bluuebunny/crossref_metadata_2025 huggingface dataset:
Somnofluoroscopy: Its Role in the Selection of Candidates for Uvulopalatopharyngoplasty
Authors: Katsantonis George P. , Walsh James K.
Published: November 2015

The purpose of this study was to evaluate the efficacy of somnofluoroscopy in the selection of candidates for uvulopalatopharyngoplasty (UPPP). Somnofluoroscopy is a lateral fluoroscopic examination of the upper airway with synchronous polysomnography that provides information about the dynamic function of the airway and the level of stenosis or occlusion during sleep. Somnofluoroscopies were performed preoperatively in 26 consecutive patients undergoing UPPP. Preoperative and postoperative polysomnographic data were obtained on each patient. On review of the somnofluoroscopic recordings, two levels of the airway were considered: level 1, above the horizontal plane through the midportion of body of the second cervical disk, and level 2, below this plane. The examinations were then scored for the following: (A) most narrow level of airway during wakefulness, (B) first level(s) of airway to collapse during apnea, and (C) all levels of the airway to collapse during apnea. It was shown that patients whose narrowest part of the upper airway is at level 1 and whose first point of airway collapse during apnea episodes is at level 1 are good candidtates for the UPPP. Only three of 15 patients in this group did not respond to the operation. Patients with other patterns are uniformly poor candidates for this procedure. Results are encouraging but preliminary because of the small number of patients. It appears that somnofluoroscopy is a reliable selection criterion for UPPP in patients with obstructive sleep apnea.
Tagliacotian Cross‐Arm Flap Reconstruction of Facial Defects
Authors: Wilson David E. , Maves Michael D.
Published: November 2015

The tagliacotian cross‐arm flap finds its basis in one of the oldest reconstructive techniques known, the brachial flap of Gaspar Tagliacozzi. Although not commonly employed today, it remains useful in difficult orbital and nasal reconstructions. Our report deals with the historic development, applicability, timing, and technique of this procedure and is well illustrated by a case report. Advantages of the tagliacotian flap include no additional scarring in the exposed area and a hidden donor site. A considerable amount of usually non‐hair‐bearing tissue can be transferred without sacrifice of valuable muscle and without special surgical techniques. The tagliacotian cross‐arm flap should be considered when local and regional tissue supply is inadequate, when aesthetic desires of the patient preclude additional local scarring, and when time allows for the training and transfer of this flap.
Beta Endorphin Enhances in Vitro Lymphokine Production in Patients with Squamous Carcinoma of the Head and Neck
Authors: Wolf Gregory T. , Peterson Karen A.
Published: November 2015

Recent studies of the effects of endorphins and other neuropeptides on immune mechanisms suggest that immune reactive cells have specific opioid‐like and nonopioid endorphin receptors, and indicate that neuropeptides may participate in regulating in vivo immune functions. Earlier demonstrations of impaired cellular immunity and impaired lymphokine production in patients with cancer of the head and neck prompted an investigation of the in vitro effects of β‐endorphin on the production of leukocyte migration inhibitory factor (LIF) in 29 patients with head and neck cancer and in 45 normal subjects. LIF production in response to phytohemagglutinin was significantly less in the cancer patients compared to normal subjects (p <. 001). β‐Endorphin significantly enhanced LIF production in the cancer patients (p =. 01) to levels that did not differ significantly from normal levels. A correlation of levels of lymphocyte subpopulations in the cancer patients suggested that enhancement of lymphokine production by β‐endorphin was related to levels of T8 (suppressor/cytotoxic) cells. The results confirm earlier demonstrations of impaired lymphokine production in patients with head and neck cancer and indicate that β‐endorphin can modulate in vitro lymphokine responses in such patients. These findings suggest that neuroendocrine peptides may play an important role in regulating immune function. Further study of the role of neuropeptides in the immune response should provide additional insight into the characterization of cellular immune dysfunction associated with head and neck cancer and should lead to the development of innovative immunotherapeutic treatment strategies.
Treatment of Posterior Pharyngeal Wall Carcinoma
Authors: Teichgraeber John F. , McConnel Fred M.S.
Published: November 2015

Thirty cases of posterior pharyngeal wall carcinoma (seen in the Emory University system between 1977 and 1982) are reviewed. The study was implemented to resolve the question, “Which therapeutic alternative is preferred for the treatment of the lesion—radiation or therapy?” From our clinical experience, a treatment plan of primary surgery with postoperative radiation appears to be preferred over a treatment plan of radiation for cure with surgery held for salvage. A current review of the literature on the treatment of posterior wall carcinoma will be presented along with a review of our series.
The Beneficial Effect of Triamcinolone Acetonide on Nerve Repair with Autogenous Grafts
Authors: Upton Richard , McCaffrey Thomas V. , Ellis John
Published: November 2015

Bilateral nerve cable graft repairs were made in the sciatic nerves of Wistar rats. One group of repairs was treated locally with triamcinolone acetonide (0.5 mg), one group was exposed to the systemic effects of the drug, and one group was left untreated. Nerve regeneration was measured by nerve‐stimulated muscle twitch strength, as well as several electrophysiologic parameters of the compound action potential conducted through the graft. Results suggest that nerve regeneration through an autogenous graft is significantly improved by local treatment with triamcinolone acetonide. Further studies are indicated to determine appropriate dosage necessary to maximize the beneficial local effects.
Laryngeal Dysfunction and Pulmonary Disorder
Authors: Wood Raymond P. , Jafek Bruce W. , Cherniack Ruben M.
Published: November 2015

