Paul Eric Hammerschlag, M.D.

Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial
Rauch, Steven D; Halpin, Christopher F; Antonelli, Patrick J; Babu, Seilesh; Carey, John P; Gantz, Bruce J; Goebel, Joel A; Hammerschlag, Paul E; Harris, Jeffrey P; Isaacson, Brandon; Lee, Daniel; Linstrom, Christopher J; Parnes, Lorne S; Shi, Helen; Slattery, William H; Telian, Steven A; Vrabec, Jeffrey T; Reda, Domenic J
2011 May 25;305(20):2071-2079, JAMA
CONTEXT: Idiopathic sudden sensorineural hearing loss has been treated with oral corticosteroids for more than 30 years. Recently, many patients' symptoms have been managed with intratympanic steroid therapy. No satisfactory comparative effectiveness study to support this practice exists. OBJECTIVE: To compare the effectiveness of oral vs intratympanic steroid to treat sudden sensorineural hearing loss. DESIGN, SETTING, AND PATIENTS: Prospective, randomized, noninferiority trial involving 250 patients with unilateral sensorineural hearing loss presenting within 14 days of onset of 50 dB or higher of pure tone average (PTA) hearing threshold. The study was conducted from December 2004 through October 2009 at 16 academic community-based otology practices. Participants were followed up for 6 months. INTERVENTION: One hundred twenty-one patients received either 60 mg/d of oral prednisone for 14 days with a 5-day taper and 129 patients received 4 doses over 14 days of 40 mg/mL of methylprednisolone injected into the middle ear. MAIN OUTCOME MEASURES: Primary end point was change in hearing at 2 months after treatment. Noninferiority was defined as less than a 10-dB difference in hearing outcome between treatments. RESULTS: In the oral prednisone group, PTA improved by 30.7 dB compared with a 28.7-dB improvement in the intratympanic treatment group. Mean pure tone average at 2 months was 56.0 for the oral steroid treatment group and 57.6 dB for the intratympanic treatment group. Recovery of hearing on oral treatment at 2 months by intention-to-treat analysis was 2.0 dB greater than intratympanic treatment (95.21% upper confidence interval, 6.6 dB). Per-protocol analysis confirmed the intention-to-treat result. Thus, the hypothesis of inferiority of intratympanic methylprednisolone to oral prednisone for primary treatment of sudden sensorineural hearing loss was rejected. CONCLUSION: Among patients with idiopathic sudden sensorineural hearing loss, hearing level 2 months after treatment showed that intratympanic treatment was not inferior to oral prednisone treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00097448
— id: 134325, year: 2011, vol: 305, page: 2071, stat: Journal Article,

Safety of high-dose corticosteroids for the treatment of autoimmune inner ear disease
Alexander, Thomas H; Weisman, Michael H; Derebery, Jennifer M; Espeland, Mark A; Gantz, Bruce J; Gulya, A Julianna; Hammerschlag, Paul E; Hannley, Maureen; Hughes, Gordon B; Moscicki, Richard; Nelson, Ralph A; Niparko, John K; Rauch, Steven D; Telian, Steven A; Brookhouser, Patrick E; Harris, Jeffrey P
2009 Jun;30(4):443-448, Otology & neurotology
OBJECTIVE: To report the adverse effects associated with prolonged high-dose prednisone for the treatment of autoimmune inner ear disease (AIED). STUDY DESIGN: Prospective data collected as part of a multicenter, randomized, controlled trial for the treatment of corticosteroid-responsive AIED with methotrexate. SETTING: Tertiary referral centers. PATIENTS: One hundred sixteen patients with rapidly progressive, bilateral sensorineural hearing loss. INTERVENTION: All patients completed a 1-month course of prednisone (60 mg/d). In Phase 2, 67 patients with improvement in hearing underwent a monitored 18-week prednisone taper, resulting in 22 weeks of prednisone therapy at an average dose of 30 mg per day. Thirty-three patients were randomized to receive methotrexate in Phase 2. Thirty-four patients received prednisone and placebo. MAIN OUTCOME MEASURE: Adverse events (AE) in patients treated with prednisone only. RESULTS: Of 116 patients, 7 had to stop prednisone therapy during the 1-month challenge phase due to AE. Of 34 patients, 5 were unable to complete the full 22-week course of prednisone due to AE. The most common AE was hyperglycemia, which occurred in 17.6% of patients participating in Phase 2. Weight gain was also common, with a mean increase in body mass index of 1.6 kg/m2 (95% confidence interval, 0.77-2.3) during the 22-week steroid course. Patients entering Phase 2 were followed for a mean of 66 weeks. No fractures or osteonecrosis were reported. CONCLUSION: Although high-dose corticosteroids are associated with known serious side effects, prospective data in the literature are limited. The present study suggests that with appropriate patient selection, monitoring, and patient education, high-dose corticosteroids are a safe and effective treatment of AIED
— id: 133706, year: 2009, vol: 30, page: 443, stat: Journal Article,

