bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Laryngotracheoesophageal Cleft
Authors: Cotton Robin T. , Schreiber J. Tracy
Published: October 2014

Laryngotracheoesophageal cleft (LTE) is a rare disorder that is still associated with a high mortality. Often the mortality is associated with other coexisting severe congenital anomalies, but even in those infants in whom the LTE cleft is the only anomaly, the mortality rate is still unacceptably high. This paper explores two avenues aimed at reducing the mortality. There are two main factors responsible for the high mortality. First, the diagnosis may be difficult and hence delayed; and second, once the diagnosis is made, management reported to date does not adequately prevent aspiration of stomach contents, which is the main mechanism of the infant's death. With respect to early diagnosis, the key symptom is respiratory distress exacerbated by attempts at feeding. The key diagnostic radiological procedure is a cineesophagram which shows a high spillover of contrast into the trachea on swallowing. The definitive diagnosis is made by endoscopy. Endoscopic evaluation can be confusing but if the anomaly is considered by the surgeon, an important maneuver at endoscopy, under general anesthesia, is to pass an endotracheal tube into the larynx. The tube stents open the edges of the cleft, which can clearly be seen while performing esophagoscopy, thus confirming the diagnosis. With respect to early management, the commonest cleft is a partial LTE cleft. Initially the airway should be maintained either by placement of an endotracheal tube or a tracheotomy. The more entensive the cleft, the more easily does the indwelling tube slip over the edge of the defect into the esophagus. In all but the mildest of clefts, gastric decompression and alimentation are required. This still allows for considerable reflux of gastric contents into the lungs, and we advocate a high total gastric section with a double gastrostomy to minimize the possibility of aspiration of stomach contents. After the infant's general condition is stabilized, definitive early surgical repair is undertaken. This paper includes a detailed case report of one patient, illustrating the above points of early diagnosis, total gastric division and early repair.
Grassheads in the Tracheobronchial Tree: Two Different Outcomes
Authors: Spencer Mary J. , Millet Victoria E. , Dudley James P. , Sherrod Jessie L. , Bryson Yvonne J.
Published: October 2014

Many vegetable foreign bodies can produce serious pulmonary complications because of chemical irritation to the airway. Barley grass, a type of grasshead, does not induce such a reaction because of its resistance to organic decay. Complications which may occur are illustrated by the clinical course of two patients with aspiration of this foreign body. In the first patient the grasshead entered the trachea with the flowering unit first and the stem following. In the second patient the stem entered the trachea first. Recurrent pneumonias were noted in the first patient. Despite its presence in the right stem bronchus for three years, no further episodes of pneumonia followed its removal. In the second patient the grassheads could not be removed endoscopically. They migrated into the right lower lobe producing pneumonia and ultimately resulting in a brain abscess. The difference of entry of the same foreign body into the trachea, stem first versus flowering unit first, is an essential factor in altering the clinical outcome.
Surgical Approach to the Medial Orbital Wall
Authors: Harrison Donald F. N.
Published: October 2014

There is a need for the head and neck surgeon to be familiar with the anatomy of the orbit, for the practice of his specialty may require deliberate entry into this region, either for access or to carry out specific procedures. A review of 561 occasions in which entry into the orbit was desirable revealed that 478 (85%) were primarily for exposure of the medial orbital wall. A variety of operative techniques were required together with knowledge of the relevant anatomy and possible hazards.
Laryngeal Reinnervation for Unilateral Vocal Cord Paralysis: Long-Term Results
Authors: Tucker Harvey M. , Rusnov Melinda
Published: October 2014

Since 1976 modified nerve-muscle pedicle reinnervation for restoration of adductor function in unilaterally paralyzed vocal cords has been performed at the Cleveland Clinic. This technique has been reserved for patients with “valuable” voices such as clergymen, public speakers, professional singers and actors. It was felt that this technique should offer potential for restoration of quality of voice and in particular of pitch control, superior to that usually obtained by Teflon® injection, because of restoration of the ability to tense the vocal cord. In this regard nerve-muscle pedicle reinnervation is potentially superior to any of the other techniques available for medialization of the unilaterally paralyzed cord. At the present time 27 patients have undergone this surgery and have been followed long enough (at least one year) to determine if the procedure was successful or not. All of these have been subjected to preoperative and postoperative voice recordings on high quality tape equipment. Some of them have been subjected to voice printing for vocal analysis. There have been no complications in the group and all but two of the patients have achieved significant voice improvement as a result of the surgery. The details of current technique and demographic data and follow-up will be presented.
Laryngeal Injuries Secondary to Nasogastric Tubes
Authors: Friedman Michael , Baim Howard , Stobnicki Marek , Ferrara Thomas , Shelton Vicki , Chilis Thomas , Skolnik Emanuel
Published: October 2014

