bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronystagmographic Findings in Central Nervous System Disease
Authors: Spector Martin
Published: October 2014

A helpful central sign on electronystagmography with eyes closed is hyper-excitability on a caloric test. Another sign is consistent nystagmus in the presence of normal calorics. With eyes open, calibration overshoot, gaze nystagmus, pendulum tracking, failure of fixation suppression, and optokinetic nystagmus are useful central signs. Abnormalities on tracking a pendulum were by far the most common central abnormality in the experience of the author.
Swyer-James Syndrome: A Cause of Hyperlucent Lung
Authors: Guzowski Jacobo , Duvall Arndt J.
Published: October 2014

Swyer-James syndrome consists of an abnormal radiolucency of one lung or lobe, secondary to obliterative bronchiolitis with distal air trapping. The etiology of the bronchiolar inflammatory process is quite diverse. The syndrome will simulate the presence of a foreign body in the bronchial tree, and the patients will usually undergo bronchoscopy with that presumptive diagnosis. Two cases are presented and the pathogenesis, clinical picture, and differential diagnosis are outlined. The separation of this condition from hypoplasia of the pulmonary artery is discussed.
Objective Evaluation of Vocal Pathology Using Voice Spectrography
Authors: Rontal Eugene , Rontal Michael , Rolnick Michael I.
Published: October 2014

Permanent objective evaluation of vocal changes associated with laryngeal pathology is a goal which has been difficult for the laryngologist and speech pathologist to attain. Most attempts at achieving objective records have focused on direct visual examination of the larynx using techniques such as high speed photography, x-ray studies or histologic sectioning. However, the important subjective qualities of the voice are difficult to translate into objective visual patterns. In order to produce these patterns, certain individual components of the voice ( i.e., breathiness, periodicity and formant structure) must be analyzed. Recently, modifications of the sound spectrograph have enabled the clinician to objectively visualize these components. The patterns produced by the spectrograph may be applied to a variety of clinical situations. For example, the technique aids greatly in determining the success or failure of medical and surgical management for vocal cord lesions. Secondly, voice spectrography can readilv show improvements or deficiencies in vocal rehabilitation for functional dysphonia. Lastly, this method provides an objective, permanent record of the voice which may be useful from a medicolegal standpoint. Sound spectrographic analysis of vocal pathology is an important diagnostic tool for the clinician. Its future use should be encouraged as a more precise aid in the evaluation of the voice.
Preoperative Embolization of Juvenile Angiofibromas of the Nasopharynx
Authors: Pletcher James D. , Dedo Herbert H. , Newton Thomas H. , Norman David
Published: October 2014

The juvenile nasopharyngeal angiofibroma is a vascular tumor. Careful and complete removal is challenging because of the brisk bleeding during surgery. The means applied to reduce this blood loss have included preoperative estrogens, ligation of feeding vessels, silicone embolization of feeding vessels, and cryosurgery. We have used preoperative Gelfoam® embolization of the internal maxillary artery in seven patients. Our clinical impression of significant reduction in loss of blood was confirmed by comparison with 16 previous patients. The average amount of blood lost in the embolized group was half that of the control group. A study of this type comprises many variables; however, the results do suggest that preoperative embolization of the internal maxillary artery is of advantage in the surgical treatment of juvenile angiofibromas.
Characterization of Tumor Antigen in Epidermoid Carcinoma
Authors: Krause Charles J. , Nysather John , McCabe Brian F.
Published: October 2014

Tumor antigens have been isolated from nine epidermoid carcinomas of the head and neck. The most strongly reactive antigens have a molecular weight of ≃ 25,000–50,000 daltons, though other antigens weighing ≃ 120,000–400,000 daltons were noted in six of the tumors. The most strongly reactive antigens from three of the tumors were further purified by isoelectric focusing. Each of these antigens had a pI between 8.36 and 8.40. The cross reactivity of these antigens will be studied next. It is hoped that the purified tumor antigen will be useful in the development of an immunodetection system for epidermoid carcinoma.
Pyriform Sinus Cancer: A Clinical and Laboratory Study
Authors: Kirchner John A.
Published: October 2014

In our patient population, cancer of the hypopharynx arose 19 times as often in the pyriform sinus as in the postcricoid space (152:8). Most of the growths were far advanced when first seen (90% T3), and enlarged cervical nodes were present in 66% of the patients. Three year survival rates free of disease were as follows: primary surgical treatment (laryngectomy, radical neck dissection) (8/28) 29%; primary radiotherapy (2/55) 4%; and combined preoperative radiation (12/33) 36%. Serial section studies of 51 surgical specimens indicate that T1 and T2 lesions, especially those confined in the medial wall, are probably curable by radiotherapy. Larger lesions invade deeply into the larynx and resemble transglottic growth in their pattern of spread. Conservation surgery would have been inadequate for all but perhaps one growth in this series of 51 lesions, because of the high rate of invasion by cancer into and through the thyroid cartilage and cricoid ring (22/51). Although surface presentation of this group of pyriform sinus cancers rarely reflected the extent of invasion, each of the 22 growths that invaded portions of the thyroid or cricoid cartilages was characterized by clinical involvement of the apex and lateral wall of the pyriform sinus on laryngoscopy or barium swallow.
Air Humidity and Mucociliary Activity
Authors: Mercke U. , Toremalm N. G.
Published: October 2014

