bluuebunny/crossref_metadata_2025 huggingface dataset:
Skull Base Chondrosarcomas: Surgical Treatment and Results
Authors: Sbaihat Ahmad , Bacciu Andrea , Pasanisi Enrico , Sanna Mario
Published: October 2014

Objectives:

We describe our experience in the management of patients with skull base chondrosarcoma, an uncommon neoplasm of the skull base.

Methods:

Thirteen cases of surgically treated skull base chondrosarcomas were identified. The patients' follow-ups ranged from 7 to 86 months (mean, 47 months).

Results:

The most common tumor locations were the jugular foramen (5 cases), the petrous apex (3 cases), and the petroclival region (3 cases). An infratemporal fossa type A approach was performed in 2 cases, and 2 patients underwent an infratemporal fossa type B approach. Two patients underwent a transotic approach, 1 patient underwent a petro-occipital transsigmoid approach, and a petro-occipital transsigmoid approach combined with a transotic approach was chosen in 1 case. One patient underwent an infratemporal fossa type C approach combined with a transotic approach, and 2 patients underwent an infratemporal fossa type B approach combined with a transotic approach. One patient underwent an infratemporal fossa type B approach combined with a transzygomatic approach, and the last patient underwent a transmastoid approach. Gross total tumor removal was achieved in all patients. Postoperative radiotherapy was performed in 7 cases. The most common complications were lower cranial nerve deficits. Two patients experienced recurrences, 36 months and 6 years after surgical removal.

Conclusions:

We believe that the primary treatment for chondrosarcomas of the skull base is gross total surgical resection. We usually do not recommend radiotherapy as the primary treatment for patients with skull base chondrosarcomas; however, radiotherapy may be considered as an alternative primary treatment in selected cases in which there are serious medical contraindications to surgery, as well as in elderly patients. We reserve postoperative radiotherapy for patients with histologically aggressive tumors (grade II or III), as well as for cases of subtotal resection or recurrent tumors.
Incidence of Chronic Laryngitis
Authors: Stein Daniel J. , Noordzij J. Pieter
Published: October 2014

Objectives:

We describe the incidence of chronic laryngitis (CL) and identify the most common presenting symptoms and initial treatments used.

Methods:

We retrospectively identified patients with a diagnosis of CL who were seen among a primary care cohort at an urban academic medical center from 2009 to 2010. The incidence of CL was calculated. Symptoms, first-visit treatment, smoking, and demographics were recorded.

Results:

Of a population of 40,317 people, 280 received a new diagnosis of CL over a 2-year period, representing a yearly incidence of 3.47 cases per 1,000 people. The subjects consisted of 160 women and 120 men. Race was recorded as black (126), Hispanic (47), white (68), or other (39). The mean age was 52.9 years (range, 20 to 90 years). The initial therapies included proton pump inhibitors (79%), voice therapy (17%), nasal steroid (13%), antihistamine (4%), amitriptyline (4%), other (17%), and none (11%). The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases.

Conclusions:

The yearly CL incidence was 3.47 per 1,000 people. Up to 21% of the population may develop CL in their lifetime. Most of the patients in this cohort were referred to otolaryngologists, and the majority were treated with proton pump inhibitors. Dysphonia, globus sensation, and pain were the most common symptoms. Population surveys could be used to define undiagnosed disease and the overall prevalence of CL.
Management of a Postradiation Esophageal Web in the Setting of a Coexisting Zenker's Diverticulum
Authors: Shah Ameer T. , Wein Richard O.
Published: October 2014

We present a case of postradiation obstructive esophageal web, seen in the setting of a coexisting Zenker's diverticulum, that was treated with combined anterograde and retrograde esophagoscopy puncture and dilation. We also review the relevant literature. Obstructing esophageal webs and stenoses are well-documented complications seen in patients with head and neck cancer treated with radiation therapy. For thin webs, combined anterograde and retrograde esophagoscopy along with puncture and dilation can be a relatively safe treatment option for selected patients. The presence of a coexisting Zenker's diverticulum may predispose the patient to the development of postradiation esophageal complications and make subsequent assessment more difficult to perform.
XIV. Tracheotomy: A Study of 200 Consecutive Cases.
Authors: Figi Frederick A.
Published: October 2014

A review of 206 tracheotomies performed on 200 patients is presented. Seventy-one of these were emergency procedures; 135 were elective. The most frequently encountered primary pathologic conditions necessitating tracheotomy were: carcinoma of the larynx (133 cases), goiter (twenty-five cases), foreign bodies in the tracheobronchial tree (fourteen cases), and multiple papilloma of the larynx (eight cases). Although there was no immediate surgical mortality directly ascribable to the operation, eighteen patients died subsequently. Bronchopneumonia was the most frequent postoperative complication. It occurred in only thirteen cases in the entire series, and probably was present in two of these before opening of the trachea. Only three patients among the thirteen recovered. Mediastinitis was not encountered in any case. The deaths in the series were almost entirely the result of dyspnea and delay in opening the trachea rather than of the tracheotomy itself. 436 Tenth Ave., S. W.
C. A Proposed Operation for the Relief of Congenital Atresia of the Esophagus.
Authors: Iglauer Samuel
Published: October 2014

A two-stage operation is proposed for the relief of congenital atresia of the esophagus:

Stage 1. Cervical esophagostomy for drainage of the blind esophageal pouch.

