bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Facial Nerve Function in Tumors of the Internal Auditory Meatus
Authors: Neely J. Gail , Neblett Charles R.
Published: October 2014

Fifty-five consecutive cases of neoplastic involvement of the internal auditory meatus resulting in ipsilateral retrocochlear auditory dysfunction were reviewed. The majority of these tumors (89%) were solitary schwannomas of the eighth nerve. Eleven percent were other tumors. Preoperative facial paralysis was unusual in eighth nerve schwannomas (6.1%) and much more common in other tumors (66.6%). These data tend to suggest that facial paralysis preoperatively increases the probability that the tumor is other than an eighth nerve schwannoma. Furthermore, facial paralysis resulting from an eighth nerve schwannoma indicates a poorer prognosis for ultimate facial nerve function. The small numbers in this series, though far from conclusive, suggest that normally functioning facial nerves may be infiltrated by eighth nerve schwannomas. Failure of eventual recovery of facial nerve function in the postoperative period may suggest tumor infiltration.
Immune Complexes in Middle Ear Fluid in Chronic Secretory Otitis Media
Authors: Palva Tauno , Lehtinen Tessa , Rinne Juhani
Published: October 2014

Data on 87 patients (113 ears) with chronic secretory otitis media (SOM) are reported. The bacteriological analysis of the middle ear fluid (MEF) revealed Streptococcus pneumoniae in 7% of ears, Hemophilus influenzae in 9%, opportunistic bacteria in 20%, while 64% of the samples showed no growth. Free capsular polysaccharide pneumococcal antigens were found in 5 % of the MEF samples using counterimmunoelectrophoresis (CIEP) with Omniserum containing 83 different pneumococcal polysaccharide types. Heating of the samples to disrupt the immune complexes increased the frequency of positive samples to 27%. These findings, together with the frequent occurrence of S pneumoniae and H influenzae in the nasopharynx, strongly support the opinion that chronic SOM in a considerable number of cases is an immune complex disease.
Subclavian Vein Thrombosis Secondary to Chronic Otitis Media
Authors: Surkin Marc I. , Kessler Scott M. , Green Robert P. , Lucente Frank E.
Published: October 2014

Complications from otitis media and mastoiditis continue to occur despite modern antibiotic therapy. We report a case of lateral sinus thrombosis and extension to the subclavian vein following a chronic otitis media. This is the first such report of this complication. The presentation and management of lateral sinus thrombosis are also discussed.
Evaluation of the Negative Pressure Suction Method in the Cytodiagnosis of Nasopharyngeal Carcinoma
Authors: Hwa Tai Fu
Published: October 2014

A special device for collecting exfoliative cells in nasopharyngeal carcinoma diagnosis by negative pressure suction method is recommended. This device consists of a metallic suction tube with a round tip and a modulator which is connected to a suction pump; it passes via the oral cavity into the nasopharynx to collect exfoliative cells. From March 1973 to July 1977, 824 out-patients were examined with cytology and biopsy in our hospital. Of these, 481 cases were confirmed as nasopharyngeal carcinoma. Among them, 431 were cytology-positive; 453 cases were biopsy-positive. The positive cytology rate was 89.6% and the positive biopsy rate was 94.2%.
Morphological Alterations Affecting the Microvasculature in Nasal Allergy
Authors: Watanabe Kensuke , Watanabe Isamu
Published: October 2014

The fine structure of human nasal blood vessels was studied in 15 nasal allergic patients. Biopsies were taken at different stages after provocation. In the early stage (two minutes after provocation), characteristic alterations of capillaries and venules were congestion, gap formation between two endothelial cells, and swollen vascular endothelial cells. Evidence of locally increased vascular permeability and congestion causing mucosal edema was found. In the late stage (20 minutes after provocation), evidence of congestion disappeared. Vascular dilatation and marked interendothelial cell gaps were observed. In both perivascular space and sometimes in intravascular space, de-granulated eosinophils were observed, suggesting that not only histamine but also lysosomal enzymes in eosinphil granules may be involved in causing increased vascular permeability.
Comparison of Subjective and Radiological Findings during the Course of Acute Maxillary Sinusitis
Authors: Axelsson Alf , Runze Ulf
Published: October 2014

Some of the most common symptoms and signs of acute maxillary sinusitis were graded and compared with the radiological findings during the course of the disease. Four different treatment modes were used in 176 patients. The radiological and the subjective findings did not differ among the groups, which consequently were evaluated as an entity. The radiographic results demonstrated that the healing course during the first 15 treatment days follows an even regression line. The subjective findings show a more marked improvement during the first five days than subsequently, and also a more rapid initial improvement than radiography shows. The cough symptom showed the slowest recovery subjectively and also compared most closely with radiological findings. Patients with sinusitis which did not show an initial healing radiographically also had more marked symptoms the fifth day, and vice versa: Patients who showed less than average healing subjectively also showed a slower healing radiographically.
Primary Squamous Cell Carcinomas of Major Salivary Glands
Authors: Batsakis John G.
Published: October 2014

Primary squamous cell carcinomas of the major (parotid and submandibular) salivary glands are uncommon neoplasms. Statistics contrary to that statement are tainted by the inclusion of mucoepidermoid carcinomas and, in the instance of the parotid gland, by metastatic carcinomas. The true frequency is less than 1% of all tumors in the parotid gland and approximately 4% for the submandibular gland.
Epidermoid Cysts of the Vocal Cords
Authors: Monday Louise A. , Bouchayer Marc , Cornut Guy , Roch Jean Blaise
Published: October 2014

