Erez Bendet

Steroids, carbogen or placebo for sudden hearing loss: a prospective double-blind study

Abstract There is no consensus regarding treatment modalities for idiopathic sudden sensorineural hearing loss (SNHL). In order to evaluate the effectiveness of steroid or carbogen inhalation therapies, a prospective double-blind placebo controlled study was designed. All 41 patients enrolled in the study had unilateral SNHL with no prior history of SNHL, otological pathological history or otoscopic findings. Patients were assigned to four treatment groups: prednisone tablets, placebo tablets, carbogen inhalation or room air inhalation. All were treated for 5 days. The audiometric data at admission was compared to that at day 6 and to data collected at follow-up (average 33 days). Results revealed no significant difference between the groups for early or late audiometric outcome. Age, time from onset of symptoms to initiation of treatment, tinnitus, audiogram configuration, and the presence of vertigo at onset did not significantly affect the outcome. The discrimination scores that were poor in all patient groups on admission improved within days in all groups. These findings suggest that steroids or carbogen inhalation have no therapeutic advantage over placebo. Also, regardless of treatment modality, hearing continued to improve for at least a month after treatment was stopped.

Rate and Extent of Early Axonal Degeneration of the Human Facial Nerve

Electrophysiologic and histologic studies on a severed human facial nerve have shown that 1) response to stimulation by electroneuronography was lost on the sixth day following injury, 2) wallerian degeneration progressed in a nonuniform “front,” leaving some of the distal stump axons still viable and responsive to intraoperative stimulation 2 days following injury, and 3) the extent of proximal retrograde degeneration was far greater than to the next node of Ranvier. These findings are discussed in light of the current knowledge regarding peripheral nerve degeneration, and explanations are suggested.

Migration of Fishbone Following Penetration of the Cervical Esophagus Presenting as a Thyroid Mass

Fishbones are among the commonest foreign bodies lodged in the cervical esophagus. A small percentage of them will penetrate the esophageal wall and will be found either intra- or extraluminally. Migration of esophageal foreign bodies to the thyroid gland, and presentation as a mass, is extremely rare. We present such a case and review the relevant literature.

Juvenile cemento-ossifying fibroma of the maxilla.

A 14-year-old girl presented with a 3-month history of bulging right cheek and right nasal obstruction. The patient denied any pain, diplopia, tooth loosening, or bite change. On examination the cheek appeared moderately swollen and firm to palpation. Except for minimal right exophthalmos, the rest of the ophthalmologic evaluation was normal. Rhinoscopy revealed a right nasal cavity obstructed by a medially displaced lateral wall and mucopurulent discharge. The nasal septum was deflected to the left. Findings on the oral and dental examinations were normal. The rest of the physical examination findings were normal.

Preoperative electroneurography (ENoG) in parotid surgery: Assessment of facial nerve outcome and involvement by tumor—A preliminary study

Facial electroneurography (ENoG) is an established and reliable method for assessing neural degeneration in various conditions affecting the facial nerve. The facial nerve may be subclinically involved by parotid tumors, but estimating such involvement preoperatively may be difficult when facial function is normal. The hypothesis that preoperative ENoG: (1) can detect subclinical facial nerve degeneration as a measure of involvement by parotid tumors and (2) can predict facial nerve function following parotidectomy was prospectively evaluated in the present study.

Cerebrospinal fluid (CSF) otorhinorrhoea following vestibular schwannoma surgery treated by extended subtotal petrosectomy with obliteration

Extended subtotal petrosectomy as a treatment for persistent cerebrospinal fluid (CSF) otorhinorrhoea is presented. Four patients were successfully operated on by this technique, all previously having undergone suboccipital removal of vestibular schwannoma: other interventions used had failed to seal the fistulae. The internal auditory canal was the usual pathway for CSF leakage as well as retrosigmoid, retrolabyrinthine, retro- or perifacial cells. Total exenteration of middle ear and mastoid cell tracts, skeletonization of sigmoid sinus, jugular bulb and facial nerve, drilling out of semicircular canals, vestibule, and cochlea, and skeletonization of the internal auditory canal, followed by obliteration, are the main steps of this approach.