bluuebunny/crossref_metadata_2025 huggingface dataset:
Gaseous Pathways in Atelectatic Ears
Authors: Sadé Jacob , Luntz Michal
Published: October 2014

Thirteen atelectatic ears were politzerized with CO2, O2, air, and N2. In consequence, the atelectasis in these ears disappeared, only to reappear again slowly. The reappearance of retraction corresponded in speed to the diffusion coefficient of the gases, indicating a regular diffusion process. At the same time, four of these politzerized patients were able to collapse the tympanic membrane of their air-filled middle ears abruptly through sniffing or swallowing. At least three patients could introduce air actively and voluntarily into their ears. These observations indicate that in atelectatic ears, as in normal ears, air can enter and leave the middle ear through one of two routes. One is the eustachian tube, through which air can pass both ways as a bolus. The second route is through the bloodstream, which gases enter and leave according to the rules of biologic diffusion. While the origin of negative pressure in atelectatic ears is unknown, this study shows that it may be a complex process stemming from a quantitative imbalance of loss versus gain of gas entry through either of the two routes.
Survival of Spiral Ganglion Cells in Profound Sensorineural Hearing Loss: Implications for Cochlear Implantation
Authors: Nadol Joseph B. , Young Yi-Shyang , Glynn Robert J.
Published: October 2014

Ninety-three temporal bones from 66 patients who were profoundly deaf during life were reconstructed by analysis of serial light microscopic sections. The correlations of total and segmental spiral ganglion cell counts with age, duration of hearing loss and profound deafness, and cause of hearing loss were evaluated. Bivariate analysis demonstrated that total spiral ganglion cell count tended to be lower in older than in younger deaf individuals and lower with longer duration of hearing loss and total deafness. However, multiple regression analysis demonstrated that the cause of hearing loss was the single most significant determinant of total spiral ganglion cell count. Patients with deafness due to aminoglycoside toxicity or sudden idiopathic deafness had the highest residual spiral ganglion cell count and patients with deafness due to presumptive postnatal viral labyrinthitis, bacterial labyrinthitis, and congenital or genetic causes had the lowest numbers of residual spiral ganglion cells.
Anatomic Foramina in the Thyroid Cartilage: Incidence and Implications for the Spread of Laryngeal Cancer
Authors: Kirchner J. Cameron , Kirchner John A. , Sasaki Clarence T.
Published: October 2014

Anatomic openings in the posterosuperior portion of the thyroid lamina of the larynx were first described in the 19th century. In the present study of 121 coronally sectioned larynges, such openings were found in 47 (39%), appearing bilaterally in 15 and unilaterally in 32. In a separate study of 69 cadaver larynges, the openings were found in 39 (57%), appearing bilaterally in 16 and unilaterally in 23. In 51 laryngectomy specimens removed for squamous cell cancer and showing foramina, tumor was not observed to invade or traverse the foramen in a single case, even in those specimens with tumor overlying the foramen and displaying framework invasion at other sites. Invasion by cancer through the foramen appears to be prevented by a layer of fibroelastic tissue overlying the medial surface of the foramen, parallel to the inner surface of the thyroid lamina. This layer of fibroelastic tissue may represent perichondrium.
Earth Horizontal Axis Rotational Responses in Patients with Unilateral Peripheral Vestibular Deficits
Authors: Furman Joseph M. R. , Wall Conrad , Kamerer Donald B.
Published: October 2014

We evaluated the vestibulo-ocular reflex (VOR) of five patients with surgically confirmed unilateral peripheral vestibular lesions. Testing used both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotation. Results indicated that the patients had short VOR time constants, asymmetric responses to both EVA and EHA rotation, and normal EHA modulation components. These findings suggest that unilateral peripheral vestibular loss causes a shortened VOR time constant even with the addition of dynamic otolithic stimulation and causes an asymmetry in semicircular canal-ocular reflexes and one aspect of otolith-ocular reflexes.
Salivary Gland Carcinosarcoma: True Malignant Mixed Tumor
Authors: Garner Steven L. , Maves Michael D. , Robinson Robert A. , Barnes Charles H.
Published: October 2014

True malignant mixed tumor, or carcinosarcoma, of salivary gland origin is rare. Only 19 cases have been reported in the literature, and a review of cases seen at the University of Iowa over the last 60 years yielded only two. In one case the mesenchymal component of the tumor contained both osteosarcoma and chondrosarcoma. In the second case, the history and the histology suggest a progression from a carcinoma ex pleomorphic adenoma to a carcinosarcoma. These features are documented in this report and literature review.
Eyes Open versus Eyes Closed: Effect on Human Rotational Responses
Authors: Wall Conrad , Furman Joseph M. R.
Published: October 2014

The effect of eyelid closure on the response to rotational vestibular stimulation was assessed by evaluating 16 normal human subjects with both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotations with either eyes closed (EC) or eyes open in the dark (EOD). Results indicated that for EVA rotation, the subjects' responses were of larger magnitude and less variable with EOD than with EC. However, for EHA rotation, responses were of larger magnitude and equally variable with EC as compared to EOD. Our data also indicated that the quality of the EHA response with EC was altered because eyelid closure influenced the amount of periodic gaze. We conclude that eyelid closure has an effect upon both canalocular and otolithocular reflexes and suggest that both EVA and EHA rotational testing be performed with EOD rather than with EC.
Complications following Rhinotomy
Authors: Bernard Peter J. , Lawson William , Biller Hugh F. , LeBenger Jeffrey
Published: October 2014

