The American journal of otology
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This study describes the endoscopic anatomy of the cerebellopontine angle (CPA). Endoscopes were introduced into the basal cisterns and it was found that the neurovascular structures of this angle could be seen in detail. ⋯ The need for minimally invasive surgery may mandate further study of the application of this type of endoscopy in surgical practice. It is stressed that considerable cadaver experience should be obtained with this technique prior to any application in the operating room.
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Review Comparative Study
A comparison of facial nerve monitoring systems in cerebellopontine angle surgery.
The use of peripheral nerve monitoring during skull base surgery is becoming a more common procedure. One widely used method (Jako) detects surface muscle contraction, which can be transduced into an audible signal. A 200 microsecond square wave current can be delivered periodically, in order to identify the nerve and verify its integrity. ⋯ Each of the three study groups are matched for a time at which postoperative evaluation was made. Analysis of results reveals that in addition to the expected increase in facial nerve preservation rates when monitoring is in use, the near real-time feedback provided by audible evoked EMG results in a significant reduction in permanent postoperative facial nerve dysfunction. Using evoked monitoring, a greater proportion of the cases had a final outcome of class I or II results, compared to those cases performed using Jako motion detection monitoring.
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As previously stated in this paper, the therapeutic goal in the management of patients with chronic pain conditions in the face, head and neck is management and rehabilitation, striving for a 50 percent decrease in pain, a 50 percent increase in function and mobility, and a 50 percent decrease in medication with the elimination of agents with an addicting potential. These results will best be obtained through proper diagnosis and utilization of the aforementioned techniques in an interdisciplinary fashion as has been described.
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Biography Historical Article
The deafness of Beethoven: an audiologic and medical overview.
The hearing loss of Ludwig von Beethoven has fascinated physicians, audiologists, and musicologists for almost 200 years. In this review of the literature, the features, treatment, and differential diagnosis of the composer's malady are discussed. ⋯ The author concludes with the majority of otologists that cochlear otosclerosis is the most likely diagnosis for the hearing loss. In addition, a summary of Beethoven's complicated medical history and results of the autopsy that confirmed chronic liver disease are included.
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Case Reports
Auditory evoked responses in the management of acutely brain-injured children and adults.
In recent years, the role of auditory evoked responses (AERs) in the intensive care unit (ICU) setting has expanded dramatically for both pediatric and adult brain-injured patient populations. AERs have unique value in early identification and evaluation of peripheral auditory dysfunction that can result directly from head trauma or as a consequence of intensive medical therapy (such as prolonged intubation and ototoxic drugs). ⋯ The rationale for monitoring neurologic status with AERs in this setting is presented and supported with original group data. Important points are illustrated with selected case reports.