Dirofilaria repens infection in northern Israel.

The fourth case of zoonotic Dirofilaria repens infection in Israel is reported, and the diagnostic morphologic characteristics of this filariid are reviewed. The importance of the exact anatomic diagnosis of this filaria is stressed in view of the fact that Israel has pockets of settlers from East Africa, a region endemic for lymphatic filariasis (Wuchereria bancrofti). Since the possibility of introduction of such an infection into the country exists, differentiating this zoonotic Dirofilaria from other filarial worms is essential. The clinicopathological features of a Dirofilaria repens infection are distinct. The patient initially has a painful subcutaneous or conjunctival swelling; the excisional biopsy shows the presence of a dead or alive, usually female worm that measures 220-660 microns across; the central intestine and the genital organs (two uteri) are located in the pseudocoelom; the thick, multilayered cuticle is provided with 95-105 sharp, longitudinal ridges, the latter being separated from each other by a distance of 12 microns; the circumferential muscle cell layer, covering the inner side of the cuticle, is bilaterally interrupted by the large chord cells, two to five nuclei of which are discernible in each cross section.

Malignant triton tumor of the nose and paranasal sinuses: a case study.

A patient with sinonasal malignant triton tumor (ie, malignant schwannoma with rhabdomyoblastic differentiation) is described. In spite of its recurrence, the tumor has behaved as a slow-growing, locally aggressive, low-grade sarcoma for 3 years. This deviatory behavior is ascribed to well-differentiated nature and the primary exophytic-polypoid growth of the tumor.

Drug-induced tinnitus and other hearing disorders.

Tinnitus and hearing loss, both reversible and irreversible, are associated both with acute intoxication and long term administration of a large range of drugs. The mechanism causing drug-induced ototoxicity is unclear, but may involve biochemical and consequent electrophysiological changes in the inner ear and eighth cranial nerve impulse transmission. Over 130 drugs and chemicals have been reported to be potentially ototoxic. The major classes are the aminoglycosides and other antimicrobials, anti-inflammatory agents, diuretics, antimalarial drugs, antineoplastic agents and some topically administered agents. Prevention of drug-induced ototoxicity is generally based upon consideration and avoidance of appropriate risk factors, as well as on monitoring of renal function, serum drug concentrations, and cochlear and auditory functions before and during drug therapy. Ototoxicity, although not life-threatening, may cause considerable discomfort to patients taking ototoxic drugs, and in some cases drug discontinuation may be necessary to prevent permanent damage. Much research has been performed to investigate the causes and mechanisms of ototoxicity, to try to prevent this complication. Despite these efforts, ototoxicity still occurs, and there is much work to be done in order to understand the mechanism of ototoxicity of different drugs and to prevent hearing loss and tinnitus in the future.

Structural abnormalities in the stria vascularis following chronic gentamicin treatment.

Freeze-fracture and thin-sectioning have been used to examine the stria vascularis of albino guinea pigs chronically treated with gentamicin. Immediately following the end of treatment, most marginal cells showed lipid bodies in the cell body region and freeze-fracture revealed alterations to the marginal cell plasma membrane. Intermediate cells also showed peculiarities including a dilation of the rough endoplasmic reticulum. A co-incidence was noted in the location in the cochlea in which effects in the stria and in outer hair cells occurred. At 4 weeks post-treatment, the stria was significantly thinner than normal and appeared less structurally complex. A minority of marginal cells degenerated. Some morphological features associated with degeneration resembled those of apoptosis, a process of controlled, cellular self-destruction. There were also indications of turnover of gap-junctions throughout the post-treatment period examined. The results indicate significant ototoxic effects of gentamicin occur in the stria and that changes to plasma membranes are one of the initial alterations.

Accuracy of fine needle aspiration biopsy in neck masses.

