bluuebunny/crossref_metadata_2025 huggingface dataset:
Young Students' Readiness for Advanced Math: Precocious Abstract Reasoning
Authors: Ablard Karen E. , Tissot Sherri L.
Published: November 2015

Academically talented students have precocious reasoning abilities and are ready for advanced math earlier than when it is typically offered. This study examined above-grade-level abstract reasoning abilities of 150 students ranging from 2nd-6th grades. Based on chi-square analyses, the distribution of students' scores on the Arlin Test of Formal Reasoning (Arlin, 1982, 1984) was not significantly different from distributions for a normative group of students four grade levels higher. An Age Level by Gender MANOVA revealed that understanding of various abstract concepts varied by age for only 4 of 8 subscales or concepts: Probability, Proportion, Momentum, and Frames of References. Performance varied widely within age level for the understanding of Volume, Correlation, Combination, and Mechanics. There may not be one age at which children acquire abstract reasoning and are ready for advanced mathematics.
A Critique of Renzulli's Theory into Practice Models for Gifted Learners
Authors: Olszewski-Kubilius Paula
Published: November 2015

In this paper, I offer my views on the theory and practice models of Dr. Joseph Renzulli, a leading researcher and theorist within the field of gifted education. Renzulli's model is critiqued against a set of criteria proposed by the author for a “good” gifted program. There are many strengths to Renzulli's model; but a major weakness is the lack of school-based assessment procedures that can guide decisions about a broader range of accelerative, enrichment, and other types of program options for gifted students with different needs. The major ideas underlying Renzulli's theory were also critically examined, including the broadening of the talent pool, the emphasis on products, and the focus on the development of creative productivity as a basis for educational programs for gifted children.
Renzulli's Model: Needed Research
Authors: Johnsen Susan K.
Published: November 2015

In this response to Renzulli's 25-year review of his work, I develop 3 questions for examining his perspectives: (a) Does Renzulli's conception reflect the gifted population? (b) Do school system practices reflect the conception? and (c) How do implemented practices of the model affect the school system and the gifted student? I argue that no classroom observational studies critically examine the dynamic interaction of Renzulli's Three-Ring Conception of Giftedness, that within a school context it is difficult to operationalize, and that its complexity limits the number of implementation studies that focus on its effects. I suggest new questions for research and encourage studies that examine closely the database's underlying current practices promulgated in the field of gifted education.
Building a Communicative Democracy: The Birth and Death of Citizen Politics in East Germany
Authors: Boyle Maryellen
Published: November 2015

What has formed historically here is best left to history. This also holds true for the issue of the German nation and of the forms of German statehood. What is important now is the political aspect. There are two German states with different social and political systems. Each of them has values of its own. Both of them have drawn lessons from history, and each of them can contribute to the affairs of Europe and the world. And what there will be in a hundred years is for history to decide.
Watching Talk: Gender and Engagement in the Viewing of Audience Discussion Programmes
Authors: Livingstone Sonia
Published: November 2015

I felt really good because I'd spoken because in the past I've actually spoken to friends about it and they hadn't been in difficult situations and so they couldn't quite relate and strangely enough the audience was really really sympathetic and I felt more empathy with them than I had with friends who hadn't been through it. It felt really like the audience was on your side so it was actually a really nice feeling, you felt like you were being supported. (Woman participant in a studio discussion)
Topical Therapeutics for Otitis Media
Authors: Fairbanks David N.F.
Published: November 2015

In chronic draining ear associated with a tympanic membrane perforation, cholesteatoma, or both, the infection is that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably Pseudomonas, staphylococcus, and enteric organisms, particularly bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure in preoperative preparation, and in prevention and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and antiseptic solutions or powders. Therapy is usually directed toward the Pseudomonas organisms with aminoglycoside‐polymyxin combination otic drops. However, Bacteroides fragilis now looms as an important pathogen in 13% of affected patients. Chloramphenicol otic drops are indicated when such an infection is suspected or identified.
Factitious Parotid Tumor
Authors: Keane William M. , Atkins Joseph P. , Perlstein Deborah A. , Gluckman Stephen J. , Faludi Georgina , Harris James
Published: November 2015

Factitious or self‐induced illness can occur as a diagnostic dilemma. We present a case of a patient who injected saliva into the parotid region with a resultant clinical picture consistent with a parotid tumor. A high degree of medical sophistication and a complex underlying psychopathologic behavior in these patients make the diagnosis and treatment difficult. Psychiatric consultation is an integral part of their management.
Upper Aerodigestive Tract Manifestations of Behçet's Disease: Review of 30 Cases
Authors: Gustafson Ray O. , McDonald Thomas J. , O'duffy J. Desmond , Goellner John R.
Published: November 2015

This review of 30 cases of Behçet's disease seen at the Mayo Clinic between 1965 and 1975 describes the multisystem nature of the disease and emphasizes its upper aerodigestive tract manifestations. The major clinical features include aphthous ulceration of the upper aerodigestive tract and genitalia, ocular inflammation, cutaneous vasculitis, and synovitis; less frequent features are meningoencephalitis and thrombophlebitis. There are no specific laboratory abnormalities, and corticosteroids remain the mainstay of therapy.
Selecting the Side of Recurrent Laryngeal Nerve Section for Spastic Dysphonia
Authors: Izdebski Krzysztof , Dedo Herbert H.
Published: November 2015

