bluuebunny/crossref_metadata_2025 huggingface dataset:
Esophageal Perforation during Esophagoscopy in Children
Authors: Simpson James S. , Ruff Tibor , Fearon Blair
Published: October 2014

Traumatic perforation of the esophagus during esophagoscopy is an ever present danger that can have long lasting or lethal effects. All are agreed on the need for early diagnosis. The question is often asked whether treatment should be nonoperative or operative. The results of management in this series of 21 patients support the opinions of those who advocate early adequate drainage of the mediastinum by means of mediastinotomy or thoracotomy, with support by antibiotic therapy, nothing by mouth and careful observation, if a large perforation is present. In minor perforations conservative treatment alone may suffice but should be accompanied by alert clinical observation.
Tracheostomy or Endotracheal Intubation
Authors: Ferlic Randolph M.
Published: October 2014

Current management of many critically ill and injured patients demands ventilatory support. The option of support through an endotracheal or tracheostomy tube is governed by eight factors: Shape of the tube, area of the cuff, material, illness or injury prompting respiratory support, size of the patient and airway, humidity, activity of the larynx and time involved in support. Review of our own experience and that of others prompts the conclusion that endotracheal intubation is relatively safe, should be used almost exclusively in infants, and is tolerated well by adults for periods to six days. Secondary tracheostomy will be required for adults requiring longer periods of support and those patients in whom secretions are too thick or copious to be managed by suctioning through the endotracheal tube. Obviously, there are some patients whose illness or injury will leave no option as to the route of intubation.
Physiology of Cough
Authors: MacKlem P. T.
Published: October 2014

The effectiveness of cough depends upon the linear velocity of the gas in the airways. Because velocity = flow/cross-sectional area, a high flow and a small cross-section are the ideal conditions for an effective cough. Pleural pressures become positive during cough and compress the large airways producing a marked reduction in cross-sectional area. At high lung volumes, expiratory flow rates are high so that the linear velocities in the trachea are approximately one-third of the speed of sound. The velocity falls in higher bronchial generations, both because the total cross-sectional area of each generation becomes progressively larger beyond the lobar bronchi, and because at high volumes the compressed segment of the airway only extends from the lobar bronchi to the thoracic outlet of the trachea. In normal lungs cough is effective in clearing secretions from these airways only. In chronic bronchitis and emphysema, expiratory flow rates are markedly reduced. Furthermore, in some cases the large airways are more easily compressed than normal. This results in a shorter segment of the airway being compressed. For both reasons, the efficiency of cough is markedly decreased leading to retention of secretions. In cystic and varicose bronchiectasis the problem is different. There is no flow through the bronchiectatic segments because they are blind sacs, and the efficiency of cough is independent of the velocity. To empty them of their secretions is analogous to squeezing toohpaste out of a tube. This is theoretically possible at low lung volumes when the compressed segment is longer.
Superior Vena Caval Obstruction Presenting as Acute Laryngotracheobronchitis
Authors: Hawkins Donald B. , Mikity Victor G. , Battaglia Charles R.
Published: October 2014

A two-year-old child was hospitalized with a diagnosis of laryngotracheo-bronchitis. His airway symptoms, however, were the presenting manifestations of superior vena caval thrombosis around a ventriculoatrial shunt. Subglottic edema obstructed his airway initially; this was relieved by tracheostomy. Later, progressive tracheobronchial compression from the dilated superior vena cava and its collateral vessels almost proved fatal. Removal of the shunt allowed blood to flow through the thrombus. This relieved the patient's severe respiratory distress within hours.
The Nature and Crystal Growth of Otoconia in the Rat
Authors: Ross Muriel D. , Peacor Donald R.
Published: October 2014

Several types of otoconia are present in the macular regions of young rats. These include multifaceted, transitional and rounded body forms, some variant otoconia and a few rhombohedrons. The adult form has typically rounded but nonsmooth body surfaces and pointed ends with three planar faces. The multifaceted and transitional otoconia fracture and etch more readily than do the adult type. The differences in properties of the otoconia are considered in the light of known facts concerning inorganic crystal nucleation and growth. This integrated approach indicates that many otoconia originate by seeding of multiple subunits on an organic substrate and develop by the mechanism of parallel growth. The basic structural unit is the rhombohedron. By analogy to inorganic crystals of calcite, it would seem that the typical otoconium grows on the end faces but growth on the side faces is suppressed by some unknown chemical factor. Some otoconia are exceptions, evidently seeding and growing in the pure rhombohedral form. Decalcification of cleaved otoconia shows that organic material is incorporated during growth. The observations are interpreted to indicate that organic substance influences growth and achievement of the adult otoconial form.
Air Bypass Voice Prosthesis for Vocal Rehabilitation of Laryngectomees
Authors: Taub Stanley
Published: October 2014

An air bypass voice prosthesis and the refinement of a surgical technique has been developed. It involves a one-stage, low retrograde cervical esophagostomy that is functionally and cosmetically feasible since it permits hidden use of the device, while eliminating fistula tract stenosis and aspiration. Most importantly, it provides a natural speech mechanism without any training period. Patients can regain immediate speech following installation of a voice prosthesis with a minimum of maintenance required. Ultimately, they have demonstrated greater self-reliance and developed a high degree of self-esteem which has enabled them to resume a normal way of life.
Permanent Deafness Associated with Furosemide Administration
Authors: Quick Cedric A. , Hoppe Wayne
Published: October 2014