For the period 1974 to 1988, 148 patients undergoing 162 rhinotomies at The Mount Sinai Medical Center, New York, for a variety of benign and malignant neoplasms were reviewed with particular attention to postoperative complications. The effects of certain predisposing factors such as prior rhinotomy, lateral versus total rhinotomy, additional medial maxillectomy or craniofacial resection, and preoperative irradiation or nasal bone erosion are discussed. In addition, a surgical technique of rhinotomy with medial maxillectomy is presented that includes maneuvers designed to prevent these complications.
Indirect Videolaryngoscopy versus Direct Endoscopy for Larynx and Pharynx Cancer Staging
Authors: Bastian Robert W. , Kaniff Thomas , Collins Sharon L. , Matz Gregory J.
Published: October 2014

Thirty-nine patients with cancer of the larynx and pharynx (33 untreated and six previously treated patients) underwent tumor mapping by both direct laryngoscopy (DL) and indirect videolaryngoscopy (IVL). The examiner in each case was unaware of the findings of the other evaluation method. After definitive treatment had been carried out so that pathologic and operative information was also available, comparisons of the accuracies of the two methods of staging were made. In 32 cases, IVL provided information equal to or better than that provided by DL, and a tissue sample also could be obtained during IVL. On the basis of these findings, we conclude that aggressive, office-based IVL can guide initial treatment planning (partial or total laryngectomy versus irradiation) and patient counseling. A confirmatory DL can be performed without surprises at the time of definitive surgery, rather than as a separate procedure — A cost-effective modification of standard practice.
Use of Ceftazidime for Malignant External Otitis
Authors: Kimmelman Charles P. , Lucente Frank E.
Published: October 2014

During the past 2 years we have used ceftazidime (Fortaz), a third-generation cephalosporin, in the treatment of eight patients with progressive necrotizing “malignant” external otitis. Ceftazidime is very active against Pseudomonas species and provides penetration into the CSF. Our results suggest that this medication has several advantages over the previously recommended combinations of aminoglycosides and semisynthetic penicillins, including improved cure rate, lower toxicity, and simpler administration schedules. We review our experience with ceftazidime in the treatment of eight patients.
Adenomatous Tumors of the Middle Ear
Authors: Batsakis John G.
Published: October 2014

Primary adenomatous tumors of the middle ear are preponderantly benign, resectable lesions and arise from the mucosa (adenomas) or salivary tissue (choristomas). Malignant variants are ill defined, are not characterized histologically, and represent less than 10% of the adenomatous tumors. Their presence may be signaled clinically by facial nerve paralysis, invasion of bone, and chronic otorrhea.
Recent Modifications in Thyroplasty Type I
Authors: Isshiki Nobuhiko , Kojima Hisayoshi , Taira Tatsuzo , Shoji Kazuhiko
Published: October 2014

Among thyroplasties, type I is the most frequently used for medialization of the vocal cord. Follow-up study on patients indicated that reversion of voice can occur after operation. Revision was done in five cases with improvement of voice. On the basis of this experience, modifications were made in the technique of thyroplasty type I. They include 1) cutting the calcified cartilage with minimal intervention in the soft tissue, 2) fixation of the window with a silicone plug to enhance medialization, and 3) overmedialization of the vocal cord and definition of criteria for it that can be used during surgery.
New Microlaryngeal Instruments for Phonatory Surgery and Pediatric Applications
Authors: Shapshay Stanley M. , Healy Gerald B.
Published: October 2014

A new microlaryngeal instrument set has been developed for phonatory surgery in adults and for pediatric laryngology. This 20-instrument set consists of forceps (cupped and alligator type) and scissors with 1-mm distal grasping and cutting tips. Open tip and whistle tip variety suction instruments with tip diameters of 1.0,1.5, and 2 mm are also available. Included as well are fine (1.0-mm) probes for palpation and laser welding and smoke evacuation double-action grasping forceps. This microlaryngeal instrument set has been extremely useful in more than 80 clinical applications.
Frontal Sinus Osteoma
Authors: Smith Marshall E. , Calcaterra Thomas C.
Published: October 2014

Osteoma is the most common benign tumor of the nose and paranasal sinuses, and the frontal sinus is its most frequent location. This tumor may be discovered incidentally on radiographs or may enlarge to produce symptoms and, rarely, complications referable to its location near the orbit and anterior cranial vault. A series of 22 cases of frontal sinus osteoma treated at the UCLA Center for the Health Sciences is reviewed. The presenting symptoms of this tumor, patient examination, radiographic evaluation, diagnosis, and indications for surgical and nonsurgical management are discussed. Various surgical approaches are reviewed, with emphasis on the advantages and disadvantages of each technique. Issues at surgery include the location of the surgical incision, technique of sinus entry, tumor removal, status of the posterior sinus table, patency of the nasofrontal duct, sinus obliteration, and avoidance of cosmetic deformity. Patient outcomes are assessed and recommendations given based on our findings and experience.
Reevaluation of Maxillary Sinus Surgery: Experimental Study in Rabbits
Authors: Kennedy David W. , Shaalan Hisham
Published: October 2014