One hundred thirty-eight fine needle aspirations (FNA) of neck masses were performed during a four-year period (1979-1982). The pre-existing literature was reviewed. An accuracy rate of 85% in FNA of neck masses was found, and a 100% accuracy rate in cases of benign tumors of the neck and developmental cysts of the neck was found.

Effect of hearing aids on hearing.

We examined 114 patients aged 10 to 91 years with different kinds of hearing aids fitted in one ear only, the unaided ear acting as a control. They were re-examined several times during a period of follow-up from 1 to 9 years comparing the relative change in hearing due to hearing aid usage with various degrees of amplification of the aid. We compared the degree of hearing loss in the aided and unaided ear looking for evidence of a possible change in hearing related to the frequency of hearing aid usage in hours per day and in years, the maximum power output (MPO) and the gain of the aid. According to our findings there is no change in hearing between the aided and the unaided ear at the alpha = 0.05 probability level at least for 8 years. There is no effect of the long-term amplification of the hearing aid on deterioration of hearing comparing the aided ear and the unaided ear, but with high MPO of the aid, the patient should be followed up more frequently than with low MPO amplification.

Sialadenoma papilliferum of the parotid gland.

A case of sialadenoma papilliferum of the parotid gland in a 35-year-old woman is described. The tumor was locally excised and no recurrence was evident after a follow-up period of 30 months.

Plasmacytoma arising in the vicinity of a foreign body in the nasal cavity.

The development of a plasmacytoma in the vicinity of a long residing metallic foreign body in the nasal cavity is presented. In spite of the multitude of reports concerning neoplasma associated with trauma, most of which arise in chronic scars, this presentation is very rare. It is speculated that the plasma cell proliferation, occurring nearby the foreign body, roots from an immunologic and granulomatous reaction. This case is discussed in light of the vast data on foreign body tumorigenesis obtained from laboratory animals, and the implications of this data are outlined. Further attention should be drawn to the clinical associations of malignant processes co-existing with long-standing foreign bodies.

Brainstem auditory evoked potentials with increased stimulus rate in patients suffering from systemic lupus erythematosus.

Central nervous system involvement in systemic lupus erythematosus is frequently occult, may be the presenting sign, and is a bad prognostic indicator. At present, there is no reliable, sensitive laboratory test for the evaluation and diagnosis of subclinical central nervous system involvement of the disease. Brainstem auditory evoked potentials with and without increased stimulus rate have been used to diagnose ischemic lesions in the central nervous system. Brainstem auditory evoked potentials, with and without increased stimulus rate, was used to investigate 15 systemic lupus erythematosus patients, 20 normal participants, and 5 patients receiving corticosteroids for bronchial asthma. A significant statistical difference was found in the net effect of increased stimulus rate in comparisons of the systemic lupus erythematosus patients with the normal group. Brainstem auditory evoked potentials, with increased stimulus rate, demonstrated subclinical involvement of the central nervous system in systemic lupus erythematosus, reinforcing the notion that increased stimulus rate measures are sensitive to ischemic changes, in this case, even in neurologically asymptomatic patients.

Toxic effects of cisplatin alone and in combination with gentamicin in stria vascularis of guinea pigs.

The toxic effects on the stria vascularis of treatment with cisplatin alone and combined with the aminoglycoside antibiotic, gentamicin, were studied in guinea pigs. The toxicity induced in albino and pigmented guinea pigs was investigated morphologically with light and transmission electron microscopy, and functionally by brainstem-evoked response audiometry. The results of hearing thresholds were variable, ranging from no change in one ear in some of the animals to a hearing loss of 20 dB in one or both ears when treated with low-dose cisplatin alone or in combination with gentamicin. Bilateral deafness resulted from high-dose cisplatin combined with gentamicin. The combined treatment produced prominent structural damage in the stria vascularis. The results should be considered when aminoglycoside therapy is required in conjunction with cisplatin.

Cisplatin ototoxicity in guinea pigs with special reference to toxic effects in the stria vascularis.