Laryngeal complications secondary to nasogastric intubation have been reported rarely in recent literature. Recent experience with three patients who developed laryngeal injuries related to nasogastric tubes prompted retrospective, experimental, and prospective studies to determine the mechanism of laryngeal injury. A review of the literature, as well as the clinical findings in our three patients, point to midline tube placement and the subsequent development of cricoid chondritis as the underlying etiology. An experimental study using anesthetized dogs was designed to compare histologically the effect on the larynx with nasogastric tubes placed in the midline, as opposed to nasogastric tubes in the lateral position. Results of the histologic study confirmed that midline tubes generate severe inflammation in the postcricoid region. One hundred patients were then evaluated roentgenographically to determine the incidence of midline tube placement in a random sample. Six percent of the patients had nasogastric tubes in the midline. Patients who have nasogastric tubes in place for more than three days or have a severe amount of discomfort should have an x-ray film to determine position of the tube. Midline tubes should be removed or replaced.
Anesthesia for Laryngeal Laser Surgery in the Infant and Child
Authors: Brummitt W. M. , Fearon Blair , Brama I.
Published: October 2014

Currently available anesthetic techniques for laryngoscopy and bronchoscopy are briefly evaluated. Recently reported complications from the literature are reviewed. Satisfactory anesthetic techniques are shown to be limited by the physical dimensions of the instruments as well as the extreme limitations of the flow capacity of the small airway itself. The technique used at the Hospital for Sick Children for the past ten years is described. It is based upon spontaneous respiration with inhalation anesthesia, supplemented by topical lidocaine (Xylocaine). Size and age of the patient are not limiting factors. The safety and effectiveness of this technique are supported by representative blood gas studies as well as the clinical records of over 400 cases.
Pseudolaryngeal Paralysis: A Postintubation Complication
Authors: Cohen Seymour R.
Published: October 2014

Seven patients in the pediatric age group who had severe posterior glottic stenosis are reported. All of these patients had been misdiagnosed as having bilateral vocal cord paralysis because of errors in observing the actual findings in the larynx. On cursory examination of the larynx, the findings resembled vocal cord paralysis, thus the name “pseudolaryngeal paralysis” was given to this disease entity. This paper describes in some detail the case histories, the endolaryngeal findings, and the therapy which was instituted and followed. The difficulties in managing this problem are also reviewed. Three of the seven patients were decannulated, two with persistent stress stridor and reduced exercise tolerance. Four other patients have improved, but are still in the process of being treated. The success of the therapy appears to be dependent on the severity of the scarring, whether there was fibrosis of the interarytenoideus muscle, and whether the cricoarytenoid joints were involved. It is hoped that by reporting this difficult problem, a more rapid and successful form of management will be developed.
Treatment of Laryngeal Stenosis
Authors: Peerless Sidney A. , Pillsbury Harold R. , Peerless Alter G.
Published: October 2014

One of the most perplexing problems in laryngology is the treatment of laryngeal scar tissue. This can be supraglottic, glottic, or infraglottic. Two acceptable methods of treatment have been surgical and endoscopic. Endoscopic treatment consists of dilatation, excision of scar tissue with a laser, removal of scar tissue with insertion of a stent, and removal of scar tissue with injection of intralesional cortisone. Twelve cases are reported, treated with microscopic removal of scar tissue followed by voice rest and beclomethasone dipropionate (Vanceril) inhalations, a topical steroid. All twelve cases showed marked improvement measured by improved glottic opening and improvement of voice quality. Further evaluation of this method of treatment should be done as an auxiliary treatment to our present accepted regime of treatments in this troublesome condition.
Testing Eustachian Tube Function
Authors: Sheehy James L.
Published: October 2014

This paper reviews the concepts, attitudes and experience at the Otologic Medical Group (OMG) in regard to testing eustachian tube function. At OMG eustachian tube function tests are not performed prior to reconstructive surgery in cases of chronic otitis media and the reasons for this are reviewed. The lack of significant incidence of serous otitis media in postoperative patients substantiates the conclusion that there is no rationale for preoperative eustachian tube function tests in patients who are to undergo reconstructive surgery for chronic otitis media.
Neural Connections between the Middle Ear, Eustachian Tube and Brain
Authors: Eden Avrim R.
Published: October 2014

This study was designed to investigate the neuroanatomic connections between the middle ear (ME), eustachian tube, and brain. The neural tracer, horseradish peroxidase (HRP), was injected into the promontory mucosa of the ME in six adult rabbits. Following a 24–48 hour survival, the brain was perfused with fixative and the HRP reacted by the tetramethylbenzidine (TMB) blue reaction process. Two groups of HRP-labeled neurons were noted in the ipsilateral brainstem: 1) a well-defined cluster of HRP-labeled neurons in the nucleus of the solitary tract, and 2) a more widely scattered group of labeled neurons in the inferior salivary nucleus. The labeled neurons in the solitary tract may represent the direct central sensory projections of the glomus tympanicum. In a second set of animals HRP was injected into both the tubal and palatal muscles to identify the motor innervation of the eustachian tube musculature; HRP-labeled motoneurons were noted in the trigeminal motor nucleus and nucleus ambiguus, respectively. Assuming that the glomus tympanicum cells can sense changes such as oxygen concentration in their immediate environment in the ME like the related glomus cells in the carotid and aortic bodies which also project to the solitary tract, then the neuroanatomic relationships of the HRP-labeled neurons in this study to other respiratory neurons in the medulla suggest the possibility of a polysynaptic ME aeration reflex. The relevance of these results to the pathogenesis of otitis media with effusion is discussed.
Management of the Tinnitus Patient
Authors: House John W.
Published: October 2014

