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Biomedical subjects

S R Saeed

Publications and source records attributed to S R Saeed.

At least 19 recordsLinked to original sources
PubMed2006

Botulinum toxin is effective and safe for palatal tremor: a report of five cases and a review of the literature.

Palatal tremor (formerly palatal myoclonus) is an extremely rare, but potentially treatable cause, of objective tinnitus. The tinnitus is thought to be secondary to rhythmic involuntary movements of the soft palate. Its aetiology is variable and it remains difficult to treat. Many different medical and surgical remedies have been tried but none have demonstrated reproducible success. Botulinum toxin has been used in sporadic cases and seems to produce good results. Ten patients with palatal tremor have presented to this department over the last three years. After discussion with the patients with regard to the management of this condition and possible complications, five opted for botulinum toxin therapy and five declined further intervention. Clinical diagnosis was made on the confirmation of soft palate movements synchronous with an audible clicking noise. Five patients underwent botulinum toxin injection into the insertion of the levator and tensor veli palatini muscles. Of the five that were treated with toxin, four showed complete resolution of symptoms after a course of treatment. Only one patient reported transient side effects. This would suggest that botulinum toxin is a safe and effective first line treatment for palatal tremor.

Botulinum Toxins, Type A↗
PubMed2006

Myringoplasty.

There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery. This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure.

Child↗
PubMed2006

Cerebrospinal fluid leak rate after the use of BioGlue in translabyrinthine vestibular schwannoma surgery: a prospective study.

OBJECTIVE: To determine the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery. STUDY DESIGN: A prospective study. SETTING: Tertiary neurotological referral center. PATIENTS: There were 24 patients in the BioGlue series. BioGlue was used in the same manner in all cases. All patients received similar postoperative care. INTERVENTIONS: We studied the use of BioGlue and its possible effect on further reducing our department's cerebrospinal fluid leak rate for translabyrinthine vestibular schwannoma surgery. MAIN OUTCOME MEASURES: Postoperative events were documented that enabled us to determine the overall cerebrospinal fluid leak rate (including incidence of various leak routes and morbidity). RESULTS: The overall cerebrospinal fluid leak rate was 62.5% (15 of 24). Rhinorrhoea was the commonest route (80%), followed by postaural wound leak (33.3%) and external auditory canal otorrhoea (33.3%). Forty percent of cases had more than one cerebrospinal fluid leak route; 73.3% of leak cases required lumbar drain insertion, 40% needed pressure bandaging, and 66.7% had to undergo formal surgical repair. Forty percent had recurrent leaks after the initial episode had completely ceased. The mean extra stay in hospital as a result of the cerebrospinal fluid leak was 13.3 days. CONCLUSION: Our preliminary prospective study of the use of BioGlue for dural and middle ear closure in translabyrinthine vestibular schwannoma surgery demonstrated poor results. The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery. The manufacturers have noted our results and have considered adding our recommendation to the product data sheet.

Adult↗
PubMed2006

Cochlear implant outcomes and quality of life in the elderly: Manchester experience over 13 years.

OBJECTIVES: To objectively evaluate the clinical and functional outcomes of cochlear implantation in an elderly population. DESIGN: Retrospective comparative study. SETTING: Neurotology unit at Manchester Royal Infirmary, a supraregional tertiary referral centre in collaboration with Adult Cochlear Implant Programme at The University of Manchester. PARTICIPANTS: All cochlear implant procedures (38) undertaken on post-lingually deafened elderly patients (age range at the time of implantation 65-80 years, n = 34) in the period from 1989 to 2002. MAIN OUTCOME MEASURES: Medical and surgical outcomes. Audiological performance outcomes for isolated words, words in sentences in quiet and noise. Functional outcome measures used are self-reported measures of the social, psychological and emotional aspects of quality of life, and the differences between expectations for functional outcomes and the realization of functional outcomes. They included expectation profiles, Glasgow Benefit inventory (GBI) and Glasgow Health Status Inventory Questionnaire (GHSI). RESULTS: There was statistically significant improvement post-implantation of both open and closed set test scores (P < 0.01). Eighty-two percentage of patients were completely satisfied with their cochlear implants. Patients judged that implantation restored half the loss of quality of life that they had experienced as a result of severe-profound deafness with a highly significant (P < 0.001) improvement in overall quality of life after implantation. The commonest post-operative observation was transient mild pyrexia. CONCLUSIONS: The age of a cochlear implant candidate should not be a factor in the candidacy decision-making process. The quality of life of our elderly recipients was significantly improved after cochlear implant.

Age Factors↗
PubMed2005

Device nonuse among adult cochlear implant recipients.

