bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Mastoid Cavity Modification on Middle Ear Sound Transmission
Authors: McElveen John T. , Miller Chris , Goode Richard L. , Falk Stephen A.
Published: October 2014

The modified radical mastoidectomy and intact canal wall mastoidectomy are the two most popular procedures used today for the treatment of chronic middle ear and mastoid disease. Their effects on the anatomy of the middle ear and mastoid cavity are quite different and it might also be expected that they would modify middle ear sound transmission in different ways. This paper describes experiments with human temporal bones and a middle ear computer analog model that attempt to define acoustic differences produced by cavity modifications in these two procedures. The temporal bone studies showed that blocking the aditus (as in modified radical mastoidectomy) produced improved sound transmission in the 1,500- to 4,000-Hz range and decreased transmission below 1,000 Hz when compared to the enlarged aditus and enlarged mastoid condition (as in intact canal wall mastoidectomy). The computer model showed better transmission at all frequencies with the intact canal wall mastoidectomy simulation.
Atlantoaxial Instability Revisited
Authors: Norton Martin L. , Ghanma Manhal A.
Published: October 2014

Atlantoaxial instability in rheumatoid arthritis patients presents a particular hazard for endoscopists. The basic pathology, while well known to orthopedists, is not common knowledge among bronchoesophagologists or anesthesiologists. This paper describes the syndrome, potential complications and possible approaches to avoiding serious neurologic sequellae.
Laryngeal Malignancies and Computerized Tomography
Authors: Schild Joyce A. , Mafee Mahmood F. , Valvassori Galdino E. , Bardawil Wadi A.
Published: October 2014

We compared the anatomic structures, computerized tomographic (CT) scan images and the histopathologic findings after surgery in 15 patients with laryngeal epidermoid carcinoma. We examined the horizontal whole-mount histologic sections along with the preoperative CT and verified the preoperative impression of the soft tissue changes of preepiglottic space involvement; true cord, false cord and aryepiglottic fold invasion; or subglottic extension in all 15 patients. It was impossible to judge reliably the microscopic invasion of bone or cartilage with this method. Preoperative CT evaluation of carcinoma of the larynx was a reliable method for judging gross tumor size, though decisions regarding conservation surgery cannot be based on CT evaluation alone.
Factors in Successful Deglutition following Supraglottic Laryngeal Surgery
Authors: Flores Toribio C. , Wood Benjamin G. , Koegel Lawrence , Levine Howard L. , Tucker Harvey M.
Published: October 2014

Aspiration is the major problem in deglutition associated with conservation laryngeal surgery. Closure of the glottic sphincter, depression of the epiglottis over the laryngeal inlet, elevation of the thyrohyoid complex under cover of the base of the tongue and appropriate relaxation of the cricopharyngeal muscle to permit unobstructed passage of food into the esophagus are important mechanisms that prevent food from entering the trachea. Partial laryngeal surgery can interfere with one or a combination of these mechanisms. Analysis of the records of all evaluable patients who underwent horizontal supraglottic resections from January 1976 to June 1981 was undertaken. The incidence of deglutition problems is reported. In addition, the effects of resection or preservation of the hyoid, arytenoid, base of tongue and branches of the vagus and the effect of cricopharyngeal myotomy upon ultimate swallowing function are analyzed.
Complications of Intubation
Authors: Keane William M. , Rowe Lee D. , Denneny James C. , Atkins Joseph P.
Published: October 2014

Endotracheal intubation with current inert low-pressure, high-volume cuffed tubes is a safe procedure associated with few complications in the vast majority of patients. However, complications related to mechanical difficulties and mucosal injury can occur even under ideal circumstances. Immediate complications are primarily associated with problems during intubation and extubation while early and late complications represent the short- and long-term effects of epithelial trauma.
Use of Foley Catheter for Removal of Esophageal Foreign Bodies a Survey
Authors: McGuirt W. Frederick
Published: October 2014

A survey was conducted among otolaryngologists, thoracic surgeons, pediatric surgeons and pediatric radiologists to determine the frequency of removal of esophageal foreign bodies with a Foley catheter. The 245 physicians responding reported 1,512 cases, 96% of which were treated with this technique by radiologists and pediatric surgeons. Although no deaths or serious complications were reported, the author warns that increasing use of this procedure by nonendoscopists carries the risk of serious complications unless certain safeguards are taken. These include trained personnel, use of fluoroscopy, a cooperative patient with a single, smooth, radiopaque foreign body lodged in the esophagus and a barium esophagogram with negative results for total obstruction and underlying esophageal disease.
Heat Sink Protection against Lasering Endotracheal Cuffs
Authors: LeJeune Francis E. , LeTard Francis , Guice Charles , Marice Harvey
Published: October 2014

The ignition of an endotracheal cuff by CO2 laser impaction has proved troublesome in several ignition sequences. Metal foil tape wrapped around the shaft of the tube will provide adequate protection for it, but the tape does not extend to the thin-walled cuff. When normal saline solution is used instead of air to fill the cuff, heat is rapidly conducted away from the wall and the cuff is prevented from reaching its kindling temperature. If penetration should occur, a fine jet of saline solution instantaneously sprays the field, extinguishing any early combustion. The reaction time of the surgeon or an assistant is not a factor in prevention of thermal injury, no new equipment is required and preparation time is minimal.
Universal Endoscopic Coupler for Carbon Dioxide Laser Surgery
Authors: Ossoff Robert H. , Karlan Marc S.
Published: October 2014

