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Objective: The purpose of this study was to determine the level of disability among patients with Meniere's disease, information needed by clinicians when evaluating patients for coverage under the Americans With Disabilities Act. We hypothesized that the unpredictability of vertiginous episodes or "Meniere's attacks" would be the most disabling problem, combined with the lack of a safe place to sit down during Meniere's attacks. Design: All patients seen in the otolaryngology faculty practice at Baylor College of Medicine, Houston, Tex, and diagnosed as having Meniere's disease over a 3-year period were sent a self-administered questionnaire. Setting: This practice is located at a tertiary care center. Subjects: One hundred forty-nine potential subjects constituted the pool, from which data from 50 subjects provided complete data sets. Results: The data from 50 adults suggested that the most problematic symptom was vertigo, followed by hearing loss. The unpredictability of Meniere's attacks and the lack of a safe place to rest during attacks was a significant problem for few subjects. (Arch Otolaryngol Head Neck Surg. 1995;121:29-33)

• The temporal bone histopathologic findings of a patient having received a Nucleus 22-channel cochlear implant (Cochlear Corp, Englewood, Colo) following bilateral transverse otic capsule fractures is presented. The case was complicated by perilymph fistulas, labyrinthitis, meningitis, and death due to drowning. The left cochlea revealed complete labyrinthitis ossificans; the implanted right cochlea demonstrated new bone formation in the basal turn of the scala tympani, degeneration of the organ of Corti, but normal ganglion cell counts. Results of psychophysical and speech perception 4 months after implantation are presented. ( Arch Otolaryngol Head Neck Surg. 1992;118:1257-1265)

Large-scale flight simulation was pioneered in the 1940s to help meet the training requirements and demand for pilots in World War II. Flight simulators have been effective for training, evaluating, and certifying military and commercial pilots. Accurate scenarios have been developed that allow pilots in training to gain experience without the risk and expense of learning while in flight. The research in aviation simulation suggests a transfer effectiveness ratio of 0.48. 1 This means that 1 hour in the simulator saves a half hour in the air. Because of the successful use of flight simulation as a training technique, computer-based simulators are now used in a variety of domains. Surgeons, by comparison, have traditionally been trained through didactic sessions, study of text material, and graduated operative experience on real patients under faculty supervision. Ancillary training techniques, such as the use of animal laboratories and cadaver dissection, have been declining in

Electronic mail (e-mail) is an extremely powerful form of communication and the most frequently used application on the Internet. While e-mail is not the appropriate mode of communication for every situation, there are many instances where its use is invaluable.

• Since a previous study conducted at the Ear, Nose, and Throat Department, University Hospital, in Zurich, Switzerland, 16 additional cases of glomus jugulare of the temporal region have been evaluated and treated surgically in this department. This article describes our experience with these additional cases and gives an in-depth description of the surgical techniques that are used in the treatment of more complicated tumors. We report one case in detail. ( Arch Otolaryngol 1981;107:209-214)

• Small-fenestra stapedotomy has recently been popularized in efforts to reduce the incidence of sensorineural hearing loss following stapes surgery for otospongiosis. Lasers have been advocated as a tool to fenestrate the stapes footplate. Conversion of radiant energy from the laser into heat in the vestibule represents the greatest potential risk to the inner ear. Using a carbon dioxide laser with a focal point of 150 μm at 300 mm, fenestrations of the stapes footplate were performed in a series of 14 anesthetized cats. The laser power output ranged from 0.47 to 3.05 W, with pulse durations of 0.2 and 0.5 s. Resultant temperature elevations in the vestibule, measured by a thin-wire thermocouple, ranged from 0 to 4.4 °C (0 to 8 °F) and directly correlated to wattage and duration of the laser-beam pulse. Temperature changes could be reduced by use of lower wattage, shorter pulse duration, timed intervals between pulses, and convection cooling of the promontory. (Arch Otolaryngol1985;111:601-605)

Epidermoids are blastomatous malformations of abnormal epithelial proliferation. Intradiploic epidermoids are very rare lesions that may occur in all flat bones of the calvarium and in the paranasal sinuses, maxilla, temporal bone, and sphenoid bone. This article describes the unique case of an intradiploic epidermoid tumor located in the greater sphenoid wing. Theories of pathogenesis, clinical behavior, diagnosis, and treatment of diploic epidermoids are reviewed.

