bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain stem auditory evoked potentials in patients with hemifacial spasm
Authors: Møsller Margarbta B. , Møsller Aage R. , Jannetta Peter J.
Published: October 2006

Brain stem auditory evoked potentials (BSEP) were elicited and recorded from the spasm side and from the non‐spasm side of 39 patients operated upon to relieve hemifacial spasm. Thirty‐seven patients were studied before the microvascular decompression surgery at the root entry zone of the facial nerve was performed. Thirty‐one patients were studied 4 to 10 days postoperatively, and 7 were evaluated a second time, 6 weeks to 6 months after surgery. The latencies of peaks III and V of the ipsilaterally recorded BSEP were statistically significantly (p<0.05) larger on the spasm side than were those recorded on the non‐spasm side. The I to III interwove latencies did not show any statistically significant difference. This implies that the effects of hemifacial spasm are not limited to the facial nerve but extend to other cranial nerves and other parts of the brain stem than those involved in facial motor function. The pure tone thresholds recorded before and after the operations were essentially the same in the majority of the patients, were 10 to 15 dB lower in 13% of the patients postoperatively, and were 10 to 15 dB higher in 13% of the patients postoperatively. One patient suffered a moderate sensorineural low‐frequency hearing loss postoperatively.
Cochleosacculotomy for meniere's disease: Theory, technique and results
Authors: Schuknecht Harold F.
Published: October 2006

A series of 51 patients with intractable vertigo from Meniere's disease were treated by a surgical procedure termed cochleosacculotomy. In this operation a right‐angled pick is introduced through the round window membrane and advanced 3 mm in the direction of the oval window. This passage carries the pick through the cochlear partition causing a fracture‐disruption of the osseous spiral lamina and cochlear duct. Within the time limits of this study (mean 4.32 months) 88% were relieved of disabling vertigo. Hearing losses of more than 20 dB occurred in 23% of the patients. Profound hearing losses occurred in two patients, one of which was associated with postoperative otitis media.
Surgery for otosclerosis in children
Authors: Cole James M.
Published: October 2006

Although otosclerosis in childhood is not common in the United States, we have done 62 stapes procedures in 43 patients who were under age 20 at the time of their initial surgery. There were 16 males and 27 females who developed a conductive hearing loss due to otosclerosis between age 6 and 17. The most common age at onset was 12 and 13 years, perhaps suggesting a relationship to puberty. Of these children and teenagers, 42% had severe oval window otosclerosis. Teflon wire prostheses were used in 33% of the operations and wire loop prostheses in most of the remainder; 27% had preoperative bone conduction of 25 dB or worse, indicating the presence of cochlear otosclerosis. The results of stapedectomy were good and approximately equal to that of adult patients.
Lesions of the hypoglossal nerve —diagnosis, treatment and rehabilitation
Authors: Rontal Eugene , Rontal Michael
Published: October 2006

The hypoglossal nerve is one of the four nerves in the posterior cranial fossa. These include the vagus, glosspharyngeal, and spinal accessory nerves. The hypoglossal is, however, distinctly different from these other three nerves, having a separate blood supply in the brain stem, a separate exit from the skull, and a distinct physiologic function.

As such, its distinctive findings provide an integral link to the diagnosis of posterior fossa disease. By coordinating anatomy and physiology to diagnosis, specific pathologic entities may be ascertained. This methodology can be applied to the classic supranuclear, nuclear and peripheral division of neurologic disorders.

It is the purpose of this paper to provide a systemized approach to the diagnosis of disease involving the hypoglossal nerve. This approach will, in turn, allow an accurate diagnosis over an extensive part of the nervous system, especially in the brain stem and posterior fossa.
The use of sclera in tympanic membrane reconstruction.
Authors: Thawley Stanley E. , Smith Peter G. , Faw Kenneth D.
Published: October 2006

Sclera appears to be an appropriate grafting material because of its high density, high tensile strength, and low antigenicity. Preserved donor sclera has been used for myringoplasty in 125 cases over a 4 year period with an overall success rate for complete closure of the perforation of 96%. Several simple techniques for creating flanges to hold the graft in place were used. The size of the perforations ranged from several millimeters to 80% of the eardrum surface. Most of the cases have been done as outpatients, the adults with local anesthesia and the children with general anesthesia.

The advantages of the procedure are: A. readily available graft material; B. high tensile strength of sclera maintains scaffolding effect for long periods of time; C. the flange technique holds the graft at the perforation site and prevents graft lateralization or medialization; D. the procedure can be performed as an outpatient, decreasing health care costs.
Summating potential in meniere's disease.
Authors: Goin Donald W. , Staller Steven J. , Asher David L. , Mischke Robert E.
Published: October 2006

This study assesses several electrocochleographic (ECoG) duration and amplitude measures in a clinically defined Meniere's group and compares the results with those from a normal hearing control group and a hearing loss group (cochlear). The summating potential (SP)/action potential (AP) amplitude ratio was the most efficient diagnostic measure, with 62% of the Meniere's group demonstrating abnormal ratios compared to 4% of the normal control group and 17% of the cochlear group.

