bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunologically Induced Changes in the Tonsillar Crypt Epithelium
Authors: Schmedtje John F. , Chinea Jose J. , Kletzing Daniel W.
Published: October 2014

The normal gross and microscopic anatomy of the palatine tonsil of the rabbit was observed, and following the direct injection of antigenic substance, structural changes were noted in the crypt epithelium. A cold light laryngoscope tube was used to inject ovalbumin or bovine serum albumin, plus Freund's complete adjuvant, into the subepithelial lymphatic tissue. Five weeks later subcutaneous challenge injections of the same protein produced increased numbers and proportions of infiltrated small lymphocytes and medium-sized lymphocytes containing a highly organized granular endoplasmic reticulum. These cells occupied wide intercellular passageways. Epithelial plasma membranes that faced these passageways remained smooth, but other surfaces of the same epithelial cells acquired vastly increased numbers of microvilli. The surfaces of other epithelial cells that faced each other also showed microvilli. These microvilli faced expanded interfacial canals. Increased numbers of small lymphocytes were observed emigrating through postcapillary venules immediately beneath the epithelium. The microvilli and other fine structures of tonsillar crypt epithelial cells are compared with similar structures of epithelial cells of the thymus. The experimentally induced increase in microvilli suggests the possibility that tonsillar crypt epithelial cells make a secretory contribution to local immune reactions.
Extracranial Meningioma
Authors: Michel Randall G. , Woodard Brett H.
Published: October 2014

A patient is presented with findings of separate intracranial and extracranial meningiomas, each of a different histologic type. A calcified fibrous meningioma, with secondary psammomatous features, presented as a left neck mass associated with hoarseness, dysphagia, a unilateral facial weakness and hearing loss. A noncalcified asymptomatic intracranial syncytial meningioma was discovered in the left frontal lobe after computerized tomographic and angiographic study of the cranial contents. The origin of the extracranial meningioma producing multiple unilateral cranial nerve disturbances and serous otitis media is discussed. The noncontiguous tumors in this patients are felt to have separate origins, with the extracranial lesion most likely arising in the temporal bone.
Laryngeal Dysfunction following Prolonged Intubation
Authors: Whited Robert E.
Published: October 2014

Prolonged endotracheal intubation in the adult is becoming more popular with the advent of “soft” tubes and cuffs. The many deleterious effects of such long-term intubation on the laryngotrachea have been extensively discussed in the literature. However, only sporatic attention has been given to vocal cord paresis or paralysis. The University of Cincinnati Medical Center experience with postintubation patients has shown that cord mobility disturbances are relatively common. Sixteen patients are presented who have had similar clinical findings and course following extubation. The clinical picture is that of a symmetrical vocal cord paresis or paralysis associated with arytenoid and posterior commissure edema and erythema. Vocal cord position is most often median or paramedian. A spontaneous recovery over days to weeks is the usual course. During the recovery phase cord movement most often remains symmetrical; however, full motion may occur in one cord before the other. In all patients abduction was most limited and slowest to return. In this series the most significant effect has been aspiration. Two patients developed a posterior commissure stenosis. This entity is believed to be due to inflammation initiated by the tube and its movement against the posterior half of the endolarynx. In particular, inflammatory involvement of the cricoarytenoid joints and interarytenoid region best explain the clinical course. When mucosal ulcerations and granulation tissue are superimposed on the immobilized cords interarytenoid scarring may lead to chronic stenosis.
The Problem of the Collapsing Upper Lateral Cartilage
Authors: McCabe Brian F.
Published: October 2014

The collapsing upper lateral cartilage is an airway problem that admits to no ready solution, such as the deviated nasal septum or deflected columella. It is my understanding from experienced nasal surgeons that an attack directly on the upper lateral cartilage has not provided a solution, but in general makes the problem worse. A look at the nasal septal base by simultaneous viewing of both nasal chambers may reveal a dimension of 1 cm or more. In that event, a fairly radical narrowing of the septal base in the plane of the pyriform crest by a subperiosteal and subperichondrial approach with well-placed transfixion sutures can increase the airflow across that plane. It has done so in eight patients. This operation is for the experienced nasal surgeon, or the otolaryngologist who has prepared himself by careful cadaver preexperience.
Acuracy of Frozen Section Diagnosis of Parotid Lesions
Authors: Miller Robert H. , Calcaterra Thomas C. , Paglia Donald E.
Published: October 2014

The accuracy of frozen section diagnosis was analyzed in a review of 132 parotid lesions. Of 107 benign lesions, 93% were correctly diagnosed on frozen section analysis, but of 25 malignant lesions, only 9 frozen sections were accurately interpreted. This study points out the difficulty encountered in using the frozen section technique when dealing with malignant parotid lesions and the importance of the surgeon's active participation in the analysis.
Hearing and Age Research
Authors: Butler Robert N. , Gastel Barbara
Published: October 2014