The normal respiratory function of the larynx has been described in detailed reports in both the otolaryngology and the respiratory physiology literature. The role of the posterior cricoarytenoid muscle in vocal cord abduction has been shown to be paramount in laryngeal respiratory function. However, only in recent reports has attention been directed toward disordered laryngeal function as evidenced in pulmonary disorders, such as asthma, or in association with underlying pulmonary disorders, such as asthma (ROAD) or emphysema (COPD), in this article, cases will be presented to demonstrate the role of disordered laryngeal function appearing as pulmonary disease and associated with various degrees of underlying pulmonary disease. The effect on pulmonary function tests and the role of treatment will be discussed.
Classification of Nasal Defects: A Practical Guide for Reconstruction
Authors: O'Quinn Bancroft , Thomas J. Regan , Patton Timothy J.
Published: November 2015

Nasal defects are among the most complicated problems frequently facing the otolaryngologists—head and neck surgeon. The complex role of the nasal structure and its anatomy makes a practical guide for reconstruction particularly attractive. The nose, as a unique facial component, must ideally perform important airway functions, while also having an acceptable appearance. A range of reconstructive problems from simple defects to total nasal loss is addressed.
Snoring: Clinical Implications and Treatment
Authors: Rice Dale H. , Persky Michael
Published: November 2015

Snoring has only recently come under wide study. Recent research has established the close relationship of severe snoring to sleep apnea in terms of the obstructive pathophysiology. Snoring tends to increase in severity over time and may progress to sleep apnea. Severe snoring may be associated with pulmonary and systemic hypertension, secondary polycythemia, and cardiac arrhythmias.
Immunology of foods
Authors: Treviño Richard J.
Published: November 2015

Investigation of food sensitivity is difficult and often confusing. However, there are multiple articles in the literature which illustrate that food is absorbed from the gastrointestinal tract in an antigenic fashion and that the entire immune system is stimulated by these antigenic food particles. All four Gell and Coombs varieties of immunologic reactions have been demonstrated as causes of symptoms in patients. Test techniques are available for each of these immunologic reactions, as is treatment for their noxious effects.
Influence of cisplatin on wound healing—an experimental model
Authors: Stiernberg Charles M. , Williams R. Mark , Hokanson James A.
Published: November 2015

Recent clinical studies have shown that adjuvant chemotherapy may improve response rates to treatment for advanced head and neck carcinomas. Given preoperatively, some chemotherapeutic agents adversely affect wound heallng. The specific purpose of this study was to evaluate the Influence of cisplatin on wound healing when it is given preoperatively. Forty‐four Swiss outbred mice were divided into control and treatment groups. One week before surgery, the treatment group received cisplatin (2 mg/ kg body weight) by subcutaneous injections on 2 consecutive days. Each control animal was given an equal volume of normal saline. A 1.5 cm transverse incision was made in each animal, and wounds were closed with surgical staples. The mean woundbreaking strength was determined for a minimum of 5 treatment and 5 control mice on postoperative days 6, 10, 13, and 16. Serum creatinine, blood cell counts, and changes in weight were also monitored. Results showed wound strength on postoperative day 10 to be significantly reduced in mice treated with cisplatin (P < 0.05). There was no significant difference for wound strength on any other days and all other variables were simllar between both groups. In conclusion, cisplatin has an adverse effect on wound healing, the peak of which probably occurs during the proliferative stage of wound healing. Further studies are needed to determine the optimal time for surgery after preoperative chemotherapy. All new chemotherapeutic agents, particularly those being considered in a preoperative regimen, should be tested in this manner.
Pediatric nasal resistance and lower anterior vertical face height
Authors: Principato Jerold J. , Kerrigan James P. , Wolf Pamela
Published: November 2015

In an effort to determine whether nasal obstruction in the pediatric population influences craniofacial and orthodontic development, nasal resistance data were collected from 211 consecutive orthodontic patients by means of active anterior rhinometry. Age‐specific nasal resistance standards had been previously accumulated from an unselected representative sample of 498 youngsters, drawn from socioeconomic and demographic backgrounds similar to those of the orthodontic group. Resistance data collected from 211 orthodontic patients were found to fall in an almost linear arrangement, varying inversely with age. Age‐specific nasal resistance mean data were found to be consistently higher than comparable age‐specific mean data of the unselected comparative sample. When orthodontic nasal resistance data were compared with cephalometric measurements of anterior lower vertical face height in 60 patients, there was a definitive correlation between elevation in nasal resistance and increased lower vertical face‐height measurements.
The State of Tinnitus after Inner Ear Surgery
Authors: Silverstein Herbert , Haberkamp Thomas , Smouha Eric
Published: November 2015