At the Otologic Medical Group, we see many patients complaining of tinnitus. Because tinnitus is a symptom the underlying cause and disease process must be identified and evaluated. Most patients complaining of tinnitus will not require special treatment. In this paper we discuss the treatment of patients who are severely disturbed by their tinnitus. We also discuss the effects of surgery on tinnitus. This surgical treatment includes stapedectomies, translabyrinthine eighth nerve sections and translabyrinthine removal of acoustic neuromas. In patients with tinnitus as a primary complaint, stapedectomy can be expected to improve the tinnitus in 50%. In patients undergoing translabyrinthine section of the vestibular nerve, 45% reported improvement and 55% reported the tinnitus to be the same or worse. Following translabyrinthine removal of acoustic tumors, 40% felt that their tinnitus was better, 50% said it was worse and only 10% felt it was the same preoperatively. When the patients' symptoms are severe, we have recommended biofeedback training, tinnitus maskers, and, when appropriate, hearing aids. Of 132 patients undergoing biofeedback training, 77% of the patients reported some degree of relief. No patients were worse. Our acceptance and utilization of the tinnitus maskers has not been as successful. Of 42 patients undergoing tinnitus masker evaluations, only 17% eventually purchased the maskers. We have found that patients with some degree of hearing loss benefit greatly from the use of hearing amplification.
Spatial Occupancy of Vessels and Facial Nerve in the Facial Canal
Authors: Ogawa Akira , Sando Isamu
Published: October 2014

The vascularity and spatial relationships of the contents of the labyrinthine portion of the facial canal were studied by measuring the diameters of arteries, the areas of the arteries, veins, facial nerve, and facial canal; and by expressing these areas as percentages of the areas of the facial canal and facial nerve. These results were compared for each of these segments of the facial canal. Using temporal bone sections which contained transverse or oblique sections of the three representative (labyrinthine, tympanic, and mastoid) portions of the facial canal, the size of the largest artery, and the area of the sectioned vessels, facial nerve, and facial canal were measured. Relative values of measured areas were calculated as an index of spatial occupancy of vessels and facial nerve in the canal. By comparing these results in three portions, we could demonstrate that, in the labyrinthine portion, the internal diameter of the main artery was less than four tenths of the diameter of the arteries in the other portions, and that the ratio of spatial occupancy of the vessels to the canal and to the nerve in the labyrinthine portion was extremely small compared with that in the other two portions. We also found that the labyrinthine and tympanic portions of the canal have less extra space for the nerve than does the mastoid portion. Considering both the vascularity of the three portions of the facial canal, and the spatial relationships of elements in the canal in each of the three segments of the canal, we feel that the facial nerve in the labyrinthine portion of the facial canal is indeed anatomically the most vulnerable portion of the nerve in its course through the temporal bone.
Tympanometric Configurations and Middle Ear Findings in Experimental Otitis Media
Authors: Giebink G. Scott , Heller Kelley A. , Harford Earl R.
Published: October 2014

Relationships between ventilation of the middle ear (ME) system and pathogenic bacteria in the upper respiratory tract were explored in an animal model to better understand the etiopathogenesis of otitis media. Otitis media developed in 12 of 18 chinchillas inoculated intranasally with Streptococcus pneumoniae followed by bilateral ME deflation (negative pressure). Otitis media with effusion developed in 19 of 36 ears examined ten days after inoculation. The development of purulent effusion after ten days was highly correlated with persistent negative ME pressure for at least 48 hours after deflation, while most ears that developed serous effusion after ten days had normal ME pressure 48 hours after deflation. Tympanometric validation of the presence or absence of effusion and type of effusion was obtained ten days after inoculation. A low compliance tympanogram detected 90% of the purulent effusions and was 100% specific for this type of effusion. In contrast, three of four serous effusions were associated with normal pressure/normal compliance tracings suggesting that the physical characteristics or volume of ME effusion and/or the histopathology of the ME cleft are reflected in the tympanometric configuration.
Mucormycosis of the Temporal Bone
Authors: Gussen Ruth , Canalis Rinaldo F.
Published: October 2014

Mucormycosis of the temporal bone is described in a 60-year-old female with uncontrolled diabetes mellitus whose symptoms related to cranial nerve palsies and hearing loss, following spread of infection from the nasopharynx. The infection spread along the eustachian tube and tensor tympani muscle to the base of the skull, involving the internal carotid artery with mycotic thrombosis and rupture. Subsequent spread occurred from this area predominantly along nerve pathways and as mycotic emboli in blood vessels of the labyrinth and middle ear. Infection also spread from the anterior middle ear wall through the oval window into the vestibule. The temporal bone changes were those of granulomatous inflammation with necrosis and ischemic infarction.
Management of Paranasal Sinus Schwannomas
Authors: Shugar Martin A. , Montgomery William W. , Reardon Edward J.
Published: October 2014

