This is a prospective in-depth study of patients with sudden idiopathic sensorineural hearing loss. We found that 65% recover completely to functional hearing levels spontaneously and independent of any type of medical treatment. The majority do so within 14 days and many within the first few days. Prognosis can be predicted according to the slope of the initial audiogram (low-frequency losses do better than high-frequency losses), hearing at 8 kHz, erythrocyte sedimentation rates, in some select instances spatial disorientation symptoms, and speech discrimination scores. There was a very poor correlation between hearing and vestibular test abnormalities, except hypoactive calories. There were no correlations with age (excepting the very elderly), with antecedent respiratory infections, hypertension, diabetes, or other chronic diseases. We conclude that there is a fundamental difference in the behavior of apical and basal cochlea losses, that hearing recovery is always better at low than at high frequencies, that because of the high spontaneous recovery rates, tympanotomies seeking peri-lymph fistulas should be delayed ten days unless there is a progressive hearing loss, and that none of the current recommended treatments, especially histamine, have any effect on the outcome.

No abstract

The excellent visualization and atraumatic surgical techniques of endoscopic sinus surgery have been applied to the management of five cerebrospinal fluid leaks and two nasal cephaloceles. In all cases, the exact site of the lesion was identified. Four cerebrospinal fluid leaks were grafted with a free or pedicled septal mucosal graft. The fifth cerebrospinal fluid leak came from a narrow sphenoethmoid recess and stopped after the mucosa was abraded. The two cephaloceles were reduced intranasally and covered with bone and mucosal grafts. Not all cases seen in the same time period were treated endoscopically; two additional cerebrospinal fluid leaks were treated with conventional techniques because of severe nasal inflammatory disease and intracranial complications. The technique and indications for endoscopic management of cerebrospinal fluid leaks and cephaloceles are discussed.

Fifty-four patients were seen between January 2002 and June 2007 with the chief complaint of constant pulsatile tinnitus, excluding those with chemodectomas. On the basis of physical examination and imaging, 14 were considered arterial, 23 venous, and 15 were indeterminate in origin. Among patients with venous tinnitus, sigmoid sinus diverticulum was the most common finding. Among patients with arterial tinnitus, carotid atherosclerotic disease was the most common. One patient had erosion of the cochlea by the carotid artery. Non-vascular entities identified include superior semicircular canal dehiscence and benign intracranial hypertension.

Functional endoscopic surgery affords the potential for dramatically reducing operative morbidity of surgery for paranasal sinus mucoceles by offering a minimally invasive approach under local anesthesia. Following surgery, direct endoscopic visualization of the area enables accurate follow-up. Unlike sinus obliteration, the ability to accurately image the sinus by CT is also preserved. This paper presents our preliminary experience with 18 mucoceles in which endoscopic sinus surgery was attempted. Five patients had preoperative proptosis and diplopia, three had Pott's puffy tumor and five had erosion of the posterior table of the frontal sinus. Fifteen patients were satisfactorily treated endoscopically, two lesions could not be satisfactorily approached and required external surgery, and one patient had persistent disease. No disease recurrence has been noted to date with endoscopic follow-up of up to 42 months.

The use of exercises in the treatment of patients with vestibular deficits has become increasingly popular, and evidence exists that these exercises are beneficial in patients with chronic vestibular deficits. The question as to whether patients with acute unilateral vestibular loss would benefit from vestibular adaptation exercises is particularly compelling, however, because animal studies have demonstrated that the acute stage after unilateral vestibular loss is a critical period for recovery. Deprivation of visuomotor experience during that period can delay the onset of recovery as well as prolong the recovery period. Patients often avoid movement during the early stage because, with movement, they experience an increase in dysequilibrium and nausea. We examined the recovery of postural stability in patients during the acute stage after resection of acoustic neuroma to determine whether vestibular adaptation exercises facilitate the onset of recovery and improve the rate of recovery. The results suggest that vestibular adaptation exercises result in improved postural stability and in a diminished perception of dysequilibrium.

In 1980, the Southwest Oncology Group instituted a multi-institutional, prospective, randomized phase III trial to evaluate whether inductive chemotherapy improved survival in patients with advanced stage resectable squamous cell carcinoma of the head and neck. From a group of 158 eligible patients, 76 were randomized to conventional treatment (surgery and postoperative radiotherapy), and 82 were assigned to experimental treatment (induction chemotherapy, surgery, postoperative radiotherapy). Median follow-up for living patients was approximately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treatment was longer than the time for patients receiving preoperative chemotherapy, although the survival time differences were not statistically significant. This final analysis demonstrates no benefit in survival using preoperative chemotherapy for advanced stage, resectable head and neck squamous cell carcinoma.

To evaluate the spatial accuracy of a rapid interactive method of transferring computed tomographic (CT) information between its display on a computer screen to its source (test object, operating field), a multidimensional computer combined with a six-jointed position-sensing mechanical arm was tested with a Plexiglas model consisting of 50 rods of varied height and known location, a plastic replica of the skull, and, subsequently, three patients. The median error value between image and real location was 1-2 mm (P > .95), regardless of the registration target sites. The accuracy, however, increased with the selection of widespread registration points, and 95% of all errors were below 3.70 mm (P > .95). The results compare favorably with the four most commonly used stereotaxic framed units. A misregistration error of 0.3-2.2 mm was found during intraoperative correlation between anatomy on the CT display and actual anatomic location in the operative field.