The SP changes were then studied from three angles: 1. Comparison of SP changes with glycerol test results; 2. Comparison of ECoG results before and after shunt surgery; and 3. Recording of SP's in guinea pig ears in which hydrops had been created by obliterating the endolymphatic duct.
Inner ear histopathology in patients treated with Cis‐Platinum.
Authors: Wright Charles G. , Schaefer Steven D.
Published: October 2006

Temporal bone histopathology was studied in five patients (aged 51–67) who received cis‐diamminedichloroplatinum (DDP) chemotherapy for head and neck squamous cell carcinoma. In each case, a sensorineural hearing loss occurred during the course of treatment and temporal bones were acquired 3–5 hours postmortem for anatomical study.

Scanning electron microscopy revealed acute degenerative changes in cochlear hair cells that appeared to be the result of drug treatment. However, the presence of age‐related degeneration made it difficult to unequivocally identify hair cell loss due solely to ototoxicity.

In one patient, a decrement in vestibular function was observed during DDP treatment. Postmortem examination showed severe degeneration of the maculae and cristae which could be correlated with the absence of caloric response seen after chemotherapy.
Vestibular function assessment in patients with meniere's disease: The vestibulospinal system.
Authors: Black F. Owen
Published: October 2006

The state‐of‐the‐art approach to clinical assessment of vestibular disturbances includes a number of procedures in which it is assumed that the status of major vestibular pathways is quantified independently from converging somatosensory and visual influences. Although it has been known for some time that this approach has limitations in a highly integrative system in which inputs from a number of sensory modalities interact, a practical remedy has been only recently forthcoming. Using an approach to assessment of the vestibulospinal system developed by Nashner, the application of moving platform techniques has been the first to systematically identify the interactions among vestibular, visual, and proprioceptive senses and determine the role of vestibular losses in the process of postural control.

A group of Meniere's disease patients were studied in order to determine whether or not such tests could be used as an effective vestibular screening method for Meniere's disease patients in remission, and whether the ability of Meniere's disease patients to use vision and proprioception to compensate for their vestibular disorders, could be assessed. Results indicated that quantitative evaluation of the vestibulospinal system was a very effective vestibular screening test. Furthermore, the adaptive ability of the subject can be estimated by varying the amounts of visual and proprioceptive vestibular information available to the patient for the control of postural sway. Preliminary results indicate that such a technique would be of great value clinically for the initial and on‐going evaluation of patients with Meniere's disease and for pre and post‐therapeutic evaluation of the Meniere's disease patient.
Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia
Authors: Dedo Herbert H. , Izdebski Krzysztof
Published: October 2006

Recurrent laryngeal nerve section for spastic dysphonia was first performed in 1975 because prior forms of treatment had failed. Virtually every patient has had a detailed postoperative follow‐up which includes a tape recording and a self‐assessment questionnaire. The majority of patients remain free of spasticity at this medium‐term follow‐up. In some, spasticity recurred with less than preoperative severity, A small percentage of patients have a persistent breathy phonation. The first group is treated with vocal fold lateralization procedure using the CO2 laser; the second, with Teflon.® When needed, voice therapy is also given. This paper provides a basis for diagnosis, indications for surgery, primary and secondary surgical techniques, encountered problems, and medium‐term follow‐up results.
Laryngeal transposition flap for reconstruction of large oral cavity defects
Authors: Spiro Ronald H. , Sobol Steven M. , Gerold Frank
Published: October 2006

Resection of the entire tongue and floor of the mouth, with or without the anterior mandibular arch, may necessitate sacrifice of the larynx to prevent life‐threatening aspiration and poses a significant reconstructive dilemma. Regional cutaneous or myocutaneous flaps can provide adequate healthy tissue for repair, but shore the inherent disadvantage of resurfacing the oral cavity with skin (which may be hair bearing), rather than mucosa. Moreover, cutaneous flaps usually necessitate a planned orocutaneous fistula and secondary closure, and bulky myocutaneous flnps may interfere with oral competence. Larynx transposition has been used for some time at Memorial Sloan‐Kettering Cancer Center to repair selected large oral cavity defects resulting from resection of the entire tongue and floor of the mouth. This report illustrates the laryngeal transposition flap which is developed from the skeletonized, laryngofissured larynx based on the superior laryngeal arteriovenous pedicle. The advantages and disadvantages of this technique, as compared with alternative methods of reconstruction, are discussed.
Tracheal involvement in laryngeal papillomatosis
Authors: Weiss Michael D. , Kashima Haskins K.
Published: October 2006

A review of 39 laryngeal papilloma patients at The Johns Hopkins Hospital revealed an incidence of subglottic and tracheal extension much higher than previously reported. Subglottic disease was present in 69% of patients and tracheal involvement in 26%. Factors associated with distal spread were the presence of subglottic papillomas, history of tracheostomy, total number of endoscopic resections, and the duration of disease. The relationship to the presence of viral antigen was cited. Detection and elimination of all papillomas is felt to be the key for the prevention of distal spread. The strategy of management is described.
Symposium continued. Nasal mucous transport and our ambient air
Authors: Proctor Donald F.
Published: October 2006

