bluuebunny/crossref_metadata_2025 huggingface dataset:
Meniére's Disease and Endolymphatic Hydrops Clinical-Histopathological Correlations
Authors: Fraysse Bernard G. , Alonso Antonio , House William F.
Published: January 2017

The clinical-histopathological correlation between Menière's disease and endolymphatic hydrops was done to explain, as much as possible, causes of symptoms of Menière's disease. Twenty-three temporal bones with endolymphatic hydrops from 17 patients were reviewed and clinical and histopathological findings were correlated. Histopathological examination revealed frequent, severe deformities in the labyrinthine walls and permanent changes in Reissner's membranes. Evidence of rupture was difficult to assess. Of 21 ears of patients with the clinical diagnosis of Menière's disease, 93% had endolymphatic hydrops. A statistical correlation between increased area of the cochlear duct and hearing loss was found. Some correlation was also found between frequency of vertigo and results of electronystagmography with histopathological findings. Consequently, the mechanical effect of endolymphatic hydrops seems to have greater significance in the production of symptoms of Menière's disease than the biochemical effect of ruptures. In a review of ten unusual cases from this series of 17 patients, traumatic neuromas or remnants of vestibular structures were found after an incomplete labyrinthectomy. Histopathological findings of four patients who had undergone endolymphatic subarachnoid shunt surgery are described.
Vitamin A-Induced Ear Malformations in Rats as a Model for Analysis of Atresia Auris Congenita a Microsurgical and Histological Study
Authors: Weidenbecher Manfred
Published: January 2017

Teratogenic damage was induced in pregnant Wistar rats with an overdose of vitamin A to clarify the genesis of the atresia plate, the behavior of the facial nerve, and the rotation of the middle ear. Results suggested that contradictory statements in the literature concerning the atresia plate could be explained in the following way: the plate does not arise from a single branchial arch. The os tympanicum, the pars squamosa of the temporal bone, and the hyperplastic labyrinthine capsule share in its formation. Findings similar to the human atresia auris congenita, such as malformation of the auricle, atresia of the external ear canal, and changes in the ossicles and lumen of the middle ear space, were obtained. A cranial and labyrinthine dysmorphia leads to rotation of the middle ear and a walling-in of the facial nerve, which explains its functional disturbance. Extreme variations in the course of the facial nerve were not found. In 62 cases of severe human ear malformation, the operative findings corresponded to the experimentally produced ear malformations.
Microbiology and Antimicrobial Treatment of Otitis Media
Authors: Klein Jerome O.
Published: January 2017

Appropriate choice of antimicrobial agents for therapy of otitis media (OM) is based on an understanding of the microbiology of the acute and chronic diseases. The results of studies of bacteriology of OM are very similar: Streptococcus pneumoniae and Hemophilus in fluenzae are the most important pathogens; Gram-negative enteric bacilli are isolated from middle ear fluids (MEF) of approximately 20% of infants to 6 weeks of age; group A β-hemolytic Streptococcus and Staphylococcus aureus are infrequent causes of otitis. Preliminary results suggest that anaerobic bacteria are responsible for some episodes of OM. Viruses and mycoplasma are infrequently isolated from MEF but Chlamydia trachomatis appears to be a significant cause of OM in young infants. Recent studies of asymptomatic children with persistent MEF indicate that bacterial pathogens are present in some of these fluids. The significance of these results is uncertain, but they suggest that the persistent effusion may be a result of prolonged infection or may be an immune response to bacterial antigens. Based on the bacteriology, amoxicillin or ampicillin are the currently preferred drugs for initial treatment of otitis media. For the child who is allergic to penicillins, cefaclor or erythromycin combined with a sulfonamide or trimethoprim-sulfamethoxazole are satisfactory alternatives. The current incidence of ampicillin-resistant H influenzae responsible for OM is low but if the patient does not respond to initial therapy with ampicillin or amoxicillin, infection with a resistant strain of H influenzae should be considered and a change in therapy to include a sulfonamide, trimethoprim-sulfamethoxazole or cefaclor is appropriate.
Auditory Brainstem and Middle Latency Responses
Authors: Kavanagh Kevin T. , Harker Lee A. , Tyler Richard S.
Published: January 2017

Auditory brainstem (ABR) and middle latency responses (MLR) were recorded for ten normal subjects. Changes in wave latency were recorded with high- and low-pass filtering using Butterworth filters with standard phase-shift characteristics. When an open filter (15–3,000 Hz) was used, waves IV, V and VI of the ABR were superimposed on wave Pø of the MLR. A positive (P) wave was recorded in the trough of wave Na as the high-frequency cutoff of the recording bandpass (15–100 Hz) was raised above 100 Hz. Wave P divided Na into two parts. The first trough was the slow-negative response and the second was Na2. The origin of the P wave is unclear but may represent a muscle potential. Because of previous inconsistencies in the waveform identification used with these recording techniques, the authors present a modified method of classification which accommodates changes in waveform appearance that occur with different response filtering.