Stage 2. A transthoracic operation for the externalization of the lower esophagus, i. e., dorsal esophagostomy for feeding purposes.

I wish to express my indebtedness to Dr. Richard Austin of the Pathological Department for anatomic material, and to Mr. Philip Goland for assistance in dissections.
XXVI A Consideration on the Circulation of the Perilymph
Authors: Kirikae Ichiro , Nomura Yasuya , Nagakura Masayuki , Matsuba Yukio , Sugiura Shigeru
Published: October 2014

A route of circulation of the perilymph in the cochlea was suggested. The perilymph was absorbed in the lower spiral ligament near the basement membrane. The perivascular space around the venule and vein plays an important role as a channel to convey fluid out of the perilymphatic space.
Development of Sensory Structures in Organ Cultures of the Twelfth and Thirteenth Gestation Day Mouse Embryo Inner Ears
Authors: Van De Water Thomas R. , Heywood P. , Ruben Robert J.
Published: October 2014

Twelfth and thirteenth gestation day mouse embryo otocysts have been explanted into an organ culture system that promotes advances in morphogenesis and differentiation of sensory structures. The pattern of morphogenesis that occurs “in vitro” is not equivalent to that which occurs in the “in vivo” environment. These morphogenetic changes occur with greatest frequency in the explanted thirteenth gestation day otocyst. The development of sensory structures occurs with equal distribution in the twelfth and thirteenth gestation day explanted otocysts. The thirteenth gestation day mouse otocyst favors the development of organ of Corti type formations, and the twelfth gestation day otocyst favors the development of maculae of sensory cells of a vestibular character in the organ culture system employed. The thirteenth gestation day otocyst requires a shorter period of “in vitro” development to produce differentiation of sensory structures. The sensory structures that develop “in vitro” follow the pattern of the sensory structures that develop “in vivo.”
Sudden Deafness and Labyrinthine Window Ruptures
Authors: Goodhill Victor , Harris Irwin , Brockman Seymour J. , Hantz Oscar
Published: October 2014

In 1971, one of the authors reported sudden deafness associated with labyrinthine window membrane ruptures. Eighteen additional cases have been explored surgically since then. Data on 21 cases are presented. Sudden profound cochlear deafness has now been encountered in 21 cases which were surgically explored. In 15 instances, fistulae of round, oval, or both windows were encountered and repaired. In 10 of the 15, there was a definite history of sudden exertion or trauma prior to onset. The oval window alone was ruptured in nine patients, the round window alone in one, and both windows were ruptured in five patients. The oldest patient was 62 years and the youngest 11 years of age. Differential audiological studies showed profound losses in all cases. Almost every case was studied by pure tone AC-BC and speech audiometry, Békésy, and impedance tests. Whenever possible other audiologic tests, such as recruitment, tone decay, and SISI were performed. These findings are presented in detail. Vestibular function was studied by electronystagmography (ENG) in 15 of the 21 cases surgically explored. There was evidence of vestibular dysfunction in almost every case with sudden hearing loss. Significant ENG details are presented. Surgical repairs of ruptured window membranes were followed by improvements in some of the patients. Postoperative audiologic data are presented. The theoretical aspects include discussion of possible cerebrospinal fluid (CSF) perilymph pathways between cochlear aqueduct and scala tympani and between internal auditory meatus and scala vestibuli. It is concluded that spontaneous labyrinthine window ruptures must now be added to the etiologic factors in “sudden hearing loss.” It is premature to set down criteria for surgical intervention in such cases. Further careful studies are necessary.
Salivation Testing in Traumatic Facial Paralysis
Authors: May Mark , Lucente Frank E. , Harvey Joseph E. , Marovitz William F.
Published: October 2014

When to explore for traumatic facial paralysis has been based upon time of onset and changes in nerve excitability testing. This study indicates that testing for submandibular salivary flow is the method of choice for making a decision to operate. Thirty consecutive patients with traumatic facial paralysis were studied for the prognostic value of whether time of onset was immediate or delayed. Immediate onset has a poorer prognosis than when the onset is delayed but time of onset is not completely reliable. Seventeen percent of the patients with an immediate onset had complete return and 29% with a delayed onset had an incomplete return. Nerve excitability testing was more accurate than time of onset but the test has a major limitation. There was a delay of up to three days between injury and the first detection of nerve excitability abnormality in patients who had an incomplete return. The salivation test performed by cannulating the submandibular salivary gland ducts and comparing the flow in terms of number of drops from each side overcame the time delay limitation of the nerve excitability test. Decrease in salivation to 25% or less when comparing the normal to the paralyzed side tended to antedate abnormal nerve excitability by several days in patients with serious nerve damage. Experimental sectioning of the facial nerve in a group of animals demonstrated immediate loss of salivary flow on the injured side whereas nerve excitability did not become abnormal until two days later. Two patients with traumatic facial paralysis were operated based upon a reduced salivary flow of 25% or less before nerve excitability became abnormal. Both had complete return of facial function. Three patients with a salivary flow of 25% or less who were not operated later developed abnormal response to nerve excitability and had incomplete return of facial function. The salivation test should be included in the prognostic evaluation of patients with traumatic facial nerve paralysis since it may be the earliest indicator for decompression of the nerve.
Quantification of the “In Vitro” Development of the Mouse Embryo Inner Ear
Authors: Van De Water Thomas , Ruben Robert J.
Published: October 2014

