John R. Emmett

A simple autologous fibrinogen glue for otologic surgery.

A simple method of concentrating a patients own fibrinogen for use with a thrombin/calcium solution—to produce a coagulum-type tissue glue for otologic surgery—is presented. The principal advantages of this system include a simple modification of the cryoprecipitate technique, which can be easily performed in any hospital laboratory using a minimal amount of the patients blood, and the use of autologous fibrinogen, which completely rules out the possibility of transmission of hepatitis or AIDS viruses. Useful tips on preparation and use of this autologous tissue glue, based on experience over the past 2 years, will be presented.

Treatment of Tinnitus with Tocainide Hydrochloride

Intravenous (IV) injection of lidocaine was used in patients with tinnitus for combined treatment with oral anticonvulsants carbamazepine (Tegretol) and primidone (Mysoline). In most cases, the high complication rate with these drugs precluded their long-term use. Tocainide hydrochloride (HCI), a primary amine analog of lidocaine, can be taken orally and was evaluated for the use in the treatment of tinnitus. A double-blind study in which one group received 200 mg tocainide HCI four times a day and one group received a placebo revealed no significant differences in tinnitus relief between the two groups. A single-blind study in which 600 mg tocainide HCI four times a day was administered showed 80% to 90% tinnitus relief in five of the six patients who tolerated the drug. Tocainide HCI treatment of tinnitus is promising.

Medical Treatment of Tinnitus

Medical treatment is presented as the best hope of the various treatment methods available for the management of tinnitus. A test dose of 100 mg lidocaine given rapidly intravenously will give good or partial temporary relief to approximately 80% of patients with tinnitus. More permanent relief can then be achieved by the oral anticonvulsants carbamazepine or primidone but the side effects of these drugs are occasionally too severe to justify their use. Three preliminary clinical studies of the oral amide of lidocaine, tocainide hydrochloride, were conducted and results with 600 mg four times daily are very promising. Further long-term clinical trials with tocainide will be started soon. It would appear that local anesthetics when given intravenously block the multisynaptic slow pathways in tinnitus as well as in chronic pain, with which there are many other similarities. The delay in wave V in the BSER and the sudden sleep induced in patients with a good response to intravenous lidocaine further confirm the site of action of these drugs in the brainstem and reticular formation. Until tocainide is available for general use it is possible to control tinnitus with large doses of intravenous lidocaine, 100 mg given rapidly and 400 mg slowly with EKG monitoring each day for several days, and then at weekly intervals, as in the treatment of clausalgia. Because patients with disabling tinnitus, as with chronic intractable pain, are rigid, insecure, chronically depressed and fatigued, a mood-elevating tranquilizer drug combination such as perphenazine-amitriptyline is of great value in maintaining these patients. While medical treatment is not the final answer it is the best treatment available and it offers a promising direction for further study.

Long-Term Experience with Biocompatible Ossicular Implants

The senior authors 8-year personal experience with biocompatible ossicular implants is reviewed. Four hundred sixty-one consecutive operations, in which high-density polyethylene sponge ossicular replacement prostheses were used, are grouped according to the Bellucci classification of chronic otitis media. The prostheses used were the drum-to-footplate prosthesis (TORP, total) and the drum-to-stapes prosthesis (PORP, partial)*. Each groups short- and long-term hearing results are compared. Prosthesis extrusion and persistent or recurrent conductive hearing loss are the most common causes of operation failure. Failures within each group are analyzed, and techniques to prevent these complications are outlined.

Total deafness with chronic propoxyphene abuse.

Sensorineural hearing loss has not been known to be among the toxic effects of propoxyphene (sold under the trade name Darvon™ in the United States) overdosage. Recently a case was reported associated with moderate bilateral sensorineural hearing loss due to accidental overdosage of this drug. This paper presents a case of a progressive bilateral sensorineural hearing loss which resulted in total deafness, in a chronic propoxyphene abuser.

Diatrizoate Meglumine (Hypaque) Treatment for Sudden Hearing Loss

During the 24 month period ending in December 1978, 31 patients with sudden idiopathic sensorineural hearing loss were treated with vasodilators and Hypaque.

Sensorineural Hearing Loss in Cordless Telephone Injury

Audiometric data from 19 cases of cordless telephone injury are reviewed, including three cases with pre-insult and post-insult audiograms. In addition, data are presented from analyses of intensity and frequency for the ring signal of three telephones involved in injury cases. The most severe hearing loss was found at 500 Hz and 1000 Hz, where the mean threshold difference in the injured ear was 20 dB and 29 dB, respectively. The three cases for which pre-insult and post-insult data were available exhibited similar audiometric patterns, although the degree of threshold shift varied. Spectral analysis of the ring signal indicated sound-pressure levels of approximately 140 dB, with a fundamental frequency near 750 Hz.

Medical treatment of tinnitus

Tinnitus is the subjective perception of sound that does not exist. Tinnitus is caused by an altered discharge in the auditory pathway from hair cell to cortex and back. Intravenous Xylocaine acts by blocking 10% of the transmission through each synapse, having more effect on the slow multisynaptic pathway through the reticular formation than the rapid pathway to have more effect on the low frequency slow pathway tinnitus than the rapid pathway high frequency tinnitus. Tocainide, the oral amide of Xylocaine, is of great value in the treatment of tinnitus responsive to intravenous Xylocaine.

Treatment of sudden hearing loss with diatrizoate meglumine (Hypaque).

Between March and November 1976, 30 patients with sudden hearing loss (SHL) were treated with vasodilators and diatrizoate meglumine (Hypaque). Nine (30%) of the patients had a good response, 7 (23%) had a moderate response, and 14 (47%) had no response to treatment. Most of the patients who responded were treated within the first month and had no vertigo associated on their onset of SHL. Their hearing loss was also less than 90 dB for any of the frequencies tested. Using the criteria of SHL of less than one months duration, no vertigo associated with onset, and a loss less than 90 dB, seven patients were treated with vasodilators plus Hypaque during the period between January and August 1977. Six (86%) of the seven patients had return of serviceable hearing.

Prevention and Management of Complications of Ear Surgery

Educational objectives: To learn how some complications can be avoided, to recognize complications when they occur and act appropriately, and to comply with quality assurance mandates being developed throughout the United States.