Functional endoscopic sinus surgery concentrates primarily on the removal of ostiomeatal complex disease. When required, maxillary sinus ostioplasty is performed. However, surgical widening of a sinus ostium is contrary to common precepts. A study therefore was performed to reevaluate the effects of antrostomies and of intrasinus mucosal removal. Widening of the natural ostium, a separate antrostomy at some distance from the ostium, or radical mucosal removal was performed on 30 rabbits. Fifteen sinuses were used as controls. After 6 to 8 weeks the status of the sinus mucosa and mucociliary clearance was studied. The study confirmed that mucociliary clearance continued toward the natural ostium following inferior antrostomy. Following widening of the natural ostium, mucociliary clearance through the ostium redeveloped in 11 of 18 sinuses but was typically imperfect. There were no cases of ostial closure; however, the incidence of infection was significantly higher in all three experimental groups than in the control group.
Auditory Brain Stem Responses to Bone-Conducted Tones in Infants
Authors: Stapells David R. , Ruben Robert J.
Published: October 2014

The auditory brain stem responses (ABRs) to 500- and 2,000-Hz bone-conducted (BC) tones were recorded from 48 infants with ears exhibiting various external and middle ear states (normal, otitis media, auditory meatal atresia). Amplitudes were greater, wave V latencies longer, and detectability better for responses to 500-Hz BC tones compared to 2,000-Hz BC tones. Overall, most (94% to 100%) infants with normal cochlear sensitivity demonstrate ABRs to 20-dB normal hearing level (nHL) 500-Hz BC tones and 30-dB nHL 2,000-Hz BC tones. In cases in which masking is difficult (eg, bilateral atresia), infant ipsilateral/contralateral ABR asymmetries may help determine from which cochlea a response to the BC tones originates. In conclusion, two-channel ABR recordings to BC tones appear to be feasible for demonstrating normal cochlear sensitivity in infants.
Duration and Frequency Characteristics of Tracheoesophageal Speech
Authors: Pindzola Rebekah H. , Cain Blanche H.
Published: October 2014

Selected characteristics were compared in the speech of five tracheoesophageal, five esophageal, and 15 normal laryngeal adult speakers. Tape-recorded speech samples were measured for durational features with a stopwatch. Frequency features were analyzed with a Visi-Pitch/Apple IIE computer interface with statistical subroutines. Tracheoesophageal speech proved comparable to normal speech in maximum phonation time, speech rate, pitch pertubation (jitter), average fundamental frequency, and fundamental frequency range, but less efficient than normal speech in phrase grouping. Tracheoesophageal speech was superior to esophageal speech in maximum phonation time, speech rate, and phrase grouping, but not significantly different in pitch perturbation, average fundamental frequency, and fundamental frequency range. Explanations and clinical implications of these findings are discussed.
Human Leukocyte Antigens -A, -B, -C, and -Dr and Nasopharyngeal Carcinoma in Northern China
Authors: Zhu Xiaonong , Chen Ren , Kong Fanhua , Liu Wei
Published: October 2014

We observed HLA associations in patients with nasopharyngeal carcinoma from northern China. There was an increased risk of nasopharyngeal carcinoma associated with HLA-B35 and a difference in the HLA association between patients with early- and late-onset disease. The frequency of B35 was significantly higher in patients than in control subjects, especially in early-onset patients (less than 30 years old). Late-onset patients had a higher frequency of DR2 as compared with normal subjects.
Variability of the Surgical Anatomy of the Neurovascular Complex of the Cerebellopontine Angle
Authors: Kim Hee-Nam , Kim Young Ho , Kim Gill Ryoung , Park In Yong , Chung In Hyuk
Published: October 2014

The variability of the anatomic relationship of the anterior inferior cerebellar artery (AICA) to the facial (seventh) and vestibulocochlear (eighth) nerves was studied in 52 cerebellopontine angles (CPAs) from 26 adult cadavers. The AICA originated from the basilar artery (98.1%) or from the vertebral artery (1.9%) as a single (92.3% of CPAs) or duplicate (7.7%) artery. Each of the 52 CPAs had one or more arterial trunks that coursed in close proximity to the seventh and eighth cranial nerves and thus were said to be nerve-related. The nerve-related arterial trunks were divided into three segments based on their relationship to the nerves and meatus: The premeatal, meatal, and postmeatal segments. The nerve-related branches of the AICA gave rise to the internal auditory artery in 92.3% of the CPAs, the recurrent perforating artery in 78.8%, and the subarcuate artery in 30.8%. The importance of understanding the surgical anatomy of the neurovascular complex of the CPA when performing a vestibular neurectomy is reviewed.
Cancer of the Tongue Base Treated by a Transpharyngeal Approach
Authors: Moore Dennis M. , Calcaterra Thomas C.
Published: October 2014

Tongue base resection plays an important role in the management of the patient with cancer of the posterior tongue. The considerable morbidity resulting from loss of functional tongue includes compromised deglutition, chronic aspiration, and altered speech articulation. The particular operative approach used dictates additional secondary morbidity, which may include cosmetic and functional defects of the mandibular arch, malocclusion, lip and chin scars, and postoperative changes in the oral cavity. Our recent experience with a transpharyngeal approach in 13 patients with tongue base cancer is reviewed. Adequate operative exposure was obtained in all cases. Persistent aspiration was not a problem, and all patients learned to swallow effectively. The transpharyngeal approach avoids unnecessary surgical trauma to the mandible and anterior oral cavity and minimizes cosmetic deformity. Our early experience with this approach is encouraging.
Distribution of Elastic Cartilage in the Arytenoids and its Physiologic Significance
Authors: Sato Kiminori , Hirano Minoru , Kurita Shigejiro , Kiyokawa Kensuke
Published: October 2014