Six cases of hearing impairment have been presented. Furosemide was administered to all of these patients at the time of the alleged onset of the deafness. None of the known or suspected causes of deafness occurring in transplant patients was evident in these cases. With the experimental evidence that furosemide does induce stria damage and the absence of other recognized causes of deafness in this series of patients, furosemide must be considered the etiologic agent responsible for the permanent sensorineural hearing loss. A characteristic audiometric pattern of hearing impairment emerged and a possible explanation for these features has been given. Certain precautionary steps in the use of ototoxic drugs are suggested.
Acrocephalosyndactyly (Apert's Syndrome): Temporal Bone Findings
Authors: Lindsay John R. , Black Franklin O. , Donnelly William H.
Published: October 2014

The otologic manifestation of acrocephalosyndactyly (Apert's syndrome) has usually consisted of bilateral conductive hearing impairment. Invariably, fixation of the stapes footplate has been found at tympanotomy. Manipulation or removal of the stapes has resulted in a copious flow of fluid from the vestibule, suggesting an unusually patent cochlear aqueduct with escape of cerebrospinal fluid. Histologic examination of a temporal bone from an infant with acrocephalosyndactyly showed cartilaginous fixation of the stapes footplate. The lumen of the cochlear aqueduct was not unusually large or widely patent in this case.
Large Tracheal Papillomas: A Difficult Anesthetic Problem and an Apparent Cure
Authors: Cardfn Edward , Ferguson George B.
Published: October 2014

A six-year-old female with papillomatosis of the trachea causing respiratory embarrassment was operated upon under general anesthesia. Utilizing a specially designed anesthetic technique to fit the problem and utilizing a cryoprobe followed by electrodessication, the lesions were removed. Furthermore, simple operative procedures and the use of bovine wart vaccine has, over the course of seven months, resulted in an apparent cure.
Adult Medulloblastoma: Neurotologic Manifestations
Authors: Britton B. Hill
Published: October 2014

Two cases of adult cerebellar medulloblastoma with neurotologic findings are presented. There appear to be several differential diagnostic features to assist the otologist in diagnosis. The importance of thorough diagnostic evaluation seems apparent from review of these cases.
Operative Treatment of Surgical Lesions with Objective Tinnitus
Authors: Ward Paul H. , Babin Richard , Calcaterra Thomas C. , Konrad H. R.
Published: October 2014

This article discusses the importance of the evaluation and diagnosis of objective tinnitus (tinnitus heard by the patient and the physician). Intracranial arteriovenous communications and vascular anomalies are most frequently responsible for the tinnitus and auscultable bruits and are highly amenable to current surgical treatment. While the otolaryngologists may initially see these patients and be responsible for the diagnosis of their problem, the surgical correction of the intracranial lesions is usually the province of the neurosurgeon. Illustrative cases of extracranial causes are presented. Particular emphasis is placed on the diagnosis and treatment of venous hum. Formerly called cephalic bruit and essential objective tinnitus, venous hum is now a recognized nosological entity that is amenable to treatment by ligation of the internal jugular vein.
Cochlear Potentials and Oxygen Associated with Hypoxia
Authors: Lawrence Merle , Nuttall Alfred L. , Burgio Paul A.
Published: October 2014

In the guinea pig, during general hypoxia produced by shutoff of respiratory air, oxygen-sensitive microelectrodes detect a decrease in oxygen concentration in the fluids of the tunnel of Corti before detecting a decrease in scala media oxygen concentration. The present experiments were designed to measure the cochlear microphonic (CM) potential generated by the organ of Corti when vibrated by a microprobe on the basilar membrane along with the oxygen decline in both tunnel and scala media to see upon which source of oxygen CM is dependent. Because oxygen concentration in both areas can decrease considerably before CM is affected, the recovery following a brief period of hypoxia is a more accurate measure. Because CM starts a recovery before scala media oxygen, the positive endolymphatic potential (EP) was also measured to determine its role in the generation of CM. Our interpretation of the course of events is that CM is partially dependent upon oxygen supplied to the extracellular spaces of the organ of Corti by the spiral vessels and upon EP that, itself, is dependent upon several factors. The data indicate that EP plays a more complex role than that of providing a current flow for modulation by a resistance varying with vibration.
Grafting Materials and Methods in Reconstructive Ear Surgery
Authors: Perkins Rodney
Published: October 2014

The evolution of tympanic membrane grafting over the past 20 years has been based on biologic tissues of mesodermal origin which contain a collagen matrix. The dominant theme of this evolution has been the modification of these collagen membranes by physical and chemical agents to achieve a more ideal graft. The graft material and the operation should be suited to specific problems. Current operative techniques and graft materials are discussed. It is believed that there will be continued modification and manipulation of collagen in the future to achieve a more ideal graft for tympanic membrane restoration.
Complications in Acoustic Neuroma Surgery
Authors: Glasscock Michael E. , Hays James W. , Murphy James P.
Published: October 2014