A new set of endoscopic couplers has been designed by the authors for laparoscopic, arthroscopic and bronchoscopic carbon dioxide laser surgery. Certain safety features have been incorporated into this design which heretofore have been unavailable. The bronchoscopic coupler was designed with a gimbeled, partially reflective germanium window to facilitate direct, coaxial vision with the laser beam. A “joy stick” has been incorporated into the design to allow the surgeon to manipulate the helium-neon-aiming laser within the lumen of the bronchoscope. Bronchoscopes as small as 4 mm in diameter and 30 to 40 cm in length have been used with this coupler.
Interferon and Laryngeal Papillomatosis
Authors: McCabe Brian F. , Clark Keith F.
Published: October 2014

Preliminary findings are presented from an ongoing clinical trial of 19 patients with moderate-to-severe respiratory papillomatosis. The patients were treated with partially purified human leukocyte (alpha) interferon; after treatment periods ranging from 6 weeks to 12 months, six had no residual disease, seven had minimal residual disease, four had moderate disease not requiring rescue laryngoscopies, and two had not responded to treatment. No patient had to be removed from the study because of drug toxicity. Although these appear to be among the best results in the literature to date, we do not know how long treatment will be required.
Psychological Problems of the Deaf
Authors: Jongkees L. B. W.
Published: October 2014

Although hearing is known to play a major role in the psychological development of human beings and their interactions in the society and culture, very little research on the effects of hearing loss on the psyche and its development has been undertaken. This paper discusses the problems of deafness as they impinge upon personality, its development and social adjustment, acquisition of language, and parenting. The physician's role as it relates to the deaf patient and to the parents is described.
Supraglottic Laryngectomy: 30 Years of Experience
Authors: Bocca E. , Pignataro O. , Oldini C.
Published: October 2014

A review of 467 cases of supraglottic laryngectomy operated during the last 30 years is presented. Cases have been subdivided into groups according to stage and TNM classification. By far the most numerous in this series were T2 cases. N0 cases prevailed over N+ by 4:1. Stage II cases represented about 60% of the total. Results are analyzed according to TNM and staging. The average overall 5-year cure rate is 75%. The influence of factors other than TNM and staging upon results is also considered. Supraglottic laryngectomy may be extended to include one arytenoid, the base of the tongue, or both, with approximately equal results. Practically all cases had en bloc bilateral functional or classic neck dissection for threatening or actual lymph node metastases. This may have contributed to a higher number of successes. Combined surgery and radiotherapy is occasionally indicated, but rarely improves the prognosis of severe cases. Site and type of recurrences are considered and their treatment and prognosis are discussed. On the basis of the present study the clinical value of supraglottic laryngectomy is further assessed.
Evaluation of Three Cyanoacrylate Glues for Ossicular Reconstruction
Authors: Koltai Peter J. , Eden Avrim R.
Published: October 2014

We evaluated and compared the separate effects of ethyl, isobutyl, and fluoroalkyl cyanoacrylate on the promontory mucosa and surgically disarticulated incudostapedial joint in the adult cat middle ear. The animals were sacrificed at 10-, 30-, and 60-day intervals after glue application. All three cyanoacrylates elicited a chronic inflammatory response when placed directly on the promontory mucosa. The use of ethyl and isobutyl cyanoacrylate resulted in persisting discontinuity of the incudostapedial joint with erosion of the incus. Fluoroalkyl cyanoacrylate maintained incudostapedial continuity without ossicular erosion. Ethyl and isobutyl cyanoacrylate are probably not appropriate for middle ear surgery. The less toxic fluoroalkyl cyanoacrylate may be useful as an ossicular adhesive in selected cases. Our findings are further contrasted with those obtained in similar studies with methyl and butyl cyanoacrylate. The effects of each of the five cyanoacrylates are reviewed in the continuing search for a safe and effective ossicular adhesive.
Malignant Transformation of Adenolymphomas
Authors: Krogdahl Annelise S. , Bretlau Poul
Published: October 2014

Adenolymphoma (Warthin's tumor) is a relatively frequent tumor of the parotid gland with characteristic cytological, histological and clinical features. Malignant transformation of the epithelial component of adenolymphomas is extremely rare and not well documented in the literature. In a series of eight adenolymphomas of the parotid gland transition to malignancy was demonstrated cytologically and histologically in one case.
Cochlear Implant Effects on the Spiral Ganglion
Authors: Sutton Dwight , Miller Josef M.
Published: October 2014

To evaluate the effects of chronic intrascalar implants on spiral ganglion cells, we studied 15 monkey cochleas that had had implants for periods ranging from 1 to 28 months. All cases exhibited loss or ongoing degeneration of cells. Cell loss typically was greater in the basal turn, where the implants were located, than at more apical locations. Increasing apical damage was a function of postimplant survival time. Preimplant local treatment of the inner ear with neomycin did not influence the loss of spiral ganglion cells. Osteoneogenesis occurred in the majority of cases, appearing in the basal turn with occasional extension into middle and apical turns. Cell loss was inconsistently associated with new bone formation. Electrical stimulation had no obvious influence on cell survival.
Ectopic Gastric Mucosa in the Upper Esophagus as a Cause of Dysphagia
Authors: Raine C. H.
Published: October 2014

