Otolaryngologist (ear, nose, throat), Surgical Specialist
31 years of experience

Accepting new patients
Dearborn
18101 Oakwood Blvd
Dearborn, MI 48124
313-253-0800
Locations and availability (8)

Education ?

Medical School Score Rankings
University of North Carolina (1979)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Auditory Tumor (Acoustic Neuroma)
Hour Detroit Magazine's Top Docs (2010)
Voted Best Doctors 2011-2012
Detroit Hour Magazine's Top Docs (2010)
Patients' Choice Award (2012 - 2013)
Compassionate Doctor Recognition (2012 - 2013)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
Vestibular Disorders Association
American Board of Otolaryngology

Affiliations ?

Dr. Monsell is affiliated with 33 hospitals.

Hospital Affilations

Score

Rankings

  • Beaumont Hospital,Troy
    Otolaryngology
    44201 Dequindre Rd, Troy, MI 48085
    • 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%
  • Mount Clemens Regional Medical Center
    Otolaryngology
    1000 Harrington St, Mount Clemens, MI 48043
    • Currently 4 of 4 crosses
    Top 25%
  • Crittenton Hospital Medical Center
    Otolaryngology
    1101 W University Dr, Rochester, MI 48307
    • 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%
  • St. Joseph Mercy Oakland
    Otolaryngology
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Ford Hospital
    Otolaryngology
    2799 W Grand Blvd, Detroit, MI 48202
    • 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%
  • Harper University Hospital
    Otolaryngology
    3990 John R St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • POH Medical Center
    Otolaryngology
    50 N Perry St, Pontiac, MI 48342
    • Currently 3 of 4 crosses
    Top 50%
  • Rehabilitation Institute of Michigan
    Otolaryngology
    261 Mack Ave, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Saint Joseph Mercy Hospital
    Otolaryngology
    505 E Huron St, Ann Arbor, MI 48104
    • 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%
  • Oakwood Hospital and Medical Center
    Otolaryngology
    18101 Oakwood Blvd, Dearborn, MI 48124
    • 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 (7 Years
  • HARPER UNIVERSITY HOSPITAL & HUTZEL WOMEN'S HOSPIT
  • Sinaigrace Hospital
  • Hutzel Women's Hospital
    3980 John R St, Detroit, MI 48201
  • Royal Oak
  • Karmanos Cancer Center
    4100 John R St, Detroit, MI 48201
  • Hutzel Hospital
  • POH Regional Medical Center
  • Sinai-Grace Hospital
    6071 W Outer Dr, Detroit, MI 48235
  • Pontiac Osteopathic Hospital
  • Crittenton Hospital Medical Center
  • John D. Dingell Veterans Affairs Medical Center
    4646 John R St, Detroit, MI 48201
  • Barbara Ann Karmanos Cancer Hospital
  • Harper Hospital
  • Beaumont Affiliation & Years on StaffRoyal Oak
  • Children's Hospital of Michigan
    3901 Beaubien St, Detroit, MI 48201
  • Oakwood Hospital
  • Detroit Receiving Hospital
  • Publications & Research

    Dr. Monsell has contributed to 44 publications.
    Title Glioblastoma Multiforme After Microsurgery for Acoustic Neuroma Without Radiotherapy: Limitations of the Cahan Criteria.
    Date September 2008
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Extracts from The Cochrane Library: Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction (review).
    Date May 2008
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    The "Cochrane Corner" is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology--head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled "Vestibular rehabilitation for unilateral peripheral vestibular dysfunction," which concludes that there is moderate to strong evidence from high-quality randomized trials supporting the safety and efficacy of this intervention.

    Title Outcomes Research and the Aao-hns Foundation.
    Date March 2005
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title The Cooperative Outcomes Group for Ent: a Multicenter Prospective Cohort Study on the Effectiveness of Medical and Surgical Treatment for Patients with Chronic Rhinosinusitis.
    Date March 2005
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: To assess outcomes for patients with chronic rhinosinusitis. STUDY DESIGN AND SETTING: Prospective, multicenter study; 31 otolaryngologists enrolled 276 adult patients with chronic rhinosinusitis; patients completed surveys at 3-month intervals, and physicians provided clinical and treatment data. The primary outcome measure was the Chronic Sinusitis Survey-Duration (CSS-D). RESULTS: One hundred seventeen adult patients completed 12-month follow-up. Most patients reported sinus symptoms lasting longer than 3 years (74%). Patients showed significant improvement (group P < 0.0001) in the CSS-D score at each follow-up interval. Baseline CSS-D ( P < 0.0001), surgical intervention ( P < 0.003), and Lund-McKay score ( P < 0.04) were predictive of clinical success in regression analysis. CONCLUSIONS: Patients referred to an otolaryngologist have a severe sinus illness. Treatment by an otolaryngologist was associated with significant improvement in sinus-related symptoms. SIGNIFICANCE: The study demonstrated the feasibility of multicenter outcome studies in chronic rhinosinusitis and generated testable hypotheses for future investigation. EBM rating: C.