Psychometric validity of the Cochlear Implant Function Index (CIFI): a quality of life assessment tool for adult cochlear implant users
Coelho, Daniel H; Hammerschlag, Paul E; Bat-Chava, Yael; Kohan, Darius
2009 Jun;10(2):70-83, Cochlear Implants International
Objective The Cochlear Implant Function Index (CIFI) is created to assess adult cochlear implant (CI) auditory effectiveness in real world situations. Our objective is to evaluate the CIFI as a reliable psychometric tool to assess 1) reliance on visual assistance, 2) telephone use, 3) communication at work, 4) 'hearing' in noise, 5) in groups, and 6) in large room settings. Study Design Based upon Guttman scaling properties, the CIFI elicits implanted respondent's functional level with auditory independence from Level 1 (still requiring signing) to level 4 (without any help beyond CI). A blinded, retrospective questionnaire is anonymously answered by cochlear implant recipients. Setting CI centers of tertiary care medical centers, CI support group, and an interactive web page of a hearing and speech center in a large metropolitan region. Subjects 245 respondents from a varied adult CI population implanted for one month to 19 years prior to answering the questionnaire. Intervention An assessment tool of CI function. Main Outcome Measure A coefficient of reproducibility (CR) for the Guttman scale format equal or greater than 0.90, indicating good scalability. Results CR in the CIFI was above 0.90. Effective scalability and mean scores from 2.5 to 3.5 for the six areas examined (1.00-4.00) were achieved. Conclusion The psychometric properties of this user friendly survey demonstrate consistently good scalability. Based on these findings, the CIFI provides a validated tool that can be used for systematic comparisons between groups of patients or for follow-up outcomes in patients who use cochlear implants. Further study is indicated to correlate CIFI scores with sound and speech perception scores.
— id: 93203, year: 2009, vol: 10, page: 70, stat: Journal Article,

Treatment of corticosteroid-responsive autoimmune inner ear disease with methotrexate: a randomized controlled trial
Harris, Jeffrey P; Weisman, Michael H; Derebery, Jennifer M; Espeland, Mark A; Gantz, Bruce J; Gulya, A Julianna; Hammerschlag, Paul E; Hannley, Maureen; Hughes, Gordon B; Moscicki, Richard; Nelson, Ralph A; Niparko, John K; Rauch, Steven D; Telian, Steven A; Brookhouser, Patrick E
2003 Oct 8;290(14):1875-1883, JAMA
CONTEXT: A number of therapies have been proposed for the long-term management of corticosteroid-responsive, rapidly progressive, bilateral sensorineural hearing loss (autoimmune inner ear disease [AIED]). Methotrexate has emerged as the benchmark agent but has not been rigorously evaluated for hearing improvement in patients with AIED. OBJECTIVE: To assess the efficacy of long-term methotrexate in maintaining hearing improvements achieved with glucocorticoid (prednisone) therapy in patients with AIED. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial conducted from February 3, 1998, to November 5, 2001, of 67 patients with rapidly progressive, bilateral sensorineural hearing loss at 10 tertiary care centers in the United States. INTERVENTION: Randomization to either oral methotrexate (15 to 20 mg/wk; n = 33) or placebo (n = 34), in combination with an 18-week prednisone taper. Follow-up examinations, including audiometric evaluation, were performed at 4, 8, 12, 24, 36, 48, and 52 weeks, or until hearing loss was documented. MAIN OUTCOME MEASURE: Maintenance of hearing improvement achieved from prednisone treatment. RESULTS: Sixty-seven patients (57.8%) enrolled in the prednisone challenge experienced hearing improvement. Twenty-five patients (37%) experienced hearing improvements in both ears. Of the individuals who reached study end points, 24 (80%) of 30 end points were because of measured hearing loss in the methotrexate group and 29 (93.5%) of 31 end points were because of measured hearing loss in the placebo group (P =.15). Methotrexate was no more effective than placebo in maintaining the hearing improvement achieved with prednisone treatment (hazard ratio, 1.31; 95% confidence interval, 0.79-2.17; P =.30). CONCLUSION: Methotrexate does not appear to be effective in maintaining the hearing improvement achieved with prednisone therapy in patients with AIED
— id: 93204, year: 2003, vol: 290, page: 1875, stat: Journal Article,

