[Snoring--a sociocultural phenomenon with medical significance].
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Adult↗
Biomedical subjects
R Häusler
Publications and source records attributed to R Häusler.
[Uvulo-palatopharyngioplasty: indication, technique and results in relation to ronchopathy and sleep apnea syndrome].
56 patients with habitual snoring (n = 43) or with complicated snoring accompanied by sleep apnea syndrome (n = 13) under went uvulopalatopharyngoplasty. The patients were observed for a period of 2 to 84 months (average: 20,8 months). Postoperatively, 80 % showed a disappearance or great reduction of snoring intensity. Other symptoms of obstructive sleep apnea syndrome such as apneas, tiredness during the day and deterioration of sleep quality also improved markedly. In ten out of 13 patients with a demonstrated sleep apnea syndrome, the apneas disappeared or became noticeably reduced (in seven patients shown by means of a polysomnographic check-up). Two patients developed velopharyngeal stenosis, which was subsequently corrected. Other operative side effects were temporary (from days to weeks) and only minor (transient speaking problems, nasal regurgitation, rhinopharyngitis sicca, taste disturbances).
Adult↗
Experimental and clinical results of fiberoptic argon laser stapedotomy.
Since 1992 a small air-cooled opthalmological argon laser (Argus system, 3 W max.) equipped with a fiberoptic microhandpiece has been used for stapedotomy at the Inselspital, Berne. The microhandpiece has been developed especially for otological purposes in our electronic laboratory. In order to measure the effect of argon laser pulses applied through the handpiece to the ear, we performed temperature measurements in a saline-filled inner ear model by using ultrathin (2 microns thick), ultrafast (4 ns) thermosensitive rhodamine-coated polyurethane films. Multiple laser pulses of 1-2.5 W and 0.1 s duration - as used in clinical applications - produced a temperature elevation of about 1 degree C in the liquid of the inner ear model. The local laser effect was then examined histologically on the isolated stapes. The thermal damage zone around the stapedotomy perforation was limited to about 100 microns. In a clinical study we compared the results of argon laser stapedotomy (n = 54) with those of a skeeter microdrill stapedotomy (n = 29). Substantial hearing gains were found in all cases in both groups. In the laser stapedotomy group the mean residual air-bone gap (0.5-2 kHz) was 10 dB or less in all cases but one. Inner ear function remained unchanged except for a 40-dB loss at 4000 Hz in one case. Transient vertigo with nystagmus occurred in one case. Facial nerve dysfunction did not occur in any patient. The most important advantage of the laser found was the absence of mechanical trauma to the stapes. Stapes luxation and a floating footplate were avoided. In contrast, thick footplates were more easily perforated with the skeeter. Use of an argon laser equipped with a fiberoptic microhandpiece and a skeeter microdrill as needed seems particularly advantageous for stapedotomy.
Equipment Design↗
Diplopia from skew deviation in unilateral peripheral vestibular lesions.
Vertical diplopia from skew deviation is well described in brainstem lesions. The phenomenon can also result from peripheral vestibular lesions. During the past years, we have observed these ocular changes in the acute stage following unilateral vestibular neurectomy and labyrinthectomy (n = 13), as well as in series of patients suffering from idiopathic sudden unilateral peripheral vestibular or cochleo-vestibular deficit (n = 5). Diplopia from skew deviation was noted immediately following ablative vestibular procedures; in patients with idiopathic vestibular deficit, it was observed as an associated sign. In all patients, clinical evaluation revealed an acute unilateral peripheral vestibular loss, with spontaneous nystagmus toward the unaffected ear and absence of nystagmic response to caloric testing on the affected ear. Skew deviation was measured using the Hess-Weiss test, which is based on the haploscopic principle. Static visual vertical was evaluated with the original methods of vertical frame and Maddox rod techniques. Photographs were made of the ocular fundi, to measure the degree of cyclotorsion of both eyes. In our patients, we found skew deviation with hypotropia of the eye that was ipsilateral to the affected ear and conjugated cyclotorsion and tilt of the static visual vertical on the side of the affected ear. Skew deviation was the first sign to disappear within a few days; conjugated cyclotorsion and tilt of the static visual vertical persisted for weeks to months. The eye-head postural reaction, consisting of head tilt, conjugated eye cyclotorsion, skew deviation, and alteration of vertical perception directed toward the side of the lesion, is known as the Ocular Tilt Reaction (OTR). The mechanism is presumably related to a lesion of the otolithic organs and/or to changes in the afferent graviceptive pathways. In man, the OTR is often mild and unrecognized, masked by spontaneous nystagmus and marked neuro-vegetative symptoms. Our observations indicate that skew deviation, as a part of the OTR, occurs in patients with sudden peripheral vestibular lesions, whether surgical or non-surgical in origin.