    Title The Cooperative Outcomes Group for Ent: a Multicenter Prospective Cohort Study on the Outcomes of Tympanostomy Tubes for Children with Otitis Media.
    Date March 2005
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: Outcomes for patients with otitis media were assessed in this prospective, multicenter study. STUDY DESIGN AND SETTING: Thirty-one otolaryngologists enrolled 272 pediatric patients with otitis media; caregivers completed surveys at 3-month intervals, and clinical and treatment data was also collected. The Otitis Media 6 (OM-6) was the primary outcome measure. RESULTS: One hundred seventy-seven patients (mean age 2.0 years) completed 3-month follow-up. One hundred thirty-seven patients underwent tympanostomy tube placement. Large improvements in disease-specific quality of life (QOL) were seen up to 9 months of follow-up. Baseline OM-6 score was the best predictor of clinical success in regression modeling. CONCLUSIONS: Patients referred to an otolaryngologist for treatment of otitis media see large improvements in disease-specific QOL regardless of treatment rendered. SIGNIFICANCE: The study demonstrates the feasibility of multicenter outcomes studies and confirms appropriate triage of patients with otitis media into surgical versus medical interventions. EBM rating: C.

    Title The Mechanism of Hearing Loss in Paget's Disease of Bone.
    Date May 2004
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES/HYPOTHESIS: The mechanism of hearing loss (HL) in Paget's disease of bone was investigated. The present study was a systematic, prospective, controlled set of clinical investigations to test the hypothesis that there is a general underlying mechanism of HL in Paget's disease of bone and to gain additional insights into the auditory and otologic dynamics of this disease. Specific questions were 1) whether the mechanism is cochlear or retrocochlear and 2) whether the bone mineral density of the cochlear capsule is related to hearing levels. STUDY DESIGN: Several double-blinded, cross-sectional, prospective, correlational studies were conducted in a population of elderly human subjects with skull involvement with Paget's disease versus a control population of elderly subjects free of Paget's disease. Demographic and clinical data were recorded. Longitudinal observations were made in subjects under treatment. METHODS: Subjects were recruited from a Paget's disease clinic. Pure-tone auditory thresholds, word recognition, and auditory brainstem responses (ABRs) were recorded. The dimensions of the internal auditory canals were measured using computed tomographic (CT) images and digital image analysis. The precision, accuracy, and temporal stability of methods to measure the bone mineral density of the cochlear capsule and an adjacent area of nonotic capsule bone were validated and applied. Correlations were sought between hearing levels and cochlear capsule bone mineral density. RESULTS: ABRs were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. ABRs were interpreted as normal in 56 ears; none were abnormal. The mid-length diameter and minimum diameter of the internal auditory canal of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relationship to hearing thresholds. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group with Paget's disease involving the temporal bone were -0.63 for left ears and -0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were -0.67 for left ears and -0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at P <.001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. CONCLUSIONS: The evidence supports the existence of a general, underlying, cochlear mechanism of pagetic HL that is closely related to loss of bone mineral density in the cochlear capsule. This mechanism accounts well for both the high-frequency sensorineural HL and the air-bone gap. Early identification, radiographic diagnosis of temporal bone involvement, and vigorous treatment with third-generation bisphosponates are important to limit the development and progression of pagetic HL.

    Title New and Modified Reporting Systems from the Consensus Meeting on Systems for Reporting Results in Vestibular Schwannoma.
    Date September 2003
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Title Role of the Specialty Society in Outcomes Assessment: the Development of Cog*ent.
    Date March 2000
    Journal The Laryngoscope
    Excerpt

    The Cooperative Outcomes Group for ENT (COG*ENT), a clinical outcomes project of the American Academy of Otolaryngology--Head and Neck Surgery Foundation, was established to assess clinical outcomes of otolaryngological care of patients with two diseases, otitis media and rhinosinusitis. COG*ENT has produced an assessment tool with many potential applications. The development and early experience of the Foundation with this project are described, emphasizing the factors the authors believe are important for success.