The findings in a series of 80 cerebellopontine angle tumors are presented. Complications and results are covered in detail. A new method of controlling postoperative cerebrospinal fluid (CSF) leak is presented. Care of the eye in postoperative facial paralysis is emphasized, and a new type of moisture chamber is introduced.
Physiology and Pathophysiology of the Lower Esophageal Sphincter
Authors: Castell Donald O.
Published: October 2014

The physiologic factors controlling lower esophageal sphincter (LES) function are interrelated in a complex fashion and include the autonomic nerve supply, gastrointestinal hormones, and specific characteristics of the circular smooth muscle at the esophagogastric junction. It might be expected that a defect in any of these three controlling mechanisms would result in a clinically recognizable symptom complex. Abnormalities with either high or low LES pressure have been shown to relate to these specific aspects. Studies of the effects of various foods and other agents which decrease or increase LES pressure are of therapeutic interest in relating to patients with reflux symptoms. Decreases in LES pressure occurring after fat ingestion may explain a mechanism for many cases of fatty food intolerance. Pressure decreases after chocolate ingestion, after smoking, and after alcohol all have strong therapeutic implications in patients with chronic heartburn. Gastric alkalinization will increase pressure for up to one hour in patients with basal sphincter hypotension and reflux symptoms. Recent studies with drugs that work through the cholinergic mechanism have important therapeutic considerations. Anticholinergic agents produce definite decreases in LES pressure and are to be avoided in treatment of patients with reflux symptoms. On the other hand cholinergic drugs such as bethanechol have been shown to increase LES pressure in normal subjects and in patients with chronic sphincter incompetence. Recently, a double-blind therapeutic trial with bethanechol in patients with chronic heartburn has indicated that this drug, when given on a regular basis, is an effective adjunct to therapy in these patients.
Surgical Management of Severe Lye Burns of the Esophagus by Colon Interposition
Authors: Berkowitz Wallace P. , Roper Charles L. , Spector Gershon J. , Sessions Donald G. , Ogura Joseph H.
Published: October 2014

Thirty-seven patients with severe esophageal and hypopharyngeal burns from lye ingestion are reviewed. Preliminary surgical procedures consisting of gastrostomy, esophagostomy, esophagectomy, and tracheotomy were often performed prior to definitive esophageal bypass with colon interposition. The technical aspects of the two-team approach to colon interposition are described with particular emphasis placed on the cervical anastomosis. Common postoperative complications included aspiration, delayed tracheal decannulation, and restenosis in the anastomotic area. Functional restoration of deglutition and phonation was successful in most cases. Attention is focused on management of early and late complications. Results of colon transposition are discussed with references made to other surgical procedures. Functional evaluation of patients followed over a long period is described.
Transbronchial Lung Biopsy through the Fiberoptic Bronchoscope in Diffuse Lung Disease
Authors: Joyner Lee R. , Scheinhorn David J.
Published: October 2014

Transbronchial forceps biopsy (TBB) of the lung through the fiberoptic bronchoscope was performed in 74 patients. A histological diagnosis compatible with the clinical course, and roentgenographic appearance was obtained in 47 (64%) patients. There were six cases with inadequate tissue and ten cases where TBB was both nondiagnostic and of no other benefit in the subsequent management of the patient. This procedure was of particular value in evaluation of acutely ill patients with diffuse parenchymal disease. TBB either gave a specific diagnosis or correctly influenced patient management in 14 (89%) of 16 acutely ill patients with diffuse parenchymal disease. There was no uncontrollable hemorrhage; in one patient (15%) pneumothorax occurred. The safety and diagnostic value of this technique in the diagnosis of diffuse lung disease is proven.
Evaluation of Major Airway Lesions Using the Flow-Volume Loop
Authors: Hyatt Robert E.
Published: October 2014

The flow-volume (FV) loop is another way of representing spirometric data from combinations of forced expiratory and forced inspiratory vital capacity breaths. The FV loop is of use in identifying, and often localizing, lesions of the larynx and the trachea (down to the carina). Three general patterns have been recognized. When the lesion behaves in a fixed fashion (as might occur with an artificial orifice), maximal expiratory and inspiratory flows are almost equally compromised. This results in a rectangular FV loop, irrespective of whether the lesion is located intrathoracically or extrathoracically. When the lesion behaves in a variable fashion, two distinct patterns are seen, depending on the location of the lesion (intrathoracic or extrathoracic). The variable lesion acts as a fixed lesion during one phase of forced respiration only. The extrathoracic variable lesion results in a predominant reduction in forced inspiratory flow, with little effect on expiratory flow, whereas the intrathoracic variable lesion produces a characteristic reduction in expiratory flow. These patterns reflect the transmural forces existing at the site of the lesion.
Hyoid Autograft Repair of Chronic Subglottic Stenosis
Authors: Finnegan Douglas A. , Wong Matthew L. , Kashima Haskins K.
Published: October 2014