This study compares the immediate postchemical paralysis voice and speech qualities of 12 spastic dysphonia patients as a function of left and right recurrent laryngeal nerve (RLN) block. No statistically significant differences for the qualities of overpressure, breathiness, aperiodicity, or tremor were found for the two experimental conditions (left, right). This being the case, and because of left RLN location and course, vocal‐fold paralysis on the left is indicated if RLN surgery is elected as a treatment method for spastic dysphonia.
Skin Flap Tension and Wound Slough: Correlation with Laser Doppler Velocimetry
Authors: Larrabee Wayne F. , Holloway G. Allen , Trachy Ron E. , Sutton Dwight
Published: November 2015

The effects of wound tension on flap viability and blood flow are investigated in an animal model using the domestic piglet. In flaps with an impaired blood supply, wound closing tensions >250 g resulted in a significantly increased incidence of flap necrosis. The laser Doppler is a device of recent origin for the measurement of cutaneous blood flow. In this study, it provided a simple quantitative measure of the inverse relationship between skin tension and blood flow.
Silastic Surgical Stent and Dilator for use with the Singer‐Blom Voice Restoration Procedure
Authors: Ossoff Robert H. , Barnes David R. , Goldman Michael E. , Sisson George A.
Published: November 2015

A Silastic surgical stent with an indwelling No. 2 Dacron polyester suture and a Silastic dilator have been designed for use in conjunction with Singer and Blom's tracheoesophageal puncture technique for voice restoration. The surgical stent is used to form the tracheoesophageal fistula; the Silastic dilator is sent home with each patient to be used as an atraumatic dilator if the puncture site becomes too small to allow for the insertion of the Singer‐Blom voice prosthesis.
Stapes Prosthesis Comparison
Authors: Elonka Dennis R. , Derlacki Eugene L. , Harrison Wiley H.
Published: November 2015

Ninety‐four consecutive stapedectomy cases using the Robinson stainless steel prosthesis are compared with 100 consecutive cases using the House stainless steel wire prosthesis. The air‐bone gap was closed to within 10 dB in 94% of the cases with the Robinson prosthesis and in 88% of the cases using the House stainless steel wire prosthesis. There appeared to be no difference in the improvement at 2,000 and 4,000 cycles between the two techniques and the results were the same. Statistical study revealed there is no significant difference in the two techniques and there is no other variable.
Regeneration of the Recurrent Laryngeal Nerve
Authors: Crumley Roger L. , McCabe Brian F.
Published: November 2015

Ten dogs underwent exploration and section of the right recurrent laryngeal nerve. A segment was removed and both stumps were ligated. Reoperation at three months and again at 15 months revealed neural regeneration through the ligated site and reconstitution of the distal nerve in seven of the eight dogs surviving the 15‐month period. This strong regenerative capability of the recurrent laryngeal nerve may explain recurrences of spastic dysphonia after nerve section. It is recommended that patients be advised of the possibility for return of the spasms. Investigators should always note whether the recurrent laryngeal nerve has regained stimulability in reporting results of experimental laryngeal paralysis and reinnervation.
Decompression of the Facial Nerve in Bell's Palsy: A Historical Review
Authors: Adour Kedar K. , Diamond Charles
Published: November 2015

This year, 1981, is the 50th anniversary of facial nerve decompression for Bell's palsy. The procedure was first suggested in 1923 but not performed until 1931. From the start, facial nerve decompression has generated disagreement regarding the indication and timing for surgical treatment and the anatomic extent of decompression. In each decade as the postonset time within which to perform surgical intervention has decreased, the anatomic extent of decompression has increased. Otologists continue to disagree, and we need to reevaluate our past and analyze how the difference may be resolved in the future. This critical review, in chronologic order, of the history and present status of facial nerve decompression is the necessary first step in resolving some of the persistent problems in surgical management of patients with Bell's palsy.
Comparison of Ossicular Replacement Materials in a Mouse Ear Model
Authors: Merwin Gerald E. , Atkins James S. , Wilson June , Hench Larry L.
Published: November 2015

Four biomaterials, UF45S5 Bioglass, Silastic, Plasti‐Pore, and Proplast, were used to replace the incus in a mouse ear model. Bioglass, a bioactive glass ceramic, compared favorably with the other test materials in maintaining surgical positioning between malleus and stapes and remaining stable to a blast of nitrogen gas and to pick manipulation. In a short‐term animal study, Bioglass showed histocompatibility comparable to that of these other implant materials now used in ossicular replacement surgery in humans.
Experimental Study on Meniere's Disease
Authors: Kitahara Masaaki , Takeda Taizo , Yazawa Yoshiro , Matsubara Hideharu , Kitano Hitoshi
Published: November 2015