The development of sensory structures in organ cultures of the twelfth and thirteenth gestation day mouse otocysts has been quantified and the expected “in vitro” development may be predicted. The scoring system may be applied to the “in vitro” analysis of congenitally malformed ears in mutant strains of mice.
Formation and Fate of the Otoconia
Authors: Lim David J.
Published: October 2014

Although mammalian otoconia are known to be composed of calcium carbonate in calcite form, their morphogenesis, maintenance, and fate are not well understood. More information on these problem areas would aid considerably in better understanding various clinical conditions, such as cupulolithiasis and otolith degeneration. This study was intended to clarify the fine morphology of the otolith in normal and adverse conditions in laboratory animals with the use of the scanning and transmission electron microscopes. It was confirmed by this study that the mammalian otoconium is composed of an organic matrix and minerals (calcium carbonate). When the minerals are removed by decalcification, or chelation, a well arranged organic matrix, and even a nucleus, can be found in the crystal. The matrix of the crystal is identical to the gelatin matrix of the otolithic membrane. This finding supports the possibility that a normal protein matrix is a prerequisite for normal otoconia formation, and that the exchange of calcium ions can occur without altering the crystal structure. The vestibular dark cells, which are thought to be endolymph-secreting cells, appear to be capable of removing calcium from the otoconia that are attached to the dark cell surfaces. Although this evidence is only circumstantial, its consistency is impressive. On the basis of the foregoing, it is tempting to speculate that the dark cells participate in the removal of the dislodged otoliths, but further study is required to ascertain this point.
An Unusual form of Alerting Mechanism in Electronystagmography
Authors: Smith James D. , McCabe Brian F. , Ulrich Richard F.
Published: October 2014

A case of perilabyrinthitis with an unusual form of nystagmus alerting mechanism is presented. Patients who are found to have a decreased or absent response to caloric or positional testing may, on global digital compression, manifest nystagmus as recorded by ENG. This form of mental alerting is one which has not previously been described, and should be kept in mind when evaluating patients with vestibular problems.
Ossicular Chain Transplantation in Cats
Authors: Touma Joseph B. , Maguda Thomas A.
Published: October 2014

Seventy-one ossicular chains were transplanted in cats to determine the fate of the transplanted ossicles which were placed in 70% alcohol for two months prior to surgery. The morphology, bone repair and viability of the ossicles were determined by gross appearance, microscopic examination, serial sections of four decalcified temporal bones and tetracycline labels followed by fluorescent microscopy. There was extreme reaction in the middle ear to the transplanted ossicles with extensive fibrosis but the shape of the ossicles was not altered even after 19 months. However, the stapes could not be grossly identified in nine ears. The endochondral bone was gradually replaced by cortical bone with the greatest activity within the period of 3 to 6 months postsurgery and cessation of the activity after 13 to 15 months. This process of transition was studied with tetracycline labels and periodic microscopic sections of the ossicles. The inner ear reacted in different ways ranging from complete degeneration of the organ of Corti, to cochlear hydrops, to new bone formation and degeneration of the stria vascularis.
Amino Acid Composition of Human Nasal Mucus
Authors: Hilding A. C. , Cowles Edward J. , Stuart Jean Hilding
Published: October 2014

A profile of the proportions of the amino acids of the nasal secretion will enhance our understanding of nasal physiology. For the clinician, today this might be an interesting fact especially because this mucous secretion differs from mucous secretions produced elsewhere. For the future, it might be worked into the practical aspects of clinical practice. For the researcher, it furnishes another step in building the complete picture of nasal physiology. To supply this information nine composites from 55 individual specimens of nasal secretion from normal persons were subjected to acid hydrolysis and quantitative amino acid estimation. Sixteen amino acids were found regularly. Analytical recovery factors were determined for the individual amino acids, and, from these, mole percentages in the original mucus were estimated. The 16 amino acids in order of decreasing abundance were: proline, glutamic acid, glycine, serine, leucine, lysine, alanine, threonine, aspartic acid, valine, arginine, phenlyalanine, tryptophan, tyrosine, isoleucine and histidine. In the nasal mucus, a relatively high proline content is balanced by a relatively lower content of threonine and serine than in other types of mucus. Compared with the proportions of free amino acids in blood plasma, the nasal mucus has a much higher content of the dicarboxylic glutamic and aspartic acids, and a much lower content of alanine and valine.
Mucous Glands in the Middle Ear and Osseous Eustachian Tube
Authors: Bak-Pedersen K. , Tos M.
Published: October 2014

