Milo Fradis

Drug-induced tinnitus and other hearing disorders.

SummaryTinnitus and hearing loss, both reversible and irreversible, are associated both with acute intoxication and long term administration of a large range of drugs. The mechanism causing drug-induced ototoxicity is unclear, but may involve biochemical and consequent electrophysiological changes in the inner ear and eighth cranial nerve impulse transmission. Over 130 drugs and chemicals have been reported to be potentially ototoxic. The major classes are the aminoglycosides and other antimicrobials, anti-inflammatory agents, diuretics, antimalarial drugs, antineoplastic agents and some topically administered agents.Prevention of drug-induced ototoxicity is generally based upon consideration and avoidance of appropriate risk factors, as well as on monitoring of renal function, serum drug concentrations, and cochlear and auditory functions before and during drug therapy. Ototoxicity, although not life-threatening, may cause considerable discomfort to patients taking ototoxic drugs, and in some cases drug discontinuation may be necessary to prevent permanent damage.Much research has been performed to investigate the causes and mechanisms of ototoxicity, to try to prevent this complication. Despite these efforts, ototoxicity still occurs, and there is much work to be done in order to understand the mechanism of ototoxicity of different drugs and to prevent hearing loss and tinnitus in the future.

Cisplatin ototoxicity in guinea pigs with special reference to toxic effects in the stria vascularis

The toxic effects of cisplatin (cis‐diamminedichloroplatinum [II]) on the organ of Corti are well established. Few and conflicting data on this drugs effects on the stria vascularis exist. The present study presents animal experiments on the toxic effects of cisplatin in the stria vascularis and in the organ of Corti. Cisplatin‐induced toxicity in albino and pigmented guinea pigs was evaluated morphologically and functionally, using light and transmission electron microscopy as well as auditory brainstem‐evoked potentials on the organ of Corti and the stria vascularis. The results showed variability in hearing thresholds, ranging from no change to hearing loss of 30 dB, and prominent damage in the organ of Corti and in the stria vascularis. The toxic effects to both the organ of Corti and the stria vascularis should be considered when cisplatin is used in chemotherapy.

Paper patching for chronic tympanic membrane perforations.

OBJECTIVE This study was designed to evaluate the results of paper-patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes. STUDY DESIGN AND SETTING A retrospective survey of paper-patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations. RESULTS Closure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure. CONCLUSIONS AND SIGNIFICANCE Paper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery.

Effects of peritonsillar infiltration on post-tonsillectomy pain. A double-blind study.

The concept that local infiltration of the operative area with a local anesthetic when using general anesthesia could alleviate postoperative pain is well known. We tested this concept on 129 patients scheduled for elective tonsillectomy. The patients were investigated in a double-blind, randomized study, and the operation was carried out via the standard technique of infiltrating the peritonsillar area preoperatively. The results indicated that preincisional infiltration of the tonsils with bupivacaine hydrochloride markedly decreased the intensity of pain following tonsillectomy, well beyond the immediate postoperative period.

A simple method of measuring the nasal airway in clinical work

The problem of measuring the nasal airway is discussed, and the previous literature has been reviewed. A simple method of measuring the airway and the degree of nasal obstruction has been proposed.

Ototoxicity of ear drops in patients suffering from chronic otitis media

The sensorineural hearing loss in 150 patients with chronic otitis media who were treated in the Haifa Medical Center (Rothschild) during a ten year period was studied. There were 124 patients treated with a mixture containing neomycin, polymyxin B and dexamethasone and a control group of 26 patients with dexamethasone only. All patients were followed up for a period of 1-2 years. Patients with hearing loss due to factors such as previous ear surgery, family history, exposure to noise etc., have been excluded. The conclusions reached were that there is a relationship between the period of disease and the sensorineural hearing loss and that the local treatment with a mixture containing neomycin + polymyxin B appears to contribute to the worsening of the sensorineural hearing loss in patients with chronic otitis media. Our numbers are small and further studies must be done, but the fact that currently used ear drops may produce a sensorineural hearing loss should not be ignored.

Otitis Media with Effusion: A Steroid and Antibiotic Therapeutic Trial before Surgery

Eustachian tube dysfunction has been considered the main factor in the etiology of otitis media with effusion (OME). A short-term systemic steroid therapy, with combined chemotherapeutics, yielded 53.1% cure in 160 children in which OME had been diagnosed, whereas only 12.5% of similar 116 children were cured by chemotherapeutic treatment alone. It is postulated that steroids, acting by a mechanism much similar to the one in the newborn lung, increase the level of a tubal surface active agent, thus enhancing Eustachian tube refunctioning. This combined treatment, we believe, deserves its place as a routine conservative trial before surgery.