An investigation of the distribution of the elastic cartilage in the arytenoids was performed on excised human adult and newborn larynges. The distribution of elastic cartilage in the arytenoids was investigated histologically in two serial sections: Horizontal and coronal. The behavior of the elastic cartilage portion of the arytenoids was investigated histologically under the conditions of adduction and abduction. The results are summarized as follows. 1) Elastic cartilage is found not only at the tip of the vocal process but at the superior portion of the arytenoid cartilage from the vocal process to the apex. 2) This phenomenon is observed at birth. 3) The vocal process bends at the elastic cartilage portion during adduction and abduction. The sides of the arytenoids come into contact mainly at the elastic cartilage portion. 4) Elastic cartilage appears to play an important role in the physiologic functioning of the arytenoid.
Pulmonary Parameters in Children after Laryngotracheal Reconstruction
Authors: Zalzal George H. , Chaney Hollis R. , Thomsen James R. , Derkay Craig
Published: October 2014

Laryngotracheal reconstruction in children with autogenous rib cartilage has proved successful in relieving laryngotracheal stenosis. To date, no objective measurements have been available to assess the upper airway's functional ability in these children after decannulation. A pilot study analyzing pulmonary function in 18 children successfully decannulated after laryngotracheal reconstruction was performed. The children ranged in age from 24 months to 12 years and were several months postdecannulation at the time of testing. The results of this pilot study offer an objective assessment of functional capacity after laryngotracheal reconstruction in older children and serve as a basis for objective follow-up. In younger children, pulmonary function values were difficult to obtain and proved to be of no significant value to the overall assessment of functional capacity of the airway.
Rhinovirus in Otitis Media with Effusion
Authors: Arola Mikko , Ziegler Thedi , Lehtonen Olli-Pekka , Puhakka Heikki , Ruuskanen Olli
Published: October 2014

We studied rhinovirus in the middle ear fluid of 61 children with subacute or chronic otitis media with effusion. Rhinovirus was recovered from the middle ear fluid of 5 children with subacute otitis media with effusion. The minimum duration of effusion was 32 to 60 days. Additionally, 1 patient had middle ear fluid that was positive for adenovirus. Bacterial pathogens were cultured from the middle ear fluid of 20 of 61 patients. Our finding that rhinovirus can be isolated from middle ear fluid after an asymptomatic period of several weeks suggests its possible role in the development of otitis media with effusion.
Patterns of Epithelial Cell Death during Early Development of the Human Inner Ear
Authors: Represa Juan J. , Moro Jose A. , Pastor Francisco , Gato Angel , Barbosa Enrique
Published: October 2014

A light microscopic study of cell death in a developmental series of otic primordia from 23 human embryos (Carnegie stages 9 to 14) was completed. Degenerated cells were noted predominantly in the placode (stages 9 and 10), cup (stages 11 and 12), and otocyst (stages 13 and 14). A systematic camera lucida study of the appearance and topography of degenerating epithelial cells showed four different areas of cell death in the otic primordia that related to 1) invagination and detachment of the otic anlage, 2) early histogenesis of the statoacoustic ganglion, and 3) development of the endolymphatic duct. The possible role of cell death in the morphogenesis of the inner ear related to morphogenetic movements is discussed.
Nonclosure of Pharyngeal Muscle after Laryngectomy
Authors: Olson Nels R. , Callaway Elizabeth
Published: October 2014

A prospective study was carried out to evaluate a new technique of pharyngeal repair following laryngectomy. The purpose of this study was to see whether satisfactory healing would occur if the pharyngeal constrictors were not sutured across the closure in the pharynx. If healing proved to be satisfactory the procedure might eliminate the need for primary or secondary myotomy or pharyngeal plexus neurectomy to facilitate tracheoesophageal speech. The results indicate that healing is as good in the group who did not have muscle closure as in those who did.
Effect of Helium Concentration on Experimental Upper Airway Obstruction
Authors: Houck John R. , Keamy Mitchell F. , McDonough Joseph M.
Published: October 2014

This study investigates the effect of helium concentration in inspired gas on resistance to breathing during experimental upper airway obstruction. Obstruction was modeled by use of a series of four polyvinyl endotracheal tubes narrowed progressively in their midportions with C clamps. Percentage ratios of helium-oxygen gas mixtures were 0:100, 40:60, 60:40, and 80:20. Gas flow was provided by two methods: 1) nontidal flow from compressed gas tanks from which resistance was calculated from pressure and flow measurements, and 2) tidal respiratory flow from human volunteers from whom respiratory effort was evaluated by using airway pressure measurements integrated over 90-second trial periods. The results derived from both methods demonstrated that the effect of helium in reducing resistance and pressure in an obstructed airway is linear (p < .016) and inversely proportional to helium concentration. Reductions in resistance and pressure were larger for the tighter obstructions (p < .007). As helium was added to the gas mixture (from 0% to 80%), resistance and airway pressure measurements dropped 42% and 58%, respectively. The major conclusions are that 1) even low concentrations of helium may have therapeutic value and 2) helium is effective only for more severe obstructions.
Warthin's Tumor
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Warthin's tumor, classed as a monomorphic adenoma, ranks second to pleomorphic adenoma in the incidence of benign neoplasms of the parotid gland. By embryologic and clinicopathologic definitions, it is a neoplasm of the parotid gland and its environs, including parotid lymph nodes. Histopathologic diagnosis requires an oncocytic (mitochondria-rich) epithelium and lymphoid stroma. Malignant Warthin's tumors are rare and are carcinomas arising from the ductal component, or non-Hodgkin's lymphomas arising from the lymphoid tissue.
Extraluminal Arytenoid Reconstruction: Laryngeal Framework Surgery Applied to a Pediatric Problem
Authors: Isaacson Glenn
Published: October 2014

