Primary peripheral T-cell lymphoma of the acoustic nerve.
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Cranial Nerve Neoplasms↗
Biomedical subjects
N L Cohen
Publications and source records attributed to N L Cohen.
Training in community psychiatry: new opportunities.
The authors describe the impact on training that accompanied an assignment of senior (PGY-4) residents to work one-half day each week for a six month period at a community-based agency concerned with the care of persons with severe and persistent mental illness who were formerly homeless. As the goals and methods of psychiatric training are rethought and adapt to programmatic shifts and economic pressures, new opportunities open up to move treatment and training to the "front lines" in the community where an innovative therapeutic armamentarium for persons with severe and chronic mental illness is developing.
Community Mental Health Services↗
Stability of the cochlear implant array in children.
OBJECTIVE: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re-evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. STUDY DESIGN: Prospective radiographic analysis of electrode position of cochlear implants in young children. METHODS: Twenty-seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multi-channel cochlear prostheses were subjects for this study. Follow-up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. RESULTS: An analysis of the data revealed no migration of the electrode array over time. CONCLUSIONS: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children.
Child, Preschool↗
Cochlear implantation in children younger than 2 years old.
OBJECTIVE: To determine the viability of giving implants to children <2 years old and to assess the development of speech perception. STUDY DESIGN: A prospective study with a follow-up period of 1-5 years. SETTING: New York University Medical Center. PATIENTS: The patients consisted of 11 consecutive profoundly deaf children, aged 14-23 months, who were given the Nucleus cochlear implant. METHODS: Closed- and open-set speech perception were assessed preoperatively and postoperatively using the following measures: Early Speech Perception (ESP) test, the Northwestern University children's perception of speech test (NU-CHIPS), the Glendonald auditory screening procedure (GASP) word and sentence tests, the phonetically balanced kindergarten (PBK) word test, common phrases test, the multisyllabic lexical neighborhood test (MLNT), and the lexical neighborhood test (LNT). RESULTS: Paired t test was used to examine changes in scores from the preoperative test interval to the last available postoperative assessment. Results indicate that all patients had significant improvement from preoperative performance to the last postoperative evaluation and were using oral language as their means of communication. There were no medical or surgical complications. CONCLUSIONS: Children <2 years old receive substantial benefit from a multichannel cochlear implant with no increase in risk when compared with older children.
Age Factors↗
Food safety training needs exist for staff and consumers in a variety of community-based homes for people with developmental disabilities.
OBJECTIVE: To determine staff and consumer-focused food safety training needs in community-based homes for people with developmental disabilities as well as dietitians' perceptions of food-handling practices in these homes. DESIGN: Direct-care staff and dietitians were surveyed according to a modified Dillman method using a mailed, self-administered questionnaire. Main outcome measures included food-handling knowledge, attitudes, and practices of staff and consumers as reported by staff and dietitians; critical control points in safe food preparation in the homes based on the Hazard Analysis and Critical Control Point system; and learning preferences of staff and consumers. SUBJECTS: A 10% probability sample of direct-care staff in homes for people with developmental disabilities in western Massachusetts and a nonprobability sample of dietitians who work with this population were surveyed. Results are reported from 132 and 18 respondents, respectively. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, chi 2 statistic, and the Fisher's exact test. RESULTS: Staff knowledge of safe food preparation is lacking in several areas, including storage and handling procedures. Although staff and consumers do not always follow safe food-handling practices, the staff reported that they follow recommended food-handling practices more often than the dietitians reported they do. Most staff and dietitians reported that staff and consumers had never attended a food safety training program, but that all of the critical control points surveyed would be somewhat helpful if they were included in a food safety workshop. APPLICATIONS: A food safety training program would be beneficial for staff and consumers. Programs should be geared to staff and include ideas and materials for consumers. Consumer modules could then be adapted to individual learning levels by direct-care staff in the homes. The Safe Food at Home workshop was developed on the basis of the results of this study and incorporates the approaches described in this article.
