David Moffat | University of Cambridge (original) (raw)

Papers by David Moffat

The Journal of Laryngology & Otology, 2008

The aim of this study was to present the management and survival data of patients with squamous c... more The aim of this study was to present the management and survival data of patients with squamous cell carcinoma of the temporal bone, and to discuss whether extensive surgery improves survival. Retrospective, case-series review of 17 patients (18 cases) with temporal bone carcinoma (15 primary and three recurrent tumours), over a period of 20 years. Tertiary referral centre-university hospital. Disease-specific and overall five-year survival. The mean age at presentation was 63 years, with a range of 39 to 75 years. Twelve cases of de novo tumour were managed by surgical resection followed by adjuvant radiotherapy in 10 cases, while three such patients were considered incurable from the outset and were given a combination of radiotherapy and chemotherapy. Of the three patients referred to our unit with recurrent disease, two were treated elsewhere with radical mastoidectomy and one with chemoradiation; all were subsequently managed by subtotal petrosectomy. The disease-specific and overall five-year survival for the entire cohort was 64.17 per cent (mean 89 months; 95 per cent confidence interval, 62-117) and 47.06 per cent (mean 70 months; 95 per cent confidence interval, 43-98), respectively. The disease-specific and overall survival for patients with advanced T3 and T4 tumours was 59 per cent (mean 83 months; 95 per cent confidence interval, 53-113) and 40 per cent (mean 62; 95 per cent confidence interval, 33-91 months), respectively. All but one recurrence developed within 12 months of initiating treatment. No deaths occurred after 26 months of follow up. A lateral temporal bone resection is adequate treatment for T1 and T2 tumours. Post-operative radiotherapy should probably be offered for large T2 tumours. For T3 and T4 tumours, a subtotal petrosectomy with parotidectomy followed by post-operative radiotherapy is adequate treatment, as it offers a similar outcome to that of more extensive procedures.

…, 2009

Abstract: Squamous cell carcinoma (SCC) is a relatively common, malignant neoplasm of dogs and ca... more Abstract: Squamous cell carcinoma (SCC) is a relatively common, malignant neoplasm of dogs and cats that can arise in a variety of locations. The gross appearance of SCC can be variable and nonspecific, so definitive diagnosis requires microscopic examination of the ...

Otolaryngology - Head and Neck Surgery, 1999

The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by t... more The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by the retrosigmoid approach at Addenbrooke's Hospital, Cambridge, during a 10-year period are presented. The hearing-preservation rate, using audiometric criteria set by others as "serviceable hearing" (Wade PJ, House W. Otolaryngol Head Neck Surg 1984;92:1184-93; Silverstein H, et al. Otolaryngol Head Neck Surg 1986;95:285-91; Cohen NL, et al. Am J Otol 1993;14:423-33) was 8% (4 of 50 cases). When the more stringent selection criteria of near-normal hearing and reporting criteria of socially useful hearing preservation (pure-tone average < 30 dB/speech discrimination score > 70%) is used, the hearing-preservation rate is 4.8% (1 of 21 cases). The only preoperative factor that may predict a favorable hearing-preservation outcome is normal auditory brain stem response morphology (Fisher's exact 2-tailed test, P < 0.001). The number of suitable candidates for hearing-preservation surgery are few. Reasonable indications for attempted vestibular schwannoma surgery with hearing preservation are discussed.

Otolaryngology - Head and Neck Surgery, 1999

With increasing refinement in the surgery of vestibular schwannoma the aims of complete tumor rem... more With increasing refinement in the surgery of vestibular schwannoma the aims of complete tumor removal and facial nerve preservation have been largely fulfilled. However, the reputation of and place for hearing-preservation surgery still remain uncertain. A major part of this uncertainty is the result of difficulties in interpretation of the various reported results of hearing-preservation surgery. Meaningful comparison between series is difficult because of the varied number of postoperative reporting criteria commonly in use today. Although it is acknowledged that the postoperative reporting criteria affect the hearing-preservation rates, what is not readily appreciated is that preoperative selection criteria for hearing-preservation cases can also significantly affect the success rate of hearing-preservation acoustic neuroma surgery. This article models the many possible outcomes of hearing-preservation schwannoma surgery by use of the previously reported Cambridge series as an illustrative example. With these models some understanding can be gained of the effect of choosing various preoperative and postoperative hearing criteria on the overall hearing-preservation success rate.