Adult↗
[Vestibular neuritis: a frequently unrecognized cause of diplopia].
The vestibular function plays an essential role in the stabilization of the image on the retina. In addition, when the head is tilted, it contributes to maintain horizontally the plane of the gaze. Vestibular changes can result in oscillopsia and/or diplopia. The latter is related to occurrence of a skew deviation. The authors emphasize the frequent occurrence of diplopia following disorders of the vestibular nerve, specially after vestibular neuritis. In clinical practice, the causal relationship between vestibular neuritis and diplopia is often unrecognized.
Adult↗
The Ineraid cochlear implant in children: surgical implications and tolerance.
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Adolescent↗
Ski sickness.
Dizziness with illusionary rotatory or pendular sensations and dysequilibrium accompanied by nausea and occasionally by vomiting may appear during down-hill skiing. It is proposed that the condition is called "ski sickness". Ski sickness seems to represent a special form of motion sickness produced by unusual and contradictory sensory information between the visual, vestibular and somato-sensory system. The pathophysiology seems to be related to vestibular overstimulation from winding turns on uneven ground, insufficient visual control, specially on foggy days with reduced visibility (on so called "white days"), often in connection with minor ophthalmologic problems such as myopia or astigmatism and altered somato-sensory input due to the wearing of ski boots and skis. Psychological factors such as fear of heights, fear of mountains, high speed and falling may contribute as well as the atmospheric pressure changes in the ear when descending rapidly from high to low altitude. The symptoms of ski sickness can be relieved by vestibular suppressants. The present report indicates various characteristics of a series of 11 persons suffering from ski sickness.
Adolescent↗
Skew deviation after vestibular neuritis.
We treated five patients with vestibular neuritis who had strabismus. Three of them spontaneously noted vertical diplopia. During the following weeks and months, strabismus progressively resolved, indicating the recently acquired nature of the oculomotor condition. In three of these individuals, a change in visual vertical and cyclo-torsion of the globes suggested that strabismus was a form of skew deviation that occurred as a part of an ocular tilt reaction resulting from the peripheral vestibular lesion. Strabismus appears to occur frequently in this common vestibular condition.
Adult↗
[Surgical treatment of vertigo].
Some types of incapacitating otologic vertigo can be successfully treated by surgery. Episodes of vertigo in Ménière's disease can be precluded either by so-called "draining" operations such as shunt of the saccus endolymphaticus, sacculotomy or cochleosacculotomy, or by ablations such as selective vestibular nerve neurectomy or labyrinthectomy. Persistent positional vertigo can be cured either by selective neurectomy of the posterior canal nerve, or by occlusion of the posterior semicircular canal. Vertigo can be caused by fistulas of the inner ear, which can be plugged with bone wax or grease. Vertigo caused by hypermobility of the stapes can be cured by surgically consolidating the ossicle chain. Surgical treatment only applies to a small minority of cases of vertigo (approximately 1.5%), but if the indication is well determined and surgery is performed in an appropriate medical and technical setting, the results can be highly satisfactory.
Ear, Inner↗
Distribution of Fos-like immunoreactivity in the auditory pathway of the Sprague-Dawley rat elicited by cochlear electrical stimulation.
Fos-like immunoreactivity (FLI) was mapped in the auditory pathway of Sprague-Dawley rats in response to unilateral electrical stimulation of the cochlea implanted with two stimulating electrodes. Densely packed FLI neurons were widely distributed in the dorsal cochlear nucleus (more ipsilaterally than contralaterally), while FLI neurons were rare in the posteroventral cochlear nucleus and virtually absent in the anteroventral cochlear nucleus. Sparse FLI was detected in the superior olivary complex, the pontine nuclei and the ipsilateral dorsal nucleus of the lateral lemniscus, whereas the contralateral dorsal nucleus of the lateral lemniscus was moderately labeled. In the inferior colliculus, the pattern of FLI was similar on both sides, restricted mainly to its dorsal and external cortices. At the thalamic level, FLI neurons were seen in the dorsal and medial divisions of the medial geniculate body as well as in the peripeduncular nucleus. A significant increase of FLI was observed in the temporal cortex. This study demonstrates the presence of selective functional changes along the auditory pathway elicited by electrical stimulation of the cochlea, as revealed by FLI.