Fifty-three cases of intracordal epidermoid cysts diagnosed, treated and followed from 1972 to 1981 are presented. In the clinical evaluation, special attention must be paid to the type of dysphonia and morphology of the vocal cords at indirect laryngoscopy. The epidermoid cyst is not easily visualized and the examiner must take into account signs like “monochorditis,” slight bulging, unilateral nodule and diminished or abolished vibrations of one of the cords at stroboscopy. Microsurgical excision followed by voice therapy is the recommended treatment. The pathogenesis of these cysts is still speculative. Two theories are discussed: the traumatic theory and the dysembryoplastic theory.
Nasopharyngeal Masses in Adults
Authors: Hopping Steven B. , Goodman Max L. , Keller Jeanne D. , Montgomery William W.
Published: October 2014

Nasopharyngeal masses in adults present a perplexing problem because of the concern for malignancy. A retrospective review of the records, radiographs and biopsy histology of 57 patients presenting in one year with nasopharyngeal masses at the Massachusetts Eye and Ear Infirmary suggests that persistent pain, epistaxis, trismus, or cervical mass are uncommon in patients with benign histology and should alert the clinician to the probability of malignancy. A high index of suspicion on the part of the clinician is essential for the successful recognition of early lesions. The roles of conventional radiography, polytomography, and computed tomography scans are discussed. Patients with malignant lesions are contrasted with those having benign lesions.
Epidemiology of Secretory Otitis Media a Descriptive Cohort Study
Authors: Fiellau-Nikolajsen M.
Published: October 2014

To determine the prevalence, incidence, and course of secretory otitis media in an age-group population, 404 3-year-old children in a town in Denmark were examined at 6-, 8-, and 12-week intervals over a 6-month period. At each of the four examinations approximately 20% of the children had middle ear effusion (MEE); it was found at least once in 42% of the children, and 6% had persistent effusion at all four examinations. Average duration of MEE was 3 months. Since spontaneous recovery rarely occurred when MEE had been present for more than 3 months, active intervention is recommended after the condition has been followed for this length of time. The highly fluctuating course of MEE demonstrated in early childhood has important implications for concepts in pediatric middle ear disease and treatment.
Perception of Sound through Direct Oscillation of the Stapes Using a Piezoelectric Ceramic Bimorph
Authors: Yanagihara Naoaki , Suzuki Katsumi , Gyo Kiyofumi , Araki Hiromasa
Published: October 2014

An ossicular vibrator of original design made from a piezoelectric ceramic bimorph was described. To test its effectiveness, the vibrator was temporarily implanted during tympanoplasty in four selected patients who had suffered extensive damage to the middle ear. By use of a special applicator, the vibrator was connected to either the stapes or the columella and was then excited by pure tone and speech signals. The subjects could hear well with the vibrator and distinguish speech signals. Thus a vibration threshold curve and a vibratory speech discrimination score were obtained. Comparing these with the results of conventional audiometry, the vibrator proved to be a highly efficient sound-conducting device. This study furthermore calls attention to some practical applications of this device, particularly to the possibility of implanting the vibrator as part of an implantable hearing aid.
Auditory Function in Children with Diabetes Mellitus
Authors: Sieger Ann , Skinner Margaret W. , White Neil H. , Spector Gershon J.
Published: October 2014

Fifty-one insulin-dependent diabetics and 13 nondiabetics between the ages of 8 and 21 years, without a history of exposure to noise, ototoxic drugs or ear disease, were evaluated to examine the relation between auditory function and diabetes, diabetic control and diabetic complications. Audiologic assessment included pure-tone audiometry, speech audiometry, impedance measures and brainstem evoked response audiometry. No statistically significant differences in auditory function were noted between insulin-dependent diabetics and normal controls, between the diabetics in good or poor control or between diabetics with or without neurologic or vascular complications.
Hearing Loss after Hemophilus Influenzae Meningitis Follow-up Study with Auditory Brainstem Potentials
Authors: Muñoz Onofre , Martinez M. C. , Benitez-Diaz Luis , Guiscafre Hector
Published: October 2014

Hearing loss was studied prospectively using auditory brainstem potentials in 34 children with Hemophilus influenzae meningitis treated with chloramphenicol and in 36 children with purulent meningitis caused by microorganisms other than H influenzae treated with ampicillin. Our results indicate that high doses of ampicillin are not associated with permanent hearing loss. Moreover, no statistically significant difference was found in the incidence of hearing loss following H influenzae meningitis and that following meningitis caused by other microorganisms, either during the acute phase or in the convalescent period. Neurological damage, when present, was probably located in the inner ear or in the auditory nerve. Finally, early hearing loss in purulent meningitis does not always constitute an irreversible lesion.
Frequency Selectivity and Temporal Processing in Friedreich's Ataxia
Authors: Cacace A. T. , Satya-Murti S. , Grimes C. T.
Published: October 2014