The relationship between varying humidity levels in the surrounding air and the mucociliary activity in rabbit trachea has been investigated. At a relative humidity (R.H.) above 70% the risk for ciliestasis is very small in the temperature range between 34 C and 40 C. At 37 C ciliestasis is not obtained until a relative humidity (R.H.) of 50% has been reached. The critical border is reached already at 60% R.H. if the temperature is 40 C. At 37 C and a decrement from 90% to 60% R.H. the mucociliary wave frequency was reduced by 30%, but at 40 C the corresponding reduction was 60%.
Hearing Function and Chronic Renal Failure
Authors: Johnson David W. , Mathog Robert H.
Published: October 2014

In order to evaluate the degree and type of hearing loss in patients with chronic renal failure, 61 patients undergoing chronic hemodialysis were examined. Hearing threshold levels, adjusted for age and sex, demonstrated a significant high frequency deficit, which in some patients was noted early in the course of hemodialysis. Fluctuations in hearing were noted over single dialysis events but were transient and apparently independent of corresponding changes in Na, K, Ca, BUN, creatinine, glucose, mean blood pressure, and weight. Preliminary attempts to evaluate hyperlipidemia as a possible cause of hearing loss did not reveal any hearing deficit or gain as related to triglyceride or cholesterol levels. The data suggested other possible causes of observed auditory loss.
Parathyroid Tumors as Lateral Pharyngeal Masses: Report of a Case
Authors: Deeb Ziad E. , Trible William M. , Page Russell , Fernandez Mario G.
Published: October 2014

This is the first reported case in the literature describing a patient free of the systemic biochemical effects of hyperparathyroidism who presented with a lateral pharyngeal mass. Diagnoses of parathyroid adenoma was made by means of a transoral biopsy prior to definitive surgical treatment. The role of parathyroid lesions in lateral cervical masses is discussed.
Sudden Deafnfess of Vascular Origin: A Human Temporal Bone Study
Authors: Gussen Ruth
Published: October 2014

Temporal bone changes are described in a 57-year-old man who had sudden onset of dizziness and unilateral deafness two months before death. The patient suffered from hypertension, and congestive and renal failure. At autopsy, subarachnoid hemorrhage with punctate cortical hemorrhages and arteriolar thickening involved the right superior cerebellar hemisphere. The pathological changes involved primarily the right cochlea, saccule and posterior ampulla, and were consistent with vascular embarrassment of the temporal bone of two months duration. The cochlea demonstrated total loss of the organ of Corti and severe degenerative changes of the stria vascularis, spiral ligament, outer sulcus cells and distal cochlear nerve fibers. The saccule demonstrated loss of its macula and nerve fibers. The posterior ampulla showed evidence of previous rupture of its membranous wall with fibrosis and beginning bone formation. Fresh hemorrhage, present in some areas of both temporal bones, was related to the patient's terminal subarachnoid hemorrhage.
Rupture of the round Window Membrane
Authors: Taylor P. H. , Bicknell P. G.
Published: October 2014

A case of sudden deafness due to rupture of the round window membrane is presented. Nineteen similar cases have previously been reported in the literature. In a review of these twenty patients, it is noted that a history of concurrent physical effort or barotrauma was present in eighteen. This supports the view that the injury is produced by pressure changes acting either along the cochlear aqueduct (the explosive route) or, directly on the middle ear structures (the implosive route). At operation, the rupture may be difficult to see, and a separate leak from the oval window may be present. The timing of any surgical intervention is important. The authors recommend that this should be deferred for one week after the onset of symptoms, as the fistula may heal spontaneously. If no definite improvement has occurred at the end of this time, then tympanotomy should be undertaken during the next week.
Vestibular Decruitment in Central Nervous System Disease
Authors: Torok Nicholas
Published: October 2014

The differential caloric test consisting of a weak and of a strong stimulation may provide evidence of certain vestibulo-oculomotor abnormality. The phenomenon of vestibular decruitment serves as an indication of central nervous system or intracranial pathology. A classification of the degree of decruitment was attempted in 139 patients exhibiting this phenomenon. Ample evidence is provided that vestibular decruitment is indicative of a variety of intracranial lesions predominantly in the posterior fossa. Decruitment was encountered with hypo- and hyperactive vestibular responses alike and also in patients in whom there was no deficit in end organ sensitivity. The armamentarium of neurotologic testing is enriched by the differential caloric stimulations providing an indication of the “site of lesion.”
Cholesterol Granuloma Involving the Temporal Bone
Authors: Nager George T. , Vanderveen Theodore S.
Published: October 2014