The nose usually serves to conduct air in and out of the lungs; but it also defends the body against airborne noxious materials and modifies the physical condition of inspired air prior to its arrival in the lungs. A major factor in these physiological functions is mucociliary clearance which depends on the secretion of airway secretions and ciliary activity. This function is impaired by certain air pollutants, but not by relative humidity or temperature of the ambient air.
Symposium continued. Nasal ciliary structural pathology
Authors: Herzon Fred S.
Published: October 2006

The nasal or sinus mucosa cilia of 31 patients with various upper respiratory tract diseases have been examined for fine structural abnormalities. Although a wide variety of membrane, microtubular and cytoplasmic changes have been observed, their effect — except for genetic disorders — on respiratory disease remains unknown.
Phenothiazine induced lingual trauma
Authors: Miglets Andrew W. , Racey Gary , Hoffer J. Lee
Published: October 2006

A 34‐year‐old woman presented with an unusual and unfortunate combination of complications to a phenothiazine drug. Rhythmic protrusion of her tongue was not a problem until it became trapped outside of her oral cavity by spasm of the muscles of mastication. Massive edema with questionable viability of her tongue ensued. She presented as an airway as well as therapeutic management problem.
Computed tomography vs. histology of laryngeal cancer: Their value in predicting laryngeal cartilage invasion
Authors: Archer Carol R. , Yeager Vernon L. , Herbold David R.
Published: October 2006

Twenty‐seven cancerous larynges were examined preoperatively by computed tomography and postoperatively by transaxial anatomic sections. Data from this correlative study provides a new radiographic classification based upon the relationship of the plane of maximal tumor size to the apex, body, or vocal process of the arytenoid. Unlike those tumors whose maximal size lies at or above the apex of the arytenoid, those below have a very high association with cartilage invasion (8% in former group, 86% in latter group). This is explained by our observation of sites of predilection of tumor invasion of the thyroid, cricoid, and arytenoid cartilages. At these sites collagen fibers have been observed to pass through the perichondrium and attach directly to cartilage. These same fibers may serve as a pathway to direct growth of tumor cells. There was no correlation between six histologic parameters and the presence of cartilage invasion.
The role of conservative surgery in the management of inverted papilloma
Authors: Lawson William , Biller Hugh F. , Jacobson Alan , Som Peter
Published: October 2006

A group of 31 patients with inverted papilloma were treated at the Mount Sinai Medical Center. There were no multicentric cases, and one patient had an associated malignancy. A conservative procedure consisting of intranasal or transantral sphenoethmoidectomy was selectively performed in 8 patients with limited lesions. No recurrences were observed in this group after a mean follow‐up of 2 years. Lateral rhinotomy with medial maxillectomy and en bloc resection of the ethmoid labyrinth was performed in 23 other patients. One recurrence appeared in this group, members of which were followed a mean of 3.8 years. Radiographic evaluation by multidirectional polytomography and CT scanning permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor excision.
Surgical treatment of chronic laryngeal stenosis secondary to vocal cord paralysis: Pre and postoperative evaluation of ventilatory function
Authors: Grahne B. , Poppius H. , Viljanen A. A. , Korhonen O. , Rinne J.
Published: October 2006

Thirteen patients with chronic laryngeal stenosis were operated upon with total excision of stenotic scar tissue, enlargement of the lumen by sectioning the back and front wall of the larynx, and application of an indwelling Teflon® prosthesis for 4 months. The stenosis was in many cases caused by long‐standing recurrent paralysis complicated by attempted surgical correction of the stenosis. Following operation, the specific airway conductance increased in all patients (mean ± SD pre and postoperative values 0.51 ± 0.30 and 1.12 ± 0.51 kPa−1.s−1, respectively). The FIV1/FVC ratio was determined in 9 patients and an increase was postoperatively noted in all of them (mean ± SD pre and postoperative values 43 ± 17 and 76 ± 13%, respectively). The physiological findings confirmed the excellent clinical results of the treatment.
Benign schwannoma involving the infratemporal fossa and orbit
Authors: Jones H. Savage
Published: October 2006

Schwann cells intimately ensheath all neurones — of both myelinated and non‐myelinated nerves — in the peripheral nervous system. Though Schwann cell tumors are uncommon, up to 45% of the total may occur in the head and neck region.

The purpose of this paper is to report a case of schwannoma arising in the right infratemporal fossa, and to describe the surgery involved in its removal.