A rare case of dysphagia, caused by ectopic gastric mucosa situated in the upper esophagus, is reported.
Mucociliary Flow in the Canine Frontal Sinus
Authors: Dolezal Rudolph F. , Baker Shan R.
Published: October 2014

The mucociliary flow in the frontal sinus of dogs is in a spiral pattern from medial to lateral. The final evacuation of mucus is through the ostium positioned anteriorly. Mucus flow rate is most rapid in the areas of the ostium and slowest in the area of the intersinus septum. Mucus flow patterns remain the same despite removing the intersinus septum and blocking one frontal sinus ostium. Mucociliary flow rate, however, appears to be diminished in the reoperated frontal sinus. Mucus does not appear to migrate readily across the intersinus septal areas when the septum has been removed and one nasofrontal duct is obstructed.
Sarcomas of the Larynx
Authors: Hacihanefioğlu Uğur , Öuztürk A. Settar
Published: October 2014

The clinical and pathologic findings of 10 laryngeal sarcomas (8 fibrosarcomas and 2 rhabdomyosarcomas) are reported. These cases constituted 0.02% of the 4,717 patients with carcinoma histologically verified at Faculty of Medicine in Istanbul from 1934 to 1980. Analysis of laryngeal fibrosarcomas reveals that they are more frequently seen in the fourth and fifth decades, while rhabdomyosarcomas of the larynx are rather tumors of childhood. They are generally less infiltrating than carcinomas and tend to grow as polypoid masses. Metastases are rare but recurrences are frequently seen.
Vocal Fold Paresis in Shy-Drager Syndrome
Authors: Hanson David G. , Ludlow Christy L. , Bassich Celia J.
Published: October 2014

Twelve patients with Shy-Drager syndrome (SDS) presenting symptoms of multiple nervous system atrophy and orthostatic hypotension were examined for laryngeal movement disorders and vocal impairment in speech. Vocal fold abductor paresis was found in 11 patients and was bilateral in 10. Speech task performance was recorded in SDS patients, Parkinson patients and age- and sex-matched controls. Trained listeners with inter-rated reliability ≥ .85 judged each recording on 20 attributes while blind to speaker identity. SDS patients had a breathy and strained voice quality, reduced loudness, monopitch and monoloudness, imprecise consonants, variations in rate and rate-slowing, suggesting a flaccid type of dysarthria. In comparison with Parkinson patients, SDS patients had excess vocal hoarseness, intermittent glottal fry and a slow and deliberate speaking rate. Orthostatic hypotension, laryngeal stridor, hoarseness, intermittent glottal fry and slow speech rate were found to be discriminating symptoms of SDS.
Organic Acids and Anaerobic Microorganisms in the Contents of the Cholesteatoma SAC
Authors: Iino Yukiko , Takasaka Tomonori , Hoshino Etsuro , Kaneko Yutaka , Tomioka Sachiko , Yuasa Ryo
Published: October 2014

Organic acids in the contents of the cholesteatoma sac from 28 cases were studied by gas chromatographic technique. Five volatile fatty acids (acetate, propionate, isobutyrate, butyrate and isovalerate) and lactate were detected in large amounts, which may lower the pH of the cholesteatoma content. These acids were considered to be derived from products of anaerobic microorganisms. Therefore, the contents from 12 cases were cultured anaerobically in a glove box. Obligate microorganisms were identified in 92% of the cases and Peptococcus, Bacteroides, and Clostridium species were frequently isolated. In vitro, such obligate anaerobes produced various organic acids from the cholesteatoma content. Facultatives such as Staphylococcus aureus and Proteus mirabilis produced acetate in the content under aerobic and anaerobic conditions, whereas no organic acid was produced by Pseudomonas aeruginosa. Organic acids in the cholesteatoma content could be fermentative products made by the microorganisms, anaerobes and facultatives, which use the content as a substrate for acid production.
Type II Collagen-Induced Autoimmune Otospongiosis
Authors: Yoo T. J. , Tomoda K. , Kang A. H. , Stuart J. M. , Townes A. S.
Published: October 2014

Otospongiosis-like lesions were induced in rats by immunizing them with native type II collagen. Immunized rats had antibody responses specific for native type II collagen and developed otospongiosis-like lesions. The spongiotic lesion was characterized by numerous osteocytes and osteoblasts in the vascular spaces and by dark staining probably due to the chemical alteration of ground substances. Bone resorption and new bone formation were clearly visible. Immunofluorescence studies demonstrated deposition of immunoglobulin and complement on the bone matrix and wall within the area of spongiosis. An antibody-mediated etiopathogenesis was suspected.
Chemodectoma of the Cheek
Authors: DeLozier Howard L.
Published: October 2014

The first case of a chemodectoma of the cheek is presented and the histopathology reviewed. Chemodectomas of the head and neck can be difficult to diagnose, with angiography remaining the single most useful aid to determining both location and diagnosis. Surgery is the treatment of choice, and prognosis depends not only on the extent of the tumor but also its predilection for malignant behavior.
Auditory Brainstem Response with High Stimulus Rates in Normal and Patient Populations
Authors: Gerling Irvin J. , Finitzo-Hieber Terese
Published: October 2014

