bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymorphonuclear Leukocyte Function during Otitis Media
Authors: Giebink G. Scott , Berzins Ilze K. , Huff John S. , Cates K. Lynn , Quie Paul G.
Published: January 2017

Polymorphonuclear leukocyte (PMN) function was evaluated in children with serous (SOM) and mucoid otitis media (MOM) and in an experimental model of acute purulent otitis media due to Streptococcus pneumoniae using chinchillas. Twenty-three of 100 children with SOM or MOM had depressed peripheral blood PMN chemotactic, bactericidal or chemiluminescence activity. Depressed PMN chemotactic acitvity was observed in 17(18%) of 97 children. Children whose middle ear effusions cultured Hemophilus influenzae were more than twice as likely to have depressed PMN chemotactic activity as children whose effusions were sterile. Depressed PMN bactericidal activity was observed in seven (23%) of 30 children, and depressed PMN chemiluminescence activity was found in three (16%) of 19 children. Combined chemotactic and bactericidal dysfunction was observed in four (13%) of 30 children. All seven of the chinchillas with pneumococcal otitis media showed significantly depressed PMN chemotactic activity during the first week after inoculation, while only two of ten uninfected control chinchillas showed the same degree of chemotactic depression ( P = .002). The association of H. influenzae and S. pneumoniae with depressed PMN function suggested that bacterial components of these microbes might have functional similarities. Both bacteria are surrounded by capsular polysaccharides which are known to persist in mammalian tissues for an extended period. It is possible that these or other components of H. influenzae and S. pneumoniae, or even host factors generated during middle ear infection and inflammation, impair the PMN response to middle ear infection resulting in delayed bacterial killing and persistent middle ear effusion.
Effect of Prostaglandin on the Composition of Chinchilla Middle Ear Effusion
Authors: Jung Timothy T. K. , Juhn S. K. , Smith Douglas M. , Gerrard Jonathan M.
Published: January 2017

Prostaglandins (PGs) are naturally occurring, cyclic, unsaturated fatty acids which possess a wide range of potent biological activities. PGs have been found in human middle ear effusions and might have implications for understanding the inflammation and possibly the bone resorption seen in chronic otitis media. We have measured PGs by radioimmunoassay in middle ear effusions (MEE) from experimentally induced serous otitis media (SOM) and purulent otitis media (POM) in chinchillas. PGE2 levels were significantly higher in the POM group compared to the SOM group. We have also demonstrated that chinchilla middle ear mucosa can convert arachidonic acid (AA), a precursor of PGs, to PG by injecting 14C-AA into bullae and assaying using radiochromatography. This conversion was completely blocked by both indomethacin and aspirin given orally or by direct injection into the middle ear. We then injected 50 μg of PGE2 into chinchilla bullae to assess its effect on the composition of MEE. First, the time course of PGE2 metabolism after its injection into the middle ear (ME) was determined by thin-layer chromatography (TLC) of labelled and unlabelled PGE2. Following this, serial daily injections of PGE2 and normal saline as control were made for one, three, and seven days. MEE and serum were collected and assayed for lactate dehydrogenase (LDH), acid and alkaline phosphatase, calcium, protein and hexosamine. Compared to the control, the levels of LDH, acid and alkaline phosphatase, calcium and protein were significantly elevated. Hexosamine levels were higher than the control at one and three days but did not differ significantly at seven days from the control. We have therefore demonstrated that chinchilla middle ear mucosa has the ability to synthesize PG from AA and suggest an active role for PGs in the inflammation and in the bone resorption seen in otitis media.
Identification of Children at Risk for Middle Ear Effusion Problems
Authors: Downs Marion P.
Published: January 2017

A listing of high risk factors for recurrent otitis media would aid in identifying children in need of early medical and educational intervention that would forestall later language dysfunction. Known percentages of risk include those of cleft palate children, Down's syndrome, native American Indians and Kartagener's syndrome. Factors whose percentage of risk should be studied are family history, early first bout, prematurity, malnutrition, child abuse and allergies. It is recommended that infants in any of the high risk groups be given special evaluation and when identified be considered for both medical and educational treatment.
Auditory Brainstem Responses in Children with Otitis Media with Effusion
Authors: Fria Thomas J. , Sabo Diane L.
Published: January 2017

Auditory brainstem responses (ABR) were recorded in 14 infants and toddlers and 12 school-age children with a previous history of recurrent otitis media with effusion (OME), or otoscopic and tympanometric evidence of persistent OME, or both. ABR tests were performed immediately before and after myringotomy and tympanostomy tube insertion in the younger subjects. For the school-age children, ABR tests were performed following otoscopy, tympanometry, and pure tone audiometry. The results demonstrate that the latency of both wave I and wave V of the ABR was sensitive (82% and 100%, respectively) to the presence of OME. Wave I also identified the absence of OME (specificity = 100%) whereas wave V did not (specificity = 25%). ABR latency was significantly decreased postoperatively in ears found to have OME, but not in ears found to have no OME. In the school-age subjects the ABR was used to predict the conductive hearing loss at 4000 Hz with less than a 20 dB error in virtually all subjects. The ABR latency delay was also found to be related to conductive hearing impairment at lower pure tone frequencies and to the average conductive loss at a variety of pure tone frequencies. Predictions of the presence of a conductive hearing loss from these relationships promise to be impressively accurate. The results suggest that the ABR can be a valuable tool for detecting the presence of conductive hearing impairment in infants and young children suspected to have OME and perhaps as an estimate of the degree of impairment.
A New Impedance Method for Measuring Middle Ear Mechanics and Eustachian Tube Function
Authors: Ivarsson Alf
Published: January 2017

