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Biomedical subjects

W H Slattery

Publications and source records attributed to W H Slattery.

34 records · Page 2Linked to original sources
PubMed1997

Familial occurrence of unilateral vestibular schwannoma.

Vestibular schwannoma (VS) may present clinically in one of two forms: sporadic unilateral or hereditary bilateral. Almost all cases of familial transmission have been associated with the diagnosis of neurofibromatosis type II (NF-2). In this report, we describe nine families (18 individuals) presenting with unilateral VS without evidence of NF-2. In four of the nine families, the affected individuals were of parent-offspring relationship, in three families they were cousin-cousin, and in the remaining two families, they were sibling-sibling and aunt-nephew. No other members of the families were diagnosed with NF-2. There was no evidence for gender predilection or genomic imprinting among affected individuals. This study suggests that familial occurrence of unilateral VS may be genetically inherited as it occurs more commonly than would be estimated by chance alone. Future genetic studies will elucidate whether occurrence of unilateral VS in these families represents a variable expression of NF-2, chance occurrence of unilateral VS in families, or a new genetic disorder.

Adult↗
PubMed1997

Postinflammatory medial canal fibrosis.

OBJECTIVE: Our objective was to describe the diagnosis and treatment of postinflammatory medial canal fibrosis by reviewing a large series. STUDY DESIGN: This study was conducted via retrospective chart review. SETTING: This study was conducted at a tertiary otologic referral center. PATIENTS: The 24 patients had a clinical diagnosis of postinflammatory medial canal stenosis. Only one of the 16 females and eight males was under 18 years of age, and the mean age for the group was 50.5 years (range 5-78). fourteen patients had bilateral diseases. INTERVENTION: Surgical therapy was performed in 14 ears (11 patients), and medical therapy was performed in nine. RESULTS: For patients undergoing surgical treatment, mean pure-tone average hearing threshold improved from 37 dB preoperatively to 26 dB postoperatively. The air-bone gap improved from 24 dB to 15 dB. There were three recurrences of disease in the surgery group. CONCLUSION: Postinflammatory medial canal stenosis is a rare disorder resulting from chronic external otitis that required surgical intervention to correct the resulting conductive hearing loss.

Ear Canal↗
PubMed1997

Middle fossa approach for hearing preservation with acoustic neuromas.

OBJECTIVE: This study aimed to provide a clinical review of middle fossa approach for hearing preservation in acoustic neuroma surgery. STUDY DESIGN: This was a prospective case review. SETTING: The study was performed in a tertiary referral center of a private otologic practice. PATIENTS: One hundred fifty-one consecutive middle fossa approaches for removal of acoustic neuroma were used. The 91 males and 60 females ranged in age from 10-72 years with a mean age of 48 years. Tumor size ranged from 0.5-2.5 cm, with a mean of 1.2 cm. MAIN OUTCOME MEASURES: House-Brackmann facial nerve grade and hearing level classified both by the American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting results of hearing preservation surgery and by comparison with preoperative level (15 dB/15%) were the main outcome measures. RESULT: Measurable hearing was preservation in 68%, with 52% within 15 dB and 15% discrimination. Excellent facial function (House-Brackmann grade I-II) was obtained in 95% of patients. CONCLUSION: The middle fossa craniotomy approach for acoustic neuroma is a reliable approach with a good hearing preservation rate and excellent facial nerve function outcome. Complications are minimal in this group of patients.

Adolescent↗
PubMed1997

Medical treatment of Meniere's disease.

The aim of this article is to review the pharmacologic therapy used in the treatment of Meniere's disease. The first portion of the article discusses the treatment of acute labyrinthine crisis, which includes medication for patients that provides relief of the nausea, vomiting, and vertigo that accompanies acute attack. The second half of the article discusses medication used to help prevent attacks of Meniere's disease.

Aminoglycosides↗
PubMed1996

Skull base osteomyelitis. Malignant external otitis.

Aggressive medical therapy is warranted to prevent morbidity and mortality that has long been associated with skull base osteomyelitis. Outcomes are now improved because of a better understanding of the pathophysiology of the disease process, improved diagnostic tests, and more effective antipseudomonal therapy.

Aminoglycosides↗
PubMed1995

Prophylactic antibiotic use in clean, uncontaminated neck dissection.

A recent report in the literature cites a 10% wound infection rate for clean, uncontaminated neck dissections in patients who did not receive antibiotic prophylaxis as compared with a 3.3% infection rate in patients who received prophylactic antibiotics. Although a trend favoring antibiotic prophylaxis was identified, the duration of therapy was not considered. The present analysis addresses this issue. The authors retrospectively reviewed the records of 120 patients who underwent clean, uncontaminated neck dissections over a 3-year period (July 1989 through May 1992) for variables related to wound infections. Radiation therapy had previously been used in 70% of these patients. Group 1 (31 patients) received 24 hours of perioperative antibiotic prophylaxis, and group 2 (89 patients) received antibiotic prophylaxis until the suction drains were removed (usually 4 or 5 days after surgery). No perioperative wound infections occurred in either group. The authors concluded that perioperative antibiotic prophylaxis for 24 hours is sufficient to prevent wound infections in clean, uncontaminated neck dissections.

Cefazolin↗
PubMed1995

Nasal mucociliary clearance after radiation therapy.

Irradiation has been demonstrated to cause decreased mucociliary clearance in animal models. We sought to verify this effect clinically by using the saccharin transport test to evaluate nasal mucociliary clearance in 9 patients previously treated with radiation therapy to the nasal cavity. The patients also completed a questionnaire examining the prevalence of nasal symptoms before and after radiation therapy. Patients who received radiation therapy had no clearance of saccharin from the nasal cavity at a minimum of 20 minutes. The controls had a median clearance time of 5 minutes. The patients noted a higher prevalence of nasal congestion, drainage, and facial pain after radiation therapy. This study demonstrates that radiation therapy to the nasal cavity causes a decrease in nasal mucociliary clearance. This alteration should be considered when selecting therapy for malignancies in the nasal area.