Laryngeal framework surgery has proved to be an important alternative in the treatment of vocal cord paralysis in adults. We have modified one of these operations in order to manage debilitating aspiration in a 14-year-old boy. His laryngeal incompetence resulted from a severe neurologic injury and laryngeal scarring from a unilateral arytenoidectomy and multiple Teflon injections. To help him, we studied a series of pediatric larynges and devised an operation that succeeded in rebuilding the bulk of his excised arytenoid cartilage and markedly reducing aspiration.
Non-Warthin's Tumor Oncocytic Lesions
Authors: Hartwick R. Warren J. , Batsakis John G.
Published: October 2014

Oncocytes differ from other epithelial cells of salivary tissues in their excessive proliferation of mitochondria, in turn leading to a hypertrophy and hyperplasia of the chondriome. Oncocytic transformation is not a degenerative process, but rather a redifferentiation of the cells as they attempt to increase their output of high-energy phosphate. As oncocytes divide, their pathologic metabolic activity and mitochondrial phenotype are passed on to their progeny, and these cells produce salivary lesions that range from focal oncocytic metaplasia and hyperplasias to benign and malignant neoplasms — Oncocytomas and oncocytic carcinomas.
Epiglottic Laryngoplasty for Repair of Blunt Laryngopharyngeal Trauma
Authors: Wenig Barry L. , Schild Joyce A. , Mafee Mahmood F.
Published: October 2014

Two unique cases of blunt laryngopharyngeal trauma are presented in which identical injuries were sustained to the supraglottic larynx and hypopharynx. Examination of the patients included the use of magnetic resonance imaging to help define the extent of injury. A successful outcome was achieved in each instance by employing the reconstructive technique of epiglottic laryngoplasty to repair the mucosal defects.
Histopathologic Study of Otitis Media in Individuals with Head and Neck Tumors
Authors: Yamaguchi Nobumasa , Sando Isamu , Takahashi Haruo , Hashida Yoshie , Myers Eugene N.
Published: October 2014

Five temporal bones, each including the eustachian tube, were obtained from five adults with advanced malignant tumors of the head and neck. The specimens were from the side on which the tumor had occurred. Otitis media had been detected clinically in two cases, and was detected histopathologically in the other three. We discuss the possibility that otitis media might have been caused by tumor invasion of the paratubal area, by postoperative inflammation in the nasopharynx, or by an inflammatory reaction of tubal structures to radiotherapy, or that these conditions may have coexisted.
Nerve Fiber Analysis and the Aging Process of the Vestibulocochlear Nerve
Authors: Fujii Mayumi , Goto Noboru , Kikuchi Kyozo
Published: October 2014

Nerve fiber analyses were performed on the human vestibulocochlear nerve stained with Luxol fast blue–periodic acid–Schiff–hematoxylin with use of a combination of an image-analyzer and a computer. The axons were counted and their transverse (cross-sectional) areas were measured in 12 individuals. The average numbers of axons in each vestibular and cochlear nerve were 17,727 and 25,098, and the average transverse areas of their axons were 4.02 and 1.79 μm2, respectively. Amyloid bodies and intervening Schwann cells in the vestibulocochlear nerve were also counted. The average number of amyloid bodies was 246 per transverse section of the nerve and their average size was 114 μm2. The average number of intervening Schwann cells was 1,513. Our results indicated that the transverse axonal areas of the cochlear nerve became reduced with age, while the transverse areas of the amyloid bodies in the vestibulocochlear nerve increased with age. The number of vestibular nerve fibers did not seem to change with age.
Head Stability and Gaze during Vertical Whole-Body Oscillations
Authors: Takahashi Masahiro
Published: October 2014

To understand head and eye stabilities during upright locomotion, we investigated head and eye movements during vertical whole-body oscillations of various amplitudes (1 to 10 cm) and frequencies (1 to 3 Hz) in both normal subjects (n = 10) and patients with bilateral labyrinthine loss (n = 5). Vertical oscillations produced pitching motions of the head, of which the amplitude was markedly altered by a change in the oscillation frequency or the displacement. Vertical eye movements, being correlated with pitching head movements, were scarcely modified by gaze at 2 and 3 Hz. Acquired bilateral lesions presented deteriorated head stability and physically induced eye movements under stronger stimulations. However, significant increase of head movement upon stepping and suppression of pitching motion upon running, both characteristically found in bilateral lesions, were not reproduced by passive oscillations. Thus, these features during active locomotion may result from imbalance produced by alternate bipedal motions and from adaptation to minimize oscillopsia, respectively.
Management of Tracheobronchial Foreign Bodies in Children: An Update
Authors: Healy Gerald B.
Published: October 2014