The main principle of this new impedance method is a continuous recording of changes in tympanic membrane compliance in relation to its neutral position during changes in pressure, using a small pressure chamber. The subject sitting in the chamber can be placed in the recumbent position by rotation of the chamber. The working principles of the impedance method are: a servosystem regulates displacement of the loudspeaker membrane in order to keep the sound pressure in the external ear canal constant, independent of tympanic membrane compliance. From this recording it is possible to isolate tympanic membrane compliance during changes in intratympanic pressure as well as during ambient pressure changes. The results indicate that the new regulated impedance method combined with the small pressure chamber should be useful in routine clinical examination of middle ear mechanics and eustachian tube function.
Acoustic Immittance Findings in Acute Otitis Media
Authors: Schwartz Daniel M. , Schwartz Richard H.
Published: January 2017

This study sought to evaluate the sensitivity of tympanometry and acoustic reflex measurement for identifying acute otitis media. Acute otitis media was diagnosed via case history and biphasic pneumo-otoscopy in 103 children (161 ears) ranging in age from four months to 17 years (mean age, 5.6 years) who had subjective complaints of only one to three days. Of the 161 ears with diagnosed acute otitis media, the tympanogram was categorized as flat in 102 ears (63%), shallow/rounded in 18 ears (11%) and negative in 17 ears (11%). Of particular interest was that 15 ears (9%) were classified tympanometrically as normal, and 19 ears exhibited a high positive pressure peak greater than + 100 mm H2O. Based on these findings, tympanometric sensitivity for identifying acute otitis media was only 74.5% which is considerably less than that reported for persistent middle ear effusion. When test sensitivity was recalculated after parceling out the 42 ears with segmental disease, however, accuracy for identification increased to 89%. Results for acoustic reflex measurement were equally discouraging with test sensitivity being only 71%. These results suggest that the use of acoustic immittance measures may be of limited value for identifying acute otitis media.
Screening Procedure for Detection of Middle Ear and Cochlear Disease
Authors: Renvall Ulf , Lidén Gunnar
Published: January 2017

Experiences from a six-year study in which 11,772 seven-year-olds have been tested with a combination of the pure tone sweep check test and impedance audiometry (tympanometry and stapedius reflex test) are presented. During the study there has been a gradual change in the screening level. The goal has been to find an ideal screening level in which the results from the screening procedure correspond as much as possible to the findings of the otologist. Analysis of the results from the stapedius reflex test demonstrated that in ears in which the middle ear pressure was within ± 50 mm H2O the stapedius reflex test could not be elicited in 1.9% of the ears when the maximum output of the audiometer was used (110 dB SPL ipsilateral stimulation); in ears with middle ear pressure within ± 150 mm H2O the stapedius reflex could not be elicited in 6.1% using the maximum output of the audiometer. Based on the experiences from our studies it is therefore recommended that the stapedius reflex test be excluded from the test battery and that pure tone screening supplemented by tympanometry be used. A middle ear pressure of ≤ − 150 mm H2O or a flat tympanogram and/or tone screening levels > 20 dB HTL at 0.5 kHz and/or 4 kHz are considered as indicative of ear pathology.
Screening Tympanometry in Infants and Two-Year-Old Children
Authors: Tos Mirko , Poulsen Gert
Published: January 2017

In 150 newborn children tympanometry was repeated each third month until the age of one year. In 222 two-year-old children repetitive tympanometric screenings were performed in November, February, May and August, and the alterations in the tympanogram types were analyzed. There was found a very low stability of the tympanogram types and about 50% of the ears changed type between the investigations. The type A tympanogram (0 to − 99 mm H2O) was the most stable type, only 52% of the ears changed type. All ears with type C1 (− 100 to − 199 mm H2O), 97% of ears with type C2 (−200 to −350 mm H2O), and 84% of the ears with type B (flat curve) changed tympanogram type at least once at the four evaluations. This large variability in the tympanometric conditions, most often caused by a change in the frequency and severity of catarrhalia, makes the prognostic value of the screening tympanometry very small.
Impedance Screening
Authors: Northern Jerry L.
Published: January 2017

