No abstract

The objective of surgical management of acoustic tumors is to remove them entirely and preserve facial nerve function and hearing when possible. A dilemma arises when it is not possible to remove the entire tumor without incurring additional neurologic deficits. Twenty patients who underwent intentional incomplete surgical removal of an acoustic neuroma to avoid further neurologic deficit were retrospectively reviewed. They were divided into a subtotal group (resection of less than 95% of tumor) and a near-total group (resection of 95% or more of tumor) and were followed yearly with either computed tomography or magnetic resonance imaging. The subtotal group was planned and consisted of elderly patients (mean age, 68.5 years) with large tumors (mean, 3.1 cm). The near-total group consisted of younger patients (mean age, 45.8 years) and smaller tumors (mean, 2.3 cm). The mean length of followup for all patients was 5.0 years. Ninety percent of patients had House grade I or II facial function post-operatively. Radiologically detectable tumor regrowth occurred in only one patient, who was in the subtotal resection group. Near-total resection of acoustic tumor was not associated with radiologic evidence of regrowth of tumor for the period of observation. Within the limits of the follow-up period of this study, subtotal resection of acoustic neuroma in elderly patients was not associated with clinically significant recurrence in most patients and produced highly satisfactory rates of facial preservation with low surgical morbidity.

Chronic vestibular dysfunction is often a frustrating problem for both patient and physician. A program of customized vestibular habituation therapy is introduced and its efficacy in a group of 65 patients is evaluated. Preliminary findings suggest that 59% of patients will have a dramatic improvement, after which their vestibular symptoms no longer cause any restriction in their lifestyles. An additional 23% of patients note considerable improvement, but have persistent symptoms that continue to restrict their activities. Vestibular habituation therapy is a rational, multidisciplinary approach to the treatment of chronic vestibular dysfunction that is a significant alternative to traditional pharmacologic management. Failure of vestibular compensation after involvement in a disciplined program of habituation therapy constitutes a much stronger indication for vestibular surgery in patients with unilateral peripheral lesions.

Facial electroneurography (ENoG) appears to be a reliable prognostic test for intratemporal facial nerve paralysis. ENoG is objective and allows a permanent record to be maintained. Nonetheless, occasional inconsistencies in clinical correlation may diminish the utility of ENoG. A qualitative study was undertaken to identify the possible reasons for the inaccuracy of ENoG in some patients. Four clinical groups and one experimental group were studied: (1) normal subjects, (2) patients with acute facial palsy, (3) patients with progressive facial palsy, (4) patients with temporal bone tumors and normal facial function, and (5) animals in which one facial nerve was crushed and repaired. The reliability of ENoG is dependent on careful interpretation of data obtained by optimal electrode placement and stimulus duration.

No abstract

We investigated the relationship between results of preoperative transtympanic electrical promontory stimulation, duration of deafness, postoperative implanted psychophysical results, and postoperative speech and speech sound recognition as indicated by a battery of five tests. Our subjects were 10 patients implanted with the Cochlear Corporation multielectrode implant, 1 year postimplantation, with a minimum of 17 active electrodes programmed in the bipolar + 1 mode. The results indicated that preoperative promontory thresholds, the slope of the threshold function, and the duration of auditory deprivation are excellent predictors of postoperative speech and speech sound recognition in the auditory (processor alone) mode. These results have significant implications for patient selection and counseling.

Advances in the diagnosis and intraoperative management of acoustic neuromas have greatly reduced the incidence of neurologic deficits following their removal. Ninety-three patients underwent acoustic tumor removal during a 41/2-year period, and hearing preservation was attempted in 20 cases. Hearing was preserved in 65% of the entire series, and excellent results were obtained in tumors less than 1.5 cm. No patient with a tumor greater than 1.5 cm had serviceable hearing preserved when total tumor removal was performed. Two patients, one with neurofibromatosis and one with an acoustic neuroma in an only-hearing ear, had planned partial tumor removal with preservation of hearing. Preoperative auditory brainstem response results were not predictive of postoperative hearing preservation. Intraoperative auditory brainstem response monitoring demonstrated that loss of wave V consistently correlated with loss of hearing postoperatively, whereas persistence of wave V (with a latency prolongation not exceeding 3.00 ms) was predictive of successful hearing preservation regardless of latency increases.

Three hundred ninety‐seven patients with 407 cutaneous malignancies of the auricle, periauricular region, and cartilaginous external ear canal were reviewed. Tumors were most commonly located in the preauricular and postauricu‐lar regions, followed by the helix, concha, antihelix, and ear canal. All lesions were excised with Mohs microscopic control of margins. For lesions requiring lateral temporal bone resection, an adaptation of fresh‐tissue microscopic control was used to analyze deep and anterior margins suspected of harboring residual tumor. Two‐year minimum follow‐up of 229 patients with periauricular and auricular tumors (N = 231 tumors) and 14 patients with cartilaginous ear canal tumors (N = 14 tumors) revealed recurrence rates of 6.9% and 14.3%, respectively. Recurrences were most common in cases of large tumors (>2.5 cm), basal cell carcinomas with morphea elements, and multiply recurrent lesions. We conclude that Mohs surgery is comparatively effective, though not uniformly curative, and can be adapted to supplement excision of large tumors in these regions.