bluuebunny/crossref_metadata_2025 huggingface dataset:
Meeting radiation therapy patients informational needs through educational videos augmented by 3D visualisation software
Authors: Williams Katelyn , Blencowe Jenna , Ind Melissa , Willis David
Published: February 2017

Introduction

Misconceptions and uncertainties about radiotherapy compound the anxiety patients experience at the commencement of treatment. This project investigated the utility of locally produced treatment process videos in meeting patients’ informational needs.

Methods

In‐house video production was conducted on a voluntary basis by staff and patients at a regional Australian radiotherapy centre. Videos included real footage and animated sections created with PEARLTM 3D visualisation software (Vertual Ltd, UK) to meet specific key content objectives. Quantitative cross sectional analysis was conducted. Patients attending for simulation watched a relevant video. After their first fraction of radiotherapy they were asked to complete an ethics‐reviewed questionnaire about how well the video addressed their information needs.

Results

The survey completion rate was 29% (n = 61/212). Surveys were collected over 9 months from August 2014 to April 2015. Statistical analysis found 98% of patients reported that the video was useful in meeting one or more of the learning objectives. Forty‐nine percent of patients also reported a reduction in fear and anxiety as a result of watching the video. Patients reported subsequent review of videos at home (39%), primarily to explain treatment processes to loved ones (46%).

Conclusion

The combination of real footage and 3D visualisation software assisted in meeting learning objectives regarding the treatment process. Standardised videos provided consistency of information provision to patients and facilitated multiple viewings of the video if desired.
A novel in silico method to quantify primary stability of screws in trabecular bone
Authors: Steiner Juri A. , Christen Patrik , Affentranger Remo , Ferguson Stephen J. , van Lenthe Gerrit Harry
Published: February 2017

Insufficient primary stability of screws in bone leads to screw loosening and failure. Unlike conventional continuum finite‐element models, micro‐CT based finite‐element analysis (micro‐FE) is capable of capturing the patient‐specific bone micro‐architecture, providing accurate estimates of bone stiffness. However, such in silico models for screws in bone highly overestimate the apparent stiffness. We hypothesized that a more accurate prediction of primary implant stability of screws in bone is possible by considering insertion‐related bone damage. We assessed two different screw types and loading scenarios in 20 trabecular bone specimens extracted from 12 cadaveric human femoral heads (N = 5 for each case). In the micro‐FE model, we predicted specimen‐specific Young's moduli of the peri‐implant bone damage region based on morphometric parameters such that the apparent stiffness of each in silico model matched the experimentally measured stiffness of the corresponding in vitro specimen as closely as possible. The standard micro‐FE models assuming perfectly intact peri‐implant bone overestimated the stiffness by over 330%. The consideration of insertion related damaged peri‐implant bone corrected the mean absolute percentage error down to 11.4% for both loading scenarios and screw types. Cross‐validation revealed a mean absolute percentage error of 14.2%. We present the validation of a novel micro‐FE modeling technique to quantify the apparent stiffness of screws in trabecular bone. While the standard micro‐FE model overestimated the bone‐implant stiffness, the consideration of insertion‐related bone damage was crucial for an accurate stiffness prediction. This approach provides an important step toward more accurate specimen‐specific micro‐FE models. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2415–2424, 2017.
Genotype‐by‐environment effect on bioactive compounds in strawberry (Fragaria x ananassa Duch.)
Authors: Palmieri Luisa , Masuero Domenico , Martinatti Paolo , Baratto Giuseppe , Martens Stefan , Vrhovsek Urska
Published: February 2017

BACKGROUND

The assessment of the relative contribution of genotype, environment and the genotype‐by‐environmental (G × E) interaction to the performance of varieties is necessary when determining adaptation capacity.

RESULTS

The influence of temperature, ultraviolet (UV)‐irradiation and sunshine duration on the quality and the composition of fruits was investigated in nine strawberry cultivars grown at three different altitudes. The UV‐radiation intensity affected both pH and sugar content, which were higher for most of the varieties at low altitudes, whereas total titratable acidity was less. Fruits from plants grown at low elevation generally had a higher benzoic acid derivative content. A significant correlation was found between phenylpropanoid content and UV‐radiation and sunshine duration. The flavone class appeared to be affected most by the variety effect, in contrast to flavonols and ellagitannins, which were highly affected by the environment. The accumulation of a number of secondary metabolites in strawberry fruits grown in an unusual environmental condition highlighted the acclimation effects in terms of the response of plants to abiotic stress. Finally, the genetic factor only appears to be more influential for the varieties ‘Sveva’ and ‘Marmolada’ with respect to all of the parameters considered.

CONCLUSION

A ‘plant environmental metabolomics’ approach has been used successfully to assess the phenotypic plasticity of varieties that showed different magnitudes with respect to the relationship between environmental conditions and the accumulation of healthy compounds. © 2017 Society of Chemical Industry
Vestibulotoxicity of Ethacrynic Acid
Authors: Mathog Robert H.
Published: February 2017

Temporary or permanent vestibulo‐auditory disability may develop after the administration of the diuretic, ethacrynic acid. A transient loss of hearIng is well documented in the literature; yet, it is suspected that permanent deafness requires the interaction of aminoglycoside agents, other ototoxic drugs, or at least renal failure. A review of earlier experiments shows that the drug affects sodium‐potassium relationships, the stria vascularis and possibly the viability of the organ of Corti.

