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Biomedical subjects

K K Adour

Publications and source records attributed to K K Adour.

At least 37 records · Page 2Linked to original sources
PubMed1983

Acute cranial polyneuritis with vertigo after stapedectomy.

Acute vertigo occurring 48 hours after stapedectomy is assumed to be related to inner ear trauma. Similarly, acute vertigo occurring weeks after stapedectomy could be related to a fistula of the oval window. No one has tested the hypothesis that some of these cases could represent concomitant cranial polyneuritis. We report the development after stapedectomy of five cases of acute cranial polyneuritis with vertigo diagnosed by physical examination of the cranial nerves. In another case we determined that vertigo occurring after stapedectomy was not related to concomitant cranial polyneuritis. Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.

Adult↗
PubMed1983

The facial paralysis prognostic index.

The treatment of facial paralysis requires a reliable estimate of prognosis as well as an accurate diagnosis. Although the majority of patients recover, the degree of subsequent facial function varies. An estimation of the risk of nerve degeneration and subsequent disability is needed to guide therapy and to advise patients. Currently, prognosis is obtained by clinical evaluation of initial signs and symptoms, specific nerve excitability and function testing, and response to medical therapy. This study attempts to identify and quantitate factors that predict the outcome of facial paralysis. In 1214 patients with Bell's palsy, we identified factors associated with a severe course or poor outcome. We analyzed the predictive value of each item in an extensive research protocol, estimating the relative contribution to the total risk of unfavorable outcome by means of multiple regression models. With the use of these data, we have developed the facial paralysis prognostic index (FPPI). The FPPI can assist otologists to more accurately estimate outcome based on physical examination and electrical testing.

Adolescent↗
PubMed1983

Herpes simplex virus and acute temporomandibular joint pain-dysfunction syndrome.

Although the TMJ or myofascial pain-dysfunction syndrome is probably not brought about by any single etiologic agent, the findings discussed here offer strong evidence that the primary disease is a form of cranial polyneuritis similar in onset, duration, and natural course to acute facial paralysis. These findings of sensory neuritis with secondary neuromuscular dysfunction leave no question unanswered, whereas the classic concept that has evolved through the years into the pain-dysfunction syndrome cannot adequately explain the myriad of signs and symptoms found in this condition. By removing the psychophysiologic (functional) label and recognizing the organic nature of this self-limiting disease, we should now be able to consolidate the many different modes of therapy that are effective in treating patients with the acute TMJ pain-dysfunction syndrome.

Adult↗
PubMed1981

Vestibular vertigo. A form of polyneuritis?

Vestibular vertigo traditionally has been considered to be of viral origin and some forms (acute vestibular neuronitis, acute labyrinthitis, acute vertigo) may be manifestations of a viral cranial polyneuritis. To test this hypothesis, otoneurologic signs and serum complement-fixation titers to herpes simplex and herpes zoster were determined in 16 patients with acute vertigo during their attack and several weeks later. One hundred unselected patients seen for nonotoneurologic problems served as control subjects. In addition to vestibular nerve abnormality, all patients with vertigo had some form of cranial nerve abnormality that cleared within four weeks of onset. These transient acute cranial nerve findings in patients with vestibular vertigo support the concept of inflammatory polyneuritis, and preliminary studies indicate that an anti-inflammatory agent such as prednisone may be the preferred treatment.

Acute Disease↗
PubMed1981

Acute temporomandibular joint pain-dysfunction syndrome: neuro-otologic and electromyographic study.