The thresholds for various waves of the auditory brainstem (ABR) or middle latency response (MLR) were determined to a 500-Hz tone pip in ten normal listeners in a variety of recording filter bandwidths. Wave V (recording filters 100–3,000 Hz) had a threhsold of 26 dB nHL. Wave SN (30–3,000 Hz) had a threshold of 18 dB nHL. Waves Na, Pa and Nb had thresholds of 10 to 11 dB nHL. The threshold for waves Na, Pa and Nb were unaffected by changing the recording bandpass from 15–100 Hz to 15–3,000 Hz. The ABR amplitude increased when the recording filter's low-frequency cutoff was lowered from 100 to 15 Hz (high frequency cutoff, 3,000 Hz). This augmentation is probably due to the inclusion of the lower frequency energy of wave Pø. Lowering the recording filters high-frequency cutoff from 3,000 to 100 Hz (low-frequency cutoff, 15 Hz) resulted in exclusion of the higher frequency ABR but did not elevate response threshold. In all listeners tested, the MLR had a lower threshold than the ABR to a 500-Hz tone pip. It is suggested that the MLR has good potential for use in evaluation of low-frequency threshold.
Click-Evoked Gross Potentials and Single-Unit Thresholds in Acoustically Traumatized Cats
Authors: Pettigrew Alastair M. , Liberman M. Charles , Kiang Nelson Y. S.
Published: January 2017

Click-evoked gross potentials were recorded from the round windows of 29 cats previously exposed to high-level sounds. The latency and amplitude of the gross neural components of these responses were determined and compared with the patterns of threshold shift measured in single auditory nerve fibers from the same 29 animals. Both of these electrophysiological measures were compared with the patterns of hair cell loss as seen in celloidin sections through the temporal bone. The correlations between single-unit abnormalities and cochlear pathology in these cases have been documented elsewhere. In this report, the correlations between gross-potential abnormalities and cochlear pathology are examined. The diagnostic potential of these correlations is discussed.
Histology, Pathogenesis, and Treatment of Cholesteatoma
Authors: Abramson Maxwell , Moriyama Hiroshi , Huang Cheng Chun
Published: January 2017

Factors present in cholesteatoma connective tissue induce bone resorption in chronic otitis media. The presence of skin and its products appears to exacerbate the destructive influence of connective tissue. One exacerbating factor is pressure, shown in an animal model to increase bone resorption by influencing the subepithelial connective tissue. Consideration of pathogenic factors provides a rationale for modifications in the treatment of middle ear cholesteatoma.
Labyrinthine Fistula in Chronic Mastoiditis
Authors: McCabe Brian F.
Published: January 2017

A series of 79 otic capsule fistulae occurring in 792 consecutive cases of chronic mastoiditis undergoing mastoidectomy was analyzed. The incidence (10%) is the same as in other large series, the primary difference being the location of the fistula. In all series cited, 90% of fistulae were in the lateral semicircular canal whereas in this series the comparable incidence was 75%. The 20 (25%) fistulae located in areas other than the lateral semicircular canal enabled us to document a method of “reading” the fistula test preoperatively to establish its precise location. Eye responses to the test and the fistula site were entirely consonant with the physiology of the vestibular system. The location of the fistula, in other words, can be reliably predicted by the eye movement. Clinicopathologic correlates are cited.
Type II Collagen-Induced Autoimmune Inner Ear Lesions in Guinea Pigs
Authors: Yoo T. J. , Tomoda K. , Hernandez A. D.
Published: January 2017

Guinea pigs immunized with type II collagen developed histologic changes resembling those observed in patients with sensorineural hearing loss associated with connective tissue diseases. The histologic changes observed in the inner ears of these guinea pigs included spiral ganglion cell degeneration, atrophied organ of Corti, atrophy of stria vascularis, and mild extension of Reissner's membrane. These pathologic changes were accompanied by both humoral and cell-mediated immune responses directed against type II collagen — a collagen found in the subepithelial layer of the endolymphatic duct and spiral ligament. These findings suggest that an immune response directed against type II collagen can induce inner ear lesions.
Cochlear Implant for Tinnitus
Authors: Thedinger B. , House W. F. , Edgerton B. J.
Published: January 2017

Various forms of electrical stimulation are effective in reducing tinnitus in some patients. Our experience with cochlear implant patients who have preimplant tinnitus demonstrated that about half experienced relief after the implant. We present five patients who underwent cochlear implant exclusively for tinnitus relief. Results are mixed with only one definite success. Electrical stimulation and our current research efforts are discussed.
Conscious Sedation for Procedures under Local or Topical Anesthesia
Authors: Scamman Franklin L. , Klein Sanford L. , Choi Won W.
Published: January 2017

For many surgical procedures in otolaryngology general anesthesia is not required, but it is difficult to block completely all noxious sensations with local or topical anesthesia. Intravenously administered antianxiety and analgesic drugs can make the procedure more tolerable for the patient. A technique of conscious sedation based upon titrating diazepam to specific eye signs and fentanyl to specific end points is described. Safety is maintained by ensuring that the patient is always in verbal contact with the surgeon. The rationale for administering the sedative before the narcotic is presented along with the treatment of side effects and untoward responses to the drugs.
Prevalence of Handicapping Hearing Loss in an Aging Population
Authors: Rahko Tapani , Kallio Veikko , Fagerström Kai , Kataja Matti , Karma Pekka
Published: January 2017