The cholesterol granuloma does not represent an independent clinical or pathological entity, rather it is a term used for the description of a tissue response of the temporal bone, to the presence of a particular foreign body, i.e., cholesterol crystals. Three factors are considered to play an important role in its development: 1) interference with drainage, 2) hemorrhage, and 3) obstruction of ventilation. The cause of the initial hemorrhage may be a hemorrhagic inflammation or diathesis, a trauma or some other form of vascular disorder. Interference with air exchange and clearance can be caused by: tubal blockage, persistent mesenchyme, polypoid changes, scar formations, tympanosclerosis, cholesteatoma, etc. The cholesterol granuloma may develop in any portion of the pneumatic system of the temporal bone and it can be associated with a variety of middle ear disorders. Its principal precursor is the chronic middle ear effusion or serous otitis media. Its clinical expression and hallmark is the “idiopathic hematotympanum,” the dark bluish discoloration of the tympanic membrane. Osteitis and bone erosion are manifestations of an unusual, more advanced stage. Resorption of bone, in a rare instance, may lead to extensive destruction of the temporal bone.
Auditory Imperception
Authors: Merifield David O. , Hall C. M. , Merrell Hal B.
Published: October 2014

The diagnosis, evaluation and treatment of learning disabilities involves many disciplines. The Otolaryngologist can play an important role in reducing the psycho-social-educational effects of perceptual handicaps by being active in early diagnosis. This paper presents: 1) an overview of significant information pertaining to auditory perceptual problems and 2) suggestions for the clinician interested in identifying children with auditory perceptual defects.
Polygenic Inheritance of Otosclerosis
Authors: Mendlowitz Judith C. , Hirschhorn Kurt
Published: October 2014

A large family has been studied and its pedigree traced for six generations. Fifteen relatives are known to have had otosclerosis. Of these, the only six individuals who developed this disease before the age of twenty were offspring of second-cousin marriages. Other children in the extended family developed the disease later and may have had somewhat less severe symptoms. The original hypothesis that the severe, early onset cases occurred among those homozygous for a monogenic trait became improbable on mathematical analysis. We conclude that the inheritance of otosclerosis in this family is polygenic and probably multifactorial. Individuals marrying within the family have a greatly increased risk of giving birth to children who will develop otosclerosis early, and perhaps severely. Those who marry outside the family have a greatly decreased risk. They do, of course, have a higher risk than the general population of having children who will at some point experience a conductive hearing loss.
Observations on Normal and Degenerating Human Otoconia
Authors: Ross Muriel D. , Johnsson Lars-Göran , Peacor Donald , Allard Lawrence F.
Published: October 2014

Specimens of human otoconia obtained from autopsy material and representing various stages from fetal to advanced old age, were studied by microdissection, scanning electron microscopy, electron microprobe analysis, and x-ray powder diffraction. The typical adult otoconial configuration is a cylindrical, finely serrated body with pointed ends; crystallographically, it corresponds to a single crystal of calcite. Other, less numerous types include joined otoconia, pure rhombohedrons and multifaceted, presumably immature forms. Many otoconia achieve the adult configuration during fetal development. The multifaceted otoconia are most numerous, and the rhombohedrons proliferate, during childhood in the utricle. Crystals from both end organs are virtually identical in composition in the young adult, but saccular otoconia are the larger. In middle and advanced age the otoconia decrease in number, especially in the saccule. Saccular otoconia degenerate progressively in a posteroanterior direction across the macula; they assume a specific, fibrous, hollowed-out appearance, which is not duplicated by either chemical etching or autolysis. Neogenesis and growth of otoconia appear to occur postnatally, with different characteristic growth potentials for those of the saccule and the utricle. Age-related saccular otoconial degeneration appears to involve the organic material, which disappears either before or simultaneously with the mineral substance.
Rapid, Atraumatic Method for Obtaining Nasal Mucus Samples
Authors: Wilson William R. , Allansmith Mathea R.
Published: October 2014

Disposable cellulose acetate sponges, properly placed in the nose, provide a rapid method of stimulating the production of nasal mucus to be obtained for study. There is little trauma to the nasal mucosa, thus minimizing the risk of contamination of samples with serum or cells. The mucus is not diluted, and therefore, quantitative measurements of immunoglobulins and other substances can be made.
Experience with Vocal Cord Injection
Authors: Lewy Robert B.
Published: October 2014

For 14 years investigators accredited by the FDA have been injecting a Teflon® - glycerin mixture into lateral-lying, paralyzed vocal cords. This paper represents a summary of the work of this author, including successes, failures, and complications; it is the largest reported series, plus that of accredited investigators. The method described is exceptionally useful; it has restored voices, laughter, the ability to strain, and has prevented aspiration. A new surgical technique involving the injection of sterile glycerin into comparable vocal cords in acute new situations is also described. This is done by direct or indirect laryngoscopy, and has been used to eliminate some tracheotomy surgery by virtue of the immediately improved cough effectiveness.
Recurrent Respiratory Papillomatosis
Authors: Strong M. Stuart , Vaughan Charles W. , Healy Gerald B. , Cooperband Sidney R. , Clemente Manuel A. C. P.
Published: October 2014