Labyrinthine fistula: an unreported complication of the Grote prosthesis
Gadre, A K; Hammerschlag, P E
2001 May;111(5):796-800, Laryngoscope
OBJECTIVES: To alert the otological surgeon that labyrinthine fistula is a rare and avoidable complication of the Grote hydroxyapatite ceramic external auditory canal (EAC) prosthesis. The reasons for its causation and strategies to prevent its formation are discussed. STUDY DESIGN: Case study and retrospective review of the literature. METHODS: Labyrinthine fistula that occurred after the use of the Grote hydroxyapatite ceramic EAC prosthesis is presented. The literature is reviewed retrospectively for various methods of reconstruction of the EAC following canal wall down mastoidectomy. Strategies and principles are outlined to avoid complications associated with reconstruction of the mastoid and EAC. RESULTS: The Grote hydroxyapatite (HA) prosthesis is a reliable prosthesis for reconstruction of the external auditory canal (EAC) in the absence of a draining mastoid cavity or cholesteatoma and with adequate soft tissue cover. Contact of the medial end of the prosthesis with the lateral semicircular canal must be avoided. Immobilization or rigid fixation and avoidance of infection are essential for optimal prosthesis stability and osseointegration. Covering the prosthesis with vascularized soft tissue appears to be important for the achievement of a successful reconstruction. CONCLUSION: The Grote prosthesis is safe and effective provided it does not contact the lateral semicircular canal, is stabilized, and covered by vesicular tissue, in the absence of infection
— id: 93205, year: 2001, vol: 111, page: 796, stat: Journal Article,

What is autoimmune inner ear disease?
Hammerschlag P
2001 Jan-Feb;22(1):20-21, Hearing loss
Here are the facts about diagnosis and treatment and how Autoimmune Inner Ear Disease relates to progressive sensorineural hearing loss. If you think you have the disease, you are invited to contact one of the clinical research centers listed at the end of the article. <14>
— id: 26860, year: 2001, vol: 22, page: 20, stat: Journal Article,

Auricular reconstruction: indications for autogenous and prosthetic techniques
Thorne CH; Brecht LE; Bradley JP; Levine JP; Hammerschlag P; Longaker MT
2001 Apr 15;107(5):1241-1252, Plastic & reconstructive surgery
Learning Objectives: After studying this article, the participant should be able to: 1. Describe the alternatives for auricular reconstruction. 2. Discuss the pros and cons of autogenous reconstruction of total or subtotal auricular defects. 3. Enumerate the indications for prosthetic reconstruction of total or subtotal auricular defects. 4. Understand the complexity of and the expertise required for prosthetic reconstruction of auricular defects.The indications for autogenous auricular reconstruction versus prosthetic reconstruction with osseointegrated implant-retained prostheses were outlined in Plastic and Reconstructive Surgery in 1994 by Wilkes et al. of Canada, but because of the relatively recent Food and Drug Administration approval (1995) of extraoral osseointegrated implants, these indications had not been examined by a surgical unit in the United States. The purpose of this article is to present an evolving algorithm based on an experience with 98 patients who underwent auricular reconstruction over a 10-year period. From this experience, the authors conclude that autogenous reconstruction is the procedure of choice in the majority of pediatric patients with microtia. Prosthetic reconstruction of the auricle is considered in such pediatric patients with congenital deformities for the following three relative indications: (1) failed autogenous reconstruction, (2) severe soft-tissue/skeletal hypoplasia, and/or (3) a low or unfavorable hairline. A fourth, and in our opinion the ideal, indication for prosthetic ear reconstruction is the acquired total or subtotal auricular defect, most often traumatic or ablative in origin, which is usually encountered in adults. Although prosthetic reconstruction requires surgical techniques that are less demanding than autogenous reconstruction, construction of the prosthesis is a time-consuming task requiring experience and expertise. Although autogenous reconstruction presents a technical challenge to the surgeon, it is the prosthetic reconstruction that requires lifelong attention and may be associated with late complications. This article reports the first American series of auricular reconstruction containing both autogenous and prosthetic methods by a single surgical team
— id: 20645, year: 2001, vol: 107, page: 1241, stat: Journal Article,

Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis
Hammerschlag PE
1999 Feb;109(2 Pt 2 Su 90):1-23, Laryngoscope
When viable proximal facial nerve is inacessible, facial nerve paralysis has been classically managed with the hypoglossal facial anastomosis (HFA) for at least the past 70 years. While this procedure has proven its reliability, its problems with hemilingual atrophy (speech deglutition, drooling, mastication), hypertonia, synkinesis, and mimetic deficits indicate the need for a more perfect solution for facial paralysis. The jump interpositional graft hypoglossal facial anastomosis (JIGHFA) along with gold weight lid implantation and electromyographic (EMG) rehabilitation achieves substantial facial reanimation without hemilingual deficits. We present our results in 18 patients who underwent JIGHFA along with gold weight lid implantation and EMG rehabilitation for facial paralysis. These results were compared with those from published series of 30 patients treated with HFA with EMG rehabilitation evaluated with objective (House-Brackmann) criteria. Anonymous retrospective information from questionnaires from 22 of 48 patients who were treated with the classic HFA was also presented. In properly selected patients, the JIGHFA technique is capable of achieving substantial facial reinnervation (House-Brackmann grade III or better) in 83.3% of the patients without hemilingual sequelae which was seen in 45% of the HFA patients. In contrast to the HFA, this procedure can be used by patients with concomitant lower cranial nerve paralysis (except hypoglossal), and bilateral facial paralysis. Hypertonia, synkinesis, and lagophthalmus were less symptomatic in the JIGHFA patients. Mimetic expression was not improved in the JIGHFA population compared with the HFA group
— id: 11615, year: 1999, vol: 109, page: 1, stat: Journal Article,

A review of 308 cases of revision stapedectomy
Hammerschlag PE; Fishman A; Scheer AA
1998 Dec;108(12):1794-1800, Laryngoscope
OBJECTIVE/HYPOTHESIS: Identify causes of primary and revision stapedectomy failure in 308 patients, assess whether these are different based on source of initial surgery, and evaluate hearing results in revision stapedectomy to improve outcome. Study Design: Retrospective, nonrandomized chart review of patients undergoing revision stapedectomy in a referral otology practice in a large metropolitan region. MATERIALS AND METHODS: Intraoperative findings, preoperative and postoperative revision stapedectomy air and bone conduction pure-tone averages, speech discrimination scores, postoperative air-bone gaps, complications, and repeated revisions were noted in 308 patients. RESULTS: Leading causes of primary stapedectomy failure included dislocated prosthesis (24.4%), inadequate prosthesis length (14%), long process resorption (14%), and fibrous adhesions (13.6%). Revision stapedectomy air-bone gaps were less than 10 dB in 80% and greater than 30 dB in 6.8% of cases. Increased sensorineural hearing loss occurred in 0.8% of revision stapedectomy cases. Five of seven cases of vertigo associated with primary stapedectomy resolved after revision surgery. CONCLUSION: Revision stapedectomy by experienced surgeons is highly effective in attaining successful air-bone gap closure in 80% and improved closure in 84.8% of operative cases. Risk of vertigo and/or sensorineural hearing loss was not any higher in this patient population when compared with reports of primary stapedectomy
— id: 7591, year: 1998, vol: 108, page: 1794, stat: Journal Article,