The mean hearing thresholds of 369 Finnish inhabitants, 65 years, and born in 3 consecutive years on two elected days each year, were studied in high standard measurement conditions. Eighty-nine of these subjects were reexamined 3 years later. They represented a typical partly industrialized white population with a high standard of living. With the criteria for hearing rehabilitation for presbycusis set at a mean hearing threshold of 30 dB or worse at 500 to 1,000 to 2,000 Hz, and or 50-dB hearing loss at 2,000 Hz, the prevalence of rehabilitation need was 3.2%. Conductive hearing losses were found in 6% of the subjects.
Type II Collagen-Induced Autoimmune Salpingitis in Rats
Authors: Tomoda Koichi , Yoo T. J. , Stuart John
Published: January 2017

Autoimmune salpingitis was induced in 17 (85%) of 20 outbred Wistar rats by immunization with bovine type II collagen: three of those also developed eustachian tube chondritis. The lesions were characterized by infiltrations of a large number of mononuclear cells in the mucosa and submucosa, destruction of cartilaginous structure, and deposition of IgG and complement C3. The animals had high titers of anti-type II collagen antibody. Immunohistochemical examination using monoclonal antibody to type II collagen revealed the presence of type II collagen in the eustachian tube cartilage. These observations suggest a causal relationship between autoimmunity to type II collagen and salpingitis in the rat, and this animal model may be useful in defining the pathogenesis of eustachian tube diseases mediated by immunity to type II collagen.
Pressure-Induced Bone Resorption in the Middle Ear
Authors: Chole Richard A. , McGinn Michael D. , Tinling Steven P.
Published: January 2017

Osteoclastic activity is seen in areas of bone resorption which are the result of experimental and human cholesteatoma. Many factors may induce osteoclasts, including transmitted pressure. The purpose of this study was to determine if transmitted pressure, in the absence of cholesteatoma, could cause localized bone resorption in the middle ear. Surgical grade silicone was implanted into the middle ear of gerbils without cholesteatoma. Bone resorption was observed only in areas where the implants exerted pressure on bone. It was estimated that pressures of 50 to 120 mm Hg (6.7 × 104 to 16 × 104 dynes/cm2) resulted in the induction of osteoclastic bone resorption.
Regional Cochlear Blood Flow Studied by Observation of Microspheres in Serial Sections
Authors: Angelborg Clarence , Larsen Hans-Christian , Slepecky Norma
Published: January 2017

Using the microsphere method combined with light microscopic observation of serially sectioned plastic-embedded cochleas, the distribution of microspheres trapped within the cochlea can be observed and the regional blood flow can be determined. In the guinea pig, the blood flow is greatest in the lateral wall, high in the modiolus, and low under the organ of Corti.
Histamine H1 Receptors and Affinity Analyses in Human Nasal Mucosa in Cases of Nasal Allergy
Authors: Ishibe Tsukasa , Kubo Nobuo , Kumazawa Hirofumi , Yamashita Toshio , Kamazawa Tadami
Published: January 2017

An increased number (density) or sensitivity (affinity) of histamine H1 receptors could cause an increase of allergic symptoms. Using the specific H1 receptor blocker 3H-mepyramine, we have demonstrated for the first time an H1 receptor number (Bmax) and a binding affinity (Kd) in guinea pig and human nasal mucosa. H1 antihistamines inhibited 3H-mepyramine binding in nasal mucosa at low concentrations, while H2 antihistamines inhibited at extremely high concentrations, indicating that 3H-mepyramine binding sites represent H1 receptors in nasal mucosa. Bmax and Kd values were not significantly different among the nonallergic sinusitis, vasomotor rhinitis, or the nasal allergy group, suggesting that H1 receptors do not change quantitatively and qualitatively in allergic nasal mucosa. There was no significant correlation between H1 receptor number and clinical data (IgE, peripheral eosinophils, RAST). These data suggest that H1 receptor number and affinity are not main etiological and pathophysiological factors in nasal allergy.
Midfacial T Cell Lymphoma: Characterization by Monoclonal Antibodies
Authors: Yamanaka Noboru , Kataura Akikatsu , Minase Takashi , Sambe Shigeo , Ishii Yoshifumi
Published: January 2017

Three cases of so-called lethal midline granuloma were studied immunologically, using monoclonal antibodies against T cell subsets, and electron microscopically. Immunofluorescence and immunoperoxidase studies of their surgical and autopsy specimens proved that the tumor cells showed positive stainings with anti-Leu 1 and anti-Leu 3a antibodies, and negative staining with anti-Leu 2a, anti-HLA-DR, and anti-immunoglobulin antibodies. These data might indicate that the tumor cells of the three cases had a similar surface antigen phenotype to that of peripheral helper-inducer T cells. The histopathological and ultrastructural examinations of the tumors showed general characteristics reported for T cell lymphomata derived from peripheral T cells.
Epiglottis in Reconstruction of the Larynx and Trachea
Authors: Olson Nels R. , Sullivan Michael J.
Published: January 2017

