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Otolaryngologist (ear, nose, throat)
31 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
Indiana University (1979)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Detroit Hour Magazine's Top Docs (2010)
U.S. News Top Doctors (2011)
Hour Detroit Magazine's Top Docs (2011)
Hour Detroit Magazine's Top Docs (2010)
Hour Detroit Magazine's Top Docs (2010), Hour Detroit Magazine's Top Docs (2011), U.S. News Top Doctors (2011)
Castle Connolly America's Top Doctors® (2005 - 2008, 2010 - 2014)
Castle Connolly America's Top Doctors® for Cancer (2005 - 2007, 2009 - 2012, 2014)
Patients' Choice 5th Anniversary Award (2014)
Patients' Choice Award (2010 - 2014)
Compassionate Doctor Recognition (2010 - 2013)
Top 10 Doctor - Metro Area (2014)
Metro Detroit
Otolaryngologist
Top 10 Doctor - State (2014)
Michigan
Otolaryngologist
On-Time Doctor Award (2014)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Bojrab is affiliated with 24 hospitals.

Hospital Affilations

Score

Rankings

  • Beaumont Hospital,Troy
    Otolaryngology
    44201 Dequindre Rd, Troy, MI 48085
    • Currently 4 of 4 crosses
    Top 25%
  • St. Mary Mercy Hospital
    Otolaryngology
    36475 5 Mile Rd, Livonia, MI 48154
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Grosse Pointe
    Otolaryngology
    468 Cadieux Rd, Grosse Pointe, MI 48230
    • Currently 4 of 4 crosses
    Top 25%
  • Providence Hospital and Medical Center
    Otolaryngology
    16001 W 9 Mile Rd, Southfield, MI 48075
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital, Royal Oak *
    Otolaryngology
    3601 W 13 Mile Rd, Royal Oak, MI 48073
    • Currently 3 of 4 crosses
    Top 50%
  • DMC - Sinai-Grace Hospital
    Otolaryngology
    6071 W Outer Dr, Detroit, MI 48235
    • Currently 3 of 4 crosses
    Top 50%
  • Oakwood Hospital and Medical Center
    Otolaryngology
    18101 Oakwood Blvd, Dearborn, MI 48124
    • Currently 3 of 4 crosses
    Top 50%
  • St. John Macomb-Oakland Hospital (Oakland Center)
    27351 Dequindre Rd, Madison Heights, MI 48071
    • Currently 3 of 4 crosses
    Top 50%
  • Harper University Hospital
    Otolaryngology
    3990 John R St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • St John Detroit Riverview Hospital
    7733 E Jefferson Ave, Detroit, MI 48214
    • Currently 3 of 4 crosses
    Top 50%
  • Detroit Receiving Hospital & University Health Center
    Otolaryngology
    4201 Saint Antoine St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Huron Valley-Sinai Hospital
    Otolaryngology
    1 William Carls Dr, Commerce Township, MI 48382
    • Currently 2 of 4 crosses
  • Royal Oak
  • Beaumont Affiliation & Years on StaffRoyal Oak
  • Providence Hospital - Southfield *
  • St. Mary Mercy Livonia
  • OAKWOOD HOSPITAL & MEDICAL CENTER DEARBORN
  • Children's Hospital of Michigan
    3901 Beaubien St, Detroit, MI 48201
  • Royal Oak 21 Years
  • Providence Park Hospital
    47601 Grand River Ave, Novi, MI 48374
  • Lutheran Hospital of Indiana
  • Parkview Hospital
  • Oakwood Hospital
  • DuPont Hospital
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Bojrab has contributed to 29 publications.
    Title Lipomatous Hemangiopericytoma of the Skull Base and Parapharyngeal Space.
    Date January 2008
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To discuss the diagnosis and clinical management of lipomatous hemangiopericytoma. STUDY DESIGN: Case report. SETTING: Tertiary referral center. PATIENT: A 36-year-old woman was encountered with symptoms of facial numbness, blurred vision, headache, and lightheadedness of 6 weeks' duration. Magnetic resonance imaging revealed a 5.0-cm mass in the right parapharyngeal space and skull base extending inferiorly to the level of the carotid bifurcation. The mass was consistent radiographically with a glomus jugulare tumor, and surgical extirpation was performed. INTERVENTION: The patient underwent a transtemporal approach to the right posterior fossa and jugular foramen including mastoidectomy and isolation and preservation of Cranial Nerves VII, X, XI, and XII. Microscopic analysis of the mass revealed a highly cellular spindled mesenchymal tumor with a pericytoma pattern. Almost half of the mass displayed a mature lipomatous component. These findings were consistent with a lipomatous hemangiopericytoma. RESULTS: The authors describe the first case of lipomatous hemangiopericytoma involving the skull base. This rare variant of the more common hemangiopericytoma has been described previously in the retroperitoneal and lower extremities. Although one case of lipomatous hemangiopericytoma has been described in the occipital region, this is the first report of this entity involving the parapharyngeal space, skull base, and jugular foramen. CONCLUSION: The authors demonstrate that lipomatous hemangiopericytoma can occur in the parapharyngeal space and skull base. Once thought to be an aggressive variant, this tumor has an extremely low propensity for distant or local recurrence. Adjuvant therapies such as radiation and chemotherapeutic agents are reserved for recurrent or metastatic lesions.