Adult↗
Cochlear implant soft surgery: fact or fantasy?
A basic surgical principle is to be as gentle as possible to accomplish the goals of the operation. The concept of "soft surgery" for cochlear implants consisted of a small, localized cochleostomy and gentle electrode insertion, the hope being that by limiting damage to the inner ear, superior hearing results might be obtained. The technique includes deferring the cochleostomy until immediately before electrode insertion, use of a large burr to flatten the promontory, followed by a smaller burr to expose the endosteum, preservation of the endosteum of the scala tympani, smoothing of the bony edges with burrs and dissectors, limited opening of the scala tympani, no suctioning of perilymph, gentle electrode insertion, and potential use of a lubricant to facilitate insertion. Although this technique has a theoretic basis, is esthetically satisfying, and has been used in many cases involving the Nucleus device at multiple centers, no data are available that demonstrate its advantages. Furthermore, the Clarion device, the results of which seem to be comparable to those of the Nucleus device, requires much more extensive and potentially damaging surgery. The pros and cons of soft surgery will be discussed. Although soft surgery seems desirable to limit trauma within the cochlea, other factors such as full electrode insertion, stimulation strategy, and survival of ganglion cells may be more important predictors of successful results.
Cell Survival↗
Surgical techniques to avoid complications of cochlear implants in children.
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Child↗
Perception and production results in children implanted between 2 and 5 years of age.
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Audiometry, Pure-Tone↗
Lessons learned from providing disaster counseling after TWA flight 800.
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Accidents, Aviation↗
Meningioma of the internal auditory canal.
Meningiomas are the second most common tumor to involve the cerebellopontine angle (CPA), but controversy exists as to whether they can arise within the internal auditory canal (IAC) or whether involvement of the IAC occurs secondarily by extension from the CPA. This paper reports on a patient with an enhancing IAC meningioma that then grew and on subsequent scans was found to involve the CPA. This case demonstrates that these tumors can arise within the IAC and can grow out to involve the CPA. These findings are discussed within the context of meningioma tumor genetics and the histologic evidence for precursor cells in the IAC. The radiologic findings useful in distinguishing an acoustic neuroma from a meningioma are reviewed in the light of this case. While an enhancing mass projecting into the IAC is most often an acoustic neuroma, this radiologic findings is not pathognomonic.
Cerebellar Neoplasms↗
Cochlear implantation in children with cochlear malformations.
OBJECTIVE: To address the surgical and habilitative issues raised by cochlear implantation in children with cochlear dysplasia. STUDY DESIGN: The English-language literature is reviewed and the New York University Medical Center experience with three patients is detailed. Two hundred institutions performing cochlear implants were queried by questionnaire. SETTING: Hospitals performing cochlear implantation. PATIENTS: Pediatric patients with a cochlear implant in an ear with a dysplastic cochlea. MAIN OUTCOME MEASURES: Preoperative computed tomography analysis of cochlear anatomy was compared with operative findings, complications, and postoperative device use. RESULTS: Facial nerve anatomy was anomalous in 16% of patients, and there were two surgical injuries. There were no cases of meningitis. All patients who received multichannel implants derive benefit and wear their devices. CONCLUSIONS: All degrees of cochlear dysplasia, ranging from incomplete partition to common cavity, can be safely implanted and auditory responses expected.
Adult↗
Open-set speech perception in congenitally deaf children using cochlear implants.