Many methods have been proposed for reconstruction of the larynx and trachea. An ideal method would utilize tissue which is native to the area, highly viable, convenient to the surgeon, and expendable to the patient. This tissue should be composite, that is, containing both epithelium and skeletal support. This paper describes the use of epiglottis in repair of laryngeal and tracheal defects due to cancer or trauma. The methods of repair include 1) pedicled composite epiglottic flap, 2) free composite epiglottic graft, and 3) pedicled epiglottic mucosal flap. Results in 15 patients are discussed and indicate that use of the epiglottis is an effective method for one-stage laryngotracheal reconstruction.
Tidal Flow Measurement in the Decision to Decannulate the Pediatric Patient
Authors: Mallory George B. , Mutich Rebecca , Reilly James S. , Kenna Margaret A. , Motoyama Etsuro K. , Stool Sylvan E.
Published: January 2017

Measurements of peak inspiratory flow obtained through the tracheostomy cannula (MIFt) during tidal breathing were compared to peak inspiratory flow measurements obtained through the mouth (MIFm) in 40 children to assess physiologic readiness to decannulate the tracheostomized pediatric patient. Ratio of peak flow MIFm/MIFt was 1.40 for 34 successfully decannulated children compared to 0.83 for 22 unsuccessful attempts (p < 0.01). Tidal flow measurements are highly predictive (84 %) in identifying children who are unlikely to be ready for decannulation. A schema is proposed to utilize tidal flow measurements as the first step in the decannulation process.
Therapeutic Rigid Bronchoscopy in the Neonatal Intensive Care Unit
Authors: Muntz Harlan R.
Published: January 2017

Often the acutely ill neonate requires endoscopic intervention for deteriorating respiratory status in spite of vigorous pulmonary toilet. Although fiberoptic bronchoscopy has been suggested at times, its mechanical airway obstruction would preclude its use in the very sick child. Rigid endoscopy using a ventilating bronchoscope may be safely and effectively used in the neonatal unit for bedside therapy, avoiding the risk of transfer to and from an operating room. Five case studies are presented outlining the indications and utility of this procedure.
Nasal Surgery in the Management of Sleep Apnea
Authors: Dayal Vijay S. , Phillipson Eliot A.
Published: January 2017

We present our experience with short- and long-term beneficial results obtained from surgery of the nasal valve area in carefully selected patients with obstructive sleep apnea (OSA). In six cases reported here, surgical treatment resulted in subjective improvement in snoring and daytime somnolence. Objective improvement was noted in three patients who had nasal valve area obstruction. Although the role of surgery in patients with mild OSA needs further assessment, surgical correction of nasal valve area obstruction in patients with moderately severe to severe OSA appears clearly indicated.
Strobofiberscopic Video Recording of Vocal Fold Vibration
Authors: Hirano Minoru , Yoshida Tetsuji , Yoshida Yoshikazu , Tateishi Osamu
Published: January 2017

We describe our current system for strobofiberscopic video recording of vocal fold vibration and our early clinical experiences. The advantages of the strobofiberscopic video system over the strobotelescopic video systems are 1) the range of subjects is wide, and 2) the patient can phonate while maintaining normal head position during examination.
Cricoid Resection and Thyrotracheal Anastomosis in the Growing Primate
Authors: Fearon Blair , McMillin Beverly Denise
Published: January 2017

Although many procedures have been described for the correction of subglottic stenosis in the infant and child, none has been universally satisfactory. Cricoid resection and thyrotracheal anastomosis have been successful in adults, and we considered that the same techniques could be applied to correct subglottic stenosis in infants and children. A feasibility study was undertaken using young primates as a surgical model. The operation in each was accomplished uneventfully, although one animal later developed a complication possibly due to the use of a tissue adhesive. In practice, this complication could have been corrected without compromising the surgical outcome.
Comparison of Thread Test of Lacrimation to Schirmer Test
Authors: Yagi Nobuya
Published: January 2017

A modified Schirmer test using thread instead of filter paper has been previously reported. The present report compares the characteristics of thread and filter paper and establishes the normal range for the tear flow rate. The moisture absorption by a 5-mm wide strip of filter paper was 0.765 μL/mm and that by a thread was 0.054 μL/mm. The thread was 14 times more sensitive in detecting small amounts of fluid than was the filter paper. The thread test was used in 42 normal subjects. The normal range was 60% to 140% (± 3 SD), so a value of less than 60% was considered to indicate lacrimal hypofunction, and over 140%, hyperfunction.
Reconstruction of the Posterior Auditory Canal Wall with a Hydroxyapatite Prosthesis
Authors: Grote Jan J. , van Blitterswijk Clemens A.
Published: January 2017

Reconstruction of the posterior auditory canal wall with a prosthesis of porous hydroxyapatite ceramic is described. The implant material is the inorganic basis of the bone matrix and is remodelled into living bone tissue. Thirty patients in whom the cavity was restored with the technique described were followed for at least 2 years, with an average of 3 1/2 years. There was no extrusion. The use of a periosteal flap and replacement of the remnants of the epithelium of the tympanic membrane and former ear canal were essential for the formation of a good epithelial lining in the new ear canal. Sufficient eustachian tube function is essential for a lasting result, as demonstrated in one patient with a recurrent otitis media. A limited retraction of the new tympanic membrane was observed without recurrent cholesteatoma in two patients.
Middle Ear Mucosa in Rats and Humans
Authors: Albiin Nils , Stenfors Lars-Eric , Hellström Sten , Cerne Anna
Published: January 2017