The American journal of otology, 1998

This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by... more This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors. This study was a retrospective case review of 473 patients with vestibular schwannoma. The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center. A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied. Measured were the principal presenting symptoms and the criteria for audiologic management. Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney ...

The American journal of otology, 1998

This study aimed to review the management of cerebrospinal fluid (CSF) fistulae in the setting of... more This study aimed to review the management of cerebrospinal fluid (CSF) fistulae in the setting of developmental inner ear deformity. The study design was a case review, close examination of preoperative radiology, and corresponding intraoperative images. A definitive method of CSF fistula closure is described using previously known techniques used commonly in skull base surgery. The use of a multiple-level, reinforced wound closure technique is necessary to definitively close CSF fistulae in extreme inner ear deformity and to prevent further episodes of CSF leak and meningitis.

The American journal of otology, 1998

This article aimed to describe a new technique for the reconstruction of middle fossa tegmental d... more This article aimed to describe a new technique for the reconstruction of middle fossa tegmental defects using autologous osteocyte containing bone pate. The technique is demonstrated using clinical photographs and x-ray examples of tegmental defects. Pliable bone pate graft is manufactured using autologous bone dust, blood, iodine solution, and tissue glue (Tisseel; Immuno, Austria). The graft is placed accurately via a combined mini-middle fossa craniotomy and middle mastoidectomy approach. This new technique of middle fossa bony tegmental repair has considerable advantages over previously described methods that use rigid or synthetic materials.

Ontology Neurotology, Dec 31, 1997

This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by... more This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors. This study was a retrospective case review of 473 patients with vestibular schwannoma. The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center. A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied. Measured were the principal presenting symptoms and the criteria for audiologic management. Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney U test; tied p value = 0.0002), shorter length of history (tied p value < 0.0001), and better preserved hearing (tied p value < 0.001) than the typical otologic presentation group. These clinical correlates are related to tumor morphology, and it is hypothesized that the site of the neurilemmal-glial junction (medial or lateral) has an effect here. If the U.S. criteria for the treatment of a patient by an audiologist are applied to this series of patients, then 7 patients (1.5%) would not have had the diagnosis of vestibular schwannoma. If the U.K. criteria are applied, this number of missed tumors is 17 (3.6%). The addition of unilateral tinnitus as an indicator of the need for otologic investigation reduced the number of patients who might be missed to 2 (0.42%) for the U.S. cases and 5 (1.1%) for the U.K. cases. Of patients with vestibular schwannoma, 10.7% have an atypical principal presenting symptom, and this group of patients has significantly larger tumors than those patients who present typically. This finding is of particular relevance to the entry point of such cases to the healthcare system. A number of patients with vestibular schwannoma appear to pass the criteria for treatment by an audiologist without reference to an otologic opinion. These patients may not be investigated from an early stage with potential implications for increased morbidity.

Head & Neck Oncology

Vestibular Schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumor that develops... more Vestibular Schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumor that develops from the vestibular nerve, or very rarely from the cochlear nerve. The tumor is located along the course of the nerve that is, between the inner ear and the brainstem in the internal auditory canal and the cerebello-pontine angle (CPA). This review summarizes the current knowledge on clinical and molecular aspects of vestibular schwannoma development with special emphasis on cellular de-differentiation of Schwann cells into plastic neural crest stem cell-like phenotype as the potentially involved cellular and molecular mechanism.

Head & Neck Oncology

Vestibular schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumour that develop... more Vestibular schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumour that develops from the vestibular nerve, or very rarely from the cochlear nerve. The tumour is located along the course of the nerve that is between the inner ear and the brainstem in the internal auditory canal and the cerebellopontine angle. This review summarizes the current knowledge on clinical and molecular aspects of VS development with special emphasis on cellular dedifferentiation of Schwann cells to plastic, neural crest stem cell-like phenotype. We also summarize the signalling cascades potentially involved in VS development and dedifferentiation of Schwann cells after injury.

Case reports in otolaryngology, 2013

Pneumatisation of styloid process is a very rare finding and has never been reported previously. ... more Pneumatisation of styloid process is a very rare finding and has never been reported previously. We present a unique case of a pneumatised styloid process with a cholesteatoma arising within the cavity. We describe the clinical features, associated radiological findings, and management of this lesion.