OBJECTIVE: To assess and document the development of open-set speech recognition in congenitally deaf children implanted with the Nucleus multichannel cochlear prosthesis at < 5 years of age. STUDY DESIGN: The study group consisted of 38 consecutively chosen children in whom the decision to proceed with implantation had already been made. PATIENTS AND SETTING: Congenitally profoundly deaf children were implanted with the Nucleus multichannel cochlear implant at < 5 years of age and followed at NYU Medical Center for a period of 1-5 years. MAIN OUTCOME MEASURES: Open-set speech perception was evaluated preoperatively and postoperatively using the following: the Glendonald Auditory Screening Procedure (GASP) word subset, the GASP sentence subtest, Phonetically Balanced Kindergarten monosyllabic word lists, Common Phrases test, Multisyllabic Lexical Neighborhood test, and Lexical Neighborhood test. RESULTS: Correlation coefficients were calculated between scores at each interval and age at implantation; one-way analyses of variance were performed independently. Results showed that all subjects had significant open-set speech recognition at the time of the last postoperative evaluation. Thirty-seven of the children use oral language as their sole means of communication. CONCLUSIONS: Multichannel cochlear implants provide significant and usable open-set speech perception in congenitally deaf children given implants at < 5 years of age.
Auditory Threshold↗
Uncommon lesions presenting as tumors of the internal auditory canal and cerebellopontine angle.
OBJECTIVE: The aim of this study was to identify distinguishing characteristics of uncommon lesions of the cerebellopontine angle (CPA) and internal auditory canal (IAC) in order to attain the correct diagnosis and thus formulate an appropriate therapeutic protocol. STUDY DESIGN: A retrospective chart analysis was performed on all patients with surgically managed lesions of the IAC and CPA referred to neuropathology from January 1985 to April 1996. SETTING: All patients were treated by New York University faculty at a tertiary referral center. PATIENTS: Among 426 surgical cases identified, 384 patients (90.1%) with acoustic neuromas and 18 patients (4.2%) with meningiomas were excluded. The remaining 24 cases, involving 17 women and seven men with a median age of 34 years, were analyzed. INTERVENTION: Most patients underwent audiovestibular evaluations, as well as magnetic resonance imaging (MRI) and computed tomographic (CT) scanning, and all patients underwent neurotologic surgery as part of their management protocol. MAIN OUTCOME MEASURES: Correlating patient presentation, preoperative imaging, and surgical findings often identified distinguishing characteristics of unusual CPA and IAC lesions. RESULTS: Unusual lesions identified at the CPA and IAC included: four epidermoids, four lipomas, two facial neuromas, two arachnoid cysts, two choroid plexus papillomas, two metastatic adenocarcinomas, one metastatic neuroblastoma, one ependymoma, one lymphoma, one cholesterol cyst, one angioleiomyoma, one venous hemangioma, one cavernous angioma, and one pontine glioma. CONCLUSIONS: Preoperative tumor differentiation based on the patient history, physical examination, audiovestibular testing, CT, and MRI help the surgeon to formulate an appropriate treatment protocol.
Adult↗
Results of speech processor upgrade in a population of Veterans Affairs cochlear implant recipients.
OBJECTIVE: This study aimed to evaluate the change in performance when the Speak processing strategy replaced the Mpeak strategy. SUBJECTS: Twenty-one veterans who participated in the original Department of Veterans Affairs Multicenter Cochlear Implant Study, received the Nucleus F0F1F2 processor (Cochlear Corp., Englewood, CO, U.S.A.) (WSP) and were subsequently upgraded to the Mpeak (MSP) processing strategy. METHODS: Closed- and open-set speech recognition in quiet and in noise in auditory only conditions at the phoneme, word, and sentence levels were evaluated. RESULTS: Changes in audiologic parameters were evaluated using a paired t-test for related samples. Statistically significant improvements in mean scores were found for all tests and were greatest for the speech-in-noise conditions. An examination of individual data revealed that 61% of the subjects improved for tests administered in quiet, whereas up to 69% of the subjects had improved performance in noise. Subjects with no open set speech discrimination using the Mpeak strategy showed no improvement with the Speak strategy. CONCLUSIONS: Cochlear implants can provide improved performance using modifications to external speech processor hardware and software without changing the internal implant.
Cochlear Implants↗
Prognostic significance of intraoperative facial nerve stimulus thresholds.