A previously unreported surgical technique has been evaluated for the correction of chronic subglottic (cricoid) stenosis. The principle of skeletal support as the primary means of repair was examined. Severe stenoses were created in sixteen adult, mongrel dogs. One to three months later a hyoid bone autograft on a sternohyoid muscle pedicle was employed for repair. The dogs were sacrificed at regular intervals from two weeks to six months. The majority of the animals maintained a widely patent lumen after repair. Vocal cord mobility remained normal in every case. The results are illustrated by photographs and histologic sections. This study convincingly demonstrates a successful surgical technique for correcting a most difficult laryngeal lesion.
New Approach to Caloric Stimulation of the Vestibular Receptor
Authors: Proctor Leonard R. , Dix Rollin C.
Published: October 2014

A new caloric testing method is described. During continuous aural irrigation, fluid is switched between hot and cold values at times computed according to a mathematical model of heat conduction in the labyrinth area. As a result, the induced temperature difference across the lateral semicircular canal describes an approximately sinusoidal time course, reaching peak values of equal magnitude but opposite sign. The magnitude of the caloric stimulus may be selected by choosing appropriate irrigation durations from a graph or table. Application of the test to clinical subjects demonstrated that the heat conduction model and analysis used in timing the sequence of thermal pulses was accurate. The new procedure causes less patient discomfort and requires less time to complete than does the conventional Fitzgerald-Hallpike test.
Temporal Bone Histopathology of Osteopetrosis
Authors: Suga Fumiro , Lindsay John R.
Published: October 2014

The histopathology of the temporal bone of an eight and one-half-year-old girl with osteopetrosis (Albers-Schönberg disease) was studied to evaluate the pathogenesis of its frequent complications in hearing and facial nerve function. The patient was blind and had acute otitis media, but facial paralysis was not noted. Although the size of the temporal bone pyramid was markedly increased due to enormously thickened periosteal layer, changes in the endosteal and endochondral layers were less marked. Exostotic growth of periosteal bone was seen in the middle ear wall, and the tympanic cavity appeared to be narrowed. At the oval window region, the facial nerve was pushed down towards the stapes due to extreme overgrowth of periosteal bone of the epitympanum, and the superstructure of the stapes was imbedded deeply into the dislocated facial nerve and had strongly compressed it. Although the footplate was free from ankylosis, the crus of the stapes appeared to be immobilized because it was lodged in the facial nerve. Such changes appeared to be the pathogenesis of one form of facial nerve paralysis and conductive hearing loss associated with osteopetrosis.
Secretory Lysozyme of the Human Middle Ear Mucosa: Immunocytochemical Localization
Authors: Lim David J. , Liu Yea S. , Birck Herbert
Published: October 2014

Lysozyme was demonstrated by an immunocytochemical technique in the biopsied mucosa obtained from the promontory of the fifteen patients who had chronic middle ear effusions. Lysozyme was localized in the mucigen granules of the secretory cells, as well as in the specific granules of the polymorphonuclear neutrophilic leukocytes (PMN) and macrophages. The specimens obtained from patients with mucous effusions showed numerous secretory cells that contained lysozyme, in sharp contrast to the serous type in which only a few secretory cells could be found. The present morphological finding was in agreement with the biochemical finding which demonstrated higher lysozyme level in mucous effusions than that of the serous type. It was concluded that human middle ear mucosa provided lysozyme and that its secretion was active in serous otitis media, particularly of mucoid type.
Histopathological Observations of Presbycusis
Authors: Suga Fumiro , Lindsay John R.
Published: October 2014

Temporal bone histopathology of 17 aged patients who had spontaneous and gradually progressive bilateral sensorineural hearing losses associated with aging was studied. Six cases in the present material showed the gradually sloping audiometric curve; nine cases, abrupt high tone hearing loss; and two cases, the flat audiometric curve. The most prominent histopathological change in the inner ear was a decrease in the population of the spiral ganglion cells. However, diffuse senile atrophy was also often seen in the organ of Corti and the stria vascularis. A positive correlation between the degree of arteriosclerosis and the degree of sensorineural degeneration in the cochlea was not obtained in the present cases. Also, the correlation was not found to be consistent between the type of the audiometric curve and the localization of lesions in the sensory, the neural or the vascular elements in the cochlea. Our observations show that a certain type of audiometric curve does not necessarily indicate a lesion in a specific cochlear element.
Labyrinthine Fistula and Tympanoplasty
Authors: Szpunar J.
Published: October 2014

Three interdependent problems have to be solved by a surgeon in each case of middle ear cholesteatoma with a fistula of the horizontal canal: 1) Whether the matrix can be safely removed from fistula or should be left in place; 2) if the matrix is removed, whether the fistula should be covered or not and, in the positive case, by which kind of graft; and 3) whether closed or open tympanoplasty should be performed. In well selected cases the matrix can be safely removed from the fistula and some technique of closed tympanoplasty used. Suitable for this type of surgery are cases of superficial fistula of the horizontal canal, with preservation of the endosteal membrane, where complete removal of the matrix from the tympanic cavity is possible. Very poor hearing and obvious middle ear infection are apparent contraindications. Furthermore, this type of surgery should not be performed on a better hearing ear. If any difficuty in removal of the matrix from the fistula is encountered, the matrix should be left in place. Fistula cases which do not fulfill these criteria should be treated either by open tympanoplasty or by modified radical mastoidectomy, leaving the matrix on the fistula. A small series of five consecutive fistula cases treated by closed tympanoplasty, using intact wall technique or reconstruction of the bony canal wall, with removal of the matrix from the fistula, leaving it bare, is reported after a follow up of three to six years. The results indicate that, in selected fistula cases, this type of surgery seems to bring favorable late hearing results and to create good conditions for closure of the fistula, apparently not presenting any risk to the inner ear.
Posterior Cricoarytenoid as a Speech Muscle
Authors: Hirose Hajime
Published: October 2014

