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Biomedical subjects

S E Kinney

Publications and source records attributed to S E Kinney.

At least 55 records · Page 3Linked to original sources
PubMed1983

Rehabilitation of facial paralysis in children.

We report the experience and philosophy of the Department of Otolaryngology and Communicative Disorders at the Cleveland Clinic in rehabilitation of facial paralysis in children 12 years old and younger. The causes and evaluation of facial paralysis in children and the options available for rehabilitation are considered, and the criteria, expectations, and limitations of successful rehabilitation are outlined. Depending on the limitations imposed by the clinical situation, the aims of treatment are as follows: (1) normal resting tonus, (2) symmetry at rest, (3) symmetry in motion, (4) no synkinesis, (5) appropriate mimetic function, (6) no significant loss of adjacent function, and (7) rapid return of function. Every attempt must be made to avoid causing any significant muscular or neurologic deficit and to avoid interfering with return of function of the seventh nerve, when that possibility exists.

Child↗
PubMed1983

Autoimmune reactivity in Ménière's disease: a preliminary report.

Autoimmune inner ear disease was first described by McCabe in 1979. The diagnosis is supported by cell mediated immune responses to inner ear membrane antigen stimulation. Meniere's disease consists of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and often aural pressure. Although most clinicians feel that Meniere's disease has no known cause, recently several researchers have suggested that some cases of Meniere's disease may be autoimmune in origin. In the present study, 10 patients with bilateral Meniere's disease were studied prospectively for autoimmune inner ear disease using both cellular and humoral immune tests. Results were compared with normal control subjects. One additional patient with Meniere's disease was identified retrospectively to have positive autoimmune test results. Preliminary conclusions suggest that at least some cases of presumed idiopathic Meniere's disease are autoimmune in origin. Therapeutic implications are significant: the addition of steroids, cytotoxic drugs and/or apheresis to conventional treatment may help prevent total deafness which otherwise might be inevitable.

Adult↗
PubMed1983

Intravenous digital subtraction angiography of the intracranial veins and dural sinuses.

When combined with computed tomography, IV DSA is usually of sufficient quality to replace conventional angiography in most patients with abnormalities of the larger intracranial veins and sinuses. Preoperatively, IV DSA can be used to evaluate normal anatomic variations of venous outflow to determine what sinuses can be safely occluded if necessary in the region of the temporal bone, jugular fossa, and base of the skull. Patients with glomus jugular tumors and carotid-cavernous fistulas also need conventional angiograms to define the feeding vessels of these lesions for obliteration by embolization or surgery.

Brain↗
PubMed1983

Autoimmune reactivity in Cogan's syndrome: a preliminary report.

Autoimmune inner ear disease was first described by McCabe in 1979. The diagnosis is supported by cell-mediated immune responses to inner ear membrane antigen stimulation. Cogan's syndrome consists of vestibuloauditory dysfunction, ocular inflammation, and nonreactive serologic tests for syphilis. The ocular disease can be controlled by steroids; unfortunately, some patients ultimately become totally deaf. An autoimmune etiology has long been suspected but only recently confirmed by McCabe. In our study two patients with Cogan's syndrome were studied for autoimmune inner ear disease with the use of both cellular and humoral immune tests. Results were compared to normal control subjects. On the basis of test results, preliminary conclusions were that (1) the vestibuloauditory symptoms of Cogan's syndrome are autoimmune in origin; (2) the autoimmune process is mediated through cellular rather than humoral (antibody) pathways; (3) systemic steroids may suppress positive test results; and (4) test results are more likely to be positive when symptoms are acute. Therapeutic implications are significant: the addition of cytotoxic drugs to steroids in selected cases may help prevent total deafness that otherwise might be inevitable.

Antibody Formation↗
PubMed1980

Defensive chronic ear surgery.