To test the hypothesis that the acute temporomandibular joint pain-dysfunction syndrome might represent a variant of acute benign cranial polyneuritis, a prospective study was designed using neuro-otologic examination and electromyography. Seven consecutive patients with cardinal symptoms of the temporomandibular joint pain-dysfunction syndrome (pain, tenderness, clicking, and limitation of jaw movement) were examined within one week after the onset of their acute symptoms. Another three with chronic symptoms were tested for comparison to the acute cases. All seven patients with the acute condition had asymptomatic hypesthesia of all three divisions of the trigeminal nerve and decreased volitional muscle action potentials in the masseter and temporalis muscles. At the end of three weeks the hypesthesia resolved in all seven patients, and the muscle action potentials returned to normal in six of the seven. Electromyographic testing of the single patient with persistent decreased muscle action potentials and three patients with chronic symptoms showed fibrillations, decreased polyphasic regeneration potentials, and spontaneous fasciculations with clinical atrophy and spasm of the affected masseter and temporalis muscles. Other acute cranial nerve findings included unilateral hypesthesia of the glossopharyngeal and second cervical nerves, motor paralysis of the superior laryngeal branch of the vagus nerve, and increased facial nerve latency. These findings suggest an organic neuromuscular, rather than a psychophysiologic, cause for the temporomandibular joint pain-dysfunction syndrome.

Acute Disease↗
PubMed1980

Ménière's disease as a form of cranial polyganglionitis.

Although endolymphatic hydrops is generally considered to be the most prominent factor in the etiology and pathology of Ménière's disease, we have concluded that this condition more probably represents a polyganglionitis caused by the herpes simplex virus with secondary hydrops changes. The wide range of symptoms occurring in the Ménière's disease complex is illustrated in seven selected cases which support this conclusion. Vestibular nerve section can stabilize hearing and relieve episodic vertigo by removing the locus of viral infection and precluding recurrent activation.

Adult↗
PubMed1980

Maximal nerve excitability testing versus neuromyography: prognostic value in patients with facial paralysis.

Neuromyography (NMG) is compared with maximal nerve excitability testing (NET) as a prognostic tool in facial paralysis. Normal latencies, summation muscle action potentials, and test/retest reliability were determined in three groups of subjects. NMG was performed in 33 control subjects of Group 1 to determine test/retest reliability. To determine the range of normal facial nerve conduction latency and amplitude and configuration of the summation muscle action potentials, NMG was performed in 172 otolaryngologic control patients without facial paralysis. NMG and NET were then compared in Group 3, which consisted of 43 patients with Bell's palsy. Fluctuations in NMG were then analyzed in a fourth test series of three subjects from Group 1, in whom summatin muscle action potentials at various positions of the electrodes were compared. The high rate of fluctuations observed indicates the need for further assessment of test/retest reliability and standardization of normal values in NMG. Our results indicate that maximal NET is more reliable than NMG for prognosis of facial paralysis.

Adolescent↗
PubMed1979

Trigeminal neurotization of paralyzed facial musculature. Modification of the Lexer-Rosenthal surgical procedure.

We introduce a modification of the Lexer-Rosenthal surgical technique for reinnervation of the facial muscles by trigeminal neurolization in patients with facial paralysis. Four patients with such paralysis were seen in the Cranial Nerve Research Clinic, Oakland, Calif. Three of the four patients had their paralysis surgically treated, and recovery of facial motion was compared with that in one patient, in whom spontaneous trigeminal neurotization occurred. Those patients whose facial paralysis was surgically treated had fair to excellent results, and the technique is considered superior to alternative hypoglossal or spinal accessory anastomosis.

Adult↗
PubMed1978

Histologic findings in the temporal bone in trisomy D (D/D translocation).

The temporal bones of an infant in whom the diagnosis of unblaanced trisomy D (D/D translocation) had been made by chromosomal analysis during life were studied histologically. Most of the findings resembled those that have been described by others in trisomy D (13-15) syndrome. A previously unreported abnoramlity was substrial edema displacing the stria vascularis. The importance of this finding remains to be defined by further study.

Abnormalities, Multiple↗
PubMed1978

Acoustic reflex and loudness discomfort in acute facial paralysis.

An extensive research protocol was used to evaluate the conditions of 48 consecutive patients with acute facial paralysis. The results indicated that after nerve excitability testing, the acoustic reflex was the most efficient indicator of impending nerve degeneration and predictor of recovery. The presence of increased sensitivity to intense acoustic stimuli (loudness discomfort level) indicated poor prognosis. The data demonstrate that dysacusis (hyperacusis) is not related to stapedial muscle paralysis and also question the validity of "topographic diagnosis" in determination of the site of the lesion in facial paralysis.