A retrospective study of several procedures—for either treatment of vertigo or resection of acoustic neuromas—was performed to determine their effect on tinnitus. Subjective ratings of the state of tinnitus (resolution, improvement, maintenance, or deterioration) were obtained by questionnaire. Surgical procedures performed for correction of vertigo frequently alter tinnitus. In general, procedures that conserve hearing—namely, retrolabyrinthine vestibular neurectomy (RVN), middle fossa vestibular neurectomy (MFVN), and endolymphatic shunt procedures (ELS)—have a 50% to 65% chance of helping relieve tinnitus and up to a 22% chance of worsening tinnitus. When there is no serviceable hearing, cochleovestibular neurectomy (CVN) offers the best cure rate for tinnitus (76%) and the least chance of worsening tinnitus (3%). When hearing is minimal and the patient complains of tinnitus, a CVN—rather than a labyrinthectomy—should be recommended. However, when useful hearing is present, a CVN is not usually recommended for relief of tinnitus, since the actual cure rates are only 35%. When vertigo is not a complaint, there is currently no surgical procedure known that can be recommended for the treatment of tinnitus.
Calvarial Bone Grafting of Facial Defects
Authors: Maves Michael D. , Matt Bruce H.
Published: November 2015

Bony defects of the face continue to challenge the reconstructive surgeon. Traditional sources of autologous bone from the rib or pelvis have been associated with the limitations of pain at the donor site, the need for a second operative field, variable “take” of the graft with poor eventual survival and, ultimately, less than optimal reconstruction. Calvarial bone grafting provides a readily accessible source of bone from an inconspicuous donor site, usually within the same operative field. The morbidity is minimal. The calvarial bone graft is especially useful in repair of the frontal sinus, orbital floor, nasal and malar regions, as well as in certain instances of cleft palate with alveolar involvement.
Photodynamic Therapy for Head and Neck Cancer Xenografts in Athymic Mice
Authors: Hill James H. , Plant Randall L. , Harris David M. , Paniello Randal C.
Published: November 2015

This study examines efficacy and optimal treatment variables of photodynamic therapy (PDT) for human head and neck squamous cancer (HNSC) xenografts in athymic mice. Two and four days after injection of hematoporphyrin derivative (HPD), tumors were illuminated with red light from an argon‐dye laser. Sixty‐three tumors were treated. With HPD dose and light intensity constant at 7.5 mg/kg and 100 mW/cm2, respectively, the extent of tumor necrosis was strongly dependent on duration of light exposure. There was no substantial difference in results for 30‐ and 60‐minute treatment durations between animals injected with HPD 2 and 4 days before treatment. After 30 minutes treatment time, responses were seen in 8 of 10 mice (2 days post‐HPD) and 11 of 12 mice (4 days post‐HPD). After 60 minutes treatment time, toxicity was high. We conclude that, in this model, PDT is effective in selective killing of HNSC. For future comparison studies in this model, if the indicated HPD dose and light intensity are used we recommend a 2‐day delay after HPD injection and a light exposure duration of 30 minutes
Pierre Robin Syndrome Combined with Unilateral Choanal Atresia
Authors: Borovik Harry R. , Kveton John F.
Published: November 2015

A case of Pierre Robin syndrome (mandibular hypoplasia, cleft palate, and glossoptosis), associated with a unilateral choanal atresia in a full‐term infant, is described. The pathogenesis of this combined anomaly is discussed through review of the embryologic development of the craniofacial structures. Diagnostic and management alternatives are reviewed
Electrical Stimulation of the Guinea Pig Cochlea
Authors: Maslan Mark J. , Miller Josef M.
Published: November 2015

As a result of practical considerations, histopathologic findings of the temporal bone in humans with cochlear prosthesis implants have been limited. This project attempts to better define safe parameters of electrical stimulation of the inner ear and compare the safe limits of intracochlear vs. extracochlear stimulation sites. Guinea pigs were implanted with single electrodes either on the promontory or in the scala tympani and were stimulated relative to a remote indifferent for 12 hours distributed over a 4‐week period. Electrical auditory brainstem evoked responses (EABRs) were tested before and after each of four 3‐hour stimulation sessions. Six weeks after implantation, the animals were killed, and their cochleas were examined under the scanning electron microscope. Intracochlear electrodes exhibited thresholds for damage well below one half of that found for most extracochlear stimulation sites. The function‐relating damage threshold (in amperes) to frequency of intracochlear stimulation is represented by two straight lines, with an intercept of 1 kHz. The low‐frequency limb exhibited a slope of 3 to 4 dB/octave, whereas the high‐frequency limb exhibited a slope of 9 to 10 dB/octave. Extracochlear results were too variable to permit speculation. Changes in EABRs were only variably related to histopathologic findings.
The Facial Nerve in the Infratemporal Approach
Authors: Brackmann Derald E.
Published: November 2015

A new method of re‐routing the facial nerve in the Infratemporal fossa approach is presented. Exposure of the skull base is not compromised and better immediate and long‐term facial function is achieved. A consecutive series of 31 cases is discussed.
Substance P Immunoreactive Nerve Fibers of the Canine Laryngeal Mucosa
Authors: Shin Takemoto , Wada Shigeru , Maeyama Tadatsugu , Watanabe Shun
Published: November 2015