Since fluids and morphologic structures within the vestibular system are similar to those in the auditory system, it would be expected that ethacrynic acid would cause similar damage in both areas of the ear. This hypothesis was tested by a series of experiments designed to determine drug‐induced changes in the vestibulo‐ocular reflex of the cat. Evaluation of the data demonstrated that ethacrynic acid, in dosages at or greater than 20 mg./kg., produced an immediate depression in the cochlear response. Although larger dosages of the drug caused a more severe depression, all responses returned to normal within 30 minutes. Evaluation at two days revealed no permanent alterations. The optokinetic‐induced eye displacement and symmetry were stable, and habituation from repetitive caloric stimulations was not affected by the administration of the drug.

The experiments demonstrated that ethacrynic acid was toxic to the vestibular system which again reinforced the precautions that should be taken in the administration of the diuretic to the patient. The transient nature of the vestibular depression suggested the possibility of applyIng this diuretic, or similar drugs, to the control of vestibular symptoms.
Progressive Necrotizing External Otitis: Treatment with Ticarcillin and Tobramycin
Authors: Horwitz Melton J. , Templeton Terry P.
Published: February 2017

The history of necrotizing external otitis, its diagnosis and management are reviewed. A case history is presented of a patient who was diagnosed as having progressive necrotizing external otitis with facial paralysis, In spite of standard medical treatment and aggressive surgical management, the disease process continued with progressive involvement of Cranial nerves IX and X. The Pseudomonas aeruginosa bacteria developed an increased minimal inhibitory concentration (MIC) to carbenicillin and gentamicin by requiring near toxic blood levels to be effective. Investigational ticarcillin (α‐carboxy‐3‐thienylmethylpenicillin) and tobramycin were used successfully in resolving the infection.
Surgical Correction Of Dural Herniation Into The Mastoid Cavity
Authors: Fernandez‐Blasini Nelson , Longo Rafael
Published: February 2017

A temporoparietal craniotomy as the approach of choice employed by the authors is presented for the surgical correction of dural herniation into the mastoid cavity in our series of four cases of middle fossa defects caused by previous operative procedures (mastoidectomy for removal of cholesteatoma) performed elsewhere. At the Triological Meeting a color movie accompanied the presentation of this paper.
Old and New in MÉniÈre Disease
Authors: Torok Nicholas
Published: February 2017

The clinical experience is increasing, but still there is no uniform understanding in the substrate of Ménière's disease. The criteria of the diagnosis is loose and great controversy exists in the therapeutic efforts. A bewildering number of concepts and methods have been suggested and praised as the best answers in solving the problem until the next claim of success shatters the popularity of earlier allegations. The array of articles in the world literature for the past 25 years treats the entity of Ménière's disease in general and from the viewpoint of etiology, pathology, histology, clinical diagnosis and treatment.

This review is concerned primarily with the treatment aspect of the literature. All the published ideas, regimens and techniques have one significant feature in common. They all claim success but not in 100% of the cases. Recovery varies from about 60% to 80%. Those cases considered “improved” are 20% to 30% and the rate of failure is between 10% and 25%. The diagnostic tools and capabilities have improved considerably. For treatment, except for reasonable medical or surgical palliation, nothing more can be offered than was offered a half century ago.
The Firm Salivary Mass In Children
Authors: Schuller David E. , Mccabe Brian F.
Published: February 2017

The firm salivary gland mass arising in a child is uncommon, representing only 3.2% of all such salivary tumors at the University of Iowa. However, the fact that 57.1% of these tumors are malignant demands thorough diagnostic evaluation by the head and neck surgeon. Histologic diagnosis is strongly recommended. In view of the fact that most of these tumors have a favorable prognosis, lateral parotid lobectomy or total sub‐mandibular gland excision represent both an effective diagnostic and adequate therapeutic procedure for benign and low‐grade malignancies. High‐grade malignancies necessitate adjunctive therapy which is based on the biologic behavior of the particular histologic type.
Carcinoma Of The Pyriform Sinus A Comparison Of Treatment Modalities
Authors: Eisbach Karl J. , Krause CHarles J.
Published: February 2017

One hundred four patients with epidermoid carcinoma of the pyriform fossa were reviewed retrospectively. Survival, local recurrence and metastatic rates were all compiled for the purpose of comparing the efficacy of combined therapy with radiation therapy and surgery alone in treating such lesions. Combined therapy consisted of 4500 rad Cobalt60 therapy at 200 rads per day preoperatively. All lesions were staged according to AJC classification. There was a similar stage distribution of patients in each therapeutic category.