    Title Quality-of-life Assessment of Ménière's Disease Patients After Surgical Labyrinthectomy.
    Date February 2007
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To examine the impact of surgical labyrinthectomy on quality of life of Ménière's disease patients. STUDY DESIGN: Cross-sectional survey. SETTING: Otology subspecialty referral center. PATIENTS: All patients with Ménière's disease who underwent surgical labyrinthectomy between 1998 and 2004 were selected. Fifty-three patients satisfied inclusion criteria. Completed questionnaires were obtained from 44 patients. INTERVENTION(S): The Ménière's Disease Outcomes Questionnaire is a disease-specific quality-of-life questionnaire. It was used to assess the quality of life of patients before and after surgical labyrinthectomy. The questionnaire encompasses physical, mental, and social well-being domains of quality of life. MAIN OUTCOME MEASURE(S): Change in total quality-of-life score was used to assess the overall impact of surgical labyrinthectomy on subjective patient outcome. Individual quality-of-life domains were also assessed. RESULTS: Forty-three of 44 respondents (98%) had improvement in total score after surgery. The one patient who demonstrated deterioration developed latent contralateral disease. Average preoperative and postoperative scores were 34 +/- 14 and 67 +/- 15, respectively (p < 0.001). All questions showed significant improvement with surgery (p < 0.001) except questions pertaining to memory (no change) and hearing loss (nonsignificant decrease in score). CONCLUSION: This study comprises the first patient-directed assessment of quality-of-life outcomes in Ménière's disease patients after labyrinthectomy. Despite the disadvantage of hearing loss, patients consistently reported significant improvement in all quality-of-life domains and do not report a significant loss of quality of life in terms of their hearing loss. Surgical labyrinthectomy remains a highly effective treatment for Ménière's disease patients.

    Title Success of Posterior Semicircular Canal Occlusion and Application of the Dizziness Handicap Inventory.
    Date April 2006
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVES: To determine the long-term efficacy and patient satisfaction of posterior semicircular canal occlusion (PSCO) as a treatment for intractable benign paroxysmal positional vertigo (BPPV). STUDY DESIGN AND SETTING: Retrospective analysis of patients with BPPV who underwent PSCO was conducted in a tertiary referral center. Demographic data, clinical records, and audiometric data were reviewed. Dix-Hallpike maneuver, dizziness handicap inventory (DHI), and a specific PSCO questionnaire (PCOQ) were used to measure outcome. RESULTS: Twenty-eight patients underwent PSCO. The mean follow-up time was 40 months. All patients had normalization of the Hallpike test. DHI scores of 20 patients were recorded. The mean preoperative score was 70 compared with postoperative mean of 13 (P < 0.001). Mild hearing loss was found in 1 patient. CONCLUSIONS AND SIGNIFICANCE: PSCO is highly successful. The DHI scores postoperatively show significant improvement. The PCOQ revealed an overall 85% patient satisfaction rate. PSCO is a safe and effective intervention for intractable BPPV with a high patient satisfaction rate. EBM rating: C-4.