The toxic effects of cisplatin (cis-diamminedichloroplatinum [II]) on the organ of Corti are well established. Few and conflicting data on this drug's effects on the stria vascularis exist. The present study presents animal experiments on the toxic effects of cisplatin in the stria vascularis and in the organ of Corti. Cisplatin-induced toxicity in albino and pigmented guinea pigs was evaluated morphologically and functionally, using light and transmission electron microscopy as well as auditory brainstem-evoked potentials on the organ of Corti and the stria vascularis. The results showed variability in hearing thresholds, ranging from no change to hearing loss of 30 dB, and prominent damage in the organ of Corti and in the stria vascularis. The toxic effects to both the organ of Corti and the stria vascularis should be considered when cisplatin is used in chemotherapy.

A comparison of auditory brain stem evoked potentials in hyperlipidemics and normolipemic subjects.

Twenty-five hyperlipidemic, neurologically and audiologically asymptomatic patients were compared to 20 normolipemic control subjects regarding different interpeak latency differences (IPLD) of auditory brain stem evoked potentials (ABEP). ABEP were recorded in response to click stimuli presented at a rate of 10/sec and 55/sec. The net effect of increasing stimulus rate (ISR) on IPLD of ABEP was significantly greater in the hyperlipidemic patients for IPLD (V-I) and IPLD (III-I). ISR of ABEP indicates a trend of subclinical impairments of brain stem function in hyperlipidemic patients, probably due to ischemia accelerated by their condition.

The efficacy of oral steroids in the treatment of persistent otitis media with effusion.

One hundred thirty-six children with otitis media with effusion of at least 2 months' duration were investigated in a strict, double-blind, randomized prospective study to evaluate the efficacy of oral steroids in the treatment of this disease. The results of our study showed a significant complete and partial recovery from otitis media with effusion in the group treated by a combination of antibiotics (amoxicillin) and oral steroids (prednisone), compared with an amoxicillin-treated group and a placebo-treated group. We believe that this treatment mostly benefits children aged 4 to 10 years without oversized adenoids. The findings of our study imply that a combined course of antibiotics and oral steroids deserves its place as a routine conservative trial before surgery.

Noninvasive recordings of cochlear evoked potentials in Meniere's disease.

Noninvasive meatal electrocochleography simultaneously recorded with brain stem auditory evoked potentials were performed on 24 adult patients with unilateral Meniere's disease. Data from the affected ear were compared with those of the nonaffected ear and with those of ten healthy normally hearing adults. The most striking finding was the significant deviation from the norm of the nonaffected ears' action potential duration. The combination of simultaneously recorded surface meatal electrocochleography and brain stem auditory evoked potentials complement the diagnostic battery of Meniere's disease in ruling out retrocochlear involvement, indicating cochlear involvement of the affected ear, and revealing subclinical changes in the contralateral ears.

Chronic otitis media treated topically with ciprofloxacin or tobramycin.

OBJECTIVE: To evaluate the efficacy of ciprofloxacin compared with tobramycin and placebo ear drops in the treatment of chronic suppurative otitis media without cholesteatoma. DESIGN: Sixty ears (in 51 patients) were randomly divided into 3 treatment groups: ciprofloxacin hydrochloride, tobramycin, and placebo interventions. SETTING: The otolaryngology department of a university teaching hospital. INTERVENTION: All ears were treated topically for 3 weeks. MAIN OUTCOME MEASURES: Each patient received a small, numbered bottle and was instructed to instill 5 drops 3 times daily for 3 weeks. The final clinical and bacteriologic assessment was made after 3 weeks. RESULTS: The organism most commonly isolated from the ear discharge was Pseudomonas aeruginosa. Its sensitivity to ciprofloxacin and tobramycin was 94.2% and 70.6%, respectively. The clinical response was 78.9%, 72.2%, and 41.2% in the ciprofloxacin, tobramycin, and placebo groups, respectively. The bacteriologic response rate was 66.7% for the ciprofloxacin and tobramycin groups and 20% for the placebo group. Treatment with ciprofloxacin ear drops seemed to be as effective as treatment with tobramycin. CONCLUSION: While the lack of ototoxicity of ciprofloxacin was not tested in our study, this treatment may be considered as a potential topical therapy for cases of chronic suppurative otitis media.