Skull base : official journal of North American Skull Base Society ... [et al.], 2006

To evaluate preoperative hearing, dizziness, and tinnitus handicap in patients with unilateral ve... more To evaluate preoperative hearing, dizziness, and tinnitus handicap in patients with unilateral vestibular schwannoma (VS). Prospective administration of the Hearing Handicap Inventory (HHI), Dizziness Handicap Inventory (DHI), and Tinnitus Handicap Inventory (THI), prior to surgical intervention. A tertiary referral neuro-otology clinic. A total of 145 consecutive patients who were admitted for excision of their vestibular schwannomas between May 1998 and July 2002. HHI, THI, and DHI scores. HHI, THI, and DHI scores were all found to be significantly correlated. There was no significant association between tumor size and any of the questionnaire scores. When data were categorized to give a measure of handicap severity, 68% had mild to significant hearing handicap, 30% had mild to severe tinnitus handicap, and 75% had mild to severe dizziness handicap. Eighty-eight percent of patients had some handicap in at least one domain, and 23% had some handicap in all three domains. Seven perc...

Skull base : official journal of North American Skull Base Society ... [et al.], 2006

To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with... more To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with unilateral sporadic vestibular schwannoma (VS) to describe the clinical characteristics of tinnitus in this population. Further, to ascertain which of the proposed mechanisms of tinnitus generation in VS was supported. Retrospective case note and database review. Tertiary university teaching hospital departments of audiology and neuro-otology. Nine hundred forty-one patients with unilateral sporadic VS, diagnosed during the period 1986 to 2002. Twenty-three additional patients were excluded due to missing clinical data. The presence or absence of tinnitus, and its rated subjective severity were analyzed in conjunction with data regarding patient demographics, symptoms, signs, and diagnostic audiovestibular test findings. No statistical association at the 5% level was found between tinnitus presence/absence and patient age, gender, 2- to 4-kHz audiometric thresholds, ipsilateral auditory...

The American journal of otology, 1995

A postal survey was conducted, using a standardized quality of life questionnaire, of patients wh... more A postal survey was conducted, using a standardized quality of life questionnaire, of patients who had undergone surgery for removal of vestibular schwannoma between 1981 and 1992. Of 257 questionnaires, 227 (88%) were returned completed. The questionnaire was based on the European Organisation for Research into the Treatment of Cancer (EORTC) core questionnaire. A series of five functional gradings were used to assess the quality of life, and specific questions were also asked. The results were numerically scored and have been correlated with patient and tumor characteristics. There was a significant difference (p = .0001) between the subjective functional outcome for small and intracanalicular tumors when compared with tumors larger than 1.5 cm maximum diameter. However, there was no significant difference when tumors 1.5 to 2.5 cm in diameter were compared to larger tumors. Poor functional outcome did not correlate with the age of the patient, position in the series, or postopera...

The Laryngoscope, 2007

Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone prima... more Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone primarily affecting elderly diabetic patients. To determine whether cranial nerve involvement in malignant external otitis affects or predicts the clinical outcome in terms of morbidity and mortality. Diagnosis of malignant external otitis was established in 23 patients (average age, 71 yr; range, 39-87) based on inclusion criteria of severe pain, otitis externa refractory to conventional treatments, diabetes mellitus, and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone involvement extending outside the external auditory canal. Retrospective analysis of hospital records. Ten of 23 (43.5%) patients showed cranial nerve involvement. The following cranial nerves were affected: facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10), and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%) patients displayed no cranial ner...

Journal of Laryngology and Otology, 1980

A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the... more A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the Out-Patient Department has been described. Homograft temporalis fascia was used as a graft material. In a series of eighteen patients a closure rate of 78.2 per cent was obtained. The advantages of the method have been discussed.