    Title Evaluating Quality of Life After Endolymphatic Sac Surgery: The Ménière's Disease Outcomes Questionnaire.
    Date September 2004
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: To develop a disease-specific instrument to measure the quality of life in patients with Ménière's disease and to assess quality-of-life outcomes after endolymphatic sac decompression. STUDY DESIGN: Retrospective survey. PATIENTS: Patients with Ménière's disease who underwent endolymphatic sac decompression from June 1996 to June 2001, after failing a course of medical management. Two hundred fifteen potential subjects were identified; completed questionnaires were returned by 159 patients. MAIN OUTCOME MEASURES: The Ménière's Disease Outcomes Questionnaire was developed, and consists of questions in three domains that determine quality of life: physical, emotional, and social well-being. The Ménière's Disease Outcomes Questionnaire consisted of 18 multiple-choice questions that were paired for pre- and postoperative conditions, and one global quality-of-life question. The preoperative quality-of-life score (total score for preoperative items) was compared with the postoperative quality-of-life score. The main outcomes measure was the change in quality-of-life score. RESULTS: Overall, the mean change in quality-of-life score was +25.6 points (range, -34 to 83) (p < 0.001). The change in Ménière's Disease Outcomes Questionnaire quality-of-life score was highly correlated with the change in the global question score (p < 0.01). Quality of life was improved in 87% of respondents, unchanged in 3% of patients, and poorer in 9% of patients after endolymphatic sac decompression. CONCLUSIONS: The Ménière's Disease Outcomes Questionnaire is a new disease-specific quality-of-life tool that is a valid measure of quality of life in patients with Ménière's disease, and is responsive to measuring change in quality of life after treatment. Significant improvement in quality of life was reported by 87% of patients after endolymphatic sac decompression.

    Title Minimally Invasive Laser Contraction Myringoplasty for Tympanic Membrane Atelectasis.
    Date June 2003
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: We sought to develop a minimally invasive surgical technique using the CO(2) laser to reduce or eliminate tympanic membrane atelectasis in a select group of patients. STUDY DESIGN: Thirty-seven ears with varying degrees of tympanic membrane atelectasis underwent CO(2) laser myringoplasty with the patients under intravenous sedation in the operating room setting. Atelectasis severity was graded for each patient and documented before and after laser myringoplasty through photodocumentation. Patients were followed for 1 year with comparison tympanic membrane photography. SETTING: The study was conducted in a tertiary care private otology-neurotology practice. RESULTS: Laser myringoplasty significantly reduced retraction pocket severity in most patients. No patients required resection of the retraction pocket or tympanoplasty. The most favorable outcomes were observed in patients with atelectasis addressed early rather than later in its more advanced stages. CONCLUSION: Laser contraction myringoplasty can reduce or eliminate atelectatic areas of the tympanic membrane through immediate contraction and "tightening" of the tympanic membrane tissues. Clinicians should use a standardized tympanic membrane atelectasis grading format. SIGNIFICANCE: A minimally invasive surgical technique for addressing tympanic membrane atelectasis is described, and a tympanic membrane atelectasis grading system is presented based on size, location, and depth of the atelectatic region.

    Title Round Window Gentamicin Absorption: an in Vivo Human Model.
    Date November 2002
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE/HYPOTHESIS: Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured. STUDY DESIGN: A prospective study. METHODS: Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative). The lateral semicircular canal and vestibule were opened, and by means of a microsyringe, labyrinthine fluid was aspirated. A sample of serum was also drawn. In all patients cerebrospinal fluid was also drawn. The samples were analyzed using a standard chemistry analyzer. RESULTS: Intratympanic gentamicin diffused through the round window membrane and achieved concentrations in the labyrinthine fluid ranging from 0 to 16 mg/L. Intratympanic gentamicin was absorbed into the systemic circulation in 4 of 11 patients with serum levels ranging from 0.3 to 0.4 mg/L. No gentamicin was detected in the cerebrospinal fluid. CONCLUSIONS: Intratympanic gentamicin diffuses rapidly through the round window membrane and achieves significant levels in the inner ear. Thus, this new model can be used to assess round window permeability to clinically relevant medications such as steroids and ototopical antibiotics.