The purposes of the study were a) to review thoroughly the literature and summarize it in a standardized fashion; b) to study the mucosa, including the distribution of mast cells, in all parts of the middle ear cavity in rats; and c) to compare the experimental findings with those known in humans. Adult, healthy rats were studied by light, scanning electron, and transmission electron microscopic techniques. The ciliated and secretory cells of the rat tympanic cavity are confined to two tracts, one anterior and one inferoposterior to the promontory. The tracts connect the epitympanum with the eustachian tube. The pars flaccida exhibits the highest density of mast cells, but mast cells are also distributed in the subepithelial layer of the tracts and in the floor of the tympanic bulla. The structure of the rat mucosa shows striking similarities to that of humans. Thus, from a morphological point of view, the rat seems to be a suitable model for middle ear studies. However, to be able to compare results obtained in different species and/or different laboratories, the areas of the middle ear from which the specimens have been taken must be carefully defined and presented in a standardized manner.
Lymphangiomas of the Larynx in Infants and Children
Authors: Cohen Seymour R. , Thompson Jerome W.
Published: January 2017

Lymphangiomas are uncommon benign congenital lymphatic tumors of childhood. They are found in all parts of the body structure, but rarely occur in the larynx. This paper reviews charts of 160 patients with cystic hygroma (lymphangiomata) of whom ten had extensive involvement of the larynx. A benign but nevertheless challenging tumor, its treatment demands the patience and skill of the surgeon. The lesion is more common in the white patient, and 40% appear in the newborn. Fifty percent present by the end of the first year of life, and 75% by the end of the second. The onset is uncommon in the older child and a rare occurrence in the adult. The treatment of lymphangiomata is surgical excision, and is more difficult when in the larynx. Laser surgery has been most helpful when the lesion is in the laryngeal complex. Considering the extreme difficulties which lymphangioma present to the child and to the physician, the ultimate results of all forms of conservative surgical therapy can be rewarding. Excessive or radical surgery will not necessarily guarantee complete elimination of disease and may be harmful.
Surgery for the Safe Insertion and Reinsertion of the Banded Electrode Array
Authors: Clark G. M. , Pyman B. C. , Webb R. L. , Franz B. K-H. G. , Redhead T. J. , Shepherd R. K.
Published: January 2017

Adhering to the surgical technique outlined in the protocol for the Nucleus implant has resulted in over 100 patients worldwide obtaining significant benefit from multichannel stimulation. A detailed analysis of the results in 40 patients shows that it improves their awareness of environmental sounds and their abilities in understanding running speech when combined with lipreading. In addition, one third to one half of the patients also understand significant amounts of running speech without lipreading and some can have interactive conversations over the telephone. It is clear that any insertion trauma is not significant, which is confirmed by the excellent clinical results.
Refined Surgical Technique for Insertion of Banded Electrode Array
Authors: Franz B. K-H. G. , Clark G. M.
Published: January 2017

A refined electrode insertion technique is presented for the multichannel cochlear implant. It comprises two basic steps. The first step is the removal of the anteroinferior overhang of the round window and crista fenestrae, or alternatively an opening drilled into the scala tympani anteroinferior to the round window. The second is rotation of the electrode during insertion, counterclockwise in the right ear and clockwise in the left ear.
Anatomy of the round Window with Respect to Cochlear Implant Surgery
Authors: Clifford A. R. , Gibson W. P. R.
Published: January 2017

Twenty-three human temporal bones were dissected to study the anatomy of the round window with respect to cochlear implantation. Information was also gathered concerning the passage of a 22-channel electrode array along the cochlear duct by using cochlear surface dissection preparations. The insertion length and any insertion trauma were noted both by observation at the time of insertion and by careful analysis of video recordings. The crista semilunaris did not interfere with smooth electrode insertion. The recommendation is made that enlarging the round window anteroinferiorly is unnecessary and potentially hazardous in most cases.
Potentials around Electrode Tips with Implications for Cochlear Implants
Authors: Kauffmann G. , Achilles A.
Published: January 2017

Any presence of technical material (eg, metals) in biologic tissue alters the spread of potentials in it. We decided to investigate the spread of potentials around electrode tips using a computer model based on material data extracted from the literature. The following results were obtained. 1) The permittivity of the tissue caused a low pass effect. The potential lost its high frequency components as the distance to the electrode tip increased. An increase of the inner resistance of the source enhanced this effect. 2) The assumption of not constant but falling permittivity and rising conductivity with frequency still enlarged the effect and altered the resulting waveform because of the response of the affected electrical properties of the tissue on the spread of potentials. The latter effect was seen in the near field; in the far field (> 20 μm), it vanished progressively.
Discrimination of Simultaneous Frequency and Level Changes in Electrical Stimuli
Authors: Pfingst B. E. , Rush N. L.
Published: January 2017

