bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathology of Ménière's Disease as it Relates to the Sac and Tack Procedures
Authors: Schuknecht Harold F.
Published: October 2014

The rationale for endolymphatic sac and tack operations is to prevent the further accumulation of endolymph, the former by draining endolymph into extralabyrinthine tissues and the latter by shunting endolymph into the perilymphatic space. While the basic concepts are reasonable enough, the probability of achieving these objectives seems remote. There appears to be adequate clinical evidence, however, to show that these procedures are of therapeutic value in selected cases. It is tempting to speculate that these surgical insults to the labyrinth, with the associated inflammatory and biochemical changes, alter the function of cells which control fluid physiology and thus improve the symptoms of Ménière's disease.
Current Status of Surgical Decompression and Drainage Procedures upon the Endolymphatic System
Authors: Alford Bobby R. , Cohn Arnold M. , Igarashi Makoto
Published: October 2014

At the present time, neither the etiologic factors nor the pathophysiologic mechanisms that lead to the development of endolymphatic hydrops or Ménière's disease are known; however, the anatomic-pathologic alterations in the labyrinth that are produced by the disease are well-documented. Undoubtedly, what is not known is responsible for the controversial status and questionable benefit that surgical decompression and drainage procedures have upon the endolymphatic system.
Papillary Adenocarcinoma of the Thyroid Invading the Upper Air Passages
Authors: Lawson William , Som Max L. , Biller Hugh F.
Published: October 2014

The clinical course of papillary adenocarcinoma of the thyroid is delayed but aggressive and lethal in an estimated 11–16% of the patients. Death results in the majority of patients from respiratory obstruction produced by a collar of tumor that has proliferated from residual or multicentric thyroid disease. Review of a large series of cases reveals an incidence of invasion of the aerodigestive tract of 1–6.5%. Six such cases are presented in which resection of the larynx, trachea and pharynx were performed along with total thyroidectomy with local control of the disease and prolonged survival. In five cases conservation surgery was done. Three patients had prior thyroid lobectomy with recurrence and invasion of the air passages 2–5 years later. Intraluminal thyroid carcinoma may be confused with a primary lesion of the larynx, trachea or hypopharynx.
Anatomy and Development of the Cricoid
Authors: Tucker Gabriel F. , Tucker John A. , Vidic Branislav
Published: October 2014

Whole organ serial-section study contributes to our understanding of neonatal intubation injury by demonstrating the previously undescribed “V” configuration of the posterior cricoid lamina; this may be readily correlated with subarytenoid paramedian intubation injury. This technique also permits detailed study of an anomalous larynx and permits the precise identification of a “tracheal” anomaly as a cricoid malformation. The need for a fetal staging system is reemphasized.
Laryngeal Amyloidosis
Authors: Barnes E. L. , Zafar Tasneem
Published: October 2014

The larynx is usually involved with amyloid as an isolated phenomenon and infrequently in generalized amyloidosis. This study includes six females and one male with an average age of 54 years who complained chiefly of prolonged hoarseness. At direct laryngoscopy, the amyloid usually presented as firm, nonulcerated yellow, red, or white lesions most often involving the ventricle, true and false cords. Surgical biopsy and/or excision was the only form of treatment. One patient experienced recurrence of her amyloid seven years after her first operation while another patient developed extralaryngeal amyloid. Amyloid is deposited extracellularly as amorphous eosinophilic material in vascular walls and basement membranes of minor salivary glands, as random tissue masses, or as “rings” in adipose tissue. Under the electron microscope, all types of amyloid have the same basic structure. However, chemical analysis has revealed three different classes of amyloid: Amyloid of immunoglobulin origin, amyloid of unknown origin, and apudamyloid. Evidence suggests an immunoglobulin origin of at least some cases of amyloid localized to the larynx. It is theorized that the secretions of a monoclonal plasmacytic infiltrate of the larynx are metabolized into immunoglobulin light chain fragments by adjacent histiocytes and deposited extracellularly as amyloid.
Early X-Ray Diagnosis of Occult Infiltrating Nasopharyngeal Carcinoma
Authors: Kaseff Leon G.
Published: October 2014

The occult type of nasopharyngeal carcinoma (NPC) accounts for 30% of all nasopharyngeal carcinomas. The occult NPC is clinically difficult to visualize, because the tumor infiltrates and grows in the submucosa. It then metastasizes to the skull base or draining lymph nodes. When the NPC is finally diagnosed, the prognosis is poor. Three refined x-ray techniques are evaluated for their utilization in earlier diagnosis of the occult NPC: Thin section tomography, nasopharyngography, and Eustachian tube function studies. In a consecutive series of 50 patients, these techniques detected 12 infiltrating carcinomas not visible on clinical examination. Five of these patients also had initially negative blind biopsies. Patients having diplopia, facial numbness, cervical adenopathy, and chronic serous otitis media are highly suspect for NPC. The described x-ray techniques, that are safe and noninvasive, can detect these occult infiltrative tumors earlier than clinical examination. Earlier detection and treatment of NPC has resulted in a significant increased cure rate.
Drug-Related Gustatory Disorders
Authors: Rollin H.
Published: October 2014

