William R. Wilson

Intralesional cidofovir therapy for laryngeal papilloma in an adult cohort

Objectives To confirm the safety and efficacy of intralesional cidofovir in the management of laryngeal papilloma and to identify variables that correlate with number of injections needed to achieve remission.

Treatment of syphilitic hearing loss. Combined penicillin and steroid therapy in 29 patients.

Twenty-nine patients with presumed syphilitic hearing loss, either congenital or acquired, were treated on one or more occasions according to a three-month protocol using penicillin and prednisone. Changes in hearing were carefully followed during treatment and for at least one year thereafter. Of 58 ears studied in 29 patients, 19 demonstrated significant partial improvement in hearing during treatment. However, 11 ears returned to pretreatment hearing levels after therapy, and only 8 ears, or 15%, maintained the hearing gains one year later. Enhanced discrimination occurred more commonly than gains in pure tone threshold. Long-term alternate day prednisone therapy was required to sustain hearing improvement in a small number of patients.

Electronystagmography in congenital and acquired syphilitic otitis.

This study is an analysis of the electronystagmogram (ENG) changes in 17 patients with luetic vestibular disease with early and late acquired syphilis and congenital syphilis. Vestibular disturbances occurred in 80% of patients with luetic otitis. Among these patients the ENG gives signs of peripheral rather than central vestibular injury, and reduced vestibular response to caloric stimulation is the most common finding. Congenital syphilis patients have the greatest dysfunction, both in degree of ENG changes and incidence of bilaterality. We found no correlation between FTA-ABS levels and the amount of hearing impairment or vestibular injury. Treatment with penicillin and steroids had a beneficial subjective effect upon the symptoms of vertigo in over half the patients.

Rapid, Atraumatic Method for Obtaining Nasal Mucus Samples

Disposable cellulose acetate sponges, properly placed in the nose, provide a rapid method of stimulating the production of nasal mucus to be obtained for study. There is little trauma to the nasal mucosa, thus minimizing the risk of contamination of samples with serum or cells. The mucus is not diluted, and therefore, quantitative measurements of immunoglobulins and other substances can be made.

Study of ventilation testing with electronystagmography.

Provocation tests such as head shaking and positional tests, as well as hyperventilation, have been used routinely by many laboratories to elicit nystagmus during an electronystagmogram. We added oxygen testing to this routine battery and compared the results with hyperventilation and other forms of provocative testing. Hyperventilation and oxygen testing are unique in that they probably affect the vestibular system by changing the levels of oxygen and carbon dioxide supplied. Hyperventilation in theory would decrease available oxygen, while oxygen testing would cause an increase. In a study of two groups totaling over 700 patients, we found that oxygen testing is only occasionally positive (2.5%) and is of little practical value. Hyperventilation testing is positive 8% of the time but rarely alone, and has no localizing value. When hyperventilation and oxygen tests are both positive, the nystagmus may be in opposite directions. In 6 of 18 patients with acoustic neurinomas, hyperventilation produced transitory direction-changing nystagmus.

Hypertelorism in Nasal and Paranasal Sinus Polyposis

This 13-year-old female has had a lifelong history of complete nasal obstruction. In early childhood she developed asthmatic bronchitis and required frequent hospitalizations for status asthmaticus. Allergy skin testing demonstrated sensitivity to dust, mold, feathers, and tree pollen. Despite antigenic therapy for four yeats, she required steroids for control of her asthma. She has no known aspirin sensitivity and evaluation for cystic fibrosis was negative.

Pacemaker Artifact on Eng Tracing

The electronystagmogram (ENG) of this 76-yearold female, who was referred for diagnostic evaluaxad tion of vertigo, demonstrates an electronic artifact secondary to the signal generated by a cardiac pacexad maker. The patient had complaints of dizziness, staggering and tinnitus associated with visual grayouts lasting 15-20 seconds almost daily for several months . Three years prior to her evaluat ion, a Medtronic® endocardial pacemaker had been placed in the t rabecular system of the right ventricle via the right cephalic vein for correction of a complete heart block.