    Title Hearing Loss As a Complication of Paget's Disease of Bone.
    Date November 1999
    Journal Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research
    Excerpt

    Hearing loss has long been known to be a complication of Paget's disease of bone. Older ideas about the mechanisms of hearing loss are being replaced by a new view based on experimental evidence from patients. Studies reviewed show no evidence of auditory nerve dysfunction and confirm a cochlear site of lesion. A loss of bone mineral density in the cochlear capsule is associated with both a high-tone hearing loss and a low-tone air-bone gap.

    Title Segmentation of Acoustic Neuromas with Magnetic Resonance Imaging and Eigen Image Filtering.
    Date January 1998
    Journal The American Journal of Otology
    Excerpt

    OBJECTIVE: This study aimed to determine whether magnetic resonance imaging with Eigen image filtering can segment acoustic neuromas as a preliminary requirement to the development and validation of a volumetric method of measuring tumor size and growth using Eigen image filtering. STUDY DESIGN: This was an observational study. SETTING: The study was performed in an academic, comprehensive multi-specialty group practice. PATIENTS: Patients were a convenience sample of adults of both sexes who had acoustic neuromas identified by magnetic resonance imaging. Tumors ranged widely in size. INTERVENTION: Magnetic resonance imaging with digital image analysis using Eigen image filtering was the intervention. MAIN OUTCOME MEASURE: Observation and analysis of magnetic resonance images was the main outcome measure. RESULTS: The ability of magnetic resonance imaging with Eigen image filtering to segment acoustic neuromas of various sizes and shapes is illustrated. CONCLUSIONS: Magnetic resonance imaging with digital image analysis using Eigen image filtering is a promising method for volumetric measurement of acoustic neuroma size and growth. The potential for acoustic neuromas to grow may be underestimated by linear methods because of their relative lack of precision and of the geometric error that occurs in representing the volumetric growth of a three-dimensional tumor as a linear diameter.

    Title Computerized Dynamic Platform Posturography.
    Date October 1997
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Computerized dynamic platform posturography is defined in this technology assessment. The review discusses what computerized dynamic platform posturography measures, what the reliability and validity of the information are, and the uniqueness of the information provided. The clinical contribution and indications for testing are discussed. There are comments on future directions for research on computerized dynamic platform posturography and a summary and conclusion.

    Title Eustachian Tube Dysfunction.
    Date November 1996
    Journal Otolaryngologic Clinics of North America
    Excerpt

    There are several types of eustachian tube dysfunction, including obstruction and abnormal patency. This article presents an update on several selected areas of eustachian tube function and dysfunction, including surfactants, cleft palate, tympanic membrane atelectasis, abnormal eustachian tube patency, and long-term middle ear ventilation.

    Title Preventive Management of Cerebrospinal Fluid Leakage in Translabyrinthine Surgery.
    Date June 1996
    Journal The Laryngoscope
    Excerpt

    A simple technique can be used to prevent cerebrospinal fluid (CSF) leakage through the nose and the wound in translabyrinthine surgery. This method, evolved from Glasscock's technique of packing the eustachian tube, adds only 5 to 10 minutes to the procedure. The procedure was modeled in the temporal bones of 20 human cadavers, and the findings are described. With this technique, no nasal CSF leaks occurred in a consecutive series of 25 patients who underwent acoustic tumor surgery. Factors thought to be necessary for the success of the technique are discussed.

    Title Proliferation Indices of Vestibular Schwannomas by Ki-67 and Proliferating Cell Nuclear Antigen.
    Date March 1996
    Journal The American Journal of Otology
    Excerpt

    Two immunohistologic demonstrations of markers of proliferating cells, Ki-67 and proliferating cell nuclear antigen, were applied to tissues from 10 vestibular schwannomas. Each method demonstrated three distinct rates of positively stained cells (p < .01 and p < .015, respectively, for each method). There was a one-to-one correspondence between the two immunohistologic methods in the assignment of cases to each growth rate category except for two cases (Spearman rank correlation r = 0.76, p < .05). These data support the concept of distinct growth rates in vestibular schwannoma. Tissues were also sampled from different areas of the same tumor within nine samples. The results suggest that tumor growth is not homogeneous within a tumor, but that proliferation may be more active near the surface.