A review is presented of the drug-induced gustatory disorders that have so far been identified. Metallic, bitter or salty phantogeusias and hypogeusias, often of a dissociated type, which may even develop into ageusia have been described as side effects of treatment with some drugs. Personal observations on six cases are reported in which the gustatory disorders are attributed to the ingestion of phenylbutazone, carbamazepine, chlormezanone and baclofen. After interruption of the treatments these disorders were reversible within weeks to months.
Thermal Injury from Mastoid Bone Burrs
Authors: Call William H.
Published: October 2014

Marked bone temperature elevations and surface osteocyte necrosis result from cutting and diamond burrs used without continuous irrigation. Temperatures generated may injure the facial nerve even if drilling is carried on a millimeter or more distant from the nerve. Irrigation of the operative field maintains bone and nerve temperatures at safe levels. Cutting and diamond burrs obey different thermodynamic principles. Higher rotation speeds, greater applied pressures and greater surface contact area increase cutting burr thermogenesis. Burrs with more flutes generate greater heat than those with fewer flutes. Diamond burr heat generation varies in proportion to applied pressure, but is independent of rotation speed or contact area. Haversian canal blood vessels do not contribute to postoperative revascularization. Rather, vessels immigrate from adjacent intact periosteum, penetrating arterioles and exposed marrow. Surface thermal injury does not impede revascularization and should not impair the healing of tissue grafts applied to the bone surface.
Endobronchial Foreign Body Removal Using the Bronchofiberscope
Authors: Heinz George J. , Richardson Robert H. , Zavala Donald C.
Published: October 2014

In certain situations the flexible fiberoptic bronchoscope can augment rigid bronchoscopy in foreign body removal. A case of a successful fiberoptic removal of an endobronchial foreign body (dental bridge) is presented. A wire basket, inserted through the channel of the bronchofiberscope, was used to capture the object.
Comparison of Five Types of Tracheostomy Tubes in the Intubated Trachea
Authors: Galoob Harry D. , Toledo Pedro S.
Published: October 2014

Recognition of excessive cuff pressures as a major factor in tracheal injury has prompted the development of different types of cuffed tracheostomy tubes. Five brands of tracheostomy tubes in common use are evaluated in anesthetized adult dogs. Visualization of interior tracheal conditions during spontaneous and positive pressure ventilation permits a dynamic study of the trachea and its interaction with each tube under varying conditions. The relationship between intracuff pressure and cuff-tracheal wall pressure is analyzed for each tube. The selection of the proper tracheostomy tube for a given clinical situation should consider: 1) the cuff pressure necessary to achieve minimal leak, 2) torque transmission, 3) the ability to monitor cuff-tracheal wall pressure as a function of intracuff pressure, and 4) simplicity of design for optimum clinical use. Tracheal expansion occurs in a predictable fashion in response to different stimuli. However, the role of expansion in the susceptibility of this organ to injury remains to be investigated.
Response of First Order Vestibular Neurons to Lidocaine Hydrochloride
Authors: Yagi Toshiaki , Simpson Norman E. , Markham Charles H.
Published: October 2014

Changes in behavior and electrical activity of primary vestibular neurons were observed following injection of lidocaine hydrochloride into the middle ear of cats. After injection the cats exhibited head and ocular nystagmus, head and neck deviation and pupillary changes. Mean preinjection resting discharge rate for first order vestibular neurons was 46.0 spikes/sec. Two hours after lidocaine application the resting rate decreased to a mean of 22.2 spikes/sec and then recovered to 43.0 spikes/sec four hours, and 47.7 spikes/sec six hours after the experimental treatment. The incremental sensitivity (increased rate of firing) of horizontal canal neurons to constant angular acceleration for the control period was 2.0 extra spikes/sec/ deg/sec2; two hours after the application, 70% of the recorded neurons were unresponsive to angular acceleration or tilt. The sensitivity after four hours was 1.0 spikes/sec/deg/sec2 and 2.1 spikes/sec/deg/sec2 at six hours. The distinct depression of sensitivity by lidocaine at four hours compared to normal mean resting rate at this time suggests these functions may be governed by two modes of action in the receptor or first order afferents.
Effects of Combinations of Sodium Salicylate and Noise on the Auditory Threshold
Authors: Woodford C. M. , Henderson D. , Hamernik R. P.
Published: October 2014

Thirty-nine monaural chinchillas were used to study the interaction between sodium salicylate and various TTS-producing noise paradigms. Five animals were included in each of the following three groups: 1) sodium salicylate (400 mg/kg) plus 2–4 kHz, 95 dB SPL noise band for one hour; 2) sodium salicylate (400 me/kg) plus 4 kHz CF octave band noise at 80 dB SPL for 96 hours; and 3) sodium salicylate (400 mg/kg) plus 50 impulses having 50 μsec A-duration and 158 dB peak SPL, presented at one per minute. The remaining 24 animals served as various controls in groups exposed to sodium salicylate or the noise paradigm alone. Thresholds were estimated before, during, and after exposure using the AER technique and cochleagrams were mapped for each cochlea 30 days after exposure. When sodium salicylate was combined with the various noise conditions, the maximum TTS values obtained from the combination studies were comparable to those obtained from the single agent producing the greatest TTS at a particular frequency. No consistent alteration in either magnitude or time course of posttreatment threshold shift was found following the combination treatments as compared to the individual agents alone. Hazard to the auditory system resulting from a combination of sodium salicylate and noise was concluded to be no greater than the hazard presented by either agent alone. This result is also substantiated in the histological results.
Bilateral Acoustic Neurinomas
Authors: Montgomery William W.
Published: October 2014