Experimental hydrops caused by underabsorption of endolymphatic fluid is a model of remissional stage of Meniere's disease. In this study, another type of model, ie, hydrops caused by overproduction of endolymphatic fluid, was accomplished by applying various pressures into scala media through a micropipette via stria vascularis. This type of hydrops could be a model of attacks of Meniere's disease. By using two types of the model, effects of glycerol administration and of opening the endolymphatic sac were discussed.
Topognostic and Prognostic Evaluation of Traumatic Facial Nerve Injuries
Authors: Babin Richard W.
Published: November 2015

If and when to intervene during the course of a traumatic facial palsy depends on the immediacy of the palsy, signs and symptoms of an associated temporal bone fracture, function of the various facial branches, and the results of electrical stimulation. Some facial nerve tests will be more valuable than others in a given case. The following is a philosophy of management that has proven useful to the author in the management of facial palsies of traumatic causes.
Quantitative Measurement of Neurologic Impairment in Patients with Multiple Sclerosis
Authors: Konrad Horst R. , Good David C. , Devleschoward Allen B.
Published: November 2015

Eleven patients with clinically diagnosed multiple sclerosis were simultaneously evaluated with history, physical, and neurologic evaluations and a series of objective neurophysiology tests. Patients were then scored independently on clinical stage of their disease using a system based on symptoms in history or findings on physical or neurologic examination. Test scores on objective tests were compared with clinical scores with each evaluator. Patients with high test scores on clinical evaluation usually had high test scores on objective testing. Symptoms and physical findings were then correlated with abnormalities on objective tests. Objective abnormalities in visual evoked response and auditory evoked response on several occasions preceded the development of symptoms. All patients except for two had more than one abnormality on objective testing, suggesting a high likelihood that objective tests are helpful in the diagnosis of early‐stage multiple sclerosis.
Management of sudden deafness
Authors: Fisch Ugo
Published: November 2015

Measurements according to the polarographic principle in cats have shown that the factors influencing the perilymphatic oxygen tension are the arterial Pco2, the arterial Po2, and the systemic blood pressure. In patients with sudden deafness, the oxygen supply to the vestibular tissues is significantly reduced but the response to carbogen is still possible. The vasodilation induced by carbogen in sudden deafness is not accompanied by a reduction (stealing effect) but by an increase of perilymphatic oxygenation. Therefore carbogen inhalation was used for the treatment of sudden deafness. In a prospective randomized study, carbogen inhalation yielded significantly better results than the intravenous infusion of papaverine and low‐molecular dextran. Carbogen inhalation is recommended for the effective, noninvasive treatment of sudden deafness.
Comparison of results of auditory brain stem response and acoustic reflex latency in acoustic tumor diagnosis
Authors: Mangham Charles A. , Burnett Patricia A. , Lindeman Roger C.
Published: November 2015

Persons with cerebellopontine angle tumors often have an increase in the latency of the acoustic reflex response that is comparable to the auditory brain stem response (ABR) in its sensitivity. However, reflex latency is less specific, since it may be prolonged in patients with Meniere's disease.
Auditory evoked responses, impedance measures, and diagnostic speech audiometry in severe head injury
Authors: Hall James W. , Huangfu Musan , Gennarelli Thomas A. , Dolinskas Carol A. , Olson Kristine , Berry Grant A.
Published: November 2015

Three case studies are presented to illustrate the clinical usefulness of serial electrophysiologic and behavioral audiologic assessments in describing CNS function in severe head injury. There was an association among acute auditory brain stem and middle‐latency evoked response findings, computed tomography of brain abnormality and neurologic status, and rate of recovery. Auditory evoked response findings 4 days after injury were also correlated with long‐term outcome of diagnostic speech audiometry.
Effects of position change on optokinetic nystagmus and optokinetic after‐nystagmus in man
Authors: Calhoun Karen H. , Leliever William C. , Correia Manning J.
Published: November 2015

Horizontal and vertical optokinetic nystagmus (OKN) and optokinetic after‐nystagmus (OKAN) were studied in 17 normal subjects who were positioned either upright or laterally tilted 90°. OKAN responses were observed in 15 of 17 subjects; horizontal OKAN asymmetry was found in 5 of 15 subjects. Static lateral tilt produced an increase in downbeat vertical OKAN (VOKAN) response and no change in horizontal OKAN (HOKAN) response. Tilt did not produce changes in either horizontal or vertical OKN. The finding of modulation of VOKAN with head tilt in humans suggests a potential test for otolith‐canal interaction.
Fluorometric Assessment of Skin Flap Viability in the Rat: Effect of Radiation Therapy
Authors: Weisman Robert A. , Blumberg Albert L. , Brousseau David A. , Hurford William E. , Silverman David G.
Published: November 2015

The fluorescein test is widely used to assess perfusion in skin flaps but tends to underestimate skin viability when visual inspection under ultraviolet light is employed. Fiberoptic dermofluorometry, which has recently been introduced, more accurately assesses fluorescein distribution in skin flaps than does visual inspection. Viability of the back flap in rats receiving ionizing radiation was evaluated by dermofluorometry. This technique was highly accurate in predicting viability and has great applicability for studying blood flow in irradiated tissues.
Odontogenic Keratocyst: Diagnosis and Treatment
Authors: Wetmore Stephen J. , Billie James D. , Howe Arthur , Wetzel William
Published: November 2015