It is well known that the posterior cricoarytenoid muscle (PCA) is the only abductor of the vocal folds, but its role in speech has not fully been clarified. Our recent electromyographic (EMG) studies indicate active participation of PCA in the production of voiceless consonants and breathy phonation in different languages. In the experiments to be reported here, computer-averaged EMG data were obtained from PCA of native speakers of American English, Japanese, and Danish who uttered test words embedded in frame sentences. The results indicated that there was consistent increases in PCA activity for the voiceless portion of the test words. The EMG results were compared to the degree of glottal opening estimated by means of the fiberoptic technique. It was suggested that the degree and timing of PCA activity were directly responsible for determining the size and temporal course of the glottal opening for voiceless segments, although the suppression of the adductors might also have to be taken into consideration for a complete description of voiceless segment production.
Leiomyosarcoma of the Nasal Cavity and Paranasal Sinuses
Authors: Dropkin Lloyd R. , Tang Chik Kwun , Williams John R.
Published: October 2014

A case of leiomyosarcoma of the nasal cavity and paranasal sinuses is presented along with a review of the medical literature. The clinicopathological aspects of this tumor are discussed. The mode of treatment is complete surgical excision with close follow-up due to its high rate of local recurrence. The long-term survival with recurrent disease in this case is unusual.
Mega-Antrum
Authors: Herzon Fred , Antoine John E.
Published: October 2014

Mega-antra may masquerade as destructive lesions of the antral portion of the temporal bone. Awareness of this entity and correlation with the physical and roentgenological examination could prevent surgical exploration of the temporal bone. New upper range size limits can be expected as mega-antra become more commonly identified.
Bilateral Abductor Paralysis
Authors: Woodman DeGraaf , Pennington Claude L.
Published: October 2014

Modifications of the technique originally reported in 1946 are presented, which may help in improving the percentage of successful decannulations. The importance of a change in the level of the vocal cord by this procedure is emphasized. The ten cautions to be followed are reviewed in doing this procedure.
Recurrent Laryngeal Nerve Section for Spastic Dysphonia
Authors: Dedo Herbert H.
Published: October 2014

Spastic dysphonia is a severe vocal disability in which a person speaks with excessively adducted vocal cords. The resulting weak phonation sounds tight, as if he were being strangled, and has also been described as laryngeal stutter. It is often accompanied by face and neck grimaces. In the past it has been regarded as psychoneurotic in origin and treated with speech therapy and psychotherapy with disappointing results. Because of laboratory and clinical observation that recurrent nerve paralysis retracts the involved vocal cord from the midline, it was proposed that deliberate section of the recurrent nerve would improve the vocal quality of patients with spastic dysphonia. In 34 patients the recurrent nerve was sectioned after Xylocaine® temporary paralysis showed significant improvement in vocal quality. Several patients have been advised against this operation because of the type of voice they developed with one vocal cord temporarily paralyzed. With nerve section plus postoperative speech therapy, approximately half of the patients have returned close to a “normal” but soft phonatory voice. The rest had varying degrees of improvement, but all, so far, have been pleased with the improvement in ease and quality of phonation and reduction or elimination of face and neck grimaces. Two men have a breathy component in their phonatory voices, and one woman has variable pitch.
An Implanted Electronic Laryngeal Prosthesis
Authors: Bailey Byron J. , Griffiths Ceri M. , Everett Robert
Published: October 2014

The authors present a preliminary progress report on their investigations dealing with the development of an implanted electronic laryngeal prosthesis system. Their initial observations indicate success in the design and fabrication of the implantable, retropharyngeal transducer and secondary induction coil elements. The surgical procedure for implantation is described, and the complications encountered during the first thirteen procedures are reported. These complications included five seromas, one postoperative abscess, one partial wound breakdown secondary to animal-inflicted trauma, and two anesthetic deaths at the time of follow-up radiographic procedures. Additional observations are presented regarding the acoustical output of the transducer in air and after implantation. Projections are made concerning the use of this laryngeal prosthesis system in human patients for vocal rehabilitation after total laryngectomy.
Dinitrochlorobenzene Skin Sensitization and Peripheral Lymphocyte Count: Predictors of Survival in Head and Neck Cancer
Authors: Maisel Robert H. , Ogura Joseph H.
Published: October 2014