A patient presented with complaint of increasing hearing loss in the right ear of five months duration. There was no hearing in the left ear as a result of previous surgery for resection of an acoustic neurinoma. Polytomes demonstrated a progressive erosion of the right auditory meatus. The patient underwent a right suboccipital craniotomy resulting in preservation hearing at a 30 dB level with 100% discrimination scores.
Immunoglobulin E in Chronic Middle Ear Effusions
Authors: Lewis Daniel M. , Schram James L. , Birck Herbert G. , Lim David J. , Gleich Gerald
Published: October 2014

To investigate the possible role of allergy in otitis media with effusion (OME), the immunoglobulin E (IgE) content of 138 middle ear effusions (MEE) and paired serum samples from patients with chronic otitis media with effusion was determined. The initial 62 paired specimens were assayed for IgE by the radioimmunosorbent test (RIST), while the later 76 paired specimens were assayed for IgE by the paper radioimmunosorbent test (PRIST). When the results obtained by these two techniques were compared, it was noted that the PRIST procedure gave significantly lower IgE values for effusions than the RIST method. When the effusion-to-serum ratios (E/S ratios) were computed from the PRIST data, the E/S ratio was less than one, while RIST data gave an E/S ratio greater than one. The results obtained with the PRIST procedure were confirmed by double antibody radioimmunoassay for IgE. Thus, the PRIST procedure appears to measure the IgE content of MEE more accurately, and the results obtained by this procedure fail to support the concept of allergy as a major causative factor in OME.
Morphology of Tensor Veli Palatini, Tensor Tympani, and Dilatator Tubae Muscles
Authors: Rood S. R. , Doyle W. J.
Published: October 2014

The relationships among the paratubal muscles were studied in human fetal and adult Eustachian tubes. That which has, in recent years, been labeled the tensor veli palatini muscle actually consists of two distinct groups of muscle fibers: a medial group, henceforth termed dilatator tubae, and a lateral group, called tensor veli palatini. The latter was found to have no Eustachian tube origin, but was continuous superiorly with the tensor tympani muscle. The dilatator tubae muscle was found to have a tubal attachment. The participation of this muscle system in the normal functioning of the Eustachian tube-middle ear system in man, and the problems inherent in the development of animal models simulating the physiology of the human system, are discussed.
Actinomycosis: Masquerader in the Head and Neck
Authors: Rankow Robin M. , Abraham David M.
Published: October 2014

The diagnosis of cervicofacial actinomycosis is usually not simple, but may be essential for adequate treatment. Cases seen in a Head and Neck Service illustrate some of the many guises under which actinomycosis may be concealed, and a review of recent literature confirms its propensity to be a masquerader. A combination of techniques is necessary to diagnose, and both surgical and medical approaches are needed to treat this often distressingly persistent affliction.
Results of New Air Caloric Testing Method among Normal Subjects. I. Biphasic Testing
Authors: Fleming Paul M. , Dix Rollin C. , Proctor Leonard R. , Metz Werner A.
Published: October 2014

A new air caloric testing method is described in which the temperature of a continuous aural irrigation is switched between hot and cold values at times calculated to control the intensity of the resulting vestibular stimulation. Applications of low or high caloric stimulus intensities to normal subjects were well tolerated and reliably produced appropriate low or high intensity nystagmic responses. Nystagmus intensity values obtained from this study were compared with predicted intensity values from a computerized simulation of the actual test conditions, and also with values obtained when using biphasic water irrigations. As a result, further improvements in our methodology have been effected.
Vascularized Hyoid Interposition for Subglottic and Upper Tracheal Stenosis
Authors: Wong Matthew L. , Kashima Haskins K. , Finnegan Douglas A. , Jafek Bruce W.
Published: October 2014

Chronic subglottic and upper tracheal stenosis can be treated successfully with lumenal augmentation using a vascularized hyoid-sternohyoid muscle interposition into the stenotic area. Successful decannulation was achieved in eight of nine patients. Follow-up periods varied from 6 months to 36 months. Concomitant laryngeal stenosis and vocal cord paralysis were treated successfully at the same time. The major complication was occasionally delayed but successful decannulation due to granulation tissue. Minimal wound and peritracheal stoma infections probably accounted for the granulation tissue.
Unsuspected Foreign Bodies of the Aerodigestive Tract
Authors: Banks William , Potsic William P.
Published: October 2014

The well-known tendency for children to place loose objects in their months not infrequently leads to the entrapment of foreign bodies in the aerodigestive tract. With prompt and adequate removal few complications occur. However, when the foreign body goes undetected or is neglected the patient may develop dysphagia, pneumonia, failure to thrive, lung or mediastinal abscesses, bronchopulmonary or bronchoesophageal fistulas, or erosion of major vessels. Fifteen cases of retained foreign bodies were identified in a chart review between 1971 and 1977 at the Children's Hospital of Philadelphia, calling attention to the problems of aerodigestive foreign bodies of prolonged duration. Early and late complications are discussed and early diagnosis and endoscopic removal emphasized.
Ultraviolet-Fluorescence Bronchoscopy in Early Detection of Bronchogenic Carcinoma
Authors: Hürzeler Dietrich
Published: October 2014