Normative data were collected on 48 subjects to determine the effects of increasing stimulus rates on the auditory brainstem response. These subjects were then compared to 221 patients referred for otoneurologic evaluation. The 90 patients with impaired auditory sensitivity demonstrated significantly less wave V latency shift than either the 131 patients with normal auditory sensitivity or the normal subjects. The incidence of abnormal wave V latency shift was 12% in the patients with normal auditory sensitivity and 8% in the patients with impaired auditory sensitivity. The high stimulus rate was often the only abr parameter indicative of brainstem involvement in patients with documented CNS pathology. The authors conclude that a high stimulus rate contributes to the diagnosis of brainstem pathology often enough to warrant its routine use.
Temporal Bone Findings in Cases of Salt Water Drowning
Authors: Kelemen George
Published: October 2014

The otologic literature contains no description of the histopathological features of temporal bones of persons who perished in drowning accidents. Three temporal bones from two fatal cases of drowning were studied in serial sections. Two temporal bones were from a man aged 31 years who collapsed after scuba diving and died three days later. One temporal bone was from a 32-year-old man, serving in the navy, who drove his car, probably accidentally, into the sea and drowned in it. Histopathological findings appeared to be similar in the two cases. Diffuse hemorrhage was evident throughout the middle ear and inner ear. The tympanic and round window membranes appeared to be intact although hemorrhage had occurred within the tissue layers of the membranes. This finding contrasts with observations of ruptured membranes by other investigators.
Vocal Fatigue
Authors: Sander Eric K. , Ripich Danielle E.
Published: October 2014

The phenomenon of vocal fatigue, although not well understood, is commonly considered a symptom of voice misuse. This paper reviews the clinical and experimental evidence linking vocal fatigue to the quality, pitch, and loudness of voice use. Other reasons for voice change are discussed. The paper concludes by stressing the immediate clinical benefits of voice endurance testing as well as its potential experimental contribution to a better scientific understanding of optimum and abusive vocal behavior.
Diagnostic Significance of Transtympanic Electrocochleography in Menière's Disease
Authors: Gibson W. P. R. , Prasher D. K. , Kilkenny G.P.G.
Published: October 2014

Transtympanic electrocochleography (ECoG) was performed on 32 normal ears, 40 ears affected by hair cell damage without any evidence of endolymphatic hydrops (sensory damage) and 44 ears affected by established Menière's disease. The amplitude of the summating potential (SP) and the amplitude of the action potential (AP) were measured at a click stimulus intensity level of 100 dB HL. The SP amplitude was expressed as a percentage of the AP amplitude. In normal ears, the mean SP/AP ratio was 25% (range 10%-63%). In sensory damage, the SP/AP ratio was 13% (range 0%-29%), and in Menière's ears, the SP/AP ratio was 51% (range 29%-89%). In this series, an SP/AP ratio of 29% provided a diagnostic dividing mark between the sensory damage and Menière's-affected ears. Although this precise division was probably fortuitous, it does suggest that ECoG is a useful tool in the differential diagnosis of these two types of cochlear disorders.
Alteration of Aminoglycoside Antibiotic Ototoxicity: Effect of Semistarvation
Authors: Garrison H. G. , Fischer J. , Prazma J. , Williford S. K. , Drake A. , Ferguson S. D. , Klingler L. E.
Published: October 2014

The effect of semistarvation on the toxicity and ototoxicity of tobramycin sulfate (TO) and gentamicin sulfate (GE) was investigated in guinea pigs by electrophysiological and histopathological methods. The presented data has shown that the toxicity and ototoxicity of aminoglycoside antibiotics is substantially increased when guinea pigs were semistarved. Our results should also warn researchers using semistarvation in their conditioning experiments which investigate the toxicity of different chemicals. Toxicity was greater in GE- than TO-treated animals, which caused the GE-treated animals to die during treatment or shortly after treatment. Thus, TO should be preferentially used because it has been shown to be less toxic and ototoxic in normal and altered nutritional conditions.
Brainstem Evoked Response Audiometry
Authors: Giroux Anne P. , Pratt Loring W.
Published: October 2014

Brainstem evoked response audiometry is useful in the identification of threshold levels as well as in the diagnosis of eighth nerve tumors. The instrumentation is a modification of the electroencephalograph and an averaging computer; 3,000 clicks, 16/s, are presented and averaged for each printed response. Evoked responses can be obtained from a patient who is unable or unwilling to respond to conventional behavioral testing; best results are obtained from quiet or asleep patients.
Carcinoma of the Pancreas Presenting with Bilateral Tonsillar Metastases
Authors: Maor Esther , Tovi Ferit , Sacks Martin
Published: October 2014

A 59-year-old woman presented with bilateral tonsillar masses due to metastases from a primary pancreatic carcinoma. Tonsillar metastases from many different primary tumors are well documented in the literature, but this seems to be the first case in which the pancreas was the primary site. It is also one of the very few recorded cases in which the patient's presenting symptoms were due to tonsillar metastases.
Abnormal Venous Drainage Simulating a Glomus Jugulare Tumor
Authors: Tjellström Anders , Svendsen Pål
Published: October 2014