The odontogenic keratocyst is a keratinizing squamous epithelium‐lined cyst that occurs in the mandible and maxilla. In 5% to 10% of patients the keratocysts may be a manifestation of the basal cell nevus syndrome. The recurrence rate after surgical therapy for odontogenic keratocysts varies from 10% to 63%.
Auricular Reconstruction with Postauricular Myocutaneous Flap
Authors: Krespi Yosef P. , Ries William R. , Shugar Joel M.A. , Sisson George A.
Published: November 2015

In the past reconstruction of large auricular defects more than 2 cm have been repaired with the use of local skin flaps from various sites in multiple stages. This entails longer hospitalization and a poorer aesthetic result. We developed a postauricular myocutaneous flap that has been used successfully in five patients. The cosmetic results are superior to previously described reconstructive techniques. This flap, which can be used in immediate one‐stage reconstruction, is based on the auricular branch of the posterior auricular artery. This vessel supplies the auricularis posterior muscle, the skin over the mastoid, and the cranial surface of the auricle. This vessel was dissected and found to be anatomically consistent in five cadavers.
Incidence of Eye Injuries in Facial Fractures: An Analysis of 727 Cases
Authors: Holt G. Richard , Holt Jean Edwards
Published: November 2015

From 1973 to 1980, 727 patients with facial fractures received formal ophthalmologic consultation. The series included 174 mandible fractures, 29 nasal fractures, 436 midfacial fractures, and 88 frontal fractures. Of these, a total of 67% sustained some degree of ocular injuries. Seventy‐nine percent of the eye injuries were categorized as temporary, 18% were serious, and 3% were blinding. Of the mandibular fractures, 29% had ocular injuries, 59% nasal fractures, 59% midfacial fractures, and 89% frontal fractures.
Monitoring Free Flap Perfusion by Serial Fluorometry
Authors: Denneny James C. , Weisman Robert A. , Silverman David G.
Published: November 2015

An efficient method to evaluate the patency of microvascular anastomoses and to predict flap viability is crucial when free flaps are used in reconstructive surgery. We report a study of 60 neurovascular island flaps in rats where the nutrient artery and/or vein were transected and anastomosed. Fluorescein dye was injected immediately after anastomosis, and the uptake and elimination of dye were quantified at 5‐minute intervals with the fiberoptic perfusion fluorometer. Analysis of dye delivery clearly identified six hypofluorescent flaps presumed to be ischemic. In five of these flaps, revision was attempted. Three evidenced improved fluorescein uptake and elimination on reinjection of dye. These flaps survived, wheras the other two necrosed. Of the 54 flaps deemed patent after the first injection, two evidenced poor fluorescence on reinjection 3 hours later. These flaps necrosed and evidenced venous thrombosis (which probably occurred during the 3 hours between the first and second injections). Fiberoptic fluorometry can be employed to assess a free flap immediately after vascular anastomosis and throughout the critical hours postoperatively. Assessment of uptake and elimination after single or serial injections reflects flap perfusion and predicts viability with a high degree of accuracy.
Composite Vascularized Free‐Rib and Pleural Transfer for Laryngotracheal Reconstruction
Authors: Watson John , Donald Paul J. , Gourley Ira M. , Pool Roy , Tyler Walter
Published: November 2015

A free rib pleura composite vascularized transfer for repair of a defect in the canine upper airway is discussed and the results are reported. The procedure was carried out on eight dogs. One dog died from the anesthetic. Three surgical failures resulted from technical difficulties: failure of the vascular anastomosis, torsion of the vascular pedicle, and hemorrhage. Four dogs successfully maintained their airways, although one demonstrated bone absorption. Bone scanning, angiography, tetracycline labeling, and light microscopy confirmed active osseous metabolism of the rib, providing further evidence of the adequacy of periosteal circulation in maintaining normal rib metabolism. Scanning electron microscopy and conventional light microscopy demonstrated the development of a healthy respiratory epithelium. Thus a free flap of rib and attached pleura will provide adequate skeletal support and a moist, functioning, epithelial lining in a single‐stage operation for reconstruction of a laryngotracheal defect in the normal dog.
Effect of Hypoxia on Laryngeal Reflex Apnea—Implications for Sudden Infant Death
Authors: Lanier Brent , Richardson Mark A , Cummings Charles
Published: November 2015

Apnea was elicited by the application of chemical stimuli to the laryngeal region of 25 piglets from 1 to 70 days of age. Animals were tested under normoxic and hypoxic conditions with water and solutions of graded acid and salt concentration. The chemoreflex was found to diminish with postnatal age. Fatal apneic episodes were confined to animals less than 3 weeks of age. Hypoxia consistently augmented the reflex, and in some cases elicited fatal apnea in animals that had survived similar stimulation under normoxic conditions. A direct relationship was also found between the strength of stimulus and respiratory response. Apnea increased with diminishing NaCl concentration or pH. The reflex was abolished by bilateral section of the superior laryngeal nerves. Fatal apnea elicited by laryngeal chemostimulation under the circumstance of hypoxia may provide further insight into the enigma of sudden infant death.
Tracheal Reconstruction with a Pleuroperiosteal Flap
Authors: Krespi Yosef P. , Biller Hugh F. , Baek Se‐Min
Published: November 2015