We performed psychoacoustical tuning curves and measured temporal summation in two patients with Friedreich's ataxia to study aspects of frequency selectivity and temporal processing in the auditory system. In the majority of frequencies tested, normal psychoacoustical tuning curves and unimpaired temporal summation functions were obtained. These findings suggest that the processing mechanism responsible for these phenomena is intact.
Middle Ear Disorders in Patients with Alpha1-Antitrypsin Deficiency
Authors: Carlsson Britt
Published: October 2014

As it is not known whether individuals with α1-antitrypsin deficiency show increased sequelae following otitis media, 52 patients with α1-antitrypsin deficiency were studied with respect to history of middle ear disease, presence of irreversible pathologic changes of the tympanic membranes, and hearing ability. The middle ear status was determined on otomicroscopy, tympanometry, and pure-tone audiometry. The frequency of individuals with a history of otitis media was 50%. The frequency of individuals with pathologic tympanic membrane changes was no different from that shown in the results obtained in a Swedish normal population study. Minor conductive hearing losses were found in three patients of which only one was related to a history of middle ear disease. However, the history of acute severe complications from otitis media revealed a higher frequency in those individuals with α1-antitrypsin deficiency as compared to normals.
Gas Absorption in Serous Otitis
Authors: Gimsing Steen
Published: October 2014

Animal experiments have shown that gas absorption can produce a considerable intratympanic underpressure when the gas composition of the middle ear is disturbed. A similar phenomenon was observed in children with serous otitis. In 12 ears with underpressures exceeding — 150 mm H2O, Valsalva inflation or politzerization produced a transient improvement followed by a rapid return to subatmospheric pressures ranging from — 130 to — 300 mm H2O. In four cases with middle ear pressures between — 65 and — 135 mm H2O, the same procedure did not result in any significant underpressures. These findings suggest that inflation of the middle ear in the presence of a deep underpressure serves no purpose. It is also possible that a negative pressure, once established, can be maintained in this way.
Congenital Laryngeal Webs
Authors: Benjamin Bruce
Published: October 2014

Congenital laryngeal web is not as common as has been previously believed, and thorough clinical, radiographic, and endoscopic assessment is needed before any form of surgical treatment is undertaken. It is important to detect associated anomalies in the larynx, the respiratory tract, or in other organ systems. The results of treatment with regard to voice quality are good only in thin, membranous, uncomplicated webs. Treatment for thick webs with or without associated congenital subglottic stenosis remains unsatisfactory.
Sudden Airway Obstruction Due to Pedunculated Laryngeal Polyps
Authors: Hausfeld Jeffrey N. , Yanagisawa Eiji , Pensak Myles L.
Published: October 2014

Acute upper airway obstruction from laryngeal polyps is uncommon. However, a large pedunculated laryngeal polyp, when unrecognized, may produce sudden airway obstruction. The importance of an early diagnosis and treatment is stressed. Primary care physicians, endoscopists, anesthesiologists, and otolaryngologists should be aware of this condition and add it to their differential diagnosis of sudden respiratory obstruction.
Pneumatic Dilatation as the Primary Treatment for Achalasia
Authors: Jacobs Joseph B. , Cohen Noel L. , Mattel Steven
Published: October 2014

Pneumatic dilatation under fluoroscopic control has proven highly successful in the treatment of achalasia. This procedure involves minimal morbidity, local anesthesia is employed, and hospitalization is brief, usually only two days. Surgical myotomy of the lower esophageal sphincter, the Heller procedure, requires a thoracotomy under general anesthesia with its attendant morbidity and at least ten days of hospitalization. In addition, there is a significant incidence of postoperative gastric reflux. We have employed pneumatic dilatation as the sole primary treatment for 30 patients over the last 10 years. The results have been highly successful with marked relief of symptoms and weight gain. Pneumatic dilatation is an effective treatment for achalasia and is recommended as the initial procedure of choice.
Bronchoscopy in the Staging and Evaluation of Head and Neck Carcinoma
Authors: Leipzig Bruce
Published: October 2014

There is no consensus of opinion regarding the use of routine bronchoscopy, either rigid or flexible, to evaluate patients with primary squamous cell carcinomas of the upper aerodigestive tract for the possibility of second synchronous primary cancers. Whereas there is certainty of the effectiveness of this endoscopy in patients with questionable lesions or masses on chest radiographs, the value of this procedure in the face of a normal, unequivocal chest radiograph remains questionable. Six patients with primary carcinomas in the upper head and neck region and normal chest radiographs were among 98 patients evaluated within the past 6 months by triple endoscopy. In three instances, a small (less than 2 cm) lesion was discovered in the tracheobronchial tree, utilizing rigid diagnostic bronchoscopy. In three other patients with positive cytology from bronchial washings, a lung primary carcinoma has not been discovered. These presumed false-positive findings add a watchword of warning. The observation of these patients provides evidence to support the routine panendoscopic evaluation of all patients with squamous cell carcinomas of the head and neck. A valid study to identify subgroups at risk to develop these cancers should be encouraged.
Antibiotics and Steroids in the Treatment of Acquired Subglottic Stenosis
Authors: Supance John S.
Published: October 2014