Frequency difference limens for sinusoidal electrical stimuli were measured at operationally defined equal-loudness points in a behaviorally trained monkey that was deafened and implanted in one ear. The equal-loudness points were defined as the levels at which the discrimination of a frequency change was minimal when frequency and level were varied simultaneously. To determine accurately these points, we varied the level in very fine steps (as small as 0.05 dB) above and below the estimated equal-loudness point. With this method we also determined precise equal-loudness contours and level difference limens. Frequency difference limens ranged from 7% at 100 Hz, 17 dB sensation level (SL) to about 30% at 100, 300, and 600 Hz, 7 to 9 dB SL. Level difference limens ranged from 0.4 to 1.9 dB. Slopes of the equal-loudness contours were 0 at 100 Hz, about 6 dB/octave at 300 Hz, and leveled off to about 2 dB/octave above 600 Hz.
Estimation of the Effective Spread of Neural Excitation Produced by a Bipolar Pair of Scala Tympani Electrodes
Authors: Tong Y. C. , Clark G. M. , Lim H. H.
Published: January 2017

Psychophysical studies were conducted on two multichannel cochlear implant patients for electrical stimulation of two bipolar electrode pairs in the human cochlea. Loudness summation was approximately complete for spatial separation of about 3 mm between the two electrode pairs. At comfortable loudness, the effective spread of neural excitation produced by a bipolar pair of scala tympani electrodes was estimated to be 3 to 4 mm on the basis of both loudness summation and forward masking results.
Profound Sensorineural Deafness: A Histopathologic Study
Authors: Hinojosa R. , Blough R. R. , Mhoon E. E.
Published: January 2017

For this study 22 temporal bones from patients with profound sensorineural deafness of various causes were selected. Graphic reconstruction of each cochlea and acoustic ganglion was performed, together with a quantitative evaluation of three types of sensorineural elements: hair cells, peripheral auditory fibers, and ganglion cells. The numbers of acoustic ganglion cells were compared with those in 16 normal temporal bones. The temporal bones were divided into five groups, based on the relative degree of degeneration found in each of the three types of elements studied. Severe to complete hair cell loss was noted in all five groups; degeneration of peripheral nerve fibers ranged from moderate to complete in all but one group; and ganglion cell counts varied widely within all groups. In a qualitative comparison no relationship was found between the clinical data and the histopathologic correlates. The results of the study suggest that neither the clinical data nor the histopathologic findings provide any criteria for selecting patients for cochlear implants.
Effect of High Electrical Stimulus Intensities on the Auditory Nerve Using Brain Stem Response Audiometry
Authors: Shepherd R. K. , Clark G. M.
Published: January 2017

The response of the auditory nerve to acute intracochlear electrical stimulation using charge-balanced biphasic current pulses was monitored using electrically evoked auditory brain stem responses (EABRs). Stimulation at moderate charge densities (64 μC cm−2 geom/phase; 0.8 mA, 200 μs/phase) for periods of up to 12 hours produced only minimal short-term changes in the EABR. Stimulation at a high charge density (144 μC cm−2 geom/phase; 1.8 mA, 200 μs/phase) resulted in permanent reductions in the EABR for high stimulus rates (> 200 pulses per second [pps]) or long stimulus durations (12 hours). At lower stimulus rates and durations, recovery to prestimulus levels was slow but complete. The mechanisms underlying these temporary and permanent reductions in the EABR are probably caused by neural adaptation and more long-term metabolic effects. These findings have implications for the design of speech-processing strategies using high stimulus rates.
Perception of Speech Pattern Contrasts via Cochlear Implants and Limited Hearing
Authors: Boothroyd A.
Published: January 2017

The ability to perceive four suprasegmental and eight segmental speech pattern contrasts was measured in several subject groups. Mean performance of a group of House 3M cochlear implantees was similar to the mean performance of a group of Nucleus implantees with a trend toward better perception of suprasegmentals in the former and better perception of segmentals in the latter. Intersubject variability was higher in the Nucleus implantees, the best subject achieving an open set phoneme recognition score of 40%. Data from a single subject showed considerably superior performance in an aided ear with a 95-dB hearing loss than in an ear implanted with the House 3M device. Data from normal subjects listening to low pass filtered speech provide a basis for evaluating the results obtained by implantees. The results, though limited, illustrate the potential value of analytical tests such as the speech pattern contrast test used in these studies.
Temporal Coding of Speech Information for Cochlear Implant Patients
Authors: Millar J. B. , Martin L. F. A. , Tong Y. C. , Clark G. M.
Published: January 2017

A modified speech-processing strategy incorporating the temporal coding of information strongly correlated with the first formant of speech was evaluated in a long-term clinical experiment with a single patient. The aim was to assess whether the patient could learn to extract information from the time domain in addition to the time domain cues for voice excitation frequency already received from the initial strategy. It was found that the patient gained no significant advantage from the modified strategy, but there was no disadvantage either, and the patient expressed a preference for the modified strategy for everyday use.
Evaluation of Rehabilitation Strategies with Cochlear Implant Patients: Preliminary Report
Authors: Waltzman S. B. , Boothroyd A. , Levitt H.
Published: January 2017

This research is sponsored by grant NS-17764 from the National Institutes of Health/National Institute of Neurological and Communicative Disorders and Stroke.
Audiological Assessment of Profoundly Hearing-Impaired Children
Authors: Busby P. A. , Dowell R. C. , Nienhuys T. G. , Clark G. M.
Published: January 2017