Just as the ear trumpet once symbolized the elderly, so do contemporary approaches to hearing loss in the aged reflect many of the major themes in geriatrics and gerontology today. This paper begins by describing the National Institute on Aging (NIA) with particular emphasis on activities relevant to hearing in the elderly. Next, several areas of research interest, including the typology of presbycusis and related conditions, the epidemiology of auditory impairment in old age, the design of testing and research, and the rehabilitation of the hearing-impaired elderly, are addressed. The NIA and the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) are coordinating their efforts to stimulate investigation of these and related topics.
Bone Resorption in Chronic Otitis Media
Authors: Gantz Bruce J. , Maynard Jerry , Bumsted Robert M. , Huang Cheng Chun , Abramson Maxwell
Published: October 2014

Bone resorption is an important aspect of chronic otitis media contributing to many complications of this disease. It is postulated that the mechanism of this localized destructive process is chemical in origin. Collagenase, lysosomal enzymes, prostaglandins, and other cell mediators are thought to induce bone resorption, but the site of action and cellular origin of these substances remains unclear. In this report, we demonstrate the location and attempt to delineate the cellular origin of two enzymes, collagenase and the lysosomal enzyme acid phosphatase in guinea pig temporal bones and human ossicles from ears containing chronic otitis media. Tissue localization of these enzymes identifies sites of active bone resorption and demonstrates the cells initiating this process. Using immunohistochemical and immunocytochemical techniques, collagenase was seen surrounding mononuclear inflammatory cells of granulation tissue at bone resorbing margins and at the periphery of osteocyte lacunae adjacent to resorbing areas. Electron microscopic data suggests that collagenase is an extracellular enzyme found at the periphery of osteocytes. In addition, abundant acid phosphatase activity was seen in the same cells that exhibited collagenase staining, lending credence to the destructive function of these cells. The chronic inflammatory reaction found in chronic otitis media appears to activate bone destruction through the dynamic activity of mononuclear inflammatory cells and stimulates bone cells to increase their destructive biochemical functions.
Effect of Transverse Temporal Bone Fracture on the Fluid Compartment of the Inner Ear
Authors: Rizvi Syed S. , Gibbin Kevin P.
Published: October 2014

Five temporal bones exhibiting transverse fractures were studied with a view to determining whether such fractures could lead to symptomatic endolymphatic hydrops. Four out of the five temporal bones showed the fracture line traversing the vestibular aqueduct. Two of these four showed complete obstruction of the endolymphatic duct. One of these had an intact membranous labyrinth and severe endolymphatic hydrops. The other had ruptures of the membranous labyrinth and no hydrops. Three ears exhibited partial preservation of auditory and vestibular hair cells and neurons. These findings are consistent with the concept that a transverse fracture may produce endolymphatic hydrops by obstructing the vestibular aqueduct while preserving enough audiovestibular epithelium and neurons to present as symptomatic Menière's disease.
Relearning the Swallowing Process
Authors: Heimlich Henry J. , O'Connor Terence W.
Published: October 2014

Three patients were encountered who had physical defects that prevented them from swallowing food. They had received nourishment for a long period of time by means of tube feedings, gastrostomy in two cases and nasogastric tube in the third. Following surgical correction of the physical problems, they were still unable to swallow food. It was conceived that they had forgotten how to swallow. A program to enable them to relearn the technique of swallowing was established, similar to that used in premature infants. The three patients were successfully rehabilitated, able to eat a regular diet. The method is being evaluated in stroke patients who have lost the ability to swallow food and saliva.
Vocal Cord Dysfunction — An Industrial Health Hazard
Authors: Rontal Eugene , Rontal Michael , Jacob H. J. , Rolnick Michael I.
Published: October 2014

Vocal cord dysfunction has a definite incidence of association with high environmental noise levels. Our study has shown roughly an 8% incidence of vocal cord dysfunction (vocal cord nodules, vocal cord polyps and chronic laryngitis) in individuals working in high noise environments. In addition, those individuals who have surgery for vocal cord nodules and who work in high noise environments will have over a 30% incidence of recurrent vocal cord dysfunction following surgery. Our study indicates that females tend to be more at risk in high noise environments than males.
Electron Microscopy in the Diagnosis of Liposarcoma and Fibrosarcoma of the Larynx
Authors: Tobey David N. , Wheelis Roger F. , Yarington C. Thomas
Published: October 2014

Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microscopy alone.
Branch of the Singular Nerve (Posterior Ampullary Nerve) in the Otic Capsule
Authors: Okano Yasumasa , Sando Isamu , Myers Eugene N.
Published: October 2014

