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New Aspects of Cochlear Mechanics and Inner Ear Pathophysiology
Book Reviews
Book Reviews ROGER KAUFMAN, MD, EDITOR New Aspects of Cochlear Mechanics and Inner Ear Pathophysiology. CR Pfaltz (ed). Karger, Basel, 1990, 170 pages, 59 figures and 16 tables, $120.
threads of thought are used to suggest that the stria vascularis is unique. This suggestion is discussed in light of other literature on the topic, but the clear purpose of the chapter is to introduce the new data and conclusions. This emphasis on new data makes this chapter a much less satisfying review.
New Aspects of Cochlear Mechanics and Inner Ear Pathophysiology is volume 44 of the Advances in OtoRhino-Luryngology series edited by Dr Pfaltz. The book contains two chapters: “Otoacoustic Emissions: an Overview” by R. Probst of Basel, and “Ototoxicity of Loop Diuretics, Morphological and Electrophysiological Examinations in Animal Experiments” by C.P. Hommerich of Diisseldorf. The purpose of the series is to review selected special topics for the nonspecialist. The two chapters in this volume are quite different in approach and content. Dr Probst’s chapter (91 pages, with 15 figures and 16 tables) is a very complete review of a highly volatile topic, and is noteworthy for its succinct organization of a somewhat fractious literature. The clear definitions of the various types of emissions (spontaneous, transientevoked, stimulus-frequency, and distortion-product) and the consistent structure of the chapter allow the reader to follow the many lines of research undertaken to describe otoacoustic emissions. The overview of the animal and human data is fairly complete, with clear descriptions of the similarities and differences in results from different species. The discussions of the clinical utility of the different emissions are brief but to the point, as are the technical discussions of measurement equipment and models of emission generation. Most of the tables are used to help pull together the literature on the varied subtopics of the chapter, and are quite complete. The last few pages of the chapter contain a successful synthesis of the varied data, the most notable point of which is the proposed dichotomy between “place-fixed” emissions, associated with specific places on the basilar membrane; and “wave-fixed” emissions, associated with some intrinsic property of the normal transduction process. Dr Hommerich’s chapter (73 pages, with 44 figures) is more like a monograph; its primary aim is to introduce new data gathered by the author and then use it to support the argument that loop diuretics are “striatoxic” not ototoxic. The data presented are morphologic and physiologic measurements from the cochlea and ampullae of guinea pigs, and the basilar papilla and ampullae of pigeons. The main justification for Dr Hommerich’s contention is that ethacrynic acid, which is known to have a large effect on the endocochlear potential and morphology of the stria vascularis of guinea pigs, has little effect on either the secretory epithelia in the ampullae of guinea pigs and pigeons, the tegmenturn vasculosum of the pigeon basilar papilla, or the endolymphatic potentials associated with these three structures. A supplemental argument is that endolymphatic potential is large only in the guinea pig cochlea and not in the other three end organs. These two
JOHN J. ROSOWSKI,PHD Boston, MA
Jury of My Peers. HC Snider Jr, MD. Montgomery, Fountain Press, 1989, 292 pages.
AL,
This 292-page narrative graphically depicts general surgeon Howard Snider’s first encounter with a malpractice case. This very complex medical case dealt with a 26-year-old woman with recurrent carcinoma who underwent an extensive pelvic exenteration. Her chances of surviving the surgery and living without recurrence of the carcinoma were slight. Although treatment was successful, Dr Snider found that, instead of being grateful for saving her life, his patient had sued him for malpractice. Dr Snider’s concise recounting and orderly discussion of this case, and the way it unfolded in court, could frighten any surgeon. The reader is made to realize that the jury system of handling these complex medical cases is a complete travesty for all involved. This case reads like a mystery to which the reader must agree with the author’s solution: the present system of jury trial must be changed. As Dr Snider clearly illustrates, 12 lay persons can not be expected to comprehend the medical facts involved in a malpractice trial. The present system is not a trial based on fact, but rather a theatrical competition in which the members of the jury award the best performance. The reader of this book should come away with the feeling that the tort system is chaotic, expensive, and inequitable. The author makes a strong case for changing the system of malpractice litigation, and not just tort reform. For the sake of both physician and patient, the current tort system must be discontinued and replaced with a system that fairly compensates an injured party. When only 28% of all the money spent goes to the plaintiff, then surely the system needs changing. Jury of My Peers would make compelling reading for any physician. This reviewer had a hard time putting the book down until the jury’s verdict was in. But the reader needn’t be a physician to identify with the author, who brings the paradoxical malpractice situation so forcibly into focus, exposes the total inadequacy of the present system, and outlines the gross changes necessary to correct it. ROGER S. KAUFMAN, MD Syracuse, NY
433
Book Reviews ROGER KAUFMAN, MD, EDITOR New Aspects of Cochlear Mechanics and Inner Ear Pathophysiology. CR Pfaltz (ed). Karger, Basel, 1990, 170 pages, 59 figures and 16 tables, $120.
threads of thought are used to suggest that the stria vascularis is unique. This suggestion is discussed in light of other literature on the topic, but the clear purpose of the chapter is to introduce the new data and conclusions. This emphasis on new data makes this chapter a much less satisfying review.