    Title Rapid Elevation of Gentamicin Levels in the Human Labyrinth Following Intravenous Administration.
    Date September 2002
    Journal The Laryngoscope
    Excerpt

    HYPOTHESIS: Adequate quantities of labyrinthine fluid can be sampled from the human labyrinth to perform quantitative analysis of medications. A rapid elevation of intralabyrinthine gentamicin levels after intravenous administration can be measured. A model for the sampling of human inner ear fluid in this manner is described. BACKGROUND: The risk of aminoglycoside ototoxicity has been a long-standing concern. The kinetics of gentamicin diffusion into the inner ear have been extrapolated to humans from various animal models. The validity of extrapolation to humans is unknown. We have developed a new model to measure the uptake of gentamicin in vivo. METHODS: A single intravenous dose of gentamicin (80 mg) was given perioperatively to 13 patients undergoing translabyrinthine acoustic neuroma surgery. The lateral semicircular canal and vestibule were opened and a microsyringe was used to obtain a sample of labyrinthine fluid concomitant with a serum sample. The gentamicin concentration of the labyrinthine fluid and serum was analyzed using a standard chemistry analyzer. RESULTS: After parenteral administration of gentamicin, fluid was obtained from the inner ear of 13 acoustic neuroma patients. Inner ear concentrations were between 1.0 and 3.8 mg/L. Serum gentamicin levels ranged from 1.2 to 10.5 mg/L. CONCLUSIONS: This method allows the sampling of intralabyrinthine fluid in humans. Gentamicin was noted immediately in the labyrinth after intravenous administration. This model may be expanded to measure other compounds given either by intravenous or transtympanic routes.

    Title Intratympanic Ciprofloxacin and the Human Labyrinthine Sampling Model.
    Date August 2002
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: The aim of the study was to investigate the potential absorption of intratympanic ciprofloxacin through the human round window membrane. STUDY DESIGN: A prospective study. METHODS: Ciprofloxacin was instilled into the middle ear of 10 patients undergoing acoustic tumor removal. The lateral semicircular canal and vestibule were subsequently opened and, using a microsyringe, labyrinthine fluid was aspirated. A sample each of serum and cerebrospinal fluid was also drawn. RESULTS: Into each middle ear, 0.5 mL ciprofloxacin (0.3%) was instilled. The time interval between the ciprofloxacin application to the round window membrane and sampling of labyrinthine fluid and plasma ranged from 9 to 120 minutes. There was no measurable ciprofloxacin in the labyrinthine fluid, cerebrospinal fluid, or serum of 10 patients. CONCLUSION: The lack of measurable absorption of intratympanic ciprofloxacin into the inner ear indicates that the chance of ototoxicity when ciprofloxacin is used clinically, even in the presence of a tympanic membrane perforation, is low.

    Title Tympanic Membrane Perforation Repair Using Alloderm.
    Date August 2000
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    BACKGROUND: Some patients lack quality autologous tissue for tympanic membrane (TM) grafting. AlloDerm (LifeCell Corp, The Woodlands, TX) is a preserved allograft that has been effective in nonotologic applications. OBJECTIVE: The goal of this study was to investigate AlloDerm in the repair of chronic TM perforations. METHODS: Ten adult chinchillas underwent a controlled, 2-stage procedure for creation and repair of bilateral TM perforations. Myringoplasties were performed. The control side (left) was repaired with autologous fascia; AlloDerm was used in all right ears. Grafts were assessed at 3 to 8 weeks. RESULTS: Complete TM perforation closure was noted in 9 of 10 (90%) control ears and 8 of 10 (80%) AlloDerm-treated ears. Fascia and AlloDerm integrated consistently with host tissues. No variables demonstrated statistical significance. CONCLUSIONS: AlloDerm appeared to be an ideal substitute for grafting of the TM. It was equally effective as fascia. Clinical trials in human beings appear warranted. Potential health care savings are discussed.

