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Acute intracranial complications of temporal bone trauma
Otolaryngology Head and Neck Surgery P202
August 1997
Scientific Posters
had improved hearing. Complications were minimal and one displayed mild retraction. Conclusions: We describe a technique for long-term ventilation of the middle ear that involves the placement of a Ttube in a subannular position. It offers the advantages of ease of placement, use in severely ateletactic tympanic membranes, and use during simultaneous tympanoplasty, mastoidectomy, and/or ossiculoplasty. 132
Acute Intracranial Complications of Temporal Bone Trauma AIJAZ ALVI, MD, and ARASH BERELIANI, MS, Chicago, IlL and Los Angeles, Calif.
Objective: To address the acute intracranial complications of temporal bone trauma. Violent crime has increased throughout our society and as a result we have seen a significant increase in the number of intracranial complications resulting from temporal bone injury. Although there have been multiple reports in the literature concerning the diagnosis and management of temporal bone trauma, few studies have addressed its intracranial complications. Methods: A retrospective review of 43 patients with temporal bone trauma between January 1992 and December 1994. Results: The number of temporal bone fractures had increased from six in 1992 to 21 in 1994. Twenty-one patients (49%) presented with a decrease in mental status. Significant alcohol and drug usage was documented in 28% and 58% of patients, respectively. The most common radiologic finding was skull and intracranial injury. Thirty-six patients (84%) had at least one abnormal intracranial finding, and of these patients, 14 (39%) had more than one abnormal finding on computed tomography scan. Cerebral midline shift, subarachnoid hemorrhage, subdural hemorrhage, and cerebral edema were the most common radiologic findings. Nineteen patients (44%) required an open neurosurgical procedure and almost all patients with more than one abnormal radiological finding had neurosurgery (86%). Seven patients required further institutional care after discharge. There were four deaths (9% mortality), and all were neurologically related. The mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994. Conclusions: An increasing number of temporal bone traumas have been observed. Intracranial complications are more common in temporal bone traumas. In such cases of temporal bone trauma radiologic studies and neurosurgical intervention should be strongly considered. 133
Otalgia in the Normal-appearing Ear JOHN P. LEONETTI, MD, JOHN LI, MD, and JOSEPH DONZELLI, MD, M a y w o o d , Ill., and Palm Beach Gardens, Fla.
Objective: The sensory innervation of the ear is complex and poorly understood by nonotolaryngologicphysicians. This
review was performed in an effort to outline and categorize a variety of causes for referred otalgia and to provide a streamlined diagnostic approach for the evaluation of these patients. Methods: Eight hundred twenty-two patients with the chief complaint of otalgia in a normal-appearing ear were evaluated between July of 1988 and July of 1996. All patients underwent a detailed clinical history review and a complete physical examination of the head and neck. Additional diagnostic testing was specifically ordered according to individual clinical manifestations. Results: The cause for referred otalgia was identified in 92% of these patients; however, the mean delay in diagnosis was 10.4 months. The most common cause for otalgia in the normal-appearing ear was dental (74%), with other categories including inflammatory, neoplastic, primary neural, and psychogenic. Conclusion: Early, definitive diagnosis of the source for referred otalgia may be possible by utilizing appropriate radiographic studies according to clinical manifestations. A diagnostic algorithm will be presented to assist in the evaluation of patients with this relatively frequent but poorly understood symptom. 134
The Surgical Management of Recurrent Acoustic Neuromas JOHN P. LEONEI-rl, MD, PETERG. SMITH, MD, PhD, DOUG ANDERSON, MD, and JOSEPH DONZELLI, MD, M a y w o o d , II1., and St. Louis, Mo.
Objective: A variety of contemporary approaches exist for the surgical removal of acoustic neuromas. Recurrent tumors may require surgical extirpation in patients with documented rapid growth, brain stem compression, or new-onset cranial nerve deficit(s). Methods: Forty-two patients underwent surgical resection of their recurrent acoustic neuroma between July 1987 and July 1996. Clinical data were collected from patient medical records and tumor growth was determined by serial magnetic resonance imaging. Results: The time for tumor regrowth ranged from 2 to 12 years (mean = 5.2 years). One patient underwent a retrosigmoid approach with hearing preservation intent while all other patients underwent a translabyrinthine approach. Total tumor removal was accomplished in all 42 patients and anatomic facial nerve preservation was achieved in the 32 patients with normal preoperative facial function. Conclusion: Microsurgery remains a safe and viable option for the complete extirpation of recurrent acoustic neuromas. Patient results are detailed with respect to facial nerve preservation, cerebrospinal fluid fistula, new onset neurologic deficit, and postoperative functional capacity. Additional management options for patients with recurrent acoustic neuromas will be discussed.