Substance P (SP) immunoreactive nerve endings in the laryngeal mucosa were studied by PAP immunohistochemistry with light and electron microscopy. SP immunoreactive sensory endings were observed in the epithelium as intra‐epithelial free nerve endings and taste bud‐like structures. A small number of autonomic SP immunoreactive nerve fibers were observed running parallel to arterioles which were over 30 μm in diameter and terminated in glandular cells. Contrary to findings by silver impregnation, intraepithelial free nerve endings were more frequently observed on the lower surface of the vocal cord. The taste bud‐like structures were classified into two different types: (1) simple terminations and (2) reticular terminations, according to the mode of the SP immunoreactive nerve fiber. Immature or degenerated taste bud‐like structures in the larynx were assumed to be mechanical receptors because these receptors lacked outer taste pores and taste hairs.
Magnetic Resonance Imaging of the Larynx and Tongue Base: Clinical Applications
Authors: Hoover Larry A. , Wortham Donald G. , Lufkin Robert B. , Hanafee William N.
Published: November 2015

The use of surface coils on subjects, and internal engineering improvements have combined to greatly improve the signal‐to‐noise ratio on the magnetic resonance imager at our institution over the past two and one‐half years. This has resulted in a marked improvement in image resolution, as well as reduction in the time required and related cost of these studies. Magnetic resonance (MR) examinations at our institution now cost less than comparable computed tomography (CT) studies. This article summarizes our experiences in imaging the larynx and tongue base. Eleven cases are presented to illustrate how the direct multiplane capacity of MRs and their increased soft tissue contrast provide some definite advantages over CT in determination of extent of disease in these regions.
Glycerol‐induced Positional Nystagmus in Human Beings
Authors: Rietz Robert , Troia Barbara W. , Yonkers Anthony J. , Norris Thomas W.
Published: November 2015

Direction‐changing nystagmus has been seen after the ingestion of ethanol in both animals and man. The direction of the nystagmus is dependent upon the position of the head and is thus called Positional Alcohol Nystagmus (PAN). This article provides information about positionally dependent, direction‐changing nystagmus in human beings after the ingestion of glycerol (1.5 g/kg). Electronystagmographic recordings were made and serum glycerol levels were repeatedly determined over a period of 7 hours. The resulting data compliment earlier work done with ethanol. These data provide support for a buoyancy hypothesis to explain positional nystagmus after ingestion of water‐soluble molecules with differing specific gravities.
Transtragal, Transtympanic Electrode Placement for Intraoperative Electrocochleographic Monitoring
Authors: Prass Richard L. , Kinney Sam E. , Lüders Hans
Published: November 2015

Transtragal, transtympanic electrode placement was performed for the purpose of intraoperative electrocochleographic (ECoG) monitoring during seven suboccipital acoustic neuroma resections. The promontory, the tragus, and two external sutures stabilized the electrode during surgery. The only noted otologic sequallae of electrode placement were small circular lesions at tympanic membrane puncture sites. Satisfactory ECoG recordings were obtained in five of seven cases. Peak‐to‐peak N, amplitudes were (on average) 13.4‐fold larger than the corresponding amplitudes of peak I of the surface‐recorded brainstem auditory evoked potential (BAEP) recordings. During acoustic neuroma resection, ECoG and BAEP recordings changed relatively independently, which suggests multiple mechanisms and/or sites of injury to the cochlea or cochlear nerve. However, once they had become manifest, none of the observed changes exhibited a tendency to return to preoperative patterns. Hearing was preserved postoperatively in only two of seven patients, one of whom could not be monitored due to technical difficulty. Transtragal, transtympanic electrode placement provided a rapid, stable, and safe method of obtaining intraoperative ECoG recordings. Although combined intraoperative monitoring of ECoG and BAEP responses appeared to provide more precise documentation of injury to the cochlea and/or cochlear nerve, it was probably not influential in preservation of hearing in this series.
Nasal Avulsion Injuries
Authors: Denneny James C.
Published: November 2015

The nose is the most frequently traumatized portion of the human face. High‐speed motor vehicle accidents and interpersonal violence commonly produce bony pyramid and septal damage and occasional minor soft‐tissue damage. Major soft‐tissue injuries are much less commonly encountered. Avulsion injuries of this type may involve skin only or the bony and cartilaginous framework as well. The severity of these injuries can range from total avulsion to minor skin loss and anywhere within the spectrum between. My experience is reviewed, management guidelines and options are detailed, and selected cases are presented.
Inferior Turbinoplasty: Patient Selection, Technique, and Long‐Term Consequences
Authors: Mabry Richard L.
Published: November 2015

When conservative medical management of symptomatically enlarged inferior turbinates is ineffective, the obstructing tissue may be reduced by an intramucosal or extramucosal destructive procedure (such as electrocautery, cryotherapy, or laser vaporization), or by conservative surgical resection. In the latter instance, enlarged conchal bones may be removed by the technique of turbinate submucous resection, while diffuse stromal hypertrophy necessitates partial resection of the inferior turbinates. A number of techniques of inferior turbinate surgery have been described. I have used the procedure of “inferior turbinoplasty” with increasing frequency for more than 9 years. Three to five years after such surgery, a detailed followup of 40 patients revealed none of the once‐feared sequelae of turbinate resection, such as bleeding, crusting, foul nasal discharge, or bothersome postnasal drainage. Histologic examination of turbinates almost 5 years after turbinoplasty revealed fibrosis and scarring, with a marked decrease in mucous gland population, and normal mucosa. To obtain the best possible functional result inferior turbinate surgery is a necessary adjunct to most septal surgery. If conservatively done, it does not impair normal turbinate function. It must be stressed, however, that if the underlying cause of the turbinate hypertrophy is not addressed, recurrent obstruction can and probably will occur.
Use of Multichannel Cochlear Implants in Obstructed and Obliterated Cochleas
Authors: Gantz Bruce J. , McCabe Brian F. , Tyler Richard S.
Published: November 2015