The mucous membranes from the osseous Eustachian tube, tympanic cavity, epitympanum, antrum, and mastoid process on clinically normal middle ears from 45 temporal bones were stained by the PAS-alcian blue whole-mount method and systematically studied for the presence, number, and density of mucous glands. Only four patients did not exhibit glands. The total number of glands in the individual patients amounted to less than 60 in 85% of the cases. Only two patients showed high counts, 273 and 337 glands, respectively. The mean density was 0.53 gland per mm2. In most of the patients the glands were found in three to six different localities, the most common locality being the oval window. Glands were found in only ten osseous Eustachian tubes, in very small numbers. By far the great majority of glands were inactive and degenerated. In ten patients, however, there was a small number of active glands. The glands demonstrated are presumably the sequelae of previous pathological actions upon the middle ear and Eustachian tube, and the glands are probably not a normal component of the middle ear mucosa.
Comparison of Wire-Vein and Wire-Gelfoam Prostheses in Stapedectomy for Otosclerosis
Authors: Sooy Francis A. , Owens Elmer , Neufeld Elizabeth S.
Published: October 2014

A comparison was made of the overall postoperative results for a group of 50 patients who had undergone a wire-gelfoam stapedectomy procedure for otosclerosis and a group of 106 patients who had undergone a wire-vein graft procedure. All operations were performed by the same surgeon and all testing was conducted in sound treated rooms by experienced audiologists using calibrated equipment. The results for the wire-vein group were consistently superior. At the four-month postoperative test date, air-bone closure for the wire-vein group was better at all frequencies by approximately 2 to 4 dB. Also, the four-month postoperative speech discrimination scores showed a decrement of only 1.8% for the wire-vein group in contrast to a decrement of 5.9% for the wire-gelfoam group. Furthermore, while no serious postoperative complications occurred for the wire-vein group, two instances of fistulae and one instance of wire migration occurred for the wire-gelfoam group. These results, coupled with recently proved long-term stability for the wire-vein graft prosthesis, support our initial clinical impression favoring the wire-vein graft stapedectomy procedure.
Osteogenic Sarcoma of the Frontal Sinus
Authors: Bone Robert C. , Biller Hugh F. , Harris Bernard L.
Published: October 2014

Although osteogenic sarcoma occurs in the head and neck, it is almost exclusively limited to the maxilla and the mandible. Single, rare cases of this tumor in other facial bones are mentioned in foreign reports, but a discussion in the English literature has not come to our attention. The case history of a 58-year-old woman with a nonspecific frontal sinus pain and right-sided proptosis is presented. Plain radiographs of the paranasal sinuses revealed a radiopaque, calcific mass in the right frontal sinus approximately 3 × 5 cm in diameter. It was noted that the mass had an “onionskin” lamination. Laminography aided in the exact localization of the mass; further, it was noted on arteriography that the frontal sinus mass did not invade the dura. A frozen section biopsy at the time of craniotomy suggested a benign histologic lesion. However, subsequent review of permanent sections showed findings typical of an osteogenic sarcoma. The patient was treated with irradiation and in the first postoperative year has done well.
Treatment of Acute Maxillary Sinusitis
Authors: Axelsson Alf , Chidekel Nathan , Jensen Cay , Grebelius Nils , Singer Frans
Published: October 2014

This paper deals with the problem of finding the optimal treatment for acute maxillary sinusitis. Only sinuses with secretion were included. Comparison between the different modes of treatment was made by the aid of a radiological gradation of the sinus changes. Each treatment group consisted of 50 patients whose sinuses were radiologically investigated on day 1, 5, 10 and 15. Treatment was given for 10 days. Irrigation was performed every second day until the lavage content was clear. Side effects were investigated. All groups were statistically similar initially. There was no statistical difference between the four treatment groups with regard to healing after 5, 10 and 15 days of treatment. Few side effects were noted on doxycycline but some on spiramycin. Both antibiotics thus afford the advantage of omitting irrigation from the treatment.
Middle Ear Effusions
Authors: Mogi Goro , Honjo Shoichi , Yoshida Toyoharu , Maeda Shoichi
Published: October 2014

Quantitative analysis of immunoglobulins (IgG, IgA and IgM) by radial immunodiffusion technique and double diffusion analysis of secretory immunoglobulin A (SIgA) were performed on specimens of middle ear effusion for the purpose of investigating the nature of middle ear effusion. Specimens consisted of 34 serous (15 acute and 19 chronic type) and 15 mucoid effusions (9 acute and 6 chronic type). Mean values of the IgG level in effusions and sera of each category were nearly the same. The IgA concentrations of mucoid effusions were significantly higher than those in serous effusions. Mean values of the IgM level in effusions of acute and chronic cases of both categories were lower than those in the sera. SIgA was found in 9 out of 34 (26.5%) serous effusions, while 14 out of 15 (93.3%) mucoid effusions were found to have SIgA. Results of this study suggest that middle ear effusion is a mixture of the transudate from the serum and of secretion by secretory cells present in the mucosa of the middle ear cavity; and that the nature of the mucoid effusion is similar to exudate, while the serous effusion for the most part comes from the serum.
Calcified Neurilemoma of the Larynx
Authors: Naeim Faramarz , Waisman Jerry
Published: October 2014