Otology & Neurotology, 2012

The Journal of Laryngology & Otology, 2008

The aim of this study was to present the management and survival data of patients with squamous c... more The aim of this study was to present the management and survival data of patients with squamous cell carcinoma of the temporal bone, and to discuss whether extensive surgery improves survival. Retrospective, case-series review of 17 patients (18 cases) with temporal bone carcinoma (15 primary and three recurrent tumours), over a period of 20 years. Tertiary referral centre-university hospital. Disease-specific and overall five-year survival. The mean age at presentation was 63 years, with a range of 39 to 75 years. Twelve cases of de novo tumour were managed by surgical resection followed by adjuvant radiotherapy in 10 cases, while three such patients were considered incurable from the outset and were given a combination of radiotherapy and chemotherapy. Of the three patients referred to our unit with recurrent disease, two were treated elsewhere with radical mastoidectomy and one with chemoradiation; all were subsequently managed by subtotal petrosectomy. The disease-specific and overall five-year survival for the entire cohort was 64.17 per cent (mean 89 months; 95 per cent confidence interval, 62-117) and 47.06 per cent (mean 70 months; 95 per cent confidence interval, 43-98), respectively. The disease-specific and overall survival for patients with advanced T3 and T4 tumours was 59 per cent (mean 83 months; 95 per cent confidence interval, 53-113) and 40 per cent (mean 62; 95 per cent confidence interval, 33-91 months), respectively. All but one recurrence developed within 12 months of initiating treatment. No deaths occurred after 26 months of follow up. A lateral temporal bone resection is adequate treatment for T1 and T2 tumours. Post-operative radiotherapy should probably be offered for large T2 tumours. For T3 and T4 tumours, a subtotal petrosectomy with parotidectomy followed by post-operative radiotherapy is adequate treatment, as it offers a similar outcome to that of more extensive procedures.

…, 2009

Abstract: Squamous cell carcinoma (SCC) is a relatively common, malignant neoplasm of dogs and ca... more Abstract: Squamous cell carcinoma (SCC) is a relatively common, malignant neoplasm of dogs and cats that can arise in a variety of locations. The gross appearance of SCC can be variable and nonspecific, so definitive diagnosis requires microscopic examination of the ...

Otolaryngology - Head and Neck Surgery, 1999

The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by t... more The results of 50 cases of vestibular schwannoma surgery with hearing preservation performed by the retrosigmoid approach at Addenbrooke's Hospital, Cambridge, during a 10-year period are presented. The hearing-preservation rate, using audiometric criteria set by others as "serviceable hearing" (Wade PJ, House W. Otolaryngol Head Neck Surg 1984;92:1184-93; Silverstein H, et al. Otolaryngol Head Neck Surg 1986;95:285-91; Cohen NL, et al. Am J Otol 1993;14:423-33) was 8% (4 of 50 cases). When the more stringent selection criteria of near-normal hearing and reporting criteria of socially useful hearing preservation (pure-tone average < 30 dB/speech discrimination score > 70%) is used, the hearing-preservation rate is 4.8% (1 of 21 cases). The only preoperative factor that may predict a favorable hearing-preservation outcome is normal auditory brain stem response morphology (Fisher's exact 2-tailed test, P < 0.001). The number of suitable candidates for hearing-preservation surgery are few. Reasonable indications for attempted vestibular schwannoma surgery with hearing preservation are discussed.

Otolaryngology - Head and Neck Surgery, 1999

With increasing refinement in the surgery of vestibular schwannoma the aims of complete tumor rem... more With increasing refinement in the surgery of vestibular schwannoma the aims of complete tumor removal and facial nerve preservation have been largely fulfilled. However, the reputation of and place for hearing-preservation surgery still remain uncertain. A major part of this uncertainty is the result of difficulties in interpretation of the various reported results of hearing-preservation surgery. Meaningful comparison between series is difficult because of the varied number of postoperative reporting criteria commonly in use today. Although it is acknowledged that the postoperative reporting criteria affect the hearing-preservation rates, what is not readily appreciated is that preoperative selection criteria for hearing-preservation cases can also significantly affect the success rate of hearing-preservation acoustic neuroma surgery. This article models the many possible outcomes of hearing-preservation schwannoma surgery by use of the previously reported Cambridge series as an illustrative example. With these models some understanding can be gained of the effect of choosing various preoperative and postoperative hearing criteria on the overall hearing-preservation success rate.

The American journal of otology, 1998

This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by... more This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors. This study was a retrospective case review of 473 patients with vestibular schwannoma. The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center. A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied. Measured were the principal presenting symptoms and the criteria for audiologic management. Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney ...