Obstruction that occurs within the scala tympani (after meningitis or otosclerosis) has been considered a contraindication for placement of a multichannel cochlear implant electrode. Two patients who exhibited radiographic evidence of intracochlear narrowing and obliteration were implanted with multichannel electrodes. Implantation involved creation of a channel for the electrode to wrap around the modiolus. The middle ear cavity and the external auditory canal also had to be removed to gain access. The response of one of the patients was similar to that of patients with normal cochlear anatomy who use multichannel devices. These early experiences, along with one case in which a single‐channel electrode was placed, is presented.
Dedifferentiated Acinic Cell (Acinous) Carcinoma of the Parotid Gland
Authors: Stanley Robert J. , Weiland Louis H. , Olsen Kerry D. , Pearson Bruce W.
Published: November 2015

Otolaryngologists‐head and neck surgeons and surgical pathologists should be aware of the potential for acinic cell carcinomas to dedifferentiate so that adequate histologic tumor sampling can be performed. Dedifferentiated acinic cell carcinoma is a highly malignant, newly recognized parotid malignancy. Clinical clues that may help identify this more ominous lesion must be recognized.
The Temporalis Muscle Flap for Intraoral Reconstruction: Technical Modifications
Authors: Koranda Frank C. , McMahon Michael F.
Published: November 2015

For three years we have used the temporalis muscle flap for reconstruction of intraoral defects. Advantages of this flap are that it is non‐hair‐bearing, nonbulky, pliable, durable, proximal to intraoral defects, and it results in better articulation and deglutition. We have modified our original technique so that we facilitate transference of the flap by a more anterior transection through the zygomatic arch, we improve the aesthetic reconstruction by use of the transected coronoid process, we produce better function by preventing adhesions and granulation tissue, and we enhance definition of the lingual sulcus by splinting.
Freud, Fliess, and the Nasogenital Reflex: Did a Look into the Nose Let us See the Mind?
Authors: Zucker Arthur , Wiegand David
Published: November 2015

Wilhelm Fliess, a Berlin nose and throat surgeon, and Sigmund Freud, the father of psychoanalysis, collaborated to treat one of Freud's earliest patients, Emma Eckstein. The basis for the treatment was their belief in the “Nasogenital Reflex,” a widely accepted theory that has disappeared from the literature of otolaryngology. The outcome of Emma's treatment may have profoundly altered the history of psychiatry, by suggesting the role of the unconscious and the existence of the Oedipus complex.
Primary Tissue Cultures of Benign and Malignant Human Thyroid Tumors: Effect of TSH
Authors: Komlos L. , Shimberg R. , Halbrecht I. , Zohar Y. , Strauss M. , Laurian L. , Laurian N.
Published: November 2015

Many thyroid carcinomas seem to be dependent upon the thyroid growth‐promoting properties of the thyroid stimulating hormone (TSH). The purpose of the present investigation was to compare the in vitro effect of TSH on tissue cultures derived from malignant and benign thyroid tumors. The results indicate that TSH can affect the morphology and protein synthesis of primary tissue cultures derived from benign and malignant thyroid tumors differently. The addition of TSH to cultures derived from benign tumors resulted in a reorganization of follicle‐like structures of the monolayer and in a reduction of protein synthesis. In contrast to this, monolayers derived from carcinomas of the thyroid were not able to reorganize and their protein synthesis was not inhibited in the presence of TSH. For a better understanding of TSH suppressive therapy, we suggest testing the influence of TSH on a large number of tissue cultures derived from benign and malignant tumors of the thyroid.
Squamous Cell Carcinoma of the Soft Palate, Uvula, and Anterior Faucial Pillar
Authors: Weber Randal S. , Peters Lester J. , Wolf Patricia , Guillamondegui Oscar
Published: November 2015

This retrospective study concerns 188 patients with squamous cell carcinoma of the soft palate, uvula, and anterior faucial pillar treated for cure between 1970 and 1983. Men predominated in the group (1.9:1) and 55% of the patients were between 60 and 70 years old. Mean duration of followup was 56.7 months. TNM stage distribution was 29, 67, 37, and 49 patients for stages I, II, III, and IV respectively; six patients were unstaged because of previous excisional biopsy. Treatment to the primary site consisted of radiotherapy for 150 patients, surgery alone for 28 patients, and combined therapy for 10 patients. Primary control for T stages 1 through 4 was: 91% (31 of 34), 77% (71 of 92), 77% (30 of 39), and 35% (6 of 17), respectively. One hundred twenty‐eight patients were N0 at presentation, as compared to 60 patients with regional nodal metastasis. Regional control was obtained in 87.5% of patients with N0 necks and in 76.7% of those with nodal involvement. In patients with primary control, these figures were 89% and 81%. Overall determinant survival was 80% at 2 years, but fell to 67% at 5 years. In addition to advanced tumor stage, the survival rate was reduced by regional lymph node metastasis. Tumor extension to the tongue base diminished survival. Survival was poorer among patients with midline tumors or tumors that extended across the palatine arch (37 patients) than for those with unilateral primary tumors (151 patients) (p < 0.05). Despite similar T‐stage distribution, the Incidence of regional nodal metastasis was 49% in the former group, compared with 28% in the latter. In patients with midline or bilateral disease, both sides of the neck are at risk for metastasis and must be included in any therapeutic regimen.
Endolymphatic Mastoid Shunt Surgery Using the Denver Inner Ear Shunt
Authors: Jackson C. Gary , Dickins John R. E. , Glasscock Michael E. , Fritsch Michael H. , Graham Sharon S. , Dimitrov Eva A.
Published: November 2015