The frequency of occurrence, location and course of the branch of the singular nerve in the otic capsule in man was investigated by examining the histological sections of 223 human temporal bones. In the proximal portion near the internal auditory meatus the branch of the singular nerve was observed in 194 bones (87%), and was seen to join the main trunk of the singular nerve in 181 of those bones. In the distal portion near the posterior semicircular canal ampulla in 58 bones (26%) and in 45 of those bones it was seen to arise directly from the main trunk of the singular nerve. In 13 bones the branch was seen taking its course in the otic capsule independently from the main trunk all the way to the posterior canal crista. The accessory portion of the branch of the singular nerve reached the dura mater of the posterior cranial fossa near the internal auditory meatus in 11 of 223 bones.
Atypical Cilia of the Human Nasal Mucosa
Authors: Takasaka Tomonori , Sato Masahiro , Onodera Akira
Published: October 2014

Typical and atypical ultrastructural features of the cilia in the human nasal mucosa are reported in this paper. The specimens were taken from patients with the diagnosis of allergic rhinitis or chronic sinusitis. Most of the cilia showed a typical 9 + 2 arrangement of the axial filament complexes, but atypical axonemes such as 9 + 4, 8 + 2 and 10 + 2 patterns were found in six cilia of three patients. The supernumerary central fibrils were observed in one cilium only, whereas atypical patterns of the peripheral fibrils were found in five cilia. Cilia which contained a multiple axial filament complex, so-called compound cilia, were also found in the mucosa of the chronic sinusitis cases. On the basis of their ultrastructural appearance, we classified these cilia into two groups, an “adhesive type” and a “bulging type.” The former had a columnar shape of variable diameter, whereas the latter had a balloon-like form. The former contained closely packed multiple axial filament complexes whereas the latter possessed only sparse and irregularly oriented complexes. Electron-lucent lumina which were formed by the remnants of the ciliary membrane were frequently found in the former's transitional portion, but never in the latter.
Effect of Word Speed, Number of Words, and Habituation on the Discrimination Score of Synthesized Speech
Authors: Rahko T. , Laine U. , Karjalainen M. , Lavonen A.
Published: October 2014

The audiologic uses of Synte 2, a speech synthetizer converting text into speech, with unlimited word capacity, are described, One hundred persons with normal hearing, who were divided into four equal groups, listened to 150 to 400 words uttered at speeds equal to rates of 50, 60, 70 and 80 words per minute. Groups of words were uttered at 5-sec intervals at 50 dB SL. After 100 words the listeners' discrimination scores rose to over 80%. The highest mean score was 85%. The results were much the same for all the speeds tried. Synthesized speech affords the only means of producing identical, sensitized-speech tests over and over again. Although naturally the original tapes wear out, master tapes made on different occasions keep the test results constant. Synte 2 also provides an aid for the mute. It makes man-machine communication possible in business and industrial use. It serves a useful purpose also in speech pathology and phoniatric examinations. A discussion machine is under development.
Keratoacanthoma of the Head and Neck
Authors: Goodwin Richard E. , Fisher George H.
Published: October 2014

Four representative cases of keratoacanthoma of the head and neck are presented; one of which contained squamous cell carcinoma at its base. Although keratoacanthoma has become recognized as a distinct clinical entity, its similarities to squamous cell carcinoma frequently result in difficult diagnosis. A discussion of the disease spectrum, diagnosis and management is presented. Prompt and complete surgical excision of head and neck keratoacanthoma is recommended.
Subcutaneous Bronchogenic Anomalies
Authors: Søhoel P. , Blom P. , Mair I.W.S.
Published: October 2014

Two cases of congenital anomalies, one cyst and one sinus, presenting in the suprasternal notch are reported. No communication with deeper structures was found at surgery, and histology was compatible with previous descriptions of subcutaneous bronchogenic cysts. The literature is reviewed, and the similarity between these lesions and many cases of branchial fistula is stressed.
Mucoepidermoid Carcinoma of the Larynx
Authors: Binder William J. , Kaneko Mamoru , Som Peter , Biller Hugh F.
Published: October 2014

A case report of mucoepidermoid carcinoma of the larynx is presented and the literature reviewed. The inherent difficulties in histologic diagnosis are noted and the clinical behavior and treatment of mucoepidermoid carcinoma are discussed. At the present time, mucoepidermoid carcinoma of the larynx should be regarded as a separate entity, its treatment based on histological grade as well as clinical behavior.
Comparison of Computer Tomography and Translabyrinthine Surgery in the Assessment of Acoustic Neurinoma
Authors: Tos M. , Gyldensted G. , Thomsen J. , Lester J.
Published: October 2014

In a series of 53 acoustic neurinomas removed by translabyrinthine surgery, measurement technique focused on maximum tumor size estimated with computed tomography (CT) compared with maximum size determined at surgery. Fifty-three tumors varying in size and location were evaluated. Ten small tumors not found with initial CT were identified at CT revision. Of the 34 % which could not be seen with CT, all but two were less than 15 mm in diameter, indicating a lower limit for CT detection of 15 mm.
Pulmonary Edema following Relief of Acute Upper Airway Obstruction
Authors: Galvis Antonio G. , Stool Sylvan E. , Bluestone Charles D.
Published: October 2014

Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artificial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.
Papillary Hypertrophy of the Palatine Tonsils
Authors: Enomoto Tadao , Enomoto Tatsuko , Matsui Kazuo , Tabata Toshihide
Published: October 2014