August 1997
Scientific Posters
had improved hearing. Complications were minimal and one displayed mild retraction. Conclusions: We describe a technique for long-term ventilation of the middle ear that involves the placement of a Ttube in a subannular position. It offers the advantages of ease of placement, use in severely ateletactic tympanic membranes, and use during simultaneous tympanoplasty, mastoidectomy, and/or ossiculoplasty. 132
Acute Intracranial Complications of Temporal Bone Trauma AIJAZ ALVI, MD, and ARASH BERELIANI, MS, Chicago, IlL and Los Angeles, Calif.
Objective: To address the acute intracranial complications of temporal bone trauma. Violent crime has increased throughout our society and as a result we have seen a significant increase in the number of intracranial complications resulting from temporal bone injury. Although there have been multiple reports in the literature concerning the diagnosis and management of temporal bone trauma, few studies have addressed its intracranial complications. Methods: A retrospective review of 43 patients with temporal bone trauma between January 1992 and December 1994. Results: The number of temporal bone fractures had increased from six in 1992 to 21 in 1994. Twenty-one patients (49%) presented with a decrease in mental status. Significant alcohol and drug usage was documented in 28% and 58% of patients, respectively. The most common radiologic finding was skull and intracranial injury. Thirty-six patients (84%) had at least one abnormal intracranial finding, and of these patients, 14 (39%) had more than one abnormal finding on computed tomography scan. Cerebral midline shift, subarachnoid hemorrhage, subdural hemorrhage, and cerebral edema were the most common radiologic findings. Nineteen patients (44%) required an open neurosurgical procedure and almost all patients with more than one abnormal radiological finding had neurosurgery (86%). Seven patients required further institutional care after discharge. There were four deaths (9% mortality), and all were neurologically related. The mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994. Conclusions: An increasing number of temporal bone traumas have been observed. Intracranial complications are more common in temporal bone traumas. In such cases of temporal bone trauma radiologic studies and neurosurgical intervention should be strongly considered. 133
Otalgia in the Normal-appearing Ear JOHN P. LEONETTI, MD, JOHN LI, MD, and JOSEPH DONZELLI, MD, M a y w o o d , Ill., and Palm Beach Gardens, Fla.
Objective: The sensory innervation of the ear is complex and poorly understood by nonotolaryngologicphysicians. This
review was performed in an effort to outline and categorize a variety of causes for referred otalgia and to provide a streamlined diagnostic approach for the evaluation of these patients. Methods: Eight hundred twenty-two patients with the chief complaint of otalgia in a normal-appearing ear were evaluated between July of 1988 and July of 1996. All patients underwent a detailed clinical history review and a complete physical examination of the head and neck. Additional diagnostic testing was specifically ordered according to individual clinical manifestations. Results: The cause for referred otalgia was identified in 92% of these patients; however, the mean delay in diagnosis was 10.4 months. The most common cause for otalgia in the normal-appearing ear was dental (74%), with other categories including inflammatory, neoplastic, primary neural, and psychogenic. Conclusion: Early, definitive diagnosis of the source for referred otalgia may be possible by utilizing appropriate radiographic studies according to clinical manifestations. A diagnostic algorithm will be presented to assist in the evaluation of patients with this relatively frequent but poorly understood symptom. 134
The Surgical Management of Recurrent Acoustic Neuromas JOHN P. LEONEI-rl, MD, PETERG. SMITH, MD, PhD, DOUG ANDERSON, MD, and JOSEPH DONZELLI, MD, M a y w o o d , II1., and St. Louis, Mo.
Objective: A variety of contemporary approaches exist for the surgical removal of acoustic neuromas. Recurrent tumors may require surgical extirpation in patients with documented rapid growth, brain stem compression, or new-onset cranial nerve deficit(s). Methods: Forty-two patients underwent surgical resection of their recurrent acoustic neuroma between July 1987 and July 1996. Clinical data were collected from patient medical records and tumor growth was determined by serial magnetic resonance imaging. Results: The time for tumor regrowth ranged from 2 to 12 years (mean = 5.2 years). One patient underwent a retrosigmoid approach with hearing preservation intent while all other patients underwent a translabyrinthine approach. Total tumor removal was accomplished in all 42 patients and anatomic facial nerve preservation was achieved in the 32 patients with normal preoperative facial function. Conclusion: Microsurgery remains a safe and viable option for the complete extirpation of recurrent acoustic neuromas. Patient results are detailed with respect to facial nerve preservation, cerebrospinal fluid fistula, new onset neurologic deficit, and postoperative functional capacity. Additional management options for patients with recurrent acoustic neuromas will be discussed.