Administration, Intranasal↗
PubMed1995

Cochlear implantation in the congenital malformed cochlea.

Cochlear implantation has proven beneficial for numerous children with profound congenital hearing impairments. Some congenitally deaf ears, however, may have anatomical malformations. This study reports the authors' recent experience with cochlear implants in patients with cogenital inner ear malformations. Since 1987, 10 patients with congenital abnormal inner ear structures have been implanted at the House Ear Clinic; 8 with abnormal cochleas and 2 with enlarged vestibular aqueducts. Nine patients received the Nucleus 22 device and 1 patient was implanted with the 3M/House device. Some modifications of the routine surgical approach were required in 5 patients. A cerebrospinal fluid (CSF) leak occurred in 4 of the 10 cases. There was a relationship between the degree of abnormality and the number of electrodes that could be inserted. All 10 patients can perceive sound and are active users of their implants.

Aged↗
PubMed1995

Prostheses for stapes surgery.

A variety of different implants are available today for use by the otologic surgeon. All prostheses are well tolerated, and the risks of complication as a result of their implantation are comparable. The most commonly used prostheses are the wire-Teflon piston and the stainless steel bucket handle. Although the otologic surgeon has a wide variety of prostheses to choose from, most have a preference for one particular type. Results of hearing improvement following a successful stapedectomy is more a function of the surgeon's experience than of the type of prosthesis used. As James L. Sheehy, MD, so often says, "if a technique is working well for you, don't change for change's sake" (personal communication, 1994).

Ear Ossicles↗
PubMed1995

Results of surgery following stereotactic irradiation for acoustic neuromas.

Stereotactic irradiation has been proposed as an alternative to surgical intervention for the treatment of acoustic neuromas. The authors present their experience with five patients previously treated with stereotactic irradiation who had progression of symptoms due to tumor enlargement. Intraoperatively, the tumors were severely scarred to the facial nerve. Histopathologic examination demonstrated viable cells typical of schwannomas. Two patients received auditory brainstem implants; neither received benefit from the implant. Three of the patients had House-Brackmann grade VI facial nerve function preoperatively, and all four patients with greater than 1 year follow-up had a grade VI postoperatively. It is concluded that, with stereotactic irradiation, surgical morbidity is increased, brainstem implant results are poor, and viable tumor persists.

Adolescent↗
PubMed1994

Monaural sound localization: acute versus chronic unilateral impairment.

We tested the ability of human listeners to localize broadband noise bursts in the absence of binaural localization cues. The subject population consisted of five patients, who had normal hearing in one ear and congenital deafness in the other, and seven normal controls, who were tested with both ears open and with one ear plugged. Consistent with previous reports, the introduction of an ear plug unilaterally into control subjects resulted in a prominent lateral displacement in their localization judgements by an average of 30.9 degrees toward the side of the open ear. Vertical localization was less strongly impaired. The five monaural patients showed a considerable range of ability to localize sounds. Two of the patients were essentially indistinguishable from the plugged control subjects in that they showed a prominent displacement of responses toward the side of the hearing ear. The other three subjects localized significantly better than the plugged controls, in that they demonstrated little or no lateral displacement toward the hearing side and that they localized targets on the hearing and on the impaired sides about equally well. The performance of these latter patients demonstrates that monaural cues can provide useful localization information in the horizontal as well as in the vertical dimension.

Acoustic Stimulation↗
PubMed1994

CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation.

Because of its superior visualization of bone detail, compared with that of MR imaging, CT commonly is used in patients who have had otomastoid or other forms of temporal bone surgery. The already complex anatomy of the temporal bone is distorted by the combination of surgical procedures and preexisting abnormalities, making proper identification of the postoperative imaging studies difficult. The purpose of this essay is to familiarize radiologists with the more common neurootologic surgical procedures and the expected postoperative findings in patients who have had this type of surgery. Special emphasis is placed on the indications for the procedure and the distinguishing features associated with each procedure.

Cochlear Implants↗
PubMed1992

Otolaryngology residency selection process. Medical student perspective.

In an effort to improve the otolaryngology matching process at the University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs.

Florida↗
PubMedDate not supplied

Evaluation of first branchial anomalies by CT and MR.

OBJECTIVE: We present the spectrum of CT and MR findings of first branchial anomalies (FBAs) in our 10 year experience and attempt to integrate these anomalies into current classification systems. MATERIALS AND METHODS: The hospital charts and all relevant imaging studies were retrospectively reviewed in 11 patients with pathologically proven FBAs. Radiographic analysis consisted of lesion size, morphology, location, relation to the expected course of the facial nerve, enhancement pattern, attenuation compared to CSF, and T1- and T2-weighted signal intensity. These findings were correlated with clinical symptoms and surgical findings. RESULTS: Seven lesions were unilocular cystic lesions within the parotid gland. Two lesions were multilobular and two consisted only of sinus tracts. Rim enhancement occurred with signs and symptoms of infection. Sinus tracts were present in 5 of 11 patients. One patient had an associated epidermoid tumor. The Arnot classification system was the most useful for categorizing our lesions. CONCLUSION: Imaging was helpful in preoperative surgical planning, and none of the patients in our series had residual neurological deficits. Computed tomography was preferred to MR due to the visualization of bony detail and better capability to determine the cystic nature of these lesions.

Adolescent↗