Papillary hypertrophy of the tonsils is one of the rare abnormalities of the palatine tonsils. Since the first reports of papillary hypertrophy of the tonsils by Ogino and Matsui, only 30 cases of this disease have been reported in Japan. The etiology of papillary hypertrophy remains a mystery. A 5-year-old female visited our clinic with a complaint of obstructive feeling in the throat. Papillary surface of the palatine tonsils were noticed. Tonsillectomy and adenoidectomy were performed under general anesthesia on October 25, 1977. The histopathological examination of the tonsils revealed the lymphoid hyperplasia with poor subepithelial connective tissues. Only slight chronic inflammation was present. This papillary hypertrophy of the tonsils was found in 13 members (6 male, 7 female) of her family pedigree. Genetical analysis of the pedigree showed this disease is transmitted by an autosomal dominant gene.
Endolymphatic Hydrops with Absence of Vein in Paravestibular Canaliculus
Authors: Gussen Ruth
Published: October 2014

Unilateral endolymphatic hydrops is described associated with absence of the vein in the paravestibular canaliculus (PVC) and with decreased vascularity of the vestibular aqueduct and endolymphatic sac. The venous return from the vestibule was normal as far as the junction of the branches forming the PVC vein. At this junction, a blind venous loop was formed with no continuation of venous drainage through the PVC. This probably represents a developmental anomaly. The decreased vascularity of the endolymphatic sac may be related to the absence of the PVC vein. However, anatomical and functional relationships of these vessels are not clear and need further study. Perisac fibrosis and endosteal bone formation are possibly secondary to the decrease in vascularity. A large chronic rupture of the inferior saccule wall probably accounts for the absence of vertigo and the relatively mild degree of cochlear endolymphatic hydrops.
Single Cell Responses in Normal and Ototoxic Drug-Treated Gerbils
Authors: Gross Nathan B. , Lifschitz Wladimiro S.
Published: October 2014

Single cell data were obtained from the inferior colliculus of normal gerbils and from those treated with ethacrynic acid. Response changes found for the drug-treated animals are as follows: Fewer cells responded to auditory stimulation. Recruitment-like functions were found which were characterized by high threshold and precipitous increase in discharge rate with intensity. Some units showed abnormally low discharge rate over an extended intensity range, which could be the underlying change in responsiveness in human patients with reduced loudness range. One half as many collicular units were responsive to auditory phase differences. The most severely affected ears showed abnormal dependency upon phase relations. This would affect auditory space perception.
Acoustic Reflex Response during Curare-Induced Weakness
Authors: Ruth Roger A. , Johns Michael E. , Gal Thomas F.
Published: October 2014

The acoustic stapedial reflex (AR) was measured in five healthy subjects during intravenous administration of d-tubocurarine in four equal doses totaling 0.2 mg/kg. The behavior of the reflex in the face of progressive muscle weakness was assessed. Amplitude changes in the AR elicited by pulsed tones were compared to measurements of maximum respiratory pressures reflecting respiratory muscle strength. Total curare dose averaged 16.1 mg and produced symptoms progressing from mild diplopia with the initial dose to absence of hand-grip and head-lifting ability with the final dose. Peak-to-peak amplitude of the AR decreased progressively with each dose of curare. Effects were not strictly additive but showed the largest change with the last dose. Decreases in expiratory muscle strength closely paralleled changes in the AR, whereas changes in inspiratory muscle strength were less marked than the AR, especially with mild weakness. The dose-dependent reduction of the AR corresponded to changes in respiratory muscle as well as general muscle strength. Therefore we concluded that the AR is a valid and sensitive index of neuromuscular transmission which has an advantage over most tests of muscle strength since subject effort and cooperation do not influence test results.
Cranial Arteritis in Otolaryngology
Authors: Sofferman Robert A.
Published: October 2014

Cranial arteritis has the common presenting manifestations of headache and visual loss and is generally limited to elderly individuals. Nearly 50% of patients with the musculoskeletal disorder of polymyalgia rheumatica have an associated cranial arteritis, but the exact pathophysiologic relationship remains unclear. Although the literature suggests that otolaryngologic manifestations of cranial arteritis are infrequent, this report supports a contradictory viewpoint. Approximately 25% of patients present with masticatory claudication, tongue pain, or frank lingual infarction. These oral manifestations should be recognized as indicators of a serious underlying arteritis.
Unusual but Treatable Cause of Fluctuating Tinnitus
Authors: Williams J. David
Published: October 2014

An unusual case of fluctuating tinnitus that was caused by the occurrence of posttraumatic facial nerve synkinesis to the stapedius muscle is presented with preoperative, operative, and postoperative supportive data.
Extracranial Technique for Temporal Bone Removal
Authors: Nadol Joseph B.
Published: October 2014