    Title Hearing Loss in Paget's Disease of Bone: Evidence of Auditory Nerve Integrity.
    Date March 1996
    Journal The American Journal of Otology
    Excerpt

    Auditory brainstem responses (ABRs) were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. Auditory brainstem responses were interpreted as normal in 56 ears; none were abnormal. Computed tomography and digital image analysis were used to quantify internal auditory canal (IAC) dimensions. The midlength diameter and minimum diameter of the IAC of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relation to hearing thresholds. Increased IAC length showed a limited relation to reduced hearing level in pagetic subjects, possibly consistent with bossing adjacent to the porus acusticus. Findings support the principle that hearing loss in Paget's disease of bone is generally associated with intact auditory nerve function and also support a cochlear site of lesion.

    Title When Paroxysmal Positioning Vertigo Isn't Benign.
    Date October 1995
    Journal Journal of the American Academy of Audiology
    Excerpt

    The electronystagmographic auditory brainstem response and magnetic resonance imaging findings for a 33-year-old male with a 3.5 cm left vestibular schwannoma are presented. Of particular interest was the presence of an unusual positioning nystagmus following the Dix-Hallpike maneuver in the right head-hanging position. The patient demonstrated a nystagmus that was immediate in onset and not fatigueable upon repeated positioning. During positioning, the patient experienced a vertical bobbing sensation and dysphoria, but not rotational vertigo. Most importantly, the nystagmus had a predominant downbeating vertical component. the case illustrates the diagnostic significance of downbeating nystagmus elicited by the Dix-Hallpike maneuver.

    Title New and Revised Reporting Guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-head and Neck Surgery Foundation, Inc.
    Date October 1995
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Hearing Loss in Paget's Disease of Bone: the Relationship Between Pure-tone Thresholds and Mineral Density of the Cochlear Capsule.
    Date August 1995
    Journal Hearing Research
    Excerpt

    We have developed a unique method of quantitative computed tomography (QCT) that enables measurement of the density of the cochlear capsule in vivo. We performed pure-tone audiometry and QCT on 67 ears from 35 subjects with radiographically confirmed Paget's disease of the skull and on 40 ears from twenty volunteer subjects. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group affected by Paget's disease were -0.63 for left ears and -0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were -0.67 for left ears and -0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at p < 0.001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. These findings demonstrate the feasibility of precise and accurate density measurements in the temporal bone in vivo and support the use of the mean cochlear capsule density as a marker of disease effect. Alteration of cochlear capsule bone density may be related to the mechanisms of hearing loss in Paget's disease of bone.

    Title Results and Outcomes in Ossiculoplasty.
    Date December 1994
    Journal Otolaryngologic Clinics of North America
    Excerpt

    This article presents a series of goals and questions for future research in ossiculoplasty. Important technical questions include what are the best materials, prosthesis shapes, and techniques of placement for both immediate and long-term success. Important clinical questions include what improvements in communication should we expect, how should cases be selected, and how should patients be counseled. There are many variables that could affect reported results, including the selection of cases, audiometric techniques, the frequencies of hearing measurement, and the methods of data analysis. These are all discussed in this article.

    Title Application of Quantitative Computed Tomography to Paget's Disease of Bone.
    Date July 1994
    Journal Seminars in Arthritis and Rheumatism
    Excerpt

    Serial evaluation of pagetic lesions is handicapped by the inability of conventional methods to reproduce precisely the positioning of the area of interest. A computed tomography method that provides visual and quantitative comparisons between data sets acquired at different times has been developed. The utility of this method is illustrated with an example of serial examinations that demonstrate the effect of treatment on small lytic lesions in the lumbar spine. A further demonstration is made of the ability of this method to identify and quantify lytic changes within the cochlear capsule.

    Title Measurement of Regional Bone Mineral Density: a New Technique for the Evaluation of the Temporal Bone.
    Date April 1994
    Journal The American Journal of Otology
    Excerpt

    The measurement of regional bone mineral density (rBMD) is a new method of evaluation of the human temporal bone in vitro or in vivo. Modified computed tomography (CT) enables us to collect a three-dimensional array of precise, reproducible bone density values, as well as high-quality CT images. Measurements are calibrated using phantoms of known composition and density. Conventional CT provides density information that is relative, qualitative, and lacks precise reproducibility over time. The rBMD technique provides precise numeric density measurements. Additional image processing capabilities are described. In vivo data from six normal temporal bones and from two patients with Paget's disease involving the temporal bone are presented to demonstrate the technique.

