- Email: [email protected]
Chronic conductive hearing loss in adults: Effects on auditory brain stem responses and masking level differences
Otolaryngology Head and Neck Surgery P 166
August 1996
Scientific Posters
to be a helpful technique in identification of cerebrospinal fluid (CSF) fistulas of the anterior skull base. We report our indications and techniques of endoscopic transnasal closure of CSF rhinorrhea. Methods: In a retrospective study, causes and symptoms of CSF rhinorrhea in 36 patients are described. CT in the coronal plane proved to be clearly superior to axial CT. Results: Fractures and defects of the roof of the ethmoid, the lamina cribrosa, and the walls of the shenoid sinus almost exclusively were approached endoscopically. Conclusion: Our experiences and results demonstrate that, with the exception of defects in the posterior wall of the frontal sinus, CSF fistulas of the anterior skull base can safely be approached transnasally endoscopically. The advantages are less morbidity and no scarring. The intrathecal application of 5% sodium fluorescein solution in more than 900 applications had a very low complication rate (0.3%) when used correctly. Since abandoning the suboccipital application in 1990, we have not seen any fluorescein-related complications in more than 200 consecutive cases. 17 Diathermy Palatoplasty: A New Technique for Snoring R. W. CLARKE, A. PANARESE, M. P. J. YARDLEY, and R. T. CLEGG, Sheffield, United Kingdom
Objective: To e v a l u a t e a p r o c e d u r e - - d i a t h e r m y palatoplasty ( D P ) - - t h a t s i m u l a t e s the e f f e c t of laser palatoplasty (LP) in the treatment of snoring and to compare its efficacy and morbidity with LP in a randomized controlled trial. Method: A Colorado microdissection needle was used to amputate the uvula and strip an inverted "V" of mucosa from the oral surface of the soft palate. The procedure was performed with the patient under general anesthesia but could be office based. Twenty-five DPs have been performed, and postoperative pain and dysphagia were monitored on a visual analog scale (0 to 100 mm). Twenty-five LPs were performed on age-matched controls. Results: DP is associated with similar postoperative pain and dysphagia as LP--respectively, 78 mm and 73 mm for pain and 71 mm and 71 mm for dysphagia at 1 day and 7 days postoperatively. Reduction in snoring on a subjective assessment again using a visual analog scale was similar for both study groups as 72 mm (LP) and 75 mm (DP) when assessed at 3 months, but there is a tendency for symptoms to relapse with time. Conclusion: DP by the method described is a simple, safe, and--at least in the short term---efficacious alternative to LP in the treatment of snoring.
18 Chronic Conductive Hearing Loss in Adults: Effects on Auditory Brain Stem Responses and Masking Level Differences MICHAEL O. FERGUSON, MSIV, RAYMOND D. COOK, MSIV, JOSEPH W. HALL Ill, PhD, and HAROLD C. PILLSBURY III, MD, C h a p e l Hill, N.C.
Objective: The auditory brain stem response (ABR) is a brief-latency, electrophysiologic response that reflects synchronous neuronal activity from the auditory nerve and brain stem structures. Investigations have shown that children with early conductive impairment exhibit abnormalities in the ABR, suggesting that the nervous system has an element of plasticity during critical periods of development. However, no similar research has been undertaken on adults to determine whether ABR abnormalities associated with chronic conductive impairment also exist in this population. This study addresses that question by investigating the ABR in a group of adults with chronic conductive loss and a control group of normal-hearing adults. The goal was to determine whether chronic conductive hearing loss in adults would result in similar abnormal ABR measurements as seen in the juvenile population. Methods: A total of 32 adult subjects (11 patients and 21 controls) were evaluated by comparing ABR interpeak latencies between waves I and III and waves I and V. In addition, interaural latency differences were assessed in cases of unilateral disease. Results: Results to date suggest that ABR abnormalities associated with conductive impairment are present. Specifically, in the cases of unilateral disease, there is a significant difference between ears in the wave I to V interpeak latency. This difference is independent of hearing sensitivity and audiometric asymmetry. A similar interaural difference is not seen in the control population. Conclusions: These data suggest that chronic conductive loss in adults leads to long-term central processing adaptation, indicating that an element of plasticity may exist in the mature auditory system. Continued investigation of these patients is warranted to determine whether the ABR pattern again changes subsequent to the return of normal audiometric thresholds after corrective middle ear surgery. (Supported by NIH NIDCD.) 19 The Efficacy of EMLA as a Topical Anesthetic in Minor Otologlc Procedures HRAIR A. KOUTNOUYAN, MD, BARRY M. RASGON, MD, and RAUL M, CRUZ, MD, Oakland, Calif.