Recurrent respiratory papillomatosis is most common in childhood but it affects all age groups; it represents a diathesis of the aerodigestive tract so that lesions may develop at various sites — the nares, lips, pharynx, nasopharynx, larynx, tracheobronchial tree, and the lungs. Ablation of all visible papillomas with the surgical laser achieved remissions in approximately one-third of patients for one year or more; since relapses may occasionally occur 2 to 20 years later, cure can never be assumed. At the present time, management is directed towards total ablation of all visible papilloma consistent with preservation of the airway and voice; reduction of the tumor burden to minimal proportions is thought to allow the maximum opportunity for remission. As the host-papilloma relationship is unraveled, it may be possible in the future to provoke an immune response so that remissions can be predicted and produced consistently.
Tracheostenosis and Bronchial Abnormalities Associated with Pulmonary Artery Sling
Authors: Cohen Seymour R. , Landing Benjamin H.
Published: October 2014

Three patients with aberrant left pulmonary artery (sling artery) are reported to illustrate associated tracheobronchial abnormalities. The clinical picture was that of severe episodic or progressive respiratory distress without dysphagia in early infancy. Striking narrowing of the trachea by complete “ring cartilages,” unrelated to compression by the abnormal pulmonary artery, was present. Tracheotomy and intubation failed to relieve the obstruction. In one patient the bronchi and bronchial segmentation pattern were normal, but in the other two patients, bronchial abnormalities included wide irregular cartilages in the main bronchi, forming more complete rings than is normal. In both, the right main bronchus was relatively longer than normal, and the bronchus intermedius showed poor cartilage ring formation and was relatively short compared to the main bronchus. This discrepancy did not appear to be due to distal displacement of the right upper lobe bronchus. In these two patients the left main bronchus was relatively short and wide with reduced number of cartilage rings (five-six vs usual normal number of nine), so that the right and left main bronchi were almost of equal length. However, the branch patterns of the lobar bronchi were within normal range. Bronchoscopy seems essential to demonstrate such ring tracheal cartilages (absence of the pars membranacea of the trachea), which when found should alert the examiner to the possible presence of an abnormal left pulmonary artery. Since surgical correction of tracheal stenosis of this type is not possible at present, the ultimate prognosis of patients with sling artery may depend more on the severity of the tracheal anomaly rather than on success of surgical correction of the abnormal left pulmonary arterial course. Although aberrant (sling) left pulmonary artery can occur in patients without respiratory tract symptoms, tracheal stenosis due to ring tracheal cartilages occurs in a significant fraction of patients with this arterial anomaly. Bronchoscopic study of the trachea, and possibly air or contrast bronchography of right and left main bronchi, can be of aid in diagnosis of this complex.
Subglottic Stenosis in Infants and Children
Authors: Holinger Paul H. , Kutnick Steven L. , Schild Joyce A. , Holinger Lauren D.
Published: October 2014

Of 158 cases of subglottic stenosis 115 were congenital and 43 acquired. Current follow-up has been obtained in 146 (92%) which constitutes the determinate group. Although stridor was the most common presenting symptom of the congenital group, 34% presented with recurrent or prolonged episodes of croup. Tracheotomy was required in 47 of the 107 determinate cases (44%). Further management of the congenital cases was based on the experience that children outgrow this disorder; periodic dilatation may augment the natural process. Of those infants and children tracheotomized, all but five have been decannulated, and there was one death — a mortality rate of 2.1%. Acquired subglottic stenosis proved to be a more difficult management problem. Tracheotomy was necessary in 38 of the 39 determinate cases (97%). Repeated active dilatations for prolonged periods were usually required as well as endoscopic removal of granulation tissue. Of those infants and children tracheotomized, all but eight have been decannulated. There were nine deaths; five were due to unrelated underlying disease; four were attributable to complications of long-term tracheostomy. Thus, in the entire series, 85 infants and children required tracheotomy and five deaths may be attributable to long-term tracheostomy complications — a mortality rate of 5.9%.
Clinical Experience with the Tracheoesophageal Anastomosis for Intractable Aspiration
Authors: Lindeman Roger C. , Yarington C. Thomas , Sutton Dwight
Published: October 2014

Clinical experience in six patients in whom the tracheoesophageal diversion procedure or a modification thereof has been performed is presented. Two of these patients have been reconstructed with resulting normal laryngeal and esophageal function. Three of the patients have successfully undergone tracheoesophageal anastomosis and are candidates for reconstruction. One patient in whom the tracheoesophageal anastomosis has been present for 2K years may never demonstrate neurological return sufficient for reversal of the procedure. On the basis of these six cases, we consider the tracheoesophageal anastomosis to be an effective, yet reversible, procedure for intractable aspiration.
Congenital Tracheoesophageal Fistulas in Adults
Authors: Stephens Robert W. , Lingeman Raleigh E. , Lawson Lawrence J.
Published: October 2014