    Title Therapeutic Use of Aminoglycosides in Ménière's Disease.
    Date December 1993
    Journal Otolaryngologic Clinics of North America
    Excerpt

    This article details the various effects of aminoglycosides used to treat individuals with Ménière's disease. Effects of aminoglycosides on hair cells and dark cells are described in addition to intramuscular streptomycin, intratympanic application of aminoglycosides, and the application of streptomycin to the lateral semicircular canal.

    Title Labyrinthotomy with Streptomycin Infusion: Early Results of a Multicenter Study. The Lsi Multicenter Study Group.
    Date November 1992
    Journal The American Journal of Otology
    Excerpt

    Early results for hearing and vertigo are reported for 47 labyrinthotomies with streptomycin infusion (LSI) by 13 coinvestigator-surgeons. Sixty-eight percent of patients had worse hearing after surgery (10 dB or 15% word recognition). Patients with a preoperative pure-tone average better than or equal to 40 dB appeared to suffer less postoperative hearing loss than those with a greater preoperative deficit. Severe to profound postoperative hearing loss was experienced by 27 patients (57%), all of whom had preoperative pure-tone averages worse than 40 dB. Opening the endolymphatic space was associated with a deleterious effect on hearing. Because of persistent vertigo, 17 percent of patients required a secondary procedure during the period of observation. These early results indicate that LSI is associated with a significant risk of postoperative hearing loss. Of the 13 coinvestigator-surgeons, four have stopped using LSI, while one considers his results satisfactory. The remaining surgeons have taken an intermediate position and feel it is useful in selected cases. Longer follow-up is required to judge the efficacy of LSI for controlling vertigo. We are currently studying these long-term results.

    Title Diagnosis and Treatment of Arachnoid Cysts of the Posterior Fossa.
    Date January 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Arachnoid cysts of the posterior fossa are rare. When arachnoid cysts are encountered, the presenting symptoms are frequently otologic, with hearing loss and imbalance occurring commonly. Three cases are presented with a previously unreported otologic symptom, that of bilateral hearing loss, which in one case was fluctuant. None of the patients had the common symptoms of unilateral hearing loss and headache. With the advent of computed tomography and magnetic resonance imaging, these cysts may be readily identified, usually with diagnostic imaging alone. Unfortunately there is often a delay in diagnosis because of the vague and fleeting nature of the symptoms. Because no single diagnostic symptom pattern is able to characterize all cases, it is believed computed tomography or magnetic resonance imaging or both are indicated in patients with long-standing otologic complaints--even in the absence of unilateral symptoms. Treatment of posterior fossa arachnoid cysts primarily consists of surgical procedures designed to decompress the cyst. In this series, treatment with diuretics alone resulted in improvement of symptoms during several years of followup, with no evidence of enlargement of the cysts.

    Title Estrogen and Progesterone Binding by Acoustic Neuroma Tissue.
    Date December 1990
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Tissue samples from 37 acoustic neuromas were assayed for estrogen and progesterone hormone receptor binding by radioimmunoassay using a dextran-coated charcoal method and Scatchard plot analysis. Twenty-one of the samples were from men, and 16 of the samples were from women. Seven of 37 samples (19%) were positive for estrogen receptor and six of 36 samples (17%) were positive for progesterone receptor. Three of 37 samples (8%) were positive for both receptors. There was no correlation of estrogen receptor positivity with the sex of the patient. These results indicate that estrogen or progesterone receptor binding activity or both are present in a small subset of acoustic tumors. Evidence is lacking, however, that binding of estrogen to the receptor results in growth changes in the tumor. The empirical use of antiestrogen treatment in acoustic neuroma does not appear to be justified at the present time.

    Title Sensorineural Hearing Loss and the Diagnosis of Acoustic Neuroma.
    Date December 1990
    Journal Henry Ford Hospital Medical Journal
    Excerpt

    Sensorineural hearing loss and tinnitus are gradually receiving more attention in medicine due to advances in diagnosis and treatment. Acoustic neuromas can now be detected when they are small, and early microsurgical removal results in the lowest overall morbidity. We examine the historical development of acoustic neuroma management, discuss current diagnosis and treatment, and present illustrative cases from our recent experience. Complaints of tinnitus and hearing loss, especially when unilateral, require appropriate medical evaluation.