Knowledge of the arterial supply and the venous drainage of a glomus jugulare tumor is of most importance for surgery, and close cooperation between the neuroradiologist and the otolaryngologist is necessary. The possibility of a variation of the vascular anatomy should be kept in mind. We report a patient with a reddish mass behind the eardrum which was found to be her transverse sinus running in a vertical direction, ending in a sigmoid sinus which was passing close to the foramen magnum.
Klippel-Feil Syndrome with Conductive Deafness and Histological Findings of Removed Stapes
Authors: Sakai Makoto , Shinkawa Atsushi , Miyake Hirosato , Komatsu Nobuyuki
Published: October 2014

The Klippel-Feil syndrome is usually associated with sensorineural hearing impairment, but rarely is it associated with conductive or mixed deafness. A 22-year-old female presented with fusion of the cervical vertebrae, torticollis, scoliosis, pterygium colli, the Sprengel deformity with an omovertebral bone, concavity of the thorax and conductive hearing impairment of the right ear. Tympanotomy disclosed an atrophic long process of incus and a fixation of the stapes footplate, and stapedectomy was performed with immediate postoperative improvement of hearing. However, she developed a sudden hearing loss with dizziness soon after she had physical exercise on the 15th postoperative day, and revision surgery revealed a perilymph fistula of the oval window. Histological investigations of the removed stapes showed no specific osseous changes but hyperostosis of the posterior edge of the footplate. The literature is reviewed and the etiology of the conductive deafness and the perilymph fistula is discussed.
Topographic Arrangement of Motoneurons Innervating the Suprahyoid and Infrahyoid Muscles: A Horseradish Peroxidase Study in Cats
Authors: Yoshida Yoshikazu , Miyazaki Toshimi , Shin Takemoto , Hirano Minoru , Kanaseki Takeshi
Published: October 2014

The topographic arrangement of motoneurons innervating the muscles which participate in the rostrocaudal movement of the larynx was studied in cats by means of the horseradish peroxidase (HRP) method. After HRP injection into these muscles, all labeled neurons were found in the nuclei of the brainstem and cervical nerves (C1, C2) ipsilaterally. The mylohyoid and anterior digastric motoneurons were seen in a cluster in the medial part of the rostrocaudal area of the motor trigeminal nucleus. Within the medial part of the nucleus, the mylohyoid motoneurons were located ventrally and the anterior digastric motoneurons dorsally. The posterior digastric neurons were situated in the accessory facial nucleus, the stylohyoid neurons in the ventral aspect of the facial nucleus, the geniohyoid motoneurons in the ventral aspect of the hypoglossal nucleus, and the thyrohyoid motoneurons in the lateral aspect of the hypoglossal nucleus and the dorsomedial part of the ventral horn cells of C1. The HRP-labeled neurons of the sternohyoid and sternothyroid muscles were observed in the central portion of the ventral horn cells of C1 and C2.
Thymopharyngeal Duct Cyst: A Form of Cervical Thymus
Authors: Zarbo Richard J. , Areen Richard G. , McClatchey Kenneth D. , Baker Shan B.
Published: October 2014

A unique case of a cystic thymopharyngeal duct with coexistent thymus and parathyroid glands is presented as a rare form of cervical thymus. The embryology of normal cervical descent of the thymus is reviewed. Special attention is given to the pathogenesis of a wide variety of cervical thymic tissue which may be encountered. A unifying scheme and nosology are proposed for deciphering the various reported types of solid and cystic cervical thymic abnormalities.
Primary Squamous Cell Carcinoma of the Middle Ear Invading the Cochlea
Authors: Hiraide Fumihisa , Inouye Tetsuzo , Ishii Tetsuo
Published: October 2014

This report describes the histopathological changes in the temporal bone of a 71-year-old man who died of meningitis and epidural abscess complicated by primary squamous cell carcinoma of the middle ear. The present case is unusual and differs somewhat from previously reported cases of the primary squamous cell carcinoma of the middle ear in three respects: 1) an extensive invasion of the cancer into the membranous labyrinth, 2) cholesterol deposits in the cochlear spiral canal, and 3) presence of ossifying labyrinthitis. Among these findings, extensive involvement of the inner ear by cancer destroying the lower part of the otic capsule is particularly unusual. It is assumed that squamous cell carcinoma overcame the biological resistance to neoplastic infiltration which probably exists in the otic capsule and the membranous labyrinth.
Secretory Immune Response in Patients with Oropharyngeal Carcinoma
Authors: Watanabe Tsuneo , Iglehart J. Dirk , Bolognesi Dani P.
Published: October 2014

The secretory immune system is a unique, local immunological mechanism which appears to be independent of systemic immunity. Secretory immunoglobulin A (SIgA), a major component in this mucosal immune system, is structurally different from the IgA immunoglobulin in serum and has a function as a first line of defense against the uptake of macromolecules and against infectious agents in the intestine, respiratory tract and genitourinary system. However, its relationship to the development and control of neoplasia is not well understood despite the fact that the major portion of human malignancies are of the epithelial type and located where the secretory immune system is vigorously functioning. In this study, the amounts of SIgA and secretory component (SC) in oral secretions and sera were measured in 20 patients with oropharyngeal carcinoma and 22 appropriate control subjects in order to elucidate the involvement of the secretory immune system as it related to oropharyngeal carcinoma. Cancer patients had increased IgA levels in oral secretions (561 ± 161 μg/ml) compared to normal subjects (166 ± 18 μg/ml, p < 0.02) and to a smoker/drinker subgroup of controls (229 ± 8.7 μg/ml, p < 0.05). The elevated IgA levels in cancer patients appear to be unrelated to local inflammation or the patient's history of smoking or drinking. Density gradient analysis demonstrated that the IgA measured in oral secretions migrates at the 11S position, confirming that it is of the secretory type and indicating that the increased levels of IgA in oral secretions of patients with oropharyngeal carcinoma are not due to nonspecific leakage of 7 SIgA from sera. Secretory component levels in sera also revealed highly significant differences between cancer patients (1.65 ± 0.73 μg/ml) and all control subjects (0.85 ± 0.12 μg/ml, p < 0.002). The data suggest that the increased SIgA concentration in secretions and SC level in sera accompany the existence of oropharyngeal carcinoma. The biological significance of these findings and their possible clinical application are discussed.
Laryngeal Injury following Short-Term Intubation
Authors: Peppard Sean B. , Dickens James H.
Published: October 2014