The efficacy of a combination of systemic antibiotics and a steroid in the prevention of acquired subglottic stenosis (ASGS) was evaluated employing a previously developed canine animal model. Thirty-five healthy, postweanling mongrel puppies aged 5 weeks were each intubated for 14 days with an uncuffed polyvinyl endotracheal tube. Twenty puppies received intramuscular dexamethasone (1 mg) daily, and procaine penicillin (100,000 IU) and dihydrostreptomycin (0.125 g) in two divided doses on the day of intubation and each day thereafter until the completion of the study. The remaining 15 puppies served as a control group and received no medical therapy. Animals from both groups were killed at 5, 7, 12, 15, 20, 30, and 56 days following intubation. Comparative examinations of the laryngotracheal complexes of treated and control dogs showed that there was no significant difference between the two groups in the ultimate degree of ASGS attained, as determined by intraluminal cross-sectional area analysis, or in the extent of the lesion as documented by gross and microscopic histology. This investigation showed that the specific systemic combination of two antibiotics and a steroid used in the study was not efficacious in the prevention of ASGS in a canine animal model; for this reason we question the benefit of analogous medical regimens employed to prevent ASGS in infants and children who require long-term endotracheal intubation.
Three-Dimensional Computer Reconstruction of the Distribution of Neuromuscular Junctions in the Thyroarytenoid Muscle
Authors: Malmgren Leslie T. , Rosen Marc , Gacek Richard R.
Published: October 2014

Microinjections of botulinum toxin have recently been shown to be effective in the treatment of strabismus, and it has also been suggested that microinjections of this myoneural blocking agent might be of value in the treatment of spastic dysphonia. The success of such a microinjection technique would rely on a precise knowledge of the distribution of myoneural junctions in the thyroarytenoid muscle. In view of this potential application as well as the need for such information in reinnervation procedures, we have used computer graphics to reconstruct the three-dimensional distribution of motor end-plates in the thyroarytenoid muscle. Three cat and one human (fresh autopsy specimen) larynges were frozen and sectioned on a cryostat. Serial sections were then processed for the histochemical localization of acetylcholinesterase activity to demarcate the neuromuscular junctions. An X-Y digitizer was used to reference the position of the motor end-plates in each serial section, and the three-dimensional distribution of the neuromuscular junctions was reconstructed on a computer graphics terminal. The results are discussed in regard to their applicability to clinical treatment of spastic dysphonia and other disorders of Phonation.
Compound Action-Potential Tuning Curves in Normal and Acoustically Traumatized Cats
Authors: Shepard Neil T. , Abbas Paul J.
Published: October 2014

Compound action-potential tuning curves, using a forward-masking paradigm, were developed on both a control group and a group of acoustically traumatized cats. Differences observed between the two populations included a decrease in the sharpness of the tip, in the sensitivity of the tip, and/or in the sensitivity of the tail region. Phase-contrast light microscopy was performed on all exposed ears using a celloidin-embedding technique with horizontal sectioning. Whenever an abnormality in an action-potential tuning curve was seen, histological evidence of damage to the organ of Corti in an appropriate region corresponding to the signal frequency was observed. However, several cases of damage to the cochlea were observed with normal tuning curves. Whenever the tip region of the tuning curve was elevated, evidence of damage to all three rows of outer hair cells and to the inner hair cells was seen.
Solitary Lateral Cervical Cyst: Presenting Symptom of Papillary Thyroid Adenocarcinoma
Authors: Tovi Ferit , Zirkin Haim
Published: October 2014

Four cases of lateral cervical cysts in young women are presented. At least three of them proved to be the result of cystic degeneration of cervical lymph nodes containing metastatic papillary adenocarcinoma from the primary neoplasm in the thyroid gland. In each case, these cystic structures were the sole presenting sign of the disease. The significance of cystic metastases from papillary thyroid adenocarcinoma and their relationship to the primary tumor is discussed. The pathogenesis of these cystic metastases, their clinical setting, and differentiation from congenital cysts are emphasized.
Arachnoid Cyst in the Internal Auditory Canal
Authors: Schuknecht Harold F. , Gao Y. Z.
Published: October 2014

An arachnoid cyst of the internal auditory canal causing compression atrophy of nerve trunks was found in each of three human temporal bones. Arachnoid cysts are found in about 0.5% of operations for suspected neoplasm of the internal auditory canal. There is no current method for differentiating intracanalicular neoplasm from arachnoid cysts.
Petrous Apicitis
Authors: Chole Richard A. , Donald Paul J.
Published: October 2014

Although petrous apicitis was a frequent occurrence in the first half of this century, it has become an uncommon disease because of the widespread use of antibiotics for otitis media. In this series of eight cases of petrous apicitis it is evident that petrositis cannot be equated with Gradenigo's triad (otitis, abducens paralysis, and deep pain) since none of the cases manifested with the classical syndrome. Abducens paralysis was seen in only two of the eight cases. Deep facial or ear pain was present in four of the eight cases and appeared to be the most useful symptom in the diagnosis of petrositis. Four of the eight cases were discovered only after previous, unsuccessful surgical procedures. Chronic petrous apicitis may be occult and manifest only after failure to control suppuration by conventional tympanomastoid surgery. When petrositis is suspected, conventional x-ray study may show bone erosion and asymmetric clouding of the petrous tip. Computed tomographic scanning was most useful in the delineation of bone destruction and opacification of the apex. When the diagnosis of petrous apicitis is made, aggressive surgical drainage is indicated.
Hearing Impairments and Vestibular Abnormalities among Children with Subclinical Cytomegalovirus
Authors: Pappas Dennis G.
Published: October 2014