Dinitrochlorobenzene (DNCB) is a simple chemical useful to evaluate both afferent (sensitizing) and efferent (reacting) limbs of the delayed, cell-mediated immune system. This system invokes the small lymphocyte (T cell) and is apparently part of the host defense against cancer. Seventy-two patients with new primary squamous cell carcinomas of the larynx, hypopharynx and oropharynx were sensitized to DNCB by contact application, and delayed cutaneous hypersensitivity tested. The T cells were also assessed in this study by lymphocyte count. All patients were treated for cure. Ninety-one percent of DNCB reactors were alive and tumor-free at two years. Forty-five percent of negative reactors had recurrent tumor and died of carcinoma. Cases grouped by site among glottic, supraglottic and inferior hypopharynx showed identical results. Lymphocyte counts showed a trend in the same direction. On statistical analysis, all differences were significant. Eighty-five percent of recurrent tumors occurred in patients who were nonresponders. The present data suggest DNCB reactivity is helpful in predicting outcome after surgery, or combined radiation and surgery, for mucosal squamous carcinoma of the head and neck.
Osteoplastic Frontal Sinusotomy
Authors: Hardy James M. , Montgomery William W.
Published: October 2014

The operative approach and findings of 250 osteoplastic frontal sinusotomy operations performed from 1956 through 1972 at the Massachusetts Eye and Ear Infirmary are reviewed. Indications for surgery were symptomatic and/or complicated disease of the frontal sinus, including primary chronic sinusitis and osteoma or trauma with or without associated infection. Immediate postoperative complications were minor. Follow-up of at least three years was obtained in 83% of the patients, and 93% of these have no significant symptoms to date. A distressing problem of persistent postoperative frontal pain is discussed in detail. Revision surgery has been performed in 6% of patients due to recurrent frontal sinus infection. The reasons for failure are analyzed, and recommendations are made to minimize the possibility of recurrence.
Tuberculosis of the Larynx Masquerading as Carcinoma
Authors: Naraqi Sirus , Raiser Manfred W. , Richards N. Mark , Andersen Burton R.
Published: October 2014

A patient with laryngeal and pulmonary tuberculosis is described. The similarity between the clinical presentation and gross appearance of laryngeal carcinoma and tuberculosis in this patient and others reported in the literature is emphasized. Laryngeal biopsy is necessary to establish the correct diagnosis, but this must be done only after the proper precautions are taken to reduce the risk of infection to the physician performing the biopsy. Examination of the chest x-ray and acid-fast stain of the sputum are rapid and highly reliable screening tests for laryngeal tuberculosis.
Observations on Laryngeal Disease, Laryngeal Behavior and Voice
Authors: Moore G. Paul
Published: October 2014

This discussion accepted the hypothesis that every laryngeal sound is produced by its unique type of vocal cord vibration. The production of vocal sound is not capricious, it follows certain laws many of which are not known. Research into the behavior of the larynx has produced some interesting and perhaps, useful findings. It was the intention of this paper to describe some of the features of laryngeal behavior as they relate to both phonation and laryngeal disorders in the belief that such knowledge lends itself to the more efficient management of certain vocal and laryngeal problems. The central theme has been that it is laryngeal behavior and not laryngeal disease itself that determines vocal deviation.
Acute Epiglottitis in Infants and Children
Authors: Benjamin Bruce , O'Reilly Brian
Published: October 2014

Sixty-one cases of acute epiglottitis at the Royal Alexandra Hospital for Children, Sydney, from July 1968 to December 1974 are reviewed. The average age of 2.7 years is lower than previously reported. The average time from the initial symptom to arrival at the hospital was 14 hours. The average time from arrival to performance of tracheotomy was two hours. The diagnosis was made when first seen and assessed in 50 of the 61 cases. There were eight respiratory arrests in the Casualty and five of these were successfully resuscitated. We believe that an artificial airway is necessary in most cases, and in this series, tracheotomy was performed, with minimal complications. Particular emphasis is given to diagnosis from the history, and a detailed description is given of physical examination of the oropharynx. Although x-ray examination is usually unnecessary when the diagnosis is in doubt, a plain lateral x-ray may be useful, with due precaution not to increase the respiratory obstruction. We consider that a patient with acute epiglottitis should be transferred immediately to a major pediatric hospital, and that in almost every case an artificial airway should be established.
Tracheal Resection and Mucociliary Clearance
Authors: Giordano Anthony , Holsclaw Douglas S.
Published: October 2014

Mucociliary transport following tracheal resection and end-to-end anastomosis was evaluated in beagle dogs, using the movement of 99MTC labeled sodium pertechnetate solution as a marker. Preoperatively, mucociliary clearance was stable, but a three-fold decrease in tracheal mucus movement was found three days postoperatively. Clearance rates had returned to normal by 31 days postoperatively and remained stable over a ten week period of observation. By histological examination, normal ciliated epithelium was seen within six months following resection and anastomosis. Since up to 25% (4 cm or seven tracheal rings) of tracheal length was removed, significant longitudinal loss can take place without functional impairment of mucociliary clearance. Circumferential narrowing, however, was associated with a significant decrease in clearance.
Newer Techniques in Fiberoptic Bronchoscopy
Authors: Atkins Joseph P. , Rowe Lee D. , Jafek Bruce W.
Published: October 2014