Prognostic significance of intraoperative facial nerve stimulus thresholds
Zeitouni AG; Hammerschlag PE; Cohen NL
1997 Jul;18(4):494-497, American journal of otology
OBJECTIVE: Intraoperative facial nerve monitoring has reduced the incidence of facial nerve paralysis associated with acoustic neuroma surgery, but poor facial nerve outcomes continue to occur. Intraoperative prediction of facial nerve outcome would be advantageous in patient management and counseling. This study seeks to evaluate intraoperative facial nerve stimulus thresholds as a tool for predicting postoperative facial nerve outcome. STUDY DESIGN: This study is a prospective clinical study of the prognostic value of intraoperative stimulus thresholds. SETTING: The study was performed at a tertiary referral center. PATIENTS: There were 109 patients undergoing excision of acoustic neuromas included in this study. INTERVENTIONS: The minimum current required to stimulate the facial nerve at the brain stem was prospectively recorded after excision of the acoustic neuroma. MAIN OUTCOME MEASURES: Facial nerve outcome was evaluated by the House-Brackmann grade. RESULTS: A statistically significant relationship was found between poor initial facial nerve outcome and higher stimulus thresholds. Long-term impaired facial function was also more common in the higher stimulus group compared to that of the lower stimulus groups. CONCLUSIONS: Although these findings suggest that intraoperative stimulus thresholds have prognostic potential, other prognostic factors should also be considered and additional research is needed
— id: 12306, year: 1997, vol: 18, page: 494, stat: Journal Article,

Evaluation and management of spontaneous temporal bone cerebrospinal fluid leaks
Pappas, D G; Hoffman, R A; Holliday, R A; Hammerschlag, P E; Pappas, D G; Swaid, S N
1995 ;5(1):1-7, Skull base surgery
Spontaneous temporal bone cerebrospinal fluid leak may be defined as a leak without an apparent precipitating cause. These transdural fistulas occur rarely, and diagnosis is predicated upon a high index of suspicion. Leaks have been reported through both middle and posterior fossa defects, although the vast majority involve the middle fossa plate. In a previous study we reported 7 cases of spontaneous temporal bone cerebrospinal fluid leaks, all involving the middle fossa tegmen. Upon further review of these cases and 5 previously unreported cases, the defect was localized to the tegmen tympani in 9 of the total 12 cases. Diagnostic methods are discussed, with the importance of high-resolution computed tomography stressed. The role of contrast cisternography is also evaluated. An outline for surgical management is presented based upon residual hearing and defect location and accessibility. A transmastoid procedure offers the advantage of visualization of both the middle and posterior fossa plates, and this approach can be supplemented with an obliterative procedure when indicated. The middle fossa approach provides optimal exposure of the tegmen plate with less likelihood of ossicular injury when dealing with tegmen tympani defects. Adjuncts to surgical therapy include intrathecal fluorescein dye and continuous postoperative lumbar cerebrospinal fluid drainage
— id: 93206, year: 1995, vol: 5, page: 1, stat: Journal Article,

Management of facial paralysis with jump interposition graft hypoglossal-facial anastomosis with gold lid weight
Hammerschlag PE; Cohen NL; Palu R; Brudny JJ
1994 ;:S137-S139, European archives of oto-rhino-laryngology. Supplement
— id: 11740, year: 1994, vol: , page: S137, stat: Journal Article,

Management of traumatic facial nerve paralysis with carotid artery cavernous sinus fistula
Roland JT Jr; Hammerschlag PE; Lewis WS; Choi I; Berenstein A
1994 ;251(1):57-60, European archives of oto-rhino-laryngology
Massive skull base injuries require detailed preoperative neurological and neurovascular assessment prior to undertaking surgical repair of isolated cranial nerve deficits. We present the management of a patient with traumatic facial paralysis, cerebrospinal fluid leak, and carotid artery cavernous sinus fistula as the result of a gunshot wound to the skull base. The carotid artery cavernous sinus fistula was ultimately controlled with super-selective embolization via the vertebral artery. The facial nerve injury was then safely treated with mobilization of the labyrinthine and vertical segments to allow a primary anastomosis
— id: 13018, year: 1994, vol: 251, page: 57, stat: Journal Article,

Cerebrospinal fluid rhinorrhea and recurrent meningitis
Pappas DG Jr; Hammerschlag PE; Hammerschlag M
1993 Sep;17(3):364-368, Clinical infectious diseases
Cerebrospinal fluid rhinorrhea is the result of transdural communication between the subarachnoid space and the skull base. A transdural fistula may originate from the anterior, middle, or posterior cranial compartments. All skull-base sites of leakage potentially lead to the nasal cavity. Recurrent meningitis is commonly associated with such a direct source of bacterial contamination. Organisms associated with recurrent meningitis secondary to cerebrospinal fluid leaks are commonly found in the upper respiratory tract. We report a case of recurrent meningitis in a 5-year-old girl that highlights the problem of cerebrospinal fluid rhinorrhea, and we discuss etiology, current diagnostic techniques, and surgical management
— id: 13084, year: 1993, vol: 17, page: 364, stat: Journal Article,