This study, merging data from two different clinics, was undertaken to evaluate the efficacy of endolymphatic mastoid shunt surgery using the Denver Inner Ear Shunt operation for Meniere's disease. This surgery was performed by the senior authors (C.G.J., J.R.E.D., and M.E.G.) between May 1984 and October 1986, after we attended the Colorado Otologic Research Center (CORC) instructional course. Sixty‐six and thirty‐four cases, respectively, were performed. Follow‐up questionnaires were sent to this total of 100 patients. Fifty‐six patients returned completed questionnaires, which formed the basis of this report. A retrospective chart study was also carried out. The results of surgery and questionnaires are reported as statistical data, and, where applicable, the 1985 AAO‐HNS criteria for reporting vertigo and hearing results in the treatment of Meniere's disease are used. Preliminary analysis of these data is reported because of its profound effect upon our treatment protocol for patients with Meniere's disease. Results on use of the Denver valve do not appear to be significantly different than the results of other shunt surgery not using the valve.
Silent Supraglottic Carcinoma
Authors: Close Lanny Garth , Merkel Marie , Reisch Joan , Burns Dennis K. , Schaefer Steven D.
Published: November 2015

In a review of 51 consecutive patients with previously untreated squamous cell carcinoma of the supraglottic larynx, five (9.8%) patients were found to have no mucosal abnormality on initial evaluation by both computed tomography (CT) and direct laryngoscopy. All five patients who manifested submucosal disease had at least one endoscopic procedure done with a biopsy negative for cancer before definitive diagnosis, resulting in an average delay from initial endoscopy to diagnosis of 19.8 weeks. These inapparent or “silent” neoplasms present unique problems in regard to establishing a diagnosis by routine biopsy techniques, even though CT reliably demonstrates their presence. Early diagnosis requires aggressive biopsy techniques based on CT findings.
Chronic Perilymphatic Fistula: Experimental Model in the Guinea Pig
Authors: Flint Paul , Duckert Larry G. , Dobie Robert A. , Rubel Edwin W.
Published: November 2015

Chronic perilymphatic fistulas were created in guinea pig cochleas using silicone rubber tubing placed into the scala tympani through the round window. Fistula patency was determined by fluorescein perfusion into cerebral spinal fluid. Fistulas were found to be patent in 6 of 6 animals at 7 days and 8 of 13 animals at 28 days. Analysis of ABRs revealed threshold increases of 10 to 15 dB across all frequencies at 1 hour and 7 days. However, thresholds returned to pre‐fistula levels by 28 days. Animals with acute fistulas (simple laceration of the round window) had similar threshold increases at 1 hour; however, recovery to baseline levels occurred by day 7. Control animals with intact round windows did not have threshold shifts. Scanning electron microscopy revealed hair cell loss localized to the apical and basal turns of the cochlea. The morphologic changes observed occurred acutely (within 7 days) and were not progressive, despite the presence of a fistula. Hair cell loss or degeneration did not correlate with hearing loss.
Pediatric Glomus Tumors
Authors: Bartels Loren J. , Gurucharri Michael
Published: November 2015

Glomus tumors of the middle ear are unusual in adults, but exeedingly rare in children. While a dull, red bulging tympanic membrane in the adult may suggest a glomus tumor, it generally signifies infection in the child. This report details our management of a 10‐year‐old girl afflicted with bilateral chronic middle ear cleft infection that obscured bilateral glomus tumors. Review of the current English language literature reveals seven additional case reports of otologic glomus tumors in children less than fourteen years of age. Two additional cases are presented that were given to the senior author by personal communication, producing a total of 10 cases for review. Glomus tumors in children may be hidden by otitis media and appear more likely to be endocrine active. Failure to cure the lesion is apparent in five of six case reports of children with glomus jugulare tumors; three of these children are reported to have expired. Complete surgical extirpation is advocated for childhood glomus tumors.
Why Do Vestibular Destructive Procedures Sometimes Fail?
Authors: Monsell Edwin M. , Brackmann Derald E. , Linthicum Fred H.
Published: November 2015

Vestibular nerve specimens and one temporal bone, from patients with vestibular symptoms after destructive surgery on the vestibular system, were studied by light microscopy. Surviving nerve axons in three specimens that followed retrolabyrinthine vestibular nerve section (RLVNS) were counted and compared to normative data. Results are consistent with persistence of the central processes of primary vestibular neurons in three specimens from patients who had persistent symptoms and ice‐water caloric responses after RLVNS. Incomplete neurectomy probably results from anatomic variations in the plane of separation of the vestibular and cochlear portions of the eighth nerve in the posterior fossa. Regeneration neuromas were found in the vestibule after a complete transmastoid labyrinthectomy and a Fick sacculotomy; this indicates that wide degrees of injury to the labyrinth may provoke this response. Disabling unsteadiness after labyrinthectomy may or may not respond to revision surgery (translabyrinthine vestibular nerve section). The indications for revision surgery are discussed. The excision of Scarpa's ganglion by the translabyrinthine route offers the best chance to ensure complete removal of peripheral vestibular tissue, minimize postoperative unsteadiness, and prevent neuroma formation.
The CT Findings of Acute Thyroiditis and Acute Suppurative Thyroiditis
Authors: Bernard Peter J. , Som Peter M. , Urken Mark L. , Lawson William , Biller Hugh F.
Published: November 2015

Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis—two with suppuration—are presented and the CT findings and clinical aspects of this disease are reviewed.
Bacterial Findings in Middle Ear Effusion in Children
Authors: Qvarnberg Yrjö , Kantola Olli , Valtonen Hannu , Vuori Esa , Salo Juha , Toivanen Meri
Published: November 2015

During 1983–87, tympanostomy tubes were inserted in a total of 4952 ears of 2575 children remitted to the ENT Department of our hospital because of chronic or recurrent otitis media problems. The children were included in a prospective study and referred to one of three groups for comparison of findings. Group 1 included all 6‐ to 12‐month‐old infants undergoing primary tube treatment; group 2, all children 1 year or older who had their first ventilation tube(s) inserted in connection with adenoidectomy; and group 3, all children in whom tympanostomy had been performed one or more times previously. Middle ear effusion was aspirated from 2392 ears (48%); 67.6% of all ears were negative for bacteria and 22.1% of the ears with effusion grew pathogenic bacteria. S. pneumoniae was the most frequently cultured pathogen among the 6 to 12 month olds in group 1, but in groups 2 and 3 H. influenzae occurred more frequently than S. pneumoniae. Beta‐lactamase–producing strains of pathogenic bacteria were formed in only 4% of all ears with effusion: H. influenzae in 1.2% and B. catarrhalis in 2.8%. Compared with figures from the United States, the frequency of beta‐lactamase–producing strains is low in the present series. This is probably explained by differences in antimicrobial treatment practices; in Finland and the Scandinavian countries, penicillin V is the primary drug for acute otitis media. In light of present results, it seems well‐suited for treatment of otitis media in young children.
Spasmodic Dysphonia: Botulinum Toxin Injection after Recurrent Nerve Surgery
Authors: Ludlow Christy L. , Naunton Ralph F. , Fujita Mihoko , Sedory Susan E.
Published: November 2015

The purpose of this study was to determine if botulinum toxin injections into the thyroarytenoid muscle would reduce symptoms in adductor spasmodic dysphonic patients who had experienced symptom recurrence after recurrent laryngeal nerve surgery. Five patients were seen between 3 to 10 years after surgery with a return of speech symptoms and persistent unilateral vocal fold paralysis. Before injection, comparisons with controls on spectrographic measures of pitch and voice breaks, aperiodicity, and sentence length demonstrated significant symptoms of spasmodic dysphonia (p ≤ 0.02). Electromyographic measures demonstrated equal levels of thyroarytenoid muscle activation on the operated and non‐operated sides with bipolar needle electrodes, and heightened activity in both muscles relative to normal. Therefore, symptom return was associated with thyroarytenoid innervation after recurrent nerve surgery. In all patients, the thyroarytenoid muscle on the side operated on was injected with type A botulinum toxin. In two patients, toxin was also injected on the side not operated on. Significant (p ≤ 0.002) reductions in all speech symptoms occurred after injection. Electromyographic measures demonstrated significant reductions in the percent activation levels of both the injected muscle and noninjected muscles (p ≤ 0.01). Botulinum toxin injections were an effective treatment of post‐surgical symptom recurrence in adductor spasmodic dysphonia.
Treatment of Radiation‐ and Chemotherapy‐Induced Stomatitis
Authors: Carnel Shirley B. , Blakeslee Don B. , Oswald Stephen G. , Barnes Margaret
Published: November 2015

Severe stomatitis is a common problem encountered during either radiation therapy or chemotherapy. Most therapeutic regimens are empirical, with no scientific basis. The purpose of this study is to determine the efficacy of various topical solutions in the treatment of radiation‐ or chemotherapy‐induced stomatitis. Eighteen patients were entered into a prospective double‐blinded study to test several topical solutions: (1) viscous lidocaine with 1% cocaine; (2) dyclonine hydrochloride 1.0% (Dyclone); (3) kaolin‐pectin solution, diphenhydramine plus saline (KBS); and (4) a placebo solution. Degree of pain relief, duration of relief, side effects, and palatability were evaluated. The results showed that Dyclone provided the most pain relief. Dyclone and viscous lidocaine with 1% cocaine provided the longest pain relief, which averaged 50 minutes This study provides objective data and defines useful guidelines for treatment of stomatitis.
Wound Infections and Recurrence in Head and Neck Cancer
Authors: Jackson Robert M. , Rice Dale H.
Published: November 2015