Three‐year determinate survival rates were as follows: radiation therapy—10%, surgery—56%, and combined therapy—40%. Evaluation of the local recurrence rate revealed it to be: radiation threapy—19/33 (58%), surgery—1/19 (5%), and combined therapy—9/32 (28%). We interpret this data to suggest that preoperative irradiation impaired the determination of adequate resection margins, despite the use of frozen sections from those margins at the time of surgery. The incidence of late contralateral palpable nodes was greatest in the surgery group—5/19 (26%), compared with radiation therapy—0/33, and combined therapy—1/32 (3%) . This supports other studies which indicate that radiation therapy is very effective in controlling subclinical nodal metastases.
Viral Particles In Nasopharyngeal Carcinoma
Authors: Nadol Joseph B.
Published: February 2017

Lymphoepithelioma of the nasopharynx was identified in a 17‐year‐old Chinese male. The Epstein‐Barr virus titer was 1:3200. Tissue from the tumor mass was prepared for electron microscopy. Particles consistent with the morphological characteristics of herpes virus were found within the cytoplasm of malignant epithelial cells. This finding is discussed in relation to other data suggesting an oncogenic role of herpes virus in human malignancy.
Otitis Externa In Man Caused By The Mite Otodectes Cynotis
Authors: Heyning Jef Van De , Thienpont Denis
Published: February 2017

A case of external otitis in a farmer's wife caused by Otodectes cynotis is described. O. cynotis is a well known parasite in dogs and cats but has never been reported as a breeding parasite in the human ear.
Effects of Topical Nasal Decongestants on the Cilia of a Chicken Embryo Tracheal Organ Culture System
Authors: Dudley James P. , Cherry James D.
Published: February 2017

There is little physiologic data concerning the possible toxicity of nasal decongestants on respiratory cilia. Consequently, a chicken embryo tracheal organ culture system was employed to study the effect on ciliary activity of various preparations and concentrations of the following medications: tetrahydrozoline hydrochloride (Tyzine®), xylometazoline hydrochloride (Otrivin®), Dristan,® Sinex®, NTZ® oxymetazoline hydrochloride (Afrin®), naphazoline hydrochloride (Privine®), and phenylephrine (Neosynephrine®). Only two dilutions of injectable phenylephrine 0.25% and 0.10% produced essentially no ciliotoxicity when compared to the cilia in control cultures. All the other topical nasal medications in the concentrations tested possessed some toxicity for cilia. The use of these medications should be tempered with the warning of possible cilia damage.
Effect of Ethacrynic Acid, Furosemide, and Ouabain Upon the Endolymphatic Potential and Upon High Energy Phosphates of the Stria Vascularis
Authors: Kusakari J. , Ise I. , Comegys T. H. , Thalmann I. , Thalmann R.
Published: February 2017

The loop diuretics ethacrynic acid (EA) and furosemide (FU) were applied systemically to guinea pigs at dosages from 10–100 mg/kg. At high dosages the endolymphatic potential (EP) invariably turned negative. When the EP had reached maximum negative values due to EA, the ATP levels of the stria vascularis were moderately reduced, but P‐creatine levels were normal. In the case of FU both high energy phosphates remained at normal levels. When EA and FU intoxicated ears were subjected to ischemia, the rate of decline of ATP and P‐creatine was markedly less than the ischemic decline in nonintoxicated ears. These results suggest a strong interference with energy utilization, and in the case of EA a moderate impairment of energy generation. In severe intoxication by perilymphatically applied ouabain (10−3 M) strial ATP remained normal but P‐creatine was significantly increased. The reduction of the ischemic decline rate in ouabain intoxicated ears was even more marked than in the case of EA or FU, indicating a very strong interference with energy utilization, presumably due to complete inhibition of Na+K+‐ATPase. The I50 of the endolymphatic potential with regard to perilymphatically applied EA and FU was found to be 10−5 M and 2 x 10−4 M respectively. By K contrast, strial Na+K+‐ATPase was 50% inhibited with 5 x 10−3 M EA and not inhibited at all by FU. It is therefore unlikely that the effect of loop diuretics upon the endolymphatic potential is due to interference with strial Na+K+‐ATPase.
Preservation of Hearing in Tumors of the Internal Auditory Canal and Cerebellopontine Angle
Authors: GlaSscock Michael E. , Hays James W. , Miller Gale W. , Drake Fred D. , Kanok Montra M.
Published: February 2017

One hundred thirty‐nine tumor removals are reviewed with special interest in ten attempts to save hearing. Three patients with bilateral tumors had some hearing preserved. One of these individuals had a 1 cm tumor removed and his postoperative SRT and discrimination scores were the same as his preoperative ones. Overall, the authors were able to maintain some hearing in six out of ten attempts. While there is no question that patients with bilateral tumors benefit from residual hearing, this is not always true in unilateral cases. The suboccipital and middle fossa procedures are discussed as well as the relative merits of each approach in the preservation of hearing. The total series (139 tumors) is discussed in detail regarding results and complications.
An Anatomic Study Of The Hypotympanic Branch Of Jacobson'S Nerve
Authors: Porto Anthony F. , Whicker James , Proud G. O.
Published: February 2017

Microscopic dissection of 20 human temporal bones revealed that the nerve of Jacobson gave rise to a hypotympanic branch in 50% of the specimens. The fact that the branch was frequently covered by promontory bone and was difficult to approach by the standard tympanotomy technique may explain the 21% failure rate as reported in the literature.
A Technique of Nasolabioplasty
Authors: Rafaty F. Mark , Cochran John
Published: February 2017

There are several techniques available for the improvement of the deep nasolabial folds. The standard face‐lift operation is the most acceptable and popular technique as it leaves no scars on the face.