The American journal of otology, 1998

This study aimed to review the management of cerebrospinal fluid (CSF) fistulae in the setting of... more This study aimed to review the management of cerebrospinal fluid (CSF) fistulae in the setting of developmental inner ear deformity. The study design was a case review, close examination of preoperative radiology, and corresponding intraoperative images. A definitive method of CSF fistula closure is described using previously known techniques used commonly in skull base surgery. The use of a multiple-level, reinforced wound closure technique is necessary to definitively close CSF fistulae in extreme inner ear deformity and to prevent further episodes of CSF leak and meningitis.

The American journal of otology, 1998

This article aimed to describe a new technique for the reconstruction of middle fossa tegmental d... more This article aimed to describe a new technique for the reconstruction of middle fossa tegmental defects using autologous osteocyte containing bone pate. The technique is demonstrated using clinical photographs and x-ray examples of tegmental defects. Pliable bone pate graft is manufactured using autologous bone dust, blood, iodine solution, and tissue glue (Tisseel; Immuno, Austria). The graft is placed accurately via a combined mini-middle fossa craniotomy and middle mastoidectomy approach. This new technique of middle fossa bony tegmental repair has considerable advantages over previously described methods that use rigid or synthetic materials.

Ontology Neurotology, Dec 31, 1997

This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by... more This study aimed to quantify the atypical presentations of patients with vestibular schwannoma by applying the audiologic criteria for the treatment of patients to the Cambridge series of such tumors to show that clinical acumen is necessary for the effective screening of these tumors. This study was a retrospective case review of 473 patients with vestibular schwannoma. The surgery was conducted at the Department of Otoneurological and Skull Base Surgery, University Hospital, Cambridge, a tertiary referral center. A total of 473 patients with a unilateral sporadic vestibular schwannoma were studied. Measured were the principal presenting symptoms and the criteria for audiologic management. Of this series of patients, 89.3% had a principal presenting symptom that was typical of vestibular schwannoma (hearing loss: progressive or sudden, imbalance or tinnitus) and 10.7% had an atypical principal presenting symptom. This group of patients had significantly larger tumors (Mann-Whitney U test; tied p value = 0.0002), shorter length of history (tied p value < 0.0001), and better preserved hearing (tied p value < 0.001) than the typical otologic presentation group. These clinical correlates are related to tumor morphology, and it is hypothesized that the site of the neurilemmal-glial junction (medial or lateral) has an effect here. If the U.S. criteria for the treatment of a patient by an audiologist are applied to this series of patients, then 7 patients (1.5%) would not have had the diagnosis of vestibular schwannoma. If the U.K. criteria are applied, this number of missed tumors is 17 (3.6%). The addition of unilateral tinnitus as an indicator of the need for otologic investigation reduced the number of patients who might be missed to 2 (0.42%) for the U.S. cases and 5 (1.1%) for the U.K. cases. Of patients with vestibular schwannoma, 10.7% have an atypical principal presenting symptom, and this group of patients has significantly larger tumors than those patients who present typically. This finding is of particular relevance to the entry point of such cases to the healthcare system. A number of patients with vestibular schwannoma appear to pass the criteria for treatment by an audiologist without reference to an otologic opinion. These patients may not be investigated from an early stage with potential implications for increased morbidity.

Head & Neck Oncology

Vestibular Schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumor that develops... more Vestibular Schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumor that develops from the vestibular nerve, or very rarely from the cochlear nerve. The tumor is located along the course of the nerve that is, between the inner ear and the brainstem in the internal auditory canal and the cerebello-pontine angle (CPA). This review summarizes the current knowledge on clinical and molecular aspects of vestibular schwannoma development with special emphasis on cellular de-differentiation of Schwann cells into plastic neural crest stem cell-like phenotype as the potentially involved cellular and molecular mechanism.

Head & Neck Oncology

Vestibular schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumour that develop... more Vestibular schwannoma (VS) is a slow-growing, intracranial extra-axial benign tumour that develops from the vestibular nerve, or very rarely from the cochlear nerve. The tumour is located along the course of the nerve that is between the inner ear and the brainstem in the internal auditory canal and the cerebellopontine angle. This review summarizes the current knowledge on clinical and molecular aspects of VS development with special emphasis on cellular dedifferentiation of Schwann cells to plastic, neural crest stem cell-like phenotype. We also summarize the signalling cascades potentially involved in VS development and dedifferentiation of Schwann cells after injury.

