Cystic lymphatic malformation of the middle ear.

Objectives: We review the clinical, radiologic, and histopathologic features of cystic lymphangioma of the middle ear, and discuss the developmental etiology and management of such a lesion.

Methods: We present an unusual location for the development of a cystic lymphangioma with emphasis on etiology, clinical implications, and current treatment.

Results: A 10-year-old girl presented with a mass involving the medial surface of the right tympanic membrane.

A study of Gulf War veterans with a possible deployment-related syndrome.

A previous symptom-based survey of veterans of the 1990-1991 Persian Gulf War suggested a neurological syndrome (blurred vision, loss of balance/dizziness, tremors/shaking, and speech difficulty). The authors conducted the present study to determine whether specific findings could indicate an organic basis for this possible syndrome. They completed an extensive clinical and laboratory evaluation on Gulf War veterans with all 4 symptoms, using 3 comparison groups.

Petroclival meningiomas: multimodality treatment and outcomes at long-term follow-up.

Objective: To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclival meningiomas.

Methods: During a 13-year period (1991-2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.

Ménière's disease.

Purpose Of Review: Ménière's disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The pathologic process involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops. This review describes the pathogenesis and etiology as well as the diagnosis and treatment of Ménière's disease.

Nonvestibular schwannomas of the brain: a 7-year experience.

Objective: Nonvestibular schwannomas are uncommon tumors of the brain. Trigeminal nerve schwannomas are the most common of this group, followed by glossopharyngeal, vagal, facial, accessory, hypoglossal, oculomotor, trochlear, and abducens nerve schwannomas, in descending order of frequency. We present a series of nonvestibular schwannomas that were surgically treated during a 7-year period.

Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area.

Objective: To study the value of an improvement of the presigmoid petrosal approach to the petroclival area by the addition of partial labyrinthectomy and petrous apicectomy and to document hearing and other results.

Methods: Thirty-six consecutive patients treated by this technique during a 2-year period were studied prospectively. The lesions treated included 33 petroclival neoplasms (25 meningiomas, 5 chordomas, 1 chondrosarcoma, 1 trigeminal schwannoma, and 1 epidermoid cyst) and 3 vertebrobasilar aneurysms.

Endodermal cysts of the posterior fossa. Report of three cases and review of the literature.

The pathogenesis of endodermal cysts of the posterior fossa is still incompletely understood. The authors reviewed three new cases and those reported in the literature to clarify the clinical, pathological, radiological, and surgical characteristics of these lesions. A total of 49 cases were reviewed.

Acoustic neuromas: results of current surgical management.

Objective: In this article, we review the surgical outcomes of 179 patients with acoustic neuromas.

Methods: Most of the tumors (84%) were operated on using a retrosigmoid, transmeatal approach. A transpetrosal, retrosigmoid approach was used in 10% of the patients, most of whom had large tumors.

Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugulare tumors. Report of two cases.

Glomus jugulare tumors always invade the jugular bulb and sigmoid sinus, making it difficult to resect these tumors totally without sacrificing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconstruction of the jugular bulb using a saphenous vein graft may enable tumor resection in these patients without complications.

Malignant otitis externa in AIDS patients: case report and review of the literature.

Malignant otitis externa is a necrotizing infection of the external ear canal and surrounding soft tissue and bone, usually caused by Pseudomonas aeruginosa. The infection classically occurs in diabetic patients, however recently, several patients with the acquired immunodeficiency syndrome (AIDS) have been reported to have malignant otitis externa. A patient with AIDS who had malignant otitis externa with skull base osteomyelitis is presented and reported cases in patients with AIDS are reviewed.

Postoperative pain following excision of acoustic neuroma by the suboccipital approach: observations on possible cause and potential amelioration.

Incisional pain and headache have been reported following cerebellopontine angle surgery via the suboccipital approach. The high incidence and severity of pain determined in a retrospective study of acoustic tumor patients prompted the present prospective study. Various modifications of the suboccipital approach have been employed in an attempt to isolate a possible cause and potential method of minimizing this problem.

Intratympanic gentamicin instillation as treatment of unilateral Menière's disease: update of an ongoing study.

A prospective study using intratympanic gentamicin instillation as treatment for disabling unilateral Meniere's disease has been ongoing at our institution for 4 years. Treatment effectiveness is evaluated based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1985 guidelines. This report is based on 30 patients who have become eligible for assessment.

Pain after surgery for acoustic neuroma.

Postoperative pain after surgery in the cerebellopontine angle (CPA) is acknowledged to occur, but is rarely taken into account as a factor in the analysis of morbidity of such surgery. It is widely acknowledged that some patients, having undergone such surgery, particularly by means of the suboccipital approach, report significant post-operative pain and headache. This study was undertaken to determine the incidence and severity of pain after excision of acoustic neuromas and to establish whether this differed between the suboccipital and translabyrinthine routes.

Presentation of large vestibular aqueduct syndrome to a dizziness unit.

An abnormally enlarged vestibular aqueduct has been associated with sensorineural hearing loss in children. Vestibular complaints, in this patient population, have not been characterized. Several patients have presented to the dizziness unit at Sunnybrook with vestibular related complaints.

Conservative management of acoustic neuromas.

The results of this study and others document the biologic behavior of acoustic neuromas. In view of the evidence presented, which describes both variable rates of individual tumor growth and spontaneous regression in size, it would seem prudent that before selecting a nonsurgical treatment modality, the growth rate for the particular tumor in question should be established. To date, none of the literature that addresses the use of focused irradiation has attempted to do so.

Recurrence rates of acoustic neuroma in hearing preservation surgery.

Several authors have detailed the microscopic appearance of the acoustic neuroma/cochlear nerve interface. Others have highlighted the anatomic relationships existent between the lateral end of the internal auditory canal (fundus) and the otic capsule, as viewed from the posterior fossa. Based on these findings, several have suggested that hearing preservation attempts are likely associated with tumor persistence.

Chemical labyrinthectomy: local application of gentamicin for the treatment of unilateral Menière's disease.

The use of aminoglycosides for selective vestibular function ablation without hearing alteration is described in the literature. Parenteral administration of streptomycin for the alleviation of vertigo in cases of bilateral Meniere's disease is well accepted. The instillation of aminoglycosides into the middle ear to produce a similar result, has been successfully used in the treatment of unilateral Meniere's disease.

Morphophysiology of synaptic transmission between type I hair cells and vestibular primary afferents. An intracellular study employing horseradish peroxidase in the lizard, Calotes versicolor.

Intracellular records with glass microelectrodes filled with horseradish peroxidase (HRP) were taken from primary afferents of the horizontal semicircular canal in the lizard, Calotes versicolor. A coefficient of variation (CV) of the interspike intervals of spontaneous action potentials (APs) was calculated and correlated with the terminal morphologies of afferents within the canal crista. Irregular fibers with CV greater than 0.