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Biomedical subjects

R A Jahrsdoerfer

Publications and source records attributed to R A Jahrsdoerfer.

At least 19 recordsLinked to original sources
PubMed1998

Ear advantage in dichotic listening after correction for early congenital hearing loss.

Twelve patients who had undergone surgical correction for either unilateral or bilateral congenital hearing loss were given a postoperative dichotic listening test for consonant vowel-consonant (CVC) words. Four normal hearing control subjects were also tested. Patients were first given a test of subjective loudness, and the level of presentation of stimuli in the atretic ear was adjusted accordingly. In the dichotic condition all controls exhibited a right ear advantage, and all unilateral atresia patients showed an ear advantage favouring the non-atretic ear. Patients with bilateral atresia essentially exhibited no ear advantage. Patients had the same error rate as controls in the dichotic condition, which suggests that ear advantage was not due to increased errors in the atretic ear. For patients there was a significant relationship between ear advantage and both preoperative interaural asymmetry in hearing loss and age at operation. Results suggest that a sensitive and critical period for development of the ear is complete by 5 years of age. Results also suggest some limited ability to adjust to permanent change in stimulation levels until, but not after, puberty.

Adolescent↗
PubMed1998

Facial nerve injury in congenital aural atresia surgery.

OBJECTIVE: This study aimed to determine those patients who have sustained a facial nerve injury during surgery for congenital aural atresia and pinpoint the site of injury vis-a-vis the operative approach. STUDY DESIGN: The study design was a retrospective review of >1,000 patients undergoing atresia repair. SETTING: The study was performed at a tertiary referral center. PATIENTS: The study consists of 10 patients with a facial nerve injury from atresia surgery. INTERVENTION: In 1 of 10 patients, the facial nerve was transected. This occurred during the skin incision at the level of the helix. A sural nerve cable graft was used to repair the severed nerve. MAIN OUTCOME MEASURES: High-resolution computed tomography of the temporal bone was the most important preoperative study. However, in cases of aural stenosis with cholesteatoma, the course of the facial nerve may be camouflaged. RESULTS: Ten of >1,000 patients operated on sustained a facial nerve injury from atresia surgery. Seven of these patients were those of the authors, whereas three had the initial surgery elsewhere, each by a different surgeon. CONCLUSIONS: For the inexperienced surgeon, the facial nerve is at its greatest risk in the inferoposterior portion of atretic bone just lateral to the middle ear. For the experienced surgeon, the facial nerve is at its greatest risk in those patients with low-set ears, canal stenosis, and an accompanying cholesteatoma.

Adolescent↗
PubMed1995

Microtia grade as an indicator of middle ear development in aural atresia.

OBJECTIVE: To correlate the appearance of the external ear with the development of the middle ear in patients with congenital aural atresia. DESIGN: Retrospective analysis of patients with congenital aural atresia. Obtain the microtia grades assigned to affected ears and correlate them with atresia scores that describe the degree of the middle ear malformation. SETTING: University of Texas-Houston Otolaryngology Clinic (1988 to 1992). PATIENTS: A total of 199 ears with congenital microtia and aural atresia and 25 ears with canal stenosis without microtia were identified, all of which had been previously evaluated by high-resolution computed tomography of the temporal bone, and then assigned an atresia score. Patients with Treacher Collins syndrome were not included in our study. RESULTS: The average atresia score in cases with grade I microtia was 8.5; grade II microtia, 7.2; and grade III microtia, 5.9. In cases with canal stenosis without microtia, the average atresia score was 8.3. CONCLUSION: The better developed the external ear, the better developed the middle ear.

Child↗
PubMed1995

Issues on aural atresia for the facial plastic surgeon.

Rehabilitation of hearing in the child with congenital microtia and aural atresia is a fundamental part of the total reconstructive process. Not all children with microtia, however, are candidates for atresia repair. A grading scheme to evaluate a patient's candidacy for atresia surgery has been developed and facilitates the selection process. If aural atresia surgery is to be undertaken, the reconstructive surgeon planning microtia repair must be aware of certain concepts. We present our recommendations on the chronology and timing of surgeries, the relation of microtia repair to atresia repair, expectations after atresia repair, the importance of the conchal bowl and tragus, and the possibility of injuring an aberrant facial nerve. We stress close coordination of efforts between reconstructive surgeon and otologist to achieve the best possible functional and cosmetic outcome.

Ear Canal↗
PubMed1995

Treacher Collins syndrome: otologic and auditory management.