This paper strengthens the importance of neonatal screening in the early identification and etiological specification of hearing loss by demonstrating that subclinical cytomegalovirus (CMV) is the most common viral agent causing sensorineural hearing loss (SNHL) among pediatric patients. Consequently, if hearing impairment is found on neonatal screening, viral studies should be done at once. In addition to a survey of previous literature, these points are presented from a retrospective study of 14 children with SNHL caused by focal CMV. Moreover, vestibular studies are presented which suggest that hearing and vestibular impairments may operate independently of one another or conjointly in patients infected with CMV.
Temporal Bone Fractures and Cholesteatoma
Authors: Freeman Joseph
Published: October 2014

Extralabyrinthine fractures of the temporal bone offer the opportunity for squamous epithelial invasion of the middle ear, petrous pyramid and mastoid air-cell system as a late complication. Cholesteatoma, secondary acquired in this situation, can be very aggressive and difficult to manage surgically, particularly where the temporal bone air-cell system is well developed. Polytomography is extremely helpful in determining the sites of fracture and in fashioning the surgical approach. Three cases are presented to illustrate the problems in diagnosis and surgical management.
Blindness and Lefort III Fractures
Authors: Weymuller Ernest A.
Published: October 2014

Injuries to the nasal frontal complex involve a moderately high degree of optic nerve trauma. This paper reviews opinions from notable experts in the field of maxillofacial trauma on appropriate management for acute facial fractures involving injury to the optic nerve and causing blindness in one eye. The opinions are mixed, but the overall attitude is one of conservatism. It is concluded that the weight of opinion supports a conservative approach consisting of external fixation without mobilization of the fractures, and a delayed cosmetic repair.
Obliteration of the Mastoid in the Treatment of Tumors of the Temporal Bone
Authors: Nadol Joseph B. , Schuknecht Harold F.
Published: October 2014

A retrospective analysis of 29 cases of squamous cell carcinoma of the external and middle ear and 15 cases of glomus jugulare tumors of the middle ear was performed to evaluate the incidence of osteoradionecrosis of the temporal bone following surgery and/or radiotherapy. Osteoradionecrosis occurred in 42% (8/19) of cases of squamous cell carcinoma which were treated with radical mastoidectomy, lateral or subtotal temporal bone resection leaving an open cavity and followed by an average of 5,840 rad postoperatively. No osteoradionecrosis, wound breakdown or otorrhea occurred in another group of six patients who were treated by surgical exenteration, total cavity obliteration, and an average of 5,700 rad of postoperative radiotherapy. Thus, cavity obliteration significantly decreased the incidence of these complications (p<0.05). In contrast, in 15 patients treated by surgery and postoperative irradiation (average dose = 4,610 rad) for glomus jugulare tumors, no osteoradionecrosis occurred despite use of an open cavity technique.
Reliability of a Measure of Eustachian Tube Function in Normal Subjects
Authors: Spitzer Jaclyn B. , Newman Craig W.
Published: October 2014

Short-term reliability of a tympanometric pressure-swallow technique for assessing eustachian tube (ET) ventilating efficiency was measured in 20 normals with intact tympanic membranes on otoadmittance and impedance instruments. Tympanograms were examined for middle ear pressure and amplitude after a swallow maneuver and manipulation of ear canal pressure in a repeated measures design. Test-retest correlations were examined for both pressure shift and amplitude. Poor reliability was obtained for pressure measures with otoadmittance, while high reliability was observed for pressure values on impedance trials and amplitude for both instruments. Findings suggested significant probability of misclassification of normals for repeated measures of ET efficiency, using the currently accepted criterion for minimum pressure shift.
Neurilemmomas of the Facial Nerve Presenting as Parotid Tumors
Authors: Balle Viggo H. , Greisen Ole
Published: October 2014

Two cases of rare benign facial neurilemmomas are presented. In both cases the only complaint was a parotid mass and both patients had normal facial function. The true nature of the tumors was not discovered before operation. Repeated fine-needle aspiration biopsy did not contribute to a correct preoperative diagnosis. In both instances the facial nerve had to be sacrificed and free autogenous nerve grafting was done.
Analysis of Glycoproteins from Nasal Polyps and Papillomas by Affinity Chromatography
Authors: Fukuda Katsunori , Matsuyama Hirofumi , Fukami Kohzo , Ozawa Masayuki , Muramatsu Takashi , Ohyama Masaru
Published: October 2014

Glycoproteins were isolated from the particulate fraction of four nasal polyps and three nasal papillomas by affinity chromatography on lectins conjugated with agarose (Concanavalin A [Con A], wheat germ agglutinin [WGA], Ricinus communis agglutinin [RCA], peanut agglutinin [PNA], and Dolichos biflorus agglutinin [DBA]). The glycoprotein mixtures so isolated were then analyzed by sodium dodecyl sulfate gel electrophoresis. Glycoprotein profiles of nasal polyps were similar to each other, but were distinctively different from those of nasal papillomas. Binding sites for Con A, WGA, and RCA isolated from nasal papillomas contained intense bands with a molecular weight less than 15,000 daltons, which were absent in nasal polyps. The major component of PNA-binding sites of nasal polyps is of a molecular weight of 65,000 daltons, which was not detected in nasal papillomas.
Histologically Proven Cochlear Otosclerosis with Pure Sensorineural Hearing Loss
Authors: Balle Viggo , Linthicum Fred H.
Published: October 2014