Tracheobronchial foreign bodies continue to be a source of morbidity and mortality in the pediatric population. Technical advances in anesthesia and equipment have made the removal of these troublesome objects more feasible. Diligence must still be exercised and a coordinated team effort must be employed in order to achieve a satisfactory and safe outcome for the patient. The appropriate use of diagnostic studies and management techniques are discussed.
Facial Nerve Monitoring in Otologic Surgery: Clinical Indications and Intraoperative Technique
Authors: Leonetti John P. , Smith Peter G. , Matz Gregory J. , Beck Douglas L.
Published: October 2014

While identification of the intratemporal portion of the facial nerve is mandatory in most otologic surgical procedures, inadvertent instrumentation, traction, or thermal injury may still result from inaccurate delineation, purposeful avoidance, or false protection of this critical structure. Improved functional preservation of the facial nerve has been achieved in acoustic neuroma surgery through the monitoring of evoked facial electromyographic activity. This technique may also be used during otologic procedures in which facial nerve manipulation is anticipated in the management of recurrent cholesteatoma, temporal bone trauma, congenital deformity, or purposeful access for cochlear implantation. Potential indications for using facial nerve monitoring in contemporary otologic surgery are detailed through illustrative case presentations, and necessary instrumentation and techniques are briefly reviewed. Intraoperative monitoring can assist the surgeon in isolating the facial nerve when chronic inflammation, traumatic injury, or anomalous development has resulted in distortion or absence of microanatomic landmarks.
Surgical Complications with the Cochlear Multiple-Channel Intracochlear Implant: Experience at Hannover and Melbourne
Authors: Webb Robert L. , Laszig Roland , Lehnhardt Ernst , Pyman Brian C. , Clark Graeme M. , Franz Burkhard K.-H. G.
Published: October 2014

The surgical complications for the first 153 multiple-channel cochlear implant operations carried out at the Medizinische Hochschule in Hannover and the first 100 operations at the University of Melbourne Clinic, The Royal Victorian Eye and Ear Hospital, are presented. In the Hannover experience the major complications were wound breakdown, wound infection, electrode tie erosion through the external auditory canal, electrode slippage, a persistent increase in tinnitus, and facial nerve stimulation. The incidence of wound breakdown requiring removal of the package was 0.6% in Hannover and 1.0% in Melbourne. The complications for the operation at both clinics were at acceptable levels. It was considered that wound breakdown requiring implant removal could be kept to a minimum by making a generous incision and suturing the flap without tension.
Tumor Necrosis Factor Alpha in Middle Ear Cholesteatoma and its Effect on Keratinocytes in Vitro
Authors: Yan Shi-Du , Huang Cheng-Chun
Published: October 2014

Tumor necrosis factor alpha (TNF-α) was found in human middle ear cholesteatoma tissues by the immunoperoxidase method using rabbit anti human TNF-α immunoglobulin G. It appeared to be localized in the epithelium and connective tissue of cholesteatomas studied, particularly on basal and spinous cells, and macrophages. The epithelium of normal external ear canal skin was lightly stained, but the staining was much weaker than that of the cholesteatomas observed. In vitro, recombinant mouse TNF-α stimulated proliferation, protein synthesis, and terminal differentiation of basal keratinocytes. These stimulatory effects were blocked by the anti-TNF-α immunoglobulin G, which by itself had no effect on basal keratinocytes. These findings suggest that TNF-α plays an important role in the development of cholesteatomas seen clinically.
Partial Laryngectomy after Irradiation Failure
Authors: Nichols Richard D. , Mickelson Samuel A.
Published: October 2014

Forty-three patients who had partial laryngectomies after radiotherapy were evaluated. Forty-two had failed irradiation for laryngeal carcinoma. Nine had supraglottic procedures, 3 endoscopic, and 31 vertical partial. Twelve (28%) required subsequent completion laryngectomy. Major complications included laryngeal stenosis in 1, incompetent laryngeal sphincters in 2, mucocutaneous fistulas in 3, and delayed deglutition in 3. Six patients had positive permanent section margins. In 5 of those, intraoperative frozen sections had been taken and were negative. Recurrent or persistent disease was eventually demonstrated in all patients with positive margins. The 2-year determinant disease-free survival rate for stage I and II disease was 85%. Three-year disease-free survival was 50% for stage III and IV disease. Partial laryngectomies, including supraglottic, can be done after irradiation failure with a high expectation of cure and acceptable morbidity. Immediate additional operation should be considered in patients with positive margins.
Surgical Management of Tracheal Stenosis in an Infant with Multiple Congenital Anomalies: When is Baby Inoperable?
Authors: Mambrino Lawrence J. , Kenna Margaret A. , Seashore John
Published: October 2014

Congenital tracheal stenosis is a rare disorder that carries a significant morbidity and mortality. It is an even greater challenge when present in combination with other life-threatening congenital anomalies. We present an infant with multiple congenital anomalies, including trisomy 21, who was diagnosed with congenital tracheal stenosis at 3 months of age. At age 5 months, the infant underwent tracheoplasty with costal cartilage graft and pulmonary artery banding. Bronchoscopy 3 weeks later revealed a patent airway. However, the patient died 2 months postoperatively of cardiac complications. At autopsy, whole organ and histologic specimens revealed excellent incorporation of the graft with no evidence of re-stenosis. Our documentation of graft incorporation in this patient is evidence that long segments of stenotic trachea can be successfully treated by tracheoplasty utilizing rib cartilage grafts.
Delayed Pharyngoesophageal Perforation: A Complication of Anterior Spine Surgery
Authors: Kelly Mark F. , Spiegel Joseph , Rizzo Karen A. , Zwillenberg David
Published: October 2014

