Steven M. Parnes

Cutaneous-evoked tinnitus. I. Phenomenology, psychophysics and functional imaging.

Complete and acute unilateral deafferentation of the auditory periphery (auditory and vestibular afferents) can induce changes in the central nervous system that may result in unique forms of tinnitus. These tinnitus perceptions can be controlled (turned on and off) or modulated (changed in pitch or loudness) by performing certain overt behaviors in other sensory/motor systems. Clinical reports from our laboratory and several other independent sources indicate that static change in eye gaze, from a neutral head-referenced position, is one such behavior that can evoke, modulate and/or suppress these phantom auditory events. This report deals with a new clinical entity and a form of tinnitus that can be evoked directly by cutaneous stimulation of the upper hand and fingertip regions. In 2 adults, cutaneous-evoked tinnitus was reported following neurosurgery for space-occupying lesions at the base of the skull and posterior craniofossa, where hearing and vestibular functions were lost completely and acutely in one ear (unilateral deafferentation) and facial nerve paralysis (unilateral deefferentation) was present either immediately following neurosurgery or had occurred as a delayed-onset event. Herein, we focus on the phenomenology of this discovery, provide perceptual correlates using contemporary psychophysical methods and document in one individual cutaneous-evoked tinnitus-related neural activity using functional magnetic resonance imaging. In a companion paper, neuroanatomical and physiological interactions between auditory and somatosensory systems, possible mechanistic accounts and relevant functional neuroimaging studies are reviewed.

Sinus Tumors Invading The Orbit

Forty -seven of 79 patients with sinus and paranasal tumors had clinical, radiographic or operative evidence of orbital involvement. Seventy percent of those patients with orbital extension had clinical or radiographic involvement of the orbit at the time of initial presentation. Common presenting signs and symptoms included proptosis, nasal obstruction or discharge, nasal mass, facial and/or eye pain, visual loss, facial and/or lid edema and diplopia. The most common tumor seen was squamous cell carcinoma. The maxillary sinus was the most frequent site of origin. Three patients were misdiagnosed as having sinusitis on initial evaluation. A diagnosis of sinusitis is tentative and should be reevaluated early with repeat roentgenographic studies and biopsy, especially in the presence of protracted facial and eye pain. When ordering CT scans, one must specifically request cuts of the base of the sinuses and skull as routine brain CT scans do not evaluate those regions. Two of four patients with intractable pain unrelieved by narcotics obtained pain relief with cisplatinum.

Predictive value of laryngeal electromyography in patients with vocal cord paralysis of neurogenic origin

Laryngeal electromyography can provide prognostic information when evaluating patients with vocal cord dysfunction. Twentyfour patients were studied to determine the predictive capacity of this test. Six patients had bilateral vocal cord paralysis, constituting a total of 30 vocal cords examined.

Cutaneous-evoked tinnitus. II. Review of neuroanatomical, physiological and functional imaging studies

Cutaneous-evoked tinnitus is a clinical entity that has not been reported previously in the neurootological literature. Herein, a neuroscience framework that encompasses several distinct areas of research is used to conceptualize and help understand this phenomenon. We review normal neuroanatomical and physiological interactions between auditory and somatosensory systems in mammals. Also considered are mechanistic accounts of lesion-induced changes in the CNS following deafferentation/deefferentation of peripheral sensory or motor structures that may have a relationship to this phenomenon, as well as the role of functional imaging modalities in studying various phantom perceptions.

Airway Complications from Laryngoscopy and Panendoscopy

Laryngoscopy and panendoscopy can cause airway complications. To determine the risk to the airway from reintubation following general anesthesia in otolaryngology patients, we examined recovery room and anesthesia records at the Albany Veterans Administration Medical Center covering a 10-year period. From this information we determined the incidence of recovery room reintubation and studied airway risk factors associated with otolaryngologic endoscopy. From 1975 to 1984, 10,060 surgical patients were intubated at the Albany VA Medical Center. Only 17 patients (0.17%) required reintubation. Of 1,365 otolaryngology patients intubated during the same period, 324 had laryngoscopy and 302 had panendoscopy. Significantly, four laryngoscopy patients (1.2%) and nine panendoscopy patients (3%) required recovery room intubation. Nine endoscopy patients needed reintubation within 1 hour of extubation. We conclude that the risk of postoperative airway compromise is significantly greater among patients who underwent diagnostic laryngoscopy and panendoscopy than among patients who had general anesthesia for other reasons.