Hearing loss from petrous-to-supraclinoid carotid bypass
Hammerschlag, P E
1991 Apr;74(4):688-689, Journal of neurosurgery
— id: 93207, year: 1991, vol: 74, page: 688, stat: Journal Article,

Intraoperative monitoring of facial nerve function in cerebellopontine angle surgery
Hammerschlag PE; Cohen NL
1990 Nov;103(5):681-684, Otolaryngology, head & neck surgery
Facial nerve paralysis associated with cerebellopontine angle surgery has been reported to range up to 26% in a recent series. Various methods of intraoperatively monitoring the facial nerve have been developed to reduce the incidence of facial paralysis. We report our experience with an intraoperative monitoring technique using intramuscular EMG electrodes to detect subclinical electrical responses that were amplified and made audible to the operating surgeon after gating stimulus artifacts. A 3.6% incidence of facial paralysis in 111 consecutive cases with this intraoperative monitoring method compared with 14.5% in 207 previously unmonitored cases indicates significant reduction of this complication in cerebellopontine angle surgery (p less than 0.001). Along with this reduction in facial paralysis, an increase in the percentage of partial facial paresis was observed in the monitored group (p less than 0.05). The percentage of those with intact facial function was similar in the monitored (82.0%) and unmonitored groups (78.3%)
— id: 14300, year: 1990, vol: 103, page: 681, stat: Journal Article,

Otologic disease in AIDS patients: CT correlation
Kohan D; Hammerschlag PE; Holliday RA
1990 Dec;100(12):1326-1330, Laryngoscope
The contrast-enhanced computed tomographic (CT) scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome (AIDS) were retrospectively reviewed. Seven scans revealed middle ear and mastoid disease; three scans were consistent with central nervous system (CNS) pathology; and eight scans demonstrated no abnormalities. CT scanning was found useful in localizing otopathology and diagnosing CNS toxoplasmosis, aural polyps, osteomyelitis, mastoiditis, and middle ear effusion due to hypertrophic lymphoid tissue. The authors conclude that AIDS patients with sensorineural hearing loss should undergo contrast-enhanced brain CT scans to rule out CNS pathology; AIDS status does not alter criteria for CT scanning in patients with conductive hearing loss; and that images of the nasopharynx should be included on temporal bone CT scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue
— id: 14260, year: 1990, vol: 100, page: 1326, stat: Journal Article,

A medical management for Meniere's disease
Cohen, N L; Hammerschlag, P E; Hoffman, R A
1989 Jan;10(1):78-78, American journal of otology
— id: 93208, year: 1989, vol: 10, page: 78, stat: Journal Article,

Pneumocystis carinii in the temporal bone as a primary manifestation of the acquired immunodeficiency syndrome
Breda SD; Hammerschlag PE; Gigliotti F; Schinella R
1988 Jul-Aug;97(4 Pt 1):427-431, Annals of otology rhinology & laryngology
Extrapulmonary infection with Pneumocystis carinii is rare and is usually associated with severe systemic illness. We report, in two patients, the histologic, ultrastructural, and monoclonal cell surface antibody identification of P carinii in otic polyps. Both patients had serum antibody to human immunodeficiency virus. These P carinii infections in the temporal bone are unusual in their location and in the apparent absence of associated pulmonary infection. This otologic presentation was the primary manifestation of the acquired immunodeficiency syndrome
— id: 11043, year: 1988, vol: 97, page: 427, stat: Journal Article,

Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal-facial nerve anastomosis
Brudny J; Hammerschlag PE; Cohen NL; Ransohoff J
1988 Apr;98(4):405-410, Laryngoscope
For reinnervation of facial paralysis, the XII-VII nerve anastomosis provides tone and mass contraction but rarely allows selective muscle control. The efficacy of EMG rehabilitation was evaluated in 30 patients who had no coordinated control of facial muscles. EMG signals from bilateral homologous facial muscle sites were converted into computer-compatible waveform traces and displayed on a video monitor. This facilitated modification of neuromuscular responses using behavioral shaping techniques. A six-point Facial Nerve Grading Scale was introduced for hypoglossal-facial nerve anastomosis to assess the results of EMG rehabilitation. Rehabilitation lasted from 3 to 18 months. Ten patients (33%) achieved the highest possible grading (II) with symmetry and synchrony of function and spontaneity of expression; 17 (57%) reached grade III, which allowed voluntary control of eye and mouth function; 3 (10%) showed minimal gains. It is suggested that neural plasticity allows therapeutic manipulation of central facilitory and inhibitory mechanisms, and possible unmasking of neural connections between the ipsilateral VII and XII nerve motor nuclei which leads to improved facial function
— id: 11131, year: 1988, vol: 98, page: 405, stat: Journal Article,

Hypoglossal-facial nerve anastomosis and electromyographic feedback rehabilitation
Hammerschlag, P E; Brudny, J; Cusumano, R; Cohen, N L
1987 Jun;97(6):705-709, Laryngoscope
Electromyographic (EMG) feedback has been proposed to enhance rehabilitation following hypoglossal-facial nerve anastomosis. Sixteen of 25 patients who underwent hypoglossal-facial nerve anastomosis with and without postoperative EMG rehabilitation were videotaped for evaluation of facial movement by four observers unaware of these patients' rehabilitation therapy. Using a House Facial Nerve Grading System and intragroup comparison, a trend discernible in this preliminary study indicates a chance for better facial function with EMG feedback rehabilitation
— id: 93209, year: 1987, vol: 97, page: 705, stat: Journal Article,

Intraoperative real-time monitoring of brain stem facial evoked response (BFER)
Hammerschlag, P E; John, E R; Prichep, L S; Berg, H M; Cohen, N L; Ransohoff, J
1987 Jan;97(1):57-62, Laryngoscope
Injury to the facial nerve is of concern in surgery of cerebellopontine angle tumors. The crossed acoustic reflex provides a way to monitor the ipsilateral facial nerve with the auditory stimuli delivered to the contralateral side. Using the method of optimum digital filtering, it is possible to monitor the resulting brain stem facial evoked response (BFER) in real time. This paper presents preliminary experiences in more than 18 such operations monitored using this method. This preliminary study demonstrates a trend for a high (88.8%) correlation between BFER and postoperative facial nerve function. Identical latencies from simultaneous BFER and facial nerve recordings along with findings after facial nerve transection suggest that some portion of the complex BFER waveform derives from facial nerve depolarization
— id: 67631, year: 1987, vol: 97, page: 57, stat: Journal Article,

Otic infection due to Pneumocystis carinii in an apparently healthy man with antibody to the human immunodeficiency virus
Schinella, R A; Breda, S D; Hammerschlag, P E
1987 Mar;106(3):399-400, Annals of internal medicine
— id: 93210, year: 1987, vol: 106, page: 399, stat: Journal Article,

Acoustic neuroma presenting as sudden hearing loss with recovery
Berg, H M; Cohen, N L; Hammerschlag, P E; Waltzman, S B
1986 Jan;94(1):15-22, Otolaryngology, head & neck surgery
In our series of patients operated on for acoustic neuromas at New York University Medical Center between 1974 and 1983, 13% (17 of 133) had sudden hearing loss. Of these, approximately 23% (four of 17) had recovered auditory function before acoustic neuroma extirpation. Three patients spontaneously recovered, while one improved with steroid therapy. Contrast computerized tomography demonstrated a widened internal auditory canal and evidence of cerebellopontine angle tumor, respectively, in 88% and 59% of patients with sudden hearing loss and acoustic neuroma. Clinical characteristics suggesting acoustic neuroma as the cause of sudden hearing loss with or without auditory recovery could not be identified in our series. Our data support the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion
— id: 93212, year: 1986, vol: 94, page: 15, stat: Journal Article,