    Title Investigation of Endolymphatic Hydrops by Electrocochleography in Patients with Cogan's Syndrome.
    Date February 2000
    Journal Ear, Nose, & Throat Journal
    Excerpt

    We compared auditory and vestibular function between a patient with typical Cogan's syndrome and a patient with atypical Cogan's syndrome. Repeat audiograms demonstrated fluctuating sensorineural hearing loss in the affected ear. Brainstem auditory evoked response testing revealed no abnormalities. Hallpike caloric testing showed a decreased response in the affected ear in the typical case and responses within normal limits in the atypical case. Sinusoidal harmonic acceleration was normal in the typical case, and there was an abnormal phase at 0.01 Hz in the atypical case. Endolymphatic hydrops was investigated by electrocochleography. In both patients, there was an enhancement of the summating potential, with an increased ratio of summating potential to action potential amplitude. This finding is consistent with endolymphatic hydrops.

    Title Otologic Injuries Caused by Airbag Deployment.
    Date October 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Airbags are clearly successful at mitigating injury severity during motor vehicle accidents. Deployment unfortunately has introduced new injury-causing mechanisms. A retrospective review of 20 patients who sustained otologic injuries resulting from airbag inflation was conducted. The most common symptoms were hearing loss in 17 (85%) and tinnitus in 17 (85%). Objective hearing loss was documented in 21 of 24 (88%) subjectively affected ears; this included unilateral and bilateral sensorineural, unilateral conductive, and mixed hearing losses. Ten patients (50%) had dysequilibrium. Four subjects (20%) had a tympanic membrane perforation; each required surgical closure. Ear orientation toward the airbag was found to be associated with hearing loss (P = 0.027), aural fullness (P = 0.039), and tympanic membrane perforation (P = 0.0004). A wide variety of airbag-induced otologic injuries occur and may have long-term sequelae. It is important for health care personnel to be aware of these potential problems.

    Title Otitis Externa.
    Date January 1997
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Otitis externa is a broad term for a disease state that includes inflammation or infection of the external auditory canal and auricle. It can range from mild inflammation and discomfort to a life-threatening disease. Treatment of otitis externa is dependent on a thorough understanding of anatomy and physiology of the external ear canal, a knowledge of the microbiology of potential pathogens, and familiarity with clinical presentation, so that an accurate and timely diagnosis can be reached.

    Title Evaluation of Residual Acoustic Schwannoma Using Gadolinium-dtpa Enhanced Magnetic Resonance Imaging with the Fat Suppression Technique.
    Date March 1996
    Journal The American Journal of Otology
    Excerpt

    After subtotal resection of acoustic schwannomas, radiographic evaluation is necessary to evaluate tumor growth. With conventional gadolinium-DTPA T1-weighted magnetic resonance imaging, tumor delineation is often obscured by surgically placed fat. This occurs because fat has the same intensity as enhanced acoustic tumor. T1-weighted magnetic resonance fat suppression techniques can be used to eliminate the strong signal of fat tissue. When this technique is used in combination with gadolinium-DTPA, the definition of pathologic structures is improved in those areas containing large amounts of fat. Twelve patients who had subtotal resection of an acoustic schwannoma underwent gadolinium-DTPA enhanced magnetic resonance imaging using the fat suppression technique. Residual tumors were more conspicuous and had improved margin definition using the fat suppression technique compared to conventional gadolinium-DTPA T1-weighted images. These refinements in magnetic resonance imaging represent a significant advance in the assessment of residual acoustic tumors.