Rationale is presented for including tympanometry as an integral part of all hearing screening programs. Impedance screening will yield more accurate screening results in the identification of middle ear disease than traditional hearing testing or otoscopic examination. Medical complications often result from unidentified otitis media which also contributes to speech, language, and educational delays in children. Although additional research information is needed on the significance of early identification of children with otitis media, it is argued that tympanometry will foster such research efforts, while providing improved identification and potential management of middle ear disease in screening programs.
Epithelial Changes in or of the Middle Ear Mucoperiosteum
Authors: Kowata Isao , Shibahara Yoshihiro , Wada Jun , Kaku Yasuo , Kawamoto Kazutomo
Published: January 2017

In this study the time necessary for the increase of the secretory cells in the middle ear mucosa was investigated by EM and SEM and by histochemical observation of the secretory cells. The first experiment revealed that a minimum of six to seven days was required for the renewal of the columnar cytoarchitecture after the exposure to silver protein solution. In the next experiment 35 guinea pigs were subjected to tubal obstruction. Columnar metaplasia was found in one case sacrificed after the third month, and gland formations without myoepithelial cells and nerve endings were seen in those after the fourth month. In an additional experiment, since the frontal sinus of the dogs is simple and pneumatized, duct obstruction was performed. Slight epithelial change and accumulation of glue-like thick mucus, which was negative in culture, was found in all four cases after three months. In one of the two cases with obstruction for four months, typical exophthalmus in the pseudostratified epithelium with an increase in secretory cells or cuboidal epithelium with nonciliated cells was demonstrated.
Tympanosclerosis an Electron Microscopic Study of Matrix Vesicles
Authors: Friedmann I. , Hodges Giselle M. , Graham Malcolm
Published: January 2017

The ultrastructure of tympanosclerotic tissue has been studied and compared with other processes of fibrogenesis and calcification. Evidence is presented of the presence of large numbers of extracellular membrane-bound matrix vesicles and their role as the site of primary calcification in tympanosclerosis. Calcified spherular structures are formed and fuse into larger structures lined by a lamina limitans indicating the lines of arrested calcification in the collagenous matrix.
Effect of Persistent Otitis Media on Language Development
Authors: Menyuk Paula
Published: January 2017

This paper suggests methods for systematically studying the short-term and long-term effects of persistent otitis media with effusion (OME) on language development and educational achievement. First, some suggestions are made about which aspects of language processing should be examined in detail during different periods of development given the nature of the hearing losses usually suffered by children with persistent OME. These aspects are phonological (speech-sound) categorization and rules and lexical (word) retrieval. Second, the factors which can interact with persistent OME to bring about long-term effects (developmental time, duration and degree of hearing loss, socioeconomic status and cognitive competence) are discussed and suggestions made for the design of studies which can examine the effects of interaction of these factors. Finally, a proposal is presented for cross-lag design, regional studies which can provide us with information needed in planning educational intervention.
Effects of Otitis Media on Cognitive Development
Authors: Horowitz Frances Degen , Leake Hunter
Published: January 2017

Studies of the effects of otitis media on cognitive development in children have not been extensive. In this paper the nature of the variables thought to influence cognitive development in the first two years of life are described. The relationship between cognitive development and language development is reviewed. The distinction between cognition and intelligence is made. The studies of the behavioral sequelae of otitis media are reviewed and suggestions are made concerning the importance of including behavioral analyses in major projects concerning otitis media in young children.
Concentration of Penicillin V in Serum and Middle Ear Exudate during Treatment of Acute Otitis Media
Authors: Ingvarsson Leif , Kamme Carl , Lundgren Kaj
Published: January 2017

Sixty-one patients, aged six months to ten years, with acute purulent otitis media were treated with penicillin V for ten days. The drug was given twice a day in a total daily dose of 50 mg/kg body weight. The concentration of penicillin was determined in serum and in middle ear exudate on one of the first six days of treatment, 60, 120 or 180 minutes after administration of the drug. Bacterial cultures were taken from the nasopharynx before and during treatment and from the middle ear exudate at the time of myringotomy. The serum level of penicillin decreased during treatment. There was also a decrease in penicillin concentration of the middle ear exudate during treatment. This decrease was most pronounced during the first two days. In a few cases Haemophilus influenzae was found in the middle ear exudate during treatment. In these cases the concentration of penicillin in the exudate was found to be higher than the mean concentration at corresponding times. The rapid decrease in the exudate concentration of the drug two to three days after the beginning of therapy may suggest that the patients responded to the treatment and that it is the initial concentration that decides whether an infection will respond to the therapy. High exudate concentrations later on seem to be due mainly to a continuation of the inflammatory reaction and had slight or no clinical effect. Thus, the present investigation produced no strong evidence for a ten-day treatment compared with, for example, a five-day treatment.
Antibiotic-Resistant Bacteria in Otitis Media with Effusion
Authors: Lim David J. , Schram James L. , Lewis Daniel M. , Birck Herbert G.
Published: January 2017

