To determine the effects of learning disability on measures of auditory perception, receptive language development, and sequential organization in children with postmeningitic cochlear implants.Retrospective study. Follow-up ranged from 12 months to 7 years.Tertiary care center.Ten pediatric patients with cochlear implants, 5 with documented learning disability.Pediatric cochlear implant test battery performance.Children with learning disability showed slower progress, more inconsistencies, and lower test scores than their partners without learning disability.Learning disability is not a contraindication to cochlear implantation, but preoperative counseling must be available to families and support personnel about preoperative achievements and expectation for these children.
We sought to estimate the prevalence and severity of tinnitus in patients with chronic pain.We conducted a prospective nonrandomized study in which a survey and the Tinnitus Handicap Inventory (THI) were distributed at a tertiary chronic pain clinic.Seventy-two patients participated. 50 women (mean age, 53 years) and 22 men (mean age, 47.5 years); 54.2% reported having tinnitus. There was an even distribution of patients reporting the onset of tinnitus as before versus after the onset of pain. Four patients reported a direct association between tinnitus and pain. The mean THI score was 27 (of 100) (n = 35). Fifteen subjects scored less than 16, indicating no handicap, and 4 scored over 58, indicating a severe handicap.The study results suggest a high incidence of tinnitus within this population. There were few strong associations between pain and tinnitus. Tinnitus does not significantly handicap the majority of these patients.Tinnitus is a common symptom in the chronic pain population but is not a significant problem for these patients.
To investigate the benefits of intratympanic administration of dexamethasone in the treatment of unilateral Meniere's disease, with particular attention to the symptoms of hearing loss and tinnitus.A prospective, randomized, double-blind, crossover study comparing improvements in hearing loss, tinnitus, aural fullness, and caloric vestibular response secondary to intratympanic dexamethasone and sodium hyaluronate injection versus placebo consisting of saline and sodium hyaluronate.A private otology/neurotology practice.Twenty patients diagnosed with either definite or probable Meniere's disease as defined by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium. All patients were < or =21 years old and were not receiving any other form of treatment for their Meniere's disease. Each patient's primary symptoms of concern were hearing loss, aural fullness, and roaring tinnitus.Three consecutive daily administrations of intratympanic dexamethasone or placebo to the involved ear.Changes in audiometric pure-tone averages, speech reception thresholds, caloric vestibular responses, scores on the tinnitus handicap inventories, questionnaires, and telephone interview responses.No significant changes were observed in any measured parameter. Patients were unable to consistently identify which medication was dexamethasone and which was placebo.Intratympanic administration of dexamethasone in a group of patients with unilateral Meniere's disease (Shea's stage IV) showed no benefit over placebo for the treatment of hearing loss and tinnitus.
Cholesterol granuloma cyst of the petrous apex is an uncommon lesion and often presents a diagnostic and management dilemma to the otolaryngologist. Patients usually demonstrate signs and symptoms referable to a mass lesion of the cerebellopontine angle or brainstem. We present two cases of cholesterol granuloma cyst that were treated at our institution and discuss our diagnostic and management algorithms. Also included is a thorough review of the literature.
Controversy regarding the management of early laryngeal carcinoma persists in the absence of a definitive comparison of treatment modalities. This study examines the basic management practices for early laryngeal cancer among the American Academy of Otolaryngology-Head and Neck Surgery membership with an emphasis on the role of conservation surgery.Questionnaires were randomly distributed to 3000 members with 1000 responses. The results were collated and statistically evaluated with multivariable frequency analysis.For operable supraglottic tumors, supraglottic laryngectomy was advocated by 41.6% of those responding. Definitive radiation therapy was suggested by 5.3% of participants and total laryngectomy by 1.4%. Explanation of treatment options with the patient deciding the therapy was selected by 48.3% of responders. For suitable glottic tumors, hemilaryngectomy was recommended by 37.1%, definitive radiation therapy by 8.1%, total laryngectomy by 1.9%, and patient choice by 50.4% of members completing the survey. When patients were left to weigh the treatment options, surgery was much less likely to be chosen than if it was advocated by the physician. Trends were evident according to practice region and setting, but these variables did not correlate strongly with physician recommendations. However, date of residency completion and rating of available radiation oncology services were significant factors. The evaluation of postoperative considerations in laryngeal conservation surgery demonstrated large variability in the definition of a close margin and the perceived need for additional therapy.The varied practice patterns among the American Academy of Otolaryngology-Head and Neck Surgery membership reflect the lack of a comparative outcome analysis for the treatment of early laryngeal carcinoma. Consequently, the full reliance on patient choice, which is more pronounced among young physicians, and cost considerations may have the greatest impact on the future treatment of this disease.