A calcified neurilemoma was discovered in a 73-year-old man whose main complaint was of progressive hoarseness associated with recent dysphagia. The tumor was located above the level of the right vocal cord, measured 4×3×3 cm and showed extensive cystic degeneration, in addition to calcification. At microscopic examination both Antoni A and B patterns were identified at the periphery of the degenerate tumor. At the ultrastructure level the tumor was composed of collagen fibrils with scattered elongated cells. Cells had a definite basement membrane and cytoplasmic substructures as described in neurilemoma. These benign encapsulated neoplasms are very rare in the larynx and the initial symptom usually is longstanding progressive hoarseness as in this report. Local excision is satisfactory treatment for laryngeal neurilemomas when practical.
Hemangioma of Maxilla
Authors: Sawhney K. L. , Rao P. B. , Sankaran Vanaja
Published: October 2014

Bony hemangiomas, while occurring with some frequency in the axial skeleton, are rare in the maxilla. A case is described bring the total in the world literature to 12. Presenting symptoms and signs can include a pulsatile cheek mass, bruit, and toothache. If conventional x-ray reveals a honeycomb effect and resorption of bone, angiography may establish the diagnosis preoperatively. Maxillectomy is probably the treatment of choice. Biopsy is fraught with danger, and should only be undertaken at the time of definitive surgery.
The Sequential Bithermal Binaural Caloric Test: II. Clinical Application of New Statistical Methods for Interpretation
Authors: Black Franklin O. , Custer David D. , Hemenway William G. , Thornby John I.
Published: October 2014

Three tests for the determination of caloric nystagmus response abnormalities have been developed, based upon analysis of intrasubject normal responses, obtained by using a statistical model that provided an exact fit with clinical procedures. Normal limits derived from interaural, stimulus temperature, and nystagmus direction responses should provide a more sensitive index of abnormality than limits based on percentage based response criteria. A retrospective examination of caloric responses from Ménière's disease patients provided preliminary support for clinical feasibility and increased sensitivity of the statistical methods advocated for clinical usage.
Surgery on “Only-Hearing” Ears with Chronic Suppurative Middle Ear Disease
Authors: Gacek Richard R.
Published: October 2014

Since the risk of sensorineural hearing loss from persistent chronic otitis media and mastoiditis is greater than the risk to loss of labyrinthine function from carefully performed surgery, it is felt that the best treatment for chronic suppurative middle ear disease in an only-hearing ear is surgical removal of disease. Between the years 1961 to 1970 14 cases of chronic otitis media and mastoiditis in only-hearing ears were treated surgically at the Massachusetts Eye and Ear Infirmary. Five cases presented with resistant foul otorrhea, while five patients presented with increasing hearing loss and four with vertigo. The patients with hearing loss and vertigo were subjected to surgery at the earliest possible date. Wide-field surgical exposure of the mastoid and middle ear spaces with thorough removal of diseased tissue was carried out. Particular attention to avoid injury to the labyrinth, either directly or indirectly, must be kept in mind and it is recommended that surgery in only-hearing ears be performed by only the most experienced and capable otologic surgeon. All 14 ears have remained dry after surgery. Hearing was significantly improved in ten cases, while two were unchanged and two were made worse, as regards the conductive loss only. In all 14 cases postoperative discrimination scores were normal, so that even those cases that did not achieve serviceable hearing levels from surgery were able to use amplification. The results in this series confirm the feeling that carefully performed and timed surgery is effective in controlling chronic suppurative disease, while preserving function in only-hearing ears.
Tumor-Specific Immunity and the Otolaryngologist
Authors: Neel H. Bryan , Ritts Roy E.
Published: October 2014

It has been known for many years that cell-mediated immune mechanisms are primarily responsible for rejection of normal tissue grafts in genetically dissimilar individuals, and it is now clear that immunity to cancer is mediated in the same way. Malignant tumors have cell surface antigens which are different from those of the tissues from which they arise, hence the term “tumor-specific antigens.” Largely responsible for this discovery was the development of syngeneic (genetically identical) host systems which have permitted assessment of tumor-specific immunity rather than the transplantation antigens of allograft immunity. Host-tumor surveillance is primarily lymphocyte mediated. The humoral immune mechanism is also involved, but the best documented action of humoral factors is interference with cell-mediated tumor destruction by “blocking.” Direct evidence for a host-tumor relationship has led to a resurgence of interest in immunologic therapy for cancer. Prospects for immunotherapy include nonspecific active immunization (i.e., BCG), transfer of lymphocytes or transfer factor, selective elimination or inactivation of humoral blocking material, and prolongation of tumor-specific antigen stimulation by in situ necrosis. At the present time it is unlikely that immunotherapy alone will play a major role in the treatment of gross deposits of cancer, but it may become an important adjunct to surgical therapy by eradicating small populations of tumor cells, both within the surgical field and at distant sites. Theoretically, immunotherapy could solve both of these problems which are the consequences of small undetectable inocula of tumor cells having been deposited at distant sites or in the surgical field. Before immunotherapy can be accepted as a standard form of cancer therapy, it will be necessary to delineate the interrelationships of tumor antigens, cytotoxic antibodies, blocking factors, and delayed type hypersensitivity.
Transtracheal Ventilation for Laryngoscopy
Authors: Smith R. B. , MacMillan B. B. , Petruscak J. , Pfaeffle H. H.
Published: October 2014