Reconstruction of extensive tracheal defects remains a difficult surgical problem. In many experiments restoration of tracheal mucosa by autogenous or homologous soft tissue grafts has usually failed because of rejection or tracheal obstruction. This experimental work employed a two‐stage surgical procedure that allowed reconstruction of extensive circumferential full‐thickness defects of the trachea. Stage I involved the creation of a vascularized pleuroperiosteal flap that was formed into a rigid tube around a Silastic stent. Stage II consisted of creation of a full‐thickness circumferential tracheal defect and repair with the flap in those animals in which a suitable rigid tube had been formed. The results of these experiments argue strongly that a vascularized composite pleuroperiosteal flap can produce an adequate tracheal replacement.
Viral and Epidemiologic Studies of Idiopathic Sudden Hearing Loss
Authors: Wilson William R. , Veltri Robert W. , Laird Nan , Sprinkle Philip M.
Published: November 2015

The relationship between viral seroconversions and idiopathic sudden hearing loss (ISHL) is studied. Compared with our control group, the incidence of viral seroconversions is greater among ISHL patients, both for single and multiple viral infections. There was a significantly greater number of patients with seroconversions to mumps, rubeola, varicella‐zoster, cytomegalovirus, and influenza B. We were unable to find a relationship between viral seroconversion and type or degree of hearing loss, vertigo, or chance for recovery. The incidences of viral conversion and sudden hearing loss track one another closely, suggesting that viral infection is a major cause of ISHL. During this 3‐year study in Boston, ISHL was most prevalent in the spring.
Tympanic Membrane Perforations from Water Sports: Treatment and Outcome
Authors: Rybak Leonard P. , Johnson David W.
Published: November 2015

A study of 15 patients with 17 tympanic membrane perforations resulting from water sports was carried out. Most small perforations healed spontaneously. Perforations that persisted after 8 weeks were treated surgically, usually with the office paper patch procedure. A frequent history of middle ear problems in these patients suggests that middle ear dysfunction may play a role in the occurrence and delayed healing of traumatic perforations.
Arterial Malformations of the Middle Ear
Authors: Sinnreich Abraham I. , Parisier Simon C. , Cohen Noel L. , Berreby Michele
Published: November 2015

Arterial malformations of the middle ear are rare entities which, if unrecognized, can lead to serious complications. We will present six such cases and summarize the relevant literature. Our presentation will review the development of middle ear arterial structures. Radiologic techniques useful in delineating these conditions will be described, and methods of treatment will be discussed.
Cochlear and Vestibular Gross and Histologic Anatomy (as Seen from Postauricular Approach)
Authors: Silverstein Herbert
Published: November 2015

The otologic surgeon must have a clear understanding of the anatomy of the seventh and eighth cranial nerves from the labyrinth to the brain stem, as seen from the postauricular approach. The surgical anatomy of the seventh and eighth cranial nerves was studied in 64 transcochlear eighth‐nerve sections and 33 retrolabyrinthine vestibular neurectomies. Analysis indicates the nerves rotate 90 degrees in their course from the ear to the brain. The key relationship is that the cochlear nerve is always the most inferior, rotating from anterior (medial) near the labyrinth to posterior (lateral) near the brain stem. The seventh (facial) nerve rotates from anterosuperior (medial superior) near the labyrinth to anteroinferior (medial inferior) near the brain stem. The seventh nerve is easily seen in the transcochlear approach and hidden from view in the retrolabyrinthine approach. Twenty‐seven fixed nerve specimens were examined with an operating microscope before being prepared for sectioning. In 73% (19 of 26) a cleavage plane was seen on the lateral aspect of the eighth nerve (that portion of the nerve facing the surgeon in the retrolabyrinthine approach).
Retrolabyrinthine Section of the Vestibular Nerve
Authors: House John W. , Hitselberger William E. , McElveen John , Brackmann Derald E.
Published: November 2015

When symptoms of dizziness and episodic vertigo cannot be controlled through medical management or drainage procedures such as endolymphatic subarachnoid shunt operations, selective vestibular nerve section may be necessary. In the 1920s eighth cranial nerve sections were performed by neurosurgeons through the suboccipital approach but were frequently associated with hearing loss and facial paralysis. The middle fossa approach has been popularized by Dr. William House and others as a method of selectively sectioning the vestibular nerve and preserving facial and cochlear function. More recently the suboccipital retrolabyrinthine approach has been described as a method of selectively sectioning the vestibular nerve. We have reviewed 42 cases of suboccipital retrolabyrinthine selective section of the vestibular nerve performed at the Otologic Medical Group over the past 2 years. The shortest follow‐up on these patients has been 6 months. Thirty‐two patients had preoperative diagnosis of Meniere's disease, and of these patients 25 had had previous endolymphatic subarachnoid shunt surgery. Eighty‐five percent (27 patients) experienced complete relief of vertigo following surgery, while 6% (two patients) stated they were improved. Three patients reported no relief. There were 10 patients with dizziness who had a diagnosis other than Meniere's disease. In this diverse group three experienced complete relief of vertigo, five were improved, and two reported no improvement of vertigo following surgery. None of the patients lost his hearing as a result of the surgery and there was no facial weakness. One patient had postoperative CSF rhinorrhea and another had meningitis.
The Professional Voice and Airline Flight
Authors: Feder Robert J.
Published: November 2015