OBJECTIVE: Intraoperative facial nerve monitoring has reduced the incidence of facial nerve paralysis associated with acoustic neuroma surgery, but poor facial nerve outcomes continue to occur. Intraoperative prediction of facial nerve outcome would be advantageous in patient management and counseling. This study seeks to evaluate intraoperative facial nerve stimulus thresholds as a tool for predicting postoperative facial nerve outcome. STUDY DESIGN: This study is a prospective clinical study of the prognostic value of intraoperative stimulus thresholds. SETTING: The study was performed at a tertiary referral center. PATIENTS: There were 109 patients undergoing excision of acoustic neuromas included in this study. INTERVENTIONS: The minimum current required to stimulate the facial nerve at the brain stem was prospectively recorded after excision of the acoustic neuroma. MAIN OUTCOME MEASURES: Facial nerve outcome was evaluated by the House-Brackmann grade. RESULTS: A statistically significant relationship was found between poor initial facial nerve outcome and higher stimulus thresholds. Long-term impaired facial function was also more common in the higher stimulus group compared to that of the lower stimulus groups. CONCLUSIONS: Although these findings suggest that intraoperative stimulus thresholds have prognostic potential, other prognostic factors should also be considered and additional research is needed.
Electromyography↗
Systematic approach to electrode insertion in the ossified cochlea.
Ossification of the fluid spaces of the cochlea occurs often in candidates for cochlear implantation, especially children. When noted before surgery on computerized tomography, ossification previously was thought to contraindicate cochlear implantation because of possible mechanical obstruction and uncertainty about the level of function that could be achieved by stimulating an ossified cochlea. However, during the preceding 6 years, techniques have been developed that permit implantation in ossified cochleas. We present a systematic approach that has been developed to treat the three clinically important categories of cochlear ossification: round window niche obliteration, inferior segment obstruction, and upper segment obstruction. Case reports are presented for each of these three drill-out procedures, demonstrating results often similar to those expected for implantation of the nonossified cochlea.
Adult↗
Perioperative complications of transseptosphenoidal excision for pituitary adenomas.
Although complications of transseptosphenoidal (TSS) pituitary surgery have been discussed in the literature, there has not been an analysis of complication rates related to clinical features and the nature of the tumor. A retrospective review of 366 TSS procedures (354 patients) for excision of pituitary adenomas evaluated the incidence and management of perioperative complications. The mortality rate was 0.82%. The most frequently encountered complications were transient diabetes insipidus (8.74%) and cerebrospinal fluid (CSF) rhinorrhea (4.10%). Other complications included exacerbation of visual acuity and visual field defects, hemorrhage, hydrocephalus, and meningitis. The factors evaluated were gender, age, tumor size, hormone secretory status, and any history of prior pituitary surgery.There was a significantly higher incidence of transient diabetes insipidus in patients with hormone-secreting tumors. Minor and total complication rates were significantly increased in microadenomas, hormone-secreting tumors, in female patients, and in patients less than 60 years of age reflecting the increased incidence of transient diabetes insipidus in young female patients with hormone-secreting tumors. Observed intraoperative CSF leaks predisposed to postoperative CSF rhinorrhea. There were no identifiable risk factors for major complications.
Journal Article↗
Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery.
A retrospective analysis was performed on 174 patients operated on from 1992 to 1995 to evaluate the safety and efficacy of continuous lumbar cerebrospinal fluid drainage (CLCFD) in the management of cerebrospinal fluid (CSF) leaks following acoustic neuroma surgery. There was a 17% incidence of CSF leak. CLCFD stopped the leak in 87% of cases. There were no cases of meningitis associated with CLCFD. One deep vein thrombosis was treated without sequelae. It is concluded that CLCFD is safe and efficacious. The authors recommend that CLCFD be implemented immediately when indicated, foregoing a trial of conservative therapy. Indications and precautions are discussed.
Cerebrospinal Fluid↗