The use of transtracheal ventilation during laryngoscopy is reported in a 66-year-old female. Indirect laryngoscopy prior to admission to the hospital revealed a deeply ulcerating and destructive lesion of the entire right side of the epiglottis with the entire right hemilarynx fixed. The technique of ventilation through a No. 16 Teflon® intravenous catheter placed into the trachea below the first tracheal ring is described. The patient was anesthetized with sodium thiamylal and paralyzed with succinylcholine. Ventilation of the lungs was with an intermittent jet of oxygen under high pressure (50 lbs/sq in). The indications for the use of this technique are described together with the possible hazards. Transtracheal ventilation may have an important role in cardiopulmonary resuscitation and in ventilation during anesthesia. It may be of particular value in the patient with a partially obstructive lesion of the larynx such as a carcinoma in whom standard tracheal intubation with an endotracheal tube would be difficult. However, in patients who are in respiratory distress with an obstructive lesion of the larynx, there may be some problems in exhalation. If this occurs, a cricothyrotomy may be performed for exhalation or an attempt should be made to open the upper airway, perhaps with a small bronchoscope. It should be emphasized that a dangerously high airway pressure may also occur with a prolonged inspiratory phase with the high pressure oxygen.
Immunoglobulins and Blood Vessels in the Tonsillar Crypt Epithelium
Authors: Schmedtje John F. , Batts Ann F.
Published: October 2014

The localization of IgA, IgG, IgM, SP and the relationships of plasma cells and lymphocytes to blood vessels in the tonsillar crypt epithelium were investigated. Immunofluorescent techniques were used that included antisera specific for the two antigenic determinants of external secretory IgA, namely, 4s SP and 7s IgA, and also antisera specific for 7s IgG and 19s IgM. The secretory piece was absent in the crypt epithelium and in most of the crypt lumen. Aggregations of plasmacyte series cells, containing either IgG, IgA, or IgM were present in the crypt epithelium. Mature plasma cells of these aggregations abutted against the walls of blood sinusoids located in the epithelium, which suggested secretion into these sinusoids. All three immunoglobulins were also identified between epithelial cells and small lymphocytes. Postcapillary venules with emigrating small lymphocytes abounded in sub-epithelial sites, and were present at the lower border zone of the epithelium. Lymphocytes in shapes of diapedesis were observed in the endothelium of epithelial blood sinusoids. These observations are in accord with the hypothesis that a “circulation” of many lymphocytes occurs in the epithelium facilitating the activation of any one genetically committed lymphocyte.
Control for Vacuum Embedding Methods in Temporal Bone Histopathology
Authors: Singleton George T. , Kohut Robert I. , Adkins Warren
Published: October 2014

An easy-to-build, relay controlled, pump-manometer system for regulation of vacuum ovens is described. It allows accurate and constant atmospheric conditions during vacuum embedding of temporal bones and other histological specimens.
Suboccipital Microsurgical Removal of Acoustic Neurinomas of All Sizes
Authors: Smith Mansfield F. W. , Miller Ray N. , Cox Dale J.
Published: October 2014

This report discusses a combined neurosurgical-otologic team approach to the management of 16 consecutive suspected VIII nerve neurinomas, all operated via the suboccipital route. A suboccipital craniectomy is done with the patient in the prone position. Dissection for all size tumors began with exposure of the internal auditory canal to the transverse crest with dissection of the neurinoma from the VII and VIII cranial nerves beginning in the lateral most posterior portion of the internal auditory canal. There was one death and one cerebrospinal fluid (CSF) leak. Total tumor removal was accomplished in 14 of 15 acoustic neurinoma patients. Facial nerve function was preserved in 12 of 15 patients and preoperative hearing maintained in 5 of 15 patients.
Surgery for Acoustic Neurinoma
Authors: Montgomery William W.
Published: October 2014

This presentation is concerned with the one-stage translabyrinthine operation of small acoustic neurinomas and a combined translabyrinthine suboccipital staged operation for removal of large acoustic neurinomas. The technique for the translabyrinthine approach to the cerebellopontine angle is described in detail and demonstrated by photographs of the dissection as it progresses. The technique includes both a one-staged translabyrinthine operation for removal of small acoustic neurinomas and preparation of the involved field when the second stage suboccipital operation is necessary. The first 75 consecutive cases are reviewed. Total removal of tumor was accomplished in 43 of these patients by the translabyrinthine route with incidence of 12% permanent facial nerve paralysis. Twenty-seven patients required a second stage suboccipital operation. Total removal was accomplished in 16 of these patients. Only three of the 11 patients with subtotal removal of tumor have required additional surgery. There was an incidence of permanent facial nerve paralysis in eight of these patients. Five of 75 patients underwent a translabyrinthine operation with subtotal removal of tumor. A second stage suboccipital operation was not performed in these patients because of advanced age or refusal. One of these five patients has a permanent facial paralysis and none have required further surgery to date. There was an incidence of 18% permanent facial paralysis among the entire 75 cases. The author prefers the hypoglossal facial nerve anastomosis procedure for rehabilitation for those patients with facial nerve paralysis. There has been no operative mortality in this entire series and 94% of the patients have been able to resume their previous level of work and activity. There was only one transient episode of cerebrospinal fluid otorhinorrhea among the 75 patients.
A Prosthesis for the Deaf Based on Cortical Stimulation
Authors: Dobelle W. H. , Stensaas S. S. , Mladejovsky M. G. , Smith J. B.
Published: October 2014