Adolescent↗
PubMed1978

The true nature of Bell's palsy: analysis of 1,000 consecutive patients.

In a series of 1502 patients seen in our Facial Paralysis Research Clinic 1048 were diagnosed as having Bell's palsy. Review of clinical, epidemiologic, and laboratory data, plus review of the literature, has led to the conclusion that Bell's palsy is an acute benign cranial polyneuritis probably caused by reactivation of the herpes-simplex virus, and the dysfunction of the motor cranial nerves (V, VII, X) may represent inflammation and demyelinization rather than ischemic compression. Spinal fluid analysis suggests that the disease is a phenomenon of the central nervous system with secondary peripheral neural manifestations. With our presently available information, treatment of a viral disease with an anti-inflammatory agent is rational. Prednisone treatment started within the first week of the disease can restore better function to the paralyzed face than is achieved without such therapy, and facial nerve decompression has been unnecessary.

Adolescent↗
PubMed1977

Auditory symptoms associated with herpes zoster or idiopathic facial paralysis.

Auditory symptoms (hyperacusis, tinnitus, decreased hearing) have long been recognized to accompany herpetic or idiopathic facial paralysis. Twenty-nine percent of 1,080 patients with idiopathic facial paralysis and 37 percent of 172 with herpes zoster oticus facial paralysis had auditory symptoms. Abnormal related sensori-neural hearing loss was documented in only 11 of these 377 patients with auditory complaints. All of the 11 had a diagnosis of herpes zoster oticus. Sensori-neural hearing loss occurs in only about 6.5 percent of patients with herpes zoster facial paralysis, and no confirmed case of such loss in idiopathic facial paralysis has been reported. In patients presenting with sensori-neural hearing loss accompanying facial paralysis believed to be idiopathic, herpes zoster should be suspected even in the absence of vesicles. Factors favorable for recovery of auditory function include age 64 years or younger, mild initial hearing loss, a cochlear pattern of hearing loss, and absence of vertigo. Recovery of auditory function does take place; however, a high-tone sensori-neural loss may persist except in younger patients.

Adolescent↗
PubMed1977

Surgical and nonsurgical management of facial paralysis following closed head injury.

The outcomes of facial nerve decompression, surgical exploration, and nonsurgical treatment for facial paralysis following closed head injury were analyzed in 30 patients with an intact facial nerve, and complete evaluation. Objective evaluation of outcome was achieved by calculation of a Facial Paralysis Recovery Profile and Recovery Index (Profile minus complications). Twelve of 15 patients with incomplete facial paralysis were treated medically. All followed patients with incomplete paralysis and bilaterally equal facial nerve excitability had a Recovery Index of + 10 (complete recovery of function, no complications). Three with partial denervation had a Recovery Profile of + 10 with mild contracture and synkinesis. The average Recovery Profiles for all patients treated by decompression, exploration, or nonsurgically were respectively 4.0, 5.7, and 5.7. The Recovery Indices were +1.8, +3, and +2.7, respectively. Where nerve excitability had become abnormal, facial nerve decompression was of no benefit in traumatic facial paralysis due to closed head injury. Nerve excitability tests of peripheral branches are of great value for prognosis and selection of patients who do not need surgical intervention. Substitution of facial nerve exploration for facial nerve decompression seems reasonable. Polytomography of the facial canal is invaluable in selection of patients for operation.

Adolescent↗
PubMed1976

Cranial polyneuritis and Bell palsy.

In view of the specific nature of the clinical and neurologic findings in Bell palsy and other acute benign cranial neuritides, the neural component of cutaneous herpes simplex, the predilection of the herpesvirus for sensory nerves, and intrinsic behavior and immunologic interreactions of the herpesvirus within ganglion cells, it is suggested that (1) the entity that has been termed "idiopathic facial paralysis" be recognized as an acute benign cranial polyneuritis; and (2) other acute benign cranial neuritides be recognized as formes frustes of Bell palsy.

Acute Disease↗