eroded otic capsule bone in 14 patients (29%). High resolution computed tomography (CT) was highly accurate in determining the extent and location of these tumors. Restoration of the continuity of the nerve was undertaken at the time of tumor removal. The major determinant of the ultimate status of facial nerve function was the duration of preoperative paralysis.

Adolescent↗
PubMed1988

Vertigo in postoperative follow-up of otosclerosis.

Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.

Follow-Up Studies↗
PubMed1987

Acoustic tumor management in senior citizens.

We reviewed records of 116 consecutive acoustic tumor surgery patients aged 65 and older during the 10 years ending in 1984. One hundred six had total removal. Ninety-four (81%) had no intraoperative complications and 66 (57%) had no postoperative complications. Only one patient, who had previously undergone partial removal elsewhere, died. Because tumors grow at 2 mm per year, and because elderly patients can expect to live up to 18 more years, we recommend planned total removal of an acoustic tumor as the management of choice for senior citizens in good health. We feel that the advantages of immediate surgery outweigh the risks of delayed surgery when age is advanced, the tumor is enlarged, and general health may be declining.

Age Factors↗
PubMed1986

Calcitonin as treatment for hearing loss in Paget's disease.

Progressive hearing loss is a potential complication of Paget's disease, a metabolic disorder of accelerated bone formation and resorption. Calcitonin (Calcimar) is a recently introduced synthetic hormone used as a systemic treatment. Some studies have shown it to halt the progression of hearing loss. This is the first study of the effects of calcitonin on hearing loss to use a large number of patients with continuous use of the drug and long-term follow-up. It confirms that the drug is effective. We conducted chart reviews to compare the degree of hearing loss over time in 45 patients. Twenty-six patients have been taking salmon calcitonin for five to eight years to date and nineteen have received no treatment. Hearing loss was recorded at the initial examination (trial 1), one to four years later (trial 2), and then one to five years after the second evaluation (trial 3). Statistical analyses show a strong relationship between treatment and rate of hearing loss. The average hearing loss in the control group progressed from 47 dB in the first trial to 59 dB in the second trial to 75 dB in the third trial. Average hearing loss in the treated group remained at 47 dB over time. The difference in hearing loss over time between the two groups was less than 1 dB for the treated group and more than 28 dB for the control group. Results thus clearly show that calcitonin is effective in halting the progression of hearing loss in Paget's disease.

Aged↗
PubMed1986

Aural cholesteatoma extending into the posterior fossa.

The case of a residual aural cholesteatoma extending into the posterior cranial fossa after radical mastoidectomy is presented. The importance of distinguishing this lesion from primary cholesteatoma of the cerebellopontine angle is discussed. The safety of canal-wall-down procedures is also discussed.

Cerebellar Diseases↗
PubMed1984

Retrolabyrinthine vestibular nerve section: a viable alternative to the middle fossa approach.

Vestibular nerve section, whether by the middle fossa or retrolabyrinthine approach, is effective in relieving intractable vertigo while preserving hearing. However, the potential morbidity and technical difficulty of the middle fossa approach have limited its usefulness. In an attempt to determine if the two approaches produce comparable results, we evaluated 52 patients who underwent retrolabyrinthine vestibular neurectomy between April 1981 and March 1983 at the Otologic Medical Group. We compared their audiometric data and questionnaire responses with published data on patients who had a middle fossa vestibular neurectomy. Although differences between the two procedures do exist, the retrolabyrinthine method, with its 93% success rate in improving or resolving vertigo and its zero incidence of total sensorineural hearing loss, offers the surgeon a strong alternative to the middle fossa approach.

Adult↗
PubMed1984

Retrolabyrinthine section of the vestibular nerve.

When symptoms of dizziness and episodic vertigo cannot be controlled through medical management or drainage procedures such as endolymphatic subarachnoid shunt operations, selective vestibular nerve section may be necessary. In the 1920s eighth cranial nerve sections were performed by neurosurgeons through the suboccipital approach but were frequently associated with hearing loss and facial paralysis. The middle fossa approach has been popularized by Dr. William House and others as a method of selectively sectioning the vestibular nerve and preserving facial and cochlear function. More recently the suboccipital retrolabyrinthine approach has been described as a method of selectively sectioning the vestibular nerve. We have reviewed 42 cases of suboccipital retrolabyrinthine selective section of the vestibular nerve performed at the Otologic Medical Group over the past 2 years. The shortest follow-up on these patients has been 6 months. Thirty-two patients had preoperative diagnosis of Meniere's disease, and of these patients 25 had had previous endolymphatic subarachnoid shunt surgery. Eighty-five percent (27 patients) experienced complete relief of vertigo following surgery, while 6% (two patients) stated they were improved. Three patients reported no relief. There were 10 patients with dizziness who had a diagnosis other than Meniere's disease. In this diverse group three experienced complete relief of vertigo, five were improved, and two reported no improvement of vertigo following surgery. None of the patients lost his hearing as a result of the surgery and there was no facial weakness. One patient had postoperative CSF rhinorrhea and another had meningitis.