A benign tumor arising in this uncommon position requires a conservative surgical approach for cosmetic reasons. In this case, access was provided by mobilization of the zygoma, which, following removal of the tumor, was repositioned. This surgical procedure provided useful access to such a cryptic anatomical region whilst ensuring a satisfactory cosmetic result.
Prediction of serous versus purulent otitis media by otoscopy and tympanometry in an animal model
Authors: Giebink G. Scott , Heller Kelley A. , Le Chap T.
Published: October 2006

Non‐invasive methods for distinguishing different types of otitis media would have clinical value in predicting otologic morbidity. Two such methods, otoscopy and tympanometry, were used in two experimental models of otitis media to determine whether there are unique otoscopic and tympanometric characteristics of serous and purulent otitis media. A flat (type B or B+) tympanogram and yellow tympanic membrane each had a high likelihood of predicting middle ear effusion in these models, and the best prediction was obtained using both parameters simultaneously. A yellow tympanic membrane color predicted purulent otitis media in one model but did not distinguish purulent from serous ears in the other model. In one model, serous otitis media was frequently associated with a type C (negative pressure) tympanogram. Tympanometry provided a valuable adjunct to otoscopy in detecting effusion and in distinguishing serous and purulent disease. These observations may apply to otitis media in humans, although the variable etiologies of otitis media in humans may confound the ability of otoscopy and tympanometry to distinguish middle ear effusion types.
Preliminary report on complications of the extended cervicofacial rhytidectomy
Authors: Dedo Douglas D.
Published: October 2006

The facelift is one of the major surgical procedures for facial rejuvenation. Over the years it has evolved from local skin excisions to wide undermining and manipulation of the subcutaneous layers. Presently, controversy exists concerning the extent of undermining. Minimal flap undermining is felt to give less than an optimum cosmetic result that in turn only lasts for a very short period of time, while more extensive procedures are thought to jeopardize the patient with increasing morbidity from associated complications. Since 1978, the author has been a strong proponent of the widely undermined facelift with concomitant excision and rotation of the subcutaneous layers. A review of the patients done since 1978, who had the more extensive operation, was undertaken to determine the incidence of postoperative complications. Even though the series is small, the results are encouraging.
Complications of CO2 laser surgery of the larynx
Authors: Fried Marvin P.
Published: October 2006

The use of the surgical laser has become commonplace in many medical centers, however the limitations of its use need to be assessed. The complications of laser use are based on the physics of the instrument and the equipment used. Direct laser effects include burns of tissue unintended for losing, and endotracheal tube (E‐T) ignition. Secondary effects occur as immediate consequences of lasing, such as E‐T tube obstruction, internal E‐T ignition, or mucosal charring. A case of airway obstruction is presented. Delayed effects relate to healing. Suggestions are made to help avoid the outlined complications.
Complications associated with the surgical treatment of cholesteatoma
Authors: Pratt Lindsay L.
Published: October 2006

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has an attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of a persistent or recurrent cholesteatoma, a satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small.

If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, rarely will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required.

Although most of the children “before puberty” in the study had middle ear cholesteatomas, all children, regardless of the location of cholesteatoma, had a higher incidence of surgical failure than did adults.
Paraganglioma of the nasal cavity
Authors: Himelfarb Mordechai Z. , Ostrzega Nora L. , Samuel Joram , Shanon Eliahu
Published: October 2006

A rare case of nasal paraganglioma is described. The tumor presented as a bleeding polyp originating from the middle turbinate. Histological evaluation was based on light and electron microscopy and the findings are discussed in detail. The tumor was locally excised.
Nasopharyngeal lipoma
Authors: Grybauskas Vytenis T. , Shugar Martin A.
Published: October 2006

Though lipoma is a common tumor in many anatomic sites throughout the body, its occurrence in the nasopharynx is extremely rare, with only several cases being reported in the literature. We describe a 17‐year‐old female with a nasopharyngeal lipoma. The mass had been present for at least 5 years and, despite its large size, was asymptomatic.
Sphenoid sinus revisited
Authors: Gibson William
Published: October 2006

J. H. Maxwell, M.D., in 1959 presented a paper on, “The Diagnosis of Chronic Inflammatory Lesions of the Sphenoid Sinus.” In that paper he reviewed chronic inflammatory lesions of the sphenoid sinus and demonstrated through means of case presentations various techniques required for proper diagnosis. During the past five years at the Geisinger Medical Center some interesting noninflammatory lesions of the sphenoid sinuses have been observed and will be reviewed. The symptoms of these sphenoid sinus lesions are usually related to abnormalities of the orbit and/or nasal passages. Cerebrospinal fluid rhinorrhea and meningitis may be present. Pain, when present, is generally not as severe as that described in inflammatory lesions, but is still localized in a similar manner. The diagnosis of sphenoid sinus disease may be suspected on the history and x‐rays of the paranasal sinuses. Poytomography and computerized tomography scanning have aided markedly in the identification of the sphenoid lesions. Surgery in these cases included either a transnnsal or sublabial transseptal approach to the sphenoid sinus and is recommended as a method to gain access to this rather obscure area.
Injection injuries of the recurrent laryngeal nerve
Authors: Raz Sharir , Ramanathan Vadakkencherry
Published: October 2006

We describe a new etiology for vocal cord paralysis. Two patients, chronic drug abusers, had in time lost access to the usual peripheral veins, and proceeded then to have the drugs injected repeatedly into the jugular veins in the neck.