The surgery for chronic ear disease has been modified in recent years because of the advances that have been made in neuro-otologic surgery including improvement in equipment and surgical techniques. There have been significant advances in the treatment of the acute phase of the inflammatory diseases of the middle ear and mastoid; however, there still remains a significant group of patients that require surgical correction of inflammatory disease of the middle ear and mastoid. A defensive approach to chronic ear surgery has been developed. This includes a proper preoperative evaluation of the patient's middle ear or mastoid problem with office microscopic examination of the ear and proper radiographic and audiologic studies. Surgical techniques include all the aspects of neuro-otologic surgery including an excellent otologic drill and suction irrigation. The point is made that careful defensive chronic ear surgery is best done with blunt instruments to avoid injury to soft tissue structures. A systematic approach to the removal of the disease from the ear is presented including the defensive approach of expecting complications and making preparations to avoid injuries as a result of these complications. This includes positive identification of the facial nerve, identification of labyrinthine fistulas, and cholesteatoma involvement of the posterior and middle fossa. Two cases are presented to illustrate how this defensive approach to chronic ear surgery may allow systemic resolution of very difficult chronic ear problems with preservation of neurologic and labyrinthine function.

Adult↗
PubMed1980

The contralateral effects of large tumors on brain stem auditory evoked potentials.

Brain stem auditory evoked potential (BAEP) testing has been demonstrated to be a useful diagnostic tool in the presence of severe or complete sensorineural hearing loss. From a series of 38 patients with tumors in the vicinity of the VIIIth nerve, 13 patients with tumors larger than 2 cm had abnormal BAEP results contralateral to the involved side. The abnormalities observed on the noninvolved side included prolonged peak latencies, reduced amplitudes, poor wave shape and poor response stability. The significance of these findings is twofold: 1. Large tumors may disrupt BAEP test results on the side contralateral to the lesions, 2. Important information may be obtained on patients having complete sensorineural hearing loss on the involved side.

Adult↗
PubMed1979

Malignant external otitis with multiple cranial nerve involvement.

A case of bilateral malignment external otitis with multiple cranial nerve deficits is presented. Thirty-five similar cases reported in the world literature are reviewed. All cranial nerves have been involved with the exception of the first and fourth. The resultant pseudomonas ostemyelitis may be spread extensively in these elderly diabetic patients to involve the entire base of the skull as well as other structures. The preferred treatment is long term systemic antibiotics followed by surgical intervention for plateau or further progression of disease. The overall mortality is 61 percent (22/36), a lower figure than previously reported.

Adult↗
PubMed1979

Glomus jugulare tumors with intracranial extension.

A glomus jugulare tumor with posterior fossa extension needs the expertise of the neuro-otologic surgeon and neurosurgeon to obtain total tumor removal. A one-stage combined otologic and neurosurgical procedure is presented for removal of base of skull tumors posterior to the carotid artery. Twelve cases of this type of tumor have been seen at The Cleveland Clinic. Two cases are presented in detail to illustrate the applicability of this procedure. In cases with infection around the temporal portion of the tumor, tumor extension around or anterior to the carotid artery, or extensive involvement of the posterior fossa, the procedure should be performed in two stages.

Bacterial Infections↗
PubMed1978

Postinflammatory ossicular fixation in tympanoplasty.

Postinflammatory ossicular fixation in chronic ear surgery is a common problem faced by the otologic surgeon. This thesis presents a review of the evolution of the three forms of postinflammatory ossicular fixation. The surgical techniques used to correct ossicular fixation are discussed. A detailed evaluation of 311 patients diagnosed as having clinical tympanosclerosis is presented.

Acute Disease↗
PubMed1977

The problem mastoid cavity: medical and surgical management.

The patient with persistent foul drainage from a previously operated-on mastoid cavity has a serious problem that requires aggressive attention from the otologic surgeon. The ear must be carefully evaluated in the office. Careful cleaning of the cavity and effective application of medication will dry up many of these cavities. Revision surgery of the ear requires a systematic approach using all the techniques of modern otologic surgery. This means the use of a post-auricular incision and wide bone removal combined with bone removal combined with obliteration techniques and grafting of the middle ear. This approach was used in 29 ears in 27 patients. Rapid healing and a trouble-free, dry ear was obtained in 26 patients or 90% of the operated-on cases.

Adolescent↗