Recent publications in the general surgery literature have reported improved survival in abdominal cancer surgery in those in whom a postoperative wound infection develops. We reviewed our experience with 100 consecutive patients operated on for head and neck cancer. All patients had 5‐year followup. The complete report covers site and stage. In summary, for all cancers of the larynx (N = 60), the recurrence rate was 45% for those in whom a wound infection developed and 26% for those in whom no such infection developed. For cancers of the oral cavity and pharynx (N = 40), the recurrence rate was 80% for those in whom wound infections developed and 51% for those who had no infections. Because of the small number of patients in whom recurrence developed, with or without infection, the relationship does not reach statistical significance. For head and neck cancer, unlike abdominal cancer, the development of a postoperative wound infection may have an adverse effect on survival rather than a salutory effect.
Familial Multiple Cervical Paragangliomas: Report of a Kindred and Review of the Literature
Authors: Sobol Steven M. , Dailey John C.
Published: November 2015

Heredofamilial paragangliomas account for less than 10% of those arising in the head and neck. Multiplicity, multicentricity, and bilaterality is roughly three times more common than in the spontaneous variety. Not unlike other hereditary neuroendocrine tumor syndromes, familial paragangliomas appear to follow an autosomal dominant transmission, with variable penetrance and expressivity. This article describes a surgical experience with nine bilateral, multicentric cervical paragangliomas (7 carotid body, 1 vagal, and 1 sympathetic) occurring in four siblings less than 35 years of age. The literature on familial paragangliomas of the head and neck is reviewed. The postulated genetic mechanisms accounting for these and other hereditary tumors are discussed. The clinical and surgical aspects of spontaneous and familial paragangliomas are compared.
Management of temporal bone carcinomas: A therapeutic analysis of two groups of patients and long‐term followup
Authors: Spector J. Gershon
Published: November 2015

Fifty‐one patients with squamous cell carcinomas arising within the temporal bone were subdivided into two groups. The initial group of 17 patients, seen between 1960 and 1980, were reviewed retrospectively and staged into four subgroups on the basis of initial tumor presentation and location (i.e., external auditory canal, superficial invasion, deep invasion, and tumors beyond the temporal bone). After treatment in a variety of surgical and radiotherapeutic combinations, the 5‐year cure rates were: 70%, 70%, 50%, and 9%, respectively. Thirty‐four patients, seen between 1980 and 1989, were placed in a new prospective protocol for combined surgery and postoperative irradiation. These patients were subdivided into the same subgroups on the basis of tumor location. The surgical procedures were formalized to be more encompassing (i.e., external canal tumors were treated by sleeve resection of the internal auditory canal and tympanic membrane, superficial invasion by superficial temporal bone resection, deep tumors by radical temporal bone resection, and those beyond the temporal bone by an infratemporal fossa approach). Radical neck dissections were performed where needed. The irradiation dosage was increased to 6250+ cGy, with a 4:1 ratio in favor of electrons for deeper penetration, and the fields were widened. At 36.6‐month average followup, the cure rates were: 100%, 100%, 70%, and 65%, respectively. Six of ten patients with neck metastases at presentation had tumor recurrence or distant disease (60%).
Operative management of acoustic neuromas: The priority of neurologic function over complete resection
Authors: Kemink John L. , Langman Alan W. , Niparko John K. , Graham Malcolm D.
Published: November 2015

The objective of surgical management of acoustic tumors is to remove them entirely and preserve facial nerve function and hearing when possible. A dilemma arises when it is not possible to remove the entire tumor without incurring additional neurologic deficits. Twenty patients who underwent intentional incomplete surgical removal of an acoustic neuroma to avoid further neurologic deficit were retrospectively reviewed. They were divided into a subtotal group (resection of less than 95% of tumor) and a near‐total group (resection of 95% or more of tumor) and were followed yearly with either computed tomography or magnetic resonance imaging. The subtotal group was planned and consisted of elderly patients (mean age, 68.5 years) with large tumors (mean, 3.1 cm). The near‐total group consisted of younger patients (mean age, 45.8 years) and smaller tumors (mean, 2.3 cm). The mean length of followup for all patients was 5.0 years. Ninety percent of patients had House grade I or II facial function post‐operatively. Radiologically detectable tumor regrowth occurred in only one patient, who was in the subtotal resection group. Near‐total resection of acoustic tumor was not associated with radiologic evidence of regrowth of tumor for the period of observation. Within the limits of the follow‐up period of this study, subtotal resection of acoustic neuroma in elderly patients was not associated with clinically significant recurrence in most patients and produced highly satisfactory rates of facial preservation with low surgical morbidity.
Modified Rambo meatoplasty in translabyrinthine tumor removal
Authors: Meyerhoff William L. , Pollock Kimberley J. , Roland Peter S. , Mickey Bruce
Published: November 2015

Spinal fluid otorrhea and otorhinorrhea are morbid complications that occur in up to 18% of patients after removal of translabyrinthine tumor. Both of these problems can be significantly reduced if, during the initial surgery, the posterior canal wall is taken down and the tympanic membrane and external auditory canal skin are removed for better exposure of the eustachian tube orifice. The external auditory meatus can then be sealed by a previously described modification of the Rambo procedure. This additional procedure adds about 20 minutes to the surgery and presents a small risk of retained squamous epithelium. Fifty consecutive patients were divided into two equal groups and studied retrospectively. In group I, the patients underwent a modified Rambo meatoplasty at the time of the removal of their translabyrinthine tumor, whereas patients in group II had the tympanic orifice of their eustachian tube obstructed through the facial recess. Review of the postoperative course of these fifty patients indicated that the addition of the modified Rambo meatoplasty was justified by the overall reduction in morbidity and expense it provided.