Schwannomas arising in the nasal cavities and paranasal sinuses are rare entities, with only sporadic cases appearing in the world literature. The lesion most commonly arises in the ethmoid and maxillary sinuses, with two cases having been reported in the sphenoid sinus. There are no reported cases of frontal sinus schwannoma. Four illustrative cases are presented which demonstrate the clinical features. The radiological investigation should include plain films and anteroposterior and lateral polytomography. Computerized tomography appears to be useful in planning surgery. An operative approach is proposed which emphasizes a meticulous and complete removal of the lesion with preservation of adjacent structures and repair of any resultant dural defect.
Combined Pectoralis Major Myocutaneous Flap with Medially Based Deltopectoral Flap for Closure of Large Pharyngocutaneous Fistulas
Authors: Maisel Robert H. , Liston Stephen L.
Published: October 2014

The pectoralis major myocutaneous flap has become the new and heavily used tool for head and neck reconstruction. This flap is reliable, versatile and allows moving large blocks of skin and soft tissue quickly, with little morbidity to the donor site. This paper describes the concept of combining the pectoralis flap with an ipsilateral medially based deltopectoral flap, to reconstruct a large pharyngostome. The skin incisions must be correctly drawn and the flaps elevated in sequence to prevent interruption of blood supply to the deltopectoral flap. Using the techniques described in the paper, rapid rehabilitation with little morbidity can be achieved.
Benign Mucous Membrane Pemphigoid
Authors: Smith Richard J. H. , Sessions Roy B. , Bean Samuel F.
Published: October 2014

Benign mucous membrane pemphigoid (BMMP) is a rare vesiculobullous disease capable of causing serious ocular and aerodigestive morbidity. The otolaryngologist must not be lulled to complacency by the adjective, benign. A case of complete laryngeal stenosis is presented and the clinical, histological and therapeutic aspects of BMMP are discussed.
Collagenase Activity in Squamous Cell Carcinoma of the Human Parotid Gland
Authors: Huang Cheng-Chun , Blitzer Andrew , Abramson Maxwell
Published: October 2014

A collagenase obtained from a single squamous cell carcinoma of human parotid gland was purified to homogeneity by procedures including precipitation with ammonium sulfate, gel filtration, ion-exchange chromatography with DEAE-cellulose, and extraction from polyacrylamide gel after electrophoresis. The parotid tumor collagenase had a molecular weight of approximately 68,000 and appeared similar to other mammalian collagenases in many respects such as action on collagen and response to common collagenase inhibitors. Analysis of specimens of various human parotid gland tumors revealed that the levels of collagenase activity were higher in squamous cell carcinoma than in nonsquamous tumors. A high level of collagenase activity from squamous cell carcinoma suggests that collagenase may promote local connective tissue destruction associated with tumor invasion and lymph node metastasis.
Semicircular Canal Structure during Postnatal Development in Cat and Guinea Pig
Authors: Curthoys I. S. , Blanks R. H. I. , Markham C. H.
Published: October 2014

The gain of the vestibulo-ocular reflex in the cat continues to increase for some time after birth. The reason for this increase is not presently known and one possibility is that it occurs because the cat semicircular canals increase in size. The present study examined this possibility by measuring the radii of curvature (R) of individual semicircular canals and the angular relationships of the semicircular canal planes within a labyrinth in cats and guinea pigs during postnatal growth. It was found that the labyrinths do move apart substantially during postnatal development in both species, but neither the planar relations nor the radii of curvature change significantly during postnatal development. The stability of semicircular canal structure during postnatal skull growth indicates that postnatal developmental changes in canal-related function, such as increased gain in the vestibulo-ocular reflex, in these species are probably due to receptor cell or neural maturational factors.
Latency of Auditory Nerve Response in Neonates One to Eight Hours Old
Authors: Rubinstein A. , Sohmer H.
Published: October 2014

Recording the response of the auditory nerve (W1) in neonates can contribute to the diagnostic distinction between audiological-otological versus neurological pathology. If W1 latency were subject to relatively rapid shortening in the hours directly after birth, inconsistencies in the literature might be clarified. The purpose of this research was to study W1 in neonates one to eight hours old in order to determine if significant latency changes occur during this period. Auditory nerve-brainstem responses were recorded in 40 full-term neonates and in 12 normal adults. W1 latency in 1- to 3-hour-old neonates was 1.81 ± 0.28 ms and 1.77 ± 0.18 ms in 7- to 8-hour-old neonates. This difference was not significant. In adults, W1 latency was significantly shorter (1.36 ± 0.06 ms). These findings indicate that auditory nerve latency is about 0.43 ms longer at birth than in the adult and that the latency does not shorten significantly during the first hours after birth.
The Giant Apical Air Cell Syndrome a New Entity
Authors: Kraus Eric M. , McCabe Brian F.
Published: October 2014

A new entity, the giant apical air cell syndrome, is presented and its surgical management is described. The syndrome triad consists of a giant apical air cell, spontaneous CSF rhinorrhea, and recurrent meningitis. Constant pounding of the brain against the dura overlying the giant air cell eventually causes dural rupture and CSF leak. The giant apical air cell communicates with the eustachian tube creating a direct route for CSF to leak from the subarachnoid space into the nasopharynx. The syndrome is best diagnosed by polytomography of the petrous apex, surgical exploration, and careful dissection using the operating microscope. Dye or contrast studies are no longer necessary. Extracranial surgical management is preferable to the intracranial approach. Tympanomastoidectomy is performed with obliteration of the eustachian tube, middle ear, and mastoid. In this manner, the subarachnoid space is separated from the nasopharynx, preventing further episodes of meningitis. A detailed knowledge of the regional anatomy and the application of basic surgical principles should enable the temporal bone surgeon to accurately diagnose and manage most CSF fistulae.
Longitudinal Study of the Efficacy of Ampicillin in the Treatment of Pneumococcal Otitis Media in a Chinchilla Animal Model
Authors: Supance John S. , Marshak Gabriel , Doyle William J. , Cantekin Erdem I.
Published: October 2014