This paper discusses cochlear otosclerosis without stapedial fixation as a cause of sensorineural hearing loss. Because many cases of cochlear otosclerosis may remain undiagnosed, we believe that patients with a progressive sensorineural hearing loss and a family history of cochlear otosclerosis should be suspected of having cochlear otosclerosis. A positive stapedial reflex on-off effect or polytomographic findings help make the diagnosis. We prescribe sodium fluoride, calcium, and vitamin D for these patients in an effort to prevent progression of the loss.
Monitoring Auditory Evoked Potentials during Acoustic Neuroma Surgery
Authors: Levine Robert A. , Ojemann Robert G. , Montgomery William W. , McGaffigan Patricia M.
Published: October 2014

By recording cochlear, auditory nerve, and brainstem potentials while monitoring acoustic neuroma (vestibular schwannoma) surgery, different patterns of changes occur that suggest different causes for the hearing loss. Having identified the putative mechanism of the hearing loss, suggestions are made about how such hearing loss might be avoided.
Comparison of Two Cochlear Implant Speech-Processing Strategies
Authors: Clark Graeme M. , Tong Yit Chow , Dowell Richard C.
Published: October 2014

Speech processors extracting either the fundamental frequency (F0) alone, or the fundamental frequency combined with second formant information (F0-F2), have been evaluated on a totally deaf patient using a multiple-channel cochlear implant. A closed set test using 16 spondees and a modified rhyme test showed that for electrical stimulation alone the F0-F2 speech processor was significantly better than the F0 processor. The open set tests using phonetically balanced words and Central Institute for the Deaf everyday sentences showed that for electrical stimulation alone and electrical stimulation combined with lipreading, the results with the F0-F2 speech processor were all significantly better than with the F0 processor. Information transmission for consonant speech features was also better when using the F0-F2 processor.
Frequency Dependence of Effective Nasal Resistance
Authors: Fullton J. M. , Fischer N. D. , Drake A. F. , Bromberg P. A.
Published: October 2014

Forced random noise techniques were used to characterize the effective resistance of the nasal passages in normal subjects and subjects who were candidates for surgical correction of nasal obstruction. The slope of the effective resistance curve was characterized by the average resistances over 3 to 5 Hz and 13 to 15 Hz. Subjects with nasal obstruction had effective nasal resistance curves which were more frequency-dependent than those of normal subjects (p< 0.05). A mathematical model consisting of two series resistance-inertance elements in parallel was used to simulate the nasal passages. With this model we were able to generate effective resistance curves similar to those measured in both normal and obstructed subjects. The forced random noise technique may be a convenient, noninvasive technique for studying the fluid mechanical properties of airflow in the nasal passages and the effects of pharmacological and surgical interventions on nasal resistance.
Epidermal Langerhans Cells in Cholesteatoma
Authors: Gantz Bruce J.
Published: October 2014

The function of the epithelial component of a cholesteatoma has been the subject of intense research. The epithelium does not appear to have proteolytic enzyme activity, yet when it is present, increased amounts of bone resorption occur. Recent evidence suggests that epidermal Langerhans cells within epithelium have an immunologic alerting function. These cells were identified in normal tympanic membranes, canal skin, and cholesteatoma. The Langerhans cells in cholesteatoma displayed morphologic features similar to a contact hypersensitivity state. Langerhans cells within the epithelial matrix of the cholesteatoma may be responsible for generating and maintaining the chronic inflammatory reaction which induces bone resorption in this disease.
Scalene Node Biopsy in Diagnosis of Intrathoracic Diseases
Authors: Felisati Dino , Bianchi Claudio , Giobbi Aldo , Sabolla Luciano
Published: October 2014

Scalene node biopsy (SNB) still represents a useful diagnostic method in the difficult interpretation of hilar-mediastinal adenopathies. Of 858 sample cases of intrathoracic pathologies of various etiology, SNB indicated a high histological degree of positivity in sarcoidosis in stages I and I + II (86%) and in malignant lymphomas (91%). As a result, the authors believe that when faced with a process of localization prevailing in the hilar-mediastinal lymphatic system, the SNB is a preferable treatment and should be performed before a mediastinoscopy.
Calcific Tendinitis of the Longus Colli Muscle
Authors: Kaplan Michael J. , Eavey Roland D.
Published: October 2014

Facility in the evaluation of the cervical prevertebral soft tissues should be a skill of any otolaryngologist. Tendinitis of the longus colli muscle mimics more serious disease processes of the prevertebral cervical region that the otolaryngologist may be required to evaluate. It has, however, received little attention in otolaryngological literature. Five cases from the Massachusetts Eye and Ear Infirmary are presented. Calcific tendinitis of the longus colli muscle is an easily recognized clinical and radiological syndrome. Characteristic features include cervical pain, dysphagia, and distinctive radiographs. The pathognomonic lateral neck film reveals prevertebral soft tissue swelling and an amorphous radiodensity anterior to the C-1 and C-2 vertebral bodies. Symptoms usually manifest over a few days and resolve benignly within 2 weeks.
Temporal Bone Pathology in Digeorge's Syndrome
Authors: Ohtani Iwao , Schuknecht Harold F.
Published: October 2014