Acoustic Stimulation↗
[Surgical treatment possibilities of middle ear hearing loss].
Otological surgery is performed under the operating microscope with special microinstruments. The introduction of new technical means such as the argon laser, equipped with a fiberoptic handpiece, and the sceeter microdrill have improved the results according to the statistic of Berne. An important aspect is the approach to the structures in the temporal bone. The classical retroauricular and endaural incisions are replaced whenever possible by the less traumatic transmeatal approach directly through the external ear canal without external skin lesion. Ear drum perforations and cholesteatomas with and without ossicular lesions are repaired by different types of tympano-ossiculoplasty. Destroyed ossicles are replaced by allogenic prostheses or homologous ossicles. Otosclerosis is treated by a 'small-fenestra' stapedotomy with insertion of a teflon-platinum wire piston. Bone conduction hearing aids with conventional mastoid vibrators can be replaced by more efficient bone-anchored hearing aids directly fixed in the skull. The teamwork between ear surgeon, audiologist and electronical engineer has turned out to be important for the implantation of hearing aids.
Cholesteatoma↗
[Automatic analysis by computer of the visual suppression test of pendular rotatory vestibular nystagmus].
This study presents an automatic computerized analysis of the visual suppression test of vestibular nystagmus. Visual suppression is measured during rotatory nystagmus examination. The amplitude variations and the frequency of the nystagmus are computed in the dark and in the light. This allows the computer to furnish with the help of an algorithm the percentage of nystagmus suppressed by ocular fixation. The results of the computerized analysis are compared to a qualitative evaluation. A percentage of 70% and more indicates a normal suppression reflex and corresponds qualitatively to a total or subtotal visual suppression. A percentage smaller than 70% indicates a pathological reflex corresponding qualitatively to a partial, weak or absent visual suppression. The study is based on 149 examinations realised in 12 healthy subjects and 137 patients. The patients are classified into 4 groups: a) 59 patients with peripheral vestibular lesions (Ménière's diseases 21, vestibular neuronitis 15, cupulolithiasis 16, ototoxicity 7), b) 67 patients with central lesions of the cerebellum and the brainstem (multiple sclerosis 23, infratentorial tumors 14, vascular brainstem lesions 14, degenerative diseases of the central nervous system 16), c) 6 patients with supratentorial central lesions (hemispheric vascular lesions 4, supratentorial tumors 2), d) 5 patients with congenital nystagmus. All healthy subjects and all patients with peripheral vestibular lesions have a total or subtotal visual suppression corresponding to computed rates greater than 70% (mean: 86.7% and 83.1%). In cerebellar and brainstem lesions about half the patients (56.8%) present a partial, weak or absent visual suppression corresponding to computed rates inferior to 70% (mean: 52.7%). In supratentorial disorders the visual suppression is total or subtotal with computed rates superior to 70% (mean: 79.2%). By patients with congenital nystagmus the visual suppression is uniformly pathological with computed rates inferior to 70% (mean: 19.2%). The results of the visual suppression test are concordant with those of smooth pursuit in 92.6% of cases and with those of optokinetic nystagmus in 89.3% of cases. This study confirms that the visual suppression test is a useful examination to detect disorders of the cerebellum and brainstem.
Adolescent↗
Intraoperative electrically evoked vestibular potentials in humans.