OBJECTIVE: To examine the causes and prevalence of previous and current device nonuse among adults who have received cochlear implants. STUDY DESIGN: Retrospective case review. SETTING: Adult tertiary referral center for cochlear implantation. METHODS: Two hundred fourteen consecutively implanted adult patients. The length of implant use ranged from 1 month to 14 years. MAIN OUTCOME MEASURE: A period of 4 consecutive weeks of nonuse of cochlear implant, including both obligatory and elective nonuse. RESULTS: Twenty-nine adults (13.6% of implantees) were identified as having at some stage not used their device for a period of more than 4 consecutive weeks. The main reason was device failure (n = 11). Ten adults are current nonusers (4.7% of implantees). Reasons include surgical complication necessitating explantation (n = 3), comorbid illness (n = 3), elective nonuse (n = 2), audiologic complication (n = 1), and device failure (n = 1). CONCLUSION: The overall prevalence of device nonuse was noted to increase slowly with time. The role of psychologic factors in contributing to the decision of an individual to elect to opt out of device use remains unproven.

Adolescent↗
PubMed2005

An easier way of inserting the Shah permavent grommet.

Ventilation tube insertion plays an important role in the management of otitis media with effusion. In selected cases, repeated grommet insertion due to persistent eustachian tube dysfunction necessitates the need for longer-term ventilation. Insertion of such tubes can however occasionally be more difficult than insertion of standard grommets. One such long-term ventilation tube is the Shah permavent grommet. This paper describes a simple modification of the technique that is less time-consuming and less traumatic.

Ear, Middle↗
PubMed2005

The genetics of hearing loss.

Hearing impairment is the most common sensory deficit with half of the causes of hearing loss having a genetic basis. There is a range of treatment devices but these do not correct the underlying pathology. Advances in molecular biology have greatly enhanced our understanding of the pathophysiology of genetic hearing loss, including potential treatments.

Genetic Testing↗
PubMed2004

Trends and outcomes in the Manchester adult cochlear implant series.

The adult cochlear implant programme in Manchester was established in 1988, initially using funding obtained from the HEAR (Help Ear and Allied Research: charity number: 519784) charity before government resources became available in the mid-1990s. Manchester was the first centre in the UK to implant multichannel devices on a regular basis. To date, over 250 adults have been implanted, including nine bilateral and eight deaf-blind patients. All the patients have a postlingual onset of severe-profound hearing loss; 73% (n = 175) of the implants performed used a Nucleus multichannel implant and 24% (n = 58) used a Medel multichannel implant. In addition, the team has implanted three Medel single channel devices, two Ineraid devices and one Clarion High Focus II device. This study is a retrospective analysis of the trends and outcomes in implant fitting during the first 14 years (1988-2002) of the programme. The paper describes the patient demographics and audiological complications for 240 implantations performed on 214 patients. Speech perception outcomes are reported for a subset of the patients. The average score for the Bench, Kowal, Bamford sentence test at the post-18-month stage of implant use is 66% and for Arthur Boothroyd words 53%. Trends in the series are analysed with respect to the change in criteria for adult implantation, the move towards bilateral implantation and the rate of uptake of cochlear implants by different ethnic groups.

Adolescent↗
PubMed2004

Complications following adult cochlear implantation: experience in Manchester.

Cochlear implantation is regarded as a safe and effective treatment for the profoundly deaf. However, a proportion of patients suffer complications after implant surgery. This paper examines the complications encountered in 240 adult cochlear implant operations performed in Manchester between June 1988 and June 2002. Minor complications were defined as those that either settled spontaneously or with conservative management. The total number of minor complications was 61 (25.4 per cent of cases). Non-auditory stimulation, which resolved with implant reprogramming, was present in 53 cases (22.1 per cent). Major complications were defined as those requiring further surgery, explantation or causing a significant medical problem, and occurred in 15 patients (6.25 per cent). These included implant extrusion, implant sepsis, electrode migration, flap-related problems, and persistent non-auditory stimulation. Nine of the 15 patients suffering a major complication required explantation. There were no post-operative deaths, cases of meningitis, nor persistent facial palsies in the series.

Adolescent↗
PubMed2004

Hypercellularity of the mastoid as a cause of spontaneous pneumocephalus.

In this paper two cases are reported in which spontaneous entry of air into the head appears to have occurred through a hypercellular mastoid air cell system. In both these cases forceful sneezing and nose blowing were considered contributory factors. They underwent surgical repair of the bony defects which, combined with less vigorous nose blowing, has affected a successful repair. The aetiology of pneumocephalus is discussed and a review of the pertinent literature is also presented.

Adolescent↗
PubMed1999

The implant-site split-skin graft technique for the bone-anchored hearing aid.

