Search PubMed⌕ Search

Biomedical subjects

R J Wiet

Publications and source records attributed to R J Wiet.

At least 19 recordsLinked to original sources
PubMed1992

Hearing results in retrolabyrinthine vestibular neurectomy.

Patients having retrolabyrinthine vestibular neurectomy (RLVN) may have complications that compromise hearing. While most reviews have emphasized sensorineural loss, less attention has been given to conductive hearing loss, which may complicate RLVN. Hearing results of 25 consecutive cases of RLVN performed for Meniere's disease with incapacitating vertigo were tabulated according to 1985 American Academy of Otolaryngology (AAO) guidelines. Nine patients (36%) had improved hearing postoperatively, 5 (20%) had no change in hearing, and 11 (44%) had worse hearing postoperatively. The most commonly observed audiometric change was low-frequency conductive hearing loss, presumably secondary to partial ossicular fixation by bone dust or fat fibrosis in the attic and antrum. Five patients (20%) had low-frequency conductive hearing losses that increased by 10 dB or greater over preoperative levels. An additional 7 patients had lesser losses at low frequencies. One patient had a flat conductive hearing loss. Six (24%) of the patients had a decrease in bone levels of greater than 10 dB. Overall hearing results in this study are comparable to those of other series in the literature. Causes and prevention of conductive hearing loss in RLVN are discussed, and a format for presentation of hearing data that will highlight conductive hearing loss after surgery for Meniere's disease is presented.

Adolescent↗
PubMed1992

Complications in acoustic neuroma surgery.

There has been a continuous lowering of mortality and morbidity rates in the 20th century, thanks to increasing experience and newer technology. Despite this, the readership should be aware of the hazards involved in this challenging field. Complications occur, and their incidence, mechanism, management, and prevention have been outlined here so physicians performing these procedures will be better prepared to manage them. We have found that the occurrence of complications can be greatly reduced through a team approach using the combined talents of a neurotologist, neurosurgeon, and frequently an internist. It is apparent from this article that the morbidity of removing larger tumors is significantly greater than the morbidity of removing small tumors. The recent introduction of MRI to the diagnostic armamentarium of the neurotologist may permit earlier detection and a further reduction of morbidity and mortality rates. Only continued study of prevention of complications will assure the improved quality of our results for patients undergoing microsurgical removal of acoustic neuromas.

Cerebral Hemorrhage↗
PubMed1990

Estrogen and progesterone receptors in acoustic neuromas.

Acoustic neuromas are more frequent, larger, and more vascular in women, and their growth rate increases during pregnancy. Estrogen receptors were claimed to be demonstrated in these neoplasms for the first time in 1981. Since then, numerous diverging studies, using various biochemical and histochemical methods, have been published on the contents of estrogen and progesterone receptors in acoustic neuromas. We determined the content of estrogen and progesterone receptors by means of an immunohistochemical method, using monoclonal antibodies, which has proved to be reliable, reasonably sensitive, and clinically relevant in other tissues, especially in breast carcinomas. No estrogen or progesterone receptors could be found in 18 consecutive acoustic neuromas from 7 men and 11 women, ranging in age from 26 to 73 years. The results do not support preoperative hormone treatment of acoustic neuromas.

Adult↗
PubMed1990

Estrogen and progesterone binding by acoustic neuroma tissue.

Tissue samples from 37 acoustic neuromas were assayed for estrogen and progesterone hormone receptor binding by radioimmunoassay using a dextran-coated charcoal method and Scatchard plot analysis. Twenty-one of the samples were from men, and 16 of the samples were from women. Seven of 37 samples (19%) were positive for estrogen receptor and six of 36 samples (17%) were positive for progesterone receptor. Three of 37 samples (8%) were positive for both receptors. There was no correlation of estrogen receptor positivity with the sex of the patient. These results indicate that estrogen or progesterone receptor binding activity or both are present in a small subset of acoustic tumors. Evidence is lacking, however, that binding of estrogen to the receptor results in growth changes in the tumor. The empirical use of antiestrogen treatment in acoustic neuroma does not appear to be justified at the present time.

Adult↗
PubMed1990

Computed tomography: how accurate a predictor for cochlear implantation?

Cochlear implantation is an accepted medical treatment for profound bilateral postlinguistically acquired hearing loss. Because cochlear implants are still in the process of development, a detailed evaluation of the results of implantation is essential. However, the capability of predetermining the auditory benefit of a cochlear implant is limited and depends upon a number of factors. This report focuses upon the ability of computed tomography (CT) to predict surgical success and audiological results of multichannel cochlear implantation. It also addresses how the disease state might affect the functional benefit of the implant. After undergoing routine clinical and audiological evaluations, 28 cochlear implant candidates underwent CT scans in order to evaluate cochlear patency prior to surgery. Subsequently, 24 patients were implanted with either a single-or 22-channel device. Surgical findings were noted and postoperative audiological assessments of sound detection and speech discrimination were made. The CT risk factors that diminish the likelihood of a successful cochlear implant result are discussed based upon a retrospective comparison of preoperative CT results, surgical findings, and postsurgical audiological evaluations of the 14 patients who received a 22-channel implant. Analysis of the predictive capability of CT will allow clinicians to use that procedure more effectively in the presurgical assessment of cochlear implant candidates.