    Title Receptors in Acoustic Neuroma.
    Date September 1990
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Age Considerations in Acoustic Neuroma Surgery: the Horns of a Dilemma.
    Date August 1989
    Journal The American Journal of Otology
    Excerpt

    Experience has shown that early removal of acoustic tumors results in less morbidity because the rate of surgical complications increases with tumor size. Nevertheless, acoustic tumors are benign and grow slowly--facts that support conservatism in elderly patients. We managed 21 patients with acoustic tumors over the age of 65. Eleven patients underwent immediate surgical excision. Ten patients were monitored clinically and with serial magnetic resonance imaging (MRI) or computed tomographic (CT) scans. To date, two of these patients have required surgical excision because of continued tumor growth. Our experience managing these patients both surgically and with "watchful waiting" is the subject of this report.

    Title Why Do Vestibular Destructive Procedures Sometimes Fail?
    Date April 1989
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Vestibular nerve specimens and one temporal bone, from patients with vestibular symptoms after destructive surgery on the vestibular system, were studied by light microscopy. Surviving nerve axons in three specimens that followed retrolabyrinthine vestibular nerve section (RLVNS) were counted and compared to normative data. Results are consistent with persistence of the central processes of primary vestibular neurons in three specimens from patients who had persistent symptoms and ice-water caloric responses after RLVNS. Incomplete neurectomy probably results from anatomic variations in the plane of separation of the vestibular and cochlear portions of the eighth nerve in the posterior fossa. Regeneration neuromas were found in the vestibule after a complete transmastoid labyrinthectomy and a Fick sacculotomy; this indicates that wide degrees of injury to the labyrinth may provoke this response. Disabling unsteadiness after labyrinthectomy may or may not respond to revision surgery (translabyrinthine vestibular nerve section). The indications for revision surgery are discussed. The excision of Scarpa's ganglion by the translabyrinthine route offers the best chance to ensure complete removal of peripheral vestibular tissue, minimize postoperative unsteadiness, and prevent neuroma formation.

    Title Cochlear Implants.
    Date March 1989
    Journal Imj. Illinois Medical Journal
    Title Superselective Embolization of Glomus Jugulare Tumors.
    Date January 1989
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    The purpose of this report is to introduce the technique of superselective embolization (SSE) and to review our experience in surgically treating glomus jugulare tumors with and without preoperative SSE. Retrospective chart review was performed to determine estimated blood loss and operative time, and illustrative case reports are presented. The technique of preoperative SSE represents an important advance in the surgical management of glomus jugulare tumors. In our experience, surgical ligation of tumor-feeding vessels or nonselective embolization of the external carotid system is unsatisfactory. Inadequate devascularization and excessive risk of complications have caused us and others to abandon these procedures. However, SSE performed by an experienced neuroradiologist can produce effective and safer tumor devascularization. Preoperative SSE results in shrinkage of tumor size and significantly decreases blood loss. The advantages to the surgeon include improved visualization and ease of dissection as well as increased confidence that complete tumor excision has been achieved.

    Title Endolymphatic Sac Surgery: Methods of Study and Results.
    Date January 1989
    Journal The American Journal of Otology
    Excerpt

    Surgery of the endolymphatic sac (ELS) in classical Meniere's disease has fallen under attack and has been abandoned by some surgeons. We studied our results for vertigo and hearing in 83 patients undergoing surgery of the ELS for intractable classical Meniere's disease. Half of the patients were completely free of definitive attacks at 2 years; another quarter experienced substantial control. Three fourths noted an improvement in their level of disability. Results for vertigo were sustained at longer follow-up intervals. Nineteen percent had revision surgery (usually retrolabyrinthine vestibular neurectomy) for intractable vertigo within 2 years of the sac operation. The 1985 reporting method of the American Academy of Otolaryngology--Head and Neck Surgery was found superior to previous methods because it specified a meaningful follow-up interval, used a graded scale accounting for partial success in treatment, and separated results for vertigo and hearing. Nevertheless, optimal use of the method in the future will require prospective reporting and a concerted effort to avoid confusion between definitive attacks of true vertigo and adjunctive vestibular symptoms. Even though the mechanism of the beneficial effect of sac surgery is unknown, we have found it useful in the control of disabling vertigo.

    Title Surgical Treatment of Vertigo with Retrolabyrinthine Vestibular Neurectomy.
    Date August 1988
    Journal The Laryngoscope
    Excerpt

    Results for control of vertigo and preservation of hearing in patients who have had a retrolabyrinthine vestibular neurectomy (RVN) by our group were analyzed retrospectively. This procedure consists of selective section of the vestibular nerve in the posterior cranial fossa. Vertigo was completely controlled in all but two of 31 patients, one of whom required revision surgery to control attacks. Analysis of these two cases suggests that the cause of persistent vertigo is incomplete neurectomy. With our current surgical technique in patients with Meniere's disease, hearing results were not statistically different from our results with surgery of the endolymphatic sac. Control of vertigo was much more successful with the RVN than endolymphatic sac surgery.