Case reports in otolaryngology, 2013

Pneumatisation of styloid process is a very rare finding and has never been reported previously. ... more Pneumatisation of styloid process is a very rare finding and has never been reported previously. We present a unique case of a pneumatised styloid process with a cholesteatoma arising within the cavity. We describe the clinical features, associated radiological findings, and management of this lesion.

Skull base : official journal of North American Skull Base Society ... [et al.], 2006

To evaluate preoperative hearing, dizziness, and tinnitus handicap in patients with unilateral ve... more To evaluate preoperative hearing, dizziness, and tinnitus handicap in patients with unilateral vestibular schwannoma (VS). Prospective administration of the Hearing Handicap Inventory (HHI), Dizziness Handicap Inventory (DHI), and Tinnitus Handicap Inventory (THI), prior to surgical intervention. A tertiary referral neuro-otology clinic. A total of 145 consecutive patients who were admitted for excision of their vestibular schwannomas between May 1998 and July 2002. HHI, THI, and DHI scores. HHI, THI, and DHI scores were all found to be significantly correlated. There was no significant association between tumor size and any of the questionnaire scores. When data were categorized to give a measure of handicap severity, 68% had mild to significant hearing handicap, 30% had mild to severe tinnitus handicap, and 75% had mild to severe dizziness handicap. Eighty-eight percent of patients had some handicap in at least one domain, and 23% had some handicap in all three domains. Seven perc...

Skull base : official journal of North American Skull Base Society ... [et al.], 2006

To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with... more To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with unilateral sporadic vestibular schwannoma (VS) to describe the clinical characteristics of tinnitus in this population. Further, to ascertain which of the proposed mechanisms of tinnitus generation in VS was supported. Retrospective case note and database review. Tertiary university teaching hospital departments of audiology and neuro-otology. Nine hundred forty-one patients with unilateral sporadic VS, diagnosed during the period 1986 to 2002. Twenty-three additional patients were excluded due to missing clinical data. The presence or absence of tinnitus, and its rated subjective severity were analyzed in conjunction with data regarding patient demographics, symptoms, signs, and diagnostic audiovestibular test findings. No statistical association at the 5% level was found between tinnitus presence/absence and patient age, gender, 2- to 4-kHz audiometric thresholds, ipsilateral auditory...

The American journal of otology, 1995

A postal survey was conducted, using a standardized quality of life questionnaire, of patients wh... more A postal survey was conducted, using a standardized quality of life questionnaire, of patients who had undergone surgery for removal of vestibular schwannoma between 1981 and 1992. Of 257 questionnaires, 227 (88%) were returned completed. The questionnaire was based on the European Organisation for Research into the Treatment of Cancer (EORTC) core questionnaire. A series of five functional gradings were used to assess the quality of life, and specific questions were also asked. The results were numerically scored and have been correlated with patient and tumor characteristics. There was a significant difference (p = .0001) between the subjective functional outcome for small and intracanalicular tumors when compared with tumors larger than 1.5 cm maximum diameter. However, there was no significant difference when tumors 1.5 to 2.5 cm in diameter were compared to larger tumors. Poor functional outcome did not correlate with the age of the patient, position in the series, or postopera...

The Laryngoscope, 2007

Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone prima... more Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone primarily affecting elderly diabetic patients. To determine whether cranial nerve involvement in malignant external otitis affects or predicts the clinical outcome in terms of morbidity and mortality. Diagnosis of malignant external otitis was established in 23 patients (average age, 71 yr; range, 39-87) based on inclusion criteria of severe pain, otitis externa refractory to conventional treatments, diabetes mellitus, and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone involvement extending outside the external auditory canal. Retrospective analysis of hospital records. Ten of 23 (43.5%) patients showed cranial nerve involvement. The following cranial nerves were affected: facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10), and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%) patients displayed no cranial ner...

Journal of Laryngology and Otology, 1980

A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the... more A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the Out-Patient Department has been described. Homograft temporalis fascia was used as a graft material. In a series of eighteen patients a closure rate of 78.2 per cent was obtained. The advantages of the method have been discussed.

Otology & Neurotology, 2012