Laryngeal injury secondary to prolonged intubation has been extensively discussed in the literature. Little however, has been reported regarding laryngeal injury from short-term intubation. It is unclear what the basis may be for the common findings of hoarseness and discomfort after intubation for general anesthesia. Examined were 475 adults using indirect laryngoscopy immediately following intubation for elective surgical procedures. Our study indicates a small but significant number of patients will exhibit an injury after elective short-term intubation. This is most likely a result of intubation technique and recovery is generally prompt with conservative observation.
Pharyngolaryngeal Web
Authors: Gerson Carol R. , Tansek Karin , Tucker Gabriel F.
Published: October 2014

Within the last several months we have seen two patients with pharyngolaryngeal webs. The webs extend from the lateral borders of the epiglottis to the lateral and posterior pharyngeal walls framing the glottis with a “keyhole” type of effect. No web of this kind has ever been documented in the literature to our knowledge. These children suffer from intermittent airway obstruction, probably secondary to tethering of the epiglottis. These webs are very difficult to identify without the panoramic view of the hypopharynx which is afforded by the fiber-illuminated endoscopic telescopes. We recommend that endoscopy of neonates include observation of the hypopharynx with the endoscopic telescope as well as with the open laryngoscope.
Comparison of Tracheal Damage from Laser-Ignited Endotracheal Tube Fires
Authors: Ossoff Robert H. , Eisenman Theodore S. , Duncavage James A. , Karlan Marc S.
Published: October 2014

Studies were undertaken by the Departments of Otolaryngology-Head and Neck Surgery and Anesthesiology at Northwestern University Medical School and the Medical College of Wisconsin (Milwaukee) to compare the potential for tissue injury to the trachea and lungs of canines. Polyvinylchloride (PVC), Rusch red rubber, and silicone tubes were tested. The effects of an intraluminal tube fire on the larynx and trachea were documented with laryngeal and bronchoscopic photographs taken immediately postburn and at the time of sacrifice six hours later. The most severe burns were associated with the PVC tube. Silica ash was seen in the airway after the silicone tube fires and raises the possibility of future problems with silicosis. Histological examination of the trachea showed acute injury in all of the animals; specimens from the dogs with the PVC tube fires demonstrated the most severe cellular damage.
Management of Benign Fistulae between Zenker's Diverticulum and the Trachea
Authors: Senders Craig W. , Babin Richard W.
Published: October 2014

Cases of acquired benign fistula of the respiratory tree and esophagus have been reported in relation to Mycobacterium tuberculosis and trauma. Fistula formation between the trachea and a Zenker's diverticulum is a similar type of condition in which nutritional and immunological deficiencies can rapidly result in further complications which may mimic a malignancy. Spontaneous fistula formation and vocal cord paralysis may result. Surgical management of this condition includes interposing viable muscle between the esophagus and trachea at the repair site.
Posterior Commissure Laryngoscope for Carbon Dioxide Laser Surgery
Authors: Ossoff Robert H. , Karlan Marc S. , Sisson George A.
Published: October 2014

A laryngoscope has been developed for microlaryngeal laser surgery in the posterior commissure of the larynx. The tip has been designed to facilitate exposure of one entire arytenoid and the posterior commissure. Other features include a concavity on the superior lip of the tip to hold the endotracheal tube anteriorly, a bifurcated smoke evacuation channel and a nonreflective finish. It is anticipated that this laryngoscope will be available in pediatric and adolescent sizes in addition to the adult size that we have worked with.
Salivary Scan after Major Ablative Head and Neck Surgery with Prediction of Postoperative Fistulization
Authors: Newman Richard K. , Weiland Fredrick L. , Rosen Paul R. , Johnson Jonas T. , Gumerman Lewis W.
Published: October 2014

Patients with carcinoma of the head and neck undergoing major ablative and reconstructive procedures following periods of prolonged debilitation, chemotherapy, and/or radiation therapy have been identified as having a high risk for postoperative wound complication, most often infection. Does postoperative wound infection arise de novo, does infection result from failure of prophylactic antibiotic coverage, or is it the result of anastomatic salivary leak? To investigate the incidence of unrecognized salivary leak into the neck, 24 patients underwent salivary radioisotope studies using technetium 99m sodium pertechnetate from three to six days postoperatively. The isotope was administered early in the morning with drainage bags empty. Patients and the collection system were scanned for activity between four and six hours later. Nine patients had postoperative evidence of salivary secretion radioactivity in their drainage system. All of these patients developed transient wound infections or fistulas. The remaining 15 had no uptake in their collection systems and no wound complications. We suggest that the preliminary results from this noninvasive, simply administered study indicate that the infected surgical neck wound may be secondary to unrecognized postoperative salivary contamination. This technique can be used to provide early identification of potential wound infection. Alternatively, information generated by this kind of study may be valuable in predicting patients with the highest risk for postoperative infection, thereby offering guidelines for the use of perioperative antibiotic prophylaxis.
Tracheobronchial Compression in Acyanotic Congenital Heart Disease
Authors: Berlinger Norman T. , Foker John , Long Charles , Lucas Russell V.
Published: October 2014