Congenital tracheoesophageal fistula without esophageal atresia is commonly known as “H” type. This is an extremely rare anomaly in infants and accounts for approximately 1½ − 4% of all congenital tracheoesophageal malformations. An anomaly should be described by its anatomical defect, not by a number or letter. There are five main anatomical categories with 85–95% being of the esophageal atresia and distal tracheoesophageal fistula type. About 1 1/2% are of the “H” type. Although today tracheoesophageal fistula is a well-recognized entity, a few of the “H” type have passed through the pediatric period without diagnosis. Those undetected fistulas have successfully masqueraded as chronic lung disease of unknown etiology. Congenital “H” type tracheoesophageal fistulas assume an oblique orientation with the growth of the host to adulthood. This helps to explain the difficulty in diagnosis plus the ability of the host to survive to adult life. Treatment is surgical, consisting of simple ligation via cervical or thoracic approach depending upon location. The 12 previously reported cases in the English literature are reviewed, and a 13th case has been added.
Endotracheal Intubation and Venturi (Jet) Ventilation for Laser Microsurgery of the Larynx
Authors: Norton Martin Lloyd , Strong M. Stuart , Vaughan Charles W. , Snow John C. , Kripke Benjamin J.
Published: October 2014

Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator,* neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves die further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.
Safe Level for Noise Exposure?
Authors: Bohne Barbara A.
Published: October 2014

The safety of long, continuous exposure to several different levels of noise was determined. Chinchillas were exposed for two or nine days to an octave band of noise with a center frequency of .5 kHz or 4 kHz. By examining the inner ear for evidence of acute cellular degeneration, exposures which produced minimal permanent damage could be identified easily. Differences were found between the two bands of noise in the level required to produce injury, and the type, location and extent of damage which occurred as the level was increased. The findings help explain why exposure to industrial noise, which is generally low frequency, first produces measurable auditory changes for high frequency tones.
Auditory-Nerve Activity in Cats Exposed to Ototoxic Drugs and High-Intensity Sounds
Authors: Kiang Nelson Y. S. , Liberman M. Charles , Levine Robert A.
Published: October 2014

The response characteristics of auditory-nerve fibers in normal cats are compared with those in cats exposed to kanamycin and high-intensity sounds. The pathophysiology is characterized by an elevation of the tuning-curve “tips,” which is sometimes associated with hypersensitivity of the “tails.” Plots of unit thresholds are correlated with patterns of sensory-cell losses in the cochlea. There can be significant shifts in unit threshold without significant loss of hair cells; however, significant hair cell loss is always accompanied by highly abnormal unit thresholds. The presence of inner hair cells seems to be essential for the long-term survival of spiral ganglion cells. An incidental observation is that in the “normal” animal there is almost always a prominent “notch” at 3–4 kHz in the plots of threshold at characteristic frequency, which may have been produced by environmental noise.
Electron Microscopic Cochlear Observations in Bilateral Ménière's Disease
Authors: Kimura Robert S. , Ota Carol Y. , Schuknecht Harold F. , Takahashi Tadahiko
Published: October 2014

Electron microscopic study of the cochleas of an individual with bilateral Ménière's disease revealed the presence of many abnormal sensory cells in the apical regions of the cochleas. The pathological alterations were greater in the left ear with the greater hearing loss. There were some giant cilia, fusion of cilia, and loss of cilia. The outer hair cells contained diffuse cuticular bodies near or basal to the nuclei. Many outer hair cells were retracted away from the reticular membrane. The population of the nerve endings appeared normal. The inner hair cells of the apical turns appeared essentially normal. The spiral ganglia were normal in number and morphology at the apical turns, and a majority of their cell bodies were of the unmyelinated or partly myelinated types. The stria vascularis showed atrophy; however, the magnitude of this change was consistent with that known to occur in the aging ear. In the distended areas Reissner's membrane showed areas devoid of mesothelial cells, as well as atrophic epithelial cells. The blood vessels were no different from other human cochlear vessels. These abnormalities seen in the stereocilia, the outer hair cells, and Reissner's membrane are a matter of fact. We must admit, however, that not enough electron microscopic studies have been performed on ears from aging individuals or ears with other pathologies to state that these changes are unique to Ménière's disease. Furthermore, there is currently insufficient knowledge to predict whether these changes affect auditory function.
The Combined Correlated Audiohistogram
Authors: Dublin William B.
Published: October 2014

The state of the spheroid cells of the superior ventral cochlear nucleus (SVCN) must be accounted for along with that of stria vascularis, hair cells, and spiral ganglion neurons in the development of the combined correlated audiohistogram in cases of sensorineural hearing loss. For the stated evaluation, transverse sections through SVCN are marked off into ventrodorsally progressive zones corresponding to the frequency levels of the audiometric chart, and the loss of spheroid cells in each level is estimated on a percentage basis. The resultant “best fit” of pattern of cell injury with audiometric curve suggests that the anatomic frequency scale of SVCN parallels the logarithmic frequency scale of the standard audiometric chart.
Hearing Loss of a Central Type Secondary to Anoxic Anoxia
Authors: Makishima Kazumi , Katz Roger B. , Snow James B.
Published: October 2014

