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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The commonest cause of the intracranial abscesses collected prospectively during the last two years was chronic middle ear infection (73%). The diagnosis was based on the clinical history, otological investigations, contrast enhanced computerized tomography and surgical findings. The clinical presentation was characterized by chronic otitis with an exacerbation of otorrhea, otalgia or pain in the temporal region or headache with high fever, vomiting and nausea. A review of our 14 patients with otogenic intracranial abscesses is reported to highlight that prompt diagnosis, appropriate therapy and careful monitoring can provide vastly improved results.
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PMID:Otogenic intracranial abscesses. 207 51

The role of nasal allergy in chronic maxillary sinusitis without an air-fluid level was studied in 37 patients. Seventy-three nasal provocation tests with various inhalant allergens were performed in 37 patients by means of rhinomanometry, and maxillary sinus radiographs were performed before and repeatedly after the allergen challenge. Forty-one positive nasal responses (NRs) occurred in 29 patients; 13 were immediate only, 18 were late only, and 10 NRs were dual responses. Of these responses, 32 demonstrated radiographic changes, primarily an increase in mucosal edema and/or opacification. These responses were accompanied by increased pressure in the maxillary sinuses, acute headache, and sometimes otalgia. Eight patients did not develop any NRs; however, increased thickening of the mucosal membrane of the maxillary sinuses, accompanied by subjective symptoms, was recorded in three of these nonresponders. These results demonstrate the role of nasal allergy in some patients with chronic maxillary sinusitis, which may affect the diagnostic and therapeutic approaches to this disorder.
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PMID:Role of nasal allergy in chronic maxillary sinusitis--diagnostic value of nasal challenge with allergen. 222 10

We tested the hypothesis that the administration of nitrous oxide (N2O) causes major (e.g., myocardial infarction, neuronal injury, hypoxemia, infection, death) or minor (e.g., nausea, vomiting, headache, earache) untoward effects in patients requiring anesthesia for 1.5-4 h. Given the higher morbidity and mortality associated with aging, we also tested whether aging increased any untoward effect of N2O. Finally, we investigated whether the substitution of N2O for a fraction of the anesthesia supplied by isoflurane altered the latter's pharmacologic effects. We studied 270 patients scheduled for elective total hip arthroplasty (n = 100), carotid endarterectomy (n = 70), or transsphenoidal hypophysectomy (n = 100) who were randomly assigned within each surgical group to receive isoflurane with or without 60% N2O. Regardless of patient age, we found no difference in major or minor untoward outcomes between anesthetic groups, nor a trend to suggest that a larger data cohort would reveal a significant adverse effect of N2O. The addition of N2O administration decreased the isoflurane requirement for clinical anesthesia but did not alter most of the clinical variables measured in practice, including blood pressure, heart rate, rate of recovery from anesthesia, development of postoperative pain, patient satisfaction with anesthesia, or duration of anesthesia or of hospitalization. Patients given N2O were no more likely to dream during anesthesia, remember events during anesthesia, or be frightened by those events. Our results support the continued use of N2O to anesthetize patients for elective surgery.
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PMID:Clinical pharmacology of nitrous oxide: an argument for its continued use. 224 Jun 27

Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.
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PMID:[Otitis externa maligna and cranial neuropathy]. 228 52

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.
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PMID:Managing temporomandibular joint syndrome. 229 2

Sixty-eight patients, who were determined clinically (by the presence of audible and palpable-joint sounds) and arthrographically to have meniscus displacement with reduction, had protrusive splints constructed, and the results were evaluated for a minimum of 1 year to a maximum of 3 years. Eighteen additional patients, arthrographically determined to have meniscus displacement with reduction, served as a nontreatment group for comparison. Odds ratios were calculated to compare the proportions of subjects who experienced follow-up symptoms on the two regimens. Results indicated that with splint therapy there was a statistically significant reduction of the intensity of jaw joint pain, temporal headache, ear pain, and pain in front of the ear, and there was a decrease in the probability of a closed lock condition developing. Splint therapy is less likely to reduce frontal headache, neck pain, and clenching of teeth.
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PMID:Use of protrusive splint therapy in anterior disk displacement of the temporomandibular joint: a 1- to 3-year follow-up. 230 94