Treacher Collins syndrome (TCS) is an autosomal dominant genetic disorder, the phenotypic expression of which is seen in the head and neck area. The syndrome has full penetrance but variable expressivity even among family members, and recent investigation has reported gene site on chromosome 5q. TCS has a reported prevalence of 1 in 50,000 live births with about 40 percent of new occurrences resulting from a positive family history and a 60 percent new mutation rate. The clinical features of TCS involve bilateral abnormalities of the pinnae, external auditory canal, tympanic membrane, and middle ear space. Microtia has been reported to be as high as 85 percent, with one third of patients presenting with stenosis or complete atresia. Treacher Collins patients present with maximum conductive hearing loss often compounded by a high-frequency sensory component. This article describes the otologic and audiologic diagnosis and management of TCS.

Adolescent↗
PubMed1995

Transposition of the facial nerve in congenital aural atresia.

It is generally recognized that surgery for congenital aural atresia is difficult. The success or failure of the operation is often directly related to the degree of development of the middle ear. In poorly developed middle ears, the facial nerve may overhang and conceal the oval window niche, making this area inaccessible to inspection, let alone manipulation. The criteria for transposing the facial nerve are; (1) the atresia must be bilateral, (2) there must be preoperative imaging evidence of a stapes and/or patent oval window, (3) there must be no large blood vessels feeding or draining the facial nerve, and (4) facial nerve monitoring must be available. Over the past 2 years, 6 of 94 patients undergoing surgery for atresia were operated with an intent to transpose the facial nerve in order to access the oval window. In all patients, it was impossible to see the oval window niche due to a displaced nerve. In four of six cases, the facial nerve was transposed. The ossicular chain was reconstructed with a total ossicular replacement prosthesis. In no case was there a postoperative facial paralysis or paresis. Facial nerve transposition allows a final chance of achieving serviceable hearing through surgery. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in otherwise marginal or poor surgical candidates.

Ear Canal↗
PubMed1993

Surface contour three-dimensional imaging in congenital aural atresia.

Sixty-five patients with congenital aural atresia-stenosis had three-dimensional reconstructions of their high-resolution computed tomographic scans. Surface anatomy of the temporal bone was readily demonstrated, including its relation to the temporomandibular joint. Three important findings were noted. (1) Contrary to popular belief, the condyle of the mandible does not rest against the anterior face of the mastoid bone. (2) A bony cleft or groove is often in the lateral temporal bone through which the facial nerve may exit. (3) Duplications of bony structures attached to or part of the temporal bone are clearly defined. The information gained from the routine use of three-dimensional imaging of the computed tomographic scan alerts us to potential intraoperative problems that may otherwise escape our scrutiny, particularly if only two-dimensional computed tomographic scanning is done.

Ear Canal↗
PubMed1992

Gunshot wounds to the head and neck.

Gunshot wounds to the head and neck contribute to substantial medical, economic, and social problems in the United States today. The treatment of these patients requires the contemporary head and neck surgeon to be precisely informed in anatomy, wound ballistics, resuscitation, and surgical decision making. Ninety recent cases at the University of Texas Health Science Center affiliated hospitals in Houston were reviewed and are reported. Data show substantial trends in patient demographics and corroborate other reports in the trauma literature. Controversies in patient management continue, but current evidence favors a protocol of selective surgical exploration.

Adolescent↗
PubMed1992

Grading system for the selection of patients with congenital aural atresia.

It is generally recognized that surgery for congenital aural atresia is difficult. In an effort to select those patients who have the greatest chance of success, we have developed a grading scheme based on the preoperative temporal bone CT scan and the appearance of the external ear. Patients are graded on a possible best score of 10. The stapes is assigned the highest rating (2 points), while all other entrees on the scale are 1 point. The grade assigned preoperatively has been shown to correlate well with the patient's chance of success, herein defined as a postoperative speech reception threshold of 15 to 25 dB. A patient with a preoperative grade of 8/10 would, therefore, have a 80 percent chance of achieving this threshold. Patients with scores of 5/10, or less, are not considered surgical candidates, because the risk of the operation would outweigh the potential benefits. We have found that the grading system allows us to avoid impossible surgical cases while allowing for a reasonable prediction of the hearing outcome.

Abnormalities, Multiple↗
PubMed1990

Subcochlear approach for cholesterol granulomas of the inferior petrous apex.