Both presented with persistent hoarseness and were found to have a unilateral vocal cord paralysis.

Neck exploration was undertaken to evaluate this pathology, to rule out other obscure disease, and to decompress the recurrent laryngeal nerve within the carotid sheaths. Severe fibrosis was encountered in the neck of one patient and mild fibrosis in the other. A biopsy specimen from the adjacent autonomic portion of the vagus nerve was submitted.

Although the follow‐up period was short, no definite return of function was observed. A discussion of injection injuries to nerves is presented.
Rhabdomyosarcoma of the larynx: A case report and review of the literature
Authors: Diehn Karl W. , Hyams Vincent J. , Harris Anthony E.
Published: October 2006

Rhabdomyosarcoma is rarely diagnosed in the larynx. A case report and five patients from the Otolaryngic Pathologic Files of the Armed Forces Institute of Pathology are added to the world literature. Current modes of treating Stage III rhabdomyosarcomas are reviewed. The recent literature suggests that certain of these neoplasms may be treated successfully without radical surgery.
Transstomal endoscopic monitoring of patients managed by tracheal silicone t‐tubes
Authors: Eliachar Isaac , Joachims Henry Z. , Silva Miriam Da
Published: October 2006

Transstomal preoperative endoscopic examination (using rigid Hopkins type telescopes) of patients considered for surgical repair or stenting of laryngotracheal stenosis is described. This technique is further employed in patients managed with silicone T‐tubes to monitor the airway during the stenting period and to determine the timing for removal of the tubes.

Immediate post‐removal endoscopic follow‐up is most valuable in determining the patency and stability of the newly reconstructed airway.
Palatal myoclonus — case report
Authors: Fitzgerald Dennis C.
Published: October 2006

Palatal myoclonus is the name of a syndrome characterized by an involuntary rhythmic movement of the soft palate, occasionally involving the facial muscles, pharynx, larynx, and diaphragm.

A review of the literature involving the etiology, pathology, symptoms, and treatment is presented. A case is reported with successful treatment with phenytoin sodium and phenobarbital. Also presented and discussed are the influences of acoustic and corneal stimulations on the myoclonic activity.
Salivary gland choristoma of the middle ear: A case report and review of the literature
Authors: Kartush Jack M. , Graham Malcolm D.
Published: October 2006

Salivary gland choristomata are heterotopic rests which have rarely been reported in the middle ear. A case report of a salivary gland choristoma of the middle ear is presented and the literature reviewed. The frequent association of ossicular chain and facial nerve anomalies is emphasized.
Sialadenoma papilliferum of the parotid gland
Authors: Grushka M. , Podoshin L. , Boss J. H. , Fradis M.
Published: October 2006

A case of sialadenoma papilliferum of the parotid gland in a 35‐year‐old woman is described. The tumor was locally excised and no recurrence was evident after a follow‐up period of 30 months.
A simple prosthesis for correction of cryptotia
Authors: Muraoka Michinari , Nakai Yoshiaki , Ohashi Yoshihiro , Furukawa Masayoshi
Published: October 2006

Cryptotia, which is a rather common anomaly among Japanese, is found in one of about every 400 Japanese. We tried the prosthesis method and obtained good results, with 26 cases (31 auricles). The results obtained were good for 15 cases, fair in 10, and poor in 1. By this method, complete correction including that of the cartilage is possible for the patients up to 8 years old, and correction by extension of the skin is possible for older age groups. This method can be applied to patients 2 or 3 years old without limiting it to those of less than 1 year.
Olfactory neuroblastoma: Presentation of a case and review of the japanese literature
Authors: Tamada Akira , Makimoto Kazuo , Okawa Masanao , Hirono Yoshinobu , Yamabe Hirohiko
Published: October 2006

Olfactory neuroblastoma is an uncommon malignant tumor arising from the nasal cavity. During the past 18 years from 1964 to 1982, only 24 cases have been in Japanese literature, including this case. The average age of these patients is 42.3 years, ranging from 4 to 75 years old. The sex ratio of male to female is 10:14, female being prevalent moderately. The peak distribution is from 30 to 40 years old. The majority of the patients died of distant metastasis within 2 years of diagnosis. Therefore, the overall prognosis in Japan is very poor, as compared with about a 50% 5 year survival rate in the western countries. This is probably because this tumor is difficult to diagnose correctly, and the chance to start treatment early is apt to be missed here, though some tumors behaved very aggressively from the beginning, metastasizing early.
Roentgenographic diagnosis of acoustic neurinoma
Authors: Harner Stephen G. , Reese David F.
Published: October 2006