Eighty-two bacterial isolates recovered from the middle ear effusions (192) of children with otitis media with effusion (OME) were tested for antibiotic sensitivity. Nearly 50% of all bacteria isolated were found to be resistant to penicillin, and in particular, 61% of the Haemophilus isolates were penicillin-resistant; 48% of the Haemophilus isolates were ampicillin-resistant. In addition, we compared the bacterial recovery rate from effusions of patients who were receiving antibiotics with those who were not. Among patients who were receiving antibiotics, 33% of the effusions were culture positive, while 82% of the effusions were culture positive in the patients who were not given antibiotics. These results are discussed with respect to the possible role of bacteria in the pathogenesis of OME.
Insertion of Ventilation Tubes into the Middle Ear: Results and Complications
Authors: Draf W. , Schulz P.
Published: January 2017

From 1969 to 1976 in the University ENT Clinic Mainz, a total of 677 patients received insertion of ventilation tubes into the eardrum. Three hundred eighty-five cases were able to be statistically evaluated. These were 80 adults and 305 children, 37 of these with cleft palate. All together a total of 875 operated ears were considered.
Adenoidectomy for Otitis Media with Mucoid Effusion
Authors: Roydhouse Noel
Published: January 2017

This random controlled study was undertaken to determine the extent to which nonsurgical treatment can control otitis media with effusion (OME); and if surgical treatment is indicated, and myringotomy, removal of middle ear liquid with insertion of aeration tubes is carried out, and whether removal of the adenoids produces any beneficial effect. A preparatory two-month nonsurgical treatment consisting of measures to improve the functional state of the nose was undertaken to eliminate from the study those children (42%) who would respond to medical treatment alone. The cure rate was similar in each of the operation groups with a greater relapse rate in the nonadenoidectomy groups who required 9% more aeration tube insertions. An estimation from x-rays of the size of the adenoids, shows that the group cured without surgery has a tendency towards the smaller adenoids. The relapse rate in the nonadenoidectomy group was independent of the size of the adenoids, and the study failed to show that any benefit accrued through adenoidectomy. Accordingly, the removal of adenoids should cease to be indicated in cases of OME as a primary form of treatment.
Efficacy of Adenoidectomy in Recurrent Otitis Media
Authors: Paradise Jack L. , Rogers Kenneth D. , Bluestone Charles D. , Taylor Floyd H.
Published: January 2017

Adenoidectomy is well established as a procedure for treating children with recurrent or persistent otitis media. Many physicians also believe that when adenoidectomy is undertaken for otitis media, tonsillectomy also should be done routinely. Thus otitis media serves as the justification for a substantial proportion of the tonsil and adenoid operations carried out on children. Nonetheless, evidence supporting the efficacy of adenoidectomy, or tonsillectomy and adenoidectomy (T&A), for otitis media is scant and inconclusive. Only six prospective studies have been reported, and in all but two of them, the combination of adenoidectomy with tonsillectomy, rather than adenoidectomy alone, was tested. The results were contradictory, perhaps because all of the studies contained flaws in design or methodology or both. Whether adenoidectomy or T&A are efficacious remains entirely uncertain. We are attempting to address the question currently in a prospective study in which children considered at high risk for otitis media are entered into a randomized, controlled clinical trial of adenoidectomy. The trial is complicated by the need to take adequate account of subject variables such as age, sex, adenoid size, and the presence or absence of allergy, and of the important treatment variable of concomitant myringotomy with tympanostomy tube insertion. Outcome measurements employed in the trial include the number of episodes per year of acute otitis media, the persistence of middle ear effusion, and the frequency of subsequent myringotomy. Data thus far collected in the study are not sufficient to reach a conclusion for or against the efficacy of adenoidectomy for otitis media, but it is apparent that adenoidectomy by no means eliminates the problem.
Serous Otitis Media and Type 1 Tympanoplasties in Children
Authors: Buchwach Kenneth A. , Birck Herbert G.
Published: January 2017

The prevalence of serous otitis media has caused a philosophical difference as to when a tympanoplasty should be performed in children. This retrospective study of 74 children (aged 3–17) who underwent 80 operations was undertaken to investigate this problem. The overall success rate for type 1 tympanoplasty was 66%. Age was not a reliable factor in predicting successful results. A history of recurrent serous otitis media was not an important indicator. Adenoidectomy did not influence the surgical outcome. The status of the nonoperated ear was probably a significant factor. Type 1 tympanoplasty has a reasonably good chance of success in children regardless of age and/or previous middle ear ventilation problems. However, a good clinical test of eustachian tube function is still needed to improve further the predictability of tympanoplasty in children.
Immunologic Response to Pneumococcal Polysaccharide Vaccine in Infants
Authors: Sloyer John L. , Karr Laurel J. , Ploussard John H. , Schiffman Gerald D.
Published: January 2017

