Stapedectomy for far-advanced otosclerosis.

Objective: This study aimed to describe far-advanced otosclerosis and to present the authors' results with stapedectomy in 78 ears with far-advanced otosclerosis.

Study Design: The study design was a retrospective case review.

Setting: The study was conducted at an Otology/Neurotology tertiary referral center.

A personal history of stapedectomy.

Aristotle has said the essential ingredient of tragedy is first hubris. Fame leads to the hubris that offends the gods, who send great punishment. This is so true in the history of stapedectomy.

Summating potential and action potential ratio in Meniere's disease before and after treatment.

Objective: This study aimed to compare the summating potential and action potential ratio (SP:AP) in patients with Meniere's disease before and after various surgical and medical treatments as an indication of change in endolymphatic hydrops to study the progression of Meniere's disease.

Study Design: The study design was a retrospective case review.

Setting: The study was conducted at an otology-neurotology referral center.

Action potential latency shift by rarefaction and condensation clicks in Menière's disease.

Transtympanic electrocochleography using rarefaction and condensation clicks was performed on 122 ears of 112 patients, including 98 ears of 89 patients with Menière's disease (MD) and 24 ears of 23 patients without Menière's disease (NMD). The mean action potential (AP) latency difference between rarefaction and condensation clicks was 0.40 +/- 0.

The role of dexamethasone or streptomycin perfusion in the treatment of Meniere's disease.

There is ample clinical and animal evidence that, in most patients, Meniere's disease is an immune-mediated disorder in a small, misplaced, malfunctioning endolymphatic sac that causes endolymphatic hydrops, the essential pathology of this disease. If this is so, then the potent anti-inflammatory steroids are the ideal first treatment for Meniere's disease and other immune-mediated diseases of the inner ear, and streptomycin perfusion is the ideal second treatment for those who do not respond to dexamethasone perfusion. The diagnosis, selection of patients, and details of operation with the results are presented.

Forty years of stapes surgery.

Objective: This study reports the results of 14,449 stapedectomy operations performed during the past 40 years.

Study Design: The study design was a retrospective case review. Approximately 100 operations were selected from each of the past 40 years, for a total of 5,444 operations, from which the results with the whole group were extrapolated.

Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Ménière's disease.

Recent clinical and laboratory evidence indicates that Meniere's disease is an immune-mediated disease. Dexamethasone perfusion of the inner ear through the round window plus intravenous dexamethasone often will stop the dizzy spells, reduce the fullness and low-frequency tinnitus, and sometimes improve the hearing in patients with Meniere's disease. The dexamethasone must act mostly on the endolymphatic sac and, to a lesser extent, on the stria vascularis and spiral ligament, the known targets of immune response in the inner ear, to reduce the endolymphatic hydrops and restore the fluid dynamics of the endolymph.

Middle ear and inner ear effects on clinical bone-conduction threshold.

The measurement of bone-conduction thresholds is an integral part of audiologic evaluation. The relationship between bone-conduction and air-conduction thresholds is the differentiating diagnostic indicator between conductive and sensorineural hearing loss. At the same time, the influence of middle ear and inner ear structures upon the bone-conduction response has been well documented.

Traumatic endolymphatic hydrops.

Traumatic endolymphatic hydrops is an accumulation of endolymph in the cochlear duct caused by traumatic insult. The causative mechanisms are: (1) fistulization of the bony labyrinth, which causes a disturbance in the normal perilymph-endolymph pressure relationship; (2) direct injury to the membranous labyrinth, which may be just a collection of fluid in the cochlear duct from irritation, resulting in endolymphatic hydrops that may not be progressive and may subside in a short period of time after injury and hearing loss may occur; and (3) injury to the endolymphatic fluid drainage system, including a temporal bone fracture in which the fissure happens to extend through the vestibular aqueduct, causing fibro-osseous blockage of the endolymphatic duct and surgical injury to the saccule with obstruction of the longitudinal flow of endolymph, resulting in endolymphatic hydrops that may be delayed in onset and is usually persistent. The diagnosis of traumatic endolymphatic hydrops is made by a history of trauma, such as barotrauma, a blow to the head, or perhaps a previous ear operation, such as stapedectomy; the presence of typical symptoms of endolymphatic hydrops, including fullness, tinnitus, fluctuant hearing loss, and episodic vertigo; and an elevated negative summating potential and an increased summating potential:action potential ratio by electrocochleography.

Scanning electron microscopic observation of dark cells after streptomycin perfusion of the vestibule in guinea pigs.

Hearing has been stabilized in the majority of patients studied in the treatment of Meniére's disease with streptomycin. This observation suggests that effects of streptomycin may ameliorate endolymphatic hydrops, possibly by attenuating the activity of secretory tissue. The purpose of this study is to observe the dark cells of the utricle in guinea pigs after streptomycin perfusion of the vestibule.

Facial nerve stimulation after successful multichannel cochlear implantation.

Postoperative rehabilitation after cochlear implantation may be difficult and frustrating for both patient and audiologist. The occurrence of facial nerve stimulation with associated twitching and discomfort can interfere with the rehabilitative process and be a cause of great concern to the patient. Such stimulation can occur at the time of initial "tune-up" or can be delayed by months or years.