E M L A (Eutectic mixture of local anesthetics) cream is an oil-in-water emulsion of two anesthetics--lidocaine and prilocaine. Several clinical applications of EMSA, its effectiveness as a topical anesthetic, and its safety profile have all been reported. We report our experience with EMLA in
August 1996
Scientific Posters
to be a helpful technique in identification of cerebrospinal fluid (CSF) fistulas of the anterior skull base. We report our indications and techniques of endoscopic transnasal closure of CSF rhinorrhea. Methods: In a retrospective study, causes and symptoms of CSF rhinorrhea in 36 patients are described. CT in the coronal plane proved to be clearly superior to axial CT. Results: Fractures and defects of the roof of the ethmoid, the lamina cribrosa, and the walls of the shenoid sinus almost exclusively were approached endoscopically. Conclusion: Our experiences and results demonstrate that, with the exception of defects in the posterior wall of the frontal sinus, CSF fistulas of the anterior skull base can safely be approached transnasally endoscopically. The advantages are less morbidity and no scarring. The intrathecal application of 5% sodium fluorescein solution in more than 900 applications had a very low complication rate (0.3%) when used correctly. Since abandoning the suboccipital application in 1990, we have not seen any fluorescein-related complications in more than 200 consecutive cases. 17 Diathermy Palatoplasty: A New Technique for Snoring R. W. CLARKE, A. PANARESE, M. P. J. YARDLEY, and R. T. CLEGG, Sheffield, United Kingdom
Objective: To e v a l u a t e a p r o c e d u r e - - d i a t h e r m y palatoplasty ( D P ) - - t h a t s i m u l a t e s the e f f e c t of laser palatoplasty (LP) in the treatment of snoring and to compare its efficacy and morbidity with LP in a randomized controlled trial. Method: A Colorado microdissection needle was used to amputate the uvula and strip an inverted "V" of mucosa from the oral surface of the soft palate. The procedure was performed with the patient under general anesthesia but could be office based. Twenty-five DPs have been performed, and postoperative pain and dysphagia were monitored on a visual analog scale (0 to 100 mm). Twenty-five LPs were performed on age-matched controls. Results: DP is associated with similar postoperative pain and dysphagia as LP--respectively, 78 mm and 73 mm for pain and 71 mm and 71 mm for dysphagia at 1 day and 7 days postoperatively. Reduction in snoring on a subjective assessment again using a visual analog scale was similar for both study groups as 72 mm (LP) and 75 mm (DP) when assessed at 3 months, but there is a tendency for symptoms to relapse with time. Conclusion: DP by the method described is a simple, safe, and--at least in the short term---efficacious alternative to LP in the treatment of snoring.
18 Chronic Conductive Hearing Loss in Adults: Effects on Auditory Brain Stem Responses and Masking Level Differences MICHAEL O. FERGUSON, MSIV, RAYMOND D. COOK, MSIV, JOSEPH W. HALL Ill, PhD, and HAROLD C. PILLSBURY III, MD, C h a p e l Hill, N.C.
Objective: The auditory brain stem response (ABR) is a brief-latency, electrophysiologic response that reflects synchronous neuronal activity from the auditory nerve and brain stem structures. Investigations have shown that children with early conductive impairment exhibit abnormalities in the ABR, suggesting that the nervous system has an element of plasticity during critical periods of development. However, no similar research has been undertaken on adults to determine whether ABR abnormalities associated with chronic conductive impairment also exist in this population. This study addresses that question by investigating the ABR in a group of adults with chronic conductive loss and a control group of normal-hearing adults. The goal was to determine whether chronic conductive hearing loss in adults would result in similar abnormal ABR measurements as seen in the juvenile population. Methods: A total of 32 adult subjects (11 patients and 21 controls) were evaluated by comparing ABR interpeak latencies between waves I and III and waves I and V. In addition, interaural latency differences were assessed in cases of unilateral disease. Results: Results to date suggest that ABR abnormalities associated with conductive impairment are present. Specifically, in the cases of unilateral disease, there is a significant difference between ears in the wave I to V interpeak latency. This difference is independent of hearing sensitivity and audiometric asymmetry. A similar interaural difference is not seen in the control population. Conclusions: These data suggest that chronic conductive loss in adults leads to long-term central processing adaptation, indicating that an element of plasticity may exist in the mature auditory system. Continued investigation of these patients is warranted to determine whether the ABR pattern again changes subsequent to the return of normal audiometric thresholds after corrective middle ear surgery. (Supported by NIH NIDCD.) 19 The Efficacy of EMLA as a Topical Anesthetic in Minor Otologlc Procedures HRAIR A. KOUTNOUYAN, MD, BARRY M. RASGON, MD, and RAUL M, CRUZ, MD, Oakland, Calif.
E M L A (Eutectic mixture of local anesthetics) cream is an oil-in-water emulsion of two anesthetics--lidocaine and prilocaine. Several clinical applications of EMSA, its effectiveness as a topical anesthetic, and its safety profile have all been reported. We report our experience with EMLA in