A chinchilla animal model was used to determine the effects of early antibiotic treatment with ampicillin on the local and systemic protective mechanisms during pneumococcal acute otitis media with effusion (AOME). The right bullae of 74 chinchillas were inoculated with 170 colony-forming units (CFU) of Streptococcus pneumoniae type 7F, and animals were randomly assigned to 1 of 2 groups; early (24 hours postinoculation) and late (12 days postinoculation) initiation of ampicillin treatment. During the first challenge, 52 chinchillas died within a I-month period, apparently from suppurative complications of AOME. Following the resolution of AOME in their right ears, all surviving animals were challenged for the second time by bilateral bullar inoculations using 130 CFU of the same organism. All 10 animals in the early ampicillin treatment group developed severe bilateral AOME, whereas only 3 of the 12 animals in the late ampicillin treatment group developed a recurrence of AOME in the right ear. Significantly, 8 of the 12 animals in this group developed severe left AOME. These findings suggest the presence of a local middle ear defense system and support the results of previous similar studies in which S pneumoniae types 3 and 6A were used. The results of the present study also suggest that in the chinchilla the early administration of a systemic antibiotic (ampicillin) interferes with this defense mechanism.
Vocal Quality, Articulation and Audiological Characteristics of Children and Young Adults with Diagnosed Allergies
Authors: Baker Barbara M. , Baker Claude D. , Le Ha Thanh
Published: October 2014

This study details vocal quality, articulation errors, and hearing disorders in 80 children and young adults with diagnosed allergies. Results indicated that almost 50 % had abnormalities in vocal quality and/or articulation and 13% had reduced auditory acuity. Vocal quality disorders showed a significant relationship to bronchial asthma in association with other allergic reactions. All subjects with diminished hearing had allergic rhinitis either singly or in combination with another disorder. Findings suggest that bronchial asthma and allergic rhinitis are related to the development of vocal quality disorders and that allergic rhinitis is associated with misarticulations and diminished hearing. The presence of speech sound omissions in allergic rhinitis patients above age 8 may predict the presence or previous history of fluctuating hearing loss.
Effects of Conductive Hearing Loss on Auditory Brainstem Response
Authors: McGee Therese J. , Clemis Jack D.
Published: October 2014

The purpose of this paper is not to propose that auditory brainstem response (ABR) be utilized for the assessment of conductive losses, but to define the effects of conductive hearing loss on the ABR when such a complication occurs. Conductive losses attenuate cochlear stimulation. Since wave V latency is inversely related to stimulus intensity, the magnitude of the conductive loss should be a predictor of the wave V latency delay. In this study, ABR wave V latencies from patients with known conductive losses due to canal occlusion, middle ear effusion, ossicular fixation and chain interruption were compared with latency values calculated from the magnitude of the loss. In those patients with occlusion of the external auditory canal and middle ear effusion, the shift of the wave V latency-intensity function correlated well with the air-bone gap. This correlation was poor for patients with ossicular chain disorders. In mixed hearing losses, the increased wave V latency due to the conductive component may totally mask an increase in latency caused by a retrocochlear component.
Cortical, Subcortical, and Brainstem Dysfunction: A Correlation in Dyslexic Children
Authors: Welsh Louis W. , Welsh John J. , Healy Michael , Cooper Bernard
Published: October 2014

A group of dyslexic students was examined by a central auditory test (CAT) battery including competing sentences, binaural fusion, filtered speech, and compressed speech. Auditory evoked brainstem responses (BSER) were measured in conjunction with the CAT data. The auditory tests indicate a high degree of failure in those areas requiring sophisticated integration, coordination, and identification of the modified speech stimuli. The BSER did not identify a significant abnormality. The cortical and subcortical areas of integration are proposed as the multicentric sites of impairment in the hearing function found in dyslexic students.
Age-Related Changes in the Epithelium of the Monkey Larynx
Authors: Stearns M. P. , Cummings C. W.
Published: October 2014

An experiment was designed to measure the area of subglottic squamous epithelium in a group of 14 adult monkeys. The animals were much older than any so far available for medical research. The larynges were strained using pyronin Y, which stains respiratory epithelium magenta and squamous epithelium pale pink. The areas of squamous epithelium inferior to the free margin of the vocal cord were measured. The results showed that the subglottic epithelium increased with age (r = + 0.61, p = <0.05). This finding may have importance in the staging of laryngeal carcinoma.
Classification and Approach to Patients with Functional Voice Disorders
Authors: Koufman James A. , Blalock P. David
Published: October 2014