Electrically evoked short latency vestibular potentials were recorded in 9 patients during vestibular neurectomy. Patients were operated on because of intractable Meniere's disease. The VIIIth cranial nerve was exposed through a limited retrosigmoidal approach; the vestibular nerve was contacted in the cerebello-pontine angle with a bipolar platinum-iridium electrode and stimulated with biphasic current pulses (100 microseconds/phase, 0.75-1 mA p-p, 20/s). The responses were recorded over 12.8 ms between a forehead and an ipsilateral ear lobe electrode. Each recording consisted of 2 x 1,000 averaged responses. A systematically reproducible vertex-negative potential occurring at a latency of approximately 2 ms and having an amplitude of approximately 0.5 microV was recorded in all patients. This vertex-negative potential disappeared after selective vestibular neurectomy proximal to the stimulation site. Simultaneous continuous acoustic masking did not affect the response and no facial nerve response was observed on the facial nerve monitoring. These features strongly suggest that the characteristic vertex-negative potential constitutes a specifically evoked response of the vestibular system. Electrophysiological monitoring of the sectioning of the vestibular nerve during operation is one possible clinical application of intraoperative recording of electrically evoked vestibular potentials.
Adult↗
Diagnosis of cerebellopontine angle tumors.
Between 1980 and 1990, 9,176 patients suffering from otoneurological disorders were investigated in our clinic. Sixty-six (0.72%) internal auditory canal or other cerebellopontine angle tumors (CPAT) were diagnosed. Brainstem auditory evoked potentials (BAEP), interaural time discrimination, and magnetic resonance imaging (MRI) revealed to be the most sensitive and efficient tests for the detection of CPAT. However, the investigation of otoneurological symptoms cannot be limited to BAEP and MRI on the a priori of a hypothetical CPAT. Electrophysiologic tests such as impedancemetry, and electronystagmographic testing are also needed to elucidate the many causes of otoneurological symptoms.
Adolescent↗
[Secondary Menière's disease].
Among 93 patients presenting the typical symptoms of a Ménière's disease associating an unilateral fluctuating hearing loss of sensorineural type, tinnitus and vertiginous attacks lasting minutes to hours, 40 patients (43%) presented in their personal history a particular otologic insult in the ear which later on developed into the full Ménière's symptomatology, or a particular systemic disease with otologic manifestations. The Ménière's triad appeared in these patients six months to twenty nine years after the initial otologic or systemic lesion. Among these initial lesions were 16 cases of sudden partial or complete deafness related to viral or bacterial infection, 3 cases of sudden cochleo-vestibular deficit and 1 case of vestibular neuritis, 5 cases of temporal bone fractures and 4 cases of significant acoustic trauma, 2 cases of otosclerosis, 1 case of chronicotitis media and 1 case of severe hearing loss after otologic surgery, 5 cases of meningo-encephalitis and 2 cases of acquired syphilis. These particular lesion could be, in our opinion, the releasing factor of the inner ear dysfonction leading eventually to a secondary Ménière's syndrome.
Electronystagmography↗
[Surgical treatment of Ménière's disease by sacculotomy, cochleo-sacculotomy and transtympanic aerators].
Sixty-two patients suffering from severe Ménière's disease with invalidating vertigo attacks were treated between 1976 and 1987 by three minoir surgical procedures: sacculotomy (19), cochleo-sacculotomy (15) or a transtympanic ventilation tube (28). The results were assessed after the second post-operative year according to the criteria of the American Academy of Otolaryngology (1985). The overall success rate for vertigo control was 79% with sacculotomy, 80 with cochleo-sacculotomy and 82% with transtympanic ventilation tubes. Severe permanent hearing-losses occurred in 20% after sacculotomy and cochleo-sacculotomy. Drop-attacks were not improved. These three surgical procedures give similar results with respect to vertigo control without any vital risk. The precise mechanisme of action in these procedures is not yet well understood.
Evaluation Studies as Topic↗
[Hennebert's sign in Menière's disease].
The fistula sign without middle-ear lesion, also known as the Hennebert's sign, was observed in 7 (14%) subjects among 50 patients with unilateral Ménière's disease. The Hennebert's sign was obtained in 4 cases (57%) by negative pressure in the external auditory canal, by positive pressure in 2 cases and by both positive and negative pressures in 1 case. The Hennebert's sign is characterized by a few beats of horizontal nystagmus seen under Frenzel glasses. Caracteristically this nystagmus is of low frequency and amplitude. Most patients indicate simultaneous sensation of dizziness. The presence of Hennebert's sign seems to indicate in most cases the existence of an endolymphatic hydrops with contact of the saccular wall up to the internal face of the footplate (internal sacculostapedopexy). The test was also performed on the controlateral healthy ear used as a control. No Hennebert's sign was obtained on the healthy side. None of the patients showed any complication following the provocation of Hennebert's sign.
Adolescent↗