The still unsatisfactory prognosis of bronchogenic carcinoma prompted the search for possibilities of better early and detailed diagnosis. This led us to the idea of UV-fluorescence bronchoscopy. The patient inhales 5 ml of an aqueous 5% solution of fluorescein, together with a β2 stimulator, 10–15 minutes before the bronchoscopy, by means of a pressure inhaler. While the normal mucous membrane cleanses itself by virtue of ciliary action (secretions containing fluorescein are expectorated or drawn off during the bronchoscopy), carcinoma, carcinomatous lymphangiosis, superficial tumor infiltrations and nonciliated metaplasias are stained. These places fluoresce in UV light, even when they cannot be observed with the naked eye or with an optical system. In this way, they are made visible for directed biopsy. Malignant changes not discernible by means of the methods hitherto employed can thus be diagnosed and sites determined with greater accuracy for proposed resection.
Suspension Microlaryngoscopy in the Boyce Position with a New Suspension Gallows
Authors: Grundfast Kenneth M. , Strong M. Stuart , Vaughn Charles W. , de Vos Paul
Published: October 2014

The patient in whom laryngoscopy is difficult, calls for the placement of the patient's head in the optimum (Boyce) position prior to insertion of the laryngoscope. A new suspension gallows has been developed which provides for suspension of the laryngoscope with the patient in the Boyce position; this ensemble maintains stability of the laryngoscope, minimizes pressure on the maxilla and gives the best possible view of the anterior commissure.
Fourth Daniel C. Baker, Jr. Memorial Lecture
Authors: Fink B. Raymond
Published: October 2014

Review of the logistics of energy supply in animals indicates that the advent of the larynx was part of a response to an earlier energy crisis. It permitted a major increase in the flow of energy available to the organism and became the mechanical control point and rate-limiting factor of the increased inflow. Phylogenetically, a succession of structural innovations steadily enhanced the flow capacity of the larynx and rendered the mechanism more versatile, most recently with the accrual of phonation (in mammals), pressurized closure (in primates and odontocetes), and vocal formants and efficiency (in man). The larynx is thus a marker of the animal's capabilities for energy intake, energy utilization and information emmission and, apparently, of the size and complexity of the brain. Today's energy crises appear to continue those of the past.
Acute Laryngeal Obstruction in Children
Authors: Davison Francis W.
Published: October 2014

When dealing with acute laryngeal obstruction, the first important consideration is the differential diagnosis of the cause. The author considers the following six types: acute laryngotracheobronchitis, acute epiglottitis, diphtheria, supraglottic allergic edema (angioedema), subglottic allergic edema (spasmodic croup) and foreign body in the larynx or trachea. He traces the development of the treatments that have in 50 years lowered the mortality rate from 70% to practically zero. High humidity, best supplied by an ultrasonic nebulizer, antibiotics, and corticosteroids in very high dose have been the prime effective measures. There still is controversy about the choice between tracheostomy and nasotracheal intubation if medical therapy is delayed or ineffective. The primary physician must know when and where to send these children in order to prevent the fatalities so frequent in previous years.
Glomus Jugulare and Vagale
Authors: Ogura Joseph H. , Spector Gershon J. , Gado Mokhtar
Published: October 2014

The therapeutic results in 72 patients with glomus jugulare and nine with glomus vagale have indicated a surgical cure rate of 80% in the former and 100% in the latter. Radiotherapy demonstrated a 65% tumor response rate and a 25% cure rate histologically and clinically. Embolization with Gelfoam® beads in seven patients resulted in diminished tumor size and arterial circulation from the external carotid system. However, in all cases the tumor persisted. Embolization diminished intraoperative bleeding. Nevertheless, the use of embolization as a palliative modality demonstrated significant symptomatic relief in aged, debilitated patients and in all patients with large inoperable glomus jugulare tumors.
Hemangiomas of the Head and Neck
Authors: Work Walter P.
Published: October 2014

Hemangiomas are an interesting group of lesions which affect many anatomical structures of the human body. Interest today is confined to head and neck lesions which can occur in the infant, child or adult. Benign lesions affect the great majority of patients as contrasted to malignant ones. Diagnosis of the superficial lesions is usually made by inspection and palpation while additional diagnostic procedures (radiological studies and surgical exploration) may be indicated in patients with deep lesions.
Clinical Correlation of Anomalies of the Supraglottic Larynx with the Staged Sequence of Normal Human Laryngeal Development
Authors: Tucker John A. , Tucker Gabriel , Vidić Branislav
Published: October 2014

The clinical correlation of the authors' observations on human laryngeal development with existing literature supports the suggestion that earlier concepts, specifically by Frazer, may not be valid. It is further proposed that development of the human larynx may similarly correspond in man to that of the rat. Congenital laryngeal malformations are fundamentally associated with a disturbance of epithelial mesenchymal interactions, particularly related to a premature arrest of the normally vigorous epithelial activity.
Management of Choanal Atresia with the Carbon Dioxide Laser
Authors: Healy Gerald B. , McGill Trevor , Jako Geza J. , Strong M. Stuart , Vaughan Charles W.
Published: October 2014