Functional voice disorders result from vocal misuse or abuse; they are more easily recognized than other psychosomatic disorders because the clinician is able to visualize the laryngeal structure and function. If those structures appear normal, then an aberration of voice quality can be assumed to be functional. Functional dysphonia with prolonged aberrant vocal usage may lead to development of secondary pathological lesions of the larynx, which, although true pathological entities, must be recognized as resulting from the underlying and preceding functional disorder. In this report, we present a classification of and an approach to the diagnosis and treatment of functional voice disorders. On the basis of our clinical experience with 52 patients, we distinguished five types of functional voice disorders: type 1, hysterical aphonia/dysphonia; type 2, habituated hoarseness; type 3, falsetto voice; type 4, vocal abuse; and type 5, postoperative dysphonia. Forty-eight of the 52 patients (92%) were followed for a median period of 16 months (range 2–51 months). Therapy yielded excellent results in patients with types 1, 2 and 3; good results with types 4 and 5.
Predictive Factors of Success or Failure in the Endoscopic Management of Laryngeal and Tracheal Stenosis
Authors: Simpson George T. , Strong M. Stuart , Healy Gerald B. , Shapshay Stanley M. , Vaughan Charles W.
Published: October 2014

Stenosis of the larynx and/or trachea presents perplexing problems. No one technique has proved totally satisfactory in the management of all varieties of stenosis. Recent reports have described the successful use of the CO2 laser in the endoscopic management of stenosis of the larynx and trachea. Failures of this technique need emphasis to assure appropriate selection of therapeutic method. Retrospectively, 49 cases of laryngeal stenosis, 6 cases of tracheal stenosis and 5 cases of combined laryngeal and tracheal stenosis were studied (total 60 patients) following treatment at the Boston University Affiliated Hospitals. Follow-up ranged from 1 to 8 years. Multiple procedures were required in 35 laryngeal patients. Of the laryngeal patients 39 were successfully managed (average number of procedures in successful cases 2.18). Of 11 tracheal patients with combined laryngeal and tracheal procedures, 3 were successfully managed (average number of procedures in successful cases 6). Failures in laryngeal stenosis included four patients in whom an adequate airway was not established though voice was present while maintaining tracheostomies. Thirteen patients failing endoscopic management required open surgery with good result. Factors associated with poor result or failure include circumferential scarring with cicatricial contracture, scarring wider than 1 cm in vertical dimension, tracheomalacia and loss of cartilage, previous history of severe bacterial infection associated with tracheostomy, and posterior laryngeal inlet scarring with arytenoid fixation. In these circumstances, multiple procedures, more extensive alternative open surgical techniques, or maintenance of tracheostomy were necessary. In successful cases only three or fewer procedures on average were required. The factors associated with failure or success of endoscopic methods in the management of laryngotracheal stenosis, including use of the CO2 laser and soft Silastic stents, are analyzed.
Infant Tracheotomy
Authors: Gerson Carol Roberts , Tucker Gabriel F.
Published: October 2014

The pediatric and neonatal tracheotomies done on our patients at Children's Memorial Hospital since 1975 have been reviewed. Patients' ages, birth weights, rates of complications, decannulations and deaths have been studied. As compared to previous studies, the proportion of procedures done on children in the first year of life has dramatically increased. A technique which has been modified for the small infant is described.
Laryngeal Papilloma: Results of Treatment with the CO2 Laser and Podophyllum
Authors: Dedo Herbert H. , Jackler Robert K.
Published: October 2014

From 1976 to 1982, 109 patients with recurrent laryngeal papillomas were treated with a total of 548 CO2 laser excisions followed by podophyllum painting. There was high incidence of multiple sites of involvement, especially the tracheobronchial tree (18.3%) and palate (8.3%). Four patients had pulmonary parenchymal involvement. Patients were treated at 2-month intervals until they entered remission. Thereafter, microdirect laryngoscopies were advised at longer intervals. Remission was achieved in 41%; it occurred at all ages although it was most common during adolescence and rarest in the very young and very old. Many patients obtained remission with the CO2 laser after multiple prior cup forceps removals had not achieved remission. Only two tracheotomies (1.8%) were required and no deaths occurred. When compared with mechanical methods of papilloma removal, CO2 laser excision with podophyllum painting represents a clear advance in terms of preservation of laryngeal physiology and avoidance of life-threatening complications.
Leukocyte Interferon in Patients with Juvenile Laryngeal Papillomatosis
Authors: Goepfert Helmuth , Gutterman Jordan U. , Dichtel William J. , Sessions Roy B. , Cangir Ayten , Sulek Marcelle
Published: October 2014

Fourteen patients with aggressive juvenile laryngeal papillomatosis were treated with systemic administration of alpha-type interferon (IFN). The initial dosage of 2 million units alpha-interferon/m2 was modified if a favorable response in the papilloma growth occurred, or if persistent drug-related side effects developed. Half of the patients showed a sustained response while on IFN, and two patients had a complete response. Persistent elevation in SGOT was the main dose-limiting toxicity, especially in infants below age seven years. All side effects subsided after the drug was discontinued. Further studies are recommended.
CT Air-Contrast Scanning of the Internal Auditory Canal
Authors: Anderson Robert , Olson James , Merkle Marie , Dowart Robert , Schaefer Steven
Published: October 2014