DiGeorge's syndrome is characterized by partial or complete absence of the parathyroid and thymus glands and is often associated with other developmental anomalies, particularly of the structures arising from the third and fourth pharyngeal pouches. The temporal bone findings in three cases of DiGeorge's syndrome are presented. Patients with this condition have a high incidence of Mondini dysplasia in both ears, sometimes with other anomalies of the external or middle ears. Hearing may range from normal to profound deafness and may manifest sensorineural, conductive, or mixed losses of varying degrees.
Bilateral Otorrhagia and Orbital Hematoma Complicating Subgaleal Hematoma
Authors: Okafor B. C.
Published: October 2014

A patient with bilateral otorrhagia and orbital hematoma following massive subgaleal hematoma is reported for the first time. The pathogenesis of the extensive subgaleal hematoma as well as the production of these unusual complications is discussed. This case would suggest that the weakest points in the attachment of the epicranial aponeurosis to the base of the calvarium are its attachments to the squamous part of the temporal bone and to the frontal bone under the eyebrow.
Staging of Cervical Lymph Node Metastasis
Authors: Johns Michael E. , Neal Danny A. , Cantrell Robert W.
Published: October 2014

In 1977 the American Joint Commission (AJC) revised its system for classification of cervical lymph node metastasis producing a variation from the staging system of the International Union Against Cancer (UICC). A review of 356 evaluable patients was carried out to determine if the AJC or UICC system was prognostically superior. The primary sites of study were the supraglottic larynx in 181, tonsil in 98, and pyriform sinus in 77. All cases were staged using both the AJC and UICC criteria. All demographic, treatment, staging, and survival data were coded for computer entry and analysis. Pairwise comparisons were made for each possible N-class combination using the method of Lee and Desu. For the UICC, statistical difference was detected only between the absence or presence of cervical metastasis but did not statistically differentiate between N1, N2 or the N3 groups. The AJC system on the other hand was highly statistically discriminative between classes. Of 15 possible pairwise comparisons, two were not significantly different. The AJC system appears to be significantly more discriminative than the UICC system.
Tracheotomy versus Intubation
Authors: Alberti P. W.
Published: October 2014

The early history of tracheotomy and intubation is reviewed. Both techniques evolved to their modern formats during the 19th century stimulated by the need to treat diphtheria epidemics. Development of technical aspects of tracheotomy during the first half of the 19th century, and of endotracheal and endolaryngeal intubation in the latter part, are reviewed.
Blunt Chest Trauma with Tracheobronchial Rupture
Authors: Pratt Loring W. , Guite Leander A. , Smith Richard J. , Tryzelaar Joan F.
Published: October 2014

The unusual complex of physiological problems associated with rupture of the tracheobronchial tree complicating blunt chest trauma is discussed. The mechanics of injury leading to rupture are abrupt compression of the chest with consequent fixation of the cervical trachea where it enters the mediastinum, separation of the lungs, and fracture of the bronchus over the vertebral bodies. Treatment by aspiration thoracentesis, tracheotomy, and thoracotomy with primary repair as well as expectant therapy are discussed. Two cases, one treated expectantly and one treated by thoracotomy, both with complete recovery, are presented.
Histopathology of Neurosensory Deafness in Sarcoidosis
Authors: Babin Richard W. , Liu Chan , Aschenbrener Carol
Published: October 2014

Sarcoidosis is an idiopathic systemic granulomatous disease which occasionally causes fluctuating auditory and vestibular dysfunction. The temporal bones from a 32-year-old man deaf for 5 years from CNS sarcoidosis were examined histologically and compared with other nervous system tissues. It was found that the acoustic, vestibular, and facial nerves were involved in a striking perivascular lymphocytic infiltration resulting in myelin and axonal degeneration. The cochlear and labyrinthine neuroepithelium and stria vascularis had degenerated. It is hypothesized that neurosensory deafness and vestibular dysfunction in sarcoidosis starts as a reversible neuropathy. In some patients, an ischemia secondary to the vasculitis results in irreversible damage to the inner ear neuroepithelium.
Electroneurographic Evaluation of the Facial Nerve
Authors: Gantz Bruce J. , Holliday Michael , Gmuer Arnold A. , Fisch Ugo
Published: October 2014

Electroneurography (ENoG) is emerging as a useful clinical tool in evaluation of acute facial nerve paralysis. The method of test performance can have an influence on the test results. This paper describes in detail the method used to perform ENoG at the University of Zurich. The variables that affect the results and methods of avoiding technical problems are emphasized. If ENoG is to be used clinically, the examination should be performed in a manner similar to that described in reports from this institution.
Respiratory and Alimentary Relations in Staged Human Embryos
Authors: O'Rahilly Ronan , Müller Fabiola
Published: October 2014

The early development of the digestive and respiratory systems is summarized in relation to embryonic staging. It has frequently been emphasized that the digestive and respiratory tubes do not arise from a common chamber, that they pursue separate courses as soon as the lung bud appears, that a mesenchymal septum comes to intervene between them, and that the two tubes rapidly acquire independent outer coats. Some commonly held views such as the supposed caudorostral separation of the trachea from the esophagus, have been shown to be incorrect. These ideas often arose from the use of unstable landmarks during development. It is pointed out that, for 3 weeks after its appearance, the tracheoesophageal separation point remains at a constant level, whereas the tracheal bifurcation descends. The application of valid embryological data to the interpretation of several congenital anomalies has been shown to be of value. Although the modes of origin in some instances are still obscure, considerable advance has been made in understanding the timing of the relevant events.
Anterolateral Extrapharyngeal Approach for Cervical Osteophyte-Induced Dysphagia
Authors: Sobol Steven M. , Rigual Nestor R.
Published: October 2014