Occasionally, the aesthetic surgeon encounters patients who, because of economic or health reasons, cannot undergo the face‐lift operation. They may also be too old to want a full face‐lift. In these individuals, a nasolabioplasty has been found very useful. The operation may also be used as an adjunct to rhytidectomy in patients with persistent sagging of the cheeks and deep nasolabial folds after a face‐lift operation.

Two incisions are placed on each side; one precisely on the nasolabial groove and the other lateral to the groove. The amount of skin outlined between the two incisions is proportional to the degree of pull desired. The island of skin between the incisions is not removed. Instead, it is deepithelialized, rolled on itself into a tube and left in situ under the nasolabial fold to minimize recurrent deepening with time.

Other techniques of nasolabioplasty are reviewed. The results of the operation in 14 patients are analyzed, and complications are discussed.
Human Laryngeal Reinnervation: Long‐Term Experience with the Nerve‐Muscle Pedicle Technique
Authors: Tucker Harvey M.
Published: February 2017

The nerve‐muscle pedicle technique for reinnervation of bilateral vocal cord paralysis has now been applied in 45 cases over the past four years. EMG studies, volume flow loop, pulmonary function studies, and the ability to extubate the patient with good to excellent exercise tolerance for day‐to‐day activity have been used as parameters to judge success or failure of this procedure. To date there has been a primary success rate of 91.1% (41/45) and a long‐term success rate of 88.8% (40/45). There has been one serious complication in the entire series and no significant morbidity other than this. Age of the patient and length of paralysis are not necessarily contraindications to the procedure. These results suggest that the nerve‐muscle pedicle technique may be successfully used for reinnervation of bilaterally paralyzed vocal cords without sacrificing residual voice, as is the case with arytenoidectomy type procedures.
The Masseter Muscle Flap
Authors: Conley John , Gullane Patrick J.
Published: February 2017

This little‐used muscle flap has four significant applications in radical ablation about the palate, pharynx, and mesopharynx that include the ascending ramus of the mandible, a portion of the tongue and lateral neck, and in radical operations on the parotid gland causing a facial paralysis:1

1. It assists in the rehabilitation of the act of swallowing when it is sutured to the lateral hyoid arch, thus elevating the thyrohyoid complex and reinforcing this portion of the upper lateral neck.

2. This flap may be transposed over the upper portion of the internal carotid artery to provide protection for this vital structure.

3. This flap may be transposed into the internal nasopharynx and then dressed with a free split thickness skin graft to close this wound and to augment the nasopharynx, with improvement in speech and swallowing.

4. In facial paralysis it can be used to restore facial movement around the oral commissure and melolabial folds, thus improving appearance in repose and animation.
The Anatomy and Movements of the Cricoarytenoid Joint
Authors: Sellars Ioné E. , Keen E. N.
Published: February 2017

The cricoarytenoid joints of 45 larynges were dissected and examined with respect to ligaments, articulating surfaces and movements. In this study the capsule of the joint was uniformly thin, and was strengthened by a superficial, medially placed, flattened band of fibers of one or two strata, known as the posterior cricoarytenoid ligament. Three movements of the arytenoid cartilage at this joint were found, the axes and ranges of which were directly related to the shape and position of the cricoid facet. Notwithstanding these differences, the positions of all the vocal folds in extreme adduction or abduction were similar. These findings contradict the traditional concepts of uniformity of the anatomy and movements of the cricoarytenoid joint and also the position, and therefore name, of the “posterior” cricoarytenoid ligament.
Reconstruction of Laryngeal Function for Recurrent Laryngeal Nerve Paralysis: Historical View, Advancement of Latest Investigations and a Preliminary Experiment
Authors: Sato Fumihiko , Ogura Joseph H.
Published: February 2017

Historical investigations of the functional restoration for recurrent laryngeal nerve paralysis are reviewed and some advancement in recent studies are introduced.

A preliminary experiment is reported in which the ansa hypoglossi and the sternothyroid muscle pedicle was implanted into the denervated posterior cricoarytenoid muscle in dogs. From these experiments we have concluded that the ansa hypoglossi and sternothyroid muscle pedicle, which has been shown to transmit efferent inspiratory bursts, is capable of restoring function to the paralyzed posterior cricoarytenoid muscle in some dogs.
Physicochemical Properties of Human Middle Ear Effusions (Mucus) and Their Relation to Ciliary Transport
Authors: McCall Allan L. , Potbic William P. , Shih Chung K. , Litt Mitchell , Khan Mohammed A.
Published: February 2017

Middle ear effusions were collected from 10 patients (14 ears) with secretory otitis media. Mucoid samples were pooled and reconstituted to various concentrations of nondialyzable solids. Viscoelasticity was studied using a magnetic microrheometer and compared with mucociliary transport rates measured on the frog palate. Results indicate that the viscoelastic properties of middle ear mucus correlate with mucociliary transport. A transport maximum was found at a 2% nondialyzable solids content. Implications relative to ineffective mucociliary transport in secretory otitis media are discussed.
Hearing Loss as a Sequela of Meningitis
Authors: Nadol Joseph B.
Published: February 2017