Two hundred and four patients with audiometric and vestibular findings suggestive of a retrocochlear lesion were studied prospectively by computed tomographic scan with air contrast of the internal auditory canal. With this technique tumor limits are clearly defined. In the absence of disease the internal auditory canal has been completely air-filled in over 97% of cases. Soft tissue masses occluding the internal auditory canal were demonstrated in 11 patients. Four studies were inconclusive and there was one false positive. Headaches have been the only side effect and there have been no complications. In reporting their results the authors examine the indications, accuracy and limitations of this technique. This study demonstrates that computed tomographic scan with air contrast of the internal auditory canal should be considered as the radiologic procedure of choice for the evaluation of small acoustic tumors.
Hindbrain Circulation and its Evaluation by Dynamic Computed Tomography
Authors: Valvassori Galdino E. , Dobben Glen D.
Published: October 2014

Permanent or transient reduction of blood flow to the end-organs and to the hindbrain is the single major cause of vestibular disorders and a common cause of sensorineural hearing loss. New imaging modalities have become available which allow the recognition of focal areas of hindbrain ischemia in the prestroke stage. The correlation between focal ischemic pathology and clinical findings opens a new approach to the mapping of central pathology. In addition a detailed knowledge of the vascular anatomy of the hindbrain is indispensible for the development of new microvascular surgical techniques aimed at the restoration of sufficient blood supply.
Observations on So-Called Idiopathic Vocal Cord Paralysis
Authors: Ward Paul H. , Berci George
Published: October 2014

A series of 238 patients with laryngeal paralysis seen during a six-year period (1976–1982) were studied with serial 16-mm motion picture filmstrips. There were 39 cases in which no etiological disease process could be found responsible for the paralysis; these were called “idiopathic.” In all 39 cases, both the superior and recurrent laryngeal nerves were paralyzed indicating that the lesion involved the central (nuclear) lower motor neurons of the dorsal and ventral nucleus ambiguus. The high incidence of upper respiratory infections suggests a viral etiology in many cases. The ability to separate a pure recurrent from a combined superior and recurrent laryngeal paralysis on morphological indirect endoscopic appearance has significant diagnostic and therapeutic implications.
Tracheostoma Valve for Postlaryngectomy Voice Rehabilitation
Authors: Blom Eric D. , Singer Mark I. , Hamaker Ronald C.
Published: October 2014

Newer surgical techniques for postlaryngectomy voice rehabilitation provide a simple, effective method of communication but require manual occlusion of the tracheostoma during speech. We report the development of a unique tracheostoma valve that avoids the necessity for covering the stoma. This airflow-sensitive valve closes during speech and remains open with normal respiration. Results of a clinical trial with 50 patients over a ten-month period are encouraging. Our experience suggests that excessive vocal tract resistance to airflow is the principal limitation to effective valve use. Approaches to decreasing airflow resistance through the vocal tract to improve both voice production and tracheostoma valve use are discussed.
Brainstem Evoked Potentials in Adult Sleep Apnea
Authors: Snyderman Nancy L. , Møller Margareta , Johnson Jonas T. , Thearle Patricia B.
Published: October 2014

Brainstem evoked potentials (BSEP) were recorded in 23 patients with adult sleep apnea (ASA). These patients were studied with all-night polysomnography prior to our testing. They were categorized as having obstructive, central, or mixed sleep apnea depending on the predominant sleep findings. All patients with central sleep apnea had abnormal BSEP with prolongation of wave V. A majority of the remaining patients with obstructive sleep apnea and mixed sleep apnea had abnormal BSEP, but without specific configurations. These findings substantiate our hypothesis that brainstem dysfunction may play a role in ASA.
A Simple Endoscopic Intubation Technique in Esophageal Obstruction
Authors: Edens Enje Th. , Van Overbeek Jos J.
Published: October 2014

Endoscopic intubation was effected in 42 cases of malignant esophageal stenosis during the period 1979–1981. The stenosis was dilated with the aid of thermoplastic probes passed through a rigid esophagoscope of sufficient length, whereupon a tube was introduced under endoscopic control and left in situ in the malignant stricture. This “rigid” technique is suitable for processes confined to the esophagus. Introduction of the tube requires adequate endoscopic skill and is not devoid of risk. Perforation, the gravest risk, occurred in two cases. Proximal tube migration was observed in five patients.
Pediatric Tracheostomy
Authors: Wetmore Ralph F. , Handler Steven D. , Potsic William P.
Published: October 2014

A retrospective review of a decade of experience with pediatric tracheostomy encompassed 420 children. Analysis was performed with respect to primary diagnosis, age, duration of tracheostomy and hospitalization, early and late complications and mortality. While the incidence of tracheostomy per hospital admission decreased over the period of review, there was substantial increase in duration of tracheostomy. Approximately half of the patients sustained complications. While overall mortality approached 28%, tracheostomy-related deaths occurred in only eight patients (2%). Almost one fifth of children with tracheostomies were discharged to home care, and 3% were involved in our home ventilator program.
Bronchoscopic Limited Lavage for Cystic Fibrosis Patients
Authors: Rothmann Bruce F. , Walker Lewis H. , Stone Robert T. , Seguin Francois W.
Published: October 2014