Using a specifically designed circular bone plug cutter, an extracranial technique to obtain temporal bones for histological study is described. This technique is useful in cases in which conventional autopsy of the head it not possible or desirable.
Improving Grant Applications for Research in Communicative Disorders
Authors: Hanson David G. , Ulvestad Rolf F. , Ranney J. Buckminster
Published: October 2014

In making research funding appropriations, Congress considers, in part, the percentage of applications which are approved, but cannot be funded with the existing budget. The Communicative Disorders Program will have difficulty justifying increased Congressional appropriation without an increase in the number of approved grant applications. Investigators in otolaryngology and other fields of communicative disorders are urged to submit innovative proposals of high scientific quality to be considered for funding. The National Institutes of Health (NIH) review process is explained and suggestions for improving a potential grantee's application are made.
Case Report and Literature Review
Authors: Spoden James E. , Bumsted Robert M. , Warner Emory D.
Published: October 2014

A case of the chondroid variant of chordoma is presented. The differentiating features of this entity are discussed on a clinical and histopathologic basis. A review of the topic of chordoma is also provided.
Intramembranous and Mesotympanic Cholesteatomas Associated with an Intact Tympanic Membrane in Children
Authors: Sobol Steven M. , Stroud Malcolm H. , Reichert Timothy J. , Spector Gershon J. , Faw Kenneth D. , Ogura Joseph H.
Published: October 2014

A series of 15 intramembranous (IMTC) and mesotympanic (MTC) cholesteatomas associated with intact tympanic membranes in children is presented. Clinical observations, audiometric and radiographic data, and surgical findings are correlated. A history of recurrent otitis media was obtained in 85% (13/15) of the cases, differentiating them from the usual congenital cholesteatomas. The possibility that many of these are indeed “acquired” lesions is emphasized. Hypothetical pathogenetic mechanisms are discussed. The basal cell papillary proliferation theory is considered the most attractive explanation of the development of both IMTCs and MTCs. The need for careful, prolonged, follow-up otoscopic examination of children with recurrent otitis media is stressed, if more of these lesions are to be recognized early.
Etiology of Stridor in the Neonate, Infant and Child
Authors: Holinger Lauren D.
Published: October 2014

Of 219 patients whose primary presenting symptom was stridor, 150 were males, 69 were females. All were under 2½ years of age; more than half were four months of age or younger. Congenital anomalies caused stridor in 191 (87.2%). Congenital laryngeal anomalies accounted for the stridor in 132 (60.3%); there were 35 (16.0%) patients with congenital tracheal anomalies, 11 (5.0%) with congenital bronchial anomalies, 12 (5.5%) with infectious conditions, 12 (5.5%) with internal laryngeal trauma and 15 (6.8%) patients with other conditions. The cause of stridor was undetermined in two patients. Sixteen vascular anomalies were diagnosed and classified according to the part of the tracheobronchial tree which was involved. Twenty-six patients required tracheotomy. Fifty-eight (26.5%) were referred with an erroneous presumptive diagnosis for which they were being treated. The mean length of time from onset of symptoms to determination of the correct diagnosis by endoscopy was four months; it varied from one day to 16 months. The importance of early endoscopy for the diagnosis of conditions causing stridor cannot be overemphasized. The occurrence of more than 1 anomaly in 99 (45.2 %) of the 219 patients demonstrates the importance of complete endoscopic examination of all patients with stridor.
Internal Laryngocele and Saccular Cysts in Children
Authors: Donegan J. Oliver , Strife Janet L. , Seid Allan B. , Cotton Robin T. , Dunbar J. Scott
Published: October 2014

Two children, one with an internal laryngocele and the other with a lateral saccular cyst are described. The anatomy, classification, and history of these unusual lesions are described. The diagnosis and management are discussed. An external approach is suggested for the more persistent cases.
Acute Upper Airway Obstruction in Infants and Children
Authors: Vauthy Pierre A. , Reddy Ramalinga
Published: October 2014

All infants and children seen by the pediatric pulmonary service who display symptoms of upper airway obstruction undergo transnasal fiberoptic evaluation with the 3.2 mm flexible instrument. The procedure enables the observer to immediately visualize the nasopharynx, supraglottic, glottic and subglottic structures. Instrumentation is done in the sitting upright position and takes the skilled observer about 20 seconds to perform. The differentiation of epiglottitis from subglottic croup, foreign body aspiration and other less common causes of airway obstruction is easily performed and well tolerated. The fiberoptic instrument is often utilized both as a diagnostic and therapeutic tool. It can be utilized to intubate cases of epiglottitis and to evaluate the epiglottis to determine the appropriate time for extubation. This procedure is superior to oral airway examination because it does not distort airway anatomy, can be performed in the upright position, and does not further exacerbate airway obstruction.
Epidermolysis Bullosa Dystrophica of the Larynx and Trachea
Authors: Thompson Jerome W. , Ahmed A. Razzaque , Dudley James P.
Published: October 2014

