Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients.

INTRODUCTION: The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS: A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS: The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION: Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

Factors associated with anxiety and depression in the management of acoustic neuroma patients.

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

Lateral skull base surgery: a complicated pursuit?

The management of lesions of the lateral skull base is a highly sophisticated branch of surgery generally performed by otolaryngology-head and neck surgeons as part of a multi-disciplinary team. Assessment of patients with diseases affecting the lateral skull base can be complex, as can the application of the various treatment modalities and the management of the expected and unexpected side effects of that treatment. A wide range of pathological conditions occur in the lateral skull base. Many operations and procedures have been described for dealing with them. There is not necessarily one correct solution to the management of any particular problem in the skull base, with multiple factors to be considered in planning and intervention. As surgeons, we need to know how our own results and outcomes compare with pooled, published data concerning the implications and complications occurring as a result of intervention, in order to better advise our patients on their management.

Improving public mental health services for trauma victims in South Carolina.

Studies have shown that trauma and posttraumatic stress disorder are highly prevalent among persons with serious mental illness who are treated in state-funded mental health systems. Nevertheless, there is strong evidence that many of these persons receive inadequate mental health services. South Carolina recently became one of at least 15 states whose departments of mental health have initiated efforts to better address these needs. The goals of this initiative are to sensitize stakeholders, influence policies, educate and train clinicians, and increase knowledge by supporting a strong empirical research platform. Current progress and future directions are described in this article.

Absence of toxicity in patients with malignant otitis externa following long-term treatment with high dosage tobramycin.

An in-vitro model of aminoglycoside dosing was used to demonstrate that the bactericidal activity of tobramycin against Pseudomonas aeruginosa is directly related to the peak concentration of the drug. In addition, six patients who were being treated for malignant otitis externa with long-term, high dosage tobramycin were monitored for oto- and nephro-toxicity; the only adverse effects were transient increases in the serum creatinine concentration in two patients.

Sinusoidal harmonic acceleration testing in normal humans.

Forty-one normal humans were tested with sinusoidal harmonic acceleration. Phase lag at 0.01, 0.02, and 0.04 Hz was the most stable parameter, with less test-retest variability than gain and asymmetry. There was no significant difference between men and women for phase lag, gain, or asymmetry at any of the five testing frequencies. Gain decreased as age increased. Age had no effect on phase lag at most test frequencies or on asymmetry at any frequency.

Congenital ossicular abnormalities: a review of 68 cases.

Sixty-eight cases of congenital conductive hearing loss due to ossicular abnormalities were reviewed. The clinical and surgical details of each case were documented, and a classification was drawn up on the basis of the abnormalities encountered. Sixty-six percent of the cases were documented as middle ear anomalies in the absence of any other evidence of congenital disease. Improved hearing was obtained in 47% of those cases where corrective surgery was undertaken. Treatment and results are reviewed. The pattern of ossicular abnormality encountered in this series suggests a variable origin of the incus, either from first branchial arch alone or from both first and second branchial arches.

Craniofacial resection of extensive benign lesions of the anterior skull base.

The craniofacial resection operation was developed for the treatment of advanced nasal, paranasal and orbital malignancies. It has been refined in recent years, giving increased cure rates and better palliation when cure is not possible. When used to treat extensive benign lesions involving the anterior skull base, this procedure allows more complete and safer resection with better access for repair and avoidance of major complications of brain damage, cerebrospinal fluid leak and haemorrhage. Presented here is a technique for craniofacial resection. The study demonstrates its effectiveness and low morbidity in treating 10 patients with extensive benign disease.

Light and electronmicroscopic studies on Polycel ossicular replacement prostheses.

Recently, a new form of porous high density polyethylene (Polycel) has been promoted for use in ossicular chain reconstruction. However, we have found no reports of investigation of the fate of this material used for this purpose in either animals or man. This study was undertaken to look at the tissue tolerance and fate of Polycel in the middle ear of gerbils before its extensive use in humans. We present the light and transmission electromicroscopic findings from these prostheses, removed from the middle ear between 1 and 5 months post-implantation. The results are similar to those found with Plastipore, showing a strong foreign body reaction and the likelihood of phagocytic consumption. As with the other porous plastics, we have reservations about the use of Polycel for ossicular reconstruction.

Problems in clinical assessment of palatal tumours.

This paper reviews the classification of tumours affecting the palate. The embryology and anatomy of the palate are outlined in relation to the TNM classification of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJC) for the oral cavity and oropharynx. A series of 80 palatal tumours is reviewed to assess the adequacy of the classification schemes in providing accurate data for tumour treatment comparison. Both schemes rely on relatively crude assessment of total tumour extent and neither provides enough detail to allow valid comparisons.