Congenital choanal atresia frequently demands immediate recognition in the newborn, and provision of a nasal airway as soon as possible. A variety of techniques are available to correct this problem, but none is entirely satisfactory. Transpalatal procedures are associated with significant morbidity in the newborn, and transnasal microsurgical procedures are less predictable when a thick bony plate is present in the choanal obstruction. Transnasal resection with the CO2 laser has been carried out in seven patients (ten sides), whose ages ranged from 16 hours to 14 years. From this early experience, it appears that the procedure is entirely feasible and convenient. It seems to have significant advantages over conventional microsurgical techniques. Eight out of ten choanae have remained patent for four months or more. A lumen keeper is needed during the immediate postoperative period for at least two to three weeks. The procedure is associated with minimal morbidity.
Voice Spectrography in the Evaluation of Myasthenia Gravis of the Larynx
Authors: Rontal Michael , Rontal Eugene , Leuchter William , Rolnick Michael
Published: October 2014

Myasthenia gravis is a neuromuscular disorder that affects striated muscles especially those innervated by the cranial nerves. The standard diagnostic regimen is to find a reversal of symptoms by acetylcholine esterase administration. The permanent and objective recording of this effect is the key to an accurate assessment of this test. The voice spectrograph is a noninvasive means of evaluating the voice. It has been used successfully to mate a clear and specific diagnosis of myasthenia gravis as it affects the larynx. The test can be used to distinguish myasthenia gravis from other functional, anatomical and neuromuscular laryngeal disorders.
Delayed Endolymphatic Hydrops
Authors: Schuknecht Harold F.
Published: October 2014

Delayed endolymphatic hydrops is a disease entity that can be differentiated from Meniere's disease. Typically it occurs in patients who have sustained a profound hearing loss in one ear, usually from infection or trauma, and then after a prolonged period of time develop either episodic vertigo from the same ear (ipsilateral delayed endolymphatic hydrops) or fluctuating hearing loss, also sometimes with episodic vertigo, in the opposite ear (contralateral delayed endolymphatic hydrops). The ipsilateral form of the disease may be treated by labyrinthectomy but no satisfactory therapy is available for the contralateral form of the disease.
Sudden or Fluctuating Hearing Loss and Vertigo in Children Due to Perilymph Fistula
Authors: Grundfast Kenneth M. , Bluestone Charles D.
Published: October 2014

Five cases are presented of children with rapid onset of sensorineural hearing loss, disequilibrium, or both, who were found at exploratory tympanotomy to have a perilymph fistula. Four of the children had histories suggesting that antecedent barotrauma or physical exertion contributed to the development of the fistula. One child with congenital unilateral craniosynostosis had a residual temporal bone abnormality on the same side as the perilymph fistula. Two children had identifiable anatomic abnormalities in the middle ear. A classification of perilymph fistula is proposed that describes a congenital, an acquired, and a combined type of fistula. Inner ear fluid dynamics and patency of the cochlear aqueduct appear to be important factors in pathogenesis. Children with unexplained fluctuating or sudden onset of sensorineural hearing loss, and children with unexplained disequilibrium or vertigo should be suspected of having a perilymph fistula. The history can be singularly important in raising the suspicion that a perilymph fistula may be present. Although audiometric, vestibular, and radiographic studies can be helpful, there is no way to prove the presence or absence of a fistula without directly viewing the middle ear. Tympanotomy with repair of the fistula does not assure improvement in hearing.
Perilymph Fistulas
Authors: Singleton George T. , Post Kathryn Nolan , Karlan Marc Simeon , Bock Douglas G.
Published: October 2014

Fifty-one patients suspected of having a perilymph fistula were evaluated. We postulated that many patients with predominantly vestibular complaints had unrecognized perilymph fistulas. An analysis was made of symptoms, physical findings, vestibular and audiometric test results in order to determine appropriate diagnostic criteria for the presence of perilymph fistulas. The patient population was divided into two groups, those with and without fistulas. Data from both groups were compared by mean values of variables, step-wise discriminant analysis, and factor analysis. A history of trauma with sudden onset of dizziness and/or hearing loss should alert the physician to a fistula. Findings of significance were positional nystagmus of short latency and long duration without import of nystagmus direction, canal paresis and reduced speech reception threshold with poor speech discrimination scores. Discriminant analysis correctly classified 19 fistula and 10 nonfistula cases explored operatively and identified two error judgments in 22 nonoperated cases. Bed rest for the first five days proved to be the most effective means of therapy. Surgical intervention with repair of the fistula by perichondrial graft provided effective control of vertigo more frequently than restoration of hearing.
Asymmetry of the Internal Auditory Canals without Acoustic Neuroma
Authors: Dolan Kenneth D. , Babin Richard W. , Jacoby Charles G.
Published: October 2014