A retrospective study of 547 cases of meningitis was performed. Of these, 236 were bacterial, 304 were viral, and 7 were fungal in etiology. Of 110 survivors of bacterial meningitis over the age of 2 1/2 years, 23 or 21% suffered partial or complete sensorineural hearing loss. The site of auditory injury in cases of partial loss was the cochlea by audiologic criteria. A positive correlation with hearing loss was found for the species of organism, delay before treatment, low CSF sugar, and CSF pleocytosis. Of 7 patients with fungal meningitis, 3 suffered hearing loss with signs of a retrocochlear site. Of 304 caseS of aseptic meningitis, none developed a hearing loss. The pathophysiology of hearing loss as a sequela of meningitis and the possible explanations for absence of hearing loss in viral meningitis are discussed.
Functional Restoration for Recurrent Laryngeal Paralysis: An Experimental Study
Authors: Sato Fumihiko , Ogura Joseph H.
Published: February 2017

The purpose of this investigation was to exclude abductor disturbance and to maintain phonation during recurrent laryngeal nerve paralysis through a new surgical design. This new method consists of implantation of the ansa hypoglossi and sternothyroid muscle pedicle which has been shown to provide sufficient abductor function in a recent publication, and the selective severance of the abductor branch after neurorrhaphy of the recurrent laryngeal which is shown to be a sufficient adductor function in another study.

The recovery of sufficient abductor function during inspiration and dyspnea was 67% and 89% of adductor function with phonation. However, after cutting an adductor nerve branch of the recurrent laryngeal nerve in cases of insufficient abduction, the vocal cord on the operated‐on side regained abduction during inspiration.

The effect of the ansa hypoglossi and sternothyroid muscle pedicle is also discussed.
The Tympanic Isthmus: Its Anatomy And Clinical Significance
Authors: Aimi Kenji
Published: February 2017

The tympanic isthmus is a narrow passage between the tubotympanic cavity and the atticomastoid air space. Obstruction of the tympanic isthmus is frequent in various types of middle ear disease and causes significant air‐diffusion disturbance within the temporal bone pneumatic system.

Using large numbers of fresh temporal bone specimens, anatomical boundaries of the tympanic isthmus are defined and pathological variations are investigated. Embryological origin of the isthmus and pathophysiological implications of the tyrnpanic isthmus block are discussed.

Among factors that cause obstruction of the tympanic isthmus are mucosal folds variations, inflammatory webs and exudate, retracted tympanic membrane, diseased attic mucosa, and cholesteatoma. Each factor is analyzed with representative specimen photographs.

Clinical signs due to tympanic isthmus block often simulate or coexist with symptoms of eustachian tube obstruction. Surgical management of the tympanic isthmus block requires clear recognition of these disease processes.

Understanding of the tympanic isthums as an anatomical entity is essential in the management of middle ear and attic disease.
Serous Otitis Media Associated with Sensorineural Hearing Loss in Children
Authors: Ruben R. J. , Math Rochelle
Published: February 2017

The effect of a conductive hearing loss secondary to serous otitis media in children with sensorineural hearing loss was seen to be an increase in threshold and in one case a decrease in speech discrimination. The diagnosis of the conductive component can be made by means of measurement of impedance, middle ear pressure, the recording of a tympanogram and otoscopy. It is likely that a conductive component can lead to delay in the diagnosis of an underlying sensorineural hearing loss in some children which could result in exacerbation of speech and language deficits. Correction of the conductive component can convert a profound hearing loss to a severe hearing loss, or a severe hearing loss to a moderate hearing loss, and it may also increase speech discrimination.
Oat Cell Carcinoma of the Larynx
Authors: Bone Robert C. , Deer David
Published: February 2017

Oat cell carcinoma is a well known pulmonary entity. Reports of this disease at extrapulmonary sites, particularly the larynx, have been rare. The natural history of such a tumor in a 64‐year‐old man is documented in this report. This supraglottic tumor (classified as T2N1bM0 was surgically resectable. Because of the large cervical node, preoperative irradiation was performed. After completion of 4000 rads to the primary tumor and regional lymphatics, there was dramatic regression of disease at both sites. Subsequently, the patient underwent supraglottic laryngectomy and neck dissection. The gross specimen revealed microscopic residual tumor at the primary site (with uninvolved margins) and in the palpable cervical node. In spite of adequate surgical excision, the patient was dead of widespread distant metastases within two months of surgery. Review of the literature reveals that oat cell carcinoma at extrapulmonary sites is likely to behave in this manner. The operating laryngologist should be aware of this rare pathological variant because of its propensity for distant metastases in the presence of surgically curable disease in the region of origin. Alternative methods of management (including radiation therapy and chemotherapy) are discussed.
Transoral Laryngeal Surgery Using the CO2 Laser: Laboratory Experiments and Clinical Experience
Authors: Vaughan Charles W.
Published: February 2017

Since the introduction of the CO2 laser coupled to the Zeiss operating microscope in 1969, it has become apparent that this instrument is without equal for the carefully controlled removal of small laryngeal lesions. It has now also been shown experimentally and with some clinical confirmation that by using the CO2 laser transorally all of the standard types of partial and excisional laryngeal surgery may be accomplished with minimal morbidity and without the use of tracheotomy. The major exception is that replacement of soft tissue is not possible. Therefore, procedures that remove sufficient amounts of soft tissue to compromise the sphincter function of the larynx should not be done transorally with the CO2 laser.