Cholesterol granulomas of the petrous apex are drained through two major extralabyrinthine routes: one, along the posterosuperior chain of air cells, and two, along the anteroinferior chain. Procedures that use the posterosuperior chain approach the apex from the sinodural angle, the base of the zygomatic arch, the attic, or through the arch of the superior semicircular canal. Operations that use the anteroinferior chain reach the apex along the internal carotid canal (Ramadier's operation) or by a posterior infralabyrinthine approach between the descending facial nerve and jugular bulb. Inferior petrous apex cholesterol granulomas may be unreachable by any of these routes, and hence the subcochlear route is proposed as an alternative. The subcochlear approach starts in a triangle bounded superiorly by the cochlea, anteriorly by the internal carotid canal and posteriorly by the deep jugular vein. This operation requires lowering the inferior bony canal wall to the level of the "crutch." It provides access to an inferiorly situated cholesterol granuloma, yet preserves hearing. It allows enough room for the placement of a tube drain from the petrous apex to the mastoid. It is particularly useful when a high jugular bulb precludes the use of the posterior infralabyrinthine route.

Adult↗
PubMed1990

The risk of cholesteatoma in congenital aural stenosis.

Congenital aural stenosis, as compared to congenital aural atresia, carries a much greater risk of cholesteatoma. In a review of over 600 patients with major congenital ear malformations, 50 patients (54 ears) were found to have congenital aural stenosis. Ninety-one percent of the ears in patients 12 years and older with a stenosis of 2 mm or less presented with cholesteatoma. Based on this review, the following opinions are given: 1. A bony ear canal opening of 2 mm or less puts the patient at risk of cholesteatoma formation; 2. the cholesteatoma is slow-growing; and 3. undiagnosed cholesteatoma will cause extensive damage to the ear by early adulthood. We recommend surgery for patients with stenosis of the external ear canal measuring 2 mm or less. The appropriate time for surgery is late childhood or early adolescence, before irreversible damage has occurred.

Adolescent↗
PubMed1990

Congenital aural atresia.

Close cooperation between the plastic surgeon and the otologist, with each understanding and respecting the importance of the other's role, will provide the atresia/microtia patient with the best possible chance of a successful outcome. The purpose of the atresia repair is to improve hearing. Our goal is to attain, through surgery, hearing thresholds that will enable the patient to discard his hearing aid.

Child↗
PubMed1989

Treacher Collins syndrome: an otologic challenge.

Patients with Treacher Collins syndrome have severe middle ear malformations that render operation difficult. We have evaluated 43 patients with Treacher Collins syndrome, on whom only 11 were operated. Computed tomography, the single most important study done preoperatively, routinely showed an underdeveloped temporal bone with islands of bone marrow and absent mastoid pneumatization. The middle ear space was often underdeveloped. Ossicular dysjunction was often noted in which the fused malleus/incus remnant was found 3 to 4 mm distant to the stapes. A common finding was severe dysplasia of the stapes-facial nerve complex that often made the middle ear malformation uncorrectable. Hearing results were much less predictable than in patients with isolated atresia/stenosis of the ear.

Adolescent↗
PubMed1988

Benign Mucor colonization (fungus ball) associated with chronic sinusitis.

Mucormycosis of the nasal cavity and paranasal sinuses is an aggressive, life-threatening condition characterized by fulminant destruction of soft tissues and bone, vascular invasion, and thrombosis. Patients who have this infection generally are immunosuppressed or diabetic. The most effective treatment is immediate surgical debridement of all involved tissue, along with systemic antifungal agents. We identified four patients with chronic sinusitis in whom Mucor organisms were histologically confirmed within the sinus contents but not in the sinus mucosa. All four were successfully treated with conservative debridement. Our dilemma was determining appropriate treatment for this apparently less aggressive condition. We conclude that conservative debridement is the treatment of choice in the absence of tissue invasion, and that systemic antifungal therapy is probably unnecessary.

Adult↗
PubMed1988

Chemotherapy of bilateral acoustic neuromas.

In patients with bilateral acoustic neuromas, it is not unusual for the tumors to be of unequal size. At the time of the first examination, the smaller tumor may have already destroyed the hearing, while the ear with residual hearing may harbor a large acoustic neuroma. The remaining hearing is then at great risk if surgical removal of the tumor is attempted. Chemotherapy of bilateral acoustic neuromas is here presented as a possible alternative to surgery in those patients whose prognosis for conservation of hearing is poor.

Adult↗
PubMed1988

The surgical repair of congenital microtia and atresia.

Auricular reconstruction for congenital microtia is a complex multi-staged procedure. The repair of congenital atresia of the ear is one of the most difficult operations an otologic surgeon may attempt. In order to accomplish both procedures without endangering the integrity of either, there must be proper planning and close cooperation between the otologist and the facial plastic surgeon. In this article, we present our philosophy concerning the management and timing of these operations. The steps of each operation, and the impact of each on the other, are reviewed. Only through careful planning and coordination of these operations will patients realize the full benefit of their surgery.

Cartilage↗