The effect of anoxic anoxia on the threshold sensitivity and amplitude of the responses from the auditory cortex, inferior colliculus and cochlea to acoustic stimuli in guinea pigs was studied. Decay of the amplitude of the responses from the auditory cortex and the inferior colliculus occurs faster and is more severe than that of the cochlea. Recovery of the amplitude of the responses is slower at the auditory cortex and the inferior colliculus than at the cochlea. Loss of auditory threshold sensitivity in anoxic anoxia is most prominent at the auditory cortex. The loss of sensitivity at the inferior colliculus is the next most severe. The loss of sensitivity at the cochlea is negligible. The relative vulnerability of the central auditory pathway to anoxic anoxia as compared to the end organ is demonstrated.
Response Characteristics of Cochlear Nucleus Neurons to Vowel Sounds
Authors: Rupert Allen L. , Caspary Donald M. , Moushegian George
Published: October 2014

Most studies in auditory neurophysiology have utilized tonal stimuli to determine the coding properties of neurons in the cochlear nuclei. In this investigation of the kangaroo rat, cochlear nuclei, neuronal responses to vowel sounds, as well as tones, were studied. The vowel sounds, each about 40 msec in duration were: [a], [i], [I], [ε], [o], [u], [Formula: see text] [æ], and [ṛ]. Five were linked together to form a 200 msec stimulus and various combinations of five vowel sounds provided us with 18 different stimuli. The results show that neurons in the cochlear nuclei are remarkably sensitive and selective to vowel sounds. Furthermore, the responses of these neurons to pure tones do not provide a complete basis to predict the types of responses to the vowel sounds. More significant is the finding that the neural discharge rate and pattern of discharge to a particular vowel may depend on where the vowel appears in the stimulus and what other vowel precedes it. This vowel positional effect is not the same for every neuron. We have called this phenomenon a neural “set.”
Malleus Fixed (Ossified) to the Tegmen Tympani in an Ancient Skeleton in Israel
Authors: Arensburg B. , Nathan H. , Ziv M.
Published: October 2014

A right malleus fixed to the roof of the tympanic cavity in a 1,600-year-old skull is described. The possible etiology of this condition is examined and the literature concerning recent and paleopathology of the middle ear ossicles is reviewed.
Electrocochleography and Recruitment
Authors: Eggermont J. J.
Published: October 2014

Electrocochleography was performed in about 80 recruiting ears, including Ménière ears and ears showing hearing loss due to asphyxia, noise trauma, or the use of ototoxic drugs. Criteria for recruitment detection on the basis of electrocochleography were investigated by means of the description of action potential waveforms, slopes of action potential input-output curves, and latency-intensity functions. The validity of two models for the mechanism of loudness recruitment is discussed in relation to data obtained from narrow-band response contributions to the compound action potential in response to tonebursts. A relationship was found between the shape of the AP input-output curve for toneburst stimulation and the shape of the response area, which favors the recruitment model recently proposed by Evans. This justifies use of the slope of the input-output curve as an indicator for the presence of loudness recruitment, and additional support is provided by the latency at near-threshold values. The AP waveform seems to have pure illustrative interest.
Tracheobronchiomegaly: Report of Two Cases with Widely Differing Symptomatology
Authors: Ratliff Jack L. , Campbell Guy D. , Reid May V.
Published: October 2014

Two cases of tracheobronchiomegaly are reported to call attention to this disease. Physicians must be mindful of this entity as another cause of recurring pneumonia which may be treatable. Various proposed etiologies for this syndrome are reviewed. The findings in and interpretation of our cases and those in the literature suggest that tracheobronchiomegaly is a congenital anomaly differing from others of the tracheobronchial tree because of its spectacular radiological appearance. The two following cases typify different presentations of this syndrome. One is largely asymptomatic; the other demonstrates superinfection of stagnant secretions, making the patient functionally bronchiectatic with progressive suppurative pulmonary destruction. The authors believe that aggressive management designed to mobilize airway secretions is indicated. There is usually no place for surgery in this disease beyond establishing the diagnosis.
Goblet Cell Population in the Pathological Middle Ear and Eustachian Tube of Children and Adults
Authors: Tos Mirko , Bak-Pedersen K.
Published: October 2014

On 64 temporal bones from slightly abnormal and pathological prematures and newborn infants, children, and adults, 35,000–40,000 counts of goblet cells were done in different parts of the Eustachian tube and middle ear. The goblet cells were present in all Eustachian tubes and middle ear areas. In ears previously exposed to infection the density was slightly increased in the tubal orifice and in most parts of the middle ear. In subacute and acute pathological actions, especially tubal occlusion, and in chronic diseases, such as active chronic otitis and in secretory otitis media, the goblet-cell density is appreciably increased.
Nasal Decongestant Activity of Pseudoephedrine
Authors: Roth Roland P. , Cantekin Erdem I. , Bluestone Charles D. , Welch Richard M. , Cho Young W.
Published: October 2014