The instrument itself is almost deceptively simple to use. However, the unusual surgical approach and the changed appearance of tissue following laser vaporization may confuse the operator until considerable expertise has been gained in the animal laboratory. Nevertheless, the ability of the instrument to excise small or large areas of the larynx transorally with precision and with almost no resultant morbidity makes this effort worthwhile.
Round Window Ultrasonic Irradiation for Meniere's Disease with Eng Monitoring
Authors: Tabb Harold G. , Norris Charles H. , Hagan Warren E.
Published: February 2017

Ultrasonic irradiation of the labyrinth via the round window is effective in controlling otological vertigo. This method of surgical management for incapacitating vertigo is presented with demonstrative intraoperative electronystagmograms and irradiated cat neuroepithelium. Such data suggest that more intense irradiation doses than previously reported should be applied to effectively destroy the diseased labyrinthine end organs. Precise end points of destructive irradiation are defined by characteristic intraoperative electronystagmograms. The authors suggest this is an ideal procedure when the situation of an unaffected cochlea, coexisting with a diseased labyrinth, requires a minimally invasive, destructive procedure which preserves hearing while eradicating vertigo.
Cervical Congenital Arteriovenous Malformation
Authors: Smith Curran J. , Clark Stephen K.
Published: February 2017

Congenital cervical arteriovenous malformations are unusual lesions. Definitive diagnosis and assessment of the extent of the lesion is best obtained by four vessel cervicothoracic aortography with selective arteriography, rapid phase radiography and subtraction techniques.

The futility and even deleterious effects of elective arterial ligation have been repeatedly documented in the literature. It is our opinion that arterial ligation should be limited to control of life threatening hemorrhage or as part of definitive resection.

In an attempt to minimize operative hemorrhage, we have successfully utilized the technique of preoperative transcutaneous selective embolization in preparation for total surgical excision. We recommend this technique as an effective means of minimizing operative hemorrhage.
Long‐Term Follow‐Up of Tympanic Neurectomy for Sialorrhea
Authors: Mullins W. Michael , Gross Charles W. , Moore Jacklyn M.
Published: February 2017

Thirty‐one patients who had undergone a bilateral tympanic neurectomy (sectioning of both Jacobson's nerve and the chorda tympani) for sialorrhea are evaluated after two years (ranging from 24–45 months). Drooling control improved in 74%. There was a significant difference of improvement in the group where a diligent search was made to sever all branches of the tympanic plexus. A 50% improvement was attained in two failures of a tympanic neurectomy who underwent transposition of Stenson's ducts into the tonsillar fossa.
Gunshot Injury to the Temporal Bone: An Analysis of Thirty‐Five Cases
Authors: Hagan Warren Eugene , Tabb Harold G. , Cox Robert H. , Travis Lawrence W.
Published: February 2017

By retrospective analysis of 35 surviving gunshot injuries to the temporal bone and by presentation of 6 representative cases, the management and reconstructive procedures of these injuries in the Tulane University affiliated hospitals are presented. The most frequent single injury was facial nerve paralysis (16 cases), followed by external canal injury and conductive hearing loss. Anacusis occurred in 12 cases. In conductive hearing loss the intact posterior wall tympanoplasty with mastoidectomy (16 cases), or the modified radical mastoidectomy (5 cases), allowed middle ear reconstruction. Transmastoid facial canal decompression, combined with the above procedures or with a middle fossa craniotomy, was performed in 6 cases. Delayed facial reconstruction (5 cases) utilized microneural anastomosis between facial‐facial and hypoglossal‐facial nerves and fascia lata slings. Intracranial complications of thrombosis of internal carotid artery, dural venous lacerations, temporal lobe aphasia, bitemporal hemianopsia, cerebral abscesses and meningitis are also discussed.
Subclinical Reduction in Airflows after Teflon Injection of Vocal Cord
Authors: Cormier Y. , Kashima H. , Summer W.
Published: February 2017

Results of intracordal Teflon® injection for symptoms of unilateral vocal cord paralysis have been excellent. There seems to be no significant long‐term foreign body reaction or limitation to maximum airflows. However, acute inflammatory reactions and airflow obstruction have been reported. The objective of the present study was to evaluate the frequency, extent, and duration of airway obstruction following Teflon® injection.