The serum antibody response to purified pneumococcal capsular polysaccharides (PCP) was determined in four groups of infants ranging in age from 3 to 24 months. Group 1 consisted of eight infants immunized with an octavalent vaccine containing serotypes 1, 3, 6, 7, 14, 18, 19 and 23 (PCP-8). Group 1 received 25 μg of each serotype at 3–6 months of age and again at 18–24 months. The antibody response after the second immunization was compared to a group of nine patients receiving a primary immunization at 18–24 months and to a group of ten age-matched controls receiving saline placebo. There were no significant differences in mean serum antibody levels between the two groups receiving the PCP-8. A fourth group of 44 infants between 6 and 21 months of age received either PCP-7 or PCP-8 and were followed for two years, at which time simultaneous injections of both vaccines were administered. Types 2, 3, 7, and 8 were most immunogenic but levels six months after immunization were approximately the same as for unimmunized controls with the exception of serotypes 3 and 7 which persisted for about two years. The class of antibody induced either by natural infection or by immunization was preferentially IgG and it was more often induced by the former. There were no significant differences between the serotypes of pneumococci isolated from nasopharyngeal cultures regardless of which vaccine was administered. Finally, the least immunogenic serotypes include 4, 6, 14, 19, and 23 and these are the only serotypes thus far associated with otitis media after immunization. The results suggest that PCP do not induce a lasting immune tolerance at the dose administered in this study; PCP are not very immunogenic in the young infant; PCP antibody tends to rise naturally; IgG antibody is preferentially induced; nasopharyngeal colonization is not altered by PCP immunization; and an association may exist between PCP immunogenicity and subsequent onset of otitis media.
Efficacy of Pneumococcal Vaccination against Recurrent Otitis Media
Authors: Karma P. , Luotonen J. , Pukander J. , Leinonen M. , Timonen M. , Herva E. , Sibakov M. , Pöntynen S. , Grönroos P. , Mäkelä P. H.
Published: January 2017

For this study, 781 children, aged 3 to 83 months, after presenting with acute otitis media, were immunized with either 14-valent pneumococcal or Haemophilus influenzae type b capsular polysaccharide vaccine. The vaccines were tolerated well. Antibody responses to the 14 pneumococcal polysaccharide types, measured by radioimmunoassay, were fair to good and increased with age, with the exception of types 1, 6 and 12 to which the responses were generally poor. During the follow-up of 1–17 months, average 13 months, 45 vaccine type (except type 6) pneumococcal recurrences were met among 456 pneumococcal-vaccinated and 45 among 288 H. influenzae-vaccinated children, at least six months old ( P < .05). The corresponding protective efficacy by the pneumococcal vaccine was 37%, for the first six months, 51% ( P < .01). No protection by the pneumococcal vaccine was seen against group 6 pneumococci, nor among 19 infants under six months of age. Nonvaccine type pneumococcal and H. influenzae recurrences did not significantly concentrate in either of the vaccination groups. Thus, it seems that parenteral immunization of children can reduce the recurrence rate of otitis media caused by pneumococci of types (except type 6) present in the vaccine.
Role of Tonsillectomy and Adenoidectomy in the Management of Children with Middle Ear Effusion
Authors: Snow James B.
Published: January 2017

Evidence for the clinical effectiveness of adenoidectomy or tonsillectomy and adenoidectomy in the management of children with persistent middle ear effusions is incomplete and what evidence there is in the literature is not convincing. In the first year after tonsillectomy and adenoidectomy there is less otitis media. The beneficial effects of tonsillectomy and adenoidectomy on the incidence of otitis media declines in the second year after the operation. The prevailing opinion is that adenoidectomy is not indicated in the vast majority of children in whom a middle ear effusion has persisted for six weeks or more in spite of antibiotic therapy. Factors favoring an adenoidectomy would be persistent nasal obstruction, persistent purulent rhinorrhea and persistent adenoiditis. The role of tonsillectomy is even less clear, but the decision regarding tonsillectomy is made by most clinicians on the basis of the amount of intercurrent or chronic tonsillitis rather than on the basis of the middle ear effusion per se.
Uses and Abuses of Hearing Aids
Authors: Peck James E.
Published: January 2017

The view is expressed that many hearing-impaired individuals are not deriving maximum benefit from amplification or are not using amplification at all because of failure of professionals to keep in mind certain uses and abuses. Some of the specific uses are for minimal and profound hearing losses, adaptation with special earmold modifications, chronic or recurrent conductive losses, part-time use, and binaural listening. Some specific abuses include: unrealistic expectations, overlooking the role of motivation, pressuring persons to try/wear amplification, overamplification, Y cord, inappropriate binaural fittings, and failure to alternate a hearing aid between ears in symmetrical hearing losses.
Time Course of Auditory Perceptual Learning
Authors: PhD Charles S. Watson
Published: January 2017

The time course of auditory perceptual learning can vary from one hour to more than a year, depending on the task, the complexity of the sounds, and the level of stimulus uncertainty under which the tasks are learned. Previous studies are reviewed which show that longer training is required to identify sounds than to discriminate between them, while the least time-consuming task is to learn to detect a sound's presence. The time course of each of these tasks is greatly extended for complex sounds compared to those for single tones. The learning of a speech-like code would thus be expected to require longer training than that employed in previous psychoacoustic research. The consequences of this fact for the exploitation of residual hearing are briefly discussed.
Neurophysiological Correlates of Auditory Maturation
Authors: Javel Eric
Published: January 2017