Bronchoscopic aspiration of the tracheobronchial tree in patients with cystic fibrosis is a controversial procedure. Results of therapy are difficult to evaluate. Many different techniques have been described, adding to the confusion. Our experience using limited lavage with 4% acetylcysteine and saline have been most gratifying in 114 procedures at the Children's Hospital Medical Center of Akron, Ohio. Each was performed under general anesthesia using the rigid bronchoscope. There were no deaths. Timing of the procedure and patient selection are partially subjective. The most impressive results have been improved pulmonary compliance and improved quality of life in the patient. Details of the procedure, techniques of anesthesia, and results of therapy are presented.
Respiratory Rehabilitation with Transtracheal Oxygen System
Authors: Heimlich Henry J.
Published: October 2014

A system of transtracheal oxygen administration has been developed which is more effective for rehabilitating chronic obstructive pulmonary disease (COPD) patients than traditional systems for providing continuous oxygen therapy. The procedure involves administering oxygen continuously through a No. 16 intravenous catheter inserted transtracheally. Therapeutic PaO2 levels are attained with an oxygen flow of 0.25 to 1 liter per minute. Transtracheal oxygen administration has numerous advantages over nasal cannula or Venturi mask devices. With this system, the patient requires 3 to 4 times less oxygen; therefore, a 2.7-kg (6–1b) portable tank will last most of one day. Oxygen-enriched air via transtracheal catheter reaches the lungs directly with less respiratory effort. Delivery of oxygen is not impaired by sinusitis, mouth-breathing, displacement of nasal cannula or loss of oxygen into the room. Patients experience an immediate sensation of being able to breathe more easily, begin ambulating the day of the procedure, have improved nutrition and return to many normal activities.
Hematoporphyrin-Derivative Phototherapy for Local Treatment of Cancer of the Tracheobronchial Tree
Authors: Cortese Denis A. , Kinsey James H.
Published: October 2014

In this paper the potential use of hematoporphyrin-derivative (HpD) phototherapy in the local treatment of bronchogenic carcinoma is discussed. Ten patients with cancer involving the tracheobronchial tree have completed at least one course of HpD-mediated laser phototherapy administered by means of the flexible fiberbronchoscope. Complete response was obtained in four cases, and in each case the tumor was small and superficial. Larger tumors with greater degrees of invasion showed only a partial response. Two patients with tumors eroding through the bronchial wall died following treatment. It appears that HpD phototherapy may be useful for control of only small, superficial squamous cell carcinomas of the tracheobronchial tree and only those within the range of the flexible fiberbronchoscope.
Pediatric Caustic Ingestion
Authors: Adam Jeffrey S. , Birck Herbert G.
Published: October 2014

Accidental caustic ingestion in the pediatric age group continues to be a controversial and difficult problem. This retrospective study gives clinical support to treating this problem with early esophagoscopy, steroids, antibiotics and dilatation. Four hundred two patients were evaluated for possible caustic burn of the esophagus. Of the 70 patients who had esophageal burns demonstrated at esophagoscopy and who were treated with steroids, antibiotics and dilatation, none developed strictures. The two patients not treated in this fashion developed strictures.
Estimating Eighth Nerve Survival by Electrical Stimulation
Authors: Smith Lee , Simmons F. Blair
Published: October 2014

Determining nerve survival is important in selecting patients for cochlear implants, and in predicting outcomes from such implants. In search of a possible method we deliberately destroyed nerve fibers (ganglion cells) in 17 cat cochleas to produce a range of degenerations Months later, we electrically stimulated these ears (and seven controls) and recorded electrical ABR input-output functions. Cats with no surviving ganglion cells showed no ABR activity. Cats with 5%–10% surviving cells had ABRs which typically had normal thresholds but decreased input-output functions. The suprathreshold slopes of these input-output functions reliably predicted ganglion cell survival for all degrees of degeneration. Thus perceptual (or electrical) threshold is a poor indicator of nerve survival. Loudness growth (or growth in the electrically-induced auditory brainstem response) is a good index of surviving ganglion cells.
Effect of Hyperthermia on the Laryngeal Closure Reflex
Authors: Haraguchi Shigenori , Fung Ramona Q. , Sasaki Clarence T.
Published: October 2014

A recent study with dogs has defined an age-related period of transient hyperexcitability in the laryngeal adductor neurons. This observation suggests that age-related neurologic instability of laryngeal mechanisms and abnormal laryngeal closure may be a cause of transient upper airway obstruction, inducing potentially fatal central apnea that could result in the sudden infant death syndrome. Since hyperthermia has been implicated as a cofactor in sudden and unexpected infant death, its effect on laryngeal excitability requires clarification. This investigation has found that both the latency and threshold of the laryngeal adductor reflex decreases during hyperthermia. Thus, hyperthermia effectively enhances this reflex during its age-related period of hyperexcitability, and is capable of triggering upper airway-induced central apnea of sufficient severity to result in death. The effect of temperature on latency is attributed to changes in axonal conduction and synaptic transmission velocities. Temperature-dependent changes in synaptic transmission are hypothesized as the cause of the observed threshold changes.