Long-term results of low dose intramuscular streptomycin for Menière's disease.

The initial results of partial ablation of vestibular function are evident to control vertigo attacks and stabilize hearing as well as to reduce the severity of ataxia. The purpose of this study is to observe the long-term results of low dose intramuscular streptomycin in the treatment of bilateral Menière's disease. Eleven patients with disabling bilateral Menière's disease were treated with low doses of intramuscular streptomycin (20-40 g, mean = 25 g).

Endolymphatic hydrops associated with otosclerosis.

Endolymphatic hydrops (EH) associated with otosclerosis has been noted for many years. However, the causal relationship of these two entities remains controversial. Having reviewed the records of patients with otosclerosis describing fluctuant hearing loss and vertiginous symptoms, the authors found the EH may coexist with otosclerosis preoperatively; they may be two separate diseases that exist coincidentally; or EH may be caused by the otosclerotic process.

Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin.

Streptomycin perfusion of the labyrinth through the round window membrane in the middle ear is a simple, safe, and effective way to stop the dizzy spells, fullness, and tinnitus of Ménière's disease without making the hearing worse. My results with 24 patients in the last 8 months are presented. Although the long-term effect of this operation remains to be seen, my experience with streptomycin perfusion of the labyrinth through the lateral semicircular canal leads me to believe these good results will be maintained in the future.

How I do primary and revision stapedectomy.

Localized anterior otosclerosis is found in about 80 percent of primary stapedectomy operations. For these patients, partial stapedectomy with vein graft is recommended. Obliterative otosclerosis is the pathology found in the remaining 20 percent of primary stapedectomy operations.

Speech perception after multichannel cochlear implantation in the pediatric patient.

Clinical trials to evaluate multichannel cochlear implantation in children ages 2 to 17 years began in late 1986, with pre-market approval granted in 1990. To date, 870 children in the United States have received the Nucleus 22-channel device. Performance on measures of speech perception in 30 children who have used the Nucleus cochlear implant for a minimum of 6 months is presented and discussed in terms of the predictive value of patient biographic variables.

Factors influencing results with streptomycin perfusion of the labyrinth.

Streptomycin perfusion of the labyrinth is the logical choice of treatment for the third stage of Meniere's disease with intractable vertigo. The results of streptomycin perfusion of the labyrinth are comparable to those of other treatments, including endolymphatic shunt and vestibular nerve section. Refinements must be made in the process of selecting candidates for the operation.

Transtympanic electrocochleography in Menière's disease using clicks and tone-bursts.

Transtympanic electrocochleography (ECoG), using clicks and tone-bursts at 500, 1000, and 2000 Hz, was employed to study 80 patients with Meniere's disease and 25 non-Meniere's patients. The magnitude of the negative summating potential and the summating potential:action potential ratio (SP:AP) were examined in both groups. Groups were further divided based upon degree of hearing loss and audiometric configuration.

Classification of Menière's disease.

To create a rational treatment system for Meniere's disease, it is helpful to divide Meniere's disease into five stages according to the signs, symptoms, pathology, and natural history by recalling what is known for certain and what is probably true about Meniere's disease. It is known that Meniere's disease is attributable to endolymphatic hydrops, caused by a small, malfunctioning endolymphatic sac, abnormally placed since birth, and Meniere's disease is therefore a congenital disorder of the endolymphatic sac. It is probably true that there is often an immune, viral, metabolic, or other insult to the inner ear, that disturbs the balance between the cochlea, where endolymph is produced, and the endolymphatic sac, where most of it is absorbed.

Intramuscular streptomycin effect on dark cells of utricle in guinea pigs.

Streptomycin has been used in the treatment of Meniere's disease for almost half a century. Clinical studies showed that streptomycin may eliminate vertigo attacks and stabilize or improve hearing in the majority of patients. Animal experiments have demonstrated severe damage to the vestibular hair cells after streptomycin treatment.

The classification and treatment of Menière's disease.

The classification and treatment of Menière's disease are especially difficult because the natural history of Menière's disease is so variable, and not possible to relate to the cochlear and vestibular pathology present, which is constantly changing and cannot be known during life. In the many new papers written each year on Menière's disease and the hundreds of older papers already in the medical literature, there is no good agreement about the definition of Menière's disease, the pathology and natural history, and the real benefit of the medical and surgical treatments given. Only recently, with transtympanic electrocochleography and three-dimensional CT scans of the external aperture of the vestibular aqueduct, have we significant information during life about the pathology present, from which to predict the likely natural history and the chances for successful treatment.

Medical and surgical treatment of Menière's disease.

To create a rational treatment system for Meniere's disease, it is helpful to recall what is known for sure and what is probably true about Meniere's disease, so as to recognise the stages through which the disease passes from beginning to end. Meniere's disease is a complex disorder of the inner ear, characterised by fullness, tinnitus, fluctuant hearing loss and dizzy spells. Meniere's disease is always associated with, and probably caused by endolymphatic hydrops, although all patients with endolymphatic hydrops do not have Meniere's disease.