Stabilization of the cervical spine is often accomplished via an anterior cervical approach. Bone grafts and/or plates and screws are used to achieve stabilization. Injuries to the pharynx and esophagus are known complications in anterior exposure of the cervical spine. These injuries are manifest in the early postoperative period. Reports of late perforations are very rare. We present four cases of delayed injury to the pharynx and esophagus that resulted in abscess or fistula. We postulate that graft displacement with resulting erosion was responsible for these serious complications. Postoperative odynophagia in patients who undergo anterior cervical fusion warrants evaluation of the bone graft location. Early surgical intervention and repair may decrease prolonged morbidity in these patients.
Transforming Growth Factor Beta: Does it Direct Otic Capsule Formation?
Authors: Frenz Dorothy A. , Van De Water Thomas R. , Galinovíc-Schwartz Vera
Published: October 2014

Interactions between the epithelium of the otocyst and surrounding periotic mesenchyme direct the formation of the capsule of the mammalian inner ear. In the present study, we have characterized the temporal-spatial distribution of transforming growth factor beta 1 (TGF-β1) in the epithelial and mesenchymal tissues that compose the inner ear between 10 and 14 days of embryonic development. In addition, using high-density cultures of periotic mesenchyme to model otic capsule formation, we have demonstrated that exogenous TGF-β1 can modulate otic chondrogenesis by acting as either an enhancer or a suppressor of this process. Our immunohistochemical and in vitro results suggest a paracrine action for this growth factor in modulation of epithelial-mesenchymal tissue interactions and otic morphogenesis.
Esophageal Foreign Bodies in Children 15-Year Review of 484 Cases
Authors: Crysdale William S. , Sendi Khalil S. , Yoo John
Published: October 2014

The findings of a retrospective analysis of the charts of 426 children admitted on 484 occasions with diagnoses of esophageal foreign bodies that were managed at the Hospital for Sick Children for 15 years to the end of 1989 are reported. In the majority of cases, ingestion of the foreign body was either witnessed or suspected. Removal was completed with the use of general anesthesia with endotracheal intubation in 90% of cases. The postcricoid area was the commonest site for impaction. Coins were the commonest foreign body. Approximately 5% of children had more than one foreign body. Fifty-nine children had esophageal anomalies. Thoracotomy or laparotomy for the retrieval of foreign bodies was necessary in less than 1% of patients. Complications occurred in 13% of patients; there were no deaths.
Microtrapdoor Flap Repair of Laryngeal and Tracheal Stenosis
Authors: Beste David J. , Toohill Robert J.
Published: October 2014

Twenty patients have undergone repair of laryngeal and tracheal stenosis by microtrapdoor accessing of scar or soft tissue and removal with the carbon dioxide laser. A total of 34 flap procedures were performed in the 20 patients. Follow-up ranged from 8 months to 4 years, and 30 of these flaps were considered successful on the basis of improvement of the airway. The only complications were postoperative granulation tissue in 2 patients that responded to endoscopic removal.
Primary Tracheojejunal Shunt Operation for Voice Restoration following Pharyngolaryngoesophagectomy
Authors: Kinishi Minoru , Tahara Shinya , Amatsu Mutsuo , Makino Kunihiko
Published: October 2014

A primary tracheojejunal shunt operation was performed for voice restoration following pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. A fistula was created between the membranous part of the trachea and the lower part of the transplanted jejunum. The membranous part of the trachea was tubed to construct the tracheojejunal shunt. All three patients who had the tracheojejunal shunt operation retained phonatory function. Pitch formation was seen in the voice waveform with use of the tracheojejunal shunt. No leakage was seen at all during deglutition and a swallowing function was obtained in all patients who had the tracheojejunal shunt.
Effect of Cyclosporine a on the Hearing Loss in Behçet's Disease
Authors: Elidan Josef , Cohen Evelyne , Levi Haya , BenEzra David
Published: October 2014

Thirty-five patients with Behçet's disease (20 under cyclosporine A [CyA] treatment and 15 under the conventional therapy), 12 patients suffering from endogenous uveitis, and 35 normal subjects were evaluated audiologically before entering the study and were followed up for at least a year. Twenty-eight Behçet patients (80%) showed some degree of hearing loss. The averaged pure tone audiogram of the Behçet group showed statistically significant auditory deficits in comparison with that of the control group. None of either the Behçet group or the uveitis group showed any hearing deterioration during the follow-up period. Five Behçet patients under CyA therapy demonstrated improvement in their hearing. The difference between the two groups of Behçet patients (CyA versus conventional treatment) was found to be statistically significant (p < .05). Thus, CyA might serve as an important mode of treatment of sensorineural hearing loss on an inflammatory “autoimmune” background.
Middle Ear Pressures of Children with Otitis Media with Effusion
Authors: Takahashi Haruo , Honjo Iwao , Fujita Akihiko , Hayashi Masahiko , Kurata Kyosuke
Published: October 2014

