Yoram Rapoport

Oral Ofloxacin Therapy for Invasive External Otitis

The clinical efficacy and safety of orally administered ofloxacin (400 mg twice daily) were evaluated in 24 adult patients (17 men and 7 women; mean age, 65.8 years) with pseudomonal invasive external otitis (IEO). The patients were divided into two groups: Group A, (n = 9) suffering from a mild form of IEO, and group B (n = 15), suffering from a more severe form of the disease. Diabetes mellitus was the main underlying disease in these patients. Pseudomonas aeruginosa was the only pathogen in 18 infected ears and part of the polymicrobial flora in an additional 6. Cure was observed in 83.3 % of the patients. Two of the cured patients required more than one course of ofloxacin treatment. Development of P aeruginosa resistant to ofloxacin (n = 3) and severe allergic reaction (n = 1) required the discontinuation of ofloxacin therapy. Other side effects such as nausea, arthralgia, and vaginal itching were minimal. Oral administration of ofloxacin seems to be an effective, convenient, relatively safe, and economical therapy of IEO caused by the susceptible organism.

Acute airway obstruction and achalasia of the esophagus

Patients with achalasia tolerate considerable distension of the esophagus. Respiratory symptoms usually are due to regurgitation and pulmonary aspiration of retained food rather than to a space-occupying mechanism. We describe a case of previously undiagnosed achalasia presenting in an elderly woman with symptoms consistent with tracheal obstruction of acute onset.

Sleep apnea following bilateral excision of carotid body tumors.

A patient is described who developed apnea, hypertention, and tachycardia following the excision of bilateral carotid body tumors. Hypertension and tachycardia resulted, most probably, from bilateral ablation of the carotid sinus and/or the nerve of Hering. These phenomena have been described in the literature. The pathogenesis of the apneic attacks may be related to the ablation of the peripheral sensory organs (both carotid bodies), interference with the function of the respiratory automatic control system, and impaired control of ventilation during non‐REM sleep. Temporary unilateral paralysis of the hypoglossal nerve with partial airway obstruction possibly represented a mechanical trigger. The apneic attacks subsided but bouts of hypertention and tachycardia persist.

Changes in auditory function associated with 2-cyano-butyl-acrylate adhesive implanted in the middle ear of experimental animals

The effects on auditory function caused by the implantation of 2‐cyano‐butyl‐acrylate adhesive in the middle ear was investigated in experimental animals. Auditory brain‐stem responses to click stimuli were used to measure hearing thresholds prior to and following implantation of 2‐cyano‐butyl‐acrylate adhesive in the middle ear of guinea pigs. A permanent and deep threshold shift observed at 2 months in 62% of the examined animals, suggested that this tissue adhesive is an ototoxic middle ear implant material and should not be considered in reconstructive middle ear surgery. The functional data correlate well with some of the previous morphological observations.

Functional changes in the brainstem auditory pathways following open-heart surgery

Measurements of the auditory brainstem responses (ABR) were used to assess the functional integrity of the brainstem auditory pathways following open-heart surgery. Recording of ABR was performed in 31 patients before and after open-heart surgery. The values of ABR measurements were compared to those of a control group of normal-hearing subjects. Postoperative aberrations in ABR were observed in 12 patients. Brainstem transmission time measured as wave I to wave V interpeak latency (I-V IPL) was prolonged in 6 patients and shortened in 8 patients. Concomitant impairment in hearing function was not present, and therefore, these changes most probably reflected a functional alteration in the neurological status of the brainstem. Possible explanations of the postoperative changes in I-V IPL are discussed, however, further studies are needed to clarify the pathogenesis of these changes. Measurement of ABR may prove to be an important adjunct in the overall assessment of the neurological status following open-heart surgery.