Anomalous cross-modal plasticity following posterior fossa surgery: Some speculations on gaze-evoked tinnitus

A unique and intriguing form of subjective tinnitus evoked by eye gaze is reviewed. A new perspective is presented because this condition is sufficiently different from other forms of subjective tinnitus and its manifestation cannot be adequately explained by existing models or conceptual frameworks. Our examination of this topic considers pathophysiologic changes in the central nervous system in the context of deafferentation-induced plasticity. Potential neuroanatomical areas contributing to this effect include a number of distributed and functionally diverse areas in the brainstem and neocortex involved in the auditory control of eye movements. We also consider contemporary psychophysical methods to evaluate the perceptual correlates of this phenomenon and tools for the development of objective tinnitus measurements. Although theoretical and speculative in nature, this article is intended to stimulate interest in, advance knowledge of, and provide a better understanding about this condition.

Study of spastic dysphonia using videofiberoptic laryngoscopy.

— Spastic dysphonia is a speech disorder, characterized by a “strangled voice quality,” irregularly occurring phonatory arrests, and a jerky pattern of speech. This is often extremely disruptive to the patients ability to communicate. Two cases are presented in which a new technique, videofiberoptic laryngoscopy, was employed in the study of these patients. The characteristic laryngeal behavior of this disorder is documented and recorded, particularly noting the increase in supraglottic activity and how different vocal maneuvers alter this activity.

Morbidity of Combined Therapy for the Treatment of Supraglottic Carcinoma: Supraglottic Laryngectomy and Radiotherapy

Many surgeons find that patients have increased morbidity after supraglottic laryngectomy if postoperative irradiation is given, but this remains poorly documented. Twenty-nine patients undergoing supraglottic laryngectomy were retrospectively reviewed. Seventeen received postoperative radiotherapy, and 12 did not. The mean follow-up was 64 months. When compared to patients treated with supraglottic laryngectomy alone, irradiated patients had a significantly higher incidence of lifelong gastrostomy dependency (35% versus 0%; p = .03) and acute upper airway obstruction (29% versus 0%; p = .05). There was a trend toward greater tracheotomy dependency (24% versus 0%), aspiration pneumonia (35% versus 9%), and delayed independent swallowing (34.8 weeks versus 7.8 weeks) in the patients treated with combined therapy, but this difference was not significant. A morbidity index score was developed to evaluate the overall lifelong morbidity of these patients, and this was found to be significantly higher in patients treated with surgery and radiotherapy (2.29 versus 0.83; p = .04). Overall survival was equal in both groups. We have shown that radiotherapy increases the morbidity of supraglottic laryngectomy. This should be considered when planning treatment for patients with supraglottic carcinoma.

Superficial Siderosis of the Central Nervous System: A Neglected Cause of Sensorineural Hearing Loss:

Superficial siderosis of the central nervous system is a rare, often unrecognized condition in which there is a deposition of intracellular and extracellular hemosiderin in the leptomeninges, subpial tissue, spinal cord, and cranial nerves as a result of chronic bleeding in the subarachnoid space. On the basis of our cases and a review of the literature, the majority of patients manifest sensorineural hearing loss in addition to cerebellar dysfunction, pyramidal tract signs, and progressive mental deterioration. Recent imaging techniques—particularly CT and MRI—can define the presence of iron deposition, confirming the diagnosis ante mortem. From post mortem specimens, histologic sections demonstrate severe damage to the eighth nerve, with microglial metabolism of iron. Cases will be presented to illustrate these points.

3 Tesla Delayed Contrast Magnetic Resonance Imaging Evaluation of Ménière's Disease

Objective: To determine whether 3 Tesla (T) magnetic resonance imaging (MRI) with delayed contrast imaging has sufficient anatomic resolution to image the intracochlear fluid spaces (i.e., the scala tympani, scala media, and scala vestibuli) of the inner ear and identify endolymphatic hydrops in vivo.