    Title Ossiculoplasty with Composite Prostheses. Overview and Analysis.
    Date December 1994
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Aeration of a mucosa-lined tympanic cavity is essential for a functioning middle ear. Extrusions of even the best-designed prostheses occur from abnormal middle ear conditions such as atelectasis, middle ear fibrosis, recurrent cholesteatoma, tympanic membrane perforation, and otitis media. Various polymers have been developed in an attempt to maximize prosthetic biocompatibility and ease of use while minimizing the chance of extrusion. One such polymer is a composite of hydroxyapatite and Silastic, known as Flex H/A. This material has been incorporated into two ossicular prostheses, the Universal Plus and the Causse Flex H/A prostheses. Certainly, refinements will continue to be made in the chemical makeup of the bioceramics in order to achieve optimal biocompatibility. In addition to biocompatibility, cost containment issues have influenced the development of ossicular prostheses. A universal prosthesis eliminates the need to stock multiple designs, thereby reducing the cost to institutions. One of the greatest challenges in the future will be to define the appropriate prosthetic design for optimal sound transmission. Consideration of prosthesis weight, head size, and footplate attachment are future research questions that need to be addressed in a scientific biologic model.

    Title Intraoperative Electrocochleography During Endolymphatic Sac Surgery: Clinical Results.
    Date November 1994
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Thirty-eight patients who underwent endolymphatic shunt surgery with intraoperative electrocochleography were questioned regarding control of symptoms. The average follow-up period was 2 years (range, 7 to 40 months). Sixteen (42%) patients showed improvement in the intraoperative electrocochleography potential, 12 (32%) showed worsening, and 10 (26%) showed no change. Complete or substantial control of dizziness was achieved in 36 (95%) patients, and insignificant control in only 2 (5%) patients. Hearing improvement was noted in 4 (11%) patients, and hearing loss in 13 (34%). No correlation was found between intraoperative electrocochleography improvement and dizziness control. However, three of the four patients who had hearing improvement also had the greatest improvement in intraoperative electrocochleography recording. Intraoperative electrocochleography may help the surgeon more accurately identity the true endolymphatic sac and duct.

    Title Oscillopsia in Patients with Loss of Vestibular Function.
    Date August 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Contrary to standard teaching, many patients with bilateral vestibular loss clearly deny oscillopsia or imbalance in darkness. In an attempt to characterize these patients within the larger population of all patients with bilateral vestibular loss, the rotation and posturography test results of 22 patients with bilateral vestibular loss were reviewed. In addition, dynamic visual acuity was assessed with an eye chart test. There was a poor relationship between oscillopsia and dynamic visual acuity or rotation testing. There were three patterns of response on rotation testing, and loss of high-frequency gain was seen in as many patients who reported oscillopsia as did not. There were some patients with normal gain values at all frequencies tested who reported oscillopsia. It may be that the change in the VOR, rather than the absolute VOR loss, is responsible for the production of oscillopsia. On the basis of this and other studies, treatment strategies for patients with bilateral vestibular loss are suggested.

    Title Fluorescein Use in the Detection of Perilymphatic Fistula: a Study in Cats.
    Date June 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    A stained or colored perilymph would be a valuable tool to otologists for the detection of a perilymph fistula. We studied the effect of intravenously injected fluorescein on the inner ear in seven cats. Still and video photography was used to clearly document our findings. Intravenously injected fluorescein appeared within the soft tissue in less than 1 minute and stayed there for at least 3 1/2 hours. Fluorescence around the round window niche resulted from soft tissue (mucosal) fluorescence and extravasation of interstitial fluid (transudate). No fluorescence of perilymph was detected. Because of this, we do not believe intravenously injected fluorescein is useful in the detection of perilymph fistula. Intrathecal injection caused quick and intense staining of labyrinthine fluid.

    Title Use of Electrocochleography to Monitor Antigenic Challenge in Menière's Disease.
    Date January 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Allergy has been reported as a cause of Menière's disease. King et al. have established the validity of the provocative food test (PFT) for the diagnosis of food allergy. When the PFT is used to test patients with Menière's disease, the test is considered positive if the patient develops aural fullness, hearing loss, increased tinnitus, or dizziness during challenge with the offending food and relief of these symptoms during neutralization. Ferraro et al. have shown that electrocochleography (ECoG) provides an objective indication of subjective symptoms in Menière's disease by demonstrating an increased SP/AP amplitude ratio when the symptoms of aural fullness and hearing loss are present. We present several patients with Menière's disease in whom measurement of the SP/AP amplitude ratio was compared with symptom production during antigenic challenge and neutralization.