This article reviews the roentgenographic studies performed in 131 patients who had surgically confirmed acoustic neurinomas. In this 5‐year study (1978‐1982), all patients had computed tomography (CT) and 82% had petrous apex tomography. Approximately 18% of patients underwent angiography, and 18% had positive contrast rhombencephalography. The diagnostic capability with CT scanning has improved remarkably. There were no false‐negative results for scans obtained in 1981 and 1982. At the same time the accuracy of other radiographic and audiometric tests was decreasing. The proportion of small tumors diagnosed has increased 200%, with a corresponding decrease in medium and large tumors. Tumors can be diagnosed at an earlier stage; and, because of this, surgical results have improved. No surgical mortality occurred in this series, preservation of the facial nerve was excellent, and in some patients cochlear function was maintained
Ear disease and hearing loss among navajo children – a mass survey
Authors: Nelson Scott M. , Berry Robert I.
Published: October 2006

A team of trained technicians in a specially equipped mobile van conducted a mass screening effort on the Navajo Reservation from 1978 to 1980 to detect and refer individuals with ear disease and hearing loss; 15,890 school children were examined. The prevalence data and correlations of hearing level with ear disease are presented: 4.0% of the children had TM perforations, 2.3% middle ear effusions, 1.9% TM atelectasis, and 0.4% had sensorineural hearing loss. Microtia was found in 1:935, with a cluster on the Western one‐fourth of the reservation. Cholesteatoma was rare. The patterns of ear disease are contrasted with other groups.
Infectious diseases of the sphenoid sinus
Authors: Holt G. Richard , Standefer John A. , Brown Willis E. , Gates George A.
Published: October 2006

Thirty‐one patients with sphenoid sinusitis were treated from 1978‐1982. Twenty patients had infections contiguous with other paranasal sinus disease. Five of these patients had fungal sinusitis. Eleven patients were seen with isolated sphenoid sinusitis; 3 were secondary to trauma and 8 were due to nontraumatic causes. Possible etiologies include upper respiratory infections, developmental abnormalities, and water forced into the nasal cavity during swimming. The immunocompromised patient is more likely to present with minimal symptoms with a fungal infection, and aggressive diagnostic and therapeutic measures should be undertaken. Because the symptoms of headache, nasal stuffiness, proptosis, ptosis and decreased visual acuity may be interpreted as an intracranial, neurological, or vascular problem, a misdiagnosis may be made. A high index of suspicion for sphenoiditis should be maintained. Therapy involves a combination of medical (antimicrobial agent) and surgical (sinus drainage and marsupialization) management.
Hazards encountered in management of basal cell carcinomas of the midface
Authors: Stanley Robert B. , Burres Steven A. , Jacobs John R. , Mathog Robert H.
Published: October 2006

Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface.
Head and neck manifestation of histiocytosis‐x
Authors: H. Smith Richard J. , G. Evans John N.
Published: October 2006

Histiocytosis‐X is an uncommon disease, but is relevant to the otolaryngologist because patients with this malady present with, or ultimately develop, head and neck manifestations. Sixty‐two patients with histologically confirmed histiocytosis‐X have been examined at the Hospital for Sick Children in London since 1958. Most patients were under 2 years of age on initial examination and had either osseous or dermatologic disease involvement. Less commonly, otic or oral lesions were found.

Histiocytosis‐X is a systemic disease and must be treated accordingly. Isolated lesions may mimic common disease processes, therefore it is imperative that if a seemingly simple problem does not resolve with routine therapy, further patient evaluation be undertaken, If diagnosed, histiocytosis‐X can generally be controlled with Steroid therapy, or in more recalcitrant cases, by the addition of chemotherapy.
Absent auditory brain stem response: Peripheral hearing loss or brain stem dysfunction?
Authors: Kraus Nina , Özdamar Özcan , Stein Laszlo , Reed Nancy
Published: October 2006

Interpretation of auditory brain stem response (ABR) findings can be problematic in cases where waves III and V are absent. Such findings can be attributed to profound hearing loss, brain stem neuropathology, or both. Over a 3‐year period, 48 patients with no known brain stem damage and on whom audiologic data were available were found to have no response by ABR or absent waves III and V. Severe to profound hearing loss was documented in 38 cases, audiometric data were equivocal in 3 cases, and 7 patients showed pure tone sensitivity ranging from normal hearing to moderate impairment. Thus 15% had better hearing sensitivity than might have been expected from their ABR findings. Each of these patients also exhibited abnormal acoustic reflex findings. We report the electrophysiological (ABR, MLR, acoustic reflex}, medical (history, neurological, EEG, CT scan) and behavioral (audiometric, speech and language, learning disabilities, psychological) data which characterize this group of patients.
Intraoral ligation of the maxillary artery for posterior epistaxis
Authors: Maceri Dennis R. , Makielski Kathleen H.
Published: October 2006