We describe the technique of implant-site split-skin grafting for the bone-anchored hearing aid (BAHA). Twenty-five patients have undergone this procedure (20 adults and five children) since 1993 with a minimum follow-up of 1 year. Fifteen adults were operated upon as single stage surgery, all other cases (including all children) were performed in two stages. In four patients (16%) significant early graft inflammation was encountered which settled with outpatient treatment. In one the abutment had to be temporarily removed to allow the graft to settle. All patients now have a stable graft site. This surgical technique is straightforward and a separate graft donor site is avoided. It would appear this technique results in a stable BAHA graft site with low associated morbidity.

Adolescent↗
PubMed1999

The large vestibular aqueduct syndrome: the role of cochlear implantation in its management.

In recent years the large vestibular aqueduct syndrome has become an increasingly recognized cause of a progressive sensorineural hearing loss. Cochlear implantation, although not correcting the bony abnormality, does offer an avenue for rehabilitation for affected individuals and initial results are encouraging. Of 15 patients identified with the large vestibular aqueduct syndrome we have implanted seven (five adults and two children). All patients underwent an uneventful electrode insertion with uncomplicated postoperative periods. Three of our adult patients are showing very good initial results with BKB speech recognition scores of 100%, 74% and 66% with the implant alone. It is still early days with the children, but initial results are encouraging. A full review of the large vestibular aqueduct syndrome is given along with our results.

Adolescent↗
PubMed1999

Petrosal cholesteatoma: management considerations for minimizing morbidity.

OBJECTIVE: This study aimed to analyze the surgical treatment of patients presenting with petrosal cholesteatoma. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Patients were referred to the University Department of Otolaryngology, Manchester Royal Infirmary, with surgically confirmed petrosal cholesteatoma. INTERVENTION: Interventions were diagnostic and therapeutic. MAIN OUTCOME MEASURES: Postoperative facial function, hearing loss, recurrent cholesteatoma, and petrous cavity morbidity in relation to preoperative signs, intraoperative findings, and surgical techniques were measured. RESULTS: Twenty-five patients were treated between 1979 and 1997. Complete preoperative facial paralysis was always associated with bony erosion around the geniculate ganglion, and facial nerve ischemia was thought to be an important factor. Resection of the ischemic nerve segment and end-to-end anastomosis over the posterior fossa dura allowed full removal of cholesteatoma matrix and reinnervation along a healthy and vascularized nerve. In five of the seven cases with recurrent disease, cholesteatoma was localized to the intrapetrous carotid or geniculate ganglion. The introduction of endoscopic techniques has allowed assessment of the full extent of disease and removal of cholesteatoma matrix missed using conventional microscopic visualization. Bipolar diathermy to areas of cholesteatoma, densely adherent to dura, is effective in destroying squamous epithelium. Patients with cavity obliteration and blind sac closure had minimal postoperative morbidity, and current magnetic resonance imaging techniques are effective in diagnosing and delineating recurrence. CONCLUSIONS: This study illustrates a gradual change in the treatment of patients with petrosal cholesteatoma. By defining the main areas of patient morbidity and using both recent technical advances and alternative surgical techniques, further improvement in patient outcome is envisaged.

Adolescent↗
PubMed1998

Cochlear ossification after meningitis.

OBJECTIVE: This study aimed to assess the pathologic processes that result in ossification of the cochlear lumen after bacterial meningitis. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary referral center. PATIENTS: Profoundly deaf postmeningitic patients who underwent cochlear implantation were studied. INTERVENTIONS: Diagnostic and therapeutic observations were performed. MAIN OUTCOME MEASURES: The extent of cochlear ossification is classified and related to age at which infection occurred, cerebrospinal fluid leukocyte count, Gram's stain, organism, and delay between meningitis and implantation. The extent of ossification noted on high-definition computed tomographic (CT) scan is compared with surgical findings and related to the time delays between meningitis, imaging, and surgery. RESULTS: Ossification fell into three groups: gross ossification of the scala tympani and variable amounts of the scala vestibuli; partial ossification localized to the basal turn of the scala tympani; and no ossification. There was no correlation between the extent of ossification and the age when infected, type of pathogen, cerebrospinal fluid leukocyte count, and time delay between meningitis and implantation. Visualization of bacteria on Gram's stain was a highly sensitive measure of ossification (0.93) but was not specific (0.6) with positive and negative predictive values of 0.76 and 0.86, respectively. High-definition CT underestimated the extent of ossification in 50% of cases when performed within 6 months of meningitis. CONCLUSIONS: Ossification is either gross or localized to the basal turn of the scala tympani. If ossification does occur, it is rapid and complete within a few months of infection. The visualization of bacteria on Gram's stain is a sensitive indicator for the presence of ossification but has low specificity. High-definition CT, if performed within the first 6 months of meningitis, can be an inaccurate diagnostic tool and therefore should be performed as close to the date of surgery as possible.

Adolescent↗