    Title Electromagnetic Semi-implantable Hearing Device: Phase I. Clinical Trials.
    Date October 1991
    Journal The Laryngoscope
    Excerpt

    Conventional hearing aids have improved significantly in recent years; however, amplification of sound within the external auditory canal creates a number of intrinsic problems, including acoustic feedback and the need for a tight ear mold to increase usable gain. Nonacoustic alternatives which could obviate these encumbrances have not become practical due to inefficient coupling (piezoelectric techniques) or unfeasible power requirements (electromagnetic techniques). Recent technical advances, however, prompted a major clinical investigation of a new electromagnetic, semi-implantable hearing device. This study presents the details of clinical phase I, in which an electromagnetic driver was coupled with a target magnet temporarily affixed onto the lateral surface of the malleus of six hearing aid users with sensorineural losses. The results indicate that the electromagnetic hearing device provides sufficient gain and output characteristics to benefit individuals with sensorineural hearing loss. Significant improvements compared to conventional hearing aids were noted in pure-tone testing and, to a lesser degree, in speech discrimination. Subjective responses were quite favorable, indicating that the electromagnetic hearing device 1. produces no acoustic feedback; 2. works well in noisy environments; and 3. provides a more quiet, natural sound than patients' conventional hearing aids. These favorable results led to phase II of the project, in which patients with surgically amendable mixed hearing losses were implanted with the target magnet incorporated within a hydroxyapatite ossicular prosthesis. The results of this second-stage investigation were also encouraging and will be reported separately.

    Title Metastatic Glomus Jugulare: Long-term Followup.
    Date April 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Malignant Paragangliomas of the Head and Neck: Clinical and Immunohistochemical Characterization.
    Date April 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Evaluation of the Monothermal Caloric Test.
    Date May 1989
    Journal The Laryngoscope
    Excerpt

    In 1970, Torok reported that patients with labyrinthine disease showed vestibular recruitment and that patients with retrolabyrinthine disease showed vestibular decruitment on the monothermal caloric test. Other investigators have failed to confirm these findings; however, their studies did not precisely replicate Torok's test procedure. Following Torok's procedure exactly, the monothermal caloric test was administered to normal individuals and to patients with well-documented vestibular lesions. Nine of ten normal persons showed normal responses and one person showed borderline decruitment. Six of eight patients who had lesions of the vestibular nerve or central vestibular pathways showed decruitment. Two patients with active Meniere's disease showed recruitment and one showed asymmetry. Two patients with Meniere's disease who had undergone endolymphatic sac operations showed normal responses. These findings support Torok's claim that the monothermal caloric test discriminates between labyrinthine and retrolabyrinthine vestibular pathology.

    Title Use of Bacitracin for Neurotologic Surgery.
    Date November 1988
    Journal The Laryngoscope
    Excerpt

    Wound infection, cerebrospinal fluid leak, and meningitis are serious potential complications of neurotologic procedures that transgress the posterior cranial fossa dura. A study of 236 patients was made to determine the effect of perioperative intravenous antibiotics and topical bacitracin irrigation on the incidence of these complications. Of the 236 patients, 170 (72%) underwent translabyrinthine resection of acoustic tumors, while 66 (28%) underwent retrolabyrinthine vestibular nerve section. Patients were divided into four groups: those who received no antibiotics, those who received perioperative intravenous antibiotics only, those who received topical bacitracin irrigation only, and those who received a combination of perioperative intravenous antibiotics and topical bacitracin irrigation. There were no untoward effects of either perioperative intravenous antibiotics or topical bacitracin. The results indicate that bacitracin irrigation reduced the incidence of wound infection from 9% to 2% (p less than 0.05); of cerebrospinal fluid leak from 12% to 5% (p less than 0.04); and of all targeted complications combined from 22% to 9% (p less than 0.006). Furthermore, the topical bacitracin irrigation only group showed a statistically significant reduction in wound infections compared to the perioperative intravenous antibiotic only group (p less than 0.02). The incidence of meningitis was statistically unaffected by any of our treatment protocols.