Flexible fiberoptic bronchoscopy has assumed a major role in the diagnosis and management of upper respiratory tract and pulmonary diseases. A new technique, utilizing a C-arm fluoroscopic control with an image intensification system, for the localization of peripheral lung lesions and subsegmental parenchymal infiltrates, is described. This method has proved useful in the early histologic and cytologic diagnosis of nonendoscopically visible bronchogenic carcinoma and in the drainage of lung abscesses. By employing a transendotracheal tube route with a ventilating, side-arm adaptor, continuous airway control and a selected inspired oxygen or anesthetic content is maintained. In addition, the problems of arterial hypoxemia, airway resistance, and ventilation-perfusion abnormalities are minimized. Several representative cases are discussed.
Ultrastructural Cochlear Changes following Acoustic Hyperstimulation and Ototoxicity
Authors: Lim David J.
Published: October 2014

Using guinea pigs and chinchillas as experimental animals, modes and patterns of sensory cell damage by acoustic hyperstimulation and kanamycin intoxication were compared. In general, outer hair cells were more vulnerable to both acoustic trauma and ototoxicity (particularly in the basal turn) than inner hair cells. However, in kanamycin ototoxicity, the inner hair cells were more vulnerable in the apical coil. Nerve endings and nerve fibers generally were resistant to both acoustic trauma and kanamycin intoxication, and their degeneration appears to be secondary to the sensory cell degeneration. A large number of unmyelinated nerve fibers were seen in both the organ of Corti and the osseous spiral lamina even three months after the organ of Corti had been completely degenerated by ototoxicity. The total number of unmyelinated and myelinated nerve fibers in the osseous spiral lamina far exceeded the scanty surviving ganglion cells in Rosenthal's canal, indicating the possibility of regeneration of these fibers following kanamycin intoxication. The remaining few ganglion cells were mainly type II or type III cells, and a majority of the type I ganglion cells appeared to be degenerated. Signs of strial damage were observed in both acoustic trauma and ototoxicity, but their pattern did not correlate well with that of sensory cell degeneration.
Hearing Loss in Patients with Dialysis and Renal Transplants
Authors: Quick Cedric A.
Published: October 2014

Hearing loss in renal dialysis and renal transplant patients occurs quite frequently. An assessment of the likely etiological factors is nearly impossible in a retrospective analysis of any one patient because many factors exist simultaneously. In a prospective study of a large series of patients an identification of factors contributing to the hearing loss was possible in the majority of patients. During the study it became increasingly apparent that what was observed at any one time was the combined effect of many factors. Although one factor seemed to precipitate the hearing loss it was inadvisable to attribute total responsibility to that agent or circumstance. Further, this combined effect was not a simple addition of effects but potentiation. The serious implications of this phenomenon are discussed.
Microfissure between the round Window Niche and Posterior Canal Ampulla
Authors: Okano Yasumasa , Myers Eugene N. , Dickson David R.
Published: October 2014

The microfissure between the round window niche and the posterior canal ampulla was examined in fetal, child, and adult human temporal bones. The communication which was filled with mesenchymal tissue and blood vessels extending from the middle ear, was observed between the round window niche and the posterior canal ampulla in 10 to 15-week human fetuses. The mesenchymal tissue in the communication was replaced by cartilage with advancing age of the fetus. No communication was observed at birth. From newborn to 12 months of age, no microfissure was observed. After one year of age, the microflssure was first observed and the frequency of the observation increased with increasing age of the patient. After six years of age, the microfissure was observed bilaterally in 100% of cases studied. The microflssure has its origin from the communication between the round window niche and the posterior canal ampulla in fetal life, and is a normal developmental and anatomical structure, and not a pathological finding.
End-Organ and Drug-Induced Vestibular Nystagmus
Authors: Dayal Vijay S. , Farkashidy Joseph , Tarantino Leopold , Thibert Roger
Published: October 2014

The occurrence of spontaneous, positional and paroxysmal positional nystagmus was studied in patients with end-organ lesions, and in subjects with drug-induced central vestibular nystagmus. Repeated vestibular examination using electronystagmography for assessment of spontaneous and positional nystagmus in the standard head positions was carried out. The findings indicate that the paroxysmal positional nystagmus is the most frequently seen nystagmus prior to its disappearance in end-organ induced nystagmus and also the most frequently seen in drug-induced nystagmus. The direction changing type of nystagmus was very frequently encountered in end-organ lesions. These findings indicate that the type of horizontal vestibular nystagmus by itself is of no diagnostic value in localizing the site of the lesion and that the various types reflect different degrees of vestibular compensation that occur prior to their disappearance. The value of various classifications of positional nystagmus lies mainly in that they help describe the nystagmus clinically.
Eye — Head Coordination an Observation
Authors: Stroud Malcolm H. , Burde Ronald M.
Published: October 2014

Voluntary or passive head movements in normal and awake individuals with or without visual clues other than prior visual fixation, produce an ocular movement in the same direction as the head movement rather than the expected counter gaze movement.
Ocular Oscillations
Authors: Daroff Robert B.
Published: October 2014