Adult↗
PubMed1989

The retrolabyrinthine approach and vascular loop.

Several researchers have made progress toward determining the cause of hemifacial spasm, tinnitus, and episodic vertigo. During the past 5 years, we have encountered a vascular loop in six of 36 patients who were undergoing retrolabyrinthine vestibular neurectomy for recurrent disequilibrium and vertigo. In five of these six patients, disequilibrium improved after neurectomy. This report describes the clinical symptomatology and the results of preoperative cochleovestibular testing for those patients found intraoperatively to have a vascular loop and suspected neurovascular compression syndrome. Audiograms, although varied, characteristically did not demonstrate the low-frequency sensorineural hearing loss characteristic of Meniere's disease. No preoperative marker, with the single exception of computed tomography pneumocisternography, dependably predicted the presence of a vascular loop.

Adult↗
PubMed1989

Age considerations in acoustic neuroma surgery: the horns of a dilemma.

Experience has shown that early removal of acoustic tumors results in less morbidity because the rate of surgical complications increases with tumor size. Nevertheless, acoustic tumors are benign and grow slowly--facts that support conservatism in elderly patients. We managed 21 patients with acoustic tumors over the age of 65. Eleven patients underwent immediate surgical excision. Ten patients were monitored clinically and with serial magnetic resonance imaging (MRI) or computed tomographic (CT) scans. To date, two of these patients have required surgical excision because of continued tumor growth. Our experience managing these patients both surgically and with "watchful waiting" is the subject of this report.

Adolescent↗
PubMed1988

Help for the hearing-impaired. Early evaluation, advanced technology, improved management.

Nearly one in ten Americans has some degree of hearing loss. The primary care physician generally is the first to evaluate patients who complain of hearing loss and thus has the first opportunity to determine the need for treatment or referral to an otolaryngologist or otologist. New technology provides better management of hearing loss than ever before. Virtually every case of hearing loss can now be corrected or improved.

Amplifiers, Electronic↗
PubMed1988

Surgical treatment of vertigo with retrolabyrinthine vestibular neurectomy.

Results for control of vertigo and preservation of hearing in patients who have had a retrolabyrinthine vestibular neurectomy (RVN) by our group were analyzed retrospectively. This procedure consists of selective section of the vestibular nerve in the posterior cranial fossa. Vertigo was completely controlled in all but two of 31 patients, one of whom required revision surgery to control attacks. Analysis of these two cases suggests that the cause of persistent vertigo is incomplete neurectomy. With our current surgical technique in patients with Meniere's disease, hearing results were not statistically different from our results with surgery of the endolymphatic sac. Control of vertigo was much more successful with the RVN than endolymphatic sac surgery.

Adult↗
PubMed1988

Endolymphatic sac surgery: methods of study and results.

Surgery of the endolymphatic sac (ELS) in classical Meniere's disease has fallen under attack and has been abandoned by some surgeons. We studied our results for vertigo and hearing in 83 patients undergoing surgery of the ELS for intractable classical Meniere's disease. Half of the patients were completely free of definitive attacks at 2 years; another quarter experienced substantial control. Three fourths noted an improvement in their level of disability. Results for vertigo were sustained at longer follow-up intervals. Nineteen percent had revision surgery (usually retrolabyrinthine vestibular neurectomy) for intractable vertigo within 2 years of the sac operation. The 1985 reporting method of the American Academy of Otolaryngology--Head and Neck Surgery was found superior to previous methods because it specified a meaningful follow-up interval, used a graded scale accounting for partial success in treatment, and separated results for vertigo and hearing. Nevertheless, optimal use of the method in the future will require prospective reporting and a concerted effort to avoid confusion between definitive attacks of true vertigo and adjunctive vestibular symptoms. Even though the mechanism of the beneficial effect of sac surgery is unknown, we have found it useful in the control of disabling vertigo.

Cost-Benefit Analysis↗
PubMed1987

Far-advanced otosclerosis. Cochlear implantation vs stapedectomy.

In 1981, our group, as part of a Food and Drug Administration investigator team directed by William House, performed Illinois' first cochlear implantation. We have since performed cochlear implantations in ten other persons. Since May 1980, approximately 35 severely to profoundly deaf persons per year have been referred to our clinic for evaluation. A small number of these patients had far-advanced otosclerosis. In these cases, exploratory tympanotomy and stapedectomy followed by rehabilitation with a hearing aid was a more appropriate management than cochlear implantation. Case histories and a temporal bone study of far-advanced otosclerosis are presented.

Aged↗
PubMed1987

Brain herniation and space-occupying lesions eroding the tegmen tympani.

Technological advances in neuroradiology and the development of skull base surgery in neurotology have improved diagnosis and management of lesions eroding the tegmen tympani. The diagnosis of brain hernia is to be suspected in patients with a history of complicated chronic ear surgery and a slowly developing pulsatile mass with CSF leak. Patients are best evaluated in the upright position, with an otomicroscope and by magnetic resonance imaging (MRI). Over 6 years, our group has treated seven patients with eight space-occupying lesions eroding the tegmen. Five of the lesions were repaired with a temporalis muscle flap, 2 with fascia and bone, and 1 with Marlex. A review of new technology in the diagnosis of brain hernia and a modification of previous techniques is given.

Adolescent↗