As the world shrinks and demands for quality performers precipitously increase around the globe, travel becomes an important part of the professional's life. The professional voice user may encounter many circumstances and situations over which he has little control and which may subject him to potential vocal irritation or injury. Airline travel is an aspect that, by and large, is uncontrollable but absolutely necessary for professional survival, yet it may have the potential for harm. The majority of airline traffic is carried by wide‐bodied aircraft, mainly the Boeing 747 and 767, the Lockheed L1011, the McDonnell Douglas DC‐10, and the European Airbus. Similar but smaller aircraft include the Boeing 707, 727, and 737 and the McDonnell Douglas DC‐8 and DC‐9. Basically, these aircraft appear to exhibit relatively similar in‐flight environments, including ambient noise level, cabin temperature, pressurization, humidity, and ozone. Each of these factors will be discussed to clarify aspects of flight which have been taken for granted, about which there have been misconceptions, or which have not been sufficiently considered. As otolaryngologists it is incumbent on us to be familiar with the consequences of flight for those patients with actual or potential voice problems. A voice lost to professional endeavor may be more emotionally devastating than an ear or sinus impairment. Careful briefing of the patient who is a professional voice user has not been standard practice prior to airline flight but certainly should be strongly considered as a protective measure.
Kaposi's Sarcoma of the Head and Neck in the Acquired Immune Deficiency Syndrome
Authors: Patow Carl A. , Steis Ronald , Longo Dan L. , Reichert Cheryl M. , Findlay Peggy A. , Potter Dorothy , Masur Henry , Lane H. Clifford , Fauci Anthony S. , Macher Abe M.
Published: November 2015

Since 1981 a new syndrome of acquired immune deficiency (AIDS) has been recognized. Male homosexuals, male and female intravenous drug abusers, and recipients of blood products (i.e., hemophiliacs) appear to be the populations at risk. The syndrome has been manifested by community‐acquired opportunistic infections and/or Kaposi's sarcoma (KS). Otolaryngologic manifestations of AIDS are not infrequent. Thirteen AIDS patients at the National Institutes of Health with KS of the head and neck region are presented. All 13 patients were homosexual or bisexual males. Nine initially presented with KS, five with KS of the head or neck. As a group the patients demonstrated lesions involving the oropharyngeal, tracheobronchial, and gastrointestinal regions. Their clinical course and complications are presented in detail. The mortality rate in this subgroup of AIDS patients is extraordinarily high (62%), with an average longevity of 11 months following initial diagnosis.
Role of the Nasal Airway in Regulation of Airway Resistance During Hypercapnia and Exercise Second‐Place Resident Award at 1982 Research Forum
Authors: Mertz Janet S. , McCaffrey Thomas V. , Kern Eugene B.
Published: November 2015

Posterior mask rhinomanometry was used to measure nasal resistance during exercise and hypercapnia in 10 healthy adult volunteers. Exercise was produced by peddling a stationary bicycle at three loads. Hypercapnia was produced by breathing O2 mixtures containing 5%, 6%, and 8% CO2. The results showed that (1) nasal resistance decreases linearly as expired CO2 levels and exercise levels increase, (2) minute ventilation increases linearly as expired CO2 levels and exercise levels increase, and (3) nasal resistance varies inversely with minute ventilation during both hypercapnia and exercise. The constant relationship between nasal resistance and minute ventilation during hypercapnia and exercise suggests that nasal resistance is regulated by the respiratory center to match the level of respiratory demand.
Congenital Epulis of the Newborn
Authors: Clark J.L. , Hanson D.J.
Published: November 2015

Congenital epulis of the newborn occurs more often in females than males and involves the maxilla more often than the mandible. The major theories of the origin of this lesion are discussed, and a case is presented along with a 7‐year follow‐up evaluation.
The Palatopharyngoplasty Operation for Snoring and Sleep Apnea: An Interim Report
Authors: Simmons F. Blair , Guilleminault Christian , Miles Laughton E.
Published: November 2015

We performed palatopharyngoplasty operations on 155 patients as of June 1, 1983, and have 4‐month clinical follow‐ups on 123 patients. Forty‐nine have had repeat polysomnograms (through September 1983) that continue to show the operation is about 50% effective in curing or considerably improving obstructive sleep apnea. Symptomatic (clinical) results in these same patients are much better than 50% and may be the reason why we have had considerable difficulty in obtaining sleep study follow‐ups. Snoring was eliminated or much improved in 93% of all patients and 95% of patients without serious obstructive sleep apnea. Daytime symptoms, if any, were improved in 64%. Some form of preoperative sleep study is mandatory in all patients. Two thirds of patients who present with the complaint of snoring and none of the classic symptoms of apnea actually do have total airway obstructions during sleep.
Opening and Closing Mechanisms of the Larynx
Authors: Konrad Horst R. , Rattenborg Christen C. , Kain Martin L. , Barton Malcolm Dennis , Logan William Joseph , Holaday Duncan A.
Published: November 2015