A variety of abnormal ocular oscillations consequent to brain stem and cerebellar dysfunction are described. The brain stem eye signs include: See-saw nystagmus, convergence-retraction nystagmus, down-beat nystagmus, ocular myoclonus, ocular bobbing, and superior oblique myokymia. The “cerebellar system” eye signs discussed are five varieties of nystagmus, square wave and macro square wave jerks, macro saccadic oscillations, ocular dysmetria and flutter, and opsoclonus.
Stapedial Reflex Decay in Retrocochlear and Cochlear Lesions
Authors: Hall C. Mike
Published: October 2014

The procedures for conducting and interpreting Stapedial Reflex Decay (SRD) are discussed. A modification of currently used procedures and interpretations in which testing is conducted at 750 and 1500 Hz as well as 500, 1000 and 2000 Hz is also discussed. Abnormal decay is defined as fatigue to half-life in less than 6.2 seconds. The SRD test patterns of 464 ears with cochlear lesions and 68 ears with retrocochlear lesions are presented and discussed. The findings are strongly supportive of SRD testing using the proposed procedures and interpretations.
Limitations of Parotid Scans
Authors: McGuirt W. F. , McCabe B. F.
Published: October 2014

In 1967, Gates and Work proposed technetium scanning as a diagnostic tool for salivary neoplasms. Since then, many publications have dealt with the results of scanning. The impression has been that it has certain diagnostic implications, especially in regard to the lesion which is radiopositive on the scan. A review of 29 salivary scans from the University of Iowa Hospitals was carried out, and the conclusion reached was that nuclear scanning using technetium gave little assurance of a specific histological entity in any individual case. Cases having both cold and hot nodules ran the gamut from benign and nonneoplastic to frankly malignant lesions. These cases are illustrated, and the conclusion is reached that salivary scanning at its present stage of development may only delay the proper diagnostic step of excisional (at least lateral lobectomy) biopsy for all nondiffuse parotid mass lesions.
Middle Components of the Auditory Evoked Potentials in Infants
Authors: Mendel Maurice I. , Adkinson Cheryl D. , Harker Lee A.
Published: October 2014

Middle components of the averaged auditory evoked potentials (AEP) were recorded from 18 infants, 6 each at one, four and eight months of age, during natural sleep. Tone bursts centered at 1000 Hz were presented from a loudspeaker at 15, 30, 45 and 60 dB HL (re: Normal adult tone burst threshold). In addition, an equal duration no stimulus control AEP was also obtained. Each averaged response consisted of the sum of 400 stimuli presented at a rate of about 6/sec. Latencies and amplitudes of the three peaks, Na, Pa and Nb, were analyzed as a function of age and intensity. There were no significant differences in latency as a function of age, and only peak Pa showed a significant increase in amplitude as a function of increasing age. The latency of peak Pa decreased significantly as a function of intensity, while the amplitude of all three peaks showed significant differences as a function of intensity. Judges' scores of the presence of responses showed that at 60 dB HL, all infants yielded patterns which were scored as “response present.” Smaller percentages of “response present” were scored for the successively lower intensity levels. The results from the 18 infants in this study were similar to those obtained from six normal, sleeping adults tested under identical stimulating and recording conditions in this laboratory.
Equilibrium Disorder in Carbamazepine Toxicity
Authors: Umeda Yoshio , Sakata Eiji
Published: October 2014

Three cases of acute carbamazepine intoxication were evaluated neurotologically and neurologically. Findings included symptoms of equilibrium, gait and speech disorders, drowsiness, gaze nystagmus, depressed optokinetic nystagmus and disturbances of smooth pursuit eye movement. These findings, suggestive of a space-occupying lesion, disappeared after the cessation of the medication. On the basis of the clinical findings it is felt that carbamazepine affects structures within the brain stem and the cerebellum. It is well known that equilibrium disorders caused by anticonvulsant intoxication are due to cerebellar disorders but from our present study it should be noted that they originate not only from cerebellar lesions but also from brain stem lesions.
Hearing Loss from Acute Carbon Monoxide Intoxication
Authors: Baker Shan R. , Lilly David J.
Published: October 2014

A case of fluctuating sensorineural hearing loss from acute carbon monoxide (CO) poisoning with presentation of a U-shaped audiogram is reported. Acute CO intoxication seems to involve vestibular function more frequently than auditory function. Hearing loss is uncommon, but when present, may often display a U-shaped audiometric curve. Decrease in hearing sensitivity probably results from hypoxia to the cochlea, VIII nerve and brain stem nuclei. Fluctuation in hearing sensitivity may be an early manifestation of acute CO exposure, and requires periodic audiometric examination until the hearing has stabilized.
Metabolism of Intranasally Applied Cocaine
Authors: Johns Michael E. , Berman Ann R. , Price John C. , Pillsbury Richard C. , Henderson Robert L.
Published: October 2014

Surprisingly little is known about the metabolism and toxicity of cocaine in man. In this study serum obtained following nasal surgery was assayed for benzoylecgonine (the major metabolite of cocaine) by radioimmunoassay. It was found that cocaine was rapidly hydrolyzed in the serum. Benzoylecgonine was detectable in the serum at 15 minutes. The peak blood level of the metabolite appeared at 4.5 hours with a peak concentration of 872.9 ng/ml. The half time clearance of the metabolite from the serum was 5.5 hours. A discussion of variables which must be considered in deriving, by a scientific method, a maximum safe clinical dose is presented.