Epidermolysis bullosa dystrophica (EBD) is a rare inherited skin disease generally presenting in newborns. It is characterized by noninflammatory bullous lesions which can involve the mucous membranes of the oral cavity and oropharynx. If death occurs, it is usually the result of septicemia or fluid and electrolyte imbalance. Although mucous membrane involvement may be extensive and despite the reported evidence of tracheal and indirect evidence of laryngeal involvement, airway obstruction has not been implicated as a possible contributor to mortality in these patients. Since the presence of EBD in the larynx of a newborn might be expected to produce upper airway obstruction, however, and because of the absence of reports of laryngeal EBD, a case is presented of EBD-induced airway obstruction accompanied by photographic evidence of laryngeal and tracheal involvement with EBD. A three-week-old boy with biopsy-proven EBD present at birth was admitted to UCLA Medical Center with increasing stridor. The patient's extremities, diaper area, and numerous pressure-bearing sites on the back and elbows demonstrated erythematous denuded skin with occasional bullae up to 2 cm in size. The mucous membranes of the mouth and oropharynx showed similar denuded lesions. A tracheotomy was performed followed by a direct microlaryngoscopy and bronchoscopy revealing EBD on the supraglottic structures, vocal cords, and trachea. Otolaryngologists who are involved in the care of newborns should be aware of the possible, nearly fatal laryngeal involvement that can accompany this disease.
Upper Airway Obstruction in Infectious Mononucleosis
Authors: Wolfe Judith A. , Rowe Lee D.
Published: October 2014

Life-threatening upper respiratory obstruction is an unusual complication of infectious mononucleosis. Although the majority of fatalities result from progressive bulbar paralysis or the Guillain-Barré syndrome, airway impairment primarily occurs as a result of pharyngeal lymphoid hyperplasia and associated faucial arch edema. Recent experience in a young child with infectious mononucleosis who exhibited progressive hypersomnolence, sleep apnea, and stridor during sleep is presented. In addition, a retrospective analysis of 72 cases of respiratory complications of infectious mononucleosis provides guidelines for specific airway management. Mild upper respiratory obstruction with persistent fever, severe odynophagia, and malaise is treated with parenteral corticosteroids. Immediate tonsillectomy using a halothane and oxygen induction technique is recommended for severe airway occlusion. Tracheotomy is currently reserved for those patients with progressive alveolar hypoventilation, hypercarbia, atelectasis, and bulbar paralysis. In general, tonsillectomy is well-tolerated, eliminating airway obstruction, improving swallowing function, and rapidly resolving pharyngeal discomfort.
Prolonged Orotracheal Intubation in the Newborn
Authors: Conner George H. , Bushey Michael J. , Maisels M. Jeffrey
Published: October 2014

One hundred seventy-four consecutive cases of newborn infants who required orotracheal intubation for longer than three days were studied retrospectively. The duration of intubation varied from 3 to 211 days with an overall mortality rate of 22.9 %. There was one complication directly related to orotracheal intubation. One tracheotomy was performed. Orotracheal intubation is felt to be superior to nasal tracheal intubation and tracheotomy in managing infants in this age group who require prolonged assisted ventilation.
Topical Chemotherapy of Recurrent Respiratory Papillomatosis
Authors: Smith Howard G. , Healy Gerald B. , Vaughan Charles W. , Strong M. Stuart
Published: October 2014

Topical chemotherapy with the antimetabolite 5-fluorouracil (5-FU) has been used as an adjunct to surgical laser excision of squamous papillomas arising in the larynx and in the tracheobronchial tree. The drug has been administered intensively to eight patients with tracheotomies and disease in both anatomic regions. These patients received repeated instillations of 5-FU at concentrations from 0.5 to 5% into the larynx and tracheobronchial tree while in the hospital and at home. More than 4,500 doses of the drug have been administered during our phase 1 study. There has been no significant toxicity associated with repeated 5-FU instillation into the airway. Several patients developed blood-tinged tracheal secretions after the repeated use of high concentrations of the agent. Other complications included coughing, bronchospasm, and peristomal irritation. These symptoms all disappeared after temporary discontinuation of the drug. No patient has developed a systemic hypersensitivity response to the drug either detectable clinically or by repeated skin testing. There were no adverse effects on the hematologic or hepatic systems. Use of 5-FU was associated with inhibition of papilloma regrowth in six of eight patients. The major limitation to drug effectiveness is the requirement for its frequent administration.
Induction of Cancer by DNA Viruses
Authors: Watson James D.
Published: October 2014

The life cycles of the tumor virus SV40 and polyoma are discussed with particular emphasis on the role of the viral coded proteins which mediate the transformation of normal cells into their cancerous equivalents. One or more of these proteins possibly act by stimulating directly the synthesis of cellular DNA, while others may mimic the action of polypeptide mitogens that act at the cell surface.
A Simple Method of Laryngeal Photography through the Operating Microscope “Macrolens Technique”
Authors: Yanagisawa Eiji , Eibling David E. , Suzuki Masafumi
Published: October 2014