Opening and closing of the larynx are determined by the intrinsic and extrinsic muscles acting on the elastic forces in the tongue, pharynx, larynx, and trachea. The pharynx is opened or closed by two mechanisms: (1) Contractions of the cricothyroid and of the intrinsic muscles of the larynx open and close the vocal cords. (2) The false cords, ventricle, and true cords accordion open or close in a bellows mechanism. We conclude that the posterior cricoarytenoid opens the laryngeal airway. The cricothyroid together with the posterior cricoarytenoid accentuates this opening. The larynx is also opened by the geniohyoid, mylohyoid, sternothyroid, and middle constrictor. The thyrohyoid, cricothyroid, sternohyoid, and inferior constrictor close the laryngeal airway. Abnormalities in the soft tissues of the neck or of the innervation of the larynx, pharynx, and neck muscles may severely interfere with patency of the laryngeal airway. This occurs in such conditions as vocal cord paralysis, sleep apnea, multiple sclerosis, amyotrophic lateral sclerosis, spastic dysphonia, mandibular fractures or hypodevelopment, and cerebrovascular disease.
Tracheoesophageal Puncture for Voice Restoration: Modification of the Blom‐Singer Technique
Authors: Ossoff Robert H. , Lazarus Cathy L. , Sisson George A.
Published: November 2015

We have used a modification of the Blom‐Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty‐eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom‐Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.
Titration Streptomycin Therapy for Bilateral Meniere's Disease: A Preliminary Report
Authors: Graham Malcolm D. , Sataloff Robert T. , Kemink John L.
Published: November 2015

Intramuscular dosages of streptomycin sulfate were titrated in eight patients with bilateral Meniere's disease in an attempt to alleviate disabling vertigo and hearing loss. It appears possible to eliminate the vertiginous episodes, preserve or improve hearing, and avoid ataxia and oscillopsia in most of these individuals. At present we consider this treatment regimen our first choice of therapy in people with bilateral active Meniere's disease or in patients whose only hearing ear is actively fluctuating and in whom associated disabling vertigo is present. Great caution and supervision should be exercised in the use of streptomycin titration therapy in the individual with bilateral Meniere's disease, as further experience is required to determine the efficacy of this form of management.
Extended Latissimus Dorsi Myocutaneous Flap Reconstruction of Major Head and Neck Defects
Authors: Maves Michael D. , Panje William R. , Shagets Frank W.
Published: November 2015

The purpose of this article is to familiarize the surgeon with the latissimus dorsi flap and some particularly useful applications of it. This flap has proved extremely versatile, with many uses, among them immediate coverage for extensive head and neck wounds. It has been equally successful in repairing defects in both normal and irradiated tissue. The range of the arc of utilization has been exceptional, easily reaching the skull vertex from the chest wall. However, to be able to extend this flap so far requires careful dissection of the neurovascular pedicle and intimate anatomic knowledge of the posterior axilla region. This flap's muscle bulk is quite acceptable and the donor site may almost always be closed primarily. There appears to be less functional disability from sacrifice of this muscle than with pectoralis or trapezius myocufaneous flaps. Accordingly, it is ideal when much tissue is needed for single‐stage coverage. Additional uses are available when flaps from other sites have failed.
Surgery of the Inferior turbinates: How Much and When?
Authors: Mabry Richard L.
Published: November 2015

Surgery of the inferior turbinates should be performed only after a trial period of medical therapy. Surgical reduction in turbinate size may be accomplished by outfracture crushing, cauterization, cryotherapy, laser vaporization, submucous resection, partial turbinate resection, turbinoplasty, or total turbinectomy. The procedure chosen should be the most conservative one consistent with obtaining a good airway.
Nonhypersomnolent Patients with Obstructive Sleep Apnea
Authors: Moran Willard B. , Orr William C. , Fixley Mark S. , Wittels Ellison E.
Published: November 2015

Until recently, snoring had been considered both a medical enigma and a psychosocial problem. Snoring is now considered to be an acoustic phenomenon produced by vibration of the soft palate and the tonsillar pillars. We describe 20 patients with a clinical complaint of excessive snoring who were referred to rule out obstructive sleep apnea. All patients were without symptoms of daytime sleepiness and failure of the right heart. Twenty subjects were studied, 18 of whom were males. All subjects were monitored for one full night in the Sleep Laboratory. The apnea rate ranged from 9.0 to 94.0 incidents an hour with a mean of 30.0. Eight of the 20 subjects had obstructive episodes longer than 1 minute and three others had episodes longer than 55 seconds. Hypersomnolence, long thought to be a cardinal symptom, is not present in all patients with an ostensibly significant degree of obstructive sleep apnea.
Laryngectomee Study: Clinical and Radiologic Correlates of Esophageal Voice
Authors: Daou Raymond A. , Robillard Judith , Remy Huguette , Turner Nancy , Attia Elhamy L.
Published: November 2015