The effectiveness of orally administered pseudoephedrine in patients with acute or chronic nonsuppurative rhinitis was evaluated under double-blind conditions. Intranasally administered ephedrine which was given to all patients at the end of this study served as the positive control. Marked nasal decongestant effects of a single oral dose of pseudoephedrine (60 mg tablet), as determined by a modified passive anterior, rhinometrie technique occurred within 30 minutes and were maintained for at least four hours. The mean nasal decongestant response (Δ% of baseline) of 57.2% was associated with a mean peak, plasma pseudoephedrine level of 274 ng/ml. In addition, the maximum response to oral pseudoephedrine treatment was equivalent to the response produced by ephedrine nasal spray. These results suggest that pseudoephedrine is an orally effective nasal decongestant.
Sudden Deafness
Authors: Sando Isamo , Loehr Anthony , Harada Takehiko , Sobel John H.
Published: October 2014

The histopathological study of two cases of sudden deafness is presented. The temporal bones showed cochleosaccular abnormality. The most striking pathological changes were collapse of the organ of Corti, atrophy of the tectorial membrane, atrophy of the stria vascularis, decrease in the number of the cochlear nerves, collapse of the saccular membrane and partial absence of the sensory epithelial layer in the saccular macula. These changes are quite similar in type to those occurring in labyrinthitis of known viral etiology and to those in previously reported cases of sudden deafness which were assumed to be of viral origin. This evidence suggests that a viral infection was the most probable etiology of sudden deafness in these ears. In addition, unusual findings of endolymphatic hydrops limited to the extreme basal end of the cochlear duct were found in Case 1. A patent cochlear aqueduct and circumscribed perilymphatic labyrinthine ossification in the superior semicircular canal were also observed. With these histopathological findings, the possibility of viral infection via the meninges as well as via the hematogenous route into the inner ear is proposed.
Primary Carcinoma of the Mastoid Bone
Authors: Clairmont Albert A. , Conley John J.
Published: October 2014

The diagnosis of carcinoma primary in the mastoid bone is usually made while performing a mastoidectomy in an effort to control presumed chronic mastoiditis. The association of chronic infection, serosanguineous otorrhea, and severe otalgia, common warning signs of carcinoma of the middle ear or external auditory canal, may or may not be present with a carcinoma primary in the mastoid bone. If the amount of bony mastoid destruction seen by roentgenography is out of proportion to the degree of clinical infection, malignancy should be strongly suspected. The authors present a case of primary carcinoma of the mastoid bone, and review the diagnosis and treatment.
Blood Supply to the Nape-of-the-Neck Flap: Implications from a Fetal Anatomical Study
Authors: Schein George , Kahane Joel C. , Myers Eugene N.
Published: October 2014

The blood supply to the nape-of-the-neck flap was studied in 11 18-week-old fetuses by infusion of methyl methacrolate into the vascular system. Dissection of the posterior cervical region showed that the major blood supply to this area was through perforating vessels from the superficial portion of the ramus decendens of the occipital artery and the posterior auricular artery. Since a “named artery” was not found in the longitudinal axis of the flap, as is reported in the literature, it should be considered a cutaneous rather than an arterial flap. The findings of this study are consistent with classical anatomical descriptions about blood supply to this region. Collateral vascular pathways from the occipital artery and the costicervical trunk are discussed.
Impression Materials for Removal of Aural Foreign Bodies
Authors: Raz Sharir , Stassen Raymond , Hilding David
Published: October 2014

A new method for removal of aural foreign bodies is introduced, employing the injection of a semifluid impression material into the external auditory canal, and its removal after curing with the engulfed foreign matter. This technique obviated the need for a general anesthetic in some pediatric cases, while in others it was just a more pleasant experience.
Malignant External Otitis: Further Considerations
Authors: Chandler James R.
Published: October 2014

Malignant external otitis is an infection which begins in the external auditory canal. It is uniformly caused by the Gram negative Pseudomonas aeruginosa organism and mainly affects elderly diabetics. It spreads to the soft tissues beneath the temporal bone and, if not properly treated leads to facial nerve palsy, mastoiditis, sepsis, osteomyelitis of the base of the skull, sigmoid sinus thrombosis, multiple cranial nerve palsies and death. Experience with 72 patients in varying stages of the disease is summarized. Stressed are the diagnostic criteria of nonresponsiveness to the usual methods of treatment, continued suppuration, and the continuing reformation of granulation tissue in the floor of the external auditory canal. Medical treatment is recommended with hospitalization and intravenous carbenicillin and gentamicin. Minor surgical debridement is helpful. All patients should be treated medically for as long as improvement continues, reserving surgical intervention only in the event a plateau is reached or symptoms and signs become worse under treatment. With or without a major surgical procedure, it is imperative to continue treatment for at least seven days after apparent cure in order to avoid recurrent disease possibly at a site distant from the canal.
Electron Microscopic Observations in a Case of Long-Standing Profound Sensorineural Deafness
Authors: Nadol Joseph B.
Published: October 2014