    Title Endolymphatic Sac Surgery in Congenital Malformations of the Inner Ear.
    Date August 1988
    Journal The Laryngoscope
    Excerpt

    A retrospective analysis of 40 patients (49 ears) with congenital progressive sensorineural hearing loss who underwent endolymphatic sac surgery was performed. The inner ears were radiographically abnormal in 57% of operated ears. In the remaining cases, subtle malformations beyond the resolving power of radiographic studies were suspected. Early postsurgical hearing loss (defined as a loss greater than 10 dB in three-tone average or greater than 15% in speech discrimination score) was found in 29% of operated ears (14/49). However, only two of these patients lost all of their residual hearing postoperatively (2/49 or 4%). An enlarged endolymphatic sac was noted at surgery in 50% of those with significant postoperative hearing losses. Longer-term stability of hearing was assessed in 22 patients with bilateral inner-ear pathology who underwent surgery on one side only. A comparison of the hearing fate of the operated and nonoperated ears suggested no benefit from the surgical intervention when compared to the natural history of the disease. Based upon this experience, endolymphatic sac surgery for the purpose of hearing stabilization in patients with congenital malformations of the inner ear is no longer recommended.

    Title Surgical Approaches to the Human Cochlear Nuclear Complex.
    Date December 1987
    Journal The American Journal of Otology
    Excerpt

    Patients with bilateral neural deafness may be candidates for rehabilitation with a device that provides direct electrical stimulation of the central nervous system. The cochlear nuclear complex at the pons-medulla junction is a logical site to implant because it is in the surgical field exposed for acoustic tumor surgery. In this study we compared four surgical approaches commonly used to reach the cerebellopontine angle for ease of access to the cochlear nuclear complex. We found the translabyrinthine approach to be the most satisfactory because the anterior approach facilitates identification of key landmarks, such as the tenia of the choroid plexus and the lateral recess of the fourth ventricle. The suboccipital, or retrosigmoid, approach would be satisfactory after removal of a large acoutic tumor; however, the amount of cerebellar retraction necessary may preclude its use in nontumor cases.

    Title Brain Herniation and Space-occupying Lesions Eroding the Tegmen Tympani.
    Date November 1987
    Journal The Laryngoscope
    Excerpt

    Technological advances in neuroradiology and the development of skull base surgery in neurotology have improved diagnosis and management of lesions eroding the tegmen tympani. The diagnosis of brain hernia is to be suspected in patients with a history of complicated chronic ear surgery and a slowly developing pulsatile mass with CSF leak. Patients are best evaluated in the upright position, with an otomicroscope and by magnetic resonance imaging (MRI). Over 6 years, our group has treated seven patients with eight space-occupying lesions eroding the tegmen. Five of the lesions were repaired with a temporalis muscle flap, 2 with fascia and bone, and 1 with Marlex. A review of new technology in the diagnosis of brain hernia and a modification of previous techniques is given.

    Title Congenital Malformations of the Inner Ear: Histologic Findings in Five Temporal Bones.
    Date April 1987
    Journal The Laryngoscope
    Excerpt

    The histopathologic findings in five temporal bones from three patients with congenital malformation of the inner ear are described. The external contour of the cochlea was deformed in two temporal bones, while the internal architecture was abnormal in all five temporal bones. Intracochlear abnormalities included defects in the interscalar septum, deficiencies in the modiolus, and a paucity of neural elements. Spiral ganglion cell populations varied, but were substantially diminished in all five temporal bones. Enlargement of the vestibule and semicircular canals (lateral and posterior) was seen in two temporal bones. A large vestibular aqueduct and saccular hydrops were found in one temporal bone each. An attempt was made to relate the histologic patterns of deformity to the proposed clinical classification of inner ear malformations. Radiographic abnormality of the cochlea would have been detectable in two bones (incomplete partition pattern), while two other bones would have appeared as vestibule-semicircular canal syndromes. One bone would have been radiographically normal.