While it is estimated that hypertrophic cervical osteophytes occur in up to 20% to 30% of the population, they are only rarely associated with dysphagia. Pathophysiologically, dysphagia may occur secondary to 1) mechanical compression with partial obstruction, or 2) periesophageal inflammation caused by pharyngoesophageal motion over the osteophytes. A careful history, indirect laryngoscopy, cineesophagography, and lateral cervical spine films establish the diagnosis in most patients. While routine rigid endoscopy is potentially hazardous in view of the recognized risk of inadvertent pharyngoesophageal perforation, it may be necessary in selected patients to rule out the presence of other more common causes of dysphagia. Conservative management consisting of sedation, antiinflammatory medication, and reassurance is often sufficient in patients with only mild to moderate and often transient symptoms. The value of surgical therapy for this disorder has been debated, but most agree that surgical excision is appropriate in selected patients whose symptoms are severe and progressive. In this report, two patients illustrate the dichotomy between and value of both conservative and surgical approaches. While both transoropharyngeal and transcervical extrapharyngeal surgical approaches have been used, a comprehensive review of the results of such procedures has not been reported. In this report a detailed description of the anterolateral extrapharyngeal approach for the excision of these osteophytes is given, and its value compared to other surgical techniques discussed.
Effects of Influenza Infection, Aspirin, and an Arginine-Deficient Diet on the Inner Ear in Reye's Syndrome
Authors: Rarey Kyle E. , Rush Nancy L. , Davis Julie A. , Deshmukh Devendra R.
Published: October 2014

The individual effects of an influenza B viral infection, aspirin, and an arginine-deficient diet on the inner ear were assessed in the ferret model for Reye's syndrome using both functional and morphological parameters. Auditory brainstem evoked responses recorded from inoculated ferrets revealed threshold elevations and increased latencies during the first 72 hours, but approximated those of control animals by 96 hours. Although there was a mild distention of Reissner's membrane, no pronounced structural alterations in sensory or supporting cells were observed in cochleas from inoculated ferrets. The administration of aspirin appeared to alter neither the functional nor the structural integrity of the cochlea. The presentation of an arginine-deficient diet, creating a hyperammonemic condition, led to both altered auditory evoked responses and vacuolization of cochlear tissues after treated animals had undergone seizures and coma. These data demonstrated that both influenza B and the arginine-deficient diet individually affected the hearing of treated animals. The individual agents did not alter the cochlea as severely as when they were presented in combination. These results suggest that hearing impairment in patients with Reye's syndrome may be a result of potentiation of certain metabolic-altering agents.
Neurotrophic Interactions during in Vitro Development of the Inner Ear
Authors: Van De Water T. R. , Ruben R. J.
Published: October 2014

The objective of this study was to explore the hypothesis that developing labyrinthine sensory receptors attract ingrowing neurites by chemotaxis. Cocultured otic explants which shared a single statoacoustic nerve (VIIIn) ganglion were explanted from 11-, 12.5-, and 14-day-old mouse embryos. Heterotypic ganglion explants consisted of 12-day-old otic explants which had their VIIIn replaced by a 10.5-day-old trigeminal nerve (Vn) ganglion. All cultures were grown to the equivalent of 20 days of gestation. Neurites of the (+) VIIIn explants grew into the sensory areas of both the (+) and (-) VIIIn cocultured explants. Neurites of the 14-day-old cocultured otic explants were only found in association with sensory areas within the (+) VIIIn explant. Neurites of nerve V of the heterotypic ganglion explants were found in association with the sensory areas of these otic explants. These results support the hypothesis that a limited period of chemotaxis (nonspecific in nature) is a possible mechanism for the establishment of the pattern of neurite ingrowth to the areas of the inner ear sensory receptors.
Infratemporal Approach to Skull Base for Glomus Tumors: Anatomic Considerations
Authors: Farrior Jay B.
Published: October 2014

Modifications in the current techniques of infratemporal fossa surgery for large glomus tumors arising from the jugular bulb can reduce the postoperative cranial nerve deficits and preserve serviceable hearing without compromising tumor removal. Glomus tumors arising from the jugular bulb tend to involve the temporal bone and vasculature of the skull base medial to the vertical facial nerve. By approaching these tumors from below, it is possible to preserve the cochlea, eustachian tube, and middle ear structures, and still obtain complete tumor removal. The surgical technique and experience in using this approach for the removal of glomus tumors from the temporal bone, petrous apex, carotid artery, jugular bulb, and infratemporal fossa are reviewed.
Fibrous Dysplasia of the Temporal Bone
Authors: Nager George T. , Holliday Michael J.
Published: October 2014

Fibrous dysplasia is a fairly common, well demarcated, misdifferentiation of the bone-forming mesenchyme affecting a single, several, or many bones, in which skeletal changes are the salient feature, but in which certain endocrinopathies, abnormal pigmentation of skin and mucous membranes, and occasionally other abnormalities form part of the entire disease process. The clinical and pathological aspects of the disease and its involvement with the temporal bone have been previously discussed. Two recent case histories are added here.