• A volumetric study on the tympanic isthmus and its relationship to temporal bone pneumatization was conducted in 110 serially sectioned temporal bones with and without middle ear pathology. With a microcomputer and digitizing tablet, the area of the tympanic isthmus and the degree of pneumatization in sample sections were calculated. Nonpathologic temporal bones showed a significant correlation between the volume of the tympanic isthmus and the degree of pneumatization. The narrowest area of the tympanic isthmus and the degree of pneumatization were also highly correlated. The result indicated a definite inhibition of pneumatization due to chronic middle ear infection when compared with nonpathologic temporal bones. ( Arch Otolaryngol Head Neck Surg 1987;113:401-404)

• While auditory involvement in multiple sclerosis is not infrequent, sensorineural hearing loss as the initial manifestation of this disease is rare. Auditory brain-stem evoked responses, speech audiometry, acoustic reflexes, and electronystagmography yield significant objective information concerning brain-stem involvement. Magnetic resonance imaging objectively documents white matter demyelinization. The acute onset of the retrocochlear type of auditory dysfunction without other evidence of central nervous system involvement can be an early manifestation of this disease. Two patients with multiple sclerosis had sudden sensorineural hearing loss, with one patient experiencing this as the sole initial complaint. ( Arch Otolaryngol Head Neck Surg 1989;115:41-45)

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnoses of infectious processes of the base of skull. A 21-year-old man presented with petrous apicitis, extradural and retromandibular abscesses, and paresis of the facial nerve. Immediate middle fossa craniotomy and drainage of the extradural abscess, in combination with a mastoidectomy, incision and drainage of the facial abscess, and antimicrobial therapy for gram-positive cocci, failed to check the destructive nature of the infection. The patient subsequently developed labyrinthitis, sensorineural hearing loss, and meningitis. Intraoperative biopsy specimens confirmed the presence of tuberculoid granulomas, and the infectious process responded to triple-drug therapy. Tuberculosis of the temporal bone should not always be considered an indolent infection. The management of tuberculous infection of the temporal bone is outlined.

• A 10-year-old boy developed a porencephalic cyst of the mastoid in conjunction with otitic meningitis and cerebrospinal otorrhea. A defect of the tegmen tympani allowed extrusion of the cyst into the antrum and the mesotympanum. The otorrhea was controlled by closure of the defect. Our review of 251 cases in the literature showed no prior incidence of mastoid involvement by a porencephalic cyst. ( Arch Otolaryngol 102:563-565, 1976)

• Forty-eight patients with Meniere's disease underwent psychological assessment with the Minnesota Multiphasic Personality Inventory and Diagnostic Inventory of Personality and Symptoms. Using the presence or absence of recurrent vertigo or chronic dysequilibrium as the differentiating feature, the results of two groups were compared. A clinical diagnosis of depression (axis I) was evident in 80% of the patients with active vestibular symptoms examined by the Minnesota Multiphasic Personality Inventory and 70% by the Diagnostic Inventory of Personality and Symptoms compared with 32% (Minnesota Multiphasic Personality Inventory) and 39% (Diagnostic Inventory of Personality and Symptoms) in the inactive group. The data support the addition of depression to the clinical picture of active Meniere's disease. ( Arch Otolaryngol Head Neck Surg . 1989;115:1355-1357)

A 62-year-old woman developed recurrent episodes of sudden sensorineural hearing loss, occurring with migraine headaches. This is an unusual complication of migraine, which probably arises from a reversible vasoconstriction of the cochlear blood vessels. Pathogenesis of migraine and its variants are reviewed herein, along with the rationale of the modalities in its treatment. In this case, the patient's hearing improved after administration of ergot alkaloids, carbon dioxide/oxygen inhalations, and stellate ganglion blocks; it is not known whether this improvement represented therapeutic effect or spontaneous recovery.