During the past five years, nine patients with “significant” unilateral enlargement of one internal auditory canal by polytomography were subsequently found to have freely filling canals on contrast posterior fossa myelography. The radiographic appearance of the enlarged canals varied greatly and included all the various configurations usually suggestive of acoustic neuroma. Likewise, the clinical presentation varied greatly from asymptomatic to highly suggestive of cerebellopontine angle tumor. This series underscores the essential nature of posterior fossa studies in the evaluation of potential acoustic neuromas and the variability of the normal architecture of the internal auditory meatus.
Aggressive Fibromatosis of the Tongue
Authors: Schwartz Harmon E. , Ward Paul H.
Published: October 2014

Fibromatoses are uncommon, locally aggressive lesions that may involve the structures of the head and neck. They are most commonly found in and along the fascial planes of the neck muscles but can involve other structures, including the oral cavity, nose, nasopharynx or paranasal sinuses. An unusual case of an extra-abdominal desmoid tumor is presented and a review of the anatomical, clinical and pathological features of these tumors is discussed.
Pathogenesis of Sinus Empyema
Authors: Carenfelt Christer
Published: October 2014

The crucial event in the pathogenesis of sinus empyema is the ostial obstruction. On the basis of recent reports, some consequences of the obstruction on the local bacterial-host interrelationship have been outlined. The anaerobic gas environment of the empyema is one quality important to the selection of bacteria but probably also to the efficiency of the antibacterial activity of the granulocytes. Release of proteolytic enzymes from neutrophilic granulocytes in the sealed sinus may jeopardize the bacterial engulfment due to proteolytic degradation of opsonins. A longstanding exposure of the sinus mucosa to uninhibited proteolytic enzymes may explain the irreversible lesion of the mucosa in chronic sinusitis.
Caloric Vestibular Test with the Use of Air
Authors: Greven A. J. , Rademakers W. J. A. C. , Oosterveld W. J. , Voorhoeve R.
Published: October 2014

In a group of 28 test subjects the vestibular caloric test was performed with the aid of two different methods. In the first method the ears were irrigated for 30 sec with water with a temperature of 30 C and 44 C, in the second method the ears were subjected to an airstream with a temperature of 30 C and 44 C and later on with an airstream with a temperature of 20 C and 50 C. The wet method proved to be a significant stronger stimulus than the dry method. The authors conclude that the water irrigation is the method of choice for the caloric test. The dry method is only useful when the wet method is undesirable.
Dilation of the Eustachian Tube by Electrical Stimulation of the Mandibular Nerve
Authors: Cantekin Erdem I. , Doyle William J. , Phillips David C. , Reichert Timothy J. , Bluestone Charles D.
Published: October 2014

The recent studies of the anatomy of the eustachian tube and related structures in the Rhesus monkey ( Macaca mulatto) have shown that the monkey tubal system is similar to the human. This investigation in Rhesus monkeys was an attempt to verify previous studies in other animals that the tensor veli palatini muscle was the only dilator of the eustachian tube. Two unipolar stimulating electrodes were introduced into the foramen ovale, and the mandibular branch of the trigeminal nerve was electrically stimulated. Simultaneously, pressure-flow recordings through the eustachian tube were monitored. Stimulus-response relationships were obtained for five Rhesus monkeys. The degree of tubal dilation by the tensor veli palatini muscle contraction was shown to be a function of stimulating current levels. Artificially induced dilations were quite similar to the physiological dilations during swallowing when these animals were tested alert. Following complete transection of the tensor muscle, regardless of the stimulus level, no tubal dilations were observed. Stimulation of the nerve to the internal pterygoid and stimulation of the levator veli palatini muscle induced only constrictions of the tube. The tensor veli palatini muscle is the only paratubal muscle responsible for active dilation of the eustachian tube in the Rhesus monkey, and its motor innervation is the mandibular division of the trigeminal nerve.
Recurrent Nerve Locating System
Authors: Rea James L. , Davis William E. , Templer Jerky W.
Published: October 2014

One recurring problem for otolaryngologists is the patient with vocal cord paralysis after thyroid surgery. We review the literature to assess the magnitude of this problem and to assess presently available techniques for sparing the recurrent laryngeal nerve. We present a new system for intraoperative recurrent laryngeal nerve location during thyroid surgery.
Benign Pleomorphic Adenoma of the Larynx: A Case Report
Authors: Som Peter M. , Feuerstein Sidney S. , Nagel Barry D. , Strauss Lotte
Published: October 2014

Minor salivary gland tumors of the larynx are relatively rare. Morphologically the majority of them are adenoid cystic carcinomas and the overwhelming location is the subglottic larynx. Benign pleomorphic adenomas are rare minor salivary gland tumors of the larynx which usually occur at the glottic and subglottic levels. We present only the sixth case of a supraglottic benign pleomorphic adenoma that we could find in the literature. A preoperative laryngogram localized the tumor to the supraglottic larynx and the intact mucosa suggested a specific differential diagnosis. The tumor was removed by a lateral pharyngotomy with retention of good laryngeal function. The relatively asymptomatic presentation of our case is a somewhat unusual finding which, however, was previously noted in similar case reports.
Minute Perilymph Fistulas: Vertigo and Hennebert's Sign without Hearing Loss
Authors: Kohut Robert I. , Haenel Judith L. , Waldorf Ronald A. , Thompson James N.
Published: October 2014