The design of an audiological assessment protocol for profoundly hearing-impaired children may be divided into three areas. First, accurate estimation of hearing loss includes the behavioral measures of unaided and aided thresholds and the objective measures of electrocochleography and auditory brain stem response. The reliability of these measures for the accurate diagnosis of a profound to total hearing loss is discussed. Second, speech perception includes the measure of perception in the audition alone, vision alone, and audition plus vision conditions. Test material should include speech features, words, and sentences. Factors influencing the choice of material are the developmental age of the child, the method of educational instruction, speech and language skills, and vocabulary limits. Third, psychophysical properties of residual auditory skills include measures such as frequency, intensity, and duration difference limens. These skills may be compared to those elicited through other sensory channels, such as visual and tactile. Other important factors that should be considered are the psychological well-being of the child and family, family motivations and expectations, and educational requirements.
Electrical Auditory Brain Stem Response: An Objective Verification of Auditory System Activation with Cochlear Implantation in an Animal Model
Authors: Balkany T. , Stypulkowski P. , Reite M. , Dinner M. B.
Published: January 2017

Deprivation of auditory input has been thought to be a major factor in the etiology of behavioral disturbances in the deaf. The provision of artificial auditory input might reasonably be expected to ameliorate or prevent such behavior disturbances. This paper reports the use of electrical auditory brain stem response measurements to validate objectively the activation of the auditory system in deafened monkeys implanted with the 3M House cochlear implant system. The study was conducted as part of a larger investigation that documented the social behavior of deafened monkeys receiving long-term electrical stimulation.
Electrically Evoked Brain Stem Auditory Potentials
Authors: Game C. J. A. , Gibson W. P. R. , Pauka C. K.
Published: January 2017

University of Melbourne cochlear prostheses were driven to deliver pulse stimuli at a repetition rate of 10 Hz. Brain stem auditory evoked potentials were recorded in the customary way. The magnitude of the presumed wave V was plotted against stimulus amplitude. Also, 10-Hz square waves of current were injected through a promontory needle into totally deaf patients with no implant. In most cases we did not succeed in recording a response, but in one case a wave iii and a wave V were recorded.
Electrically Elicited Stapedius Reflex and Preferred Listening Level in a Patient with a Cochlear Implant
Authors: Jerger J. F. , Jenkins H. A. , Chmiel R. , Oliver T. A.
Published: January 2017

In a patient with a multichannel cochlear implant, it was possible to demonstrate stapedial reflex contraction to intracochlear electrical stimulation. Using a standard immittance measurement technique, characteristics of the electrically evoked reflex were compared to analogous characteristics of the acoustically evoked reflex. Latency-intensity functions were similar for the two modes of excitation, but reflex waveform morphology and amplitude growth functions were different. The effects of electrode position and electrode spacing were of particular interest. In our patient, neither position nor spacing affected onset latency. Both electrode position and electrode spacing did, however, affect reflex amplitude. As position moved from base to apex, reflex amplitude increased systematically and substantially. Although we have reported amplitude results in suprathreshold current level, we also found the same relationship across electrode position for stimulation at constant current level. Reflex amplitude by electrode spacing was also affected. The widest spacing (3 mm) produced the largest reflex amplitude, and the narrowest spacing (1.5 mm) produced the smallest amplitude. The spacing effect, however, showed a strong interaction with electrode position, being greatest at the apical position and least at the basal position.
Patient Selection for the Multichannel Electronic Prosthesis
Authors: Berlin C. I. , Jenison V. W. , Hood L. J. , Lyons G. D.
Published: January 2017

We recommend individualized evaluation strategies for cochlear implant candidates that consider new developments in hearing aid technology. Four categories of patients are presented. Category I patients can be helped by modern ear level high-powered hearing aids and implantation is not warranted. Categories II and III patients leave us uncertain; they have improved sound detection with hearing aids, but achieve no open set word recognition. Category IV patients are unquestionably candidates for implants because no method of stimulation helps them. Experience has taught us that the most appropriate evaluation plan reflects the patient's history and is sensitive to the emotional and financial consequences of aborted candidacy. Those patients who are candidates can be guided through each component of the evaluation process with ever increasing confidence of ultimate success at the time of surgery.
Vestibulo-Ocular and Vestibulospinal Function before and after Cochlear Implant Surgery
Authors: Black F. O. , Lilly D. J. , Peterka R. J. , Fowler L. P. , Simmons F. B.
Published: January 2017

Vestibular function in cochlear implant candidates varies from normal to total absence of function. In patients with intact vestibular function preoperatively, invasion of the otic capsule places residual vestibular function at risk. Speech-processing strategies that result in large amplitude electrical transients or strategies that employ high amplitude broad frequency carrier signals have the potential for disrupting vestibular function. Five patients were tested with and without electrical stimulation via cochlear electrodes. Two patients experienced subjective vestibular effects that were quickly resolved. No long-term vestibular effects were noted for the two types of second generation cochlear implants evaluated. Histopathological findings from another patient, who had electrically generated vestibular reflex responses to intramodiolar electrodes, indicated that responses elicited were a function of several variables including electrode location, stimulus intensity, stimulus amplitude, and stimulus frequency. Differential auditory, vestibulocolic, and vestibulospinal reflexes were demonstrated from the same electrode as a function of stimulus amplitude, frequency, and duration.
Overview of the Hannover Program Using the Nucleus Device
Authors: Battmer R. D. , Lehnhardt E. , Laszig R.
Published: January 2017

