To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Little is known about the long term (greater than 10 years) quality of life in patients with vestibular schwannoma. This study aimed to evaluate long-term outcomes in patients with vestibular schwannoma.
A retrospective cohort study was performed across 2 academic institutions, with patients followed at least 10 years after vestibular schwannoma surgery (2000 to 2007). Telephone interviews were used to assess quality of life using the Glasgow Benefit Inventory and short form 12 item (version 2) health survey.
A total of 99 out of 110 patients were included. Increasing age and symptom burden were associated with poorer quality of life (p = 0.01 and 0.02, respectively). The presence of imbalance, headache and facial nerve dysfunction were all associated with poorer quality of life scores (p = 0.01, 0.04 and 0.02, respectively).
Identifying and managing post-operative symptoms may improve quality of life in vestibular schwannoma patients and can guide clinical decision making.
Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific situations.
A retrospective review of all cases of subtotal petrosectomy in cochlear implant surgery over a five-year period was performed. The indications, complications and outcomes for this procedure are outlined.
Sixteen patients underwent cochlear implantation in combination with subtotal petrosectomy and blind sac closure of the external auditory meatus from 2008 to 2013. Seventy-five per cent of these were completed as a two-stage procedure and 25 per cent as a single-stage procedure. The most common indications for the procedure were chronic otitis media, previous radical cavity, and for surgical access in challenging anatomy or in drill-out procedures. Mastoids were obliterated with fat or musculoperiosteal flaps. The complication rate relating to blind sac closure was 6 per cent. Cochlear implants were successfully placed in all cases and there was no incidence of device failure.
For patients with chronic suppurative otitis media or existing mastoid cavities, subtotal petrosectomy with blind sac closure of the external auditory canal, closure of the eustachian tube, and cavity obliteration is an effective technique to facilitate safe cochlear implantation.
Patients with Ménière's disease can develop unaidable sensorineural hearing loss. Cochlear implantation has recently been utilised in this group with favourable results. A more challenging group are those with intractable vertigo, and they have traditionally posed a significant management dilemma.
Two female patients with unaidable hearing and recurrent incapacitating vertigo attacks despite conservative management underwent simultaneous labyrinthectomy and cochlear implantation. There was complete resolution of vertigo in both patients. Speech perception in quiet conditions and the ability to hear in background noise improved considerably.
Surgical labyrinthectomy is effective for the elimination of vertigo in Ménière's disease patients. The major disadvantage in the past was loss of residual hearing. Cochlear implantation is now an option in these patients. The benefits of simultaneous labyrinthectomy with cochlear implantation include the prevention of implantation of a fibrosed or ossified cochlea, a decrease in the duration of deafness, and a single operative procedure.
Many microorganisms have evolved the ability to feed on naturally occurring petroleum hydrocarbons, which they use as sources of carbon and energy to make new microbial cells. Most of the tens of thousands of chemical compounds that make up crude oil can be attacked by bacterial populations indigenous to marine ecosystems. A consortium of different bacterial species rather than any single species acts together to break hydrocarbons down into carbon dioxide, water, and inactive residues. Even toxic oil residues, including highly toxic polycyclic aromatic hydrocarbons (PAH), can be detoxified. Microorganisms do not accumulate hydrocarbons as they consume and degrade them, so they are not a conduit for transferring hydrocarbons into the food web. In fact, microorganisms grown on hydrocarbons can be a potential source of protein for animal and human food (Shennan, 1984).
For many years before the Exxon Valdez oil spill, the US Environmental Protection Agency (EPA), the National Oceanic and Atmospheric Administration (NOAA), and other governmental agencies had supported research on microbial degradation of oil in marine environments – biodegradation – and on ways to enhance and accelerate it – bioremediation. These studies showed that, while in many cases biodegradation can mitigate toxic impacts of spilled oil without causing ecological harm, environmental conditions for it to happen rapidly are not always ideal (Atlas, 1995). If water carrying sufficient amounts of oxygen and nutrients cannot reach the oil, rates of biodegradation will be severely limited: oil incorporated into, or on, sediment above the tidal zone, oil buried in low-permeability sediments (Chapter 7), and thick oil layers and tarballs that are not intimately in contact with flowing water are especially resistant to biodegradation.
To review the microbiology of open tympanomastoid cavities in patients who underwent revision surgery due to chronic instability.
This paper describes a retrospective chart review of surgical revision cases of chronically unstable open mastoid cavities. Patient records from 2000 to 2010 were reviewed for the type of organism cultured, antimicrobial resistance and the presence of cholesteatoma.
In total, 121 revision surgical procedures were performed on 101 patients. Seventy-nine procedures involved culture specimen processing, 37 of which were positive. The most commonly cultured organism was Staphylococcus aureus, which was more than twice as common as any other pathogen. The presence of cholesteatoma had no impact on the likelihood of a positive culture or polymicrobial culture. Antimicrobial-resistant pathogens were uncommon.
A positive culture was not an overwhelmingly common characteristic of unstable tympanomastoid cavities. Furthermore, antimicrobial resistance did not appear to play an essential role in leading patients towards revision open mastoid surgery.
Chronic tympanic membrane perforations can cause significant morbidity. The term myringoplasty describes the operation used to close such perforations. A variety of graft materials are available for use in myringoplasty, but all have limitations and few studies report post-operative hearing outcomes. Recently, the biomedical applications of silk fibroin protein have been studied. This material's biocompatibility, biodegradability and ability to act as a scaffold to support cell growth prompted an investigation of its interaction with human tympanic membrane keratinocytes.