A simple and inexpensive method of laryngeal photography through the eyepiece of the operating microscope is described. Provided that the operating room is equipped with the microscope, the laryngoscope and the laryngoscope holder, the only essential equipment required is an “aperture-preferred” automatic single lens reflex camera with a 50 mm macrolens. The macrolens of the camera is placed against an eyepiece of the microscope and the laryngeal image is centered and focused via the viewfinder of the camera. The respiration of the patient is temporarily halted. The camera is held still and pictures taken. Kodak high speed Ektachrome® tungsten film ASA 160 is used and push-processed to ASA 320. With practice, one should be able to obtain satisfactory photograph of the larynx suitable for teaching and documentation.
Retrospective Comparison of Conservative and Radical Neck Dissection in Laryngeal Cancer
Authors: Molinari Roberto , Cantù Giulio , Chiesa Fausto , Grandi Cesare
Published: October 2014

A retrospective comparison of radical and conservative technique for neck dissection in cancer of the larynx was made, starting from analysis of 98 patients operated on with the conservative procedure (128 cervical neck fields at risk of recurrence) at the Istituto Nazionale Tumori of Milan. Furthermore, a series of 162 patients was selected from more than 500 radical neck dissections performed in the past to set up a series as comparable as possible as far as several parameters were concerned. No significant difference was found between radical and conservative neck dissection with regard to the incidence of recurrences in the operative field, either considering the whole series (2.5% versus 1.6%), or cases with histologically proven metastases (9.4% versus 4.5%). Conservative neck dissection seems as safe as radical neck dissection, at least within the limits set in the present study for the indication of the former procedure, ie, nonsuspect nodes or metastatic mobile nodes not greater than 2.5 cm.
Influence of Adenoid Hypertrophy on Secretory Otitis Media
Authors: Elverland Hans H. , Haugeto Olav K. , Mair Iain W. S. , Schrøder Knut E.
Published: October 2014

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.
Effect of Voice Therapy on Contact Granuloma of the Vocal Fold
Authors: Bloch Carole S. , Gould Wilber J. , Hirano Minoru
Published: October 2014

Contact granuloma of the vocal folds caused by physical trauma secondary to voice abuse has traditionally been treated by surgical removal. This mode of handling can be frequently disappointing since these lesions have a strong tendency to recur and may require additional operative procedures. This paper describes 17 patients in whom treatment of the primary problem was approached through voice therapy. Treatment consisted of a comprehensive history and voice evaluation, stress reduction, relaxation methods, auditory and kinesthetic feedback, pitch change and elimination of voice abuse. Patients were closely followed by the speech pathologist and laryngologist who worked together as a team. The results of voice therapy were evaluated by the laryngologist, the speech pathologist and the patient himself. As a result of voice therapy, the granuloma disappeared in 9 patients, was reduced in size in 4 and remained unchanged in 1. For the remaining three patients, posttherapeutic laryngoscopic findings were not available. The speech pathologist found voice and manner of phonation returned to normal in 4 patients, improved in 7 and remained unchanged in 6. Four patients felt that complete recovery had taken place, 10 felt that some improvement was noted, and 3 felt no change had taken place. Based on the assessments of all three evaluators, the success rate of treatment with voice therapy can be stated as 71% (12 of 17 cases) or 100% (eliminating 5 of 17 cases who terminated treatment very early).
Familial Multiple Glomus Tumors and Pheochromocytomas
Authors: Parkin James L.
Published: October 2014

Isolated cases of cervical cranial glomus tumors have been reported in association with pheochromocytoma. Two family pedigrees are presented and four individual cases discussed indicating a hereditary syndrome of pheochromocytoma associated with multiple glomus tumors of the head and neck. The hereditary potential has not previously been described. In three of the patients, the pheochromocytomas were asymptomatic at the time of initial presentation. These pheochromocytomas were discovered by arteriography after one of the patients developed a hypertensive crisis with the induction of anesthesia. The silent presence of pheochromocytoma in patients with multiple glomus tumors should be considered in the evaluation of these patients.
Aberrant Internal Carotid Artery in the Middle Ear
Authors: Goodman Roy S. , Cohen Noel L.
Published: October 2014

Aberrant internal carotid artery in the middle ear is a rare anomaly. Myringotomy in a patient with this anomaly caused violent hemorrhage, requiring immediate packing and eventual ligation of the artery. The anomaly may represent the artery bulging through a dehiscent bony canal, or it may be due to traction on the developing carotid by a persistent stapedial artery. Various middle ear symptoms have been reported in earlier cases. Diagnosis is by angiography, and therapy is surgical.
Pneumococcal Otitis Media following Middle Ear Deflation
Authors: Meyerhoff William L. , Giebink G. Scott , Shea Donald
Published: October 2014