Forced inspiratory and expiratory airflows were measured in seven consecutive patients before, 24 hours, and 10 days after Teflon® injection. Significant variable upper airway obstruction, as demonstrated by an increase in the ratio of forced expiratory airflows at 50% Vital Capacity to the forced inspiratory airflows at the same lung volume (VE60/VI,o), was found in each subject. At 24 hours after the injection this ratio increased from a baseline of .098 ± 0.50 (mean ± S.D.) to 1.41 ± 0.67 (P < 0.01), and returned to baseline values in 10 days (0.95 ± 0.14). We conclude that Teflon® injection into a paralyzed vocal cord creates a significant inspiratory airway obstruction that is reversible in 10 days.
Horizontal Nystagmus in Methylmercury Poisoned Squirrel Monkeys
Authors: Wilpizeski Chester R. , Lowry Louis D. , Zook Bernard C.
Published: February 2017

Chronic states of methylmercurialism were induced in squirrel monkey subjects. Principal neurological signs included ataxia, abnormal gait, incoordination and amaurosis. Although slight to moderate vacuolization occurred in supporting cell layers of the cristae and maculae, receptor cell function was essentially normal. Except for a lowered cold threshold, bithermal caloric‐induced nystagmus was not significantly different from control values. Pre and postrotatory (Barany chair) tests revealed a reduction only in frequency related variables. The development of spontaneous and positional nystagmus (sometimes with eyes open) coupled with the behavioral signs and the evidence of normal receptor response suggested cerebellar dysfunction. Severe pathologic changes were present in the cerebral cortex, but no lesions were found in the cerebellar cortex. Substantial neuronal degeneration and gliosis, however, were observed in several subcortical nuclei, including cerebellar and vestibular nuclei.
Histopathological Study of Radionecrosis in Laryngeal Carcinoma
Authors: Keene Malcolm , Harwood AndrewR. , Bryce Douglas P. , Van Nostrand A. W. Peter
Published: February 2017

With modern radiotherapy techniques, clinical radionecrosis is uncommon following erradication of primary squamous cell carcinoma from the larynx. Histologic sections from 265 specimens, prepared by the technique of whole organ subserial step‐sectioning were studied to determine the incidence and location of chondronecrosis and/or osteomyelitis in both irradiated and non‐irradiated cases. Chondronecrosis occurred in only 1 of 41 early (pT1 ‐ pT2) tumors but in 143 advanced tumors (pT ‐ pT4) treated with radical radiotherapy and containing residual carcinoma, 27% had evidence of significant necrosis, compared with 24% of those not irradiated. Age, sex, tumor grade and previous laryngeal surgery did not appear to be significant factors in the development of necrosis in irradiated patients. The arytenoid cartilage was most frequently involved when chondronecrosis occurred in association with radiotherapy. Six total laryngectomy specimens (3%) were received from patients with symptoms of chondronecrosis and in whom no residual tumor was present. We conclude that although the incidence of clinical perichondritis is low, histologic chondronecrosis andlor osteomyelitis occurred in 26% of all the larynges studied. Radiotherapy appears to be a significant causative factor only in advanced supraglottic tumors.
Retropharyngeal Tendinitis
Authors: Weinberg Susan , Scott Robert A.
Published: February 2017

We report a case of retropharyngeal tendinitis. A brief review of the literature, as well as extensive differential diagnosis, is presented. Retropharyngeal tendinitis should be a prime diagnostic consideration in patients who present with acute cervical pain, retropharyngeal calcium deposition, and prevertebral soft tissue swelling.
Sudden Sensorineural Hearing Loss: Operative Complication in Non‐Otologic Surgery
Authors: Millen Steven J. , Toohill Robert J. , Lehman Roger H.
Published: February 2017

Sudden sensorineural hearing loss is a well recognized phenomenon in otologic practice with both viral and vascular etiologies being supported. However, sudden hearing loss as a complication of non‐otologic surgical procedure is a seldom reported and rare phenomenon. Five cases of unilateral sudden sensorineural hearing loss which are time related and probably causally related to non‐otologic surgery are presented. Two cases underwent open heart surgery and support previous reports of hearing loss secondary to cardiopulmonary bypass procedures. Three noncardiac cases are also reviewed. None of these patients had prior otologic disease which would predispose to a sudden hearing loss, and no intraoperative or postoperative complication was specifically noted as a cause of the hearing loss. The literature is reviewed and attention is drawn to the problem. We wish to encourage further reports and to recommend early identification and treatment in those cases related to cardiopulmonary bypass.
Adenotonsillar Hypertrophy and Upper Airway Obstruction in Evolutionary Perspective
Authors: Grundfast Kenneth M. , Wittich Donald J.
Published: February 2017

Primary care physicians have become increasingly reluctant to refer children for tonsillectomy and adenoidectomy (T and A) during the past years while antimicrobial therapy for pharyngotonsillitis and otitis media has become more common. Consequently, more children retain tonsils and adenoids throughout the childhood years. Airway compromise from adenotonsillar hypertrophy is reported in 11 cases — 8 with insidious onset, 3 with acute onset. Typical symptoms occurring during sleep include snoring, snorting, enuresis and obstructive apnea. Daytime symptoms include hyponasal speech, oral respiration and morning cephalgia. Methods of assessing children with adenotonsillar hypertrophy and airway compromise included polysomnography and acoustic analysis of respiratory sounds. It appears that airway compromise from adenotonsillar hypertrophy is more common now that fewer children are undergoing T and A, is being more commonly recognized because of improved methods of assessment, or both.
Changing Face of Treatment of Peritonsillar Abscess
Authors: Schechter Gary L. , Sly Donald E. , Roper Albert L. , Jackson Robert T.
Published: February 2017

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches.