This study reports the results of an analysis of the relationship between clinical and radiologic factors, on the one hand, and the acquisition of esophageal speech, on the other. It involved 25 laryngectomees who underwent videofluoroscopy of their pseudoglottis at least 6 months following laryngectomy. Significant correlations were found between esophageal speech performance and each of the following variables: tumor size, pseudoglottis length, pseudoglottis shape, and presence of a geometric prominence on the posterior hypopharyngeal wall. The most important is the logarithmic correlation between speech skill and pseudoglottis length. Other factors that yielded controversial results in previous studies were not found significant in this investigation.
Voice Quality and Intelligibility Characteristics of the Reconstructed Larynx and Pseudolarynx
Authors: Rizer Franklin M. , Schechter Gary L. , Coleman Robert F.
Published: November 2015

The ideal laryngeal substitute would provide a voice with good intelligibility, volume, and character. The basic components of these qualities are being studied in our laboratories to refine laryngeal reconstruction and replacement techniques. Exact definition of these characteristics may then be translated into specific requirements for reconstruction. In this study the phonation of laryngectomees using hand‐held artificial laryngeal devices and patients with reconstructed larynges was compared with that of normal speakers. Presentations were evaluated by adult listeners with normal voice and hearing, and intelligibility scores were developed. These studies show, in part, that the fundamental frequencies at which various artificial speech aids are used do not significantly correlate with user intelligibility. Computerized spectral analysis was then utilized to ascertain the unique acoustic characteristics of the voices. Further computer analysis was carried out to determine what characteristics of the normal speakers' voices were shared in common with patients using artificial devices and patients with reconstructed larynges. Initial attempts at using these findings in laryngeal reconstruction based on computer modeling will be presented.
Head and Eye Movements in Congenital Nystagmus
Authors: Furman Joseph M. , Stoyanoff Susan , Barber Hugh O.
Published: November 2015

Patients with congenital nystagmus exhibit a wide range of unusual nystagmus waveforms and strategies to obtain maximum visual acuity. We investigated target acquisition strategies, head‐eye coordination, and the effects of alteration of head position relative to gravity on congenital nystagmus waveforms in five patients. No changes in the nystagmus were found when patients' heads were placed in different positions relative to gravity. Two patients had distinctive abnormalities of head‐eye coordination characterized both by failure of eye movement to precede head movement and by position of the eye in the orbit, after target acquisition, being in a direction opposite that of the head movement. We conclude that static changes in head position relative to gravity probably do not influence congenital nystagmus waveforms. In addition, some patients with congenital nystagmus may have abnormal head‐eye coordination.
The Jugular Bulb in Otologic Surgery: Anatomic, Clinical, and Surgical Considerations
Authors: Kennedy David W. , El‐Sirsy Hesham Hafez , Nager George T.
Published: November 2015

The jugular bulb varies widely in position and dimensions. In certain pathologic conditions there is an increased incidence of jugular bulb enlargement, but such enlargement also occurs without an obvious underlying cause. Jugular bulb enlargement may lead to clinical symptoms for the patient and particular difficulties for the otologic surgeon, not only in the middle ear but also in neurotologic approaches. The different clinical aspects and problems associated with jugular bulb enlargement are discussed with illustrative cases and temporal bone histologic findings.
Anesthesia for Bronchoscopic Laser Surgery
Authors: Eisenman Theodore S. , Ossoff Robert H.
Published: November 2015

Choice of anesthesia for bronchoscopic laser surgery depends on the surgical technique. Fiberoptic bronchoscopy can be managed with either topical or general anesthesia, while rigid bronchoscopy usually requires general anesthesia. In either case precautions for laser surgery must be taken. Preoperative evaluations should include cardiovascular status and the anatomy of the lesion. Preoperative medication should include an anticholinergic agent. The influence of total intravenous vs. inhaled anesthetics on prolonged respiratory depression is discussed, and the techniques for providing controlled vs. spontaneous respiration are described. Finally, postoperative care, including the management of airway obstruction and hemorrhage, is outlined.
Electronic Reanimation of Facial Paralysis—A Feasibility Study
Authors: Rothstein Jack , Berlinger Norman T.
Published: November 2015

We set out to adapt the concept of functional electrical stimulation to the reanimation of the paralyzed face. In the New Zealand white rabbit model we studied the strength‐duration curves of both innervated and denervated facial muscles. We next studied the electromyographic signals corresponding to different strengths of contraction of innervated facial muscles. With Teflon‐coated stainless steel electrodes implanted at opposite ends of the denervated muscle groups under study, bipolar stimulation yielded useful mimetic function that was modifiable by varying the voltage output and the rate of pulse generation. We demonstrated that an electronic circuit can indeed respond to the voltage generated within a functioning facial muscle, and then reproducibly trigger a corresponding graphic signal in synchrony with the mimetic function. The next step will be to adapt an electronic circuit that will deliver a predetermined electrical current to a denervated facial muscle in response to a determined generated voltage in the contralateral corresponding innervated facial muscle.