New Aspects of Cochlear Mechanics and Inner Ear Pathophysiology is volume 44 of the Advances in OtoRhino-Luryngology series edited by Dr Pfaltz. The book contains two chapters: “Otoacoustic Emissions: an Overview” by R. Probst of Basel, and “Ototoxicity of Loop Diuretics, Morphological and Electrophysiological Examinations in Animal Experiments” by C.P. Hommerich of Diisseldorf. The purpose of the series is to review selected special topics for the nonspecialist. The two chapters in this volume are quite different in approach and content. Dr Probst’s chapter (91 pages, with 15 figures and 16 tables) is a very complete review of a highly volatile topic, and is noteworthy for its succinct organization of a somewhat fractious literature. The clear definitions of the various types of emissions (spontaneous, transientevoked, stimulus-frequency, and distortion-product) and the consistent structure of the chapter allow the reader to follow the many lines of research undertaken to describe otoacoustic emissions. The overview of the animal and human data is fairly complete, with clear descriptions of the similarities and differences in results from different species. The discussions of the clinical utility of the different emissions are brief but to the point, as are the technical discussions of measurement equipment and models of emission generation. Most of the tables are used to help pull together the literature on the varied subtopics of the chapter, and are quite complete. The last few pages of the chapter contain a successful synthesis of the varied data, the most notable point of which is the proposed dichotomy between “place-fixed” emissions, associated with specific places on the basilar membrane; and “wave-fixed” emissions, associated with some intrinsic property of the normal transduction process. Dr Hommerich’s chapter (73 pages, with 44 figures) is more like a monograph; its primary aim is to introduce new data gathered by the author and then use it to support the argument that loop diuretics are “striatoxic” not ototoxic. The data presented are morphologic and physiologic measurements from the cochlea and ampullae of guinea pigs, and the basilar papilla and ampullae of pigeons. The main justification for Dr Hommerich’s contention is that ethacrynic acid, which is known to have a large effect on the endocochlear potential and morphology of the stria vascularis of guinea pigs, has little effect on either the secretory epithelia in the ampullae of guinea pigs and pigeons, the tegmenturn vasculosum of the pigeon basilar papilla, or the endolymphatic potentials associated with these three structures. A supplemental argument is that endolymphatic potential is large only in the guinea pig cochlea and not in the other three end organs. These two
JOHN J. ROSOWSKI,PHD Boston, MA
Jury of My Peers. HC Snider Jr, MD. Montgomery, Fountain Press, 1989, 292 pages.
AL,
This 292-page narrative graphically depicts general surgeon Howard Snider’s first encounter with a malpractice case. This very complex medical case dealt with a 26-year-old woman with recurrent carcinoma who underwent an extensive pelvic exenteration. Her chances of surviving the surgery and living without recurrence of the carcinoma were slight. Although treatment was successful, Dr Snider found that, instead of being grateful for saving her life, his patient had sued him for malpractice. Dr Snider’s concise recounting and orderly discussion of this case, and the way it unfolded in court, could frighten any surgeon. The reader is made to realize that the jury system of handling these complex medical cases is a complete travesty for all involved. This case reads like a mystery to which the reader must agree with the author’s solution: the present system of jury trial must be changed. As Dr Snider clearly illustrates, 12 lay persons can not be expected to comprehend the medical facts involved in a malpractice trial. The present system is not a trial based on fact, but rather a theatrical competition in which the members of the jury award the best performance. The reader of this book should come away with the feeling that the tort system is chaotic, expensive, and inequitable. The author makes a strong case for changing the system of malpractice litigation, and not just tort reform. For the sake of both physician and patient, the current tort system must be discontinued and replaced with a system that fairly compensates an injured party. When only 28% of all the money spent goes to the plaintiff, then surely the system needs changing. Jury of My Peers would make compelling reading for any physician. This reviewer had a hard time putting the book down until the jury’s verdict was in. But the reader needn’t be a physician to identify with the author, who brings the paradoxical malpractice situation so forcibly into focus, exposes the total inadequacy of the present system, and outlines the gross changes necessary to correct it. ROGER S. KAUFMAN, MD Syracuse, NY
433