Children with acyanotic congenital heart disease frequently develop respiratory difficulties such as atelectasis, pneumonia, or infantile lobar emphysema. In some cases, the cause of the respiratory difficulty is compression of the tracheobronchial tree by hypertensive dilated pulmonary arteries, since this type of heart disease frequently demonstrates large left-to-right intracardiac shunts. Sites of predilection for compression include the left main bronchus, the left upper lobe bronchus, the junction of the right bronchus intermedius and right middle lobe bronchus, and the left side of the distal trachea. Cardiac anomalies which predispose to this type of compression include ventricular septal defect, patent ductus arteriosus, interruption of the aortic arch, and tetralogy of Fallot. Pulmonary arteriopexy may relieve the tracheobronchial compression.
Bilateral Pneumothorax Resulting from the Bronchoscopic Removal of a Puncture Vine Fruit
Authors: Dudley James P.
Published: October 2014

Because pneumothorax may impair ventilation, it should be included in the differential diagnosis whenever ventilating problems are encountered during intraoperative procedures. Since pneumothorax is not an expected complication following atraumatic removal of tracheobronchial foreign bodies, it may not be considered if ventilation problems arise. When a foreign body has one or more sharp spines, however, consideration should be given to the possibility that the spine may have perforated the airway wall and that a pneumothorax may ensue following removal. Removal of a fruit of a puncture vine ( Tribulus terrestris) from the junction of the carina and right main stem bronchus was followed by increased resistance to ventilation due to bilateral pneumothorax. Insertion of chest tubes bilaterally returned respirations to normal. Bronchoscopists should be aware of this possible complication of spine-covered foreign bodies.
Ten-Year Review of Pediatric Tracheotomy
Authors: Carter Peter , Benjamin Bruce
Published: October 2014

One hundred sixty-four consecutive tracheotomies are reviewed over the 10-year period 1972–1981. Early in the series acute inflammatory airway obstruction was the major indication for tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced tracheotomy for acute epiglottitis. More recently it has become the treatment of choice for acute laryngotracheobronchitis. Tracheotomy prior to reconstructive surgery for major craniofacial abnormalities is becoming more frequent. Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of hemorrhage, no posttracheotomy stenosis, and no death was attributable to tracheotomy. These results demonstrate that in a major pediatric hospital tracheotomy is a relatively safe and effective procedure with minimal morbidity.
Quantification of Intralaryngeal Pressure Exerted by Endotracheal Tubes
Authors: Weymuller Ernest A. , Bishop Michael J. , Hibbard Arlis W. , Fink B. Baymond , Spelman F. A.
Published: October 2014

Prolonged endotracheal intubation in critically ill patients has become an accepted routine. One notable consequence of this form of management is injury to the posterior aspect of the glottis, apparently an injury caused by the presence of an endotracheal tube. Utilizing two types of sensing devices, the pressure exerted by endotracheal tubes was measured in the canine larynx via a laryngofissure approach. Pressure in excess of 200 mm Hg was consistently noted in the region of the arytenoid cartilage. A variety of tubes were tested with similar results.
Further Observations on the Treatment of Recurrent Respiratory Papillomatosis with Interferon: A Comparison of Sources
Authors: Goepfert Helmuth , Dichtel William J. , Sessions Roy B. , Donovan Donald T. , Gutterman Jordan U.
Published: October 2014

Between June 1982 and March 1983, 11 patients with aggressive recurrent respiratory papillomatosis were treated with alpha or human leukocyte interferon (IFN) that was produced by and purchased from the New York Blood Center, Inc. The year before, nine of these patients had been on a similar protocol utilizing alpha-IFN that had been supplied by the Finnish Red Cross Blood Transfusion Service. Comparisons regarding response and toxicity were made and are reported. In our series we have not seen an overall difference in response of papillomatosis to these two IFNs. As many of our patients responded better to the New York product as responded worse. There is a suggestion, however, that the New York product is associated with less toxicity than the Finnish IFN.
Preoperative Irradiation and Surgery for Carcinoma of the Base of the Tongue
Authors: Thawley Stanley E. , Simpson Joseph R. , Perez Carlos A. , Marks James E. , Ogura Joseph H.
Published: October 2014

From 1960 through 1978, 101 patients with histologically proven epidermoid carcinoma of the base of the tongue were treated with preoperative irradiation and surgery at Washington University School of Medicine. Local and regional control at 3 years was achieved in 65% of the patients, and at 5 years in 57%. Sixteen percent of patients who suffered local or regional failure were salvaged by further surgery. Distant metastases developed in approximately 18% of patients and second malignancies developed in 20%. It appears that the combination of preoperative irradiation plus surgery provides substantial local control rates and survival for patients with base of tongue cancer in both early and moderately advanced stages.
Management of Congenital Ear Malformations
Authors: Glasscock Michael E. , Nissen Alan J. , Schwaber Mitchell K. , Jackson C. Gary
Published: October 2014