The purpose of this study was to determine if the intraoral vertical ramus osteotomy is an effective treatment for anterior disk displacements with reduction and associated temporomandibular joint pain and dysfunction. Success with this procedure was predicated on producing a more functional articular disk-condyle relationship by anterior and inferior repositioning of the condyle. The prospective study was undertaken of nine (eight female and one male) patients (mean age of 25.8 years) with anterior disk displacement with reduction and associated temporomandibular joint pain and dysfunction (mean duration of pain of 6.8 years). History, clinical dysfunction, and pain indices were used to determine the frequency and severity of temporomandibular joint dysfunction. The incidence of ear pain, muscle fatigue, tinnitus, headaches, and clicking was also assessed. The severity of the pain experience in the masticatory muscles and temporomandibular joints was evaluated through the use of a pain index. The severity of the pain experience and temporomandibular joint dysfunction in all of the patients was significantly reduced or totally eliminated during the period of followup. Surgical treatment of anterior disk displacement with reduction by intraoral vertical ramus osteotomy resulted in improved temporomandibular joint function and resolution of symptoms.
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PMID:Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy. 237 14

The clinical and radiologic findings in 30 patients who sustained injuries to the temporomandibular joint (TMJ) were retrospectively analyzed. Imaging consisted of variable combinations of radiography, tomography, two-compartment arthrography, computed tomography, and magnetic resonance imaging and was performed 2 days to 24 months after injury. Indications for imaging included acquired and/or unstable occlusal disturbances, cephalalgia, facial pain, otalgia, TMJ pain, tinnitus, dizziness, hearing disturbance, masticatory dysfunction, and muscle atrophy. Radiologic findings included internal derangement of the TMJ meniscus, swelling of retrodiskal tissues, joint effusion, mandibular condyle and condylar neck fractures, osteochondritis dissecans, avascular necrosis, degenerative condylar remodeling, osteoarthritis, musculotendinous injuries, and atrophy of masticatory muscles. After imaging studies, seven patients underwent surgery, at which time imaging findings were confirmed; one patient underwent successful aspiration of a painful hemarthrosis. TMJ injuries may result in joint derangement, radiologically demonstrable joint degeneration, masticatory muscle dysfunction, pain, and progressive clinical disability.
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PMID:Temporomandibular joint injuries. 278 Oct 10

A 54-year-old man initially complained of frontal headache, right ear pain and tinnitus in May, 1985. This was followed by right facial palsy and hearing loss, and he was admitted to our hospital. Physical findings revealed right trigeminal nerve disturbance, left facial nerve palsy and bulbar palsy. The spinal fluid showed pleocytosis, increased protein, decreased glucose, markedly increased carcinoembryonic antigen and adenocarcinoma cells. Gastric carcinoma was revealed by an upper GI series. He was treated with chemotherapy. However, he die in August, 1985. Nodular metastases were discovered at the right internal acoustic meatus and other areas. Microscopically, signet-ring cell carcinoma had diffusely infiltrated at the subarachnoid space.
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PMID:[An autopsy case of meningeal carcinomatosis with vestibulocochlear nerve disturbance as the first manifestation]. 302 29

A number of typical ENT complaints which do not involve organic signs or symptoms are presented, such as sinusitis-like headache, otitis-like earache and tonsillo-pharyngitis-like dysphagia. Since patients with such complaints usually visit an ENT specialist first, an introduction of additional diagnostic and therapeutic measures is imperative. Without having been trained in chirotherapy, it is possible to identify painful locations, myogeloses and functional disorders in the craniocervical area. In many cases treatment of these disorders leads to disappearance of associated irritational complaints. In addition to local treatment of the neck, the ENT specialist may employ a procedure as described. Superficial infiltration of the mucous membrane is performed with a local suprarenin-free anaesthetic in an area around the upper wisdom tooth and on the palatoglossal arch. This procedure often leads to spontaneous and lasting relief of symptoms. It is assumed that this has the effect of inhibiting the pathologically irritated afferents and thus of interrupting an altered reflex arc. Relief from the complaints is improved by physiotherapy and by avoiding the detrimental influence of bad posture, nervous stress, air draughts, cold chills etc. Extensive massage therapy can result in worsening of complaints.
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PMID:[Neck-induced myoneural irritation pain--a recommendation for therapy by the ENT physician]. 328 78


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