Middle ear (ME) pressures were measured in 30 children with chronic otitis media with effusion (OME) transtubally with the use of a catheter pressure transducer (Mikro-tip, PC-330F). They were found to range from 40 to −185 mm H2O, the average being mildly negative (–54.33 ± 59.04 mm H2O). About two thirds of these children had pulsating changes of ME pressure; the range of the pressure change was between 10 and 50 mm H2O. The ME pressure tended to be lower in ears with serous effusion than in those with mucoid effusion, but there was no significant difference between them.
Postural Compensation in Children with Congenital or Early Acquired Bilateral Vestibular Loss
Authors: Enbom Håkan , Magnusson Måns , Pyykkö Ilmari
Published: October 2014

The relative roles of different receptor systems in compensating for vestibular loss were studied in 18 children (12 to 16 years of age) with congenital or early acquired bilateral vestibular loss (BVL) and impaired hearing, and compared to that in 33 normal children (9 to 16 years of age). Postural stability was studied with posturography evaluating the velocity of anterior-posterior body sway. With closed eyes the increase of sway velocity did not differ between the groups, either with or without simultaneous proprioceptive disturbances when the subjects were standing on a bare surface. Body sway velocities were found to increase more in subjects with a BVL than in normal children when subjects were standing on foam rubber. When proprioceptive cues were disturbed, body sway velocities increased in both groups, but significantly more in children with BVL when subjects stood on foam rubber. This occurred both with and without open eyes.
Endoscopic Surgery of the Vidian Nerve: Preliminary Report
Authors: El Shazly Mohamed A.
Published: October 2014

The anatomy, surgical technique, and difficulties of endoscopic vidian neurectomy are described. The procedure was carried out on 12 patients: 8 had resistant secretomotor rhinopathy and 4 had recurrent nasal polyposis. This technique is a minor surgical procedure with symptomatic relief and minimal postoperative morbidity.
Apron Tracheostome
Authors: Talaat Mohammad
Published: October 2014

Stenosis of the tracheostome following total laryngectomy is not an infrequent complication, either immediately postoperatively or years later, and it poses a common problem for head and neck surgeons. The opening becomes inadequate and the patient is uncomfortable and panicky. A secondary plastic operation is necessary in order to improve the airway, or a laryngectomy tube must be worn constantly. I have developed a satisfactory technique for tailoring the tracheostome during total laryngectomy so as to minimize postoperative stenosis even in irradiated cases and allow the patient to dispense with the laryngectomy tube. It may render the posterosuperior wall of the tracheostome more suitable for a tracheoesophageal puncture tract for voice restoration after total laryngectomy. These goals are achieved by interdigitating a small skin-thick superiorly based apron flap, raised from the lower midline of the front of the neck, into a similar recipient area at the upper posterior tracheal wall after removal of an equal mucosal apron.
Effectiveness of an Intensive Speech Perception Training Program for Adult Cochlear Implant Recipients
Authors: Gagné Jean-Pierre , Parnes Lorne S. , Hassan Rajaa , LaRocque Margaret , Vidas Silvia
Published: October 2014

A staggered multiple baseline single-subject experimental design was used to assess the effectiveness of a postimplant intensive aural rehabilitation program. Four adults with an acquired profound hearing loss were provided with a Nucleus 22-channel cochlear implant. The subjects completed a speech perception test protocol once before their cochlear implant operation and at 3-month intervals for a period of 12 months postimplantation. Each subject participated in a 12-week postimplant intensive aural rehabilitation program. A comparison of the prerehabilitation and postrehabilitation results failed to reveal any systematic improvements in performance on the speech perception tests that could be attributed unequivocally to the aural rehabilitation program.
Strobovideolaryngoscopy: Results and Clinical Value
Authors: Spiegel Joseph R. , Sataloff Robert T. , Hawkshaw Mary J.
Published: October 2014

Strobovideolaryngoscopy is a valuable addition to the diagnostic armamentarium because it allows the otolaryngologist to perform a detailed physical examination of the vibratory margin of the vocal fold. From 1985 through 1989, we performed 1,876 strobovideolaryngoscopy procedures, the majority on professional voice users. Previously, we reported findings on our first 486 strobovideolaryngoscopy procedures. Stroboscopic information influenced diagnosis or treatment in approximately one third. The present study was undertaken to determine whether additional experience had altered the clinical usefulness of the procedure. Diagnoses were noted before and after stroboscopy prospectively for 377 strobovideolaryngoscopy procedures performed during the calendar year 1989. In 53% of the procedures, strobovideolaryngoscopy resulted in no change in diagnosis. In 29%, preprocedure impressions were confirmed and additional diagnoses were made. In 18%, preprocedure diagnoses were found to be incorrect. The procedure has proven very helpful in caring for voice patients, modifying diagnoses in 47%, and confirming uncertain diagnoses in many of the other patients studied.
Special Instruments for Laryngeal Framework Surgery
Authors: Kojima Hisayoshi , Isshiki Nobuhiko , Sawada Masaki
Published: October 2014

Thyroplasties involve a variety of delicate surgical techniques that affect the outcome decisively. In particular, opening a window in the thyroid cartilage, undermining around the window frame and fixation of a window plug in thyroplasty, and passing a suture through the muscular process and thyroid ala are some examples of difficult procedures. Several instruments were devised to facilitate such procedures. They include a special raspatory, an ultrasonic osteotome for cartilage cutting, a narrow polyvinyl tube for suture passing, a suture holder for passing through the muscular process, and a wound retractor for arytenoid adduction. These were found useful in minimizing soft tissue damage and in precise performance of the procedures.