Methods and materials:
Silk fibroin membranes were prepared and human tympanic membrane keratinocytes cultured. Keratinocytes were seeded onto the membranes and immunostained for a number of relevant protein markers relating to cell proliferation, adhesion and specific epithelial differentiation.
The silk fibroin scaffolds successfully supported the growth and adhesion of keratinocytes, whilst also maintaining their cell lineage.
The properties of silk fibroin make it an attractive option for further research, as a potential alternative graft in myringoplasty.
In order to safely explore the medial wall of the attic, a working knowledge of the anatomy of the anterior supralabyrinthine air cell tract is required.
To clarify the surgically relevant anatomical relationships that comprise the anterior supralabyrinthine air cell tract.
Materials and methods:
Surgical dissection of 10 fresh cadaveric temporal bones was undertaken, including measurement of distances between the key anterior supralabyrinthine anatomical landmarks.
The following mean distances were calculated: the labyrinthine segment between the geniculate ganglion and the ampullated end of the superior semicircular canal, 2.33 mm (range 1.75–2.75); the tympanic segment between the anterior margin of the oval window niche and the geniculate ganglion, 3.58 mm (range 3.25–4); and from the tympanic segment adjacent to the anterior margin of the oval window niche to the labyrinthine segment adjacent to the superior semicircular canal, 3.48 mm (range 3–4.25).
The key anatomical landmarks of the anterior supralabyrinthine air cell tract define a distinct triangular segment of bone, knowledge of which is helpful in surgical dissection.
Debra J. Pepler, LaMarsh Centre for Research on Violence and Conflict Resolution, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3, firstname.lastname@example.org,
Wendy M. Craig, Department of Psychology, Queen's University, Kingston, Ontario, Canada, email@example.com,
Paul O'Connell, LaMarsh Centre for Research on Violence and Conflict Resolution, York University, Canada,
Rona Atlas, LaMarsh Centre for Research on Violence and Conflict Resolution, York University, Canada,
Alice Charach, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
Impetus for the intervention study, early stages of planning, and funding
Over the past decade, Canadians have become increasingly aware of the extent and consequences of bullying problems. Recently, there have been several high-profile cases of Canadian children who have suffered from prolonged victimisation, with severe consequences of suicide, revenge attacks, or death at the hands of peers. These cases have highlighted the need for empirically based prevention and intervention programmes. We will describe a school-based intervention programme developed prior to the recent surge in interest in the problem of bullying in Canada.
This anti-bullying initiative emerged from a survey conducted in the early 1990s by the Toronto Board of Education in collaboration with researchers from York University. The questionnaire used for the survey was modelled after the Olweus self-report questionnaire (Olweus, 1989), with some adaptations for the Canadian context. The survey indicated that bullying and victimisation were pervasive problems. During the past two months, 24% of the grade 3–8 students reported that they had bullied other students at least once or twice, and 15% more than once or twice. Half of the students (49%) indicated that they had been victims of bullying at least once, 20% more than once or twice, and 8% reported being victimised weekly or more often during the past two months (Charach, Pepler, and Ziegler, 1995).
Vestibular schwannomas are the most common tumours encountered in the cerebellopontine angle (CPA) region, accounting for 90 per cent of all lesions. Early pyogenic abscess following surgery and delayed abscesses due to retained foreign bodies have been reported. We describe a case of sterile abscess of unknown aetiology in the CPA region, occurring 13 years after surgical excision of a vestibular schwannoma. The clinical and radiological features were suggestive of recurrent vestibular schwannoma or malignant transformation.
We believe this is the first reported case of delayed occurrence of sterile abscess in the CPA region. Further the diagnostic difficulties of such rare lesions occurring in the CPA after vestibular schwannoma surgery are discussed.
The multichannel auditory brainstem implant (ABI) provides the potential for hearing restoration in patients with neurofibromatosis type 2 (NF2). Programmes for auditory brainstem implantation have been established in two Australian centres. Eight patients have been implanted under the protocol of an international multi-centre clinical trial. Three patients had ABI insertion at the time of first side tumour removal, four at second side tumour removal and one after previous bilateral surgery where there was some residual tumour. The translabyrinthine approach was used in all cases. Successful positioning of the electrode array was achieved in seven of eight patients, all of whom achieved auditory perception with electrical stimulation. Intra-operative electrically evoked auditory brainstem response testing was successful in four patients and was useful in confirming correct electrode position. In six cases postoperative psychophysical and auditory perception testing demonstrated that useful auditory sensations were achieved. Five of these patients regularly used the implant. In one patient electrode placement was unsuccessful and only non-auditory sensations occurred on stimulation. In the remaining patients nonauditory sensations were minimal and avoidable by selective electrode programming. Auditory brainstem implantation should be considered in patients with NF2. The greatest benefit is seen in patients without debilitating disease who have non-aidable hearing in the contralateral ear.
From 1985–1994, the Skull Base Unit at St. Vincent's Hospital, Sydney, operated on 61 patients with tumours involving the jugular foramen. Pre-operative assessment by a Speech Pathologist and the institution of swallowing techniques prior to surgery have improved post-operative morbidity. Ancillary procedures at the time of surgery were not required in the majority of cases. An individual assessment of each patient early in the postoperative period was found to be more important with regard to the benefits of supplementary surgery. The majority of patients with dysphagia settled with conservative management and only a few underwent ancillary surgery. It is perceived that the cortical and subcortical control of swallowing is a major factor in the rehabilitation of these patients.
Email your librarian or administrator to recommend adding this to your organisation's collection.