The feasibility of developing a functional auditory prosthesis, or “artificial ear” to restore hearing to the totally deaf is discussed. The approach taken involves connecting electrodes to the auditory cortex of the brain. Previous work by other groups has concentrated on stimulation of the cochlea or auditory nerve. However, stimulation of auditory cortex bypasses the entire peripheral auditory system and this approach may thus be applicable to a wider group of people, including those with hearing loss caused by lesions of the auditory nerve, or even central pathways. Establishment of the feasibility of any such sensory prosthesis requires demonstration of meaningful information transfer in human subjects, demonstration that chronic implantation and stimulation can be achieved without damaging the brain, and the demonstration of engineering feasibility at reasonable cost. Each of these areas is discussed separately. Although progress to date gives reason for optimism, it must be stressed that large amounts of work remain to be done and the successful development of such a system may take many years. One principal limitation is the small number of patients suitable for experimentation. Other investigators are accordingly encouraged to take advantage of the rare clinical opportunities which permit progress in such areas.
The Role of the Organ of Corti in Auditory Nerve Stimulation
Authors: Lawrence Merle , Johnsson Lars-Göran
Published: October 2014

An analysis of the contribution to hearing made by the presence of a normal organ of Corti as compared to direct electric stimulation of the nerve leads to the following conclusions: The portion of the basal turn of the cochlea which can be stimulated contains activity regions primarily limited to frequencies above 5000 Hz. Electrical stimulation of sensory afferent nerve fibers gives rise to sensations of very limited dynamic range compared to normal adequate stimulation through the organ of Corti. Following destruction of the organ of Corti, the speed of nerve degeneration in man is not known, but appears to be slow. Some ganglion cells almost always persist but it is doubtful that these are excitable. The severe nerve degeneration known to be present in most cases of human deafness raises critical questions about the feasibility and logic of a direct stimulation of the auditory nerve in these patients. The unavoidable damage to the capillaries and endosteum of the walls of the scala tympani by insertion of a wire is certain to produce further degeneration and new bone formation.
Incus Interposition Techniques
Authors: Pennington Claude L.
Published: October 2014

This report describes a technique of incus interposition which has resulted in a closure of air-bone gaps from 30 dB to 15 dB or less in 69.4% of 216 ears, which have been followed for two to five years after surgery. An analysis of a subgroup of preoperative near normal hearing ears revealed no significant increased postoperative hearing loss, while another subgroup with very wide preoperative air-bone gaps showed significantly less air-bone gap closure at 15 dB (44.0%) than the general group. Preoperative and postoperative hearing tests in another subgroup of ears, in which the posterior ear canal wall was removed at the time of surgery, revealed that there was no significant increased hearing loss when compared with the entire group. This finding would suggest that removal of the posterior ear canal wall per se does not decrease the chances for hearing improvement when this technique is used. A study of the tympanosclerotic ears in this series revealed a postoperative air-bone gap closure of 15 dB or less in 58.5%. Failure to achieve adequate air-bone gap closure was most frequently caused by middle ear atelectasis (24.0%), on an allergic basis (52.0%), while graft malposition was infrequent (2.8%) and resorption or rejection of autografts or banked ossicles was not observed.
Viral Disease of the Labyrinth
Authors: Davis Gustave L. , Strauss Melvin
Published: October 2014

Investigation of the routes of infection of viral labyrinthitis was undertaken using mouse cytomegalovirus (CMV) and CMV-free Swiss-Webster mice. Intraperitoneal and intranasal inoculation caused no CMV infection of the ears or central nervous system. Intraperitoneal inoculation of pregnant mice yielded no evidence of fetal infection. Intracerebral inoculation of newborn mice resulted in viral infection of the ear by extension: 1) from the arachnoid into cochlear periotic connective tissue via the cochlear aqueduct and 2) along the perineurium of the acoustic nerve into the modiolus. There were neither changes in the stria vascularis nor endolymphatic labyrinth in spite of vasculitis and viremia. This experimental labyrinthitis resembles that found in human temporal bones infected with herpes zoster rather than the endolymphatic labyrinthitis seen in rubella, rubeola, mumps, and cytomegalovirus. The chronic effects of the mouse CMV labyrinthitis are under study.
Cochlear Potentials and Electron Microscopy Applied to the Study of Small Cochlear Lesions
Authors: Bohne Barbara A. , Eldredge Donald H. , Mills John H.
Published: October 2014

Many investigators have attempted to define the relations among behavioral auditory thresholds, cochlear potentials and cochlear pathology after excessive exposure to noise. We have observed that some noise exposed chinchillas have fewer missing sensory cells yet lower cochlear potentials than nonexposed controls. By comparing the cochleae of animals with the above characteristics, we found that the noise exposed ear had many misshapen outer hair cells, possible loss of some of the peripherally arranged mitochondria in the same cells and an increase in vesicles, vacuoles and smooth endoplasmic reticulum in the afferent nerve fibers in the region of the organ of Corti from which the low cochlear potentials were recorded. It is clear from these findings that hair cell counts alone do not always give a true indication of the functional status of the cochlea. In describing the permanent anatomical effects of a particular noise exposure on the inner ear, the condition of the cells and nerve fibers which remain after injury must be determined in addition to the number of sensory cells and nerve fibers which were lost.
The Effect of Sodium Fluoride on Otosclerotic Activity as Determined by Strontium85
Authors: Linthicum F. H. , House Howard P. , Althaus Sean R.
Published: October 2014