    Title Normal Hearing in Patients with Acoustic Neuroma.
    Date March 1987
    Journal Southern Medical Journal
    Excerpt

    We reviewed the cases of 614 patients who had operation for acoustic neuroma. In 38 cases, hearing was either normal or decreased symmetrically. Almost all patients had unilateral otologic complaints. All patients with unilateral otologic complaints should be evaluated for acoustic neuroma even if results of routine audiometry are unremarkable.

    Title Neuromas of the Skull Base.
    Date August 1986
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Ten skull-base neuromas treated at the Otology Group P.C. are presented. Each case is reported in detail. The method by which preoperative diagnosis was made is reviewed. Specific attention is paid to distinguishing these tumors from chemodectomas. Presenting signs and symptoms are enumerated. Operative--especially postoperative--management is discussed in detail.

    Title Open Mastoid Procedures: Contemporary Indications and Surgical Technique.
    Date October 1985
    Journal The Laryngoscope
    Excerpt

    The history of the management of chronic ear disease with and without cholesteatoma is dominated by a canal wall down philosophy. The implication is that such an open procedure insures disease control and an uncomplicated future. In point of fact, problem canal wall down procedures can be fraught with as many serious complications as their more controversial canal wall up counterpart is alleged to propagate. Such problem cavities most commonly result from poor execution of basic technique. The objective of this paper is to identify what constitutes a problem cavity and to describe the authors' techniques to avoid such difficulties. A technique has evolved which not only eradicates disease, but which is self-cleansing and of minimal impact on the patient's lifestyle. The authors' experience with canal wall down procedures is reviewed.

    Title Management of Metastatic Glomus Jugulare Tumors.
    Date
    Journal Skull Base Surgery
    Excerpt

    METASTATIC GLOMUS JUGULARE TUMORS (JUGULAR PARAGANGLIOMAS) ARE VERY UNCOMMON: consequently, no single report has been able to accurately describe their biologic or clinical behavior, and there are no established guidelines on caring for patients with these tumors. Identification of metastatic paraganglioma can be difficult because these tumors are known to occur synchronously, many other tumor types appear histologically similar to paragangliomas, and histologically the metastasis may not resemble the primary tumor. Immunohistochemistry, using neuroendocrine markers, and electron microscopy are the two most useful techniques available to identify definitely paragangliomas. A few studies have shown differences in the immunohistochemical staining patterns between benign and metastatic paragangliomas. We reviewed the literature and include two additional cases of metastatic glomus jugulare tumors in this article. We discuss the clinical management of these patients, the importance and usefulness of immunohistochemistry in characterizing these tumors, and their clinical outcomes.

    Title Endoscopic Vascular Decompression.
    Date
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: This article describes the technique and reports the results of endoscopic vascular decompression (EVD) in patients with trigeminal neuralgia (TGN), hemifacial spasm (HFS), and cochleovestibular nerve compressive syndrome. STUDY DESIGN: Retrospective case review. SUBJECTS AND METHODS: This study evaluates the outcome and length of stay (LOS) of 20 patients who underwent EVD for vascular compressive disorders from 2005 to 2007. It also evaluates LOS in 41 patients who underwent traditional microvascular decompression (MVD) by the same surgeons from 1999 to 2004. RESULTS: Eighty-six percent (12 of 14) patients had resolution of their TGN, and 80% (4 of 5) had resolution of their HFS. There were no major complications. The EVD patients had an average LOS of 2.36 days as compared with 4.36 days for the MVD patient group (p < 0.001). CONCLUSION: Endoscopic vascular decompression for patients with vascular compressive syndromes such as TGN and HFS is a safe and equally effective procedure when compared with the traditional and widely successful MVD surgery, with the added benefit of less morbidity and shorter hospital stays.

    Title Malignant Peripheral Nerve Sheath Tumor of the Vestibulocochlear Nerve and Brainstem: Multimodality Treatment with Survival of 27 Months. A Case Report and Review of the Literature.
    Date
    Journal Neurosurgery
    Excerpt

    Malignant peripheral nerve sheath tumors are the most common malignant mesenchymal tumors of soft tissues, but they are very rare when found to arise from a cranial nerve and when not in association with neurofibromatosis. These tumors are highly malignant and carry a poor prognosis with survival usually less than 6 months.

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