Transmastoid labyrinthectomy in older patients.

Transmastoid labyrinthectomy is an effective procedure for the control of episodic vertigo due to unilateral peripheral vestibular dysfunction. However, its application in older patients has been limited, primarily because of concerns that older patients may not compensate well postoperatively. Poor vestibular compensation results in constant disequilibrium, motion intolerance, and visual symptomatology. The purpose of this report is to review our results with transmastoid labyrinthectomy in patients over the age of 65. Complete records were available for 22 patients operated on between July 1984 and June 1994. Patient's records were reviewed for age, preoperative duration of symptoms, coexistent medical conditions, vertigo control, and postoperative disequilibrium. Advanced age need not be a contraindication to transmastoid labyrinthectomy.

Carotid body tumors: a review of 30 patients with 46 tumors.

Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors < 5.0 cm, compared with 5 of 9 with tumors > 5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First-bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first-bite pain are postoperative sequelae that are often disregarded in the postoperative period.

Lipocortin I immunolocalization in normal and hydropic guinea pig ears.

Annexins are a family of eight highly conserved proteins that bind phospholipids in the presence of calcium. One of these proteins, lipocortin I, has restricted distribution in adult and developing tissues, suggesting regulatory function. Among the protean roles theorized are regulation of inflammation by influencing eicosanoid production, participation in endo- and exocytosis, and control of membrane permeability. Such processes could have important roles in the inner ear; therefore, we investigated the patterns of lipocortin I expression in the normal guinea pig ear. Lipocortin I appeared at high levels in nonsensory, endolymph-facing tissues. Perilymph-facing cells had little lipocortin I activity. Lipocortin I was minimally expressed, or is absent, in sensory cells of the cochlea and vestibular systems. In the kidney, changes in quantity and distribution of lipocortin I have been seen during recovery from acute tubular necrosis. In an attempt to gain insight into the role of lipocortin I, the authors investigated its response to an experimental insult. Surgically created endolymphatic hydrops was chosen as an insult involving the endolymph-producing epithelia that richly express lipocortin I. Comparing unilaterally created hydrops, for up to 3 weeks' duration, to contralateral control ears demonstrated no quantitative or distribution changes in lipocortin I.

Intracavernous carotid pseudoaneurysm after blunt trauma: case report and discussion.

Epistaxis following blunt facial trauma is usually self-limited and arises from the nasal mucosa, sphenopalatine, or anterior ethmoid arteries. Pseudoaneurysm of the intracavernous carotid artery (ICCA) occurs rarely with penetrating facial trauma, but is even more rare following blunt trauma. Rupture carries a greater than 50% mortality. Because rupture usually occurs after several episodes of epistaxis, recognition of subtle historic and physical findings is paramount to optimal management. Once suspicion is raised, definitive diagnosis and treatment is best accomplished with cerebral arteriogram and trapping of the pseudoaneurysm. We have noted that rupture may be precipitated by angiography, and therefore, we advocate availability of emergent and definitive treatment equipment and personnel prior to performing cerebral arteriography. This should include an otolaryngologist, an interventional radiologist, and a neurosurgeon. A case of ICCA pseudoaneurysm is presented, and the key historic factors are discussed. Radiographic diagnosis and management options are discussed.