Biomedical subjects

Robert A Battista

Publications and source records attributed to Robert A Battista.

9 recordsLinked to original sources

PubMed2006

Revision stapedectomy.

Revision stapedectomy can be a technically demanding operation. The surgeon must be prepared for many pathologic conditions before revision stapes surgery. Appropriate preoperative patient counseling is a must. The best chance for hearing improvement is in those cases that have a delayed conductive hearing loss after primary stapedectomy. This article serves as a guideline for discussing the myriad possibilities that may be encountered during this type of revision stapedectomy. Indications for revision stapedectomy and general surgical guidelines for management of specific pathologic conditions are discussed. The material presented is based on literature review, the authors' personal experience, and a review of temporal bone studies relative to stapes surgery.

Hearing Loss, Conductive↗

PubMed2006

Revision BAHA Surgery.

The osseointegrated auditory implant (BAHA) is a system used for hearing rehabilitation through direct bone conduction. Although BAHA surgery is not difficult, the surgeon must observe meticulous technique to prevent complications. Indications for revision BAHA surgery can be divided into (1) failure of fixture osseointegration; (2) bone overgrowth; or (3) skin reaction or skin loss. This article discusses the conditions that might predispose a patient to require BAHA revision, and the steps, if any, that can be taken to prevent these complications. Specific surgical steps for revision of each of these three conditions are also addressed.

Bone Conduction↗

PubMed2006

Should ossicular reconstruction be staged following tympanomastoidectomy.

OBJECTIVES: To determine whether ossicular reconstruction (OCR) performed concurrent with tympanomastoidectomy for cholesteatoma results in significantly different hearing results when compared to OCR performed in a separate, staged procedure. STUDY DESIGN: Retrospective. MATERIALS AND METHODS: Study subjects were patients undergoing OCR within a 2-year period. Intervention was OCR concurrent with tympanomastoidectomy for cholesteatoma (group 1) or staged following tympanomastoidectomy for cholesteatoma (group 2). Main outcome measures were mean postoperative air-bone gap (ABG), proportion achieving ABG closure to <20 dB and <30 dB for group 1 and group 2 overall and when controlling for type of mastoid cavity created (open or closed) and the status of the stapes suprastructure (TORP vs. PORP OCR). RESULTS: Eighty-three patients were identified. Forty underwent OCR concurrent with tympanomastoidectomy and 43 underwent a staged OCR after tympanomastoidectomy. Overall, similar hearing results were seen in the two groups. When considering the status of the stapes and mastoid cavity, concurrent OCR resulted in improved mean postoperative ABG in a closed mastoid cavity with an intact stapes suprastructure (P = .024). Furthermore, a greater proportion of patients who had concurrent OCR within this group achieved ABG <20 dB and ABG <30 dB, although this difference did not reach statistical significance (P = .092 and P = .078, respectively). By contrast, staged OCR resulted in improved mean postoperative ABG and ABG <30 dB in open mastoid cavities with an absent stapes suprastructure (P = .040, and P = .019, respectively). Similarly, a greater proportion achieved ABG <20 dB, approaching statistical significance (P = .055). CONCLUSIONS: Staged OCR is advantageous in those with most severe disease, whereas those with least severe disease may benefit from a concurrent OCR.

Adolescent↗

PubMed2005

Trends in the diagnosis and the management of Meniere's disease: results of a survey.

OBJECTIVE: To determine the practices of the American Neurotology Society (ANS) membership in the evaluation and treatment of the Meniere's patient. STUDY DESIGN: Prospective. INTERVENTION: Questionnaire. MAIN OUTCOME MEASURE: Respondents' response to questions pertaining to the diagnostic and therapeutic practices in the management of Meniere's disease. RESULTS: Three hundred members of ANS were mailed a 15-item questionnaire. Two hundred three responded, for a 67.7% response rate. For the diagnosis of Meniere's disease, 1 in 3 practitioners relied solely on history, physical exam, and audiometry, whereas 2 in 3 relied in part on adjunctive tests, such as electrocochleography (ECOG) and electronystagmography (ENG). Two in 3 practitioners pursued retrocochlear studies on initial evaluation, with the overwhelming majority using MRI. In treating Meniere's disease, conservative medical management was preferred. For medically recalcitrant Meniere's disease, endolymphatic sac surgery (ESS) was the most commonly employed initial intervention (50%), followed by transtympanic gentamicin (38%). Currently, <10% routinely recommend the Meniett device. Eighty-three percent include ESS as a therapeutic option for medically recalcitrant Meniere's disease. The vast majority continue to perform surgical labyrinthectomies and vestibular nerve sections for Meniere's disease. CONCLUSIONS: Meniere's disease continues to pose a difficult diagnostic and therapeutic problem, resulting in heterogeneous approaches to both evaluation and treatment. Despite the 1995 American Academy of Otolaryngology guidelines in the diagnosis of Meniere's disease, most clinicians rely in part on ENG or ECOG in diagnosing Meniere's disease. Furthermore, despite the passing of 20 years since the publications claiming a purely placebo effect, ESS is the most commonly employed initial surgical treatment for Meniere's disease.

Audiometry, Evoked Response↗

PubMed2005

Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss.