The clinical entity characterized by episodic vertigo and a positive Hennebert's sign in patients without hearing loss is described. The history of perilymph fistulas is reviewed. Minute perilymph fistulas of the oval window were documented surgically in five consecutive patients with this syndrome. All experienced relief of their symptoms after surgical correction.
Completion Laryngectomy
Authors: Myers Ernest M. , Ogura Joseph H.
Published: October 2014

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Missouri. Forty-two or 9.4% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed in regards to original conservation surgery, clinical presentation, histopathology and salvage rate. The most common indications for completion laryngectomy were: 1) local recurrence, 2) local recurrence with associated severe upper respiratory obstruction, and 3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44%), and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or 10 patients) associated with completion laryngectomy, particularly in patients with antecedent hemilaryngectomy. Most indications for completion laryngectomy present early, however, all patients must be carefully followed. Both the patient and the otolaryngologist must be ever vigilant following conservation surgery.
High Dose Preoperative Irradiation for Advanced Laryngeal-Hypopharyngeal Cancer
Authors: Sagerman Robert H. , King Gerald A. , Chung Chung T. , Yu Woon Sang , Cummings Charles W. , Johnson Jonas T.
Published: October 2014

Combined therapy, consisting of 5000 rads delivered in five weeks followed by total laryngectomy ± radical neck dissection, was compared with treatment by irradiation (6000–7000 rads) with surgical salvage when clinically possible for radiation failure. Patients were categorized according to site of primary cancer (glottic, supraglottic and pyriform sinus) and staged (T, N, M). Survival was equally good in the two programs for glottic and supraglottic lesions, N0 or N1. The combined treatment program was judged superior for supraglottic and pyriform sinus lesions, N2 or N3.
Fate of Middle Ear Mucosa Introduced into the Vestibule
Authors: Miglets Andrew W. , Coopey F. Donald
Published: October 2014

The etiology of poststapedectomy reparative granuloma remains obscure. To evaluate the possibility of inadvertently introduced mucous membrane into the vestibule as a possible cause of granuloma formation, this animal study was devised. The stapes was removed from the right ear of four squirrel monkeys and middle ear mucosa placed in the vestibule, the stapes then being replaced. In the left ear, a control operation was done in which only the stapes was removed, then replaced. The animals were sacrificed between the 2nd and 17th day and their temporal bones were prepared and studied. The mucous membrane was identified within the vestibule of all animals. It was well-tolerated and did not evoke the inflammatory response, which would be expected if mucosa was a cause of granuloma formation. The mucosa was still present at 17 days, eventually becoming surrounded by the endosteal lining of the vestibule.
Acute Laryngeal Abscesses
Authors: Canalis Rinaldo F. , Jenkins Herman A. , Osguthorpe J. David
Published: October 2014

The clinical features of laryngeal abscess have changed markedly since the introduction of antibiotics and are rarely seen by clinicians today. Three cases of acute laryngeal abscess associated with malignancy, airway instrumentation and a preexisting laryngocele respectively are presented. Management of these cases included immediate tracheostomy, intravenous antibiotics and surgical drainage. Current etiological factors and modes of presentation are discussed. Laryngeal abscess remains a serious and potentially lethal problem requiring emergent treatment. Serious sequelae may result from this disease.
Influences on the Coiling of the Cochlea
Authors: Li Cheuk W. , McPhee Joseph
Published: October 2014

The growth and shape of the cochlea appears to be controlled by the formation of the cartilaginous capsule. Coiling of the cochlear duct is apparently the result of the physical barrier and support provided by the cartilage cells differentiating from mesenchyme surrounding the ventral portion of the otocyst. In addition, tissue interactions between this mesenchyme and the developing cochlear duct will influence the formation of the cartilaginous capsule and they may also be the origin of one of the controlling agents for the coiling mechanism.
Cochlear and Brain Stem Responses in Hearing Loss following Neonatal Hyperbilirubinemia
Authors: Chisin R. , Perlman M. , Sohmer H.
Published: October 2014

The site of lesion in hearing loss following neonatal hyperbilirubinemia is unclear. Histopathological studies have implicated the brain stem auditory nuclei while other investigations have hinted at a lesion in the cochlea. In order to clarify this issue, attempts were made to record responses from the auditory pathway in 13 patients with hearing loss following neonatal hyperbilirubinemia. The neural response from the auditory nerve was absent in 11 of the 13 patients and present only in response to high intensity stimuli in 2 patients. However, the response of the cochlear hair cells (cochlear microphonic potential) was present in 9 of the 13 patients. In most other cases of sensorineural hearing loss, with no history of hyperbilirubinemia, the hair cell response was absent. This is functional evidence for auditory nerve damage in cases of hearing loss following neonatal hyperbilirubinemia while the hair cells are spared.
Tissue Adhesion with Highly Concentrated Human Fibrinogen in Otolaryngology
Authors: Staindl O.
Published: October 2014