In spite of modern diagnostic and surgical techniques, the results of congenital ear malformation surgery are often disappointing. Not only are hearing results less than expected, but also postoperative canal stenosis is a significant problem. This paper reviews the historical development of atresia surgery, the various classification systems, and the management of congenital ear malformations at The Otology Group. The authors' surgical technique is described and the postoperative results of 33 ear operations are discussed. Twenty-two of 33 cases showed some improvement in hearing. Postoperative stenosis occurred in 42% of atresia cases.
Evaluation of the Adult with Sleep Apnea
Authors: Snyderman Nancy L. , Reynolds Charles F. , Johnson Jonas T.
Published: October 2014

Twenty-seven cases of adult sleep apnea are reported. The patients were studied with all-night polysomnography. Seven (26%) had predominately obstructive sleep apnea, while another seven (26%) had predominately central sleep apnea. Thirteen patients (48%) were found to have a mixed pattern. Obesity was not a reliable guideline for predicting differential etiology. We conclude that sleep studies with specific monitoring are essential in the evaluation of the adult with sleep apnea prior to therapeutic intervention.
Osteomyelitis of the Clavicle
Authors: Monsell Edwin M. , Krespi Yosef P. , Sisson George A.
Published: October 2014

Osteomyelitis of the clavicle is rare; however, it may occur following head and neck surgery. Risk factors include radiation, longstanding tracheitis, disruption of the periosteum or the cortical bone with interruption of the blood supply to the clavicle. Proper management includes early diagnosis, surgical debridement of soft tissue and bone, appropriate antimicrobial therapy, and coverage of the defect with a myocutaneous flap to protect the great vessels of the upper mediastinum.
Juvenile Otosclerosis
Authors: Robinson Mendell
Published: October 2014

An in-depth study of 610 patients who developed clinical otosclerosis before the age of 18 is reported; this is 15.1% of the total number of stapedectomy cases performed within the period 1961 to 1981. The study illustrates differences noted in those patients who had surgery performed before age 18 and those whose surgery was performed after age 18. These differences will be analyzed with respect to sex family history, bilaterality, preoperative cochlear reserve, stapes footplate pathology, type of footplate surgery, and postoperative hearing results, as well as the follow-up for delayed complications and delayed hearing losses. Statistical data supports the hypothesis that there is no contraindication to performing stapedectomy surgery in children. This study demonstrates that the success rate is significantly higher in the under-age-18 group and correlates closely with the less severe footplate pathology encountered in children.
The Sleeve Autograft in Congenital Cholesteatoma
Authors: Wehrs Roger E.
Published: October 2014

An epithelial cyst behind an intact tympanic membrane with no previous history of ear infections is an unusual but not infrequent finding in children. If it is recognized early and completely removed, a permanent cure is obtained. However, if it is unrecognized or poorly treated, there may be far-reaching complications. The conventional technique of creating a tympanomeatal flap to remove the congenital cholesteatoma is often unsatisfactory. This is because the cyst may be located in the anterior-superior quadrant and extend beneath the malleus. It therefore becomes impossible to accomplish a complete removal and still preserve auditory function. This leads to incomplete removal with recurrence and subsequent radical removal with loss of auditory function and alteration of normal anatomy. A technique is presented whereby the canal skin, malleus, and cholesteatoma are removed en bloc. Once outside the confines of the bony ear canal, the tympanic membrane is inverted and the epithelial cyst removed under direct vision. The eardrum-malleus-canal skin autograft is then replaced in anatomical position and the hearing reconstructed with a homograft notched incus. This technique has been utilized in nine cases over the past 10 years. Case reports demonstrate the anatomical and functional results.
Electrical Stimulation of the Ear: Experimental Studies
Authors: Aran J.-M. , Wu Z. Y. , Cazals Y. , de Sauvage R. Charlet , Portmann M.
Published: October 2014

The possibility of stimulating the ear by way of an electrode on the round window in order to relieve tinnitus or to produce auditory sensations has been investigated experimentally in guinea pigs. The deleterious effects of DC currents applied to a normal cochlea clearly demonstrate that this means is unsuitable for use in relieving tinnitus in hearing patients. Although AC currents do not cause further damage in ears with the organ of Corti already destroyed by aminoglycosides, the effects of DC currents in such cases have still to be investigated before they can be recommended for the relief of tinnitus in totally deaf patients. Electrical stimulation of the round window combined with masking has made it possible to record responses of auditory neural elements from the eighth nerve to the auditory cortex. This technique could be promising for the basic study of the central auditory nervous system, both experimentally and clinically, and could lead to a more accurate evaluation of candidates for cochlear prostheses.
Electrical Stimulation of the Ear: Clinical Applications
Authors: Portmann M. , Aran J.-M. , Nègrevergne M. , Cazals Y.
Published: October 2014

Electrical stimulation of the ear in humans was performed with an extracochlear electrode on the round window. With positive currents, suppression of tinnitus could be induced. With negative currents, auditory sensations were evoked. Since electrical stimulation with DC currents may be hazardous in the long term, it cannot yet be proposed for the suppression of tinnitus. However, electrically evoked hearing sensations with AC currents seem to be of definite interest for some totally deaf patients.