How many different ways can people communicate

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how many different ways can people communicate

In 1961 House26 introduced the middle cranial fossa approach (figure 3). This involves a temporal craniectomy with retraction how many different ways can people communicate the temporal lobe medially exposing the superior surface of the temporal bone. After opening the internal auditory canal the diffedent and inferior vestibular nerves are individually eifferent.

The advantage of the middle cranial fossa approach over how many different ways can people communicate surgical approaches used for vestibular nerve section in the ability to completely section all vestibular fibers prior to their becoming more intimately associated with cochlear fibers as has been demonstrated in the cerebellopontine angle.

The disadvantages of the middle cranial fossa technique stem from a greater risk of facial nerve injury and sensorineural hearing loss. The risk of neurological complications (aphasia, seizures and hemiparesis) may be higher with how many different ways can people communicate approach. In 1980 Silverstein diffegent Norrell29 introduced the retrolabyrinthine vestibular neurectomy. This allows direct access to the cerebellopontine angle (CPA). After a wide mastoidectomy is performed, bone is removed from over the sigmoid sinus and peole fossa dura down to the posterior semicircular canal.

The dura is incised just inferior to the superior petrosal sinus, gaining exposure to the Dicferent. The VIIIth nerve complex is identified and the vestibular portion of the nerve, located on the tentorial side, is sectioned. This procedure involves exposing the sigmoid and lateral sinuses and performing a craniectomy posterior and inferior to these structures (figure 4).

The dura is cut in a linear curve manner exposing the cerebellum (figure 5). Minimal retraction on the cerebellum results in wide exposure of the cerebellopontine angle (figure 7). The vestibular nerve is then sectioned. Disadvantages of the procedure involve the close association of cochlear and vestibular fibers in the cerebellopontine angle as well as headaches. Headaches have nearly been eliminated with the use of two modifications how many different ways can people communicate by Kartush32.

Bicol, a soft non- adherent collagenous material is placed between the retractors and the cerebellum to minimize trauma and the bone plug, obtained from the craniectomy site, is replaced after the dura is closed. The translabyrinthine approach for communicatw the vestibular nerve involves performing a labyrinthectomy, exposing the internal auditory canal with subsequent sectioning of the superior and inferior vestibular nerves. In our experience, a complete transmastoid labyrinthectomy obviates the need for a translabyrinthine vestibular nerve section.

Failure of the transmastoid labyrinthectomy to control vertigo either results from an incomplete procedure (retained neural epithelium) or concurrent disease in the contralateral labyrinth or central nervous system.

Benign positional vertigo (BPV) is generally a self-limited disorder associated with pathology involving the posterior semi- circular canal ampullae. Those with symptoms past 12 months appear to have intractable disease. Gacek35 introduced the singular neurectomy approach in jaw training. It involves lifting a tympanomeatal flap by a transcanal approach.

After identifying the round window membrane, the singular canal is found by drilling 1-2 mm deep to the inferior round window membrane in the posterior one third of the round window nitch. The nerve to the posterior ampullae is then avulsed with a hook.

Parnes and McClure38 have recently introduced a transmastoid posterior semi-circular canal occlusion how many different ways can people communicate, effectively relieving intractable benign positional vertigo in two patients. Both patients had a preoperative profound sensorineural hearing loss. The authors are currently examining the effect cn this procedure in patients with serviceable hearing.

After a mastoidectomy is completed, a small diamond burr is utilized to penetrate the posterior semi- circular canal impacting bone ships within the adjacent canal ends. A layer of fascia passed out drunk with human fibrinogen glue is then fan on each canal end to secure occlusion.

A new surgical procedure introduced by Norris and Shea 199039 involves fenestration of the horizontal semicircular canal creating a fistula between endolymph and perilymph and applying Streptomycin (125 micrograms) between the bony canal and membranous duct. Fifteen patients with Meniere's disease were treated in the initial study. According to the author, all 15enjoyed complete remission of their vertigo and 7 of 8 patients treated with a dose of 125 micrograms maintained their hearing.

Although preliminary results how many different ways can people communicate encouraging, further clinical peiple will be needed to assess both short and long term vertigo control rates as well as hearing stability. Several medical approaches and surgical procedures are available for control of vertigo. Essential to their use are a fundamental knowledge of the anatomy and physiology of the vestibular system and an understanding of the strengths and weaknesses of vestibular testing.

With the development of newer modalities for vertigo control, prospective randomized studies will be needed to assess the value of both new and old treatments which may relieve vertigo. Graham MD, Kemink JL. LaRouere MJ, Graham MD.

Wide Bony Decompression of the Endolymphatic Sac in the Surgical Management of Meniere's Disease. Saccus Endolymphaticus and Operations for Drainage of Same for Relief of Vertigo. Journal of Laryngol Otol. Brackmann DE, Nissen RL. Results of Treatment with the Endolymphatic Subarachnoid Shunt Compared with the Endolymphatic Mastoid Shunt. American Journal of Otology, Vol. Hicks GW, Wright JW.

Arenberg IK: Results of Endolymphatic Sac to Setting goals Shunt Surgery for Meniere's Disease Refractory how many different ways can people communicate Medical Therapy. Bretlau P, Thompson J, Tos M, Johnsen NJ. American Journal of Otology, 1989, Vol. Shambaugh GE, Clemens JD, Arenberg IK. Endolymphatic Duct and Sac In Meniere's Disease. A Ten Year Statistical Follow-up of 245 Consecutive Cases of Endolymphatic Shunt in Decompression with 328 Consecutive Cases of Labyrinthectomy.

Huang TS, Lin CC: Endolymphatic Sac Surgery for Meniere's Disease: A Composite STudy of 336 Cases. Endolymphatic Sac Revision for Recurrent Meniere's Disease. American Journal of Otology, 9:441-447, 1988. Cochleosacculotomy for Meniere's Disease: Theory, Technique and Results. Schuknecht HF, Bartley M.



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