Sodium fluoride (NaFl) has the effect of changing active foci of otosclerosis to quiescence. Strontium85 (Sr85) was used to determine the process of calcium deposition in normal canal wall bone and in the footplates of patients with bilateral otosclerosis before and after the administration of NaFl. The first surgery was performed on the poorer hearing ear. Fragments from oval window bone initially showed up to 34 times as much radioactivity as fragments from canal wall bone. The patients then took 25 mg of NaFl daily for six months. None failed to close and maintain gap closure within 11 dB for five months. The same evaluation was done on the bone of the footplate after surgery on the second ear. There was little or no more radioactivity in the footplate bone than in the ear canal wall bone used as a control, indicating cessation or diminution of activity at the otosclerotic focus. Prior to initiating this study, other patients with familial, progressive, purely sensorineural loss showed little or no hearing loss progression after undergoing fluoride therapy. We now recommend 25 mg daily for individuals with progressive hereditary sensorineural hearing loss and evidence of otosclerosis by polytomography.
Evaluation of Therapy
Authors: Senturia Ben H.
Published: October 2014

There is much conflicting information regarding the treatment of external otitis. Therefore an attempt was made to perform a controlled study of the effectiveness of a typical widely used combination of antibiotics and corticosteroids in aqueous and cream vehicles. Bacterial cultures and sensitivities were obtained before and during treatment to assess clinical progress. It was shown that the proper utilization of the antibiotic-steroid preparations was very effective in controlling the symptoms and inflammatory changes and in eliminating the exogenous bacteria.
Unusual Laryngeal Problems in Children
Authors: Jaffe Burton F.
Published: October 2014

Three rare laryngeal lesions were seen in one year at Children's Hospital Medical Center in Boston. Case 1 is a subglottic mass that is a diagnostic problem since various pathologists have differing opinions ranging from a benign to a malignant tumor. The tumor mass was totally removed as a biopsy and to avoid a tracheotomy. Clinical management is now conservative and awaits both a definite pathologic diagnosis as well as a definite clinical course. Case 2 is an isolated lymphangioma of the larynx unrelated to a cervical cystic hygroma. The edematous arytenoid prominences and aryepiglottic folds were removed with an excellent functional result. Case 3 is a bilateral vocal cord adhesion following four days of endotracheal intubation. An inappropriate diagnosis of bilateral vocal cord abductor paralysis was made earlier and corrected on a later microscopic examination of the larynx. Simple division of the posterior adhesion gave an excellent functional result. Suspension laryngoscopy with microscopic examination of the larynx was important in all three cases both from a diagnostic and a therapeutic viewpoint.
Does Cryosurgery Have a Place in the Treatment of Papillomata or Carcinoma of the Larynx?
Authors: Miller Daniel
Published: October 2014

Cryosurgery may be used as primary treatment for T1 cancer of the larynx in elderly patients with fair or poor medical status and as secondary treatment in postradiation failures of T1 carcinoma, or in multicentric carcinoma in situ. It is of proven value in cases studied to date. Many properly classified patients are being treated by this method with the expectation that most will not require a laryngectomy. Recurrent squamous papillomata of the larynx have responded excellently in many patients with cryosurgery, some necessitating more treatment than others. Fewer laryngoscopies are necessary; in most patients, the disease was eliminated in one to five treatments.
Intracordal Injection of Teflon® in the Treatment of 135 Patients with Dysphonia
Authors: Dedo Herbert H. , Urrea Robert D. , Lawson Lucie
Published: October 2014

The correction of paralytic dysphonia is primarily a mechanical problem requiring movement of the paralyzed vocal cord to the midline so that the functioning cord can meet it and effectively close the glottis. Intracordal Teflon® injection is now the treatment of choice. This paper reviews 135 patients who received Teflon® injections of the vocal cord during the last five years. Eighty-one percent of the patients with dysphonia recovered a normal solid phonatory voice and 96% were clinically improved at least one step. Pure laryngeal paralysis was virtually always improved, usually to a normal phonatory voice. Although some patients with hoarseness after surgical or blunt trauma were improved, the results were not as consistent. Aspiration was decreased or eliminated in the majority of patients unless there was too much laryngeal scarring to permit vocal cord repositionment or unless multiple cranial nerve or cerebellum deficits were present.
Hyperplastic Rhinosinusitis
Authors: Davison F. W.
Published: October 2014

Sinus surgery can, by ventilation and drainage, assist in curing infection. It does nothing to cure atopy or vasomotor rhinitis owing to autonomic dysfunction with cholinergic excess. Four etiologic factors may coexist in the same patient: 1) Infection with bacterial allergy; 2) Atopy (food or inhalant sensitivity); 3) Cholinergic vasomotor rhinitis and 4) Endocrine abnormality, notably poor adrenocortical function. Medical treatment must be continued after operation.