Acoustic neuroma surgery: an eclectic approach with emphasis on preservation of hearing. The New York University-Bellevue experience
Cohen, N L; Hammerschlag, P; Berg, H; Ransohoff, J
1986 Jan-Feb;95(1 Pt 1):21-27, Annals of otology rhinology & laryngology
During the past 10 years, 157 patients have been operated on at the New York University-Bellevue Medical Center for acoustic neuromas and other cerebellopontine angle tumors. We describe our diagnostic protocol with joint neurosurgical evaluation leading to either translabyrinthine (otology only) or suboccipital-transmeatal (combined otology-neurosurgery) surgery. The decision is made on the basis of tumor size, level of hearing, age, and health of the patient. Using these criteria, 105 suboccipital and 59 translabyrinthine operations were performed with eight patients having had two-stage operations. In 12 of 29 patients, hearing was successfully preserved. Of 18 patients with good hearing and extracanalicular tumors less than 2 cm, hearing was preserved in 11. We describe the surgical technique used in this suboccipital-transmeatal operation and present illustrative cases in detail
— id: 67635, year: 1986, vol: 95, page: 21, stat: Journal Article,

Real-time monitoring of brainstem auditory evoked response (BAER) during cerebellopontine angle (CPA) surgery
Hammerschlag, P E; Berg, H M; Prichep, L S; John, E R; Cohen, N L; Ransohoff, J
1986 Dec;95(5):538-542, Otolaryngology, head & neck surgery
The signal-to-noise ratio of brainstem auditory evoked responses (BAER) can be greatly enhanced by use of optimal digital filtering before averaging. This permits accurate assessment of auditory nerve status every 5 to 10 seconds, making real-time intraoperative monitoring possible. The major advantages yielded by real-time monitoring--in our experience thus far--have been identification of potentially adverse functional consequences of apparently uneventful surgical maneuvers, reducing postoperative dysfunction, early indication of potential for improved clinical function, and potential identification and localization of neural tissue in the face of absent surgical landmarks. Examples of these advantages will be provided from case studies, and the possibility that real-time monitoring may improve ability to preserve hearing will be discussed
— id: 67633, year: 1986, vol: 95, page: 538, stat: Journal Article,

Cholesteatoma vs. cholesterol granuloma of the petrous apex
Rosenberg, R A; Hammerschlag, P E; Cohen, N L; Bergeron, R T; Reede, D L
1986 Mar;94(3):322-327, Otolaryngology, head & neck surgery
Lesions involving the petrous apex are rarely encountered in clinical practice. This directly affects the ability of the otolaryngologist to diagnose and effectively treat these lesions. Greater physician awareness and increased technologic capability are leading to more effective management of pathologic conditions involving this area of the temporal bone
— id: 93211, year: 1986, vol: 94, page: 322, stat: Journal Article,

Reversible facial paralysis in sarcoidosis. Confirmation by serum angiotensin-converting enzyme assay
Cohen JP; Lachman LJ; Hammerschlag PE
1983 Dec;109(12):832-835, Archives of otolaryngology
Facial nerve paralysis is an unusual manifestation of sarcoidosis and is frequently associated with parotitis and uveitis. This triad of symptoms constitutes uveoparotid fever (Heerfordt's disease). Until recently, diagnosis was primarily clinical, aided by histologic confirmation of sarcoidosis (sarcoid of Boeck). An enzymatic assay has now been developed that seems to be specific for sarcoidosis. A case is reported herein, in which the origin of the facial paralysis was confirmed by this serum angiotensin-converting enzyme assay
— id: 22131, year: 1983, vol: 109, page: 832, stat: Journal Article,

Transcanal labyrinthectomy for intractable vertigo
Hammerschlag, P E; Schuknecht, H F
1981 Mar;107(3):152-156, Archives of otolaryngology
Labyrinthectomy may be the therapy of choice for intractable and disabling vertigo that is caused by unilateral disease of the vestibular labyrinth. The transcanal method through the oval window offers the most direct surgical approach for complete ablation of the vestibular sense organs. The technique includes visual identification and removal of the utricle; this is followed by blind probing of the ampullae. This method was used in 124 patients, including 90 patients with unilateral Meniere's disease. Three of four cases of moderately severe continuing postoperative vertigo were successfully managed by revision transcanal labyrinthectomy. Twenty-seven (22%) of the 124 patients had continuing mild transient unsteadiness associated with quick head movements; this condition is considered to be the physiologic consequence of unilateral loss of vestibular function rather than unremitted disease
— id: 93213, year: 1981, vol: 107, page: 152, stat: Journal Article,

The role of Chlamydia trachomatis in middle ear effusions in children
Hammerschlag, M R; Hammerschlag, P E; Alexander, E R
1980 Oct;66(4):615-617, Pediatrics
— id: 93214, year: 1980, vol: 66, page: 615, stat: Journal Article,