This paper summarizes a tissue adhesive system consisting of highly concentrated human fibrinogen and thrombin. The addition of blood-clotting factor XIII stabilizes the adhesive system against fibrinolysis. Although the adhesion system cannot and should not replace surgical suture, it provides valuable assistance in tissue synthesis and in local hemostasis, particularly in cases where conventional suture methods are especially difficult to apply. In addition to good adhesion, an elastic consistency, and good tissue compatibility, the adhesive is completely absorbed and, therefore, preferable to conventional tissue adhesives based on cyanoacrylate. The system has been used successfully in split thickness skin graft application, myringoplasty, repair of dural defects, hemostasis after tonsillectomy, and achieving an airtight seal in tracheoplasty.
Enteral and Parenteral Nutrition in Patients with Head and Neck Cancer
Authors: Sobol Steven M. , Conoyer J. Michael , Sessions Donald G.
Published: October 2014

Head and neck cancer patients present with special problems in nutritional homeostasis because of local pharyngeal discomfort and obstruction and difficulty with deglutition due to either the neoplasm or the surgical alterations in the upper aerodigestive tract. Pretreatment malnutrition and vitamin deficiency are only compounded by the nutritional stress imposed by radiation and surgery. Reduced wound complications occur if the patients are nutritionally replenished before treatment. While nasogastric feedings will suffice in many patients, rapid nutritional restoration by this method is limited, and positive nitrogen balance may be difficult to achieve in the severely malnourished patient. Intravenous hyperalimentation offers a rapid and efficacious alternative in selected cases. The case histories of two patients are presented to illustrate these concepts.
Bilateral Hypoglossal Nerve Paralysis after Irradiation Therapy
Authors: Saunders William H. , Hodgson Sheila E.
Published: October 2014

Cancericidal doses of irradiation therapy to the head and neck may be followed by paralysis of cranial nerves due to fibrosis of tissue about the nerves and infiltration of the nerves with fibrous tissue. The hypoglossal nerve is particularly prone to this delayed effect of irradiation therapy and a case is presented here in which there was bilateral hypoglossal paresis appearing three years after therapy.
Giant Functioning Cervicomediastinal Parathyroid Cyst
Authors: Buchanan George , Gregory Monica M.
Published: October 2014

A rare case of a large cervicomediastinal parathyroid cyst associated with hypercalcemia and an elevation of serum parathyroid hormone is presented. The pathogenesis of such a large cyst is discussed, hemorrhage into an adenoma being the most likely cause. Clinical investigations which should be carried out for any cystic mass at the root of the neck should include a serum calcium, and if this is found to be elevated, the possibility of the cyst being of parathyroid origin should be considered. In view of the high concentration of parathyroid hormone found within the cyst, aspiration of the cyst contents for parathyroid hormone estimation might well prove a valuable test to confirm the diagnosis.
Brain Stem Potentials Evoked by Electrical Stimulation of the Cochlea in Human Subjects
Authors: Starr Arnold , Brackmann Derald E.
Published: October 2014

Brain stem potentials were recorded from scalp electrode to biphasic square wave electrical stimulation of implanted electrodes in the cochlea of three patients. Reliable potentials could be recorded that appeared 1.5 to 2.0 msec prior to the customary acoustically-evoked brain stem potentials. The effects of variations in electrical stimulus parameters of rate and intensity were measured. Brain stem potentials can provide objective indices of the effectiveness of electrical stimulation of the cochlea in man.
Micromethod for Determination of Middle Ear Gas Composition
Authors: Ostfeld Ervin , Blonder Judith , Crispin Moshe , Szeinberg Arieh
Published: October 2014

This is a microchromatographic method for simultaneous determinations of O2, N2, CO2 and N2O in gas samples of 40–100μl. A Packard 836 U gas chromatograph with a thermal conductivity detector and helium gas as carrier was used. The combination of Porapak® and 5A molecular sieve column system was found adequate and is described in detail. The fidelity of this method was proved by a high constancy of the retention time, the linearity of the response and the reproducibility of results. The present method proved to be reliable for determination of all middle ear gases in man and experimental animals during general anesthesia with N2O.
Osteomas and Exostoses of the External Auditory Canal
Authors: Graham Malcolm D.
Published: October 2014

Osteomas of the external auditory canal are considered clinically to be discrete, pedunculated bone lesions arising along the tympanosquamous suture. They are benign lesions but often are slowly progressive in size. Exostoses of the external auditory canal are broad-based elevations of bone usually multiple and bilaterally symmetric, involving the tympanic bone. It appears that both clinical and histopathologic evidence is sufficient to justify the impression that these two lesions should be considered separate entities and clinical diagnostic and histopathologic criteria have been suggested for diagnosis of these lesions.
Vestibular Neuroanatomy
Authors: Gacek Richard R.
Published: October 2014

The modern neuroanatomical technique of using a retrograde axoplasmic tracer (horseradish peroxidase) to label neurons has aided the revelation of several important connections in the vestibular system. The organization of the oculomotor nucleus and the existence of an interneuron in the abducens nucleus have importance in understanding some ocular disorders. A detailed description of the location of vestibulo-ocular neurons to individual extraocular muscles is now available which may provide a basis for understanding how these reflexes function normally and abnormally. Interconnections between the vestibular nuclei are provided by commissural neurons located in the superior, medial and group Y nuclei. These projections are probably of importance in vestibular compensation. A possible hypothesis of vestibular hair cell projection suggests that type I cells project over vestibulo-ocular neurons while type II cells project over commissural pathways.