Temporal bone histology has been studied in chinchillas following middle ear deflation in the presence of nasopharyngeal colonization with S pneumoniae. All animals sacrificed within one hour following deflation had similar middle ear hsitology regardless of whether or not the animals had been colonized with S pneumoniae. All animals with negative nasopharyngeal culture for S pneumoniae sacrificed from 3–24 days following − 30 mm Hg negative middle ear pressure had negative middle ear cultures and normal morphology. During the same time period, however, nearly 60% of animals colonized with S pneumoniae developed acute otitis media with positive middle ear cultures for S pneumoniae. Histologic changes in the middle ear included the presence of effusion, leukocytes, granulation tissue, osteoneogenesis, mucosal metaplasia, and hemorrhage. Changes in the inner ear were much less frequent and included some leukocyte infiltration with hyperemia in the scala tympani and endolymphatic hydrops.
Radiation-Associated Carcinoma of the Salivary Glands a Controlled Study
Authors: Maxon Harry R. , Saenger Eugene L. , Thomas Stephen R. , Shafer Margaret L. , Buncher C. Ralph , Kereiakes James G. , McLaughlin Carolyn A.
Published: October 2014

Five hundred fifty-four persons were evaluated who had received external radiation therapy for benign diseases of the head and neck in childhood and whose salivary glands were presumably included in the radiation field. A significant excess of salivary gland cancers were noted when they were compared to 958 nonirradiated control subjects.
Quantitative Study of Scarpa's Ganglion and Vestibular Sense Organs in Endolymphatic Hydrops
Authors: Richter Ernst
Published: October 2014

The density of vestibular hair cells and the number of neurons in Scarpa's ganglion were estimated for 11 temporal bones with endolymphatic hydrops. The ten subjects from which these bones were taken all exhibited decreased caloric response (when tested), fluctuating hearing loss, and episodic vertigo. The degeneration of vestibular sense organs was found within the “normal” range for all except one case, which showed total degeneration of the posterior crista ampullaris. Ganglion cell counts in all cases were low. In three of the ten subjects, counts fell below the lowest values seen in a sample of “normal” ears. These three subjects exhibited fluctuating hearing loss and episodic vertigo for more than six years prior to death. In cases of unilateral endolymphatic hydrops there was no significant difference between counts in the affected and unaffected ear. Thus, the apparent ganglion cell degeneration may be due to ear disease other than endolymphatic hydrops.
Complications of CO2 Laser Surgery of the Larynx
Authors: Meyers Arlen
Published: October 2014

Since the introduction of CO2 laser surgery, surgeons have stressed the importance of protecting nontarget structures from errant irradiation. Although striking areas outside the intended field may inflict little or no damage, irradiating an exposed endotracheal tube may result in an endotracheal fire. Recent experience with a case of endotracheal tube ignition led to a reevaluation of those factors associated with this serious complication. In an attempt to determine the best endotracheal tube to use during laser surgery of the larynx, the flammability of polyvinyl chloride and red rubber endotracheal tubes was compared. Several factors were noted to contribute to the potential hazard of endotracheal tube ignition. Since red rubber tubes are less flammable, they should be used during laryngeal CO2 laser surgery.
Medical Management of Menière's Disease
Authors: Jackson C. Gary , Glasscock Michael E. , Hughes Gordon B. , Davis William E. , Sismanis Aristides
Published: October 2014

The medical management of Menière's disease appears to be a misunderstood and controversial subject. There are those physicians who state that all cases can be controlled by medical means and that surgery is never indicated. Another group of investigators now emphasizes early surgical intervention without a medical trial. These conflicting views have led the authors to review all of their cases of Menière's disease (almost 1,000) in relation to medical management. The medical regime and its rationale are presented in detail. The results of this therapy are discussed in the context of control of vertigo, relief of tinnitus and pressure, and the stabilization of hearing.
Eye-Head Coordination and Lateral Canal Block in Squirrel Monkeys
Authors: Kubo Takeshi , Jensen David W. , Igarashi Makoto , Wright William K.
Published: October 2014

Eye and head nystagmus during horizontal optokinetic stimulation was analyzed in squirrel monkeys. Slow phase speed of coupled head and eye nystagmus showed highly significant negative correlations in normal subjects; correlation coefficients were −0.81 at 60°/sec and −0.72 at 100°/sec stimuli. Bilateral lateral semicircular canal block resulted in a reduction of the negative correlation. The postoperative reduction of the correlation coefficient value ranged from 0.17–0.28 (significant at P<0.01 level) at 60°/sec stimulus and 0.06–0.13 (not significant) at 100°/sec stimulus. Gaze speed was calculated by summing slow phase speeds of coupled head and eye nystagmus. Mean error of gaze in normal subjects was 1.5% at 60°/sec stimulus and 7.8% at 100°/sec stimulus. Mean gaze speed showed an overshoot (8% at 60°/sec stimulus and 6.5% at 100°/sec stimulus) in the three to four weeks postoperative period; however, this subsided two to three months after the operation. Measurement of head-turning performance (in yaw plane) in humans may provide a clinically useful index for the assessment of certain types of vestibular function.