Moshe Goldsher

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.

Auditory Brainstem Evoked Potentials in Insulin-dependent Diabetics with and without Peripheral Neuropathy

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 33 insulin-dependent diabetes mellitus (IDDM) patients (17 with diabetic peripheral neuropathy and 16 without) as well as from 20 normals. Pure-tone audiometry, speech reception threshold and discrimination were also evaluated. Sub-clinical pure-tone threshold elevation was observed for IDDM patients with neuropathy. Pure-tone thresholds of IDDM patients without neuropathy were not significantly different from those of normals. ABEP abnormality (at 10/sec click rate) was observed in 31% of IDDM patients with neuropathy, rising to 44% when 55/sec click rate measures were included. Abnormalities included bilateral and symmetrical peak-latency prolongations for all waves, greater for the later waves, and prolongation of V-I and V-III interpeak latency differences, all at 10/sec, and only prolonged peak latency for I at increased rate. Abnormalities coincided with microangiopathy and peripheral neuropathy. The incidence of ABEP abnormality for IDDM patients without neuropathy was only 12%, unilateral and sporadic in nature. As a group, IDDM patients with neuropathy had significantly prolonged IV and V peak-latencies, compared with the normals, or with the IDDM patients without peripheral neuropathy. In contrast, IDDM patients without neuropathy resembled the normals in all respects. ABEP have proven useful in understanding the variety of pathologies underlying the clinical manifestation of diabetes.

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.

Occurrence of Additional Primary Neoplasms in Patients with Laryngeal Carcinoma in Israel (1960–1976)

One thousand-six-hundred and sixty cases of laryngeal cancer were diagnosed in Israel during the years 1960–1976. In 98 of these cases another primary cancer accompanied the laryngeal carcinoma. Patients whose second primary cancer was basal or squamous cell carcinoma of the skin were not included in this study. Therefore, the results reported here deal with 84 patients. The prevalence of multiple primary cancer in patients with laryngeal carcinoma was found to be 5%. Lung cancer is the other primary tumor accompanying laryngeal carcinoma most frequently (29% of the additional tumors) followed by colorectal and bladder cancers. Most of the additional tumors (83%) appeared in a metachronic form with an average time interval of six years. In most metachronic tumors laryngeal carcinoma appeared as the first tumor (86%). Eighty percent of the patients were dead by August 1978. The majority (74%) succumbed due to the additional tumor and only 4% died of laryngeal carcinoma.

Hyoid bone fracture with pharyngeal lacerations

Four cases of hyoid bone fracture with laceration of the pharynx are presented. The emergency treatment must aim at an exploration of the neck in an attempt to suture the lacerations of the pharyngeal mucosa. The fractured hyoid bone may be left untouched in most cases. The most common causes of fractures of the hyoid bone were previously considered to be violent strangulation and hanging. In the last two decades, however, road accidents seem to have become the most important cause in patients who survive the initial impact of collision. The biodynamics of injury to the pharynx and larynx in road accidents have been adequately described by Nahum and Siegel (1967). The concluded that the driver was the most frequent victim and the steering wheel was the object with which the neck most commonly collides. It is very easy to miss a fractured hyoid bone during the urgent admission of a patient injured in a traffic accident, since the more dramatic injuries are treated first and a treacheostomy is often performed to provide an airway.

Complication of Jet Ventilation during Microlaryngeal Surgery

Complications during jet ventilation for microlaryngoscopy, which is usually a relatively safe procedure, are rare. Those described have included hypoventilation, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, and gastric distention. We describe herein a case of a life-threatening complication during jet ventilation with a Cardens tube that ended in laparotomy.

Primary hydatid cyst of the maxillary sinus

An unusual case of hydatid cyst of the maxillary sinus compressing the orbit is presented. No similar report has appeared in world literature.

Assessment of Long-Term Middle Ear Ventilation

Pathologic changes of the middle ear cavity are almost invariably caused by eustachian tube malfunctions which are either permanent, fluctuating or recurrent. The process may deteriorate from middle ear effusion to atelectasis of the middle ear, adhesive otitis, and can potentially end in cholesteatoma. Close association with eustachian tube malfunction is common in the following conditions: cleft palate, allergy, obstructive lymphoid hypertrophy, hypoimmune state, etc. Negative intratympanic air pressures typify the above conditions, leading to the progressive pathology of the ear drum and cavity. Localized atelectatic retraction pockets signal the alarm of impending irreversible complications. They may be localized in any part of the eardrum, predominantly in the posterosuperior quadrant. Inpocketed by the continuous vacuum, these invaginations may fill with trapped epithelial debris. Re-establishment of adequate middle ear ventilation is the key in every attempt to arrest and reverse this pathology. Cl...

Superiorly based tracheostomal flap to counteract tracheal stenosis: Experimental study.

A superiorly based tracheal flap raised from the anterior tracheal wall was rotated anteriorly and superiorly to be sutured to the subcutaneous tissues. A series of 16 tracheostomies were performed on mongrel dogs. The stenosing effects of conventionally performed operations were compared to those of the new method. Autopsy sections of the post‐tracheostomy sites demonstrated a significant loss of anteroposterior diameter averaging 16.5% as compared to the original unoperated‐on luminae. No signs of tracheal stenosis were found whenever the proposed new technique was employed. This technique seems applicable to patients in whom assisted ventilation is contemplated.

Auditory Brainstem Evoked Potentials in Blast Injury

Blast injury typically consists of a mixed conductive and sensorineural hearing loss. The sensorineural component includes temporary as well as permanent threshold elevations. Auditory brainstem evoked potentials (ABEP) are sensitive to functional changes in various levels along the auditory pathway. ABEP were recorded from 37 survivors of blasts and latency measures were correlated with clinical findings. Prolongation of peak latencies was correlated with the conductive component of blast-induced hearing loss, as well as with the TTS component of the sensorineural impairment. No central effects of blast on the auditory system were detected. In addition to their objectivity, ABEP hold the promise of differentiating between the permanent and temporary effects of blast on hearing.