The ultrastructural pathology in an ear with long-standing profound deafness is presented. Endolymphatic hydrops was present, although there had been no vestibular symptoms. Although hair cells were absent, the intercellular junctional complex at the endolymphatic surface of the organ of Corti was maintained, suggesting “healing” by migration or proliferation of supporting cells to fill the empty spaces. Severe atrophy of the stria vascularis was present, and crystalline deposits were found within the strial remnant. An encapsulated tectorial membrane was interpreted in light of ultrastructural findings as either herniation of the fibrillar connective tissue of the spiral limbus into the scala media or alternatively demonstrating abnormal continuity between the connective tissue of the spiral limbus and the remnant of tectorial membrane. Neural degeneration was severe in all cochlear turns. However, more nerve fibers were seen in the proximal portion of Rosenthal's canal than at the habenula perforata or in the organ of Corti, and central processes from the ganglion area were more numerous than peripheral processes. The ganglion cell population was reduced to approximately 10% of normal, and only unmyelinated cell bodies were found. Few recognizable neural fibers were seen within the organ of Corti, although bizarre collections of apparent cellular debris and cell processes containing many mitochondria or vesicles were seen in regions normally containing neural fibers.
Sudden Deafness with Severe Loss of Cochlear Neurons
Authors: Ishii Tetsuo , Toriyama Minoru
Published: October 2014

We report our postmortem findings in the temporal bones of a patient who, at the age of 13, after having had a cold, experienced a sudden and profound hearing loss in her right ear. She died of nasopharyngeal carcinoma at 41. The patient's right temporal bone showed a complete loss of cochlear neurons, but the organ of Corti was well-preserved. These findings indicate a primary degeneration of the cochlear nerve. The authors speculated that the possible cause of this sudden deafness was severe neuronitis of the cochlear nerve.
Pathogenesis of Bell's Palsy
Authors: Gussen Ruth
Published: October 2014

The pathogenesis of Bell's palsy is presented as retrograde epineurial compression edema with ischemia of the facial nerve. Although the etiology is unknown, an attractive theory is vasospasm, from any cause, along any facial nerve branch, with the chorda tympani, perhaps, the usual primary involvement. Retrograde vascular distension and edema, within the epineurium of the bony facial canal, compresses the nerve from outside its perineurial sheath. The compression force may be mild or severe, resulting in varying degrees of reversible or irreversible ischemic degeneration of myelin sheaths and axons, with varying degrees of cellular reaction to myelin breakdown. The edema may be resorbed, leaving reversible or irreversible nerve damage, or may stimulate collagen formation within the epineurium, with persisting fibrous compression (entrapment) neuropathy of the facial nerve. This concept is consistent with the varying results of Bell's palsy, and depends on the severity and duration of edema, and whether fibrosis occurs within the epineurium of the facial canal. Epineurial fibrosis also results in disturbance of metabolic exchange through the epineurial-permeurial-endoneurial tissues, and may ultimately result in obliteration of vascular drainage. Two temporal bone cases of Bell's palsy, one occurring ten years before death, with residual paralysis. and one two years before death, with clinical recovery, are added to the previously described four cases in the literature, three of early Bell's palsy, and one of remote palsy with almost complete recovery.
In Quest of the Prevention of Hyaline Membrane Disease
Authors: Avery Mary Ellen
Published: October 2014

Hyaline membrane disease or respiratory distress syndrome of prematurely born infants is more common in males, in Caucasians, has a familial predisposition, and is associated with maternal diabetes and delivery by cesarean section before the onset of labor. Now known to be the sequel of surfactant deficiency, it can be predicted prenatally by assay of amniotic liquid for surface active materials produced by the fetal lung. Deficiency of adequate surfactant synthesis or secretion can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can be accelerated if labor or elective delivery can be deferred at least 24 hours. Glucocorticoids given to the mother cross the placenta and enter fetal lung tissues; specific receptors exist in the lung which permit glucocorticoids to promote cell differentiation and surfactant synthesis precociously. Clinical trials support the efficacy and lack of short-term toxicity of glucocorticoids in human pregnancy after 28 weeks gestation in the event of premature onset of labor. Maternal toxemia, infection or illness which may be aggravated by glucocorticoids may contraindicate prenatal treatment. Postnatally endogenous glucocorticoids accelerate lung maturation, and further administration confers no additional benefit.
Complications of Percutaneous Transtracheal Procedures
Authors: Lyons George D. , Garrett Maynard E. , Fourrier David G.
Published: October 2014

The increasing use of transtracheal procedures by various specialties has caused a rash of new complications which have interested the endoscopist. These complications have resulted from the many diagnostic and therapeutic procedures involving the percutaneous puncture of the laryngeal or tracheal air space. The validity of these procedures is not questioned. However, they have spawned a host of diverse and bizarre complications which have led to serious and even fatal problems. The role of the endoscopist as a consultant in both the diagnosis and therapy of these developments must be understood and stressed.