The patients ' ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow‐up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis.

The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.
Treatment of Juvenile Laryngeal Papillomatosis with Two Types of Interferon
Authors: Schouten T. J. , Weimar W. , Bos C. E. , Bos J. H. , Cremers C. W. R. J. , Schellekens H.
Published: February 2017

The successful application of fibroblast and leucocyte interferon in the treatment of juvenile laryngeal papillomatosis in two patients with papillomas extending down into the lower airways is reported. The papillomas recurred during interruption of interferon ad ministration. This indicates that the regression of papillomas is a genuine effect of interferon and not merely a reflection of the capricious natural course of the disease.
Cervicofacial Mycobacterial Infections Presenting as Major Salivary Gland Disease
Authors: Stanley Robert B. , Fernandez James A. , Peppard Sean B.
Published: February 2017

Mycobacterium tuberculosis and atypical mycobacterium are well‐known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally — if not more — difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands.

Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid‐fast stains, culture, and response to surgery and antituberculous chemotherapy.
CO2 Laser in Otolaryngology‐Head and Neck Surgery: A Retrospective Analysis of Complications
Authors: Ossoff Robert H. , Hotaling Andrew J. , Karlan Marc S. , Sisson George A.
Published: February 2017

A retrospective review was conducted of all patients undergoing CO2 laser surgery by members of the Department of Otolaryngology‐Head and Neck Surgery at Northwestern University Medical School from January 1, 1980 through December 31, 1981; 204 cases were identified and all are included in this report.

Early in our department's experience with laser surgery, an endotracheal tube fire occurred. This incident precipitated a departmental review of complications associated with the use of the CO2 laser and resulted in the formulation of a laser safety protocol. All patients in this group were treated under the directives of this protocol; the operative complication rate was low.

This retrospective analysis of complications associated with the use of the CO2 laser under a strictly applied protocol demonstrates the relative safety associated with judicious use of this instrument.
Posterior Commissure Stenosis Post Long‐Term Intubation
Authors: Whited Robert E.
Published: February 2017

A prospective study of 200 patients having long‐term endotracheal intubation has been completed. This study has defined the events in stenosis evolution for the two varieties of scarring in the posterior commissure of the larynx. An overall stenosis incidence of 6% for this long‐term intubated patient population has been found. In the majority of patients the posterior commissure stenosis is a component of more complex injury.

The importance of tube tissue interfacing in the posterior commissure and the role of ongoing movement of both a shearing and blunt nature is of increasing significance as intubation time lengthens. Changing the character of this interface by the addition of a small posterior air cushion on the endotracheal tube can minimize ongoing trauma in the posterior endolarynx.
Carcinoma Of the Mobile Tongue: Incidence of Cervical Metastases in Early Lesions Related to Method of Primary Treatment
Authors: Bradfield John S. , Scruggs R. Pickett
Published: February 2017

One hundred thirty‐eight patients receiving initial treatment for squamous cell carcinoma of the mobile tongue from 1960 to 1978 were reviewed to determine the frequency of cervical metastasis in early carcinoma (T1N0 and T2N0).Occult cervical node metastasis in an elective neck dissection or subsequent neck recurrence in an initially negative neck was found in 14.5% (9/62) of patients staged T1N0 and 30.6% (11/36) of patients staged T2N0.

Refinement of the staging system demonstrated that 9.7% (3/31) of patients with a primary lesion less than or equal to 1.0 cm and a clinically negative neck (T1aN0) subsequently developed a cervical metastasis. Patients with primary lesions greater than 1.0 cm but less than or equal to 2.0 cm (T1bN0) had twice the risk of occult cervical metastasis (19.4% or 6/31).

The crude 5‐year survivals in Stage I for radium alone, partial glossectomy, and partial glossectomy with neck dissection were 64%, 58% and 75% respectively and in Stage II were 31%, 66% and 71% respectively. Local‐regional failure is the principal mechanism of failure In patients treated locally particularly in Stage II.
Primary Laryngeal Malignant Fibrous Histiocytoma: Review of the Literature and Report of Seven Cases
Authors: Ferlito Alfio , Nicolai Piero , Recher Gianfranco , Narne Surendra
Published: February 2017

After describing 4 new cases of malignant fibrous histiocytoma of the larynx (3 cases had been recently published), the authors review the literature, from which it appears that 16 such lesions of the larynx havebeenreported (including their 7 cases). Malignant fibrous histiocytoma usually occurs in the soft tissues, tendons and joints of the upper and lower extremities, and is uncommon in the head and neck — though not exceptional. The lesion is a mesenchymal tumor probably of histiocytic origin and may be divided into 6 subtypes,i.e.,pleomorphic, fibrous, giant cell, angiomatoid, myxoid and inflammatory, to be distinguished on the basis of the predominant feature. The tumor has an aggressive biologic behavior as it tends to recur and to metastasize to distant organs. The treatment of choice is surgery and adjuvant combination chemotherapy which at times may improve the survival rate.