    Title Organization of the Motor Neuron Components of the Pallial Nerve in Octopus.
    Date July 1986
    Journal Brain Research
    Excerpt

    Following horseradish peroxidase (HRP) and cobalt (CO2+) application to the pallial nerve of two species of octopus, neurons that control various aspects of mantle behaviors were located in several lobes of the three main regions of the central brain. In the subesophageal region, cells were labeled in the anterior chromatophore, posterior chromatophore, palliovisceral, pedal and vasomotor lobes; in the superior buccal lobe of the supraesophageal region; and in the magnocellular lobe of the periesophageal region. Localization of labeled cells in and around both the anterior and posterior chromatophore lobes suggests a modification of the idea that a single functional area is solely located in an anatomically defined brain lobe of a cephalopod.

    Title Hearing and Balance Disorders. How to Recognize, when to Refer.
    Date February 1985
    Journal Postgraduate Medicine
    Excerpt

    Nearly one in ten Americans has some degree of hearing loss. The primary care physician is frequently the first to examine patients with hearing and balance disorders. Examination begins with a thorough history and examination and may also include specific tests performed in the office. In many cases, the primary care physician can diagnose and treat disorders successfully. In other cases, referral to a specialist is necessary.

    Title Functional Hearing Loss Presenting As Sudden Hearing Loss: a Case Report.
    Date October 1984
    Journal The American Journal of Otology
    Excerpt

    A case of functional hearing loss presenting as sudden sensorineural hearing loss in the only hearing ear of a musician is presented. Pure-tone audiometric evaluation showed good intratest and intertest consistency. The pitfalls of diagnosis, ultimately made by brain stem evoked response audiometry, are discussed in light of the literature on sudden and functional hearing loss. Psychiatric evaluation revealed features consistent with hysterical conversion. It is argued that it is important to establish the exact etiologic agent of functional hearing loss despite the difficulty of diagnosis so that the patient may receive appropriate treatment.

    Title Tumor Involvement of the Facial Nerve.
    Date November 1983
    Journal The Laryngoscope
    Excerpt

    Tumors involving the facial nerve are rare and challenging in both diagnosis and treatment. In this paper we report 18 cases of benign and malignant neoplasms involving the temporal portion of the facial nerve. The selection of those patients with facial paralysis who require detailed evaluation is discussed. Often, despite thorough evaluation of these patients, a preoperative diagnosis is unavailable or erroneous. An occasional patient may require surgical exposure of the nerve from the middle cranial fossa to the parotid gland.

    Title Osteomyelitis of the Clavicle.
    Date November 1983
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Osteomyelitis of the clavicle is rare; however, it may occur following head and neck surgery. Risk factors include radiation, long-standing tracheitis, disruption of the periosteum or the cortical bone with interruption of the blood supply to the clavicle. Proper management includes early diagnosis, surgical debridement of soft tissue and bone, appropriate antimicrobial therapy, and coverage of the defect with a myocutaneous flap to protect the great vessels of the upper mediastinum.

    Title Cobalt and Horseradish Peroxidase Tracer Studies in the Stellate Ganglion of Octopus.
    Date May 1980
    Journal Brain Research
    Excerpt

    The connectivity of the stellate ganglion of Octopus was investigated using cobalt and horseradish peroxidase (HRP) tracers applied to severed preganglionic and postganglionic nerves. Centripetal cells, defined as cells in the ganglion which send their axons back toward the brain, were discovered by both methods. Application of HRP to the pallial (preganglionic) nerve labeled the preganglionic fibers which enter the ganglion and spread widely within the neuropil. Application of either tracer to a single stellar (postganglionic) nerve labeled motor neuron cell bodies spread over 1/4 to 1/3 of the ganglion. Since there are 25-40 such stellar nerves per ganglion, it may be inferred that there is only a limited topographic relationship between the location of motor neuron cell bodies in the stellate ganglion and the segment of mantle muscle which they innervate. The axon and many side branches of these motor neurons were also labeled. The smooth, diffuse form of HRP labeling produced in pre- and portganglionic axotomized neurons in Oct0pus is similar in appearance to that produced in damaged mammalian neurons.

    Title Retrograde Intraaxonal Transport of Horseradish Peroxidase by Neurons in Octopus.
    Date March 1980
    Journal Brain Research
    Excerpt

    While retrograde axonal transport is the basis of a widely used neuroanatomical method, it has been rigorously demonstrated in vivo only in a few vertebrate species and not yet in an invertebrate. Evidence is presented that motor neurons of the octopus stellate ganglion are capable of retrograde intraaxonal transport of horeseradish peroxidase. This demonstration shows that retrograde transport occurs in widely divergent groups of animals, and may be a general property of neurons.


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