Fiberoptic-guided Airway Exchange of the Esophageal-tracheal Combitube[registered sign] in Spontaneously Breathing Versus Mechanically Ventilated Patients

The aim of this study was to compare fiberoptic-guided airway exchange of the esophageal-tracheal Combitube[registered sign] (ETC, Kendall-Sheridan Catheter Corp., Argyle, NY) with an endotracheal tube in spontaneously breathing versus mechanically ventilated patients. Forty patients with Mallampati score III and IV scheduled for elective surgery were randomly allocated into two groups (n = 20 each): nonparalyzed, spontaneously breathing or paralyzed, mechanically ventilated patients. After anesthetic induction and insertion of the ETC, a fiberoptic bronchoscope threaded into an armored endotracheal tube was passed transnasally into the larynx. Endotracheal intubation was successful in 18 spontaneously breathing patients and in 15 patients during controlled ventilation. Successful airway exchange was completed in significantly less time (P < 0.05) in spontaneously breathing patients (9 +/- 3 min; mean +/- SD) than in mechanically ventilated patients (13 +/- 4 min). Both methods allowed for continuous airway control and maintenance of ventilation and oxygenation. The described method is a means of replacing the ETC with an endotracheal tube without interruption of airway control or ventilation. Replacing the ETC with an endotracheal tube using this method is more readily accomplished during spontaneous ventilation than during controlled ventilation. Implications: We describe the replacement of the Combitube[registered sign] by an endotracheal tube by the aid of fiberoptic bronchoscopy and without interruption of airway control or ventilation. The performance of this technique was facilitated by spontaneous ventilation compared with mechanical ventilation. (Anesth Analg 1999;88:193-6)

Inferior Turbinectomy versus Submucosal Diathermy for Inferior Turbinate Hypertrophy

In order to compare and evaluate bilateral inferior turbinectomy (BIT) and submucosal diathermy (SMD), we retrospectively examined these two well-known techniques for treatment of nasal obstruction due to bilateral congestion of the inferior turbinates. One hundred patients with bilateral nasal obstruction were divided into 4 groups according to their nasal airflow patency. Forty-nine patients underwent BIT, and 51 patients underwent SMD. All 100 patients were followed for 2 months after surgery. Patients with difficult postoperative courses were followed up to 1 year after surgery, in order to decide on the necessity of operative revision. Postoperative improvement in nasal breathing after BIT was reported for 96% of patients 2 weeks after surgery, and for 88% 2 months after surgery. Only 1 BIT patient had to undergo revision operation. Diathermy showed good results in 78% of cases 2 weeks after surgery. The efficacy of the procedure was reduced to 76% 2 months after surgery. Twenty percent of SMD patients were advised to undergo operative revision. Postoperative bleeding occurred in 20% of BIT patients and in only 4% of SMD patients. We found that the extent of postoperative improvement does not depend on preoperative conditions; therefore, it is impossible to predict the extent of postoperative improvement on the basis of the results of preoperative assessment. Both procedures can be performed under local anesthesia, are relatively safe and effective, and do not need expensive instrumentation that may not be available in many medical centers.

ENDOTHELIAL INJURY OF CAPILLARIES IN THE STRIA VASCULARIS OF GUINEA PIGS TREATED WITH CISPLATIN AND GENTAMICIN

The drugs cisplatin and gentamicin are used for treatment of various cancer patients suffering from infection. The authors report a detailed electron microscopic study of blood vessels in stria vascularis of guinea pigs after treatment with cisplatin alone and in combination with gentamicin. The most distinctive features expressing endothelial cellular injury were mitochondrial, including occasional paracrystalline inclusions; electron-lucent foci with depleted organelles; intracytoplasmic vacuole formations; lipid bodies; cytoplasmic extrusions located on the luminal surface; and severe luminal constriction of part of the vessels from animals treated with the combined drugs. The study suggests that the damage to strial capillaries due to treatment with cisplatin alone and in combination with gentamicin may contribute to the injurious effects of these drugs on the strial tissue. Furthermore, the results of this study may enlarge the awareness of the potential vascular damage and vascular complications in additional body systems after medical use of cisplatin alone or in combination with gentamicin.