Successful implantation of a cochlear implant requires a healthy auditory nerve. Subjective and qualitative data can be obtained by means of promontory testing (PT). Cochlear microphonics (CM) in electrocochleography, on the other hand, gives information about the status of the hair cells in the inner ear. The results of both tests together can indicate the feasibility of an implant in cases of sensory deafness (PT positive, no CM), while other combinations help to localize the origin of the deafness, eg, neural or sensorineural. Therefore, the reliability of results is extensive and almost doubly guaranteed. To answer the question of using single-channel or multichannel cochlear implants we decided to use the 22-channel Nucleus device. The digital working system consists of the implanted receiver-stimulator and external speech processor. To date we have implanted 14 patients. In all of them, the electrode array could be inserted easily, and the threshold and comfortable levels could be adjusted very fast. The dynamic range showed a growth in the first weeks after the operation. Results of 11 of our patients are presented. They show that 1) speech-tracking scores with the processor are much higher than with lipreading only; 2) lipreading ability remains constant; 3) the understanding of vowels and consonants with the speech processor is much better; and 4) three of our patients reached scores between 20 and 30 words per minute with hearing alone for speech tracking.
Diagnostic Methods in Osteomyelitis
Authors: Norden Carl W.
Published: January 2017

The mainstays of diagnosis of acute and chronic osteomyelitis remain clinical suspicion and radiographic examination, respectively. For both diseases, accurate microbiologic diagnosis is critical and can usually be obtained by aspiration of bone or pus. Imaging studies such as bone scans, CT scans, and magnetic resonance imaging have not been systematically evaluated for sensitivity, specificity, and predictive value in the diagnosis of this disease. Thus, they generally remain expensive and unproven adjuncts in the workup of patients with osteomyelitis. Both the incidence and the outcome of osteomyelitis have been dramatically altered by antibiotics. The disease, however, still continues to pose difficulties in diagnosis. The purpose of this report is to review and update approaches to the problem.
Complications and Sequelae of Chronic Suppurative Otitis Media
Authors: Brown Orval E. , Meyerhoff William L.
Published: January 2017

Chronic suppurative otitis media is an infection of the ME space associated with irreversible tissue disease. This entity is generally seen clinically as ME infection associated with a nonhealing perforation of the TM. It has significant complications and sequelae. Otologic complications of C Supp OM include petrositis, facial paralysis, and labyrinthitis. Intracranial complications include lateral sinus thrombophlebitis, meningitis, and intracranial abscesses. Sequelae include osseous changes of the ME with associated hearing loss, cholesteatoma, and tympanosclerosis.
Human Leukocyte Antigens in Bell's Palsy
Authors: Shibahara Toyohiro , Okamura Hiroshi , Yanagihara Naoaki
Published: January 2017

Ninety-three patients with Bell's palsy including 12 members of two families with familial Bell's palsy were typed for human leukocyte antigens (HLAs). Significant association between HLAs and Bell's palsy was found. The association of certain HLAs with the palsy may predict the specific clinical course and prognosis.
Distortion Product Emissions in Humans
Authors: Lonsbury-Martin Brenda L. , Harris Frances P. , Hawkins Margaret D. , Stagner Barden B. , Martin Glen K.
Published: January 2017

Multifrequency and multicomponent evaluations of aural acoustic immittance, including tympanometry and acoustic reflex testing, were performed on 44 normal ears to examine the influence of middle ear functioning on the generation and detection of distortion product otoacoustic emissions (DPEs). In the same ears, the prevalence and parametric features of spontaneous and stimulus frequency emissions were also assessed so that their relationship to the detection “thresholds” and amplitudes of corresponding DPEs could be determined. The general outcome was that none of the examined features of acoustic immittance provided an explanation for the discrete, low-amplitude DPE regions observed in about one third of normal ears. Moreover, the presence of typical spontaneous and stimulus frequency emissions in these same “irregular” ears indicated that emission generation and reverse cochlear transmission were also operating normally within these regions of reduced DPEs. Consequently, other, as yet undetermined influences appear to contribute to the DPE variability noted in some ears. Finally, the simultaneous presence of stimulus frequency emissions, but not spontaneous emissions, appeared to reduce the detection “thresholds” and increase the amplitudes of low-frequency DPEs.
Otitis Media in Association with Various Congenital Diseases; Preliminary Study
Authors: Sando Isamu , Takahashi Haruo
Published: January 2017

We studied temporal bone histopathology to obtain clues as to the role of eustachian tube (ET) disease in the pathogenesis of otitis media (OM) in patients with congenital anomalies. Thirteen temporal bones obtained from 13 individuals with various congenital anomalies were used. We looked in particular at severity of inflammation in the middle ear (ME) and ET, and at deformity of the ET cartilage. Evidence of OM was found in all the temporal bones. The ETs consistently showed a moderate degree of inflammation but without any particular correlation with the severity of ME inflammation. Deformity of the ET cartilage was present in six cases (46.2%), representing three cases of cleft palate and three of other congenital anomalies. Because the deformity of ET cartilage tended to be associated with more severe OM, we consider this cartilage deformity to be an important cause of tubal dysfunction, and thus of the high incidence of OM among individuals with congenital ear anomalies.