Cholesteatomas associated with ventilation tube insertion.

OBJECTIVES: To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication. DESIGN: We reviewed the medical records of 2829 children following VT insertion between the years 1978 and 1997 to obtain 1- to 20-year follow-up data. SETTING: Departments of Otolaryngology-Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers. PATIENTS: A study population of 2829 children, ranging in age from 1.2 to 14 years (5575 ears), underwent a total of 6701 VT placements. MAIN OUTCOME MEASURE: Cholesteatomas were considered a complication of VT placement whenever they developed at or near the site of the tube insertion. RESULTS: Cholesteatomas directly attributed to VT placement occurred in 1.1% of the ears that were operated on. A higher incidence occurred (1) in children younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent post-operative otorrhea. CONCLUSIONS: Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.

Carbon-carbon middle ear prosthesis: a preliminary clinical human trial report.

In a variety of structural forms, carbon-carbon possesses certain properties that render it suitable for implantation in the human body. Twenty-four patients underwent tympanoplasty in which carbon-carbon was used as an alloplastic material for reconstructing the ossicular chain; these patients were followed for a period of 9 to 15 months. The good anatomic and hearing results of our clinical trial led us to suggest the carbon-carbon prosthesis as an alternative alloplastic material to be used in tympanoplasties.

Intrinsic vasculature of the labyrinthine segment of the facial nerve--implications for site of lesion in Bell's palsy.

Recent studies of the intrinsic vasculature of the cat facial nerve have demonstrated relatively poor blood supply to the labyrinthine segment. In this study, the intrinsic vasculature of the human facial nerve was systematically evaluated in 25 temporal bones and three fresh cadaver nerves. Cross-sectional vessel counts were obtained for the labyrinthine, tympanic, and mastoid segments. Capillary densities for each segment were derived from these data. The labyrinthine segment of the human facial nerve, like that in the cat, contains fewer and smaller intrinsic blood vessels than do the mastoid and tympanic segments. This may indicate that the labyrinthine segment of the facial nerve may be more vulnerable to ischemic damage. In conjunction with the previously demonstrated narrowness of the labyrinthine fallopian canal, these findings support the contention that the labyrinthine segment is a likely site of lesion in Bell's palsy.

Is the vestibular system affected by middle ear effusion?

The association between middle ear effusion (MEE) and vestibular pathology is controversial. To investigate this point, 50 children with MEE scheduled for myringotomy and grommet, and 20 normal hearing children without MEE scheduled for adenotonsillectomy, underwent vestibular investigations by craniocorpography and rotatory chair, preoperatively and postoperatively. Most of the correlations, preoperative vs. postoperative, and study vs. control groups, were nonsignificant. Assuming that serous labyrinthitis is responsible for vestibular involvement in MEE, the lack of significant vestibular pathology in our study could probably be explained by the fact that no children with acute otitis media episodes or otalgia were included.

Brain stem auditory evoked potentials: effects of ovarian steroids correlated with increased incidence of Bell's palsy in pregnancy.

To investigate the effect of ovarian steroids on the brain stem during changes of estrogen and progesterone blood levels, we recorded brain stem auditory evoked potentials with increased stimulus rates from 26 women treated for sterility by menotropins (Pergonal and Metrodin). These women were divided into three groups according to their estrogen and progesterone blood levels. The brain stem auditory evoked potential results revealed a significant delay of peak III only, with an increased stimulus rate in the group with the highest estrogen level. Estrogen may cause a brain stem synaptic impairment, presumably because of ischemic changes, and thus also may be responsible for a higher incidence of Bell's palsy during pregnancy.