At the time of its birth, the auditory system of the cat is not completely developed. Anatomic maturity of the peripheral auditory system, ie, the cochlea, auditory nerve and cochlear nucleus, is attained at about two or three weeks of age. Physiological response properties of neural elements of the peripheral auditory system change radically during the first few weeks of life, with most measures of responsiveness to acoustic stimuli reaching adult status by the end of the third or fourth postnatal week. The physiological maturation of neural responses correlates well with the anatomic maturation of the auditory structures. At least one physiological response property, namely the ability of cochlear nucleus neurons to time their discharges in response to low-frequency tones, is not fully achieved until the sixth postnatal week or later. Although considerably less is known about the development of the central auditory system, it appears that it is in part dependent upon the maturation of more peripheral elements. Auditory evoked responses, for example, follow roughly the same developmental time course as do the majority of response properties of peripheral neurons. This implies that the central system is ready to function at birth, but that it must await the maturation of more peripheral elements before it can function properly. In contrast to that of the cat and other mammals, the auditory system of the human is relatively well advanced at birth. Certain aspects of brain development, such as dendritic aborization and axonal myelination, undergo considerable change postnatally. How these factors influence hearing is not known.
Neurochemistry of the Auditory System
Authors: Wenthold Robert J.
Published: January 2017

Two areas of auditory biochemistry are reviewed: the identification and characterization of neurotransmitters in the auditory system and the biochemical approach to the study of genetic hearing disorders. Studies to identify neurotransmitters at major auditory synapses are outlined. Evidence supporting glutamate or aspartate as the neurotransmitter for the auditory nerve is presented. The application of biochemistry to the study of genetic hearing disorders is discussed.
Prevention and Treatment of Stuttering
Authors: Perkins William H.
Published: January 2017

Evidence is reviewed that forms the basis for prevention and treatment of stuttering as a problem of motor speech coordination. Simplification of phonatory complexity and retardation of phone rate have been demonstrated experimentally to virtually eliminate stuttering. These invariant relationships are used in rate control and breath stream management procedures to facilitate fluency.
Research Priorities in Speech
Authors: Van Hattum Rolland J.
Published: January 2017

The need for increased research activity in speech and its disorders is reviewed. Increasing interest in language and its disorders appears to have lessened research activity in areas commonly identified as speech disorders: articulation, voice and rhythm. Yet these areas, as well as all aspects of the total communication function, are little understood and some current understandings are even likely to be inaccurate. Thus, not only is additional new research needed but reinvestigation of current beliefs is also essential. Goals for communication research can be classified under five areas: better understanding of the speech mechanism, the communication processes, the individual as a communicator, disorders of speech, and prevention and remediation. Specific research needs are discussed in each of these five broad categories.
Aspects of Mother-Child Interaction as Related to the Remediation Process
Authors: Friel-Patti Sandy
Published: January 2017

Selected aspects of mother-child interaction are discussed with initial consideration given to the evidence regarding the emergence of conversational exchanges between normally developing language-learning children and their mothers. The results of a preliminary investigation in the area of mother-child interaction involving the clinical population of language-disordered children are presented. The research results are discussed in terms of the remediation process.
Language-Based Learning Disabilities
Authors: Hook Pamela E.
Published: January 2017

The purpose of this paper is to highlight the complexity of the relationship between oral language development and the acquisition of reading skills. As background information, a hierarchy of language development including factors related to both oral and written language is discussed. Case studies of two learning-disabled males are presented to illustrate the differences in reading skills between two children with similar language comprehension abilities. Discussion of the underlying processing deficits responsible for these differences is also included.
Electrocochleography and Auditory Brainstem Electric Responses in Patients with Pontine Angle Tumors
Authors: Eggermont J. J. , Don M. , Brackmann D. E.
Published: January 2017

In 45 patients with surgically proven pontine angle tumors, compound action potential (AP) and summating potential (SP) were recorded with transtympanic electrocochleography (ECochG) together with brainstem electric responses (BSER). The aims were to quantify the mechanism by which tumors cause hearing loss and to evaluate the diagnostic potentials of ECochG and BSER for detecting eighth nerve and brainstem tumors. Except for AP latency and narrow band AP waveform, response parameters recorded by ECochG are uncor-related. Four uncorrelated parameters were abnormal in only 10% of the cases, three in 25%, two in 40%, and one in 90%.

The BSER criterion was the latency delay between waves I and V and resulted in about 90% detection, improving to 95% when used in combination with the interaural wave V delay criterion.

ECochG results provide evidence that, for hearing losses up to 60 dB HL, the origin is cochlear, resembling that caused by Menière's disease. Evidence is presented that the increase in I-V delay in the BSERs is caused by differential action of the tumor upon low and high frequency fibers in the auditory nerve and that desynchronization of the firings of the nerve fibers is of more importance than an increase in neural conduction time.