Intraoral ligation of the maxillary artery for intractable posterior epistaxis has been used effectively in 14 consecutive patients, all of whom had failed conventional anterior and posterior packing techniques. Fresh cadaver material was dissected in order to define the anatomic relationships of the infratemporal portion of the maxillary artery, as well as to develop the surgical technique prior to clinical application. The results indicate that this technique is rapid, safe, versatile, and effective in the majority of patients that require surgical interruption of the blood supply to the nose. The results of this study and the surgical technique are discussed.
Computed tomography in suppurative ear disease: A correlation of surgical and radiographic findings
Authors: Jackler Robert K. , Dillon William P. , Schindler Robert A.
Published: October 2006

Forty‐two patients with chronic otitis media underwent preoperative CT scanning followed by surgical exploration of the middle ear and mastoid. The CT finding of abnormal soft tissue density associated with bone erosion was highly correlated with the surgical finding of cholesteatoma. By contrast, the total absence of abnormal soft tissue on CT essentially excluded cholesteatoma. However, 50% of all patients had abnormal soft tissue on CT scan not accompanied by bone erosion. In this largest group of patients it was not possible to diagnose or exclude cholesteatoma on the basis of CT findings alone. Also, CT occasionally gave the erroneous impression of lateral semicircular canal fistulization, tegmen tympani erosion, and facial nerve involvement due to volume averaging of these structures with adjacent soft tissues. CT scan has a role in the evaluation of selected patients with chronic otitis media, but must be interpreted cautiously in view of its limitations and numerous pitfalls.
Practical versus theoretical management of autoimmune inner ear disease
Authors: Hughes Gordon B. , Kinney Sam E. , Barna Barbara P. , Calabrese Leonard H.
Published: October 2006

Autoimmune inner ear disease is an uncommon but distinct clinical entity. Our ignorance of the immune mediating pathways, need of further animal model experimentation, variability of laboratory test results and of patient treatment responses illustrate how poorly we understand this disorder. The purpose of this review is to compare practical vs. theoretical management of autoimmune inner ear disease, based upon our current knowledge of the disease process and upon a review of clinical experience at the Cleveland Clinic Foundation. Representative case histories are presented. The following preliminary conclusions are discussed:
After early identification – What follows? a study of some aspects of deaf education from an otolaryngological viewpoint
Authors: Stewart Irwin F.
Published: October 2006

Otolaryngologists hove accepted their role in the early diagnosis of the deaf and hard of hearing child; however, the social implications and habilitative programs embarked upon may often be regarded as unrelated to the practice of otolaryngology. The otolaryngologist is a key member of the team responsible for early detection and diagnosis, and he must become as involved with the available educational programs as are the other highly qualified competent individuals bringing expertise to the problem. The reason for emphasizing this area is that the otolaryngologist has witnessed a number of major expansions in knowledge which have occurred in the past 15 years. These include: 1. Early identification of deafness through screening programs. 2. Early diagnosis through peripheral and brain stem evoked response audiometry. 3. Improvement in amplification in hearing aids. 4. Earlier placement in educational programs, many of which have been the center of controversy, particularly in the past 15 years. 5. Emphasis on continued research and development of programs such as the Cochlear Implant.

A historical review of deaf education is presented together with an evaluation of the various claims made by the supporters of the auditory‐oral vs. total communication techniques. No totally convincing argument for either system can be advanced. There is considerable doubt that the tri‐stimulus, or total communication approach to teaching of the deaf, has any superiority over the auditory‐oral approach. There are failures with both philosophies and the “deaf voice” is a stigma often associated with either system's graduates.

A 13‐year follow‐up case study is presented in which the child was enrolled in an auditory‐oral program. Comments are made as the child was followed through home training to preschool and on to complete integration in the regular school system. The implications of such a study for the Otolaryngologist, particularly with regard to early identification in order to avoid linguistic delay, are outlined.
Alveolar pyogenic granuloma: Review and report of a case
Authors: Steven Moriconi E. , Popowich L. D.
Published: October 2006

A large exophytic bone‐resorbing lesion was discovered in the oral cavity of an institutionalized 33‐ycar‐old male. An excisional biopsy under general anesthesia was performed. Frozen and permanent histologic sections confirmed a reactive gingival fibroma consistent with a pyogenic granuloma. This lesion is unusual in that it attained a very large size and caused marked remodeling of the alveolar bone of the mandible. Of interest as well, this highly vascular lesion was found to have numerous feeding vessels from the alveolar bone. A retained tooth root was encountered within the lesion, presumably the etiologic factor producing this lesion. A differential diagnosis is presented and discussed. The lesion should be of particular interest to otolaryngologists who deal with intraoral lesions and their treatment, since it illustrates an extreme presentation of a totally benign process.
Nasopharyngeal brain heterotopia – A cause of upper airway obstruction in infancy
Authors: Seibert Robert W. , Seibert Joanna J. , Jimenez Jorge F. , Angtuaco Edgardo J.
Published: October 2006

The finding of mature neuroglial tissue in a mass from the head and neck region of a child raises four differential diagnostic possibilities: teratoma, encephalocelc, glioma, and heterotopic brain tissue. We present a review of the literature and discuss the clinical, radiographical, and pathological features of a rare nasopharyngeal brain heterotopia in an infant causing upper airway obstruction.
Cystic metastasis from occult tonsillar primary simulating branchiogenic carcinoma: The case for tonsillectomy as a “grand biopsy.”
Authors: Marlowe Frank I. , Goodman Roy S. , Mobini Jalal , Dave Uday
Published: October 2006