Dizziness↗
PubMed1983

Acute mastoiditis in children: a review of 54 cases.

Fifty-four children with acute mastoiditis were managed at the Los Angeles County-University of Southern California Medical Center from 1972 through 1982. Our criteria for the diagnosis of acute mastoiditis are acute or subacute otitis media, postauricular swelling and erythema, protrusion of the auricle, and clouding of mastoid air cells on radiographs. Thirty-one (57%) recovered with conservative therapy consisting of early myringotomy and intravenous antibiotic, usually ampicillin. Twenty-three patients were managed surgically. The indication for surgery in each case was the clinical diagnosis of subperiosteal abscess; mastoid radiographs played no part in the decision to operate. Two of the 23 patients managed surgically had only incision and drainage of abscess; simple mastoidectomy was performed on 20 and radical mastoidectomy on one. Etiologic bacteria were cultured in 21 instances, S. pyogenes was cultured in 9, S. pneumoniae was cultured in 6, H. influenzae in 1, enterococci in 1, anaerobes in 2, and M. tuberculosis in 2.

Acute Disease↗
PubMed1983

Facial nerve grading systems.

A comprehensive, accurate, and valid system for reporting results of facial nerve surgery and disease is needed. This study describes and statistically analyzes eight currently available systems for reliability, validity, and ease of use. They are divided into three grading categories: gross scales, regional systems, and specific scales. Botman and Jongkees, May, and Peitersen have proposed five-point gross scales. Janssen, Smith, Adour and Swanson, and Yanagihara have devised regional systems. Stennert has proposed a specific criteria scale. Fifteen otologists experienced with facial nerve problems used modifications of the existing scales to evaluate videotapes of 12 patients representing the complete range of facial function. The observers' responses were translated back to the original scales. Observers also ranked patients from least to most severe, to obtain an accurate assessment of facial function for patients in the study. A follow-up questionnaire examined observers' system preferences. Validity is measured by correlating responses to different scales and by comparing responses to each scale with observers' rankings. All scales have good validity except the scales of Stennert and Yanagihara. Consistency of responses is determined by reliability coefficients. Coefficients for all scales are high except for the gross scale, which is moderately reliable, and the Stennert scale, which is unreliable. Results indicate that all scales succeed in evaluating patients with normal function or total paralysis. The regional scales have the highest reliabilities but they also have wide response ranges. Most also assume a level of precision that is unsubstantiated. Gross scales have smaller ranges, which result in greater agreement of responses but lower reliability. Comparisons to more complex scales show that the simpler gross scales convey similar information about patients. The study concludes that a gross scale is the best type of system and proposes a new scale for international acceptance. This system has six categories, includes secondary defects, is designed to clearly differentiate between moderate degrees of dysfunction, and should facilitate interpretation and communication of facial nerve results.

Adult↗
PubMed1981

Tinnitus: surgical treatment.

Surgical treatment of tinnitus includes destructive procedures, neurectomies, stapedectomies and tympanosympathectomies. Translabyrinthine procedures for the removal of acoustic neuromas and sectioning of the eighth nerve to eliminate vertigo are analogous to cutting the eighth nerve as a surgical intervention for tinnitus. After surgical removal of acoustic tumours with excision of the auditory nerve in 414 patients, only 40% reported improvement in their tinnitus. Of 68 patients undergoing translabyrinthine eighth nerve section, 60 (80%) had tinnitus preoperatively. Improvement occurred in 45%, while 55% reported the condition to be the same or worse. In patients undergoing middle cranial fossa section of the vestibular nerve for vertigo or dizziness, most reported the tinnitus to be the same but a significant number felt that it was worse. Stapedectomy improves hearing in most patients but improves the symptom of tinnitus in only about half of the patients. Cochlear implant patients report an improvement in their tinnitus with use of the stimulator and implant. Implant procedures might therefore be used in patients who suffer from severe tinnitus. Surgical management of tinnitus, although successful in some cases, does not provide a valid and reliable mode of treatment for subjective tinnitus.

Cochlear Implants↗
PubMed1981

Demyelinating disease as the assumed cause of hearing loss and vertigo. A case report with light- and electron-microscopic findings.

A patient initially presenting typical symptoms of idiopathic sudden deafness later developed disabling episodic vertigo, which led to translabyrinthine eighth nerve transection. Morphological examination of the removed cochlear nerve specimen revealed a demyelinating process in the neuroglial portion of the nerve. The major part of the peripheral, neurolemmal portion of the cochlear nerve was normal. The inferior vestibular nerve was fibrotic. The major part of the superior vestibular nerve was normal. Some of its peripheral bundles showed increased endoneurial fibrosis. It is suggested that a demyelinating process was the cause of the patient's symptoms.

Adult↗