ECochG as the sole test for detection of pontine angle tumors appears to be of limited value. Brainstem response on its own has great merits; however, it should be emphasized that no wave I was detected in about 30% of the cases. The 95% detection score obtained with BSER depends on specifying the latency of wave I. For these cases, we substituted the latency of the AP recorded by ECochG.
Computer-Aided and Graphic Reconstruction of the Human Endolymphatic Duct and Sac
Authors: Antunez Juan-Carlos M. , Linthicum Fred H. , Galey Frank R. , McCann Gilbert D.
Published: January 2017

The anatomy of the human endolymphatic duct system of three cases — one with Menière's syndrome (with no histopathological evidence of endolymphatic hydrops), one with Menière's disease (with histopathological evidence of endolymphatic hydrops), and one with no evidence of disease — has been studied by means of computer-aided and graphic reconstruction from serial sections of temporal bones. The reconstructions have revealed a canalicular arrangement of the epithelial lining of the rugose portion of the human endolymphatic sac. Accordingly, new nomenclature, “pars canalicularis,” is suggested for this portion. The computer produced lateral and medial views of the endolymphatic duct and sac of the patient with Menière's syndrome. The computer also calculated the luminal volume, the surface area of the epithelium, and the surface-to-volume ratio of the rugose portion of the sac.

In addition, the authors graphically reconstructed the rugose portion of the sac of all three cases. Measurements of the dimensions of these reconstructions were made, from which the luminal volume was estimated. The reconstructed images and the calculations allowed quantitative comparison of the microscopic anatomy of the rugose portion of the sac in the Menière's syndrome and Menière's disease ears with that in an ear without evidence of disease.

Significant differences were found in the volumes of the rugose portion of the sac of the three cases. The results suggest that the luminal volume of the rugose portion of the sac of Menière's disease patients may be significantly reduced. The authors speculate that endolymphatic hydrops may be the result of a loss of epithelial surface area in the canalicular portion, thus diminishing its resorptive function.

The computer and graphic reconstruction techniques in conjunction with their analytical capabilities provide a new method for studying inner ear structures. These techniques have the potential to expand the capabilities of quantitative morphology and provide the means for deriving clinically useful data from histopathological and ultrastructural material.
II. Quantitative Analytical Procedure
Authors: Rudnick Michael D. , Ginsberg Irwin A. , Huber Pamela S. , Rose Joel S.
Published: January 2017

A statistical methodology has been established to describe and compare, quantitatively, the ototoxic effects of aminoglycoside antibiotics. Sampling techniques for obtaining reliable estimates of cell damage in the organ of Corti and the vestibular system are described in this paper. The relationship of drug dosage to the percentage of hair cell damage in each inner ear sensory region was expressed as the slope of the least-squares linear regression line and was tested to reject the null hypothesis (slope u = 0) at the 0.05 level of significance. It was determined that, in each of the cases discussed, dosage and damage correlated positively and that by repeated computations, each time controlling for one observed or measured variable, guinea pigs contributing skewed results could be eliminated on a rational basis. By this method of careful selection, statistically significant relationships have been established from the data.
IV. Influence of Vestibular Stimulation
Authors: Huber Pamela S. , Ginsberg Irwin A. , Rudnick Michael D.
Published: January 2017

Guinea pigs were given transtympanic dosages of neomycin followed by three hours of either vestibular stimulation or immobilization to test the hypothesis that inner ear hair cell membrane permeability is increased for drugs as a consequence of the transduction process. It was found, however, that neither the topographic pattern nor the degree of hair cell damage differed between the two groups. It is concluded that if the transduction process is accompanied by cell membrane permeability changes, the effect is not an increased susceptibility to neomycin toxicity. A measurable effect of stimulation was the significant decrease in the standard deviation of the mean dosage-damage response at each dosage level. This increase in reliability probably resulted from mixing of the inner ear fluids (especially in the vestibular compartment) which encouraged consistent dosages to the hair cells with each repeated trial. Finally, the impact of these findings on hypotheses related to the mechanism of selective ototoxicity is discussed briefly.
Upper Respiratory Tract Ciliary Ultrastructural Pathology
Authors: Herzon Fred S.
Published: January 2017

Nasal and sinus ciliary ultrastructure was evaluated in 16 patients with various pathologies of the upper respiratory tract including sinusitis, nasal polyposis, purulent rhinitis, and rhinitis medicosa. Ultrastructural findings include absent dynein arms, central tubule disorientation, radial spoke defects, atypical microtubule patterns and ciliary membrane abnormalities. Examples of each condition are presented and the implications of these findings are discussed.
Measurement of Optokinetic Nystagmus for Otoneurological Diagnosis
Authors: Abel Sharon M. , Barber Hugh O.
Published: January 2017

Optokinetic nystagmus was recorded and measured in 101 subjects comprising six diagnostic categories: 1) normal, screened for otologic disease, 2) chronic unilateral labyrinthectomy, 3) unilateral Menière's disease, 4) neurologically confirmed focal brainstem lesion, 5) brainstem-cerebellar syndrome, and 6) focal unilateral supratentorial lesion. For the OKN test, each subject looked at a translucent screen onto which a field of parallel black and white bars was back-projected. The array of bars could be projected vertically or horizontally to allow for study of nystagmus beating right and left or up and down. The speed of movement of the bars varied over a range from 20 to 140°/sec of visual angle, in each axis for both directions.