The occult primary is a problem well known to head and neck surgeons. Less frequently discussed, but well documented, is cystic degeneration of metastatic nodes. When these conditions combine, they can suggest tumor arising in a pre‐existing cervical cyst. This is a controversial condition, rare if it occurs at all, and is not to be invoked lightly.
Visual loss associated with orbital and sinus diseases.
Authors: Manigila Anthony J. , Kronberg Frank G. , Culbertson William
Published: October 2006

Visual loss associated with orbital and sinuses diseases is mainly due to infectious processes, trauma and neoplasm. From 1975 to 1983, we have encountered 34 such cases.

The most common cause in our series was infectious processes, either due to aerobic or anaerobic bacteria or fungi (aspergillosis and phycomycosis). Iatrogenic trauma resulting in complete unilateral irreversible blindness was the second most common etiology in the series of cases that came to our attention for several reasons.

Three of our patients with complete blindness, even with documented absence of light perception, secondary to infections or mucocele, underwent emergency surgical treatment with successful restoration of vision. Other patients with various degrees of visual loss experienced improvement, often to normal levels, when timely appropriate surgical treatment was applied.

Orbital or optic nerve decompression was used according to pathologic findings encountered. High resolution CT scan has been very helpful in precisely pinpointing the lesion. It is also indispensable in the follow‐up of orbital abscesses in order to rule out intracranial complications. Blindness with immediate onset secondary to either external or iatrogenic trauma, with rare exceptions, has a dismal prognosis.

Early diagnosis and prompt treatment are essential for salvage of vision or even lives of patients affected by such dreadful complications.
Twenty‐Five years experience treating Cerebro‐Rhino‐Orbital mucormycosis.
Authors: Abedi Esrafil , Sismanis Aristides , Choi Kwang , Pastore Peter
Published: October 2006

Mucormycosis is an acute fungal disease with high mortality exhibiting craniofacial, pulmonary, cutaneous, gastrointestinal and disseminated forms.

Cerebro‐rhino‐orbital (CRO) mycormycosis is the type that most frequently involves the structures of the head and neck. While usually non‐pathogenic, these saprophytic organisms can be particularly lethal in chronically debilitated patients. Between the years 1957 and 1982, 18 cases of CRO mucormycosis were seen at the Medical College of Virginia Hospital and the McGuire VA Medical Center. Four illustrative cases of CRO mycormycosis are presented to emphasize: the importance of clinical awareness of the disease, the necessity of tissue biopsy for diagnosis, the need of appropriate management of any underlying disorder, administration of amphotericin‐B, and the performance of adequate surgery.
Nonbacterial inflammation as a means of enhancing skin flap survival.
Authors: Liston Stephen L.
Published: October 2006

Painting the skin of the dorsum of a rat with croton oil improved the survival length of caudally based skin flaps. No vasodilation was demonstrated in the deeper layers of skin treated with croton oil. The mechanism by which the application of croton oil leads to improvement of the skin flap survival is thought to be the nonbacterial inflammation produced by the croton oil (a chemical burn). This inflammatory effect probably acts upon the microcirculation via arachidonic acid metabolite mediators.
Occult metastases in cancer of the larynx and their relationship to clinical and histological aspects of the primary tumor: A Four‐Year multicentric research.
Authors: Bocca Ettore , Calearo Carlo , Vincentiis Italo De , Marullo Tommaso , Motta Giovanni , Ottaviani Antonio
Published: October 2006

The authors have tried to verify whether some clinical or pathological features of laryngeal cancer may favor the occurrence of occult metastases in the lymphnodes of the neck in No cases. The purpose of the investigation was to define the possible existence of tumors, where elective neck dissection, in the absence of palpable nodes, could be done without, thus contributing to settlement of a long debated problem.

Different parameters, both clinical and pathological, have been considered. The result of a cross comparison of such parameters in 237 cases of cancer of the larynx without palpable nodes, submitted to surgery on the primary and elective neck dissection, indicates that, although the frequency of occult metastases is significantly related to the site and size of the tumor, its grading, and the degree and type of stromal reaction, the favorable concurrence of all said parameters occurs in 2% of cases only. However, if only clinical parameters, viz. site and size of tumor, are taken into account, a favorable concurrence occurs in 18% of cases with an incidence of occult metastases lower than 2%. These cases are almost exclusively represented by T1No supraglottic and T2N0 glottic tumors. We can conclude by saying that clinical and pathological preoperative findings may offer a useful clue in evaluating the risk of occult metastases, and hence advising, or not, an elective neck dissection in No cases. Nevertheles, in the vast majority of cases, an elective functional neck dissection still offers the best guarantee of oncologic safety while avoiding unnecessary mutilation.