OBJECTIVES: To determine hearing recovery by using intratympanic dexamethasone for profound, idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN AND SETTING: A prospective, clinical study was performed of 25 consecutive patients seen with profound ISSNHL. Patients received 4 intratympanic treatments of dexamethasone over the course of 2 weeks. Complete hearing recovery was defined as the final pure-tone average (PTA) within 10 dB of baseline. Partial recovery was defined as a final PTA with >/=50% hearing. The hearing in the contralateral ear was used as baseline. RESULTS: The average time to treatment was 28 days. Two patients had significant hearing recovery, and 1 additional patient had partial recovery. The 2 patients with significant hearing recovery were treated within 9 days of onset of hearing loss. CONCLUSIONS: By using the treatment protocol and definition of hearing recovery of this study, intratympanic dexamethasone does not result in significant hearing improvement for patients with profound ISSNHL. There is a possible trend for improved hearing results if intratympanic treatment is performed within 11 days of onset of hearing loss.

Adult↗

PubMed2004

Audiometric findings of patients with migraine-associated dizziness.

OBJECTIVE: The objective of this study was to determine whether the audiometric findings of migraine-associated dizziness could be used to better distinguish migraine-associated dizziness from Meniere's disease. STUDY DESIGN: A retrospective chart review. SETTING: Tertiary, otology/neurotology practice. PATIENTS: Two groups of patients were studied, a migraine-associated dizziness and a Meniere's disease group. There were 76 and 34 patients in the migraine-associated dizziness and Meniere's disease groups, respectively. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Initial and follow-up pure-tone average and low-frequency pure-tone average were recorded for both groups. Independent samples t tests were used to test for mean differences in pure-tone average and low-frequency pure-tone average. RESULTS: Pure-tone average and low-frequency pure-tone average were significantly worse for patients in the Meniere's disease group at both the initial and follow-up assessments. Three patients in the migraine-associated dizziness group had an elevated pure-tone average (>/=26 dB) and/or low-frequency pure-tone average at initial and/or follow-up assessment. The remaining 73 migraine-associated dizziness patients had normal hearing. In the Meniere's disease group, only two patients had a normal pure-tone average and low-frequency pure-tone average at both initial and follow-up evaluations. The hearing difference between the two groups was significant even when controlling for age and duration of dizziness symptoms. CONCLUSION: Audiometric findings of patients with migraine-associated dizziness are most often normal. Unlike Meniere's disease, the sensorineural hearing loss in migraine-associated dizziness rarely progresses. These audiometric findings may help to distinguish migraine-associated dizziness from Meniere's disease when diagnostic ambiguity exists between these two diagnoses.

Adolescent↗

PubMed2003

Early results with titanium ossicular implants.

OBJECTIVE: To report the efficacy of titanium middle ear prosthesis for ossicular reconstruction. STUDY DESIGN: Retrospective chart reviews were performed for 25 patients who had undergone titanium ossicular implants between January 1, 1999, and June 1, 20001. SETTING: Tertiary otology referral center. PATIENTS: All patients had a minimum of 6 months of postoperative follow-up and no evidence of recurrent otologic disease. INTERVENTION: All patients had undergone ossiculoplasty using titanium middle ear implants. MAIN OUTCOME MEASURES: Comparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap closures and implant extrusion rates were measured. RESULTS Overall mean pure tone averages improved 22.2 dB with air-bone gap improvement at 20.9 dB. Fifty-six percent of patients achieved air-bone gap less than 20 dB postoperatively. The overall extrusion rate was 4%. However, with the placement of cartilage graft interposed between the prosthesis and the tympanic membrane, no extrusion was observed. CONCLUSION: Titanium implants provide comparable hearing improvement compared with other materials. The extrusion rate seems quite low if cartilage interposition graft is inserted. Its ease of handling, biocompatible properties, and sound conducting properties improve its efficacy as an ossicular implant.

Adolescent↗

PubMed2003

Twenty-year review of revision stapedectomy.

OBJECTIVE: To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary otologic referral center. PATIENTS: A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz. RESULTS: Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB. CONCLUSIONS: More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.

Animals↗

PubMedDate not supplied

Electrocochleography in patients with Meniere's disease.

OBJECTIVE: The objective of this study was to evaluate the role of electrocochleography (ECoG) in the diagnosis of Meniere's disease. STUDY DESIGN: This study is a retrospective case review. METHODS: Patients undergoing ECoG for Meniere's disease between 1995 and 2003 were identified and segregated as having definite , probable , or possible Meniere's disease according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines for Meniere's disease classification. Those determined to have probable and possible Meniere's disease were then combined to form a less-than-definite group for statistical analysis. Electrocochleography summating potential (SP)/action potential (AP) ratios were determined, and ratios greater than 0.4 were considered abnormal. The 2 groups were then compared to assess for any correlation between ECoG with the 1995 American Academy of Otolaryngology-Head and Neck Surgery Meniere's disease classification. RESULTS: Sixty patients with definite Meniere's disease and 37 with less-than-definite Meniere's disease were identified. Overall, 59.8% had abnormally elevated SP/AP ratios. Of those with definite Meniere's disease, 66.7% had abnormally elevated SP/AP ratios, whereas of those with less-than-definite Meniere's disease, 52.7% had abnormal ECoGs ( P = .069). CONCLUSIONS: A significant difference in ECoG results was not seen between the definite and less-than-definite Meniere's disease groups. Furthermore, approximately 30% of those with definite Meniere's disease would not be classified as having Meniere's disease based on ECoG results. Because of its lack of sensitivity, ECoG should not play a decisive role in determining the presence or absence of Meniere's disease.

Electrooculography↗