An analysis of the slow phase velocity of OKN indicated that patients with brainstem disease produced significantly lower eye speeds than did normal subjects or patients with chronic peripheral vestibular disease. The latter groups could not be distinguished. The responses of patients with cortical lesions fell midway between these two extremes and were significantly different from those of the brainstem group. Directional preponderance of nystagmus proved to be significantly related to the side of lesion for both the labyrinthine and cortical groups. However, the absolute value of the difference in slow phase velocity for nystagmus beating toward or away from the side of lesion was no greater than the difference between right and left-beating nystagmus in normal subjects. While the results provide statistical confirmation for the findings of earlier investigations, it is noted that for purposes of clinical diagnosis, the test is of value only in the context of the otoneurological test battery. Distribution of results for individuals in the various groups overlap considerably. The designation of a numerical cutoff for differential diagnosis leads to error rates far in excess of what may be confidently attributed to chance.
Tumors of the Parapharyngeal Space Preoperative Evaluation, Diagnosis and Surgical Approaches
Authors: Som Peter M. , Biller Hugh F. , Lawson William
Published: January 2017

This report demonstrates that preoperatively the radiologist can provide the surgeon with the size, extent, origin and probable histology of a parapharyngeal space tumor. Using this information, the surgeon can then determine the best surgical approach for complete and safe tumor excision.
Anaerobic Infections in Otolaryngology
Authors: Finegold Sydney M.
Published: January 2017

The role of anaerobes in head and neck infections is discussed. Data from several key studies are presented. It is emphasized that the source of anaerobic organisms in otolaryngological infections is the indigenous flora of the upper respiratory tract.
Postoperative Wound Infections
Authors: Herzon Fred S.
Published: January 2017

Postoperative wound infection represents a serious complication of any surgical procedure. Prevention is the cornerstone when approaching this problem. Host factors, prophylactic antibiotics and meticulous surgical technique are key elements in achieving normal wound healing. These are discussed, as is wound infection in various types of surgery of the head and neck.
Invasive Hemophilus Infections: Epiglottitis and Cellulitis
Authors: Cherry James D.
Published: January 2017

Epiglottitis, along with other infectious croup syndromes (laryngotracheitis and spasmodic croup), are illnesses which cause acute upper airway obstruction. They are discussed in terms of etiology, symptoms, diagnosis and treatment. Cellulitis and the role of Hemophilus influenzae and antibiotic therapy are also described.
Pharmacology of Oral Antibiotics Used for Treatment of Otitis Media and Tonsillopharyngitis in Infants and Children
Authors: Ginsburg Charles M. , McCracken George H. , Nelson John D.
Published: January 2017

Data are presented from pharmacologic evaluations of major oral antibiotics used in treatment of acute otitis media and tonsillopharyngitis in children. Information is included on serum and middle ear specimens obtained almost simultaneously following administration of many of these antibiotics. Discussion covers ampicillin and amoxicillin, penicillin G and V, erythromycin estolate, erythromycin ethylsuccinate and the orally administered cephalosporins.
Pharmacokinetics of Cefaclor in Chronic Middle Ear Effusions
Authors: Lildholdt Torben , Bluestone Charles D. , Cantekin Erdem I. , Rohn Dale D. , Marshak Gabriel , Schuit Kenneth E.
Published: January 2017

Fifty children aged 1 to 13 years with chronic or recurrent otitis media with effusion received a single dose of cefaclor (15 mg/kg body weight) by the oral route 30 minutes to seven hours before the removal of middle ear effusion and insertion of tympanostomy tubes. Serum and middle ear aspirate concentrations of the antibiotic were determined employing a microbiological assay technique by a disk diffusion method. Middle ear specimens were also cultured for aerobic bacteria. The mean peak serum concentration level (8.49± 7.89 μg/ml) was observed after 30 minutes, whereas the middle ear peak level (0.47± 0.78 μg/ml) occurred after one hour. Of the 87 middle ear specimens, 37 had cefaclor concentrations which were detectable within the resolution of the bioassay method (>0.16 μg/ml). There was no correlation between the type of middle ear effusion (mucoid or serous) and the concentration of cefaclor in the middle ear. Only 18% of the middle ear cultures were positive for aerobic bacteria; Hemophilus influenzae was the most common organism.
Antimicrobial Prophylaxis for Recurrent Acute Otitis Media
Authors: Paradise Jack L.
Published: January 2017

Antimicrobial prophylaxis for children who have frequently recurring, severe episodes of acute otitis media appears to constitute a reasonable management option, even though it is not yet clear whether the advantages outweigh the disadvantages and risks. It remains for well-designed and well-executed studies that extend over relatively long periods to indicate whether this approach to management is the best of the available options, and if so, which of the available drugs is preferable.